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Cody SL, Kusko DA, Gonzalez CE, Owens MA, Hobson JM, Gilstrap SR, Thomas SJ, Goodin BR. Improving Sleep in People with HIV and Chronic Pain: A Pilot Study of Brief Behavioral Treatment for Insomnia. Behav Sleep Med 2024:1-11. [PMID: 39244666 DOI: 10.1080/15402002.2024.2396820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
OBJECTIVES Insomnia and chronic pain are common symptoms in people with HIV. Poor sleep has been associated with chronic pain. While cognitive behavioral therapy for insomnia improves insomnia in clinical populations, there are barriers to people with HIV accessing treatment including the lack of trained providers and lengthy sessions. Only one study has examined the efficacy of brief behavioral treatment for insomnia (BBTI) in people with HIV. This study examined BBTI effects on sleep and pain in people with HIV. METHODS Ten adults with HIV and chronic pain completed a 4-week, telephone-delivered BBTI treatment. A control group (n = 10) completed a brief mindfulness training (BMT). The Insomnia Severity Index and Brief Pain Inventory were used to assess insomnia severity and pain outcomes, respectively. RESULTS There was a significant interaction between intervention and time on insomnia severity, F (2,14) = 5.7, p = .02, partial η2 = 0.45). The BBTI group demonstrated significant improvements in insomnia severity from pre- to post-intervention (p < .001) and from pre-intervention to one-month post-intervention (p = .001) compared to the BMT group. There was a significant interaction between intervention and time on pain interference, F (1,18) = 4.9, p = .02, partial η2 = 0.27). The BBTI group demonstrated a significant decrease in pain interference from pre- to post-intervention (p < .001) compared to the BMT group. CONCLUSIONS This pilot study demonstrated that BBTI improved insomnia in people with HIV for up to one-month post-treatment. Novel preliminary evidence suggests that BBTI may also improve pain outcomes in people with HIV.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Daniel A Kusko
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cesar E Gonzalez
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | - Michael A Owens
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna M Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon R Gilstrap
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen J Thomas
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
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Tam CC, Harrison SE, Benotsch EG, Litwin AH, Zhou Y, Shen Z, Li X. Psychological Distress Mediates the Relationship Between HIV-Related Stigma and Prescription Opioid Misuse Among Chinese People Living with HIV. AIDS Behav 2024; 28:1673-1683. [PMID: 38334862 DOI: 10.1007/s10461-024-04288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
Prescription opioid misuse (POM) among people living with HIV (PLWH) is a serious concern due to risks related to dependence and overdose, and PLWH may be at higher risk for POM due to psychosocial stressors including psychological distress. However, scant POM research has examined the role of HIV-related stigma (e.g., internalized stigma, enacted stigma) in POM among PLWH. Guided by minority stress theory, this study examined a hypothesized serial mediation among enacted stigma, internalized stigma, psychological distress, and POM within a sample of Chinese PLWH with pain symptoms enrolled in a wave (between November 2017 and February 2018) of a longitudinal cohort study in Guangxi (n = 116). Models were tested individually for six enacted stigma experiences, controlling for key demographic and health-related variables (e.g., CD4 + count). Results showed HIV-related workplace discrimination was the most common stigma experience (12%,) and 10.3% of PLWH reported POM. Indirect effect analyses showed that internalized stigma was indirectly associated with POM through psychological distress. Internalized stigma and psychological distress mediated the association between workplace discrimination and POM. Family discrimination, gossip, and healthcare discrimination were directly associated with POM. This study suggests that Chinese PLWH may engage in POM to cope with psychological distress that is rooted in HIV-related stigma and highlights the important context of workplace discrimination for PLWH. Implications for interventions to reduce POM among PLWH are discussed.
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Affiliation(s)
- Cheuk Chi Tam
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA.
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Sayward E Harrison
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Psychology, College of Arts and Sciences, University of South Carolina, 1512 Pendleton St., Columbia, SC, 29208, USA
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, PO Box 842018, Richmond, VA, 23284, USA
| | - Alain H Litwin
- School of Health Research, Clemson University, 605 Grove Road, Greenville, SC, 29605, USA
- Department of Medicine, School of Medicine Greenville, University of South Carolina, 876 W Faris Rd, Greenville, SC, 29605, USA
| | - Yuejiao Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Discovery I, 915 Greene Street, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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O'Donnell AT, Foran AM. The link between anticipated and internalized stigma and depression: A systematic review. Soc Sci Med 2024; 349:116869. [PMID: 38678910 DOI: 10.1016/j.socscimed.2024.116869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
Stigmatized groups may experience psychological distress. Yet, some studies show no significant relation between stigma and mental health outcomes. This systematic review investigates the link between anticipated and internalized stigma, and one mental health outcome, depression. We aimed to (1) determine whether anticipated and internalized stigma predict levels of depression, and (2) review the quality of evidence for this link. We searched PsycInfo, PubMed and EMBASE databases. Eighty-three studies (N = 34,705) met our inclusion criteria, across five stigma categories: Sexual and gender minorities; HIV/AIDS; Illness or disability-related (non-HIV); Weight, and Other. We reviewed evidence within each category and study design and developed a narrative synthesis. Sixty studies (72.3%) supported the proposed link, which varied across categories from 53.6% to 100%. Using the NIH quality assessment tool, most studies were of fair quality. Most cross-sectional studies (76.7%) straightforwardly supported the positive relation between internalized and/or anticipated stigma and depression, while only 40% of longitudinal studies did. Implications for the study of stigma and mental health outcomes are discussed.
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Affiliation(s)
- Aisling T O'Donnell
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife-Marie Foran
- Centre for Social Issues Research, Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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4
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Yuan GF, Qiao S, Li X, Zhou Y, Shen Z. Psychological Mechanisms of Internalized HIV Stigma Affect Sleep Impairment among People Living with HIV in China: A follow-up Study. AIDS Behav 2024; 28:439-449. [PMID: 38048016 DOI: 10.1007/s10461-023-04236-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
Prior studies have demonstrated that HIV-related stigma (e.g., internalized HIV stigma) is detrimental to the physical and mental health (e.g., sleep impairment and depressive symptoms) of people living with HIV (PLWH). However, follow-up data are limited regarding the longitudinal relationships between internalized HIV stigma, future orientation, self-esteem, depressive symptoms, and sleep impairment. The present study attempted to examine a mediation model involving these variables among Chinese PLWH. A two-wave follow-up design (6 months intervals) was employed in a final sample of 1,140 Chinese PLWH (Mage = 41.63, SD = 9.29, age range: 21-67 years; 64.6% men). Participants completed Internalized HIV Stigma Scale, Optimism About the Future Scale, Rosenberg Self-Esteem Scale, Center of Epidemiological Studies Depression Scale, and an adapted version of Pittsburgh Sleep Quality Index. Results revealed that internalized HIV stigma at baseline had a significant direct relationship with sleep impairment over time, and a significant indirect relationship with increased sleep impairment over time via future orientation and depressive symptoms. Furthermore, the linkage between internalized HIV stigma and sleep impairment was serially mediated via self-esteem and depressive symptoms. This study highlights the deleterious effects of internalized HIV stigma on the physical and psychological health of PLWH. The findings suggest that interventions targeting internalized HIV stigma and related factors such as future orientation, self-esteem, and depressive symptoms may facilitate improvements in sleep quality and overall well-being among PLWH.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, Sichuan, China.
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China
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Abstract
PURPOSE OF REVIEW To highlight recent publications about sleep disorders and sleep health in adult persons with HIV (PWH), with a focus on how sleep relates to comorbidities in PWH. RECENT FINDINGS Sleep disorders are more common in PWH than in seronegative controls, especially insomnia, with four different recent studies estimating insomnia prevalence in PWH at 21-35%. Sleep apnea prevalence estimates in PWH have varied widely. Most studies suggest PWH do not have higher sleep apnea prevalence compared with controls, though definitions of sleep apnea may affect these analyses. Comorbidities recently associated with sleep in PWH include myocardial infraction (insomnia), depressive symptoms (insomnia and restless legs syndrome), and pain (insomnia). Cognition associations with sleep were inconsistent and may depend on data collection and analytic methods. Sleep health dimensions are uncommonly reported, but PWH appear to report worse sleep health dimensions and these demonstrated mixed associations with cognition and depressive symptoms in recent studies. SUMMARY Sleep disorders and poor sleep health are common in PWH and are related to comorbidities. More data from longitudinal studies and clinical trials are needed. Clinical trials of insomnia interventions in PWH are especially warranted.
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Affiliation(s)
- Ken M Kunisaki
- Minneapolis Veterans Affairs Healthcare System
- University of Minnesota, Minneapolis, Minnesota, USA
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Cody SL, Miller GH, Fazeli PL, Wang G, Li W, Goodin BR, Vance DE. Preventing Neurocognitive Decline in Adults Aging with HIV: Implications for Practice and Research. J Alzheimers Dis 2023; 95:753-768. [PMID: 37599532 DOI: 10.3233/jad-230203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Mild to moderate forms of neurocognitive impairment persist among people living with HIV (PLWH), despite being virally suppressed on antiretroviral therapy. PLWH are disproportionally impacted by physiological and psychosocial comorbidities compared to those without HIV. As adults live longer with HIV, the neurocognitive burden of physiological and psychosocial stressors can impair everyday functioning and may contribute to the development of neurodegenerative diseases such as Alzheimer's disease. This article outlines neurocognitive consequences of everyday stressors in PLWH. While some lifestyle factors can exacerbate inflammatory processes and promote negative neurocognitive health, novel interventions including the use of cannabinoids may be neuroprotective for aging PLWH who are at risk for elevated levels of inflammation from comorbidities. Studies of integrated neurocognitive rehabilitation strategies targeting lifestyle factors are promising for improving neurocognitive health, and may over time, reduce the risk of Alzheimer's disease in PLWH.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | - Gabe H Miller
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ge Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Gilstrap SR, Hobson JM, Owens MA, White DM, Sammy MJ, Ballinger S, Sorge RE, Goodin BR. Mitochondrial reactivity following acute exposure to experimental pain testing in people with HIV and chronic pain. Mol Pain 2023; 19:17448069231195975. [PMID: 37542365 PMCID: PMC10467217 DOI: 10.1177/17448069231195975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/06/2023] [Accepted: 08/03/2023] [Indexed: 08/06/2023] Open
Abstract
Background: Physical stressors can cause a physiological response that can contribute to an increase in mitochondrial dysfunction and Mitochondrial DNA damage (mtDNA damage). People living with HIV (PWH) are more likely to suffer from chronic pain and may be more susceptible to mitochondrial dysfunction following exposure to a stressor. We used Quantitative Sensory Testing (QST) as an acute painful stressor in order to investigate whether PWH with/without chronic pain show differential mitochondrial physiological responses. Methods: The current study included PWH with (n = 26), and without (n = 29), chronic pain. Participants completed a single session that lasted approximately 180 min, including QST. Blood was taken prior to and following the QST battery for assays measuring mtDNA damage, mtDNA copy number, and mtDNA damage-associated molecular pattern (DAMP) levels (i.e., ND1 and ND6). Results: We examined differences between those with and without pain on various indicators of mitochondrial reactivity following exposure to QST. However, only ND6 and mtDNA damage were shown to be statistically significant between pain groups. Conclusion: PWH with chronic pain showed greater mitochondrial reactivity to laboratory stressors. Consequently, PWH and chronic pain may be more susceptible to conditions in which mitochondrial damage/dysfunction play a central role, such as cognitive decline.
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Affiliation(s)
- Shannon R Gilstrap
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joanna M Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael A Owens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Dyan M White
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa J Sammy
- Bio-Analytical Research Biology (BARB) Core, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Scott Ballinger
- Bio-Analytical Research Biology (BARB) Core, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert E Sorge
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University, St Louis, MO, USA
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Cody SL, Hobson JM, Gilstrap SR, Thomas SJ, Galinat D, Goodin BR. Sleep Disturbances and Chronic Pain in People with HIV: Implications for HIV-Associated Neurocognitive Disorders. CURRENT SLEEP MEDICINE REPORTS 2022; 8:124-131. [PMID: 36687512 PMCID: PMC9851157 DOI: 10.1007/s40675-022-00236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/14/2022]
Abstract
Purpose of Review Antiretroviral therapy has significantly reduced morbidity and mortality in people with HIV. Despite being virally suppressed, sleep disturbances, chronic pain, and neurocognitive impairments persist which can negatively impact quality of life for people with HIV. This article presents relevant literature related to sleep disturbances and chronic pain in people with HIV. The potential impact of these comorbidities on cognition is discussed with implications for managing HIV-associated neurocognitive disorder (HAND). Recent Findings People with HIV and chronic pain report greater insomnia and depressive symptoms compared to those without chronic pain. The neurotoxic effects of HIV itself and sleep and chronic pain induced inflammation can contribute to poorer cognitive outcomes. Summary Sleep disturbances and chronic pain are prevalent conditions in people with HIV that may perpetuate the development and exacerbation of HAND. Sleep and pain interventions may preserve cognitive function and improve quality of life for people aging with HIV.
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Affiliation(s)
- Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, U.S.A
| | - Joanna M Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Shannon R Gilstrap
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - S Justin Thomas
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - David Galinat
- Alabama Water Institute, The University of Alabama, Tuscaloosa, Alabama, U.S.A
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
- Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, U.S.A
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Aroke EN, Hobson JM, Ptacek T, Jackson P, Goodin BR. Genome-wide DNA methylation study identifies significant epigenomic changes associated with internalized stigma in adults with non-specific chronic low back pain. FRONTIERS IN PAIN RESEARCH 2022; 3:1021963. [PMID: 36518098 PMCID: PMC9742283 DOI: 10.3389/fpain.2022.1021963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/26/2022] [Indexed: 11/29/2022] Open
Abstract
Non-specific chronic low back pain (cLBP) represents a common musculoskeletal condition with no identifiable cause. It cannot be diagnosed with conventional neuroimaging techniques such as computerized tomography (CT). The diagnostic uncertainty that characterizes non-specific cLBP can lead to stigmatizing responses from others that can become internalized Among individuals with non-specific cLBP, internalized stigma is associated with greater pain intensity and disability. Yet, no study has examined the biological mechanism linking high internalized stigma to worse outcomes in individuals with non-specific cLBP. We aimed to identify differentially methylated loci (DML), enrichment pathways, and associated network interactions among individuals with non-specific cLBP experiencing low vs. high internalized stigma. We examined DNA methylation in whole blood samples from 48 adults, ages 19-85, using reduced representation bisulfite sequencing (RRBS). After controlling for age, sex, race, and multiple testing, differentially methylated loci (DML) differed in adults with low vs. high internalized stigma by at least 10% and q < 0.01 in 3,665 CpG sites: 2,280 hypomethylated and 1,385 hypermethylated. Gene ontology (GO) analyses of the annotated genes from these sites revealed significant enrichment of 274 biological processes, 29 cellular components, and 24 molecular functions (adjusted p < 0.05). The top enriched molecular functions regulate protein binding and DNA binding of transcription factor activity. Pathway analyses indicated that many functional genomic pathways, including Hippo Signaling, Melanogenesis, and Pathways in Cancer, were enriched with differentially methylated genes. Also, there was a significant interaction between relevance pathways such as P53, mTOR, PI3K-Akt, and Wnt signaling pathways. These pathways have previously been associated with neuroinflammation, neurodegeneration, and stress-related conditions. Thus, findings point to possible stress-induced DNAm changes as the link between high levels of internalized stigma and worse outcomes in adults with non-specific cLBP.
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Affiliation(s)
- Edwin N. Aroke
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Joanna M. Hobson
- Biobehavioral Pain Lab, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Travis Ptacek
- Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Pamela Jackson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Burel R. Goodin
- Biobehavioral Pain Lab, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
- Center for Addiction and Pain Prevention and Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, United States
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