The sense-of-coherence predicts health-related quality of life and emotional distress but not disability in Parkinson's disease

Factors associated with self-rated health in people with late-stage parkinson's and cognitive impairment

PURPOSE

To investigate the contributors to self-rated health in people with late-stage Parkinson's disease (PD) and cognitive impairment.

METHODS

A secondary analysis of baseline data from the international Care of Late-Stage Parkinsonism (CLaSP) cohort study was conducted. Participants with PD and either dementia or mild cognitive impairment or MMSE < 24/30 in the absence of major depression were included if they had completed the EQ-5D-3L assessment (n = 277). Factors associated with self-rated health (EQ-5D-3L Index and Visual Analogue Scale) were investigated through multivariable linear regression.

RESULTS

More severe PD (motor and non-motor) was associated with worse self-rated health. The EQ-5D-3L dimensions of Mobility, Self-Care and Usual Activities were almost universally affected; the latter two particularly severely. Being unable to perform usual activities or having moderate to extreme anxiety or depression were significantly associated with EQ-5D-3L Visual Analogue Scale, suggesting these are particularly valued. Worse motor impairment and function and the non-motor symptom domains of mood, perception, sexual function, and miscellaneous (e.g., pain) were associated with worse self-rated health, whereas greater burden of gastrointestinal symptoms was associated with better self-rated health in multivariate analysis. Better self-rated health was associated with recent PD nurse consultation, and higher doses of dopaminergic medication.

CONCLUSION

Improvement of activities of daily living, mood and anxiety should be prioritised in clinical practice, with consideration of perception and sexual function in this population. Recent nurse consultations and higher antiparkinsonian doses are associated with better self-rated health, suggesting there is no room for a therapeutic nihilism in this population of people within a complex phase of PD.

COVID-19 Stress and Teachers Well-Being: The Mediating Role of Sense of Coherence and Resilience

The outbreak of the COVID-19 pandemic has impacted many professions with short-, medium-, and long-term consequences. Hence, this study examined the mediating role of sense of coherence (SOC) and resilience in the relation to COVID-19 stress and teachers' well-being (TWB). It recruited 836 teachers from Ethiopia's higher-education institutions, of which 630 (75.4%) were men and 206 (24.6%) were women, with a mean age of 32.81 years and a standard deviation of 6.42. Findings showed that COVID-19 stress negatively predicted SOC, resilience, and TWB and that SOC and resilience positively predicted TWB. It was concluded that SOC and resilience, both together and separately, mediated the relation between COVID-19 stress and TWB. These results were discussed alongside relevant literature, and the study is found to be valuable for practitioners and researchers who seek to improve well-being using SOC and resilience as resources across teaching professions.

Psychophysical quality of life and its determinants in prisoners: the role of selected psychosocial factors

PURPOSE

Penal institutions affect their inmates' mental as well as physical health. Prisoners have higher rates of physical health conditions than the public. While it is known that psychosocial factors determine patients' quality of life, little research has focused on factors related to prisoners' psychophysical quality of life (PQoL). The purpose of this study is to analyze the determinants of prisoners' PQoL.

DESIGN/METHODOLOGY/APPROACH

The sample consisted of 390 prisoners recruited from correctional facilities administered by the Warsaw District Inspectorate of Prisons. This study hypothesized that social support, coherence and self-efficacy would be positive determinants of PQoL and that depression, anxiety and anger would be its negative determinants. The collected data were analyzed by means of structural equation modeling.

FINDINGS

The positive determinants of PQoL in prisoners are coherence, self-efficacy and social support. The negative determinant of PQoL is trait depression.

ORIGINALITY/VALUE

This study has revealed a list of factors significant for improving prisoners' PQoL. Factors have also indicated which of the predictors measured are the most significant. The identified set of significant factors should be taken into account in social rehabilitation programs for prisoners as contributing to the preservation of life and health.

Psychosocial Quality of Life and Its' Correlates in People Serving Prison Sentences in Penitentiary Institutions

The aim of the present study was to identify and analyze the determinants of prison inmates' psychosocial quality of life (PQol) as a positive and negative correlates. Three hundred ninety prison inmates were recruited from the correctional facilities administered by the Warsaw District Inspectorate of Prisons. Data were collected by means of the SQLQ, SOC-29, SWS, SPI/TPI, SIPR, COPE, GSES questionnaires and analyzed by means of SEM. The positive correlates for prison inmates' PQol are: sense of coherence, self-efficacy, intensity of religious attitude, social support, and trait curiosity. Among the strategies of coping with stress, only seeking social support for emotional reasons is a significant factor that directly predicts PQol. Substance use and planning play only a mediating role in PQol prediction. The negative correlate for inmates' PQol is trait depression. Contrary to predictions, anxiety is not a negative correlate-as noted above, it is associated with a positive score on PQol.

Factors Associated with Health-Related Quality of Life in Late-Stage Parkinson's Disease

Background

There is limited knowledge on health-related quality of life (HRQoL) in late-stage Parkinson's disease (PD).

Objective

To assess factors associated with HRQoL in patients with late-stage PD, with a focus on health care provision.

Methods

The Care of Late Stage Parkinsonism (CLaSP) project is the largest study on late-stage PD to date. The current study analyzed data of 401 patients from 6 European countries in whom HRQoL was assessed with the 8-item PD Questionnaire in patients without dementia. Factors potentially associated with HRQoL were assessed and examined in linear regression analyses.

Results

Better HRQoL was associated with living at home, greater independence in activities of daily living (Schwab and England Scale), less severe disease (Hoehn and Yahr stage), better motor function (Unified PD Rating Scale Part III), and lower non-motor symptoms burden (Non-Motor Symptoms Scale [NMSS]) across all NMSS domains. Having a PDspecialist as physician for PD, contact with a PDnurse, and no hospital admission during the past 3 months were associated with better HRQoL, but having seen a physiotherapist or occupational therapist was associated with worse HRQoL.

Conclusions

The results emphasize the importance of optimizing treatment for motor and multiple non-motor symptoms to improve HRQoL in patients with late-stage PD. PD-specific health care resources, particularly PDnurses, are likely important in addressing issues to improve HRQoL in this population. Worse HRQoL in those who had recently seen a physiotherapist or occupational therapist may reflect referral based on factors not measured in this study.

The Effect of E-Learning on Self-Efficacy and Sense of Coherence of Cancer Caregivers: Application of the Bandura and Antonovsky Social Cognitive Theory

AIM

Cancer is one of the most important chronic diseases which affects caregivers. Therefore, in this study, we decided to increase the self-efficacy and sense of coherence of caregivers by using virtual learning via mobile to increase the power of managing in such situations.

METHODS

This study is a clinical trial performed on 60 caregivers of cancer patients. Questionnaires of demographic information, Bandura self-efficacy, and Antonovsky's sense of coherence were completed for both intervention and control groups. Then, for the intervention group, a virtual educational intervention was performed daily for 1 month using the mobile phones, and for the control group, no intervention was performed.

RESULTS

The mean score of self-efficacy in the intervention group was (18.09±93.21) before and (135.12±11.14) after the intervention, which was statistically significant (P=0.001). While in the control group, this means was (84.71±18.55) before and (84.75±17.13) after the study, but this difference was not statistically significant (P=0.2). Also, the mean score of sense of coherence in the intervention group was (73.25±7.28) before and (89.11±7.11) after the intervention, which was statistically significant (P=0.001). While in the control group, this means was (76.42±7.45) before and (76.89±7.27) after the study, but this difference was not statistically significant (P=0.31).

CONCLUSION

Educational interventions, even virtually, can lead to improved self-efficacy and a sense of coherence in caregivers of cancer patients and can be used as one of the low-cost and effective methods in managing and controlling the disease.

A Multi-Site Study of Traumatic Brain Injury in Mexico and Colombia: Longitudinal Mediational and Cross-Lagged Models of Family Dynamics, Coping, and Health-Related Quality of Life

Latin America has high rates of traumatic brain injury (TBI), yet reduced mental and physical health outcomes due to limited rehabilitation services. To understand the psychosocial adjustment process in TBI patients in Latin America, the incorporation of cultural values including family-based variables is imperative. The current study examined relations among healthy family dynamics, coping, and mental and physical health related quality of life (HRQL) among a sample of TBI patients across three sites and two countries over the first 4 months post-injury. A sample of 109 acute TBI patients from Mexico and Colombia were recruited, and a series of longitudinal mediation and cross-lag panel analyses were run. Mental and physical HRQL were positively associated with each other, as well as healthy family dynamics and coping. Coping partially mediated the effects of healthy family dynamics on both mental and physical HRQL. Family dynamics showed the strongest cross-lag relationships with coping going from 2 months to 4 months. Similarly, coping showed the strongest cross-lag relationships with both mental and physical HRQL going from baseline to 2 months. Results provide empirical support for the importance of a rehabilitation workforce that has been trained in and can effectively implement family-based interventions for individuals with TBI in Latin America.

Stress and neurodegeneration

Neurodegenerative diseases are a great concern because of aging worldwide population. Despite substantial effort to advance our understanding of the etiology and potential treatment of neurodegeneration, there remains a paucity of information with respect to this complex disease process. Interestingly, stress has been implicated among the potential mechanisms implicated in neurodegenerative pathology. Given the increase in chronic stress in modern society, this premise warrants further investigation. The aim of this review is to evaluate the influence of stress on neurodegeneration, the effect of neurodegenerative diseases diagnosis on stress, and therapeutic strategies for neurodegenerative diseases with a special focus on stress reduction. Neurodegenerative disorders such as Alzheimer's, Parkinson's and Huntington's Disease showed an acceleration in disease progression and a worsening of symptoms under stress. Some therapies (e.g., yoga, meditation) focused on reducing stress showed beneficial effects against neurodegeneration. Nevertheless, more studies are necessary in order to completely understand the implications of stress in neurodegeneration and the usefulness of stress reduction in the treatment thereof.

Emotional Distress Correlates Among Patients With Chronic Nonspecific Low Back Pain: A Hierarchical Linear Regression Analysis

BACKGROUND

Chronic low back pain (CLBP) has become a worldwide health concern, and emotional distress is an important issue for CLBP management. However, it remains poorly understood how emotional distress happens and develops. This study aimed to systematically explore the correlates of emotional distress in patients with CLBP.

METHODS

The study was a multisite, cross-sectional survey with a sample of 252 patients with CLBP in urban communities. A battery of questionnaires was used to collect data. Univariate analysis, Pearson correlation analysis, and hierarchical linear regression analysis were performed.

RESULTS

The mean score of emotional distress among 252 patients with CLBP was 13.85 ± 6.50. Hierarchical regression analysis indicated that the demographic factors, psychobehavioral factors, and social support of patients with CLBP were associated with their emotional distress, uniquely explaining 16.5%, 18.4%, and 6.2% of the variance, respectively. Five factors were found to be associated with patients' emotional distress: pain intensity (β = 0.257, P < 0.001), passive coping (β = 0.297, P < 0.001), active coping (β = -0.254, P < 0.001), self-efficacy (β = -0.155, P = 0.005), and social support (β = -0.268, P < 0.001).

CONCLUSIONS

Patients with CLBP suffered from clinically significant emotional distress. Patients' demographics, psychobehavioral factors, and social support were all related to emotional distress. The findings help us to identify the characteristics of patients with CLBP at high risk for emotional distress and to formulate corresponding countermeasures.

LAY SUMMARY

This study aimed to explored the correlates of emotional distress of patients with chronic low back pain (CLBP) by hierarchical linear regression analysis. The study found that patients' demographic factors, psycho-behavioral factors, and social support were associated with their emotional distress, uniquely explaining 16.5%, 18.4%, and 6.2% of the variance, respectively. Pain intensity, passive coping, active coping, self-efficacy, and social support were detected as significant correlates.

Comparison of three scales to evaluate personality traits in Parkinson's disease: which one to use?

BACKGROUND

Personality traits have gained interest in the field of disability and stress, because they may either prompt or deny compliance. They can also foster motivation and influence outcome. Parkinson disease (PD) is a disabling and stressful condition that requires coping strategies and rehabilitation plans. Three constructs and their relative scales have been a matter of investigation, namely dispositional optimism (DO), locus-of-control (LOC), and sense-of-coherence (SOC).

AIM

The present study compared the psychometric properties of three constructs in Parkinson's disease (PD). The health-related variables were: emotional distress (ED), quality of life (HR-QoL) and activities of daily living (ADL). The final objective was to provide guidance on scale selection to be implemented in clinical protocols.

DESIGN

A cross sectional study.

SETTING

Community-based general physicians.

POPULATION

Participants with PD (N.=84) from community-based general physicians.

METHODS

PD patients completed 3 self-report scales, namely Life Orientation Test-Revised (LOT-R, measuring Dispositional Optimism), Internal and External Locus Of Control (LOC-int. LOC-ext) and Sense of Coherence (SOC). All participants had magnetic resonance imaging. The MDS-UPDRS and the Barthel Scale were compiled by the investigator with the assistance of a caregiver.

RESULTS

LOC-ext was the only scale to be associated with PD severity and disability (P<0.05). A higher level of LOC-ext was also associated with a higher level of ED (P<0.005). LOT-R was inversely associated with ED. Subjects in the highest tertile had a 41% lower ED (P<0.001). SOC was also inversely associated with degree of ED. Subjects in the highest tertile have a 44% lower ED (P<0.01). Moreover, HR-QoL is associated with several parameters, but LOT-R is the one with the strongest association (P<0.001).

CONCLUSIONS

DO and SOC are predictive of important end-points, namely HR-QoL and ED. DO is even better under this respect. Conversely, those clinicians who are more interested in motor problems may find LOC more suitable. DO may be the most efficient construct to use in PD because of its favorable psychometric properties.

CLINICAL REHABILITATION IMPACT

DO, LOC and SOC are constructs to be implemented in both research and clinical PD protocols. It is recommended to implement these, because they have predictive value especially when HR-QoL and ED are studied.

Patient and Family Caregiver's Neuroticism and Conscientiousness Personality in Relation to Quality of Life of Patient With Parkinson's Disease: A Cross-Sectional Study Neuroticism and Conscientiousness Personality in Relation to QoL of Patient With PD

Background: Personality impacts life expectancy and comprehensive treatment efficacy for patients with Parkinson's disease (PD). However, current research fails to involve the family caregiver's personality despite significant external support provided by family caregivers. This study explored neuroticism and conscientiousness personality factors of the patient and family caregiver associated with quality of life (QoL) of PD patients.

Methods: 134 couples of patients presenting with PD and their family caregivers that met inclusion criteria, were recruited for this cross-sectional study at Shanghai Tenth People's Hospital from October 2015 to 2017. The Parkinson's Disease Questionnaire-39 Items (PDQ-39) for QoL, including the physical component summary (PCS) and mental component summary (MCS), the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI) for neuroticism and conscientiousness personalities, and the Unified Parkinson's Disease Rating Scale (UPDRS) for PD severity questionnaires were employed. Multivariate stepwise linear regression determined the contributions of demographic, clinical and personality variables in PDQ-39, PCS, and MCS.

Results: PD patients and neuroticism were significantly associated with total PDQ-39, PCS, and MCS. Additionally, conscientiousness was significantly associated with PDQ-39 and PCS. After adding neuroticism and caregiver conscientiousness personality, the importance of neuroticism for the QoL model dramatically decreased, and caregiver conscientiousness personality was associated with lower scores in total PDQ-39 and PCS.

Conclusion: We revealed a significant association between neuroticism and physical or mental status of PD patients; however, this association decreased when caregiver conscientiousness was added to the model. Moreover, conscientiousness of patients and caregivers were associated with improved QoL.

Sense of Coherence and Stress-Related Resilience: Investigating the Mediating and Moderating Mechanisms in the Development of Resilience Following Stress or Adversity

Background: Trauma, stress, and adversity are well-known for having lasting negative effects on health. Yet, not all individuals go on to develop psychopathology or impaired health. However, little is known about the underlying mechanisms which influence the development of stress-related resilience. Sense of coherence-revised (SOC-R) may play a role in this process, as it is formed through overcoming stress or adversity. It may also influence the steeling effect, which suggests that previous exposure to moderate adversity increases resilience to later adversities. Objectives: This study aimed to examine the mediating and moderating roles of SOC-R in the relationship between stress or adversity, and psychological health and well-being. It further aimed to investigate the role of SOC-R in steeling processes. Methods: The study used a longitudinal design, with data collection at baseline and one-year follow-up. Participants included (N = 238) Swiss older adults (Mage = 68.3 years). Standardized questionnaires assessed early-life adversity, recent chronic stress, SOC-R, and current health and well-being. Mediation and moderation analyses examined the mechanisms underpinning stress-related resilience and curvilinear associations assessed steeling. Results: Results showed that the Manageability subscale of SOC-R significantly moderated the relationship between chronic stress and general mental health (b = 0.04, 95% CI [0.007, 0.082], t = 2.32, p < 0.05). Furthermore, SOC-R significantly mediated the relationship for general mental health (GMH) and satisfaction with life (SWL) with childhood emotional neglect (GMH: b = -0.056, 95% BCa CI [-0.126, -0.002]; SWL: b = -0.043, 95% BCa CI [-0.088, -0.004]), childhood physical neglect (GMH: b = -0.100, 95% BCa CI [-0.232, -0.002]; SWL: b = -0.081, 95% BCa CI [-0.181, -0.002]), and chronic stress (GMH: b = -0.052, 95% BCa CI [-0.100, -0.001]; SWL: b = -0.055, 95% BCa CI [-0.097, -0.020]). No curvilinear associations were observed between stress or adversity and SOC-R. Conclusions: This study expands on the limited research on stress-related resilience by examining the role of SOC-R in the interactions between adversity, stress, and health. Future research should examine SOC-R in samples with a greater range and different types of adversity. Overall, findings suggest that SOC-R is an important mechanism underpinning the development of stress-related resilience.

Sense of Coherence in persons with late effects of polio

BACKGROUND

Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population.

OBJECTIVE

To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability).

METHOD

Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC.

RESULTS

SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants' marital status and level of education explained 37% (p < 0.001) of the variance in SOC.

CONCLUSION

Persons with LEoP have a level of SOC indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC.

The impact of self-perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients: results of a cross-sectional study

Objective:

To examine the impact of perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients.

Design:

Cross-sectional survey.

Setting:

Department of Neurology, University Medical Center Groningen, the Netherlands.

Subjects:

Multiple sclerosis patients.

Main measures:

World Health Organization Quality of Life – abbreviated version, Stigma Scale for Chronic Illness, Sense of Coherence Scale, background and disease-related questions.

Results:

In total, 185 patients (61% response rate) participated in the study with moderate to severe limitations. Stigma was highly prevalent but low in severity. Patients with a higher sense of coherence experienced a lower level of limitations (B = −0.063, P < 0.01) and less stigma (enacted stigma B = −0.030, P < 0.01; self-stigma B = −0.037, P < 0.01). Patients with a higher level of limitations experienced more stigma (enacted stigma B = 0.044, P < 0.05; self-stigma B = 0.063, P < 0.01). Patients with a higher sense of coherence experienced better quality of life (physical health B = 0.059, P < 0.01; psychological health B = 0.062, P < 0.01; social relationships B = 0.052, P < 0.01; environmental aspects B = 0.030, P < 0.01). Patients with a higher level of limitations experienced poorer quality of life (physical health B= −0.364, P < 0.01; psychological health B = −0.089, P< 0.05) and patients with more stigma also experienced poorer quality of life (self-stigma: physical health B = −0.073, P < 0.01; psychological health B = −0.089, P < 0.01; social relationships B = −0.124, P < 0.01; environmental aspects B = −0.052, P < 0.01, and enacted stigma: physical health B = −0.085, P < 0.10).

Conclusion:

Patients with less perceived limitations and stigma and a higher level of sense of coherence experienced better quality of life. Patients with a higher sense of coherence experienced a lower level of limitations and less stigma.

Health-related quality of life of a very special population: monks of Holy Mountain Athos, Greece

PURPOSE

The investigation of Health-Related Quality of Life (HRQOL) of Orthodox Christian monks who live at the Holy Mount Athos in Greece, and its correlation with demographic characteristics and Sense of Coherence (SOC-13).

METHODS

A cross-sectional study was designed. The seven monasteries and five scetes with the largest number of monk population were invited to participate. Two monasteries and 1 scete gave their permission for the study. The final monks sample was formed by 166 monks from 215 who participated to the study. HRQOL was assessed using the SF-12 and Sense of Coherence the SOC-13 scales that were completed by monks from May to August 2012. Μultiple linear regression analyses were conducted to explore the association of the HRQOL subscales with the demographics and SOC-13.

RESULTS

The mean age was 45.5 ± 13.0 years; 83.7% lived in communal monasteries, and the mean number of years in monasticism was 18.4 ± 12.1. The mean value of their Physical Component Summary (PCS) score was 47.3 ± 5.3, which is lower than in the general Greek men population, while their Mental Component Summary (MCS) score was 56.4 ± 5.8, which is higher than in the general Greek men population. The mean value of SOC-13 was 65.7 ± 6.5. Positive association for PCS appeared for place of living (β = 5.43, SE = 1.27, p < 0.001) and negative association for age (β = -0.16, SE = 0.03, p < 0.001) while for MCS for number of years in monasticism (β = 0.07, SE = 0.06, p = 0.023) and sense of coherence (β = 0.47, SE = 0.06, p < 0.001).

CONCLUSIONS

The results indicated that monks had better mental health but worse physical health compared to the general Greek male population. More studies are required to validate the above findings.

Sense of Coherence as a Predictor of Quality of Life Among Iranian Students Living in Ahvaz

OBJECTIVES

There is evidence to support the correlation between a stronger sense of coherence (SOC) and better perceived quality of life (QOL). However, this association has not been described among Iranian students.

METHODS

Students were selected by stratified randomization and demographic data including age, gender, and employment status were collected. SOC was measured using the short-form of the Sense of Coherence Scale (SOC-13). The World Health Organization Quality of Life (WHOQOL)-BREF questionnaire was used to assess the QOL. Data was collected over one year between 2014 and 2015.

RESULTS

A total of 459 students participated in the study. The Cronbach's alpha score in domains of physical health, psychological health, environmental health, social relationships, and WHOQOL-BREF total score were 0.84, 0.83, 0.84, 0.78, and 0.94, respectively. Measured Cronbach's alpha for domains of meaningfulness, manageability, comprehensibility, and SOC-13 total score were 0.68, 0.67, 0.76, and 0.87, respectively. Marital status was not related to SOC whereas married students had significantly higher scores of QOL in the domains of psychological health, social relationships, and environment health (p=0.006, p<0.0001 and p=0.043, respectively). There were significant strong positive relationships between all components of SOC (meaningfulness, manageability, and comprehensibility) and all domains of WHOQOF-BREF (p<0.0001 for all).

CONCLUSION

This study shows that SOC and marital status are significant predictors of QOL among Iranian students.

Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis - surgical outcome: A 5-year follow-up study

This study investigated the association between the 3-month postoperative sense of coherence and the 5-year postoperative outcome of decompressive surgery for lumbar spinal stenosis. The participants with a lower sense of coherence at the 3-month follow-up had a poorer functional ability and lower satisfaction with surgery, higher pain ratings, lower life satisfaction and more depressive symptoms 5 years postoperatively. A low 3-month sense of coherence associated with greater pain and a poorer functional ability 5 years postoperatively. Evaluating sense of coherence and depressive symptoms in patients who have had lumbar spinal stenosis surgery may help in identifying those in need of enhanced support for postoperative recovery.

Finding meaning in life while living with HIV: validation of a novel HIV meaningfulness scale among HIV-infected participants living in Tennessee

BACKGROUND

People living with HIV who maintain a positive outlook on their future may manage stress better than those who do not, leading to improved coping behaviors and better health outcomes.

METHODS

While studying 125 HIV+ adults participating in two clinical trials of expressive writing we assessed their HIV-specific meaningfulness of life with a short, unidimensional scale (the HIVMS).

RESULTS

The HIVMS had a strong Cronbach's alpha (0.80) and acceptable test-retest reliability (0.70). HIVMS scores were strongly correlated with measures of perceived control, optimism, and psychological well-being. Participants with lower HIVMS scores had higher probability of non-adherence to antiretroviral medication, suggesting a decreased ability to manage their illness successfully. Neither the control nor expressive writing intervention groups showed increased HIVMS scores.

CONCLUSIONS

Future research is necessary to determine the effect of HIV meaning on long-term health outcomes and to develop interventions that can significantly improve a person's perception of their meaning in life.