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Georgiades A, Almuqrin A, Rubinic P, Mouhitzadeh K, Tognin S, Mechelli A. Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:38. [PMID: 37330526 DOI: 10.1038/s41537-023-00362-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.
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Affiliation(s)
- A Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, 27-29 Fairlight Avenue, London, NW10 8AL, UK.
| | - A Almuqrin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - P Rubinic
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - K Mouhitzadeh
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - S Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - A Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
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Fekih-Romdhane F, Dissem N, Cheour M. How did Tunisian university students cope with fear of COVID-19? A comparison across schizotypy features. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 178:110872. [PMID: 33814659 PMCID: PMC8009054 DOI: 10.1016/j.paid.2021.110872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022]
Abstract
Background Little consideration has been given to the impact of COVID-19 on people at risk of psychosis despite their particular preexisting vulnerability. We aimed to examine the role of coping strategies in determining the levels of fear in nonclinical students with high levels of self-reported schizotypal personality traits as compared to low-schizotypy controls. Method This was a cross-sectional survey. The Schizotypal Personality Questionnaire, the Fear of COVID-19 Scale and The Brief-Coping Orientation to Problems Experienced were used. Results High-schizotypy students had significantly higher maladaptive strategies scores and higher levels of fear of COVID-19 as compared to low-schizotypy students. Multivariate analyses have shown that high-schizotypy individuals were likely to rely on coping responses that are maladaptive (venting) and have potential exacerbating effects on fear of COVID-19, whereas low-schizotypy individuals were likely to use adaptive responses (acceptance) that seemed to be effective in reducing fear of COVID-19. Conclusion This study provided preliminary cross-sectional evidence for a differential impact of COVID-19 on individuals according to their schizotypy features. However, larger longitudinal population-based studies are necessary to confirm our findings.
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Affiliation(s)
- Feten Fekih-Romdhane
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
| | - Nouha Dissem
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | - Majda Cheour
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
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Huang ZH, Hou CL, Huang YH, He XY, Wang QW, Chen X, Wang ZL, Wang SB, Jia FJ. Individuals at high risk for psychosis experience more childhood trauma, life events and social support deficit in comparison to healthy controls. Psychiatry Res 2019; 273:296-302. [PMID: 30677717 DOI: 10.1016/j.psychres.2019.01.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 11/18/2022]
Abstract
Evidence for psychological risk factors on prodromal state of psychosis remained limited and inconsistent. This study aimed to investigate childhood trauma, life events and social support in subjects with high risk for psychosis (HR), first episode psychosis with schizophrenia (FEP) and healthy control (HC). In the study, 56 FEP, 83 HR and 61 HC underwent face-to-face clinical interview and psychological assessment, including Childhood Trauma Questionnaire (CTQ), Life Events Scale (LES) and Perceived Social Support Scale (PSSS). The results showed that in univariate analysis, HR individuals had more childhood trauma, more recent life events and less social support than HC group, and these findings were also supported by ANCOVA analysis except for the results related to social support after taking age, education, marital and employment status as covariates. Logistic regression analysis revealed that HR group was significantly associated with more childhood trauma, poorer overall function and unmarried state than HC group after controlling the interfering factors. HR group was similar with FEP group in these assessments. In conclusion, HR individuals experienced more childhood trauma, life events and social support deficit than HC group, which may be risk factors of conversion to psychosis. Further explorations are warranted to develop optimal psychosocial interventions.
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Affiliation(s)
- Zhuo-Hui Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China
| | - Cai-Lan Hou
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China.
| | - Ying-Hua Huang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China; Shantou University, Shantou, Guangdong Province, China
| | - Xiao-Yan He
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Liuzhou Worker's Hospital, Liuzhou, Guangxi Province, China
| | - Qian-Wen Wang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China
| | - Xie Chen
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China; Shantou University, Shantou, Guangdong Province, China
| | - Zhong-Lei Wang
- ShenzhenKangning Hospital, Shenzhen, Guangdong Province, China
| | - Shi-Bin Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China
| | - Fu-Jun Jia
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangdong Province, China.
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Carvalho CB, da Motta C, Pinto-Gouveia J, Peixoto E. Psychosocial roots of paranoid ideation: The role of childhood experiences, social comparison, submission, and shame. Clin Psychol Psychother 2018; 25:650-661. [PMID: 29744971 DOI: 10.1002/cpp.2195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Social experiences have a significant impact on cognitive functioning and appraisals of social interactions. Specifically, recalls of antipathy from parents, submissiveness, and bullying during childhood can have a significant influence on paranoid ideation later in life. METHOD Multiple hierarchical regression analysis was performed on a sample of 91 patients diagnosed with paranoid schizophrenia in remission and active phase, their first-degree relatives (n = 32) and unaffected controls (n = 64). OBJECTIVES Exploring the impact of distal (events from childhood) and proximal factors (current cognitive, emotional, and behavioural aspects of social functioning) in the frequency, degree of conviction, and distress resulting from paranoid ideation in the participants from 4 samples. RESULTS Proximal and distal factors (shame, submissive behaviour, negative social comparison, antipathy from father) predicted several aspects of paranoid ideation. Those variables had a differential impact in affected patients and healthy controls. DISCUSSION Finding suggests different variables being involved in paranoid ideation, and the specificities of patients with paranoid schizophrenia should be considered in the development of more effective psychotherapeutic interventions.
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Affiliation(s)
- Célia Barreto Carvalho
- Faculty of Social and Human Sciences, Psychology Department, Azores University, Ponta Delgada, Portugal.,Cognitive-Behavioural Research Centre (CINEICC) of the Psychology Department, University of Coimbra, Coimbra, Portugal
| | - Carolina da Motta
- Faculty of Social and Human Sciences, Psychology Department, Azores University, Ponta Delgada, Portugal.,Cognitive-Behavioural Research Centre (CINEICC) of the Psychology Department, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC) of the Psychology Department, University of Coimbra, Coimbra, Portugal
| | - Ermelindo Peixoto
- Faculty of Social and Human Sciences, Psychology Department, Azores University, Ponta Delgada, Portugal
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Negative social comparisons and psychosis proneness in a healthy adolescent population. Eur Psychiatry 2017; 46:51-56. [PMID: 29017064 DOI: 10.1016/j.eurpsy.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023] Open
Abstract
There is growing evidence of an association between negative social comparisons (NSC) and both psychosis, and psychosis proneness. The majority of the work thus far, however, has focused largely on one type of NSC, namely, social rank. Whilst social rank is clearly an important factor, an individual's perception of belonging is likely also of importance; particularly, when considering individuals from collectivistic cultures such as China, where greater emphasis is placed on fitting into the group. There is also limited research investigating what factors may contribute towards the relationship between NSC and psychosis proneness, and to what extent this relationship may be due to common familial factors. To address these issues, we examined whether (1) Social rank and perceived belonging predict negative, positive and depressive psychotic experiences in a Chinese, adolescent, twin and sibling population, (2) coping styles moderate the impact of these relationships and (3), there is a familial association between NSC and psychosis proneness. Both social rank and perceived belonging were found to predict the negative and depressive dimensions of psychosis. These relationships were moderated by problem-focused coping styles. Interestingly, the association between perception of belonging, and negative psychotic experiences was familial-and stronger in Monozygotic twins-indicating perhaps shared aetiology due to common genes. Our findings highlight NSC as potential vulnerability markers for negative and depressive psychotic experiences, and suggest potentially different aetiological pathways amongst different NSC and different psychotic experiences. On a clinical level, our findings emphasize the need to consider coping styles when treating at-risk individuals.
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Kommescher M, Gross S, Pützfeld V, Klosterkötter J, Bechdolf A. Coping and the stages of psychosis: an investigation into the coping styles in people at risk of psychosis, in people with first-episode and multiple-episode psychoses. Early Interv Psychiatry 2017; 11:147-155. [PMID: 25726849 DOI: 10.1111/eip.12223] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/19/2014] [Indexed: 11/29/2022]
Abstract
AIM The concept of coping is central to recent models of psychosis. The aim of the present paper is to explore whether specific coping styles relate to certain stages of the disorder. METHODS Thirty-nine clients at clinical high risk (CHR) of first-episode psychosis, 19 clients with first-episode psychosis and 52 clients with multiple-episode psychosis completed a Stress Coping Questionnaire. This questionnaire consists of 114 items defining one overall positive coping scale (with three subscales) and one negative coping scale. Analyses of variance with group as between-subject factor and coping behaviour as within-subject factor were used to identify different coping patterns. RESULTS On the level of subscales no group differences could be detected, but analysis of variance revealed slightly different patterns: CHR clients used significantly more negative than positive coping styles (P = 0.001), followed by patients with multiple-episode psychosis (P = 0.074). First-episode patients were most likely to use negative as well as positive coping (P = 0.960). Across all stages of illness, stress control was significantly preferred compared to the other positive coping styles distraction and devaluation. Again, this pattern was especially pronounced for at-risk clients and patients with multiple-episode psychosis, whereas patients with first-episode psychosis were most likely to use devaluation as well as distraction. CONCLUSIONS The overall coping styles were similar across the different stages of psychosis. However, at-risk persons presented especially pronounced negative coping and a small range of strategies, indicating a specific need for psychosocial support in this stage of the disorder.
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Affiliation(s)
- Mareike Kommescher
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Sonja Gross
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Abstract
Background. There is strong evidence that those with a long-standing psychotic disorder have fewer social contacts and less social support than comparison groups. There is less research on the extent of social contacts and support prior to or at the onset of psychosis. In the light of recent evidence implicating a range of social experiences and contexts at the onset of psychosis, it is relevant to establish whether social networks and support diminished before or at the time of onset and whether the absence of such supports might contribute to risk, either directly or indirectly. We, therefore, conducted a systematic review of this literature to establish what is currently known about the relationship between social networks, support and early psychosis. Methods. We identified all studies investigating social networks and support in first episode psychosis samples and in general population samples with measures of psychotic experiences or schizotype by conducting systematic searches of electronic databases using pre-defined search terms and criteria. Findings were synthesized using non-quantitative approaches. Results. Thirty-eight papers were identified that met inclusion criteria. There was marked methodological heterogeneity, which limits the capacity to draw direct comparisons. Nonetheless, the existing literature suggests social networks (particularly close friends) and support diminished both among first episode samples and among non-clinical samples reporting psychotic experiences or with schizotype traits, compared with varying comparison groups. These differences may be more marked for men and for those from minority ethnic populations. Conclusions. Tentatively, reduced social networks and support appear to pre-date onset of psychotic disorder. However, the substantial methodological heterogeneity among the existing studies makes comparisons difficult and suggests a need for more robust and comparable studies on networks, support and early psychosis.
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Eschleman KJ, Alarcon GM, Lyons JB, Stokes CK, Schneider T. The dynamic nature of the stress appraisal process and the infusion of affect. ANXIETY STRESS AND COPING 2012; 25:309-27. [DOI: 10.1080/10615806.2011.601299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lin A, Wigman JTW, Nelson B, Vollebergh WAM, van Os J, Baksheev G, Ryan J, Raaijmakers QAW, Thompson A, Yung AR. The relationship between coping and subclinical psychotic experiences in adolescents from the general population--a longitudinal study. Psychol Med 2011; 41:2535-2546. [PMID: 21524327 DOI: 10.1017/s0033291711000560] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Subclinical psychotic experiences during adolescence may represent liability for developing psychotic disorder. Both coping style and the degree of persistence of psychotic experiences may play a role in the progression to clinical psychotic disorder, but little is known about the causal relationship between the two. METHOD Path modelling was used to examine longitudinal relationships between subclinical positive psychotic experiences and three styles of coping (task-, emotion- and avoidance-oriented) in an adolescent general population sample (n=813) assessed three times in 3 years. Distinct developmental trajectories of psychotic experiences, identified with growth mixture modelling, were compared on the use of these coping styles. RESULTS Over time, emotion-oriented coping in general was bi-directionally related to psychotic experiences. No meaningful results were found for task- or avoidance-oriented coping. Females reported using a wider range of coping styles than males, but the paths between coping and psychotic experiences did not differ by gender. Persistence of psychotic experiences was associated with a greater use of emotion-oriented coping, whereas a decrease in experiences over time was associated with an increased use of task-orientated coping. CONCLUSIONS Emotion-oriented coping is the most important coping style in relation to psychotic experiences, as it may contribute to a 'vicious cycle' and is associated with persistence of experiences. In addition, more task-oriented coping may result in a decrease in psychotic experiences. Results suggest that opportunities for intervention may already be present at the level of subclinical psychosis.
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Affiliation(s)
- A Lin
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Victoria, Australia.
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Abstract
BACKGROUND Trower and Chadwick argued that there are two types of paranoia: 'poor me', in which persecution is seen as undeserved, and 'bad me', in which it is perceived to be deserved. These authors outlined a theory which accounts for both types of paranoia and makes predictions regarding their stability. AIMS AND OBJECTIVES To examine whether different degrees of persecutory ideation and deservedness are associated with different coping strategies in non-clinical populations. METHODOLOGY Six hundred and eight university students from two European countries (UK and Portugal) took part via the Internet, and were assessed in terms of the severity of persecution and deservedness (Persecution and Deservedness Scale), mood (Beck Depression Inventory), and coping strategies (Response Styles to Depression Questionnaire and COPE Questionnaire). RESULTS Deservedness was associated with acceptance and with engaging in dangerous activities. CONCLUSIONS 'Poor me' and 'bad me' paranoia may represent separate phases of the same unstable defensive phenomenon. The effectiveness of the existing psychological interventions in prodromal psychosis could be increased by addressing the negative impact of safety behaviours and of substance misuse and by encouraging the practice of more adaptive ways of dealing with everyday problems.
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Alvarez-Moya EM, Barrantes-Vidal N, Navarro JB, Subira S, Obiols JE. Exophenotypical profile of adolescents with sustained attention deficit: A 10-year follow-up study. Psychiatry Res 2007; 153:119-30. [PMID: 17662473 DOI: 10.1016/j.psychres.2006.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 07/26/2006] [Accepted: 12/15/2006] [Indexed: 11/23/2022]
Abstract
UNLABELLED We aimed to explore prospectively the relationship between the presence of sustained attention deficit (SAD) in early adolescence and exophenotypical measures of vulnerability to schizophrenia spectrum disorders (personality and psychosocial measures) in early adulthood. Two cohorts of community adolescents were selected in 1993 according to the presence or absence of a CPT-linked SAD. In 2003, both cohorts (Index: n=42, and CONTROL n=38) were administered the O-LIFE, the SCID-II, the DOI battery and the COPE scale, among other tests. T-tests were used to compare both cohorts. Index subjects showed a higher level of negative schizotypy, avoidant, depressive and narcissistic personality traits, as well as more asocial behavior and poorer use of coping resources than CONTROL subjects did. A SAD in early adolescence may be associated with coping and social deficits, negative schizotypy, and personality traits indicative of emotional disturbance in adulthood. Our results suggest that SAD in early adolescence might be an indicator of psychopathology in adulthood and give support to dimensional models of psychopathology.
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Affiliation(s)
- Eva M Alvarez-Moya
- Psychopathology and Neuropsychology Research Unit, Department of Health Psychology, Autonomous University of Barcelona, Bellaterra, 08193, Barcelona, Spain.
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Dangelmaier RE, Docherty NM, Akamatsu TJ. Psychosis proneness, coping, and perceptions of social support. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2006; 76:13-7. [PMID: 16569121 DOI: 10.1037/0002-9432.76.1.13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study examined coping styles and perceived levels of social support in hypothetically psychosis-prone individuals. Results suggest that psychosis-prone individuals did not differ from a comparison group on levels of adaptive coping or positive social support but that they did endorse higher rates of nonadaptive coping and negative social support compared with the comparison group.
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Affiliation(s)
- Ruth E Dangelmaier
- Kent State University, Department of Psychology, Kent, OH 44242-0001, USA.
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Abstract
BACKGROUND Self-esteem and optimism have been associated with appraisal and outcomes in a variety of situations. The degree to which the contribution of self-esteem and optimism to outcomes over time is accounted for by the differences in threat (primary) or resource (secondary) appraisal has not been established in persons with human immunodeficiency virus (HIV). OBJECTIVES To examine the longitudinal relationship of personality (self-esteem and optimism) on primary and secondary appraisal and outcomes of well-being, mood, CD4+ T-lymphocyte count, and selected activities. METHODS Men (n = 56) and women (n = 42) infected with HIV completed eight self-report measures twice over 18 months. Hierarchical Multiple Regressions were used to examine the relationship of personality variables on appraisals and outcomes. The mediating effects of primary and secondary appraisals were explored. RESULTS Self-esteem uniquely accounted for 6% of the variance in primary appraisal and 5% in secondary appraisal. Optimism accounted for 8% of the unique variance in secondary appraisal. Primary and secondary appraisal mediated differently between personality and outcome variables. A strong predictor of well-being, mood disturbance, and activity disruption at Time 2 was participants' initial level of these variables. Socioeconomic status was a strong predictor of mood. CONCLUSIONS Self-esteem and optimism are important but different resources for adapting to HIV disease. Strategies for reducing threats and increasing resources associated with HIV may improve an individual's mood and sense of well-being.
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Affiliation(s)
- E H Anderson
- University of Connecticut School of Nursing, Storrs 06269-2026, USA.
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