Depressive symptoms, self-esteem, HIV symptom management self-efficacy and self-compassion in people living with HIV.

The aims of this study were to examine differences in self-schemas between persons living with HIV/AIDS with and without depressive symptoms, and the degree to which these self-schemas predict depressive symptoms in this population. Self-schemas are beliefs about oneself and include self-esteem, HIV symptom management self-efficacy, and self-compassion. Beck's cognitive theory of depression guided the analysis of data from a sample of 1766 PLHIV from the USA and Puerto Rico. Sixty-five percent of the sample reported depressive symptoms. These symptoms were significantly (p ≤ 0.05), negatively correlated with age (r = -0.154), education (r = -0.106), work status (r = -0.132), income adequacy (r = -0.204, self-esteem (r = -0.617), HIV symptom self-efficacy (r = - 0.408), and self-kindness (r = - 0.284); they were significantly, positively correlated with gender (female/transgender) (r = 0.061), white or Hispanic race/ethnicity (r = 0.047) and self-judgment (r = 0.600). Fifty-one percent of the variance (F = 177.530 (df = 1524); p < 0.001) in depressive symptoms was predicted by the combination of age, education, work status, income adequacy, self-esteem, HIV symptom self-efficacy, and self-judgment. The strongest predictor of depressive symptoms was self-judgment. Results lend support to Beck's theory that those with negative self-schemas are more vulnerable to depression and suggest that clinicians should evaluate PLHIV for negative self-schemas. Tailored interventions for the treatment of depressive symptoms in PLHIV should be tested and future studies should evaluate whether alterations in negative self-schemas are the mechanism of action of these interventions and establish causality in the treatment of depressive symptoms in PLHIV.

Mediators of antiretroviral adherence: a multisite international study.

The purpose of this study was to investigate the effects of stressful life events (SLE) on medication adherence (3 days, 30 days) as mediated by sense of coherence (SOC), self-compassion (SCS), and engagement with the healthcare provider (eHCP) and whether this differed by international site. Data were obtained from a cross-sectional sample of 2082 HIV positive adults between September 2009 and January 2011 from sites in Canada, China, Namibia, Puerto Rico, Thailand, and US. Statistical tests to explore the effects of stressful life events on antiretroviral medication adherence included descriptive statistics, multivariate analysis of variance, analysis of variance with Bonferroni post-hoc analysis, and path analysis. An examination by international site of the relationships between SLE, SCS, SOC, and eHCP with adherence (3 days and 30 days) indicated these combined variables were related to adherence whether 3 days or 30 days to different degrees at the various sites. SLE, SCS, SOC, and eHCP were significant predictors of adherence past 3 days for the United States (p = < 0.001), Canada (p = 0.006), and Namibia (p = 0.019). The combined independent variables were significant predictors of adherence past 30 days only in the United States and Canada. Engagement with the provider was a significant correlate for antiretroviral adherence in most, but not all, of these countries. Thus, the importance of eHCP cannot be overstated. Nonetheless, our findings need to be accompanied by the caveat that research on variables of interest, while enriched by a sample obtained from international sites, may not have the same relationships in each country.

Prevalence, correlates, and self-management of HIV-related depressive symptoms.

Depressive symptoms are highly prevalent yet undertreated in people living with HIV/AIDS (PLHAs). As part of a larger study of symptom self-management (N=1217), this study examined the prevalence, correlates, and characteristics (intensity, distress, and impact) of depressive symptoms, and the self-care strategies used to manage those symptoms in PLHAs in five countries. The proportion of respondents from each country in the total sample reporting depressive symptoms in the past week varied and included Colombia (44%), Norway (66%), Puerto Rico (57%), Taiwan (35%), and the USA (56%). Fifty-four percent (n=655) of the total sample reported experiencing depressive symptoms in the past week, with a mean of 4.1 (SD 2.1) days of depression. Mean depression intensity 5.4 (SD 2.7), distressfulness 5.5 (SD 2.86), and impact 5.5 (SD 3.0) were rated on a 1-10 scale. The mean Center for Epidemiologic Studies Depression Scale score for those reporting depressive symptoms was 27 (SD 11; range 3-58), and varied significantly by country. Respondents identified 19 self-care behaviors for depressive symptoms, which fell into six categories: complementary therapies, talking to others, distraction techniques, physical activity, medications, and denial/avoidant coping. The most frequently used strategies varied by country. In the US sample, 33% of the variance in depressive symptoms was predicted by the combination of education, HIV symptoms, psychological and social support, and perceived consequences of HIV disease.

Unhealthy behaviours for self-management of HIV-related peripheral neuropathy.

The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.

Strategies for self-management of HIV-related anxiety.

This study examines the frequency and effectiveness of commonly used strategies for self management of anxiety in an international sample of 502 participants from Norway (n=42, 8%), Taiwan (n=35, 7%), and the US (n=426, 85%). An activities checklist summarized into five categories of self-care behaviours including activities/thoughts, exercise, medications, complementary therapies, and substance use determined self-care behaviours. Ratings of frequency and effectiveness for each self-care activity were also included. Praying received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.10 (scale 1 to 10), followed by meditation (7.37), exercising (7.32), using relaxation techniques (7.22), cooking (6.98), and walking (6.90). An analysis of effectiveness scores for each self-care strategy by country reflected a wide variation. The three most effective anxiety self-care strategies reported by participants from Norway included exercise (7.31), walking (6.96), and reading (6.44). Highest ratings of effectiveness by participants from Taiwan included talking with others with HIV (6.0), attending support groups (6.0), and exercising (6.0). US participants allocated highest ratings of effectiveness to complementary/alternative therapies, including praying (8.10), meditating (7.43), and using relaxation techniques (7.35). Regardless of the country, watching television and talking with family and friends were the two most frequently reported strategies. These strategies for self-management of HIV-related anxiety are important for clinicians to be aware of in the care of persons with HIV/AIDS.

Quality of life in persons living with HIV.

This study investigated the effects of selected variables on quality of life (QOL) in persons living with HIV. Eighty-one HIV-positive adults completed a demographic questionnaire, the Sickness Impact Profile, the Center for Epidemiologic Studies Depression Scale, and a fatigue visual analog scale. Blood samples were collected for CD4+, CD8+, and CD16+ Lymphocyte numbers. Based on an expanded psychoneuroimmunology model, hierarchical multiple regression analysis was used to determine the extent to which four blocks of variables predicted variance in quality of life. These included sociodemographics, depression, immune status, and fatigue. Findings revealed that work status, depression, and fatigue predicted 58% of the variance in QOL in persons with HIV Findings support the need for routine assessment and management of depression and fatigue in persons living with HIV.

Guided imagery interventions for symptom management.

For the past several decades, papers in the nursing literature have advocated the use of cognitive interventions in clinical practice. Increasing consumer use of complementary therapies, a cost-driven health care system, and the need for evidence-based practice all lend urgency to the validation of the efficacy of these interventions. This review focuses specifically on guided imagery intervention studies identified in the nursing, medical and psychological literature published between 1966 and 1998. Included were 46 studies of the use of guided imagery for management of psychological and physiological symptoms. There is preliminary evidence for the effectiveness of guided imagery in the management of stress, anxiety and depression, and for the reduction of blood pressure, pain and the side effects of chemotherapy. Overall, results of this review demonstrated a need for systematic, well-designed studies, which explore several unanswered questions regarding the use of guided imagery. These include the effects of different imagery language, symptoms for which guided imagery is effective, appropriate and sensitive outcome measures, method of delivery of the intervention and optimum dose and duration of the intervention, and individual factors that influence its effectiveness.

Effects of cognitive-behavioral interventions on quality of life in persons with HIV.

This study explored the effects of cognitive-behavioral interventions on quality of life in persons with HIV. In a randomized, 3 x 3 block design, 69 participants were assigned to a guided imagery, progressive muscle relaxation or control group. Following brief instruction, subjects practiced their respective intervention over six weeks. Post intervention, perceived health status, but not quality of life, was significantly different across treatment groups. Findings suggested differential effects for guided imagery and progressive muscle relaxation, with larger effects for those at mid-stage disease and for low frequency users of guided imagery.

Testing a model: effects of pain on immunity in HIV+ and HIV- participants.

In this study, the cold pressor test (CPT) was used to test a model of the effects of acute pain on 10 HIV+ and 10 HIV- adults. Participants were exposed to the CPT for a maximum of 5 minutes. Blood samples were collected immediately before, immediately after, and 1 hour after the CPT. Variables included immune measures (CD4+, CD8+, and CD16+ 56+ lymphocyte number, CD4+ CD8+ lymphocyte ratio and NK cell cytotoxicity), cardiovascular reactivity (heart rate, systolic and diastolic blood pressure), anxiety, perceived pain intensity and perceived self-efficacy. Effects of pain were generally consistent across HIV+ and HIV- groups, with no between-group differences across time in immune responses, state anxiety and diastolic blood pressure. Within-subjects differences across time averaged over both groups were significant for NK cell cytotoxicity, CD8+ and CD16+ 56+ lymphocyte numbers, anxiety and heart rate. Significant nonlinear trends were observed for CD16+ 56+ lymphocyte numbers, NK cell cytotoxicity and state anxiety in both groups and for heart rate in the HIV+ group only. Perceived pain intensity was significantly associated with state anxiety (r = .65), systolic (r = -.56) and diastolic (-.52) blood pressure and CD4+ lymphocyte number (r = .48). Heart rate and trait anxiety were significantly associated with all immune variables. Associations were positive for CD4+ lymphocyte number and inverse for all other immune measures. Associations between perceived self-efficacy and both perceived pain intensity and anxiety were inverse, as predicted, but not significant. Overall, the direction and strength of observed relationships provided some support for the theoretical model on which the study was based. Generally, responses to acute pain were consistent and did not differ by HIV status.