Exploring self-esteem during expressive writing about trauma predicts decreased depression in people with HIV.

Self-esteem is often negatively impacted by trauma. Low self-esteem has been related to significantly worse depression in people with HIV (PWH). This study explores whether the expression of words related to self-esteem during a 4-session augmented trauma writing intervention predicted post-traumatic stress, depressive symptoms, and health outcomes 6-months later. Ninety-five PWH completed four 30-minute augmented trauma writing sessions in the intervention arm of a randomized controlled trial. One augmented session was devoted to self-esteem. Two individuals coded trauma essays for number of self-esteem words. CD4+ and viral load data were collected, and the Davidson PTSD Scale and the Hamilton Depression Rating Scale were administered at baseline, one-, and six-month follow-up. Greater total self-esteem words were related to lower depressive symptoms at 6-months, controlling for depressive symptoms at study entry, age, race, and education (t(80) = -2.235, ß = -0.239, SE = 0.283, p < 0.05, 95% CI [-1.195, -.069). Total self-esteem words were not predictive of PTSD, viral load, or CD4+ at 6-months. Exploring self-esteem when writing about and processing a traumatic event could be an important mechanism for decreasing depressive symptoms among PWH. Research is needed to test augmented expressive writing interventions that support efforts to bolster self-esteem in PWH.

A New Attitude Towards Treatment Measure Predicts Survival Over 17 Years.

BACKGROUND: For patients diagnosed with chronic illness, attitude towards treatment may play an important role in health and survival. For example, negative attitudes towards treatment have been related to poorer adherence to treatment recommendations and prescribed medication across a range of chronic illnesses. In addition, prior research has shown that attitude towards treatment assessed through a psychiatric interview predicted survival at 1 year after bone marrow transplantation with great accuracy (> 90%). OBJECTIVE: The purpose of this study was to determine the relationship between a self-report attitude to a treatment measure that operationalized a psychiatric interview, and survival over 17 years in a sample of people living with HIV (PLWH). PARTICIPANTS AND DESIGN: Participants (N = 177) who were in the mid-range of HIV illness at baseline (CD4s 150 to 500, no prior AIDS-defining clinical symptom) were administered the Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale and followed longitudinally to determine survival at 17 years. MEASURES: The Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale is a 20-item self-report questionnaire designed to survey multiple factors that contribute to an overall psychological construct of the treatment process. RESULTS: The MMAT-20/HIV predicted survival over 17 years controlling for biomedical (baseline CD4, viral load, antiretroviral medications, age) and psychosocial (race, education, antiretroviral medications) variables. Those in the top half on the MMAT-20/HIV were almost twice as likely to survive than those in the lower half. Scores on the MMAT-20/HIV were significantly but modestly correlated with adherence (r = .20, p < .05), but adherence was not a mediator of the relationship between the MMAT-20/HIV and survival. CONCLUSIONS: An individual's attitude towards the treatment process predicted survival, raising the possibility that optimal clinical management would include ways to probe these attitudes and intervene where possible. The ease of administering the MMAT-20 and adaptability to other illnesses could facilitate this endeavor.

Interview-Rated Meaning and Survival Over 17 Years in People Living With HIV.

OBJECTIVE: The primary purpose of this study was to determine whether meaning in life predicts survival in people living with HIV (PLWH) over 17 years. This study also examined whether interviewer- and transcript-rated meanings predict survival equivalently. A third purpose of the study was to investigate whether meaning in life adds to the prediction of survival over positive emotional expression. METHODS: A diverse sample of people with HIV (n = 177) completed an interview on stress and coping at baseline and were followed up for survival up to 17 years. Meaning was measured by interviewer rating of four items (meaningful purpose, unfinished business, finding new meaning, and meaningful activities). Transcript-rated meaning was assessed by two independent raters. Cox proportional hazards regression was used to determine whether meaning predicted survival over 17 years. RESULTS: Meaning in life predicted significantly greater survival, adjusting for biomedical and sociodemographic variables whether assessed by interviewer or by transcript raters. Hazard ratios suggest that the effect is moderate to large (2.66-3.45 for top versus bottom third; 2.05-2.49 for top versus bottom half). Significance was maintained after adjusting for positive emotion. CONCLUSIONS: Meaning assessed by interview (by both interviewer and transcript ratings) predicted greater survival over 17 years in PLWH and did so above positive emotion. This adds to a literature that is primarily based on self-report questionnaires. Meaning may have beneficial effects for both psychological and physical health in PLWH.

Effectiveness of three brief treatments for recent traumatic events in a low-SES community setting.

OBJECTIVE: To determine whether brief treatments provide psychological relief after traumatic events in low-resource communities. METHOD: Participants (n = 105) who had experienced a traumatic event within the past 6 months were randomly assigned to 1 of 3 4-session treatments: individual eye movement desensitization and reprocessing (EMDR), group-administered stress management with a trauma focus (SMT), or group-administered psychological first aid (PFA). Measures administered pretreatment and at 1-, 3-, and 6-month posttreatment included posttraumatic stress disorder (PTSD) symptoms, posttraumatic cognitions (PTCI), and depressive symptoms (BDI). RESULTS: The 3 treatment groups all showed significant declines in PTSD, PTCI, and BDI symptoms over time with large prepost effect sizes (median 1-month: 0.96, 3-month: 1.38, 6-month: 1.10). However, the treatment groups showed significantly different rates of decline, with the EMDR group showing the fastest declines-interaction PTCI: F(1, 237) = 5.85, p = .016; depression:, F(1, 239) = 4.90, p = .028-followed by the SMT and then PFA group. While there were significant differences between the EMDR and PFA groups at the 1- and 3-month follow-ups, there were no significant differences in any of the 3 outcome measures at the 6-month follow-up, nor were there significant differences between groups on PTSD symptoms, F(1, 239) = 2.30, p = .131. CONCLUSION: This study provides preliminary evidence that any of these 3 approaches may be useful in low-resource community settings. Because it gives the quickest relief, EMDR is the preferred approach, followed by SMT, due its ease of administration. PFA provides a reasonable alternative. Where possible, booster sessions should be planned. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Positive and negative emotional expression measured from a single written essay about trauma predicts survival 17 years later in people living with HIV.

OBJECTIVE: To determine whether expression of positive and negative emotions measured within a single written trauma essay predicts survival over 17 years in people living with HIV. METHODS: This is a longitudinal, observational study of a volunteer sample of HIV-seropositive individuals at the mid-range of disease (150-500 CD4-cells/mm3 with no prior AIDS-defining symptoms). Exclusion criteria included substance dependence, dementia, and/or psychosis. Baseline assessments occurred between 1997 and 1999 and survival data was collected in 2014 (17 year follow up). At baseline, participants wrote an essay about the most traumatic event in their life. Emotional expression was measured by the number of positive and negative emotional words in the essay. The primary study outcome measure was survival from baseline. Biomedical covariates included CD4 count, viral load, age, and antiretroviral medications. Sociodemographic covariates included gender, race, and education. RESULTS: The sample was diverse in terms of age (M [SD] 37.60 [9.07]), sex (70.7% male), sexual orientation (55.5% gay or bisexual), and race/ethnicity (37.2% African American, 30.5% white, 28.0% Hispanic, and 4.3% other). Positive, negative, and total emotional expression predicted greater survival (ps < 0.015). Those in the top third of total emotional expression had 3.83 times the survival rate (95% CI: 1.62, 9.02) of those in the bottom third. Odds ratios were 1.85 for positive emotion expression and 2.18 for negative emotion expression. CONCLUSIONS: Both positive and negative emotions expressed in a written trauma essay predict survival over 17 years in people living with HIV. Expressing emotions may have benefits for health.

Posttraumatic cognitions, childhood sexual abuse characteristics, and posttraumatic stress disorder in men who have sex with men.

BACKGROUND: High rates of experience of childhood sexual abuse (CSA) among in men who have sex with men (MSM) place this population at increased risk for posttraumatic stress disorder (PTSD). OBJECTIVE: This study explores how specific characteristics of CSA relate to posttraumatic cognitions (PTCs) and explores the role that specific PTCs play in the relationship between CSA and PTSD in MSM. METHODS: Two-hundred and ninety MSM completed a CSA interview, the Davidson Trauma Scale, and the Posttraumatic Cognitions Inventory. RESULTS: Controlling for sociodemographic factors, CSA involving physical injury and CSA with intense fear were associated with higher levels of PTCs about the self and world, but not with self-blame. We did not find significant associations for CSA involving a family member, CSA with penetration, or duration or frequency of CSA with any subscale on the PTCI. Experiencing CSA for the first time during adolescence was associated with higher self-blame. Analyses revealed that physical injury and intense fear each had indirect effects on PTSD symptoms through negative cognitions about the self and world. First CSA episode during adolescence had an indirect effect on PTSD symptoms through self-blame. CSAs accounted for 16.7% and PTCs accounted for 31.7% of the variance in PTSD, underlining the importance of PTCs. CONCLUSIONS: Assessing for physical injury, intense fear, and age at first CSA are particularly relevant to PTCs and of critical importance to advancing assessment and treatment strategies for PTSD in MSM.

The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress.

Inflammation, often measured by C-reactive protein (CRP), is thought to be related to a number of debilitating illnesses as we age, including cardiovascular disease, cancer and diabetes. Stress has also been implicated in these processes. This study examines potential protective effects of spirituality and religion in older adults who have experienced stressful life events. As part of the nationwide Landmark Study of Spirituality and Health, a subsample of 643 middle-aged and older adults (age ≥ 50) who were at or above the median in number of life stressors (≥ 2) was included in this analysis. Psychospiritual and religious (PS/R) variables included: religious service attendance, prayer, religious meaning, religious hope, general meaning, general hope and sense of peace. Control variables included: age, gender, education, BMI, smoking, alcohol use, social support. Only church attendance predicted significantly lower CRP after controlling for covariates, even above the other PS/R variables (standardized ß = - 0.14, t = - 3.23 p = 0.001). Those with frequent religious service attendance were 38% less likely to have clinically elevated CRP than those who attend rarely or never. Religious service attendance may confer protection in older adults experiencing stressful events as it was significantly associated with lower CRP, an inflammatory marker associated with illness.

Sexual Identity, Stigma, and Depression: the Role of the "Anti-gay Propaganda Law" in Mental Health among Men Who Have Sex with Men in Moscow, Russia.

Depression is a major public health problem in the Russian Federation and is particularly of concern for men who have sex with men (MSM). MSM living in Moscow City were recruited via respondent-driven sampling and participated in a cross-sectional survey from October 2010 to April 2013. Multiple logistic regression models compared the relationship between sexual identity, recent stigma, and probable depression, defined as a score of ≥23 on the Center for Epidemiological Studies Depression scale. We investigated the interactive effect of stigma and participation in the study after the passage of multiple "anti-gay propaganda laws" in Russian provinces, municipalities, and in neighboring Ukraine on depression among MSM. Among 1367 MSM, 36.7% (n = 505) qualified as probably depressed. Fifty-five percent identified as homosexual (n = 741) and 42.9% identified as bisexual (n = 578). Bisexual identity had a protective association against probable depression (reference: homosexual identity AOR 0.71; 95%CI 0.52-0.97; p < 0.01). Those who experienced recent stigma (last 12 months) were more likely to report probable depression (reference: no stigma; AOR 1.75; 95%CI 1.20-2.56; p < 0.01). The interaction between stigma and the propaganda laws was significant. Among participants with stigma, probable depression increased 1.67-fold after the passage of the anti-gay laws AOR 1.67; 95%CI 1.04-2.68; p < 0.01). Depressive symptoms are common among MSM in Russia and exacerbated by stigma and laws that deny homosexual identities. Repeal of Russia's federal anti-gay propaganda law is urgent but other social interventions may address depression and stigma in the current context.