Denial, Daily Hassles and Distress in HIV Positive Individuals

Transcription

1 Denial, Daily Hassles and Distress in HIV Positive Individuals Brooke Gomez, Thomas DeSena M.A., James Miller M.A., Kyle Deaton B.A., & John Ridings B.A., Mark Vosvick PhD University of North Texas

2 BACKGROUND Health Distress is associated with lower Quality of Life, higher anxiety, depression and general emotional distress in people living with HIV/AIDS (Lightfoot, et. al.,2005). Denial is a significant predictor of lowering treatment initiation and retention in mental health care (Ortega, Bicaldo, 2005). Illness denial is a major indicator of nonresponsiveness and nonadherence of treatment (Sperry, 2009). Daily Hassles can be more influential than a major life event as they occur more frequently (Landreville, 1992). In the HIV+ population, it is predicted that the intensity of these hassles will predict lowered quality of life.

3 Theoretical model Social Cognitive Theory (Bandura, 1997) Person (Cognition) Health Distress Behavior Denial Coping Environment Daily Hassles

4 Hypotheses 1. Daily Hassles are negatively associated with Health Distress. 2. Denial is negatively associated with Health Distress. 3. Daily Hassles and Denial explain a significant portion of variance in Health Distress.

5 Participants Participants were recruited from the Dallas/Fort Worth metroplex Participants received a $15 incentive Participants were 18 years or over, HIV+ and English speaking Participants signed informed consent and IRB approval was obtained

6 Demographics N= 221 Variable N % M(SD) Range Female % African American % European American % Latino % Other 3 1.4% Age 41.6 (8.5) Education (years) 12.1 (2.5) 1-19 Income < $10, %

7 Procedures Participants were given an electronic survey at either the Dallas Resource Center or the Samaritan House in Fort Worth. Each survey took approximately hours to complete. Participants were given an ID number to ensure confidentiality.

8 measures Daily Hassles Scale (Kanner, et al., 1980) Intensity subscale; 3 point likert-type scale; anchors 1 (somewhat extreme) to 3 (extremely extreme); higher scores denote a higher intensity of daily hassles Example of item: Problems with your children

9 Measures Brief Cope Scale (Carver, 1997) Denial subscale; α=.54; 3 point likert-type scale; anchors 0 (I haven t been doing this at all) and 3 (I ve been doing this a lot); higher scores indicate higher use of denial coping; concurrent validity (Carver 1997) Example of item: I ve been saying to myself this isn t real

10 Measures MOS-HIV Scale (Wu et al., 1991) Health Distress Subscale; α =.91; 6 point likert-type scale; anchors 1 (all the time) and 6 (none of the time), with higher scores denoting less health distress; construct validity (Wu et al., 1991) Example of item: How often in the last four weeks were you discouraged by your health problems?

11 Data analysis Mean(SD) Univariate Data was first cleaned and checked for normalcy. Possible Range Actual Range Calculated α Daily Hassles 1.8 (.52) Denial 3.7 (1.90) Health Distress 51.7 (24.61)

12 Data analysis 1. Age - 2.Education Female.12* African American Bivariate p<.05*, p<.01** * <10, ** Daily Hassles Denial ** - 8. Health Distress

13 Data Analysis Out come variable: Health Distress IV β t p Tol VIF Daily Hassles < Denial < African American < Age Education Income < $10,000 Female Hierarchical Regression Analysis F(7,213)= 27.96, adj. R² =.25, p<.001

14 discussion 1. Daily Hassles are negatively associated with Health Distress: Not supported 2. Denial is negatively associated with Health Distress: Not supported 3. Daily Hassles and Denial explain a significant portion of variance in Health Distress: Supported

15 discussion Denying HIV status creates a barrier for treatment. Patients may avoid health care or deny taking medication (Luseno, Wechsberg, Kline, Ellerson, 2010). Quality of life can be increased by using an alternative coping strategy such as acceptance (Gray & Hedge, 1999). In addition to our hypothesized variables, being of African American ethnicity also serves as a predictor of health distress.

16 Clinical implications Cognitive-behavioral therapy can be used to find more constructive forms of coping. Clinicians can focus on finding the daily hassles in a client s life and finding a more effective way of handling the stress that comes with these hassles. Since African American ethnicity is a significant indicator of variance in health distress, giving greater attention to this community would serve to be beneficial.

17 limitations Some responses may be influenced by self report bias. Limited generalizability due to sample s demographics (ethnicity, locations, etc.). Due to cross sectional correlational design, causation cannot be inferred.

18 acknowledgements We would like to thank the Center for Psychosocial Health Research s members and faculty, the HIV community, the Dallas Resource Center and the Samaritan House of Fort Worth.

19 Questions?

20 References Gray, J., & Hedge, B. (1999). Psychological distress and coping in the partners of gay men with HIV-related disease. British Journal of Health Psychology, 4(Part 2), doi: / Landreville, P., & Vézina, J. (1992). A comparison between daily hassles and major life events as correlates of well-being in older adults. Canadian Journal on Aging, 11(2), Retrieved from EBSCOhost. Lightfoot, M., Swendeman, D., Rotheram-Borus, M., Comulada, W., & Weiss, R. (2005). Risk Behaviors of Youth Living with HIV: Pre- and Post-HAART. American Journal of Health Behavior, 29(2), Retrieved from EBSCOhost. Luseno, W. K., Wechsberg, W. M., Kline, T. L., & Ellerson, R. (2010). Health services utilization among South African women living with HIV and reporting sexual and substance-use risk behaviors. AIDS Patient Care and STDs, 24(4), doi: /apc Ortega, N. L., Bicaldo, B. F., Sobritchea, C. C., & Tan, M. L. (2005). Exploring the realities of HIV/AIDSrelated discrimination in Manila, Philippines. AIDS Care, 17(Suppl2), S153-S164. doi: /