A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women.

Objective: To determine the efficacy of a peer-led social support intervention involving support groups and telephone contacts compared with standard clinical care to enhance antiretroviral medication adherence. Design: Randomized controlled trial with follow-up. Participants were 136 HIV-positive indigent mainly African American and Puerto Rican men and women recruited from an outpatient clinic in the Bronx, New York. The 3-month intervention was delivered by other HIV-positive clinic patients trained in addressing barriers to adherence and sensitively providing appraisal, spiritual, emotional, and informational adherence-related social support. Main outcome measures: Medical chart-abstracted HIV-1 RNA viral load, antiretroviral adherence according to electronic drug monitoring and participant self-report, and social support and depressive symptomatology. All assessments conducted at baseline, 3 months, and 6 months. Results: Intent-to-treat and as-treated analyses indicated no between-conditions intervention effects on the primary outcome of HIV-1 RNA viral load or any of the secondary outcomes at immediate postintervention or follow-up. Post hoc analyses within the intervention condition indicated greater intervention exposure was associated with higher self-reported adherence, higher social support, and lower depressive symptomatology at follow-up, even after controlling for baseline adherence. Conclusion: Null findings, consistent with the limited literature on efficacious highly active antiretroviral therapy (HAART) adherence interventions, may be due to insufficient exposure to the intervention, its low intensity, or the nature of the sample-a heterogeneous HAART-experienced group of patients with high levels of substance use and multiple other competing stressors. Overall, findings highlight the need for more comprehensive and intensive efforts to battle nonadherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Support, Positive States of Mind, and HIV Treatment Adherence in Men and Women Living With HIV/AIDS.

Numerous studies have linked social support to better medication adherence among illness groups, but few have examined potential mechanisms for this relationship. Relationships were examined between social support, depression, positive states of mind (PSOM), and medication adherence among HIV positive men who have sex with men (n = 61) and women (n = 29) on highly active antiretroviral therapy. Depression and PSOM were evaluated as potential mediators of the relationship between support and adherence. Cross-sectional data showed that greater social support and PSOM related to better adherence whereas higher depression scores related to nonadherence. PSOM partially mediated the relationship between social support and adherence. PSOM may be an important mechanism through which social support is related to better medication adherence in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social context, coping strategies, and depressive symptoms: an expanded model with cardiac patients

This research broadened and refined a resources model of coping to encompass negative as well as positive aspects of social relationships and examined this expanded conceptualization in a 4-year prospective model with 183 cardiac patients (140 men and 43 women). Social support and social stressors in the family and extrafamily domains contributed significantly to a common social context latent construct. In addition, this conceptualization of social context was significantly related to depressive symptoms 4 years later. Especially important conceptually, coping strategies functioned as a mechanism through which both social support and social stressors related to subsequent depressive symptoms. Moreover, positive and negative aspects of social relationships made essentially unique contributions in predicting subsequent coping efforts.     

Intimate partner violence and its effects on the health of African American HIV-positive women.

The medical outcomes of women infected with HIV are typically worse than those of HIV-positive men. HIV-positive women report high rates of intimate partner violence, and there is evidence that traumatic events have a negative impact on health status. In addition, African American women make up 1 of the fastest growing groups of HIV-positive individuals. Therefore, this study sought to examine the impact of intimate partner violence on HIV medication adherence, HIV-related physical health outcomes, and health-related quality of life in 40 HIV-positive African American women. The results were that women who had experienced intimate partner violence had worse HIV-related health as indicated by reduced CD4 counts and increased HIV viral load. In addition, posttraumatic stress disorder symptoms were related to both intimate partner violence and health-related quality of life. Lastly, HIV medication adherence mediated the relationships between intimate partner violence and the HIV-related health outcomes. Implications for further work and clinical interventions to address intimate partner violence, medication adherence, and health-related quality of life in this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV.

Objective: Psychosocial factors (e.g., depression, avoidant coping, life stress) have been related to disease progression in HIV. This study examined the relationship between the Big Five Conscientiousness factor and HIV disease progression (CD4 cell and viral load) over 1 year in 119 seropositive participants. The study also examined whether Conscientiousness effects were mediated by adherence, perceived stress, depression, or coping measures. Design: In a 1-year longitudinal design, participants completed the NEO Five-Factor Inventory Conscientiousness scale (P. T. Costa & R. R. McCrae, 1992). Participants also completed psychosocial assessments and underwent blood draws at initial assessments and 1-year follow-up. Main Outcome Measures: Multiple hierarchical regression models were used to predict change in CD4 cell numbers and viral load log 10, controlling for demographic variables, initial disease status, and antiretroviral medications. Results: Conscientiousness predicted significant increases in CD4 number and significant decreases in viral load at 1 year. Conscientiousness was related positively to medication adherence and active coping and negatively to depression and perceived stress. Only perceived stress emerged as a possible mediator. Conclusion: The significant relationship between Conscientiousness and medication adherence, distress, and coping suggests that an assessment of Conscientiousness in patients with HIV may help specify or target behavioral interventions to promote optimal disease management. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease.

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between adjustment to HIV and both social support and coping.

This study examined the relationships between HIV stage, social support, coping strategies, and adjustment to HIV. Ninety-six HIV-infected gay men and 33 seronegative comparison group participants participated in the study. In general, coping strategies and social support did not differ according to HIV stage. As predicted, adjustment was related to social support and coping strategies. Coping strategies were linked to psychosocial adjustment, whereas social support was more strongly associated with health-related variables. There was little evidence of buffering effects of either coping strategies or social support. Four coping strategies were related to low levels of psychological distress. Contrary to expectation, the relationships between coping strategies and adjustment did not vary as a function of HIV stage. However, the relationship between adjustment and some elements of social support varied as a function of HIV stage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life stress, physiological and subjective indexes of negative emotionality, and coping reasons for drinking: Is there evidence for a self-medication model of alcohol use?

Alcohol use is often viewed as means of coping with distress, but support for this model has been inconsistent. The author examined stress and negative emotionality and their interaction as predictors of drinking motives in a sample of college drinkers. Both physiological and self-reported reactivity to a mood induction, and self-reported trait negative affect, were assessed. High stress was associated with coping motives, particularly among individuals who exhibited electrodermal reactivity to the mood induction. Respiratory sinus arrhythmia (RSA) reactivity was associated with coping motives. Electrodermal and RSA reactivity and stress were unrelated to enhancement and social motives. Self-reported mood reactivity and trait negative affect were not associated with any of the drinking motives. These findings offer some support for the self-medication model of alcohol use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults' recovery from surgery for osteoarthritis of the knee: Psychosocial resources and constraints as predictors of outcomes.

The authors investigated psychosocial resources (positive support, active coping) and psychosocial constraints (negative support, avoidant coping) as predictors of improvement in the health of 63 older adults undergoing surgery for osteoarthritis of the knee. Following surgery, patients and social partners are motivated both to strive for the appetitive goal of recovery (approach), and to protect themselves from pain and impairment (avoidance). The authors assessed resources and constraints 6 weeks after surgery as predictors of outcomes (improvement in knee pain, knee functioning, and psychological well-being) 6 months after surgery. The constraints patients encountered early in recovery were strong predictors of poor recovery. Although resources were associated with some improvement, these effects were largely accounted for by constraints. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An information-motivation-behavioral skills model of adherence to antiretroviral therapy.

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Care of stroke patients by relatives--social support and coping strategies

OBJECTIVE: To assess the coping ability and the social support of relatives looking after patients who have had a stroke. Of special interest was to ascertain how coping behaviour and social support differed between short-term (caring period of 3-6 months) and long-term (caring period longer than 2 years) carers. Differences in social networking between relatives and a control group (no caring tasks) were also assessed. SUBJECTS AND METHODS: A questionnaire based on the well-established "Berne coping forms" and another on social support were filled in by 20 relatives (18 women, two men; mean age 50.6 years) after a short-term caring period of up to 6 months and 20 relatives after a caring period longer than 2 years (14 women, six men; mean age 64.9 years) and a control group (27 women, 10 men; mean age 57.8 years). RESULTS: Among the total group of relatives the coping strategies (listed by order of importance) were: "passive cooperation", "acceptance", and "lending a hand". The short- and long-term carers showed no significant differences in these strategies. However, there were significant deficits in social support between the relatives and the controls as to practical support (P < 0.05), social integration (P < 0.01), social support received (P < 0.01), social burden (P < 0.01) and the caring persons (P < 0.05). There was no difference regarding social support between the short- and long-term carers. CONCLUSIONS: The results confirm the importance of social support for relatives who look after stroke patients. Every form of psychosocial help should be given at the time the patient is discharged to home care. This would require day clinics and short-term places in nursing homes.     

Coping and distress in organizations: The role of gender in work stress.

This article investigates the positive value of women's interpersonal way of coping by examining coping benefits on distress depending on gender socialization in the Spanish cultural context. The participants were 332 men and 129 women employed by financial companies. Preliminary results showed that women used social support coping more frequently than men, whereas there were no gender differences in the use of direct action coping. Interactive effects of gender in the relationship between coping strategies and distress and psychosomatic complaints were found; social support coping was only beneficial for women, whereas direct action coping was more beneficial for men than for women. Implications of these results and their significance within the framework of national and sector cultures are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insecure attachment moderates women's adjustment to inflammatory bowel disease severity.

Objective: Insecure attachment was explored as a moderator of the relationship between disease severity and psychosocial variables in a study of adjustment in women with inflammatory bowel disease (IBD). Method: Participants were 218 women recruited through notices placed in the community, in gastroenterologists' offices, and through online postings to support groups and message boards specifically for people with Crohn's disease, colitis, or IBD in general. Participants completed a mail-in or online survey assessing severity and frequency of symptoms, attachment style (separated into anxious and avoidant subscales), perceived social support, negative affect, and efficacy of coping with IBD. Results: Anxious and avoidant attachment styles were correlated positively with disease severity and negative affect and negatively with perceived social support and coping efficacy. Hierarchical regressions indicated that disease severity was most strongly associated with negative affect for high avoidant attachment, as compared with moderate and low avoidant attachment. Disease activity was inversely related to perceived social support and coping efficacy for high and moderate, but not low, anxious attachment. Conclusion: Our study indicates that attachment moderates associations between disease severity in women with different kinds of IBD and psychological indicators of adjustment. Limitations and relationship to previous research on attachment and health are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-esteem, social support, internalized homophobia, and coping strategies of HIV+ gay men.

The relationship was examined between self-esteem, social support, internalized homophobia, and coping strategies used by gay men (N?=?89) who were positive for human immunodeficiency virus (HIV) and between the use of coping strategies and mood state. Multiple regressions were conducted with avoidant (escape avoidance, accepting responsibility) and proactive (seeking social support, planful problem solving) coping serving as criterion variables. Greater homophobia and less self-esteem predicted avoidant coping, whereas less homophobia and less time since diagnosis predicted proactive coping. Greater time since diagnosis, less avoidant coping, less homophobia, and greater self-esteem predicted better mood state and accounted for 50% of the total variance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

Objective: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. Design: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. Main Outcome Measures: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. Results: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR = 1.78; 95% CI = 1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p = .02) and achieved an undetectable VL p = .04). However, the majority of participants who remained on study experienced some reduction in VL (≥ 1-log drop or undetectable), regardless of experimental condition. Conclusion: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-critical perfectionism and daily affect: Dispositional and situational influences on stress and coping.

This study of university students (64 men and 99 women) examined both dispositional and situational influences of self-critical (SC) perfectionism on stress and coping, which explain its association with high negative affect and low positive affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Structural equation modeling indicated that the relation between SC perfectionism and daily affect could be explained by several maladaptive tendencies associated with SC perfectionism (e.g., hassles, avoidant coping, low perceived social support). Multilevel modeling indicated that SC perfectionists were emotionally reactive to stressors that imply possible failure, loss of control, and criticism from others. As well, certain coping strategies (e.g., problem-focused coping) were ineffective for high-SC perfectionists relative to low-SC perfectionists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial and socioeconomic factors associated with glycated hemoglobin in nondiabetic middle-aged men and women.

The authors tested associations between glycated hemoglobin (HbA1c; an index of glucose homeostasis and an indicator of cardiovascular disease risk in nondiabetic populations) and socioeconomic status (defined by grade of employment) and psychosocial factors in 234 British civil servants. HbA1c concentration was inversely related to grade of employment. Higher HbA1c was associated with greater waist-hip ratio, lower control at work, lower internal locus of control, lower active coping, and lower social support. Control at work, internal and chance locus of control, and active coping were also related to socioeconomic status. The association of social support but not other psychosocial factors with HbA1c, was independent of socioeconomic status. HbA1c may complement measures of the metabolic syndrome and insulin resistance in studies of psychosocial factors in cardiovascular disease risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Loneliness, attachment, and the perception and use of social support in university students.

This study examined factors related to family, social, and romantic loneliness in 173 undergraduate students (66 males, 107 females). Participants completed measures of attachment style, perceived availability of social support, use of social support coping, and loneliness. Results indicated that participants with greater attachment security reported lower levels of all types of loneliness compared to those with less attachment security, and this was partially mediated by perceived social support but not the use of social support coping. When examining underlying attachment constructs, a more positive model of others was related to less family and social loneliness, and these associations were mediated by greater perceived social support. Model of others also was associated with less romantic loneliness and model of self was associated with less loneliness in all domains, and these relations were partially mediated by perceived social support. Findings are discussed with respect to possible interventions to increase students' perceptions of available social support and to decrease overall loneliness levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daily stress, coping, and well-being in parents of children with autism: A multilevel modeling approach.

This study used a repeated daily measurement design to examine the direct and moderating effects of coping on daily psychological distress and well-being in parents of children with Autism Spectrum Disorders (ASD). Twice weekly over a 12-week period, 93 parents provided reports of their daily stress, coping responses, and end-of-day mood. Multilevel modeling analyses identified 5 coping responses (e.g., seeking support, positive reframing) that predicted increased daily positive mood and 4 (e.g., escape, withdrawal) that were associated with decreased positive mood. Similarly, 2 coping responses were associated with decreased daily negative mood and 5 predicted increased negative mood. The moderating effects of gender and the 11 coping responses were also examined. Gender did not moderate the daily coping?mood relationship, however 3 coping responses (emotional regulation, social support, and worrying) were found to moderate the daily stress?mood relationship. Additionally, ASD symptomatology, and time since an ASD diagnosis were not found to predict daily parental mood. This study is perhaps the first to identify coping responses that enhance daily well-being and mitigate daily distress in parents of children with ASD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)