Illness Behavior, Emotional Stress and Psychosocial Factors among Asymptomatic HIV-Infected Patients

Abstract

Background: Over the last years the way in which patients with chronic physical illness respond to their illness (illness behavior) has been explored by several studies. This study sought to examine characteristics of illness behavior and to investigate the association between illness behavior and psychosocial and clinical variables among asymptomatic HIV-infected subjects. Methods: Seventy-three asymptomatic HIV+ outpatients completed self-report questionnaires to evaluate illness behavior (Illness Behavior Questionnaire), psychological stress symptoms (Brief Symptom Inventory), personality variables (External Locus of Control and Courtauld Emotional Control Scales) and social support (Social Provision Scale). Results: Psychological morbidity (‘caseness’ = 34%) was associated with a pattern of illness behavior characterized by conviction of disease progression, irritability, dysphoria, psychological perception of illness and low denial. Individual capacity to express emotions, adequate levels of social support and low levels of depression, as well as clinical variables (high number of CD4+ cells, recent notification of HIV infection and nonintravenous drug use category) influenced a more adaptive illness behavior. Psychological stress and low CD4+ cell count were the main predictors of the affective dimension of illness behavior. Conclusions: Psychosocial variables resulted to influence the tendency to interpret illness in a nonadaptive way in asymptomatic HIV-infected subjects. Such variables merit to be routinely examined within the doctor-patient relationship in AIDS clinics.

Decreased Depression Up to One Year Following CBSM+ Intervention in Depressed Women with AIDS: The Smart/EST Women’s Project

“…Minority women with AIDS have many other life stressors including single parenthood (Marcenko & Samost, 1999), unstable income and limited access to health care (Gonzalez-Calvo, Jackson, Hansford, & Woodman, 1998). Of particular relevance to the objectives of this study, depression has been found to be related to disease progression and mortality in women with HIV (Ickovics et al, 2001 Numerous studies have documented the prevalence of distress among HIV/AIDS infected individuals (Chandra, Ravi, Desai, & Subbakrishna, 2001;Fukunishi et al, 1997) and have linked this distress to stressful life events (Crystal & Kersting, 1998), health status (Grassi et al, 1999), illness-related stressors, including social stigmatization (Kadushin, 1996) and cognitive deficits (Claypoole et al, 1998), loss of employment and autonomy (Hoffman, 1991) and faster disease progression (Cruess et al, 2003;Leserman, 2003).…”

“…Minority women with AIDS have many other life stressors including single parenthood (Marcenko & Samost, 1999), unstable income and limited access to health care (Gonzalez-Calvo, Jackson, Hansford, & Woodman, 1998). Of particular relevance to the objectives of this study, depression has been found to be related to disease progression and mortality in women with HIV (Ickovics et al, 2001 Numerous studies have documented the prevalence of distress among HIV/AIDS infected individuals (Chandra, Ravi, Desai, & Subbakrishna, 2001;Fukunishi et al, 1997) and have linked this distress to stressful life events (Crystal & Kersting, 1998), health status (Grassi et al, 1999), illness-related stressors, including social stigmatization (Kadushin, 1996) and cognitive deficits (Claypoole et al, 1998), loss of employment and autonomy (Hoffman, 1991) and faster disease progression (Cruess et al, 2003;Leserman, 2003).Cognitive-behavioral interventions have been found to be successful in reducing distress associated with human immunodeficiency virus (HIV) disease (Church, 1998;Kelly et al, 1993). Investigators from our research team have tested the utility of a targeted cognitivebehavioral stress management (CBSM) intervention in reducing distress in gay men with clinically significant results (Antoni et al, 1991;Lutgendorf et al, 1997), as well as predicting clinical outcomes (Ironson et al, 1994) for those with better attendance.…”

Emotional Stress, Psychosocial Variables and Coping Associated with Hepatitis C Virus and Human Immunodeficiency Virus Infections in Intravenous Drug Users

“…In contrast to the paucity of HCV literature, a number of studies have investigated the psychosocial concomitants of HIV infection. A burgeoning series of data have accumulated over the last 20 years regarding the prevalence of psychiatric disorders among HIV-infected patients [14, 15], the role of personality and social support variables in molding coping strategies and, in turn, psychiatric morbidity [16, 17]and the possible effect of psychosocial factors, mainly life events, depression and poor social support, in favoring HIV progression [18, 19]. …”

Assessment of the Efficacy of a Cognitive-Behavioural Group Psychotherapy Programme for HIV-Infected Patients Referred to a Consultation-Liaison Psychiatry Department

“…In our context, heterosexuals and intravenous drug users (IDUs) in particular constitute the main group of all HIV-infected subjects. It has also been recently observed that asymptomatic HIV-infected IDUs show a less adaptive illness behaviour and that this illness behaviour is associated with psychological morbidity [24]. Public mental health settings should offer this population an efficient psychotherapeutic and supportive intervention programme.…”