Publication Date

2016-02-22

Availability

Open access

Embargo Period

2016-02-22

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Psychology (Arts and Sciences)

Date of Defense

2015-05-06

First Committee Member

Gail Ironson

Second Committee Member

Neil Schneiderman

Third Committee Member

Julie Barosso

Fourth Committee Member

David Kling

Fifth Committee Member

Ray Winters

Sixth Committee Member

Rick Stueztle, Ph.D.

Abstract

INTRODUCTION: Depression is common in people living with HIV (PLWH) and is a primary predictor of poor adherence to HAART medications which brings serious health consequences. PLWH also tend to experience more stress and trauma in their lifetime, all of which have been implicated in the onset and exacerbation of depression and poor health behavior performance. Positive and negative psychosocial variables and coping strategies have been associated with psychosocial functioning and health behaviors suggesting that understanding the ways in which PLWH cope is key to understanding depression and health behavior performance within this population. Different coping techniques work differently depending on gender and more research is needed to clarify which coping strategies work best for which gender. Additionally, despite the frequency with which HIV and depression co-occur, there is little research investigating factors that predict the onset of depression in this population. Lastly, the impact of medication adherence on depression represents a gap in the literature. OBJECTIVE: For the study detailed in this dissertation, we investigated the impact of nine different psychosocial variables and coping strategies on depressive symptoms and medication adherence. Additionally, we investigated how gender moderated these relationships. Lastly, we investigated the impact of medication adherence on depressive symptoms over time. METHODS: A total of 177 HIV positive participants were asked to fill out self-report measures assessing a variety of psychosocial factors potentially related to disease progression and quality of life with HIV. Follow-up assessments were conducted at six month intervals for 2 years. Measures included psychosocial variables (optimism, social support, coping, benefit finding, stressful life events, and perceived stress), depressive symptoms, and medication adherence. Linear regression and hierarchical linear modeling were used to investigate cross-sectional and longitudinal relationships respectively. RESULTS: Depressive symptoms were correlated with all positive and negative psychosocial variables with the exception of benefit finding. Gender moderated the relationship between adaptive coping and depressive symptoms. Religious coping and poorer medication adherence significantly correlated with fewer depressive symptoms for men only. Optimism, social support, avoidance coping, alcohol use, and perceived stress partially mediated the relationship between negative life events and depressive symptoms. Sub-optimal adherence predicted greater depressive symptoms in men only. Alcohol use predicted greater depressive symptoms over time for women only. Positive psychosocial variables were not correlated with medication adherence. Optimism predicted better adherence while avoidance coping, perceived stress, depressive symptoms, and negative life events predicted poorer adherence. Gender moderated the relationship between negative life events and medication adherence. Negative life events significantly predicted poor adherence in women. Perceived stress correlated with poorer adherence in men only but was predictive of poor adherence for women only. Depressive symptoms significantly predicted poor adherence for both genders. CONCLUSIONS: Positive and negative psychosocial variables have greater predictive power with more instrumental activities such as medication adherence than for depressive symptoms but correlate more strongly with depressive symptoms in PLWH. Additionally, different psychosocial variables correlate with and predict both depressive symptoms and medication adherence differently depending on gender of PLWH. Lastly, those psychosocial variables traditionally associated poor medication adherence seem to impact depressive symptoms in men and are predictive of greater depressive symptoms in men over time.

Keywords

HIV; depression; medication adherence; predictors of depression

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