Changes in depressive symptoms, distress, and HPA and HPG axis hormones during cognitive-behavioral stress management in symptomatic HIV-positive gay men

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)

First Committee Member

Michael H. Antoni, Committee Chair


This study examined 82 mildly symptomatic, HIV-positive gay men randomly assigned to either a 10-week cognitive-behavioral stress management (CBSM) intervention (n = 46) or to a modified wait-list control group (n = 36). Baseline and post-treatment assessments were conducted to determine if changes in distress and depressive symptoms are related to changes in stress and sex hormonal measures during CBSM. Four stress hormones of the hypothalamic pituitary adrenal (HPA) axis (total cortisol, free cortisol, corticosteroid binding globulin (CBG), dehydroepiandrosterone-sulfate (DHEA-S)) and two hormonal measures of the hypothalamic pituitary gonadal (HPG) axis (total testosterone, free testosterone) were analyzed in plasma using radioimmunoassay techniques. Psychological distress measures included the Beck Depression Inventory total score (BDI-T) and cognitive-affective subscale (BDI-C), the Profile of Mood States total score (POMS-T) and Confusion (POMS-C) and Depression (POMS-D) subscales, and the Perceived Stress Scale total score (PSS-T). The results indicated significant group by time interactions for CBG, DHEA-S, total testosterone, free testosterone, BDI-T, BDI-C, POMS-T, and POMS-C. Follow-up analyses revealed a buffering effect of CBSM on CBG, DHEA-S, total testosterone, and free testosterone levels. The CBSM intervention also enhanced levels of both total and free testosterone, as well as decreased BDI-T, BDI-C, POMS-T, and POMS-C scores. Changes in both free and total testosterone were inversely related to changes in BDI-T, BDI-C, POMS-T, and POMS-C scores over time. Furthermore, change in free testosterone served to mediate the relationship between CBSM assignment and post-treatment BDI-T and BDI-C scores. This study shows that in HIV-positive gay men, stress and sex hormones may potentially serve as biological markers for the changes in distress and depressive symptoms observed during CBSM.


Psychology, Clinical

Link to Full Text