Off-campus University of Miami users: To download campus access dissertations, please use the following link to log into our proxy server with your University of Miami CaneID and Password.

Non-University of Miami users: Please talk to your librarian about requesting this dissertation through interlibrary loan.

Publication Date



UM campus only

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Psychology (Arts and Sciences)

Date of Defense


First Committee Member

Gail Ironson

Second Committee Member

Neil Schneiderman

Third Committee Member

Ray Winters

Fourth Committee Member

Rick Stuetzle

Fifth Committee Member

Robert C. McMahon


To this day, limited research has been conducted to examine psychosocial factors that can potentially influence survival outcomes in people living with HIV (PLWH). In this study, we examined the relationships between distress tolerance, anxiety, and long-term survival. We also explored the role of different mediators in these relationships. Finally, we investigated the role of distress tolerance and anxiety as moderators in the relationship between life stress and survival. Questionnaires, blood draws (VL, CD4), and a urine sample (cortisol) were collected every 6 months for 2 years among a diverse sample of PLWH. Survival analyses and hierarchical regression analyses were used in this study. Consistent with our hypothesis, greater distress tolerance (appraisal) and anxiety predicted longer survival in PLWH for up to 10 years. However, depression, adherence and substance use, and cortisol were not found to mediate the relationship between distress tolerance and survival, or the relationship between anxiety and survival. In addition, no relationship was found between stressful life events and survival in the current study. To our knowledge, this is the first study to highlight that lower distress tolerance and anxiety predict poorer survival in PLWH over an extended period of time. Methodological limitations as well as clinical implications are discussed.


Distress tolerance; Anxiety; Life Stress; Survival; HIV

Available for download on Thursday, May 28, 2020