Despite the fact that fatigue is a common and debilitating symptom among HIV-infected persons, we know little about the predictors of fatigue in this population. The goal of this cross-sectional study was to examine the effects of early childhood trauma, recent stressful life events and depression on intensity and impairment of fatigue in HIV, over and above demographic factors and clinical characteristics. One hundred and twenty eight HIV-infected men and women from one southern state in the US were studied. The median number of childhood traumatic events was two and participants tended to have at least one moderate recent stressful event. Multiple regression findings showed that patients with less income, more childhood trauma, more recent stressful events and more depressive symptoms had greater fatigue intensity and fatigue-related impairment in daily functioning. Recent stresses were a more powerful predictor of fatigue than childhood trauma. None of the disease-related measures (e.g. CD4, viral load, antiretroviral medication) predicted fatigue. Although stress and trauma have been related to fatigue in other populations, this is the first study to examine the effects of traumatic and recent stressful life events on fatigue in an HIV-infected sample.
Despite the fact that fatigue is a common and debilitating symptom among HIV-infected persons, we know little about the predictors of fatigue in this population. The goal of this cross-sectional study was to examine the effects of early childhood trauma, recent stressful life events and depression on intensity and impairment of fatigue in HIV, over and above demographic factors and clinical characteristics. One hundred and twenty eight HIV-infected men and women from one southern state in the US were studied. The median number of childhood traumatic events was two and participants tended to have at least one moderate recent stressful event. Multiple regression findings showed that patients with less income, more childhood trauma, more recent stressful events and more depressive symptoms had greater fatigue intensity and fatigue-related impairment in daily functioning. Recent stresses were a more powerful predictor of fatigue than childhood trauma. None of the disease-related measures (e.g. CD4, viral load, antiretroviral medication) predicted fatigue. Although stress and trauma have been related to fatigue in other populations, this is the first study to examine the effects of traumatic and recent stressful life events on fatigue in an HIV-infected sample.
Social Work Maatskaplike Werk, 44(3), August 2008, pp.246-251.
This article advances the argument that a diagnosis with HIV is inappropriately regarded as traumatic and that to a large extent the shift in diagnosis criteria from the DSM-III-R to the DSM-IV has played a role in expanding definition of what might be regarded as a traumatic event. The notion of conceptual bracket creep is offered to account for the ever-increasing number of events that may qualify as traumatic. The article considers the persons diagnosed with HIV require help in living with their condition, accessing treatment, and dealing with social stigma instead of being regarded as traumatised.
This article advances the argument that a diagnosis with HIV is inappropriately regarded as traumatic and that to a large extent the shift in diagnosis criteria from the DSM-III-R to the DSM-IV has played a role in expanding definition of what might be regarded as a traumatic event. The notion of conceptual bracket creep is offered to account for the ever-increasing number of events that may qualify as traumatic. The article considers the persons diagnosed with HIV require help in living with their condition, accessing treatment, and dealing with social stigma instead of being regarded as traumatised.
Subject terms:
HIV AIDS, post traumatic stress disorder, traumas, diagnosis;
British Journal of Health Psychology, 13(1), February 2008, pp.81-84.
Publisher:
Wiley
... Survivors (N=37;>9-months with <50 CD4 cells/mm3 and asymptomatic), and an HIV+ comparison groups (N=100) wrote essays describing their reactions to past traumas; these were scored for emotional disclosure/processing. Healthy survivors had higher levels of emotional disclosure and emotional/cognitive processing than the comparison group. Emotional/cognitive processing mediated the relationship
This study compared written emotional disclosure and processing of trauma among a relatively rare group of people with AIDS with atypically favourable disease status with an HIV+ comparison group. The study also examined the mediational role of emotional/cognitive processing and natural killer (NK) cells. This study utilized a cross-sectional group comparison design. Two HIV+ groups, the Healthy Survivors (N=37;>9-months with <50 CD4 cells/mm3 and asymptomatic), and an HIV+ comparison groups (N=100) wrote essays describing their reactions to past traumas; these were scored for emotional disclosure/processing. Healthy survivors had higher levels of emotional disclosure and emotional/cognitive processing than the comparison group. Emotional/cognitive processing mediated the relationship between emotional disclosure and group membership. NK cell number mediated the relationship between emotional/cognitive processing and `healthy survival'. The results suggest that higher levels of emotional disclosure and processing of trauma may confer health and immunological benefits to people living with HIV/AIDS.
Families in Society, 84(4), October 2003, pp.523-529.
Publisher:
The Alliance for Children and Families
War and disaster often strike impoverished and stressed communities. The Lower East Side of New York City (LES) became one of those communities on September 11, 2001, when youth and parents experienced the destruction of the nearby World Trade Center. HIV-affected and HIV-infected parents discussed their own and their families' reactions. LES parents felt they had dealt with the initial effects of the World Trade Center disaster well, but were concerned about their ability to deal with continued threat. This challenge was made more difficult as they saw the number and quality of safe places from which to view and interpret events diminish, and their opportunities to establish reserves that would help them cope erode. HIV posed additional difficulties post-disaster. Implications are drawn for emergency preparedness planning for urban families.
War and disaster often strike impoverished and stressed communities. The Lower East Side of New York City (LES) became one of those communities on September 11, 2001, when youth and parents experienced the destruction of the nearby World Trade Center. HIV-affected and HIV-infected parents discussed their own and their families' reactions. LES parents felt they had dealt with the initial effects of the World Trade Center disaster well, but were concerned about their ability to deal with continued threat. This challenge was made more difficult as they saw the number and quality of safe places from which to view and interpret events diminish, and their opportunities to establish reserves that would help them cope erode. HIV posed additional difficulties post-disaster. Implications are drawn for emergency preparedness planning for urban families.
Describes women's subjective experiences of being informed of a positive HIV antibody test and, from their point of view, explains the meaning and impact of discovering that one is HIV-infected. Findings of a multi-staged narrative analysis suggest that, for women like those in this study, the discovery of HIV seropositivity is a traumatic event, carrying with it elements that are common to other types of trauma: perceived threat to one's life and perceived responsibility for the deaths of others. Implications for counselling and follow-up at diagnosis and early in the course of HIV illness are discussed.
Describes women's subjective experiences of being informed of a positive HIV antibody test and, from their point of view, explains the meaning and impact of discovering that one is HIV-infected. Findings of a multi-staged narrative analysis suggest that, for women like those in this study, the discovery of HIV seropositivity is a traumatic event, carrying with it elements that are common to other types of trauma: perceived threat to one's life and perceived responsibility for the deaths of others. Implications for counselling and follow-up at diagnosis and early in the course of HIV illness are discussed.
Clinical Social Work Journal, 4(4), 2015, pp.362-374.
Publisher:
Springer
Place of publication:
New York
Many HIV-positive asylum seekers have experienced multiple traumas and human rights violations, circumstances that engender posttraumatic stress disorder (PTSD). This qualitative study examines the impact of PTSD symptoms among HIV-positive asylum seekers in Scotland. Data were collected from 19 participants, using open-ended interviews, and narrative analysis was used to develop significant
(Publisher abstract)
Many HIV-positive asylum seekers have experienced multiple traumas and human rights violations, circumstances that engender posttraumatic stress disorder (PTSD). This qualitative study examines the impact of PTSD symptoms among HIV-positive asylum seekers in Scotland. Data were collected from 19 participants, using open-ended interviews, and narrative analysis was used to develop significant themes. All respondents had significant traumatic experiences, such as physical and sexual assault, witnessing the beating and death of a loved one, and being forced to participate in the sex trade. Many experienced multiple symptoms of PTSD, including re-experiencing of intrusive thoughts, flashbacks, avoidance, and arousal. These symptoms met the duration and impairment requirements for DSM-5 diagnosis of PTSD. Their symptoms impacted their ability to tell their stories convincingly when interviewed by immigration officials. Legal processes for asylum seeking require individuals to tell their stories but ignore the impact of trauma on their ability to do so, thus increasing the likelihood of their applications being rejected. The findings indicate the need for asylum seekers to have routine assessment and treatment for PTSD and the provision of appropriate therapeutic and advocacy services.
(Publisher abstract)
Subject terms:
HIV AIDS, asylum seekers, human rights, post traumatic stress disorder, women, traumas;
A sample of 171 HIV-positive men over 18 years of age were recruited from the San Francisco Bay Area. All participants reported experiencing symptoms of traumatic stress. The participants were recruited as part of a larger study assessing a group intervention for individuals with HIV and symptoms of trauma. Self-report questionnaires were administered to assess participants’ exposure to bullying in childhood and trauma symptoms in adulthood. Bullying was commonly reported by men in the current sample, with 91% of the sample endorsing having experienced some level of bullying before age 18. Having been bullied in childhood was significantly associated with methamphetamine use in adulthood, difficulties with mood, and with symptoms of trauma. Results of a hierarchical regression equation found that report of bullying in childhood predicted additional, unique variance in trauma symptoms in adulthood above and beyond the effect of exposure to other forms of trauma, resulting in a better-fitting model. The study highlights the association between rate of childhood bullying and symptoms of trauma in adulthood, accounting for the effect of exposure to other forms of trauma. Exposure to bullying must be considered in any intervention aiming to reduce trauma symptoms or improve mental or physical health among HIV-positive populations.
(Edited publisher abstract)
A sample of 171 HIV-positive men over 18 years of age were recruited from the San Francisco Bay Area. All participants reported experiencing symptoms of traumatic stress. The participants were recruited as part of a larger study assessing a group intervention for individuals with HIV and symptoms of trauma. Self-report questionnaires were administered to assess participants’ exposure to bullying in childhood and trauma symptoms in adulthood. Bullying was commonly reported by men in the current sample, with 91% of the sample endorsing having experienced some level of bullying before age 18. Having been bullied in childhood was significantly associated with methamphetamine use in adulthood, difficulties with mood, and with symptoms of trauma. Results of a hierarchical regression equation found that report of bullying in childhood predicted additional, unique variance in trauma symptoms in adulthood above and beyond the effect of exposure to other forms of trauma, resulting in a better-fitting model. The study highlights the association between rate of childhood bullying and symptoms of trauma in adulthood, accounting for the effect of exposure to other forms of trauma. Exposure to bullying must be considered in any intervention aiming to reduce trauma symptoms or improve mental or physical health among HIV-positive populations.
(Edited publisher abstract)
Subject terms:
traumas, bullying, HIV AIDS, men, long term outcomes, children;
Receiving a diagnosis of a long-term condition such as HIV is disruptive and life-changing, but nurses can use narrative care to help patients manage the disruption. This article summarises the findings of qualitiative research conducted with four women diagnosed with HIV during pregnancy. The women were interviewed shortly after diagnosis, and again after the birth of their baby. Six key themes were identified: the chaos of diagnosis; the experience of otherness; the threat to their relationships; concerns for the baby; pregnancy as a saviour; and creating continuity out of the disruption of diagnosis. The research highlights the role of narrative care during difficult life transitions or trauma and how the reconstruction and telling of their stories helped the women.
Receiving a diagnosis of a long-term condition such as HIV is disruptive and life-changing, but nurses can use narrative care to help patients manage the disruption. This article summarises the findings of qualitiative research conducted with four women diagnosed with HIV during pregnancy. The women were interviewed shortly after diagnosis, and again after the birth of their baby. Six key themes were identified: the chaos of diagnosis; the experience of otherness; the threat to their relationships; concerns for the baby; pregnancy as a saviour; and creating continuity out of the disruption of diagnosis. The research highlights the role of narrative care during difficult life transitions or trauma and how the reconstruction and telling of their stories helped the women.
Subject terms:
HIV AIDS, life story work, nursing, pregnancy, traumas, women, diagnosis;
The authors hypothesise that a diagnosis of HIV+ and the associated stigmatisation are sources of trauma for most patients. In this article they examine the relationship between temperament traits and coping style, and the intensity of trauma symptoms in HIV+ men and women (with and without AIDS). The study involved 310 HIV+ individuals (157 men and 153 women). Temperament traits were assessed with the Formal Characteristics of Behaviour – Temperament Inventory and coping styles with the Coping Inventory for Stressful Situations. Intensity of trauma symptoms was examined with the factorial version of the Post-Traumatic Stress Disorder Inventory. Coping style had the greatest effect on intensity of trauma symptoms. Emotion-focused coping accounted for 13% of the variance. Together, sensory sensibility, emotional reactivity and emotion-focused coping accounted for 26% of the variance of trauma intensity symptoms. Emotion-focused coping and emotional reactivity were conducive to increased trauma symptom intensity whereas sensory sensibility tended to reduce symptom intensity. The findings also revealed a difference between those with and without AIDS, suggesting that there are two phases in the course of HIV infection, each of which involves a different set of personality factors. Initially traits associated with active coping and buffering against trauma are to the fore, followed by an increase in perseveration and emotion-orientate coping.
The authors hypothesise that a diagnosis of HIV+ and the associated stigmatisation are sources of trauma for most patients. In this article they examine the relationship between temperament traits and coping style, and the intensity of trauma symptoms in HIV+ men and women (with and without AIDS). The study involved 310 HIV+ individuals (157 men and 153 women). Temperament traits were assessed with the Formal Characteristics of Behaviour – Temperament Inventory and coping styles with the Coping Inventory for Stressful Situations. Intensity of trauma symptoms was examined with the factorial version of the Post-Traumatic Stress Disorder Inventory. Coping style had the greatest effect on intensity of trauma symptoms. Emotion-focused coping accounted for 13% of the variance. Together, sensory sensibility, emotional reactivity and emotion-focused coping accounted for 26% of the variance of trauma intensity symptoms. Emotion-focused coping and emotional reactivity were conducive to increased trauma symptom intensity whereas sensory sensibility tended to reduce symptom intensity. The findings also revealed a difference between those with and without AIDS, suggesting that there are two phases in the course of HIV infection, each of which involves a different set of personality factors. Initially traits associated with active coping and buffering against trauma are to the fore, followed by an increase in perseveration and emotion-orientate coping.
Among those infected with HIV, a history of traumatic and/or stressful life experiences is prevalent and has been associated with poorer health outcomes including reduced medication adherence. This article describes the frequency and prospective predictors of a wide range of traumatic and stressful events experienced by participants in the Coping with HIV/AIDS in the South East (CHASE) Study. A total of 611 HIV-infected individuals in the Southeastern USA were followed for 27-months to determine predictors associated with three incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences were frequent; 91% reported at least one stressful experience (median=3.5 experiences) and 10% of study participants reported traumatic stress in any given nine-month reporting period. Financial stressors were most common. Greater emotional distress, substance use, and a higher number of baseline stressful experiences were associated with reporting a greater number of incident stressful experiences and any traumatic experiences. It is suggested that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors.
Among those infected with HIV, a history of traumatic and/or stressful life experiences is prevalent and has been associated with poorer health outcomes including reduced medication adherence. This article describes the frequency and prospective predictors of a wide range of traumatic and stressful events experienced by participants in the Coping with HIV/AIDS in the South East (CHASE) Study. A total of 611 HIV-infected individuals in the Southeastern USA were followed for 27-months to determine predictors associated with three incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences were frequent; 91% reported at least one stressful experience (median=3.5 experiences) and 10% of study participants reported traumatic stress in any given nine-month reporting period. Financial stressors were most common. Greater emotional distress, substance use, and a higher number of baseline stressful experiences were associated with reporting a greater number of incident stressful experiences and any traumatic experiences. It is suggested that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors.
Subject terms:
HIV AIDS, medication, outcomes, personal finance, stress, traumas, emotions;