published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

The focus of the research study is to explore chronically ill African American, Latino, and White patients' causal attributions of symptoms of depression and factors that predict depression care treatment preferences among these groups. Research has demonstrated that perception of illness impacts what treatments a person will deem appropriate for their mental health problems and from whom they will seek treatment. Research also indicates that certain ethnic groups are more likely to seek treatment for their symptoms of depression in the primary care setting. Yet, it is unclear how they actually perceive their symptoms and what best predicts the treatments that they are likely to consider acceptable. A convenient sample of 109 HIV+ adults, 79 diabetic adults, and 3 adults with both conditions were recruited for this study. Participants had to be receiving services for either HIV, diabetes, or both conditions in one of the three central Austin facilities and be a representative from one of three racial/ethnic groups: African Americans, Latino, and White. Differences were found across ethnicity with regard to causal beliefs and treatment preferences for the symptoms of depression both among the HIV and the diabetic subgroups. Latinos in both groups were more likely than Whites to prefer counseling or a single form of treatment over combined treatment methods. Diabetic Latinos were more likely to prefer counseling for symptoms of depression. HIV seropositive individuals who reported the least number of symptoms of physical illness were more likely to attribute their symptoms of depression to stressful life events, whereas those who reported the greatest number of symptoms of physical illness were more likely to attribute their symptoms of depression to their medical illness. Additionally among the HIV subgroup, individuals who reported high stress tended to predict the preferences for treatment provided by a psychiatrist/psychologist and Whites scored highest on this factor. Finally, differences in depression scores across race/ethnicity were also revealed. The utility of assessing a patient's understanding of symptoms of depression in order to determine how personal illness models impact treatment preferences and knowledge of patient's causal attributions can aid medical social workers and physicians in collaborative management of chronic illness and depression are discussed.

The relationships between post-traumatic growth (PTG), benefit finding, happiness, pessimism and antiretroviral (ART) medication adherence were examined among 10 people living with HIV or AIDS who attended HIV support groups, and were currently prescribed ART medications. Analyses indicated that none of these psychosocial factors were significantly correlated with ART adherence, that the relationships continued to be non-significant after pessimism was partialled out of the analysis, and that participants who reported achieving optimal ART adherence did not significantly differ from participants who reported taking less than optimal ART adherence in regards to PTG, benefit finding, subjective happiness, or pessimism. The results suggest that interventions designed to change these psychosocial factors may not be effective means of improving ART adherence. / Department of Psychological Science

Thesis (MA (Psychology))--University of Stellenbosch, 2008. / Few studies have assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) associated with the receipt of an HIV-positive diagnosis and no published studies in South Africa have used a structured clinical interview to assess the above-mentioned. The present cross-sectional study assessed the prevalence of HIV-related PTSD among a sample of recently diagnosed patients attending public health clinics in the Boland region of the Western Cape. The PTSD module of the Composite International Diagnostic Interview (CIDI), together with a battery of self-report instruments assessing symptoms of traumatisation, depression and anxiety were administered to 85 patients who had been diagnosed with HIV in the year preceding data collection. In addition, HIVrelated PTSD and symptomatology were assessed using an adapted version of the PTSD module of the CIDI. The self-report instruments administered were (a) a demographic questionnaire, (b) the Posttraumatic Stress Diagnostic Scale (PDS) which assessed current PTSD symptom severity, and (c) the 25-item Hopkins Symptom Checklist (HSCL-25) which assessed psychological distress, and symptoms and intensity of anxiety and depression. The primary aim of the present study was to determine the prevalence of HIV-related PTSD among a sample of recently diagnosed HIV-positive individuals attending HIV clinics in the Boland region. The second aim was to determine the lifetime prevalence of PTSD among the sample. The third aim was to determine the percentage of the sample that endorsed the DSM-IV’s PTSD A2 criterion and the subsequent HIV-related PTSD symptomatology among those who did and did not meet full criteria for HIV-related PTSD. The fourth aim was to determine the level of psychological distress reported by the sample. The prevalence of lifetime PTSD was 29.4% (95% confidence interval [CI], 20.7% - 39.8%). Sixty-nine of the eighty-five participants (81.2%) endorsed the DSM-IV’s PTSD A2 criterion. Of the total sample, 34 participants (40%) (95% CI, 30.2% - 50.6%) met the full criteria for HIV related PTSD. The majority of participants reported mild PTSD symptom severity (45.8%). Over half the sample (51.4%) experienced clinically significant distress. Of those participants diagnosed with HIV-related PTSD, 82.4% were clinically distressed, and 76.5% and 58.8% experienced high levels of depression and anxiety, respectively. The present study’s findings suggest that receiving an HIV-positive diagnosis and/or being HIVpositive may be considered a traumatic stressor that frequently results in HIV-related PTSD. Findings of the present study indicate the need for adequate support and care for HIV-positive individuals. Given the various barriers to efficient mental health interventions and services in South Africa, there are significant challenges that need to be addressed in order to ensure that the mental health and welfare of HIV-positive individuals are both adequately assessed and appropriately maintained.

Thesis (MA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: This paper provides an overview and critical evaluation of current (1990-2001) research into Human Immune-deficiency Virus (HIV) and Acquired Immuno-deficiency Syndrome (AIDS), with particular reference to factors affecting quality of life (QOL) among those living with the disease. A brief look at the importance of optimal QOL when faced with a life crisis such as HIV/AIDS, leads to a discussion of factors influencing QOL in HIV/AIDS. These factors include coping styles, mental adjustment, social support, stigmatization, socio-economic and socia-cultural factors, gender, depression as well as disease progression. The overview is informed by prominent research trends and a critical look at the current understanding of factors impacting on the QOL of people living with HIV/AIDS. Recommendations are made on issues that need further clarification, while future research orientations are also suggested. In the absence of satisfactory treatment strategies or a cure for HIV/AIDS, as well as the evidence of a potentiall0 to 12 year life expectancy, there is a pressing need for a better understanding of factors that influence QOL. There is strong support for the notion that QOL directly impacts on disease progression and therefore also on the quality and quantity of survival time. It follows that a better understanding of the nature and determinants of QOL for HIV patients will yield valuable intervention guidelines within a biopsychosocial framework. / AFRIKAANSE OPSOMMING: Hierdie artikel bied 'n oorsig en kritiese evaluering van onlangse (1990-2001) navorsing in die veld van Menslike Immuniteitsgebrek Virus (MIV) en Verworwe Immuniteitsgebrek Sindroom (VIGS), met besondere verwysing na faktore wat bydra tot die lewenskwaliteit van geïnfekteerde indiwidue. Die belangrikheid van optimale lewenskwaliteit teen die agtergrond van 'n lewenskrisis soos 'n MIV-diagnose, word kortliks bepsreek. Daarop volg In bespreking van faktore wat In invloed het op lewenskwaliteit in HIV/AIDS. Hierdie faktore sluit in hanteringstyl, psigiese aanpasbaarheid, sosiale ondersteuning, stigmatisering, sosio-ekonomies en sosio-kulturele faktore, geslag, depressie asook siekteverloop. Die oorsig word gerugsteun deur prominente navorsingstendense asook 'n kritiese blik op huidige perspektiewe op faktore wat 'n impak het op die lewenskwaliteit van mense wat leef met MIVjVIGS. Aanbevelings word gemaak aangaande aspekte waaroor verdere helderheid verkry moet word, asook oor toekomstige navorsingsvraagstukke. Gegewe die afwesigheid van voldoende behandelingstrategieë of selfs 'n geneesmiddel vir MIV, tesame met die bewys van 'n 10 tot 12 jaar potensiële lewensverwagting, bestaan daar 'n dringende noodsaaklikheid vir grondiger insig in faktore wat lewenskwaliteit beïnvloed. Daar is sterk steun vir die uitgangspunt dat lewenskwaliteit 'n direkte impak het op siekteverloop en derhalwe ook op die duur en kwaliteit van oorlewingstyd. Verbeterde kennis oor die aard en determinante van lewenskwaliteit in MIV-pasiënte sal dus waardevolle inligting kan verskaf in terme van toepaslike riglyne vir intervensies binne 'n biopsigososiale raamwerk.

M.A. (Psychology) / The Acquired Immunodeficiency Syndrome not only threatens the world with hitherto unknown rates of mortality and economic ruin, but has also saddled the health sciences with an unprecedented challenge in curing and managing this disease. Herein, the health sciences have not found a cure, and the management of the disease is made extremely difficult because of the unpredictable nature of the interrelationships in biopsychosocial factors inherent in the disease. In order to attempt a description of the complex interrelationships between biopsychosocial factors in this disease, a group of twenty patients in a treatment programme comprising of an exercise and cognitive-behavioural intervention, were subjected to immunologic and psychological assessment before and subsequent to the intervention. The data obtained indicated that none of the interrelationships between psychological and immunological variables predicted by psychoneuroimmunological science existed prior to the intervention. It would appear that the interrelationships between these variables were in total disarray - defeating the object of systematic logical description of biopsychosocial factors in this condition. The post- intervention data suggested a pattern of interrelationships totally within the confines of predicted neuropsychoimmunologic patterns of a biopsychosocial interaction in a disease of immunologic origin. This pattern of predictability would then render possible a treatment programme of a multidisciplinary nature which would bear predictable fruit. It also underscores the necessity of psychological interventions as an adjunct in the treatment of AIDS.

M.A. (Psychology) / The present study was undertaken in an attempt to understand and ascertain the nature and influence of psychological variables on the longevity of people who are infected withHN. The specific postulate of this study was that depression is the most important psychological variable that influences the longevity of people with my, either directly or indirectly. A number of variables were hypothesized to playa concomitant role with depression as factors that mediate longevity in people with my. These factors include learned helplessness, self-efficacy, sickness impact, sexual risk behaviors and substance use. The testing of these hypotheses involved an experimental group consisting ofHN positive, gay men who suffered from depression and a control group that consisted ofmv positive gay men who did not suffer from depression. None of the subjects had previously been diagnosed with depression. The subjects were subjected to testing of the mentioned psychological variables by means of the Hamilton-Depression Scale, the Attributional Style Questionnaire, the Coping Self-Efficacy Scale, the Biweekly Record of Sexual Behavior, the Substance Use Behavior Questionnaire and the Sickness Impact Profile. It was found that the experimental group differed significantly from the control group in terms of self-efficacy, sexual risk behavior, substance use and sickness impact. It has been speculated that the lack of significant difference between the experimental and control groups on learned helplessness could imply that equal amounts of learned helplessness was present in both groups.

People living with HIV/AIDS (PLH) struggle with depression. Recent research suggests that depression affects medical regimen adherence, disease progression, and risky sexual behaviors. The present study uses a stress and coping theory viewing HIV-related stigma and physical symptoms as stressors in PLH. Results suggest whereas symptoms and stigma consistently predict negative affect, positive affect, and overall depression, the role of optimism, pessimism, active coping, denial, and behavioral disengagement is not as clear. Pessimism and denial predict negative affect and depression. Optimism and behavioral disengagement predict depression and positive affect. Active coping only predicts positive affect. Focusing on positive and negative affect as distinct components that contribute to overall depression may help researchers develop interventions more effectively.

The HIV/AIDS epidemic continues to grow and minorities have been affected at a disproportionate rate. Two factors that are hypothesized to be associated with HIV/AIDS stigma include ethnic identity and acculturation. The current study uses a diverse, gender-balanced sample (n= 201, aged 23-68) of African-Americans (54.2%), European Americans (31.8%), and Latinos/Hispanics (10%) to evaluate the relationship among the proposed variables. The study found that higher levels of ethnic identity and other group orientation were associated with lower levels of perceived HIV/AIDS stigma. A stepwise linear regression analysis (adjusted R2 = .13, F(11, 189) = 3.74, p < .001) revealed that as the level of inclusiveness of other ethnic groups (t = -4.263, p < .001) increases, the level of perceived HIV/AIDS stigma decreases. The results from this study suggest that the development of interventions that address stigma and inclusiveness of other ethnic groups may benefit people living with HIV/AIDS.

Although the negative impact of HIV stigma is well documented, a gap exists in exploration of constructs that mediate the relationship between HIV stigma and psychological QOL (PQOL). Self-esteem is often conceptualized as a protective factor. We used PLS-SEM to explore the relationships between HIV stigma, PQOL and self-esteem, where PQOL and self-esteem are latent constructs represented by direct observations. Our hypotheses were supported - stigma is negatively related to self-esteem (as measured by self-blame, forgiveness of self, acceptance without judgment and self-esteem), self-esteem is positively related to PQOL (as measured by depression, mental health, QOL and perceived stress) and when the two aforementioned relationships are controlled for, a previously significant relation between stigma and PQOL changes its value significantly. These findings have implications for interventions designed to mitigate the negative psychosocial effects of stigma in PLH.