Abuse is associated with higher depressive symptoms (DS) and coronary heart disease risk (CHD), lower health-related quality of life (HRQOL), and dysregulated levels of cortisol and norepinephrine (NE). In HIV+ women, abuse relates to higher viral load (VL), lower CD4 count, and nonadherence to highly active antiretroviral therapy (HAART). Resilience (adaptive functioning following trauma) and positive self-esteem (PSE) were hypothesized to buffer the impact of abuse and predict better health outcomes. Three studies tested these hypotheses using self-report measures (for abuse, resilience, DS, HRQOL, and HAART use and adherence), autobiographical narratives (for PSE), Framingham Risk Score (for CHD risk), and blood and urinary specimens for cortisol, NE, and HIV disease markers (VL and CD4 count). Study 1 included 138 HIV+ and 64 HIV- women (87% African-American), and investigated the relationships between childhood sexual abuse (CSA), DS, and HRQOL and whether resilience moderated the relationships between CSA and outcomes. Consistent with the hypothesis, multiple regressions indicated that higher resilience related to lower DS and higher HRQOL across both HIV+ and HIV-women, and CSA related to higher DS only for women scoring low in resilience. Study 2 examined how resilience moderated the relationships between abuse history and HAART adherence, VL, and CD4 count in 138 HIV+ women. As predicted, multiple regressions revealed that resilience related to having undetectable VL. Sexual and multiple abuse histories related to lower HAART adherence only for women scoring low in resilience. Study 3 with 53 HIV+ women investigated the relationships among resilience, PSE, abuse histories, NE, cortisol and CHD risk. In partial support of hypotheses, partial correlations showed that higher resilience related to lower cortisol; higher PSE related to lower NE; higher NE/cortisol ratio related to higher CHD risk; histories of abuse related to higher CHD risk, and lower cortisol related to higher CHD risk. The findings suggest that resilience and PSE relate to better health outcomes for HIV+ and HIV- women, and levels of stress hormones in HIV+ women are related in complex ways to abuse, resilience, PSE, and CHD risk. Promoting resilience and PSE may help HIV+ and HIV- women achieve better health outcomes.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/15171 |
| Date | 12 March 2016 |
| Creators | Dale, Sannisha K. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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