Skip to main content

Advertisement

SpringerLink
Log in

Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV

  • Full length manuscript
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (< 80 copies/ml).

Method

Ninety-eight WLWH from the Women’s Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses.

Results

Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence.

Conclusion

Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

Access to individual-level data from the MACS/WIHS Combined Cohort Study Data (MWCCS) may be obtained upon review and approval of a MWCCS concept sheet. Links and instructions for online concept sheet submission are on the study website (https://mwccs.org/).

References

  1. Bacon MC, von Wyl V, Alden C, et al. The Women’s Interagency HIV Study: an observational cohort brings clinical sciences to the bench. Clin Diagn Lab Immunol. 2005;12(9):1013–9. https://doi.org/10.1128/CDLI.12.9.1013-1019.2005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Adimora AA, Ramirez C, Benning L, et al. Cohort Profile: The Women’s Interagency HIV Study (WIHS). Int J Epidemiol. 2018;47(2):393–394i. https://doi.org/10.1093/ije/dyy021.

    Article  PubMed  PubMed Central  Google Scholar 

  3. McIntosh RC, Rosselli M. Stress and coping in women living with HIV: a meta-analytic review. AIDS Behav. 2012;16(8):2144–59. https://doi.org/10.1007/s10461-012-0166-5.

    Article  PubMed  Google Scholar 

  4. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530. https://doi.org/10.1007/s11920-014-0530-4.

    Article  PubMed  Google Scholar 

  5. Moskowitz JT, Hult JR, Bussolari C, Acree M. What works in coping with HIV? A meta-analysis with implications for coping with serious illness. Psychol Bull. 2009;135(1):121–41. https://doi.org/10.1037/a0014210.

    Article  PubMed  Google Scholar 

  6. Ironson G, O’Cleirigh C, Fletcher MA, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67(6):1013–21. https://doi.org/10.1097/01.psy.0000188569.58998.c8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ironson G, Hayward H. Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence. Psychosom Med. 2008;70(5):546–54. https://doi.org/10.1097/PSY.0b013e318177216c.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bassett SM, Schuette SA, O’Dwyer LC, Moskowitz JT. Positive affect and medication adherence in chronic conditions: A systematic review. Health Psychol. 2019;38(11):960–74. https://doi.org/10.1037/hea0000778.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wilson TE, Weedon J, Cohen MH, et al. Positive affect and its association with viral control among women with HIV infection. Health Psychol. 2017;36(1):91–100. https://doi.org/10.1037/hea0000382.

    Article  PubMed  Google Scholar 

  10. Carrico AW, Moskowitz JT. Positive affect promotes engagement in care after HIV diagnosis. Health Psychol. 2014;33(7):686–9. https://doi.org/10.1037/hea0000011.

    Article  PubMed  Google Scholar 

  11. Firpo-Perretti YM, Cohen MH, Weber KM, Brody LR. Past, present or future? Word tense and affect in autobiographical narratives of women with HIV in relation to health indicators. J Behav Med. 2018;41(6):875–89. https://doi.org/10.1007/s10865-018-9944-5 (Epub 2018 Jun 25).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ickovics JR, Milan S, Boland R, et al. Psychological resources protect health: 5-year survival and immune function among HIV-infected women from four US cities. AIDS. 2006;20(14):1851–60. https://doi.org/10.1097/01.aids.0000244204.95758.15.

    Article  PubMed  Google Scholar 

  13. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001;56(3):218–226. https://doi.org/10.1037//0003-066x.56.3.218

  14. Moskowitz JT, Carrico AW, Duncan LG, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409–23. https://doi.org/10.1037/ccp0000188.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ironson G, Kremer H, Lucette A. Compassionate love predicts long-term survival among people living with HIV followed for up to 17 years. The Journal of Positive Psychology. 2018;13(6):553–562. Accessed May 3, 2021. http://search.ebscohost.com.ezproxy.bu.edu/login.aspx?direct=true&db=psyh&AN=2018-45399-002&site=ehost-live&scope=site

  16. McAdams DP, Anyidoho NA, Brown C, Huang YT, Kaplan B, Machado MA. Traits and stories: links between dispositional and narrative features of personality. J Pers. 2004;72(4):761–84. https://doi.org/10.1111/j.0022-3506.2004.00279.x.

    Article  PubMed  Google Scholar 

  17. McAdams DP, Bauer JJ, Sakaeda AR, et al. Continuity and change in the life story: a longitudinal study of autobiographical memories in emerging adulthood. J Pers. 2006;74(5):1371–400. https://doi.org/10.1111/j.1467-6494.2006.00412.x.

    Article  PubMed  Google Scholar 

  18. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res in Psychology. 2006;3:77–101.

    Article  Google Scholar 

  19. Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269–77. https://doi.org/10.1097/00002030-200201250-00017.

    Article  PubMed  Google Scholar 

  20. Nieuwkerk PT, Oort FJ. Self-reported adherence to antiretroviral therapy for HIV- 1 infection and virologic treatment response: a meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2005;38(4):445–8.

    Article  Google Scholar 

  21. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  22. Shafer AB. Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol. 2006;62(1):123–46. https://doi.org/10.1002/jclp.20213 (PMID: 16287149).

    Article  PubMed  Google Scholar 

  23. Merchant W, Smith G, Hayslip B Jr. Using the CES-D with custodial grandmothers: cross-validation and convergent validity. J Ment Health Aging (Lond). 2017;1(1):1–9. PMID: 29978855; PMCID: PMC6029623.

  24. Bottonari KA, Tripathi SP, Fortney JC, et al. Correlates of antiretroviral and antidepressant adherence among depressed HIV-infected patients. AIDS Patient Care STDS. 2012;26(5):265–73. https://doi.org/10.1089/apc.2011.0218.

    Article  PubMed  Google Scholar 

  25. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36(4):717–31. https://doi.org/10.3758/bf03206553 (PMID: 15641418).

    Article  PubMed  Google Scholar 

  26. Cohen MH, Cook JA, Grey D, et al. Medically eligible women who do not use HAART: the importance of abuse, drug use, and race. Am J Public Health. 2004;94(7):1147–51. https://doi.org/10.2105/ajph.94.7.1147.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Murphy K, Hoover DR, Shi Q, et al. Association of self-reported race with AIDS death in continuous HAART users in a cohort of HIV-infected women in the United States. AIDS. 2013;27(15):2413–23. https://doi.org/10.1097/01.aids.0000432537.92958.73.

    Article  PubMed  Google Scholar 

  28. Leserman J, Pence BW, Whetten K, Mugavero MJ, Thielman NM, Swartz MS, Stangl D. Relation of lifetime trauma and depressive symptoms to mortality in HIV. Am J Psychiatry. 2007;164(11):1707–13.

    Article  Google Scholar 

  29. Fossati P. Is major depression a cognitive disorder? Rev Neurol (Paris). 2018;174(4):212–5. https://doi.org/10.1016/j.neurol.2018.01.365.

    Article  CAS  Google Scholar 

  30. Brody LR, Jack DC, Bruck-Segal DL, et al. Life lessons from women with HIV: Mutuality, self-awareness, and self-efficacy. AIDS Patient Care STDS. 2016;30(6):261–73. https://doi.org/10.1089/apc.2016.0031.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Han SH, Tavares JL, Evans M, Saczynski J, Burr JA. Social activities, incident cardiovascular disease, and mortality. J Aging Health. 2017;29(2):268–88. https://doi.org/10.1177/0898264316635565.

    Article  PubMed  Google Scholar 

  32. Pace TW, Negi LT, Dodson-Lavelle B, et al. Engagement with cognitively-based compassion training is associated with reduced salivary C-reactive protein from before to after training in foster care program adolescents. Psychoneuroendocrinology. 2013;38(2):294–9. https://doi.org/10.1016/j.psyneuen.2012.05.019.

    Article  PubMed  Google Scholar 

  33. Luszczynska A, Sarkar Y, Knoll N. Received social support, self-efficacy, and finding benefits in disease as predictors of physical functioning and adherence to antiretroviral therapy. Patient Educ Couns. 2007;66(1):37–42. https://doi.org/10.1016/j.pec.2006.10.002.

    Article  PubMed  Google Scholar 

  34. Gayner B, Esplen MJ, DeRoche P, et al. A randomized controlled trial of mindfulness-based stress reduction to manage affective symptoms and improve quality of life in gay men living with HIV. J Behav Med. 2012;35(3):272–85. https://doi.org/10.1007/s10865-011-9350-8.

    Article  PubMed  Google Scholar 

  35. Gonzalez-Garcia M, Ferrer MJ, Borras X, et al. Effectiveness of mindfulness-based cognitive therapy on the quality of life, emotional status, and CD4 cell count of patients aging with HIV Infection. AIDS Behav. 2014;18(4):676–85. https://doi.org/10.1007/s10461-013-0612-z.

    Article  PubMed  Google Scholar 

  36. Costa RV, Pakenham KI. Associations between benefit finding and adjustment outcomes in thyroid cancer. Psychooncology. 2012;21(7):737–44. https://doi.org/10.1002/pon.1960.

    Article  PubMed  Google Scholar 

  37. Crockett KB, Entler KJ, Brodie E, et al. Brief Report: Linking depressive symptoms to viral nonsuppression among women with HIV through adherence self-efficacy and ART adherence. J Acquir Immune Defic Syndr. 2020;83(4):340–4. https://doi.org/10.1097/QAI.0000000000002268.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jennissen S, Huber J, Ehrenthal JC, Schauenburg H, Dinger U. Association between insight and outcome of psychotherapy: Systematic review and meta-analysis. Am J Psychiatry. 2018;175(10):961–9. https://doi.org/10.1176/appi.ajp.2018.17080847.

    Article  PubMed  Google Scholar 

  39. Watkins PC, Emmons RA, Greaves MR, Bell J. Joy is a distinct positive emotion: Assessment of joy and relationship to gratitude and well-being. J Posit Psychol. 2018;13(5):522–39. https://doi.org/10.1080/17439760.2017.1414298.

    Article  Google Scholar 

  40. Du J, An Y, Ding X, Zhang Q, Xu W. State mindfulness and positive emotions in daily life: An upward spiral process. Personality Individ Differ. 2019;141:57–61. https://doi.org/10.1016/j.paid.2018.11.037.

    Article  Google Scholar 

  41. Salces-Cubero IM, Ramírez-Fernández E, Ortega-Martínez AR. Strengths in older adults: Differential effect of savoring, gratitude and optimism on well-being. Aging Ment Health. 2019;23(8):1017–24. https://doi.org/10.1080/13607863.2018.1471585.

    Article  PubMed  Google Scholar 

  42. Quoidbach J, Berry EV, Hansenne M, Mikolajczak M. Positive emotion regulation and well-being: Comparing the impact of eight savoring and dampening strategies. Personality Individ Differ. 2010;49(5):368–73. https://doi.org/10.1016/j.paid.2010.03.048.

    Article  Google Scholar 

  43. Quoidbach J, Mikolajczak M, Gross JJ. Positive interventions: An emotion regulation perspective. Psychol Bull. 2015;141(3):655–93. https://doi.org/10.1037/a0038648.

    Article  PubMed  Google Scholar 

  44. Cole SW. Psychosocial influences on HIV-1 disease progression: neural, endocrine, and virologic mechanisms. Psychosom Med. 2008;70(5):562–8. https://doi.org/10.1097/PSY.0b013e3181773bbd.

    Article  PubMed  Google Scholar 

  45. Seligman M. PERMA and the building blocks of well-being. J Posit Psychol. 2018;13(4):333–5. https://doi.org/10.1080/17439760.2018.1437466.

    Article  Google Scholar 

  46. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–48. https://doi.org/10.1037/0022-3514.84.4.822.

    Article  PubMed  Google Scholar 

  47. Emmons RA, McCullough ME. Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003;84:377–89.

    Article  Google Scholar 

  48. Stirratt MJ, Dunbar-Jacob J, Crane HM, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med. 2015;5(4):470–82. https://doi.org/10.1007/s13142-015-0315-2.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nakash O, Brody LR. The effects of power imbalances and gender on autobiographical memory. Self and Identity. 2007;6(4):304–21. https://doi.org/10.1080/15298860601109495.

    Article  Google Scholar 

  50. Wager TD, Atlas LY. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci. 2015;16(7):403–18. https://doi.org/10.1038/nrn3976.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Carrico AW, Neilands TB, Dilworth SE, et al. Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine. J Int AIDS Soc. 2019;22(12): e25436. https://doi.org/10.1002/jia2.25436.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Herman J. Trauma and recovery: The aftermath of violence – from domestic abuse to political terror. New York, NY: Basic Books; 2015.

    Google Scholar 

  53. van der Kolk B. The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books; 2014.

    Google Scholar 

  54. Bassett SM, Brody LR, Jack DC, Weber KM, Cohen MH, Clark TM, Dale SK, Moskowitz JT. Feasibility and acceptability of a program to promote positive affect, well-being and gender empowerment in Black women living with HIV. AIDS Behav. 2021;25(6):1737–50. https://doi.org/10.1007/s10461-020-03103-w.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Data in this manuscript were collected by the Women's Interagency HIV Study (WIHS), now the MACS/WIHS Combined Cohort Study (MWCCS). MWCCS Principal Investigators for the Chicago-Cook County CRS are Mardge Cohen and Audrey French, U01-HL146245.   The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health and Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental and Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR) and U01-HL146193 (DACC).

Author information

Authors and Affiliations

  1. Department of Psychological and Brain Sciences, Boston University, Boston, USA

    Leslie R. Brody, Yudelki Firpo-Perretti, Dana Bruck-Segal & Elizabeth G. Ruffing

  2. Department of Psychology, University of Miami, Miami, USA

    Sannisha K. Dale

  3. Triangle Area Psychology Clinic, Durham, USA

    Clair Cassiello-Robbins

  4. Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, USA

    Kathleen M. Weber

  5. Departments of Medicine, Stroger Hospital, Cook County Health and Hospitals System and Rush Medical School, Chicago, USA

    Mardge H. Cohen

Authors
  1. Leslie R. Brody
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yudelki Firpo-Perretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dana Bruck-Segal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sannisha K. Dale
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elizabeth G. Ruffing
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Clair Cassiello-Robbins
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kathleen M. Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mardge H. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Leslie Brody, Mardge Cohen, Sannisha Dale, Clair Cassiello-Robbins, Yudelki Firpo-Perretti, Kathleen Weber, Dana Bruck-Segal, and Elizabeth Ruffing. The first draft of the manuscript was written by Leslie Brody, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leslie R. Brody.

Ethics declarations

Disclaimer

The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflicts of Interest/Competing Interests

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brody, L.R., Firpo-Perretti, Y., Bruck-Segal, D. et al. Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV. Int.J. Behav. Med. 29, 469–479 (2022). https://doi.org/10.1007/s12529-021-10032-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-021-10032-y

Keywords

Search

Navigation