Religious and Psychosocial Covariates of Health-Related Quality of Life in People Living with HIV/AIDS
DOI:
https://doi.org/10.17140/HARTOJ-1-101Keywords:
HIV/AIDS, Health Related Quality of Life, Religion, Coping, Social support, AdherenceAbstract
HIV/AIDS is a chronic, highly stigmatized illness that requires significant lifestyle adjustments, including consistent adherence to Antiretroviral Therapy (ART) in order for People Living With HIV/AIDS (PLWH) to survive and maintain good immune health. PLWH often report poor or moderate Health-Related Quality of Life (HRQoL) that is worse than the general population. This may be related to the psychological and physiological demands of HIV disease and the sociodemographic stressors associated with it. The role of religious coping, religiosity, and social support in the mental and physical dimensions of HRQoL is less known, although recent studies highlight that PLWH rely on spirituality/religion to cope with HIV-associated stressors. This study examined the effects of religious coping, religiosity, depressive symptoms, medication adherence, and social support satisfaction in various dimensions of Health Related Quality of Life (HRQoL) in a sample of 292 PLWH. Majority of participants were African-American (90.1%) and 56.2% were male. Mean age was 45 years and, on average, participants lived with HIV for nearly 11 years. Descriptive statistics, correlations, Analysis of Variance (ANOVA), and hierarchical multiple linear regression were used to analyze the data. Income, sex (β= .14), age (β= -.14), depressive symptoms (β= -.27), and social support satisfaction (β= .17) significantly predicted physical HRQoL. Results indicate that income (β=.13), sex (β= .14), medication adherence (β= .13), negative religious coping (β= -.18), religious attendance (β= .13), religiousness (β= .16), and social support satisfaction (β= .27) significantly predicted mental HRQoL. Depressive symptoms (β= -.38), positive religious coping (β= .24), and social support satisfaction (β= .16) significantly predicted general HRQoL. Participants, who were female, prayed less than daily, attended religious services less than weekly or who were non/less religious had significantly poorer HRQoL. The findings confirm the importance of religion, mental health, medication adherence and social support in the HRQoL of PLWH, which should all be routinely assessed by clinicians.
References
Hays RD, Cunningham WE, Sherbourne CD, et al. Health-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV Cost and Services Utilization Study. The American journal of medi-cine. 2000; 108(9): 714-722. doi: http://dx.doi.org/10.1016/ S0002-9343(00)00387-9
Tsevat J, Leonard AC, Szaflarski M, et al. Change in quality of life after being diagnosed with HIV: a multicenter longitudinal study. AIDS patient care and STDs. 2009; 23(11): 931-937. doi: 10.1089/apc.2009.0026
Idler EL. Religion as a Social Determinant of Public Health: Oxford University Press. Website: http://www.oxfordscholar-ship.com/view/10.1093/acprof:oso/9780199362202.001.0001/ acprof-9780199362202. 2014; Accessed 2014.
Dalmida SG, Thurman SL. HIV/AIDS. In: Idler EL, ed. Re-ligion as a Social Determinant of Public Health. New York: Ox-ford University Press; 2014.
Tsevat J. Spirituality/religion and quality of life in patients with HIV/AIDS. Journal of general internal medicine. 2006; 21(S5): S1-S2. doi: 10.1111/j.1525-1497.2006.00640.x
Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc. 2001; 76(12): 1225-1235. doi: http://dx.doi. org/10.4065/76.12.1225
Miller WR, Thoresen CE. Spirituality, religion, and health. An emerging research field. Am Psychol. 2003; 58(1): 24-35. doi:
Dalmida SG, Holstad MM, Diiorio C, Laderman G. Spiritual Well-Being and Health-Related Quality of Life Among African-American Women with HIV/AIDS. Applied research in qual-ity of life. Jun 2011; 6(2): 139-157. doi: 10.1007/s11482-010- 9122-6
Dalmida SG, Holstad MM, Diiorio C, Laderman G. Spiritual well-being, depressive symptoms, and immune status among women living with HIV/AIDS. Women & health. 2009; 49(2-3): 119-143. doi: 10.1080/03630240902915036.
Dalmida SG, Holstad MM, DiIorio C, Laderman G. The meaning and use of spirituality among African American wom-en living with HIV/AIDS. Western journal of nursing research. 2012; 34(6): 736-765. doi: 10.1177/0193945912443740
Lorenz KA, Hays RD, Shapiro MF, Cleary PD, Asch SM, Wenger NS. Religiousness and spirituality among HIV-infected Americans. Journal of palliative medicine. 2005; 8(4): 774-781. doi: 10.1089/jpm.2005.8.774
Hill PC, Pargament KI. Advances in the Conceptualization and Measurement of Religion and Spirituality: Implications for physical and mental health research. American Psychologist. 2003; 58(1): 64-74. doi: http://dx.doi.org/10.1037/0003-066- X.58.1.64
Klierwer SD. Allowing Spirituality into the healing process. The Journal of Family Practice. 2004; 58(8): 616-624.
Powell LH, Shahabi L, Thoresen CE. Religion and Spiritual-ity: Linkages to physical health. American Psychologist. 2003; 58(1): 36-52. doi: http://dx.doi.org/10.1037/0003-066X.58.1.36
Coyle J. Spirituality and health: towards a framework for exploring the relationship between spirituality and health. Jour-nal of Advanced Nursing. 2002; 37(6): 589-597. doi: 10.1046/ j.1365-2648.2002.02133.x
Seeman TE, Dubin LF, Seeman M. Religiosity/Spiritual-ity and Health: A critical review of the evidence for biological pathyways. American Psychologist. 2003; 58(1): 53-63. doi:
Dalmida SG. Spirituality, mental health, physical health, and health-related quality of life among women with HIV/ AIDS: integrating spirituality into mental health care. Is-sues in mental health nursing. 2006; 27(2): 185-198. doi: 10.1080/01612840500436958
Dalmida SG. Relationships Among Spirituality, Depression, Immune Status, and Health-related Quality of Life in Women with HIV. ProQuest; 2006.
Tsevat J, Sherman SN, McElwee JA, et al. The will to live among HIV-infected patients. Annals of internal medicine. 1999; 131(3): 194-198. doi: 10.7326/0003-4819-131-3-199908030- 00006
Trevino KM, Pargament KI, Cotton S, et al. Religious cop-ing and physiological, psychological, social, and spiritual out-comes in patients with HIV/AIDS: cross-sectional and longitu-dinal findings. AIDS Behav. 2010; 14(2): 379-389. doi: 10.1007/ s10461-007-9332-6
Mrus JM, Leonard AC, Yi MS, et al. Health-Related Quality of Life in Veterans and Nonveterans with HIV/AIDS. Journal of General Internal Medicine. 2006: S39. doi: 10.1111/j.1525- 1497.2006.00644.x
Flannelly LT, Inouye J. Relationships of religion, health sta-tus, and socioeconomic status to the quality of life of individuals who are HIV positive. Issues in mental health nursing. 2001; 22(3): 253-272.
O’Leary A. Stress, Emotion, and Human Immune Func-tion. Psychological Bulletin. 1990; 108(3): 363-382. doi: http:// dx.doi.org/10.1037/0033-2909.108.3.363
Eller LS. Stress and Coping: Psychoneuroimmunology. Cop-ing with Chronic Illness: Overcoming Powerlessness 3ed. Phila-delphia: FA Davis Company; 2000: 91-123.
Frame MW, Uphold CR, Shehan CL, Reid KJ. Effects of Spirituality on Health-Related Quality of Life in Men With HIV/ AIDS: Implications for Counseling. Counseling and values. 2005; 50(1): 5. doi: 10.1002/j.2161-007X.2005.tb00037.x
Prado G, Feaster DJ, Schwartz SJ, Pratt IA, Smith L, Szapoc-znik J. Religious involvement, coping, social support, and psychological distress in HIV-seropositive African American mothers. AIDS Behav. Sep 2004; 8(3): 221-235. doi: 10.1023/ B:AIBE.0000044071.27130.46
Tarakeshwar N, Hansen N, Kochman A, Sikkema KJ. Gen-der, ethnicity and spiritual coping among bereaved HIV-positive individuals. Mental health, religion, & culture. 2005; 8(2): 109- 125. doi: 10.1080/1367467042000240383
Hansen NB, Tarakeshwar N, Ghebremichael M, Zhang H, Kochman A, Sikkema KJ. Longitudinal effects of coping on out-come in a randomized controlled trial of a group intervention for HIV-positive adults withAIDS-related bereavement. Death Stud. Sep 2006; 30(7): 609-636. doi: 10.1080/07481180600776002
Simoni JM, Martone MG, Kerwin JF. Spirituality and psy-chological adaptation among women with HIV/AIDS: Implica-tions for counseling. Journal of counseling psychology. 2002; 49(2): 139.
Weaver KE, Antoni MH, Lechner SC, et al. Perceived stress mediates the effects of coping on the quality of life of HIV-positive women on highly active antiretroviral thera-py. AIDS and Behavior. 2004; 8(2): 175-183. doi: 10.1023/ B:AIBE.0000030248.52063.11
Cotton S, Puchalski CM, Sherman SN, et al. Spirituality and religion in patients with HIV/AIDS. Journal of general inter-nal medicine. 2006; 21(S5): S5-S13. doi: 10.1111/j.1525-1497- .2006.00642.x
Cotton S, Tsevat J, Szaflarski M, et al. Changes in religious-ness and spirituality attributed to HIV/AIDS: are there sex and race differences? J Gen Intern Med. Dec 2006; 21 Suppl 5: S14- 20. doi: 10.1111/j.1525-1497.2006.00641.x
Bormann JE, Gifford AL, Shively M, et al. Effects of Spiritu-al Mantram Repetition on HIV Outcomes: A Randomized Con-trolled Trial. Journal of Behavioral Medicine. 2006; 29(5): 499. doi: 10.1007/s10865-006-9063-6
Yi MS, Mrus JM, Wade TJ, et al. Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. Jour-nal of general internal medicine. 2006; 21(S5): S21-S27. doi: 10.1111/j.1525-1497.2006.00643.x
Coleman CL. Spirituality and sexual orientation: relation-ship to mental well-being and functional health status. J Adv Nurs. Sep 2003; 43(5): 457-464. doi: 10.1046/j.1365-2648- .2003.02743.x
Grimsley LP. Spirituality and Quality of Life in HIV-Positive Persons. Journal of cultural diversity. 2006; 13(2): 113.
Tuck I, McCain NL, Elswick Jr RK. Spirituality and psycho-social factors in persons living with HIV. Journal of advanced nursing. 2001; 33(6): 776-783.
Ironson G, Stuetzle R, Fletcher MA. An Increase in Reli-giousness/Spirituality Occurs After HIV Diagnosis and Predicts Slower Disease Progression over 4 Years in People with HIV. Journal of General Internal Medicine. 2006: S62. doi: 10.1111/ j.1525-1497.2006.00648.x
Plattner IE, Meiring N. Living with HIV: The psychologi-cal relevance of meaning making. AIDS Care. 2006: 241. doi: 10.1080/09540120500456227
Sparber A, Wootton JC, Bauer L, et al. Use of Complemen-tary Medicine by Adult Patients Participating in HIV/AIDS Clinical Trials. The journal of alternative and complementary medicine. 2000; 6(5): 415. doi: 10.1089/acm.2000.6.415
Nott KH, Vedhara K, Spickett GP. Psychology, immunology, and HIV. Psychoneuroendocrinology. 1995; 20(5): 451-474. doi:
Sowell R, Moneyham L, Hennessy M, Guillory J, Demi A, Seals B. Spiritual Activities as a Resistance Resource for Women With Human Immunodeficiency Virus Nursing Research. 2000; 49(2): 73-82. doi: 10.1097/00006199-200003000-00003
Brown JL, Vanable PA, Carey MP, Elin L. Computerized stress management training for HIV+ women: a pilot inter-vention study. AIDS care. Dec 2011; 23(12): 1525-1532. doi: 10.1080/09540121.2011.569699
Coleman CL, Holzemer WL, Eller LS, Corless I, al. e. Gen-der Differences in Use of Prayer as a Self-Care Strategy for Managing Symptoms in African Americans Living With HIV/ AIDS. The Journal of the Association of Nurses in AIDS Care. 2006; 17(4): 16. doi: 10.1016/j.jana.2006.05.005
Coleman CL, Nokes KM, Corless IB, Kirksey K, Nicolas PK, Tsai. Y-F. Prayer as a Complementary Health Strategy for Managing HIV-related Symptoms Among Ethnically Diverse Patients. Holistic Nursing Practices. 2006; 20(2): 65-72.
Tarakeshwar N, Hansen N, Kochman A, Sikkema KJ, Tar-akeshwar N. Gender, ethnicity and spiritual coping among be-reaved HIV-positive individuals. Mental health, religion & cul-ture. 2005; 8(2): 109. doi: 10.1080/1367467042000240383
Gray J, Cason CL. Mastery over stress among women with HIV/AIDS. The Journal of the Association of Nurses in AIDS Care. July/August 2002; 13(4): 43-57. doi: 10.1016/S1055- 3290(06)60370-1
Bader A, Kremer H, Erlich-Trungenberger I, et al. An adher-ence typology: coping, quality of life, and physical symptoms of people living with HIV/AIDS and their adherence to antiretrovi-ral treatment. Medical Science Monitor. 2006; 12(12): CR493- CR500.
Chou F-Y. Testing a predictive model of the use of HIV/ AIDS symptom self-care strategies. AIDS patient care and STDs. 2004; 18(2): 109-117. doi: 10.1089/108729104322802533
Chang BL, Van Servellen G, Lombardi E, Chang BL. Fac-tors Associated with Complementary Therapy Use in People Living with HIV/AIDS Receiving Antiretroviral Therapy. Jour-nal of Alternative & Complementary Medicine. 2003: 695. doi: 10.1089/107555303322524544
Friedland J, Renwick R, McColl M. Coping and social sup-port as determinants of quality of life in HIV/AIDS. AIDS care. 1996; 8(1): 15-32. doi: 10.1080/09540129650125966
Dalmida SG, Koenig HG, Holstad MM, Wirani MM. The psychological well-being of people living with HIV/AIDS and the role of religious coping and social support. International journal of psychiatry in medicine. 2013; 46(1): 57-83. doi: 10.2190/PM.46.1.e
Burgoyne R, Renwick R. Social support and quality of life over time among adults living with HIV in the HAART era. So-cial Science & Medicine. 2004; 58(7): 1353-1366. doi: 10.1016/ S0277-9536(03)00314-9
Swindells S, Mohr J, Justis JC, et al. Quality of life in patients with human immunodeficiency virus infection: impact of social support, coping style and hopelessness. International journal of STD & AIDS. 1999. doi: 10.1258/0956462991914302
Snyderman D, Rovner B. Mental status exam in primary care: a review. American family physician. 2009; 80(8): 809-814.
Fetzer Institute. Multidimensional measurement of religious-ness/spirituality for use in health research: a report of the Fetzer Institute/National Institute on Aging Working Group. In: Insti-tute F, Aging NIo, eds. Kalamazoo, Michigan: Fetzer Institute; 1999.
Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of Positive and Negative Religious Coping with Major Life Stres-sors. Journal for the scientific study of religion. 1998; 37(4): 710-724.
Radloff LS, Locke BZ. The community mental health as-sessment survey and CES-D scale. New Brunswick, NJ: Rutgers University Press; 1986.
Radloff LS. The CES-D Scale: A self-report depres-sion scale for research in the general population. Ap-plied Psychological Measurements. 1977; 1: 385-401. doi: 10.1177/014662167700100306
Miles MS, Burchinal P, Holditch-Davis D, Wasilewski Y, Christian B. Personal, family, and health-related correlates of depressive symptoms in mothers with HIV. Journal of family psychology. 1997; 11(1): 23. doi: 10.1037/0893-3200.11.1.23
Vedhara K, Schifitto G, McDermott M. Disease progression in HIV-positive women with moderate to severe immunosup-pression: the role of depression. Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders. Behav Med. Spring 1999; 25(1): 43-47. doi: 10.1080/08964289909596738
Holstad MM, Foster V, Diiorio C, McCarty F, Teplinskiy I. An examination of the psychometric properties of the Antiretro-viral General Adherence Scale (AGAS) in two samples of HIV-infected individuals. J Assoc Nurses AIDS Care. Mar-Apr 2010; 21(2): 162-172. doi: 10.1016/j.jana.2009.08.002
Holstad MK, Pace JC, De AK, Ura DR. Factors associated with adherence to antiretroviral therapy. J Assoc Nurses AIDS Care. Mar-Apr 2006; 17(2): 4-15.
Sarason IG, Sarason BR, Shearin EN, Pierce GR. A brief measure of social support: Practical and theoretical implications. Journal of social and personal relationships. 1987; 4(4): 497- 510. doi: 10.1177/0265407587044007
McHorney CA, Ware Jr JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clini-cal tests of validity in measuring physical and mental health con-structs. Medical Care. 1993: 247-263.
Bell DS, Kahn Jr CE. Health status assessment via the World Wide Web. Paper presented at: Proceedings of the AMIA annual fall symposium, 1996.
Brazier J, Roberts J, Deverill M. The estimation of a prefer-ence-based measure of health from the SF-36. Journal of health economics. 2002; 21(2): 271-292. doi: 10.1016/S0167-6296- (01)00130-8
Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Journal of health economics. 1993; 2(3): 217-227.
Ware JE, Sherbourne CD. The MOS-36 Item Short-Form Health Survey (SF-36). I: Conceptual framework and item se-lection. Medical Care. 1992; 30: 473-483.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, stra-tegic, and statistical considerations. Journal of personality and social psychology. 1986; 51(6): 1173. doi: http://dx.doi. org/10.1037/0022-3514.51.6.1173
Cederfjäll C, Langius-Eklöf A, Lidman K, Wredling R. Gen-der differences in perceived health-related quality of life among patients with HIV infection. AIDS patient care and STDs. 2001; 15(1): 31-39. doi: 10.1089/108729101460083
Ruau D, Liu LY, Clark JD, Angst MS, Butte AJ. Sex differ-ences in reported pain across 11,000 patients captured in elec-tronic medical records. The Journal of Pain. 2012; 13(3): 228- 234. doi: 10.1016/j.jpain.2011.11.002
Woodrow KM, Friedman GD, Siegelaub A, Collen MF. Pain tolerance: differences according to age, sex and race. Psychoso-matic Medicine. 1972; 34(6): 548-556.
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in HIV/AIDS Research and Treatment (HRT) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.