Chronic pain is a common and costly experience. Cognitive-behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. It is unknown whether CBT works in low-socioeconomic (SES), minority and non-minority groups. To address this question, we conducted a Randomized Controlled Trial within a low-SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared to a group education intervention (EDU). We hypothesized that while both interventions would elicit short- and long-term improvement across pain-related outcomes, the cognitively-focused CBT protocol would uniquely influence pain catastrophizing. Mixed design ANOVAs were conducted on the sample of eligible participants who did not commence treatment (N=26), the intent-to-treat sample (ITT; N=83), and on the completer sample (N=61). Factors associated with treatment completion were examined. Results indicated significantly more drop-outs occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain-related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6-month follow-up (N=54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate CBT and EDU are viable treatment options in low-SES, minority and non-minority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations.

The purpose of this study was to describe HIV/AIDS-related stigma in older African Americans living in the South, a population disproportionately affected by HIV/AIDS. Four focus groups were conducted with 24 men and women over 50 years old and a confirmed diagnosis of HIV. The focus group discussions were audiotaped and transcribed for analysis. Additionally, two stigma instruments, Self-Perceptions of HIV Stigma, and Stigma Impact of HIV, were used to enhance the qualitative data from the focus groups. Constant comparative data analysis of the focus group discussions resulted in four themes related to HIV/AIDS stigma: (1) disclosure; (2) stigma experiences; (3) need for HIV/AIDS education; and (4) acceptance of the disease. Strategies to prevent or decrease anticipated stigma were described, such as selective or non-disclosure and not receiving care where they lived. The stigma instruments indicated that the participants had experienced the most stigma related to their internalized shame about having HIV disease, and had experienced little or no direct stigma. The study findings have implications for designing prevention programs, and strategies to improve social support for this age group.

This study was undertaken in order to better understand the detection of depression by primary care physicians. Specifically, we investigated the relationship between information gathered during the course of the medical interview and the subsequent diagnosis of depression. Forty-seven community-based primary care physicians, unaware of the mental health focus of this research, were videotaped in the office setting, as they interviewed two "typical" standardized patients who met DSM-III-R criteria for major depression. One patient presented with headaches and the other presented with palpitations and chest pain. After each interview, physicians were provided with physical findings and results of any diagnostic procedures they ordered, then asked to construct and explicate their differential diagnoses. The two patients were correctly diagnosed as depressed by 53 and 45% of the physicians. Although detection was related to greater amounts of information gathered, inquiry about the DSM-III-R criteria symptoms was generally low, and in no case was sufficient information acquired to make a formal DSM-III-R diagnosis of depression. However, a subset of the DSM-III-R symptoms (those related to disturbances of appetite, sleep, and other neurovegetative functions) were among the reasons cited for inclusion of depression in the differential, as were psychosocial stressors and the patient's appearance. These findings suggest that detection of depression is low by primary care physicians.

Disclosure of one's HIV status to others is an important decision. There are benefits and risks to be considered. Also decisions must be made about the recipients of the disclosure. This study explored reasons for disclosure and non-disclosure among rural African American men in the south. Audiotaped interviews were conducted with 40 men. The most common reasons for disclosure were to relieve stress, satisfy the need to tell, help others, and to receive support. The most common reasons for non-disclosure were the fear of negative reaction or stigma, the fear of the disclosure recipient telling others, a belief that there was no need to tell, not being ready to tell, and not wanting to burden others with the disclosure.

1. Sources of hope in older adults include religious symbols, relationships with others, and activities. 2. In older adults, hope gives their lives purpose and meaning. 3. Hope transcends time; it is a present positive emotion related to the future that may be influenced by the past.