Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression

Abstract

The issue of whether optimism may prospectively protect against disease progression is one that has generated much interest, with mixed results in the literature. The purpose of this study was to determine whether dispositional optimism predicts slower disease progression in HIV. Two indicators of disease progression, CD4 counts and viral load, were assessed over 2 years in a diverse group (men, women, White, African American, Hispanic) of 177 people with HIV in the midrange of disease at entry to the study. Optimism predicted slower disease progression (less decrease in CD4 and less increase in viral load) controlling for baseline CD4 and viral load, antiretroviral treatment, gender, race, education, and drug use. Those low on optimism (25th percentile) lost CD4 cells at a rate 1.55 times faster than those high on optimism (75th percentile). Optimists had higher proactive behavior, less avoidant coping, and less depression: These variables mediated the linear optimism-disease progression relationship. Thus, optimists may reap health benefits partly through behavioral (proactive behavior), cognitive (avoidant coping), and affective (depression) pathways. Implications, limitations, and interpretations are discussed. Taylor et al., 2000). One of the most intriguing of these is optimism. There is the popular belief that maintaining hope or optimism may influence survival. Many doctors encourage their patients to develop a positive attitude believing it may be helpful to patients (Schofield et al., 2004). However, there have only been a few studies scientifically examining this.One study gaining widespread attention (Schofield et al., 2004) recently found that dispositional optimism did not predict progression-free survival in patients with lung cancer and concluded that "encouraging patients to 'be positive' may only add to the burden of having cancer while providing little benefit" (p. 1276). Schulz, Bookwala, Knapp, Scheier, and Williamson (1996) found that, although dispositional optimism did not predict survival in patients with recurrent or metastasized cancer receiving palliative radiation treatment, pessimistic life orientation was a risk factor for mortality but only in younger (age < 59) patients. In contrast, dispositional optimism predicted survival over 1 year in head and neck cancer patients (Allison, Guichard, Fung, & Gilain, 2003). Several studies not restricted to cancer patients found that dispositional optimism is related to better health outcomes including better recovery and less rehospitalization from coronary bypass surgery Scheier et al., 1999) and lower all cause and cardiovascular mortality (Giltay, Geleijnse, Zitman, Hoeskstra, & Evert, 2004). In addition, one study found that a "cognitive adaptation index," which included dispositional optimism, situational-specific optimism, self-esteem, and mastery, predicted fewer new coronary events after Percutaneous Transluminal Coronary Angioplasty (PTCA) (Helgeson & Fritz, 1999).Although most of the studies noted previously focused on dis...

Personality and HIV Disease Progression: Role of NEO-PI-R Openness, Extraversion, and Profiles of Engagement

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