Trauma history in African-American women living with HIV: effects on psychiatric symptom severity and religious coping

Abstract

Women living with HIV (WLHIV) have rates of post-traumatic stress disorder (PTSD) up to 5 times higher than the general population. Individuals living with HIV and a concurrent diagnosis of PTSD have poorer HIV-related outcomes; however, the prevalence and impact of PTSD on African-American WLHIV seeking mental health treatment is unknown. The aim of this study is to examine the associations between PTSD symptoms with psychiatric symptom severity and psychological/religious coping strategies in African-American WLHIV who are seeking mental health treatment. This is a cross-sectional study of 235 African-American WLHIV attending an urban community mental health clinic. Bivariate analyses were conducted to evaluate associations between a PTSD symptoms scale (PSS≥21 versus PSS<21) and (1) psychiatric severity, (2) coping strategies, and (3) religious coping strategies. Thirty-six percent reported symptoms consistent with PTSD (PSS≥21). These women were significantly more likely to have worse mental health symptoms and were more likely to employ negative psychological and religious coping strategies. On the contrary, women with a PSS<21 reported relatively low levels of mental health symptoms and were more likely to rely on positive psychological and religious coping strategies. Over one-third of African-American WLHIV attending an outpatient mental health clinic had symptoms associated with PTSD. These symptoms were associated with worse mental health symptoms and utilization of dysfunctional religious and nonreligious coping strategies. Untreated PTSD in WLHIV predicts poorer HIV-related health outcomes and may negatively impact comorbid mental health outcomes. Screening for PTSD in WLHIV could identify a subset that would benefit from evidence-based PTSD-specific therapies in addition to mental health interventions already in place. PTSD-specific interventions for WLHIV with PTSD may improve outcomes, improve coping strategies, and allow for more effective treatment of comorbid mental health disorders.

Global estimate of the prevalence of post-traumatic stress disorder among adults living with HIV: a systematic review and meta-analysis

“…Of those, 7 were excluded for repeated data, 9 were excluded for targeting PLWH who received psychological intervention or suffered from genocide/natural disaster and 62 were excluded for not reporting the PTSD prevalence among PLWH. Finally, a total of 38 studies14 24 25 38–72 met inclusion criteria and were included in this meta-analysis. Search results are elaborated in figure 1.…”

PTSD co-morbid with HIV: Separate but equal, or two parts of a whole?

“…In addition to low SES as mentioned above, additional risk factors for HIV include drug use, risky sexual behaviors, traumatic experiences, and geographical region ( Johnson et al, 2014 ). Additionally, the psychiatric symptoms of PTSD have an adverse influence on patient compliance with treatment of concurrent medical illness ( Shemesh et al, 2001 ; Delahanty et al, 2004 ; Hilerio et al, 2005 ; Sledjeski et al, 2005 ; Kartha et al, 2008 ), and may independently influence progression and risk for medical disease, ( Delahanty et al, 2004 ; Kubzansky et al, 2007 ) such as HIV ( Yiaslas et al, 2014 ; Brownley et al, 2015 ).…”

“…Furthermore, nonadherence in PLWH is particularly prevalent in individuals with a history of early life trauma and post-traumatic stress disorder (PTSD) ( Keuroghlian et al, 2011 ; Samuels et al, 2011 ; Machtinger et al, 2012a ; Whetten et al, 2013a ). In fact, PTSD predicts worse HIV-related outcomes for both women ( Katz and Nevid, 2005 ; Brownley et al, 2015 ) and men ( Yiaslas et al, 2014 ). Furthermore, increased emotional reactivity and stress can raise the risks to the larger community because along with increased nonadherence, elevated stress and emotional reactivity have been linked to increased sexual transmission risk behaviors ( Machtinger et al, 2012a ; O’Cleirigh et al, 2013 ; Adedimeji et al, 2014 ).…”

Religious Fundamentalism, Satisfaction with Life and Posttraumatic Stress Symptoms Intensity in a Polish Sample of People Living with HIV/AIDS

“…Positive association between religiosity and well-being in PLWHA is based on religion providing a source of social support, recovery of meaning in life and a coping mechanism (Siegel and Schrimshaw 2002 ; Steglitz et al 2012 ). Positive religious coping (e.g., a reflection of a secure relationship with God, a belief in life’s larger meaning and a sense of spiritual connectedness with others; Pargament et al 1998 ) was significantly associated with positive mood and life satisfaction in PLWH (Lee et al 2014 ), reduced depressive symptoms in PLWHA (Dalmida et al 2013 ) and PTSSs in HIV-positive women (Brownley et al 2015 ). Religiosity may also be associated with lower-HIV-risk behaviors (Shaw and El-Bassel 2014 ) and adherence to therapy in PLWH (Kisenyi et al 2013 ).…”