Academic journal article Research and Theory for Nursing Practice

Do Social Support, Stigma, and Social Problem-Solving Skills Predict Depressive Symptoms in People Living with HIV? A Mediation Analysis

Academic journal article Research and Theory for Nursing Practice

Do Social Support, Stigma, and Social Problem-Solving Skills Predict Depressive Symptoms in People Living with HIV? A Mediation Analysis

Article excerpt

Social support, stigma, and social problem solving may be mediators of the relationship between sign and symptom severity and depressive symptoms in people living with HIV (PLWH). However, no published studies have examined these individual variables as mediators in PLWH. This cross-sectional, correlational study of 150 PLWH examined whether social support, stigma, and social problem solving were mediators of the relationship between HIV-related sign and symptom severity and depressive symptoms. Participants completed self-report questionnaires during their visits at two HIV outpatient clinics in the Southeastern United States. Using multiple regression analyses as a part of mediation testing, social support, stigma, and social problem solving were found to be partial mediators of the relationship between sign and symptom severity and depressive symptoms, considered individually and as a set.

Keywords: social support; stigma; depressive symptoms; social problem solving; HIV

Despite the use of highly active antiretroviral therapy (HAART) to delay the progression of HIV to AIDS, people living with HIV (PLWH) continue to experience varying degrees of sign and symptom severity. Empirical data indicate that PLWH report moderate-to-severe signs and symptoms (Merlin et al., 2011) from disease- and medication-related side effects (Cook, Sousa, Matthews, Meek, & Kwong, 2011; Feasey, Healey, & Gordon, 2011; Wantland et al., 2011). Several studies also suggest that PLWH are at high risk for depressive symptoms (Bhatia, Hartman, Kallen, Graham, & Giordano, 2011; Havlik, Brennan, & Karpiak, 2011; Hudson, Lee, & Portillo, 2003). Furthermore, HIV-related sign and symptom severity in PLWH may contribute to their high risk for depressive symptoms (Jong et al., 2010). Empirical findings also indicate that social support, stigma, and social problem solving are associated with these depressive symptoms in PLWH (Andrinopoulos et al., 2011; Chibanda et al., 2011; Smit et al., 2012).

This study uses a statistical approach known as mediation analyses to examine whether social support, stigma, and social problem solving alter the relationship between HIV-related sign and symptom severity and depressive symptoms in PLWH. It is important to remember that mediation analyses cannot substantiate causation. Identification of factors that influence depressive symptoms in PLWH is important in the development of effective interventions. Therefore, knowledge generated from this study may be useful in identifying components that are important for decreasing the risk of depressive symptoms in PLWH experiencing varying degrees of HIV-related sign and symptom severity. Unfortunately, we were unable to find any published studies that examined these variables as mediators in PLWH. Therefore, the purpose of this study was to examine whether social support, stigma, and social problem solving were mediators of the relationship between HIV-related sign and symptom severity and depressive symptoms in PLWH.

The current investigation used components of stress, appraisal, and coping theory (D'Zurilla & Nezu, 2007; Lazarus, 1999; Lazarus & Folkman, 1984) to conceptualize relationships among variables in this study. HIV-related signs and severity of symptoms are viewed as stressors that influence psychological adaptation or depressive symptoms in PLWH. PLWH use social support (Lazarus & Folkman, 1984) and social problem solving (D'Zurilla & Nezu, 2007) as resources to manage or cope with HIVrelated sign and symptom severity and promote positive adaptational outcomes. Stigma negatively affects positive beliefs and use of coping resources. Furthermore, social support and social problem solving are coping resources that are viewed as mediators between the cognitive appraisal of stressful situational demands and the response to those demands (D'Zurilla & Nezu, 2007). Therefore, in addition to their influence on depressive symptoms, HIV-related sign and symptom severity may affect depressive symptoms through social support, HIV-related stigma, and social problem solving. …

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