Depressive Symptoms among African American Women with HIV Disease
Moneyham, Linda Dns, Rn, Sowell, Richard PhD, Rn, Faan, Seals, Brenda PhD, Mph, Demi, Alice Dns, Rn, Faan, Scholarly Inquiry for Nursing Practice
Depressive symptoms are a common response to HIV disease and evidence suggests that women may be at particular risk. Very little of the research on depressive symptoms within the context of HIV disease has included women, however, and even fewer studies have targeted African American women. In a beginning effort to address this gap, the authors performed a secondary analysis of data collected from 1992-1995 in a sample of 264 HIV+ women. The purpose of the secondary analysis was to describe the levels of depressive symptoms for a subsample of 152 African American subjects and to identify significant covariates. The original analysis was based on a stress and coping framework and was designed to provide a description of stressors, resistance factors, and adaptational outcomes of HIV+ women. It included various measures of psychological distress and quality of life. Depressive symptoms were not examined in the original analysis as an outcome of HIV disease, however. In the secondary analysis, depressive symptoms were operationalized using a depression subscale of the Brief Symptom Inventory (BSI) (Deragotis, 1993). Major categories of correlates examined included person resources, environmental resources, coping responses, and diseaserelated stressors. The data used in the analysis were collected during the fourth and fifth interviews of the longitudinal study, with 152 of the African American women having completed both interviews. Variance in depressive symptoms was analyzed using ANOVA, zero-order correlations, and multiple regression analysis. The mean depressive symptoms score for the subsample of African American women was considerably higher than published means for female and male normative samples, respectively. The regression model accounted for over half of the variance in depressive symptoms (R2 = .515). Significant correlates included self-esteem, family cohesion, HIV symptoms, and quality of life. The findings support personal and social resources and disease-related factors as important correlates of HIV+ African American women's depressive symptoms and suggest the need for interventions to address such factors.
As a result of recent advances in the medical treatment of human immunodeficiency virus (HIV) and the resultant acquired immune deficiency syndrome (AIDS) that slow or arrest disease progression, HIV/AIDS is now viewed as a chronic illness (Gaskins & Brown, 1997; Ungvarski, 1997; Williams, 1997). Depressive symptoms commonly occur in response to the difficulties of living with a chronic illness (Cassem, 1995; Katon & Sullivan, 1990) and are the most common secondary symptoms reported by individuals with HIV/AIDS (Holland & Tross, 1985; Markowitz, Rabkin, & Perry, 1994; Williams, Rabkin, Remien, Gorman, & Erhardt, 1991). Up to 2/3 of HIV-positive individuals report depressive symptoms at levels significantly higher than those reported for other comparison groups (Percides, Dunbar, Grunseit, Hall, & Cooper, 1992; Walker, McGown, Jantos, & Anson, 1997).
Women and minorities, however, have been underrepresented in research on depressive symptoms in HIV/AIDS. This omission is particularly significant given that women and minorities constitute the fastest growing segments of the HIV-infected population (Centers for Disease Control and Prevention [CDC], 1997, 1999), and among the general population, they report significantly higher levels of depressive symptoms than males (e.g., Hanninen & Aro, 1996; Linn, Anema, Hodess, Sharp, & Cain, 1996; Markowitz, Rabkin, & Perry, 1994). Because of their minority status, high levels of poverty, and limitations in supportive resources, African American women with HIV disease may be at particularly high risk for depressive symptoms (Brody & Flor, 1997; Warren, 1997).
The authors undertook a secondary analysis of data collected from 1992 to 1995 in a sample of 264 HIV-positive women and their families. The major findings of this longitudinal study of stressors, resistance factors, and adaptational outcomes are reported elsewhere (Demi, Moneyham, Sowell, & Cohen, 1997; Moneyham et al. …