Lauren M. Kaplan

Victimization in Early Life and Mental Health in Adulthood: An Examination of the Mediating and Moderating Influences of Psychosocial Resources.

Although numerous studies have documented the long-term effects of childhood victimization on mental health in adulthood, few have directly examined potential mediators and moderators of this association. Using data from the Welfare, Children, and Families project (1999)—a probability sample of 2,402 predominantly black and Hispanic low-income women with children living in Boston, Chicago, and San Antonio—we predict psychological distress in adulthood with measures of physical assault and sexual coercion before age 18. Building on previous research, we test the mediating and moderating influences of emotional support, instrumental support, and self-esteem. Although we observe no indirect effects of physical assault, the effect of sexual coercion is partially mediated by instrumental support and self-esteem. We also find that the effects of physical assault and sexual coercion are moderated (buffered) by emotional support and self-esteem.

The fork in the road: HIV as a potential positive turning point and the role of spirituality.

Abstract We interviewed 147 HIV-positive people regarding their key life-changing experiences – involving profound changes in attitudes, behaviors, beliefs (including spiritual beliefs), or self-views – to determine the prominence of HIV as the key positive/negative turning point. HIV was the key turning point, for 37% (26% positive, 11% negative), whereas for 63% of our sample it was not. Characteristics associated with perceiving HIV as the most positive turning point included having a near-death experience from HIV, increasing spirituality after HIV diagnosis, and feeling chosen by a Higher Powerto have HIV. Notably, perceived antecedents of viewing HIV as the key positive turning point were hitting rock bottom and calling on a Higher Power. Conversely, viewing HIV as the most negative turning point was associated with declining spirituality after diagnosis. Spirituality can both negatively and positively affect coping with HIV. Promoting positive spiritual coping may offer new counseling approaches. Further, for the majority of the participants, HIV is not the key turning point, which may be an indicator of the normalization of HIV with the advent of effective treatment.

The Long-Term Health Consequences of Relationship Violence in Adulthood: An Examination of Low-Income Women from Boston, Chicago, and San Antonio

OBJECTIVES We examined the long-term health consequences of relationship violence in adulthood. METHODS Using data from the Welfare, Children, and Families project (1999 and 2001), a probability sample of 2402 low-income women with children living in disadvantaged neighborhoods in Boston, Massachusetts; Chicago, Illinois; and San Antonio, Texas, we predicted changes in the frequency of intoxication, psychological distress, and self-rated health over 2 years with baseline measures of relationship violence and a host of relevant background variables. RESULTS Our analyses showed that psychological aggression predicted increases in psychological distress, whereas minor physical assault and sexual coercion predicted increases in the frequency of intoxication. There was no evidence to suggest that relationship violence in adulthood predicted changes in self-rated health. CONCLUSIONS Experiences with relationship violence beyond the formative and developmental years of childhood and adolescence can have far-reaching effects on the health status of disadvantaged urban women.

Americans’ Attitudes toward Mental Illness and Involuntary Psychiatric Medication:

This study uses data from the Mental Health Modules of the General Social Survey (1996 and 2006) to understand why some Americans endorse the involuntary use of psychiatric medication. Results indicated that in 1996 and 2006, 28 percent of Americans believed that people with mental illness should be forced by law to take psychiatric medication. The belief that people with mental illness are dangerous significantly contributed to Americans’ endorsement of this form of mandated treatment. Interestingly, the belief that mental illness is caused by stress increased the odds of support for mandated medication in 1996 and then reduced the odds of support in 2006. Moreover, stigmatizing preferences for social distance from those with mental illness were no longer contributing factors in 2006. It is still imperative, however, that public policy makers promote anti-stigma initiatives to reduce barriers to psychiatric treatment and counteract the public’s lingering fear of people with mental illness.

Compassionate love as a predictor of reduced HIV disease progression and transmission risk

Objectives. This study examined if compassionate love (CL) predicts HIV disease progression and transmission risk. Scientific study of CL emerged with Underwoods working model of other-centered CL, defining five criteria: free choice, cognitive understanding, valuing/empowering, openness/receptivity for spirituality, and response of the heart. Method. This 10-year cohort study collected 6-monthly interviews/essays on coping with HIV and trauma of 177 people with HIV in South Florida. Secondary qualitative content analysis on other-centered CL inductively added the component of CL towards self. Deductively, we coded the presence of the five criteria of CL and rated the benefit of CL for the recipient on a 6-point Likert scale. Growth-curve modeling (reduced to 4 years due to cohort effects) investigated if CL predicts CD4 slope (HIV disease progression) and cumulative viral load detection (transmission risk). Results. Valuing/empowering and cognitive understanding were the essential criteria for CL to confer long-term benefits. CL had a higher benefit for recipients if given out of free choice. High scores of CL towards self were reciprocal with receiving (93%) and giving (77%) other-centered CL. Conversely, those rated low on CL towards self were least likely to score high on receiving (38%) and giving (49%) other-centered CL. Growth-curve modeling showed that CL towards self predicted 4-year cumulative undetectable viral load (independent from sociocultural differences, substance use disorder, baseline CD4 and viral load). Those high versus low on CL self were 2.25 times more likely to have undetectable viral load at baseline and 1.49 times more likely to maintain undetectable viral load over time. CL towards self predicted CD4 preservation after controlling for differences in CL giving. Conclusions. CL towards self is potentially the seed of being expressive and receptive of CL. Health care professionals prepared to walk the extra mile for those who neglect and isolate themselves may break a vicious circle since those lacking CL self were least likely to receive CL from others. Future studies should examine whether any enhancement of CL towards self may translate into slower disease progression and reduction of transmission risk.

Does Alcohol Consumption Exacerbate the Mental Health Consequences of Interpersonal Violence

Although studies show that interpersonal violence is associated with poorer mental health, few studies specify the conditions under which victimization can be more or less detrimental to psychological well-being. Building on previous research, the authors test whether the association between interpersonal violence and psychological distress is moderated by alcohol consumption. Our analysis of longitudinal data from the Welfare, Children, and Families project suggests that interpersonal violence is more strongly associated with psychological distress in the context of more frequent intoxication. Programs designed to treat the combination of victimization and heavy alcohol consumption may make unique contributions to the well-being of women.

Biographical Analysis Using Narrative and Topical Interviews

The use of biographical methodology grew in the 1960s as researchers became increasingly concerned with the importance of personal and social meanings as a basis for action and critiqued positivist approaches as being detached from lived reality (Chamberlayne et al. 2000). Researchers focused on the debates of the relationship between agency and social structure and felt that despite Gidden’s (1995) contribution of structuration theory to help clarify the link between agency and social structure, their linkage remained insufficiently clarified. The search to identify research methods that examined multiple aspects of social reality drove a “turn” to biographical methodology (Chamberlayne et al. 2000). Biographical research provides a means of relating micro- and macro- levels of social reality which are rooted in personal and collective history.

Frankfurt am Main, Germany, and Miami, Florida, The United States of America: A Constant Comparative Case Analysis

In the following chapters the comparative analysis research and findings are discussed. First I provide the interview settings and case descriptions. Then, the findings of this study are organized into four parts. In Part 1, I discuss the conditions for the emergence of a trajectory of suffering. Next, in Part 2 biographical processes including processes of action and transformative processes are examined. Theoretical aspects of negotiating HIV such as disclosure and stigma are presented in Part 3. Finally, structural conditions related to negotiating HIV such as immigration and medical care social policies as experienced by participants are discussed. All names have been changed to ensure confidentiality.