Nancy T. Blaney

Active coping style is associated with natural killer cell cytotoxicity in asymptomatic HIV-1 seropositive homosexual men

The aim of this study was to examine the hypothesis that a psychosocial model was associated with natural killer cell cytotoxicity (NKCC) in HIV-1 infection. A sample of 62 HIV-1 seropositive homosexual men at CDC stages II and III were given a psychosocial battery assessing life stressors, social support, and coping style. A regression model quantifying these variables along with control variables for alcohol use, substance use and nutritional status was estimated. Active coping style was directly and positively associated with NKCC, and trends toward a negative relationship of life stressors and a buffering effect of social support on lives stressors were also observed. The results suggest that (1) control variables should be included with psychosocial models and that (2) psychosocial factors, especially active coping, may have a deterrent effect on loss of NK cell function. Active coping style may merit a specific focus in future research of life stressors and the immune system.

A stress-moderator model of distress in early HIV-1 infection: Concurrent analysis of life events, hardiness and social support

A stress moderator framework was employed to investigate the relationship of negative life events, hardiness and social support to psychological distress among 67 asymptomatic HIV-1 seropositive gay males. Both main effects and stress moderator (interaction) models were evaluated. Main effects were found for negative life events and social support but not hardiness (either as commitment or overall hardiness); no moderator effects emerged. Results were the same whether events were quantified as negative impact or as number of events, and were in the predicted direction--life events associated with greater distress, social support with less distress. The present study replicates for early HIV-1 infection findings obtained in non-HIV-infected samples about the influence on psychological distress of negative life events and social support. Methodological limitations, possible explanations for the absence of stress moderator effects, and clinical implications of the findings are discussed.

A psychological assessment of chronic fatigue syndrome/chronic epstein-barr virus patients

Abstract Chronic Fatigue Syndrome (CFS), the current name for a malady most recently known as Chronic Epstein Barr Virus (CEBV), is a medical puzzle that now is a focus of intense research interest. Although the literature is sparse and studies are either anecdotal or based on small samples, psychological and psychiatric symtoms are frequently reported for patients with symptoms suggestive of CFS/CEBV. Cognitive impairment in this population has been frequently noted but has also received little systematic attention in CFS/CEBV research. Consequently, the aim of this study was twofold: (1) to broaden understanding of the psychological aspects of CFS/CEBV, including cognition, and (2) to place this understanding on a firmer empirical basis by use of a more comprehensive battery and a larger sample than typifies previous research. Twenty-four subjects exhibiting both serological profile and clinical symptomatology indicative of CEBV/CFS infection were investigated. Multiple measures were employed to tap per...

A psychosocial model of distress over time in early hiv-1 infection: The role of life stressors, social support and coping

Abstract This study tested whether a psychosocial model-consisting of life event stressors, social support and coping strategy-was associated with distress over time in 40 homosexual men with asymptomatic HIV-1 infection. With prior distress controlled, changes in distress were associated with changes in negatively rated life events and social support (replicating our cross-sectional findings) and with coping strategy (disengagement/denial, venting emotions and religion). Stringent tests that ruled out spurious moderator effects yielded significant stress moderator interactions for social support and active coping, as well as evidence for nonlinear relationships for both main effects and interactions. These findings confirm that the psychosocial model is associated with distress over time during asymptomatic HIV-1 infection. The model thus provides a framework for screening to identify patients who would benefit from clinical interventions while simultaneously identifying the areas most needing intervention.

Cobalamin level is related to self-reported and clinically rated mood and to syndromal depression in bereaved HIV-1+ and HIV-1- homosexual men

OBJECTIVE An examination of the relationship of plasma cobalamin (vitamin B(12)) level to overall psychological distress, specific mood states, and major depressive disorder was conducted in 159 bereaved men (90 HIV-1(+) and 69 HIV-1(-)). METHODS The relationship of a continuous measure of cobalamin level to psychological distress was examined, while controlling for HIV-1 serostatus, life stressors, social support, and coping styles. RESULTS Of this sample, 23.9% were either overtly or marginally cobalamin deficient; however, the deficiency rate was not significantly different by HIV-1 serostatus. Cobalamin level was inversely related to self-reported overall distress level and specifically to depression, anxiety, and confusion subscale scores, as well as to clinically rated depressed and anxious mood. Lower plasma cobalamin levels also were associated with the presence of symptoms consistent with major depressive disorder. CONCLUSION These findings suggest that cobalamin level may be physiologically related to depressed and anxious mood level, as well as to syndromal depression.

Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men

Objective Previous research has demonstrated that a theoretical model including measures of life stressors, social support, and coping style significantly predicts psychological distress. This study tested plasma pyridoxine (vitamin B6) deficiency status as a predictor of overall psychological distress and specific mood states in this model, controlling for HIV-1 serostatus. Method Subjects included HIV-1 + (N = 76) and HIV-1 - (N = 58) recently bereaved homosexual men. At baseline, subjects completed a battery of psychosocial questionnaires, together with a physical examination and venipuncture. The Profile of Mood States (POMS) provided measures of overall psychological distress as well as specific mood states. Pyridoxine deficiency status (a categorical measure of deficient vs. adequate status) was determined with a bioassay of erythrocyte aspartate aminotransferase activity. Results Pyridoxine deficiency was a significant predictor of increased overall psychological distress in this model, controlling for life stressors, social support, coping style, and HIV-1 serostatus. In post hoc analyses of specific mood state effects, pyridoxine deficiency status was significantly associated with increases in depressed, fatigued, and confused mood levels, but not with those of anxiety, anger, or vigor. Discussion These findings suggest that adequate pyridoxine status may be necessary to avert psychological distress in the setting of bereavement. Inasmuch as pyridoxine is a cofactor for 5-hydroxytryptophan decarboxylase-an enzyme in the biosynthesis pathway of serotonin-serotonin level in the brain is implicated as the mediating factor.

Emotional distress, stress-related disruption and coping among healthy HIV-positive gay males

Abstract Although emotional distress is extensive both when HIV seropositivity is first determined and during symptomatic stages of the infection, it is not known if distress also characterizes the often lengthy asymptomatic period. To ascertain if it does, a sample (N=45) of asymptomatic HIV seropositive gay males was assessed on emotional distress, stressors, and coping styles. Data were compared with available normative data as well as with a small control sample (N=13) of seronegative gay males. On emotional distress indices, the majority of seropositive participants scored below the norms for psychiatric patient groups, resembling more the norms for non-patients, although there was a distressed subset. Despite evidence of considerable event-related stress, the moderate levels of currently-perceived stress among the seropositives indicated that as a whole they were not feeling overwhelmed. Coping styles did not appear to be disrupted in that they were nearly identical to normative data. In comparison ...

Immune function and anti-HTLV-I/II status in anti-HIV-1-negative intravenous drug users receiving methadone

PURPOSE The study objective was to evaluate the effects of long-term methadone use and human T-cell leukemia virus (HTLV) types I and II seropositivity on the distribution of lymphocyte subsets and on lymphocyte function as measured in vitro in intravenous drug users seronegative for human immunodeficiency virus type 1 (HIV-1). PATIENTS AND METHODS Anti-HIV-1-negative intravenous drug users receiving methadone maintenance therapy (n = 24) were studied in a Veterans Administration drug abuse treatment center. These subjects were compared to 38 age- and sex-matched control subjects who did not abuse drugs. HIV-1 and HTLV serostatus was determined by repetitive enzyme-linked immunosorbent assay and confirmed by immunoblot. Lymphocyte subsets were determined by two-color flow cytometry. Lymphocyte function was measured by proliferative response to plant mitogens and by natural killer (NK) cell-mediated cytotoxicity to a tumor cell target. RESULTS Significant differences were seen in lymphocyte phenotype in the methadone-treated group, with elevations in the T-cell helper subset CD4+CD26+; in CD8 and CD8+I2+ cells, suppressor/cytotoxic T lymphocytes, and activated suppressor/cytotoxic T cells; and in CD2+CD26+ cells and activated total T lymphocytes. Lymphocyte function was suppressed in the methadone group, with poor responses to pokeweed mitogen and phytohemagglutinin in culture. Moreover, NK-cell cytotoxicity was significantly reduced in the methadone group. None of these immunologic differences were attributable to HTLV serostatus. CONCLUSION The immune abnormalities seen suggest that a clinically significant degree of immune impairment exists in methadone-treated intravenous drug users. However, these abnormalities could not be explained by the presence of other retroviruses in this HIV-1-negative study group, as there was no significant difference in immune function when HTLV-seropositive patients were compared to HTLV-seronegative subjects treated with methadone.

Integrating mental health services into primary care for HIV-infected pregnant and non-pregnant women: whole life—a theoretically derived model for clinical care and outcomes assessment

Poor women of color who are disproportionately both infected and affected by HIV/AIDS also face multiple lifestyle and psychosocial burdens that complicate effective delivery of health care, thereby contributing to their poorer prognosis. Addressing these factors within the context of HIV/AIDS primary care for women is the aim of Whole Life, a program to integrate mental health services into primary care for HIV-infected pregnant and non-pregnant women. Whole Life utilizes a theoretically derived clinical services model that provides data for both clinical care and patient outcomes research within the constraints of a clinical setting. During a womans first two clinic visits, data are gathered in structured interviews with standardized instruments-adapted for relevance to the population-that meet clinical and service needs, as well as measure components of the Whole Life model. Interviews are conducted by existing front-line staff who have been trained in using these instruments to gather information typically recorded in clinical notes. The implementation of Whole Life to date clearly demonstrates the feasibility of mental health-primary care services integration in a publicly funded HIV primary care clinic serving poor women of color.

Bereavement and HIV infection

The loss of a loved one is a potent and frequent life stressor for those infected with HIV and those at risk for infection. Early in the epidemic, bereavement in homosexual men was associated with increased distress in a dose-response relationship with the number of losses. More recent research suggests that this is not the case, though a relationship with increased grief level and with perceived self-threat is still recognized. A change in the form of bereavement response to a reaction resembling chronic, post-traumatic distress is also possible. Future research using a stressor-support-coping model is advocated to investigate this possibility. Studies on the effect of bereavement should be conducted with other HIV infected and at-risk groups. Brief, supportive, group psychotherapy for recent loss and total loss burden due to HIV/AIDS is advocated to prevent associated psychological morbidity. The effects of such interventions on immune measures and the clinical progression of HIV disease also merits inv...