The Role of Stress, Behavioral Disengagement and Self Distraction:

Perceived Stigma in HIV-Positive Individuals

Brooke Gomez, Chwee-Lye Chng Ph.D. & Mark Vosvick Ph.D. Center for Psychosocial Health Research

Background•Living with human immunodeficiency virus (HIV) comes with a host of complex psychological and physical stressors.• Although the rigorous and expensive treatment and taxing consequences of physical setbacks can be daunting, the stigma associated with this chronic illness is one of the primary challenges (Leary, 1998).

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Background•HIV stigma is related to negative psychosocial outcomes in people living with HIV (PLH), and is a barrier to seeking screening and healthcare for HIV (Dowshen, Binns, & Garofalo, 2009).

•Disengaging coping strategies have adverse implications on the mental health of PLH (Moskowitz, et al., 2009).

Theoretical Model

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Stress

Challenge

Threat

Primary Appraisal

Positive Stress

Secondary

Appraisal

Negative Stress; Increased Negative

Self-Image

Positive Stress

Reappraisal

Transactional Model of Stress and Coping (Lazarus and Folkman, 1984)

Hypotheses1. Stress is positively correlated with

negative self-image stigma.2. Behavioral disengagement is

positively correlated with negative self-image stigma.

3. Self distraction is positively correlated with negative self-image stigma.

4. Stress, behavioral disengagement and self distraction make up a significant proportion of the variance in negative self-image stigma.Center for Psychosocial Health Research

Participants•Participants were recruited from the Dallas/Fort Worth metroplex.

•Eligibility criteria required that participants were 18 years or over, HIV-positive and English speaking.

•IRB approval was obtained and participants signed informed consent.

•Participants received a $15 incentive.

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Demographics

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N= 215Variable N % M(SD) Rang

e

Female 96 44.7%

African American 137 55.8%

European American 77 30.7%

Latino/a 26 10.2%

Other 10 3.3%

Age (years) 41(8.52)

19-68

Education (years) 12(2.63)

1-22

Income < $10,000 65 30.2%

Unemployed 186 86.5%

LGB 182 85.7%

Duration of Infection (years)

7.7(5.24)

.08-21.6

Procedures

•Participants were given a pen-and-paper, self-report survey. Each participant was given a ID number to ensure confidentiality.

•Data was assessed for normalcy

•Participants with missing data were removed from the study

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MeasuresPerceived Stress Scale

(Cohen, Kamarck & Mermelstein, 1983; α=.84)

•10 item measure on a 5 point likert-type scale from 0 (Never) to 4 (Very Often)

•Higher scores indicate higher stress

• Item examples include “In the last month, how often have you been able to control irritations in your life?” and “In the past month how often have you felt nervous and ‘stressed?’”

•Demonstrates concurrent and predictive validity (Cohen, Kamarck & Mermelstein, 1983)

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MeasuresBrief Cope(Carver, 1997)

• 28 items, measured on a 4 point likert-type scale, from 1 (I haven’t been doing this at all) to 4 (I’ve been doing this a lot).

• Higher scores indicate a higher use of that particular coping mechanism.

• Example items include “I’ve been giving up on trying to cope” (behavioral disengagement) and “I’ve been turning to work or other activities to take my mind off things” (self distraction).

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Behavioral Disengagement Subscale:

α=.65Self Distractions Subscale: α=.71

MeasuresHIV Perceived Stigma Scale

(Berger, Ferrens & Lashley, 2001)

•40 item scale is scored on a 4 point likert-type scale from 1 (strongly disagree) to 4 (strongly agree).

•Higher scores indicate higher stigma

•Example items include “ People’s attitudes about HIV makes me feel worse about myself” and “Most people believe that a person who has HIV is dirty.”

•Moderate construct validity with the Stigma Consciousness Questionnaire (Bunn, 2007).

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Negative Self-Image Subscale: α=.84

Data Analysis

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Mean(SD)Possible Range

Actual Range

Calculated α

Behavioral Disengagement

3.8(1.79) 2-8 2-8 .63

Self Distraction 4.9(1.76) 2-8 2-8 .50

Perceived Stress 19.6(6.37) 0-40 1-40 .66

Negative Self-Image Stigma

29.9(8.89) 13-52 13-52 .90

Univariate

Data AnalysisBivariate p<.05*, p<.01**

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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

1. Age -

2. Gender -.11 -

3. Education .19**

-.24**

-

4. <10,000 .04 -.15* .27**

-

5. Duration .23**

-.06 .00 .00 -

6. Sexual Orientation -.08 -.59**

.24**

.19**

.11 -

7. Employment -.02 .04-.14**

-.29**

-.04 -.06 -

8. African American .13* .02 .04 -.10 .02 -.10 .04 -

9. Behavioral Disengagement

-.13* .04-.19**

-.13* -.01 .01 .10 .07 -

10. Self Distraction -.06 .02 .03 .09 -.01 .03 -.00 -.02 .36** -

11. Perceived Stress -.10 .17**

-.05 -.02 -.06 .03 .06 -.06 .29**.29*

*-

12. Neg. Self-Image Stigma -.06 .04 .04-.17**

-.01 .05 .04 -.02 .32**.27*

*.37*

*

Data AnalysisHierarchical Regression Analysis

Outcome variable: Negative Self-Image Stigma

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IV β t p Tol VIF

Perceived Stress .28 4.06 <.001 .90 1.1

Behavioral Disengagement

.16 2.34 <.05 .90 1.1

Self Distraction .16 2.31 <.05 .98 1.0

(Adj. R squared: .21 (F (11, 203) = 8.26, p < .01)

Discussion•Negative self-image stigma includes feelings of shame, guilt and lack of self-worth and it is associated with low adherence to highly active antiretroviral therapy (HAART), a decrease in help seeking behavior, and low quality of life (Jimenez, et al., 2010).

•Our findings suggest that using disengaging coping mechanisms to deal with the stress associated with HIV is a predictor of increased negative self-image stigma.

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Clinical Implications•Clinicians should be mindful of the stressors PLH encounter, and the impact they have on their client’s life.

•Clinicians should work to assess client’s coping mechanisms, particularly those that are maladaptive and disengaging.

•Cognitive behavioral therapy can be used as a way to find positive alternative coping strategies.

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Limitations•Some responses may be influenced by self report bias.

•Limited generalizability due to sample’s demographics (ethnicity, locations, etc.).

•Due to cross sectional correlational design, causation cannot be inferred.

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Acknowledgements

We would like to thank the Center for Psychosocial Health

Research’s members and faculty, the HIV community, the Dallas Resource Center

and the Samaritan House of Fort Worth.

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Questions?

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References•Bunn, J., Solomon, S. E., Miller, C., & Forehand, R. (2007). Measurement of stigma in people with HIV: A reexamination of the HIV stigma scale. AIDS Education And Prevention.

•Dowshen, N., Binns, H. J., & Garofalo, R. (2009). Experiences of HIV-related stigma among young men who have sex with men. AIDS Patient Care And Stds,

•Leary, M. R., & Schreindorfer, L. S. (1998). The stigmatization of HIV and AIDS: Rubbing salt in the wound. In V. J. Derlega, A. P. Barbee, V. J. Derlega, A. P. Barbee (Eds.) , HIV and social interaction (pp. 12-29). Thousand Oaks, CA US: Sage Publications, Inc.

•Jimenez, J., Puig, M., Ramos, J., Morales, M., Asencio, G., Sala, A., & ... Zorrilla, C. (2010). Measuring HIV felt stigma: A culturally adapted scale targeting PLWHA in Puerto Rico. AIDS Care,

•Moskowitz, J., Hult, J. R., Bussolari, C., & Acree, M. (2009). What works in coping with HIV? A meta-analysis with implications for coping with serious illness. Psychological Bulletin,

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