1. Center for Psychosocial Health Denial, Daily Hassles and Distress in HIV Positive Individuals Brooke Gomez, Thomas DeSena M.A., James Miller M.A., Kyle Deaton B.A., & John Ridings B.A., Mark Vosvick PhD University of North Texas University of North Texas Center for Psychosocial Health

2. BACKGROUND Health Distress is associated with lower Quality of Life, higher anxiety, depression and general emotional distress in people living with HIV/AIDS (Lightfoot, et. al.,2005). Health Distress is associated with lower Quality of Life, higher anxiety, depression and general emotional distress in people living with HIV/AIDS (Lightfoot, et. al.,2005). Denial is a significant predictor of lowering treatment initiation and retention in mental health care (Ortega, Bicaldo, 2005). Illness denial is a major indicator of nonresponsiveness and nonadherence of treatment (Sperry, 2009). Denial is a significant predictor of lowering treatment initiation and retention in mental health care (Ortega, Bicaldo, 2005). Illness denial is a major indicator of nonresponsiveness and nonadherence of treatment (Sperry, 2009). Daily Hassles can be more influential than a major life event as they occur more frequently (Landreville, 1992). In the HIV+ population, it is predicted that the intensity of these hassles will predict lowered quality of life. Daily Hassles can be more influential than a major life event as they occur more frequently (Landreville, 1992). In the HIV+ population, it is predicted that the intensity of these hassles will predict lowered quality of life. Center for Psychosocial Health

3. Social Cognitive Theory (Bandura, 1997) Person (Cognition) Health Distress Environment Daily Hassles Behavior Denial Coping Center for Psychosocial Health Theoretical model

4. Center for Psychosocial Health Hypotheses 1.Daily Hassles are negatively associated with Health Distress. 2.Denial is negatively associated with Health Distress. 3.Daily Hassles and Denial explain a significant portion of variance in Health Distress. Center for Psychosocial Health

5. Participants Participants were recruited from the Dallas/Fort Worth metroplex Participants were recruited from the Dallas/Fort Worth metroplex Participants received a $15 incentive Participants received a $15 incentive Participants were 18 years or over, HIV+ and English speaking Participants were 18 years or over, HIV+ and English speaking Participants signed informed consent and IRB approval was obtainedParticipants signed informed consent and IRB approval was obtained Center for Psychosocial Health

6. Demographics N= 221 VariableN%M(SD)Range Female11150.2% African American11652.5% European American 3616.3% Latino6629.9% Other31.4% Age41.6 (8.5)19-68 Education (years)12.1 (2.5)1-19 Income < $10,00015268.8% Center for Psychosocial Health

7. Procedures Participants were given an electronic survey at either the Dallas Resource Center or the Samaritan House in Fort Worth.Participants were given an electronic survey at either the Dallas Resource Center or the Samaritan House in Fort Worth. Each survey took approximately 1.5-2 hours to complete.Each survey took approximately 1.5-2 hours to complete. Participants were given an ID number to ensure confidentiality.Participants were given an ID number to ensure confidentiality. Center for Psychosocial Health

8. measures Daily Hassles Scale (Kanner, et al., 1980) Intensity subscale; 3 point likert-type scale; anchors 1 (somewhat extreme) to 3 (extremely extreme); higher scores denote a higher intensity of daily hassles Intensity subscale; 3 point likert-type scale; anchors 1 (somewhat extreme) to 3 (extremely extreme); higher scores denote a higher intensity of daily hassles Example of item : “Problems with your children” Center for Psychosocial Health

9. Measures Brief Cope Scale (Carver, 1997) (Carver, 1997) Denial subscale; α =.54; 3 point likert-type scale; anchors 0 (I haven’t been doing this at all) and 3 (I’ve been doing this a lot); higher scores indicate higher use of denial coping; concurrent validity (Carver 1997) Example of item : “I’ve been saying to myself ‘this isn’t real’ Center for Psychosocial Health

10. Measures MOS-HIV Scale (Wu et al., 1991) Health Distress Subscale; α =.91; 6 point likert-type scale; anchors 1 (all the time) and 6 (none of the time), with higher scores denoting less health distress; construct validity (Wu et al., 1991) Health Distress Subscale; α =.91; 6 point likert-type scale; anchors 1 (all the time) and 6 (none of the time), with higher scores denoting less health distress; construct validity (Wu et al., 1991) Example of item : “How often in the last four weeks were you discouraged by your health problems?” Center for Psychosocial Health

11. Mean(SD) Possible Range Actual Range Calculated α Daily Hassles1.8 (.52)1-3.97 Denial3.7 (1.90)2-8.76 Health Distress51.7 (24.61)0-1000-83.3.94 Data analysis Univariate Center for Psychosocial Health Data was first cleaned and checked for normalcy.

12. Center for Psychosocial Health Data analysis 1.2.3.4.5.6.7 1. Age- 2.Education.08- 3. Female.12*.04- 4. African American.13*.07-.03- 5. <10,000-.02-.09-.16**.08- 6. Daily Hassles-.04.01-.08.10.01- 7. Denial.01-.07-.01.07.05.32**- 8. Health Distress.13-.03.02.06 -.03.01 Bivariate p <.05*, p <.01** Center for Psychosocial Health

13. Data Analysis IV β tpTolVIF Daily Hassles.39-6.18<.001.901.1 Denial.44-7.18<.001.901.1 African American-.20-2.17<.05.981.0 Age Education Income < $10,000 Female Hierarchical Regression Analysis F(7,213)= 27.96, adj. R² =.25, p<.001 Out come variable: Health Distress Center for Psychosocial Health

14. discussion 1.Daily Hassles are negatively associated with Health Distress: Not supported 2.Denial is negatively associated with Health Distress: Not supported 3.Daily Hassles and Denial explain a significant portion of variance in Health Distress: Supported Center for Psychosocial Health

15. discussion Denying HIV status creates a barrier for treatment. Patients may avoid health care or deny taking medication (Luseno, Wechsberg, Kline, Ellerson, 2010). Denying HIV status creates a barrier for treatment. Patients may avoid health care or deny taking medication (Luseno, Wechsberg, Kline, Ellerson, 2010). Quality of life can be increased by using an alternative coping strategy such as acceptance (Gray & Hedge, 1999). Quality of life can be increased by using an alternative coping strategy such as acceptance (Gray & Hedge, 1999). In addition to our hypothesized variables, being of African American ethnicity also serves as a predictor of health distress. In addition to our hypothesized variables, being of African American ethnicity also serves as a predictor of health distress. Center for Psychosocial Health

16. Clinical implications Cognitive-behavioral therapy can be used to find more constructive forms of coping. Cognitive-behavioral therapy can be used to find more constructive forms of coping. Clinicians can focus on finding the daily hassles in a client’s life and finding a more effective way of handling the stress that comes with these hassles. Clinicians can focus on finding the daily hassles in a client’s life and finding a more effective way of handling the stress that comes with these hassles. Since African American ethnicity is a significant indicator of variance in health distress, giving greater attention to this community would serve to be beneficial. Since African American ethnicity is a significant indicator of variance in health distress, giving greater attention to this community would serve to be beneficial. Center for Psychosocial Health

17. limitations Some responses may be influenced by self report bias. Some responses may be influenced by self report bias. Limited generalizability due to sample’s demographics (ethnicity, locations, etc.). Limited generalizability due to sample’s demographics (ethnicity, locations, etc.). Due to cross sectional correlational design, causation cannot be inferred. Due to cross sectional correlational design, causation cannot be inferred. Center for Psychosocial Health

18. 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. Center for Psychosocial Health

19. Questions?

20. References Gray, J., & Hedge, B. (1999). Psychological distress and coping in the partners of gay men with HIV-related disease. British Journal of Health Psychology, 4(Part 2), 117-126. doi:10.1348/135910799168515Gray, J., & Hedge, B. (1999). Psychological distress and coping in the partners of gay men with HIV-related disease. British Journal of Health Psychology, 4(Part 2), 117-126. doi:10.1348/135910799168515 Landreville, P., & Vézina, J. (1992). A comparison between daily hassles and major life events as correlates of well-being in older adults. Canadian Journal on Aging, 11(2), 137-149. Retrieved from EBSCO host.Landreville, P., & Vézina, J. (1992). A comparison between daily hassles and major life events as correlates of well-being in older adults. Canadian Journal on Aging, 11(2), 137-149. Retrieved from EBSCO host. Lightfoot, M., Swendeman, D., Rotheram-Borus, M., Comulada, W., & Weiss, R. (2005). Risk Behaviors of Youth Living with HIV: Pre- and Post-HAART. American Journal of Health Behavior, 29(2), 162-171. Retrieved from EBSCO host.Lightfoot, M., Swendeman, D., Rotheram-Borus, M., Comulada, W., & Weiss, R. (2005). Risk Behaviors of Youth Living with HIV: Pre- and Post-HAART. American Journal of Health Behavior, 29(2), 162-171. Retrieved from EBSCO host. Luseno, W. K., Wechsberg, W. M., Kline, T. L., & Ellerson, R. (2010). Health services utilization among South African women living with HIV and reporting sexual and substance-use risk behaviors. AIDS Patient Care and STDs, 24(4), 257-264. doi:10.1089/apc.2009.0213Luseno, W. K., Wechsberg, W. M., Kline, T. L., & Ellerson, R. (2010). Health services utilization among South African women living with HIV and reporting sexual and substance-use risk behaviors. AIDS Patient Care and STDs, 24(4), 257-264. doi:10.1089/apc.2009.0213 Ortega, N. L., Bicaldo, B. F., Sobritchea, C. C., & Tan, M. L. (2005). Exploring the realities of HIV/AIDS- related discrimination in Manila, Philippines. AIDS Care, 17(Suppl2), S153-S164. doi:10.1080/09540120500119833Ortega, N. L., Bicaldo, B. F., Sobritchea, C. C., & Tan, M. L. (2005). Exploring the realities of HIV/AIDS- related discrimination in Manila, Philippines. AIDS Care, 17(Suppl2), S153-S164. doi:10.1080/09540120500119833 Center for Psychosocial Health