Denial, Daily Hassles and Distress in HIV Positive Individuals Side: 1 of 2

                                
•Individuals with HIV may use denial to cope with their daily
hassles which in turn may increase their distress over having HIV.
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•Health Distress is associated with lower Quality of Life, higher
anxiety, depression and general emotional distress in people
living with HIV/AIDS (Rotheram-Borus, 2000).
•Denial is a significant predictor of lowering treatment initiation
and retention in mental health care (Ortega, Alegria, 2005). Denial
can also hinder a clinician/client relationship, making it difficult to
assess patients mental health through self-report (Shelder,
Mayman, Manis, 1993).
Procedures
•IRB approval and participant informed consent
obtained
•Participants recruited from the Dallas/Fort Worth
metroplex
•Participants received $15 compensation
•Participants were 18 years or over, HIV+ and
English speaking
•Daily Hassles can be more influential than a major life event as
they occur more frequently (Miezo, 2004). In the HIV+ population,
it is predicted that the intensity of these hassles will predict
lowered quality of life.
•Albert Bandura’s Social Cognitive Theory (1997) can serve as a
model for these variables, displaying a triadic reciprocal
relationship between a person’s cognition, behavior and
environment. With health distress representing a person’s
cognition, denial the behavior and daily hassles the environment,
we can begin to understand the relationship between these
variables more clearly.
Hypotheses
A negative association between Daily Hassles and Health
Distress exists.
A negative association between Denial and Health Distress
exists.
Daily Hassles and Denial explain a significant portion of variance
in Health Distress.
Theoretical Model
Social Cognitive Theory (Bandura, 1997)
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
• Example of item: “Problems with your children”
Brief Cope Scale
(Carver, 1997)
Denial subscale a = .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
•Example of item: “I’ve been saying to myself ‘this
isn’t real’”
MOS-HIV Scale
(Wu et al., 1991)
Health Distress Subscale a =.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?”
Variable
n
%
M (SD)
Range
Female
111
50.2%
African American
116
52.5%
European American
36
16.3%
Latino
66
29.9%
Other
3
1.4%
Age
41.6 (8.5)
19-68
Education (years)
12.1 (2.5)
1-19
<$10,000
152
68.8%
Discussion
Univariate Statistics
Daily
Hassles
Denial
Distress
1.8 (.52)
1-3
1-3
.97
3.7(1.90)
2-8
2-8
.76
51.7 (24.61)
0-100
0-83.3
.94
Bivariate Statistics
p<.05*, p<.01**
1. Age
2. Education
3.    Female
4.    African
American
5. <$10,000
6.    Daily
Hassles
7.    Denial
8.    Health
Distress
-.02    -.09
-.04    .01
13    -.03
.08 -
.10 .01
.07    .05    .32**
.06'    .06 -.03
ression Analysis
tress is our outcome variable
Tol VIF
Daily
Hassles
Denial
African
American
-6.18 <.001
•Findings support our hypothesis that denying HIV/AIDS diagnosis
along with experiencing daily hassles lowers QOL.
•Our findings also suggest that denying these daily hassles will
predict less quality of life.
•In addition to our hypothesized variables, being of African
American ethnicity also serves as a predictor of health distress.
•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).
Clinical Implications
•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.
•Since African American ethnicity is a significant indicator of variance in
health distress, giving greater attention to this community would serve
to be beneficial.
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