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Social relationships, coping strategies, and mood all influence the adjustment of people living with HIV disease

People infected with the human immunodeficiency virus are subject to ongoing stress. They often are plagued by night sweats and nausea, unpleasant medication side effects, and periods of physical disability. They may have to cope with loss of employment, rejection by members of their social network, hospitalization, impoverishment, and the prospect of premature death. Coping strategies combined with social conflict and support affect the psychological adjustment of these men and women to their illness, according to a recent study led by John A. Fleishman, of the Center for Cost and Financing Studies, Agency for Healthcare Research and Quality.

They found that compared with perceived social support, social conflict was more strongly related to coping behaviors. Negative encounters with others—such as arguments, misunderstandings, and inappropriate demands—had a very strong effect on negative coping strategies such as wishful thinking, anger, and especially social isolation or withdrawal, and on negative mood. Coping by social withdrawal was also related to negative mood. A dynamic may occur in which conflictual social interactions and social isolation aggravate each other and result in escalating psychological distress, notes Dr. Fleishman.

Negative encounters were associated with more symptoms and feelings of stigma. Older respondents coped more than younger ones by seeking information and by engaging in positive actions, but they also were more likely to cope through isolation. Greater physical limitations were associated with more social isolation and fatalism. Feelings of HIV-related stigma were significantly related to coping by social isolation, anger, and cognitive avoidance (trying to repress HIV-related concerns). Coping by seeking information and by cognitive avoidance were more strongly related to positive mood than negative mood.

More details are in "Coping, conflictual social interactions, social support, and mood among HIV-infected persons," by Dr. Fleishman, Cathy Donald Sherbourne, Ph.D., Stephen Crystal, Ph.D., and others in the American Journal of Community Psychology 28(4), pp. 421-453, 2000.

Reprints (AHRQ Publication No. 00-R054) are available from the AHRQ Publications Clearinghouse.

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