by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
December 20, 2022
Investigators from the Multicenter AIDS Cohort (MACS) – Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS) sought to determine how resilience and optimism may moderate associations that stigma in health care settings (both experienced and anticipated) has with depression symptoms and trust in health care providers. 1405 participants (mean age: 51 years) across 9 U.S. sites provided cross-sectional data on self-reported experiences of HIV-related stigma in health care settings; anticipated HIV-related stigma in health care settings; trust in HIV care providers; depression symptoms; dispositional resilience (using the 10-item Connor-Davidson Resilience Scale); and optimism (using the 6-item Life-Outcomes Orientation Test-Revised tool). Moderation analyses suggested that higher levels of experienced as well as anticipated stigma in health care settings were associated with higher depression symptom severity and also with lower levels of trust. However, “buffering” effects of resilience and optimism were observed in many associations. For example, when resilience was low, the association between experienced stigma and depression symptoms was stronger compared with the association when high levels of resilience were reported (similar findings were observed when trust in HIV provider was examined). With regard to optimism, when self-reported optimism was high, depression scores were lower and trust was higher: further, the association that experienced stigma had with depression symptoms and provider trust was no longer significant when optimism was high. Associations between anticipated HIV stigma in health care settings and both outcomes were moderated by optimism.
Little is known about how resilience and optimism play a role for PWH with regard to individual patient-HIV care provider relationships, health behaviors and care outcomes, although studies of other chronic health conditions suggest they serve as protective factors. Findings from this study suggest that dispositional resilience might function as a buffer against harmful effects of stressors which disproportionately impact PWH, particularly health care-associated stigma. Although systems-level structural changes are necessary to address the stigmas and discriminations experienced by many PWH, authors offer that individual-level resilience and optimism may be “valuable change objectives” to incorporate within interventions aiming to reduce depression-related symptoms or improve trust in HIV care providers, and possibly improve health care system engagement.
The author has no conflicts of interest to disclose.
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