Negative life events and depression in adolescents with HIV: a stress and coping analysis

Abstract

The prevalence of negative life events (NLE) and daily hassles, and their direct and moderated associations with depression, were examined among HIV-infected adolescents. Specifically, we examined whether the negative association with depression of NLE, daily hassles, and/or passive coping were moderated by social support or active coping strategies. Demographic characteristics, depression, coping, social support, NLE, and daily hassles were collected at baseline as part of the Adolescent Impact intervention via face-to-face and computer-assisted interviews. Of 166 HIV-infected adolescents, 53% were female, 72.9% black, 59.6% with perinatally acquired HIV (PIY), the most commonly reported NLE were death in family (81%), violence exposure (68%), school relocation (67%), and hospitalization (61%); and for daily hassles “not having enough money (65%)”. Behaviorally infected youth (BIY – acquired HIV later in life) were significantly more likely to experience extensive (14–21) lifetime NLE (38.8% vs. 16.3%, p < .012) than PIY. In multiple stepwise regression analysis, the model accounting for the greatest variability in depression scores (32%) included (in order of entry): daily hassles, low social support, behaviorally acquired HIV, minority sexual orientation, and passive coping. A significant passive coping-by-social support interaction revealed that the association between passive coping and depression was exacerbated when social support was low. Social support moderated the effect of NLE, such that NLE were associated with greater depression when social support was low, although the effect did not remain statistically significant when main effects of other variables were accounted for. Daily hassles, poor coping, and limited social support can adversely affect the psychological well-being of HIV-infected adolescents, particularly sexual minority youth with behaviorally acquired HIV. Multimodal interventions that enhance social support and teach adaptive coping skills may help youth cope with environmental stresses and improve mental health outcomes.

Keywords:

• negative life events
• HIV
• youth
• depression
• coping
• social support

Acknowledgements

The authors would like to thank Lawrence D'Angelo, MD; William Barnes, PhD; Latoya Conner, PhD; Jean Fletcher, RN; Maureen Lyon, PhD; Kathryn Platky; Yolanda Peele, M.Ed; Anne Sill, MS; and Connie Trexler, RN, from Children's National Medical Center; Washington, DC; Ligia Peralta, MD, Vicki Tepper, PhD; John Farley, MD; Hibest Assefa, MPH; Maria Metcalf, MPH; and Rhonda Phill, MPH, from University of Maryland School of Medicine; Baltimore, MD; Stephanie Marhefka, Ph.D; David Moschel, BA; Joe Stavola, MD; Christine Nguyen, BS; Harriet Plaskow, MSW; and Erika Rexhouse, MSW, from NYU School of Medicine/Cornell Medical Center, New York, NY; and Holly Clark, MPH; Krystal Hodge, MPH; Goli Vamshidar, MPH; Sivakumar Rangarajan; Zaneta Gaul, MSPH; Ngozi Kamalu, MPH; Mary Glenn Fowler, MD, from Centers for Disease Control & Prevention, Atlanta, GA.

Disclosure statement

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Notes

1. Neither age nor sexual abuse was entered: age because of its significant interaction with transmission mode; and sexual abuse because it was a variable constructed from items in the NLE questionnaire.

Additional information

Funding

This work was supported by the Centers for Disease Control & Prevention through cooperative agreements with NYU School of Medicine [grant number U64CCU219448]; Children's National Medical Center [grant number U64CCU319459]; University of Maryland School of Medicine [grant number U64CCU319455].