Faculty Bibliography

The findings from a qualitative investigation of HIV-infected African American and Puerto Rican gay and bisexual men's experiences obtaining HIV-related information; seeking HIV-related health care; as well as soliciting assistance from, and involvement with, HIV/AIDS service organizations are presented. Many men felt that their race or ethnicity-alone or together with their lower socioeconomic status-had been a factor in their experiences in seeking illness-related information, health care, advocacy, and social services. With respect to medical care, African American men held move critical and distrustful attitudes toward physicians than did Puerto Rican men. Both groups of men viewed the principal, high-profile, HIV-related advocacy and social service organizations as largely disinterested in non-White and non-middle-class clients. The men also viewed the minority-focused HIV/AIDS organizations as largely ineffectual.

The association between HIV disease progression (asymptomatic, symptomatic, AIDS) and mental health and psychosocial adjustment was examined among 144 men living in the New York City metropolitan area who had sex with men. While mean levels of mental health reported by the men did not differ by disease stage, mean levels of psychosocial adjustment did, with asymptomatic participants reporting significantly higher levels of adjustment on average, than those with AIDS. The data indicated that gay and bisexual men with HN or AIDS were at risk of intrapsychic distress throughout the disease course, but the likelihood of problematic adjustment associated with their social interactions appeared to increase with the progression of the disease. The data also revealed that the men reported relatively high levels of psychological symptomatology and low levels of psychosocial adjustment compared to normative general population samples, and lower levels of psychosocial adjustment compared with some samples of individuals having other acute or chronic conditions. The implications of these findings for community psychologists are discussed. (C) 1996 John Wiley & Sons, Inc.

OBJECTIVE: To compare predeath and postdeath levels of depression and anxiety reported by a sample of children who lost a parent to cancer ("study children") with the levels reported by children in a community sample who did not experience such a loss. METHOD: T scores for depressive symptomatology (Children's Depression Inventory) and state and trait anxiety (State-Trait Anxiety Inventory) were compared. Both samples were weighted to control for multiple participants from the same family. Weights for children in the community sample were further adjusted to match the distribution of the two samples with regard to gender, age, and number of children in the household. Comparisons were made using t tests and chi 2 tests. RESULTS: Whereas study children reported significantly higher levels of depression and anxiety in the predeath period, levels of symptomatology reported for both measures postdeath were similar in both samples. DISCUSSION: The data suggest that while many children experiencing the loss of a parent to cancer report elevated levels of depression and anxiety predeath, by 7 to 12 months postdeath their reports of depression and anxiety are comparable with those of similarly situated children in the community who did not experience such a loss.

Bereaved spouses comprise a population at risk for psychological distress. Evidence suggests that spouses 55 years of age and younger are at increased risk of morbid outcomes, including major depressive episodes. Although the emotional impact of the sudden loss of a spouse has been well studied, less attention has been paid to the psychological impact of loss that is foreseeable, as in the case of a serious illness. In this study, data were obtained from pre-death interviews with 103 well spouses of terminally ill cancer patients. Subjects were white, 55 years of age or younger, and living with the patient and their child(ren) aged 7 to 16 years old. Depressive distress was assessed using the Brief Symptom Inventory. Fifty eight percent of males and 42% of females had scores for depressive distress in a clinically significant range. Regression analyses revealed gender was the most important predictor of the level of depressive distress reported, followed by patient's functional status and whether the well spouse quit work as a result of the patient's illness. The number of children 18 years or younger living in the household was inversely related to the level of depressive distress. The results of this analysis suggest that a large proportion of well spouses of patients with cancer who are also the parents of school-aged children may experience significant depressive distress during the terminal phase of their spouse's illness. These findings are important for planning future programs and improving existing ones for the spouses of terminal cancer patients.

While the positive functions of social network interactions in ameliorating the effects of life stress are widely documented and acknowledged, a growing body of research investigations has demonstrated that social relationships can concurrently be a source of stress and that actions intended to be supportive may instead be experienced as psychologically disturbing. Data from a study of the social support experiences of gay men diagnosed with AIDS were examined to determine the contribution to the men's depressive mood of positive and negative network interactions (n = 83). Although the results are consistent with the social support literature regarding the beneficial effect of positive network interactions for seriously-ill individuals, the findings also indicate that negative illness-related network interactions are associated with decreases in depressive mood, as indicated by scores on the Center for Epidemiological Studies of Depression Scale (CES-D). The findings also demonstrate the additive effects of positive and negative network interactions and clearly point out the value of investigating the complexity and multiple functions of social interactions.

This research quantified the contribution of traditional gender roles to patient-reported receipt of assistance with personal care activities, housework, cooking, shopping, transportation, and administrative activities among a sample of 629 cancer patients with advanced disease who were undergoing outpatient treatment. Approximately 80 percent of male patients and 30 percent of female patients attributed help received with household tasks to longstanding division of labor. This response was particularly common among married men and did not differ by age or educational status. However, available morbidity indicators suggest that approximately one-third of these patients actually were functionally impaired, despite attribution to gender role expectations. We adjusted estimates of need for assistance to avoid overestimation due to role-related help, and a second time to avoid underestimation due to underreporting of physical inability to perform a task alone. After making these adjustments, male patients' level of need for assistance with traditionally female-associated tasks was reduced by approximately 50 percent.

Since it was first recognized that human immunodeficiency virus (HIV) infection could be sexually transmitted, celibacy has been advocated by some as the only unequivocally effective adaptation for avoiding the risk of infection. Others, however, have countered that few will be willing to be celibate and, further, that such behavior may have adverse psychosocial consequences. As part of a qualitative study of gay men's sexual decision-making in the context of the AIDS/HIV epidemic, we identified a subsample of respondents who had adopted celibacy for varying periods of time as an adaptation to the threat of AIDS/HIV infection. A content analysis of these men's interviews revealed 5 principal themes relating their reasons for choosing celibacy.

Clinical data on all non-hemophiliac adult cases of transfusion-induced HIV infection (TI-HIV) referred for treatment to the Infectious Disease Service at Memorial Sloan-Kettering Cancer Center between 1987 to 1989 (N = 20) provided an opportunity to investigate the social and psychological impact of transfusion-induced HIV-infection. The specific psychosocial issues presented by this population which relate to the circumstances of their infection (i.e., blood transfusions) include: coping with personal feelings of victimization, sadness, anger, and isolation; decision-making concerning medical treatment; and re-building trust in relationships with medical care professionals. Counseling interventions with this population are described.

While a public health emphasis on primary prevention of human immunodeficiency virus (HIV) infection continues, it is recognized that large numbers of individuals are already infected. Efforts at secondary prevention focus on early medical intervention and may be effective in slowing progression to a diagnosis of AIDS. Understanding the factors that promote or impede seropositive individuals from receiving prompt medical treatment and complying with treatment regimens is essential to prolonging survival. During unstructured interviews in an ongoing study of sexual decision-making, 55 urban, gay, seropositive men spontaneously offered information about their treatment choices for their HIV infection. Findings regarding their considerations in initiating, delaying, or rejecting medical treatment are presented.