Abstract
African-American HIV-seropositive women are at elevated risk for depressive symptoms compared to their seropositive counterparts. Depressive symptoms have been linked to HIV/AIDS-related health predictors and outcomes such as medication and care adherence, and viral load. Project UPLIFT, a mindfulness-based cognitive therapy intervention originally designed for persons with epilepsy has been shown effective to reduce depressive and anxiety symptoms. Focus groups were conducted to assess the appropriateness and acceptability of UPLIFT for African-American HIV-seropositive women and to obtain feedback on needed modifications. The focus groups, including cisgender and transgender African-American HIV-seropositive women, revealed, while well received, modifications should include lowering the reading level of content and altering specific mindfulness-based exercises to make them relevant and acceptable to the target population. This qualitative work demonstrates UPLIFT could be a promising avenue to improve the mental health of African-American HIV-seropositive women, a group for which mindfulness interventions had not been previously considered.
Significance
Mindfulness-based interventions have been found effective in reducing depression, anxiety, and chronic pain. Further, it has been used for groups living with chronic illness, particularly HIV/AIDS. It has helped to improve mental and behavioral health, as well as increase CD4 count and reduce viral load for some samples of people living with HIV/AIDS. African-American women living with HIV/AIDS are especially vulnerable to poor mental and behavioral health given their experience of mental illness and hesitancy to engage mental healthcare. Though used for other groups of people living with HIV/AIDS, mindfulness-based cognitive therapy has not previously been considered for this population. This study explored the acceptability and feasibility of an MBCT intervention for this group. The data suggests that this intervention could be potentially useful in improving the mental health of this population, and includes suggestions for making the intervention culturally relevant.
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References
National Institute of Mental Health (U.S.). Depression and HIV/AIDS. NIH publication no. 02-5005.
Chaudoir SR, Norton WE, Earnshaw VA, Moneyham L, Mugavero MJ, Hiers KM. Coping with HIV stigma: do proactive coping and spiritual peace buffer the effect of stigma on depression? AIDS Behav. 2012;16(8):2382–91. https://doi.org/10.1007/s10461-011-0039-3.
Persons E, Kershaw T, Sikkema KJ, Hansen NB. The impact of shame on health-related quality of life among HIV-positive adults with a history of childhood sexual abuse. AIDS Patient Care STDs. 2010;24(9):571–80. https://doi.org/10.1089/apc.2009.0209.
Simoni JM, Ng MT. Trauma, coping, and depression among women with HIV/AIDS in New York City. AIDS Care. 2000;12(5):567–80. https://doi.org/10.1080/095401200750003752.
Kalichman SC, Heckman T, Kochman A, Sikkema K, Bergholte J. Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS. Psychiatr Serv. 2000;51(7):903–7.
Vyavaharkar M, Moneyham L, Tavakoli A, Phillips KD, Murdaugh C, Jackson K, et al. Social support, coping, and medication adherence among HIV-positive women with depression living in rural areas of the southeastern United States. AIDS Patient Care STDs. 2007;21(9):667–80. https://doi.org/10.1089/apc.2006.0131.
Bennett DS, Traub K, Mace L, Juarascio A, O'Hayer CV. Shame among people living with HIV: a literature review. AIDS Care. 2015;28:1–5. https://doi.org/10.1080/09540121.2015.1066749.
Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95. https://doi.org/10.1007/s10461-013-0437-9.
HIV Among Women. Centers for Disease Control and Prevention. Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. 2017.
Moneyham L, Sowell R, Seals B, Demi A. Depressive symptoms among African American women with HIV disease. Sch Inq Nurs Pract. 2000;14(1):9–39 discussion 41-6.
Miles MS, Holditch-Davis D, Pedersen C, Eron JJ Jr, Schwartz T. Emotional distress in African American women with HIV. J Prev Interv Community. 2007;33(1–2):35–50. https://doi.org/10.1300/J005v33n01_04.
Cook JA, Burke-Miller JK, Grey DD, Cocohoba J, Liu C, Schwartz RM, et al. Do HIV-positive women receive depression treatment that meets best practice guidelines? AIDS Behav. 2014;18(6):1094–102. https://doi.org/10.1007/s10461-013-0679-6.
Cook J, Grey D, Burke-Miller J, Cohen M, Anastos K, Gandhi M, et al. Effects of treated and untreated depressive symptoms on highly active antiretroviral therapy use in a US multi-site cohort of HIV-positive women. AIDS Care. 2006;18(2):93–100.
Tsao JC, Dobalian A, Moreau C, Dobalian K. Stability of anxiety and depression in a national sample of adults with human immunodeficiency virus. J Nerv Ment Dis. 2004;192(2):111–8.
Valente SM. Depression and HIV disease. J Assoc Nurses AIDS Care. 2003;14(2):41–51.
Willie TC, Overstreet NM, Sullivan TP, Sikkema KJ, Hansen NB. Barriers to HIV medication adherence: examining distinct anxiety and depression symptoms among women living with HIV who experienced childhood sexual abuse. Behav Med. 2016;42(2):120–7.
Cook JA, Cohen MH, Burke J, Grey D, Anastos K, Kirstein L, et al. Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. JAIDS. 2002;30(4):401–9.
Wingood GM, DiClemente RJ, Mikhail I, Lang DL, McCree DH, Davies SL, et al. A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: The WiLLOW Program. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S58–67.
Fuller TR, Brown M, King W, Prather C, Cazaubon J, Mack J, et al. The SISTA pilot project: understanding the training and technical assistance needs of community-based organizations implementing HIV prevention interventions for African American women--implications for a capacity building strategy. Women Health. 2007;46(2–3):167–86. https://doi.org/10.1300/J013v46n02_11.
Thompson NJ, Patel AH, Selwa LM, Stoll SC, Begley CE, Johnson EK, et al. Expanding the efficacy of project UPLIFT: distance delivery of mindfulness-based depression prevention to people with epilepsy. J Consult Clin Psychol. 2015;83(2):304–13. https://doi.org/10.1037/a0038404.
Thompson NJ, Walker ER, Obolensky N, Winning A, Barmon C, Diiorio C, et al. Distance delivery of mindfulness-based cognitive therapy for depression: project UPLIFT. Epilepsy Behav. 2010;19(3):247–54. https://doi.org/10.1016/j.yebeh.2010.07.031.
Walker ER, Obolensky N, Dini S, Thompson NJ. Formative and process evaluations of a cognitive-behavioral therapy and mindfulness intervention for people with epilepsy and depression. Epilepsy Behav. 2010;19(3):239–46. https://doi.org/10.1016/j.yebeh.2010.07.032.
Carlson LE. Mindfulness-based interventions for physical conditions: a narrative review evaluating levels of evidence. ISRN Psychiatry. 2012;2012:651583. https://doi.org/10.5402/2012/651583.
Creswell JD, Myers HF, Cole SW, Irwin MR. Mindfulness meditation training effects on CD4+ T lymphocytes in HIV-1 infected adults: a small randomized controlled trial. Brain Behav Immun. 2009;23(2):184–8. https://doi.org/10.1016/j.bbi.2008.07.004.
Gonzalez-Garcia M, Ferrer MJ, Borras X, Munoz-Moreno JA, Miranda C, Puig J, et al. Effectiveness of mindfulness-based cognitive therapy on the quality of life, emotional status, and CD4 cell count of patients aging with HIV infection. AIDS Behav. 2013;18:676–85. https://doi.org/10.1007/s10461-013-0612-z.
Jam S, Imani AH, Foroughi M, SeyedAlinaghi S, Koochak HE, Mohraz M. The effects of mindfulness-based stress reduction (MBSR) program in Iranian HIV/AIDS patients: a pilot study. Acta Med Iran. 2010;48(2):101–6.
Moskowitz JT, Duncan LG, Moran PJ, Acree M, Epel ES, Kemeny ME, et al. Dispositional mindfulness in people with HIV: associations with psychological and physical health. Pers Individ Differ. 2015;86:88–93. https://doi.org/10.1016/j.paid.2015.05.039.
Riley KE, Kalichman S. Mindfulness-based stress reduction for people living with HIV/AIDS: preliminary review of intervention trial methodologies and findings. Health Psychol Rev. 2015;9(2):224–43. https://doi.org/10.1080/17437199.2014.895928.
Robinson FP, Mathews HL, Witek-Janusek L. Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with the human immunodeficiency virus: a quasiexperimental study. J Altern Complement Med. 2003;9(5):683–94. https://doi.org/10.1089/107555303322524535.
SeyedAlinaghi S, Jam S, Foroughi M, Imani A, Mohraz M, Djavid GE, et al. Randomized controlled trial of mindfulness-based stress reduction delivered to human immunodeficiency virus-positive patients in Iran: effects on CD4+ T lymphocyte count and medical and psychological symptoms. Psychosom Med. 2012;74(6):620–7. https://doi.org/10.1097/PSY.0b013e31825abfaa.
Yang Y, Liu Y-H, Zhang H-F, Liu J-Y. Effectiveness of mindfulness-based stress reduction and mindfulness-based cognitive therapies on people living with HIV: a systematic review and meta-analysis. Int J Nurs Sci. 2015;2(3):283–94. https://doi.org/10.1016/j.ijnss.2015.07.003.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Fullilove MT. Psychiatric implications of displacement: contributions from the psychology of place. Am J Psychiatry. 1996;153(12):1516–23.
Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The group-based medical mistrust scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38(2):209–18. https://doi.org/10.1016/j.ypmed.2003.09.041.
Newkirk LA, Kim JM, Thompson JM, Tinklenberg JR, Yesavage JA, Taylor JL. Validation of a 26-point telephone version of the mini-mental state examination. J Geriatr Psychiatry Neurol. 2004;17(2):81–7. https://doi.org/10.1177/0891988704264534.
Eaton DK, Kann L, Kinchen S, Shanklin S, Flint KH, Hawkins J, et al. Youth risk behavior surveillance - United States, 2011. MMWR Surveill Summ. 2012;61(4):1–162.
Dalmida SG, Holstad MM, Diiorio C, Laderman G. Spiritual well-being and health-related quality of life among African-American women with HIV/AIDS. Appl Res Qual Life. 2011;6(2):139–57. https://doi.org/10.1007/s11482-010-9122-6.
Dalmida SG, Holstad MM, DiIorio C, Laderman G. The meaning and use of spirituality among African American women living with HIV/AIDS. West J Nurs Res. 2012;34(6):736–65. https://doi.org/10.1177/0193945912443740.
Braxton ND, Lang DL, J MS, Wingood GM, DiClemente RJ. The role of spirituality in sustaining the psychological well-being of HIV-positive black women. Women Health. 2007;46(2–3):113–29. https://doi.org/10.1300/J013v46n02_08.
Amutio A, Franco C, Pérez-Fuentes MC, Gázquez JJ, Mercader I. Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Front Psychol. 2015;5:1572.
Dalmida SG. Spirituality, mental health, physical health, and health-related quality of life among women with HIV/AIDS: integrating spirituality into mental health care. Issues Ment Health Nurs. 2006;27(2):185–98. https://doi.org/10.1080/01612840500436958.
Dalmida SG, Holstad MM, Diiorio C, Laderman G. Spiritual well-being, depressive symptoms, and immune status among women living with HIV/AIDS. Women Health. 2009;49(2–3):119–43. https://doi.org/10.1080/03630240902915036.
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Hunter-Jones, J.J., Gilliam, S.M., Carswell, A.L. et al. Assessing the Acceptability of a Mindfulness-Based Cognitive Therapy Intervention for African-American Women Living with HIV/AIDS. J. Racial and Ethnic Health Disparities 6, 1157–1166 (2019). https://doi.org/10.1007/s40615-019-00617-5
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DOI: https://doi.org/10.1007/s40615-019-00617-5