International Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 294–304 | Cite as

Psychological Distress Mediates the Effect of Alexithymia on 2-Year Change in HIV Viral Load

  • Roger C. McIntoshEmail author
  • Gail Ironson
  • Michael Antoni
  • Betty Lai
  • Mahendra Kumar
  • Mary Ann Fletcher
  • Neil Schneiderman



Individuals with trait alexithymia (AL) display poor cognitive assimilation of thoughts, feelings, and emotions. This may result in the persistence of stress, anxiety, and depressive disorders. The cumulative effect of this psychological distress is also linked clinical markers of human immunodeficiency virus (HIV) disease progression. This study examines the indirect effect of AL on HIV viral load as a function of baseline levels and change in psychological distress.


N = 123 HIV positive adults aged 37.9 ± 9.2 years provided blood samples for HIV-1 viral RNA and CD4 T lymphocytes along with self-reported stress, anxiety, and depression every 6 months for 2 years. A second-order conditional latent growth model was used to represent baseline and 2-year change in cumulative levels of psychological distress and to test the indirect effect of baseline levels of trait AL on change in HIV-1 viral load through this latent measure.


AL was associated with baseline and latent change in psychological distress. Furthermore, baseline psychological distress predicted 2-year change in HIV-1 viral RNA after controlling for viral load at baseline. Altogether, trait AL had a significant indirect effect on change in viral load (β = 0.16, p = 0.03) as a function of baseline levels of distress.


Identification and communication of thoughts, feelings, and emotions are important for long-term psychological adaptation in HIV. Greater psychological distress, in turn, allows for persistence of peripheral viral replication.


Human immunodeficiency virus Alexithymia Anxiety Stress Depression Latent growth modeling 


Compliance with Ethical Standards


This study was funded by the National Institutes of Mental Health (T32 MH018917 and R01 MH53791, G. Ironson, PI).

Conflict of Interest

Roger McIntosh declares that he has no conflict of interest. Gail Ironson declares that she has no conflict of interest. Michael Antoni declares that he has no conflict of interest. Betty Lai declares that she has no conflict of interest. Mahendra Kumar declares that he has no conflict of interest. Mary Ann Fletcher declares that she has no conflict of interest. Neil Schneiderman declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  • Roger C. McIntosh
    • 1
    Email author
  • Gail Ironson
    • 1
  • Michael Antoni
    • 1
  • Betty Lai
    • 2
  • Mahendra Kumar
    • 3
  • Mary Ann Fletcher
    • 4
  • Neil Schneiderman
    • 1
  1. 1.Department of Health PsychologyUniversity of MiamiMiamiUSA
  2. 2.School of Public HealthGeorgia State UniversityAtlantaUSA
  3. 3.Departments of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Department of Clinical Immunology, Institute of Neuro Immune MedicineNova Southeastern UniversityDavieUSA

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