Skip to main content

Advertisement

SpringerLink
Log in

HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12–24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Center for Disease Control and Prevention (2011) HIV Surveillance Report. vol. 23

  2. UNICEF (2011) Opportunity in crisis: preventing HIV from early adolescence to young adulthood. UNICEF (United Nations), New York

    Google Scholar 

  3. Louthrenoo O, Oberdorfer P, Sirisanthana V (2014) Psychosocial functioning in adolescents with perinatal HIV infection receiving highly active antiretroviral therapy. J Int Assoc Provid AIDS Care 13:178–183

    Article  PubMed  Google Scholar 

  4. Marhefka SL, Lyon M, Koenig LJ, Orban L, Stein R, Lewis J et al (2009) Emotional and behavioral problems and mental health service utilization of youth living with HIV acquired perinatally or later in life. AIDS Care 21:1447–1454

    Article  PubMed  Google Scholar 

  5. Bordeaux JD, Loveland KA, Lachar D, Stehbens J, Bell TS, Nichols S et al (2003) Hemophilia growth and development study: caregiver report of youth and family adjustment to HIV disease and immunologic compromise. J Pediatr Psychol 28:175–183

    Article  PubMed  Google Scholar 

  6. Smith Fawzi MC, Eustache E, Oswald C, Surkan P, Louis E, Scanlan F et al (2010) Psychosocial functioning among HIV-affected youth and their caregivers in Haiti: implications for family-focused service provision in high HIV burden settings. AIDS Patient Care STDs 24:147–158

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mellins CA, Malee KM (2013) Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc 16:18593

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kim MH, Mazenga AC, Devandra A, Ahmed S, Kazembe PN, Yu X et al (2014) Prevalence of depression and validation of the Beck Depression Inventory-II and the Children’s Depression Inventory-Short amongst HIV-positive adolescents in Malawi. J Int AIDS Soc 17:18965–18977

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gosling AS, Burns J, Hirst F (2004) Children with HIV in the UK: a longitudinal study of adaptive and cognitive functioning. Clin Child Psychol Psychiatry 9:25–37

    Article  Google Scholar 

  10. Bennett DS, Traub K, Mace L, Juarascio A, O’Hayer CV (2015) Shame among people living with HIV: a literature review. AIDS Care. doi:10.1080/09540121.2015.1066749

    PubMed Central  Google Scholar 

  11. O’Hayer C, Bennett D, Jacobson J. The lasting impact of HIV/AIDS. In: Skinta M (ed) Mindfulness and acceptance for gender and sexual minorities. New Harbinger, Oakland, CA

  12. Goffman E (1963) Stigma: notes on the management of spoiled identity. Anchor Books, Garden City

    Google Scholar 

  13. Logie C, Gadalla TM (2009) Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care 21:742–753

    Article  PubMed  Google Scholar 

  14. Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, Szekeres G et al (2008) Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS 22:S67–S79

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bogart LM, Cowgill BO, Kennedy D, Ryan G, Murphy DA, Elijah J et al (2008) HIV-related stigma among people with HIV and their families: a qualitative analysis. AIDS Behav 12:244–254

    Article  PubMed  Google Scholar 

  16. Swendeman D, Rotheram-Borus MJ, Comulada S, Weiss R, Ramos ME (2006) Predictors of HIV-related stigma among young people living with HIV. Health Psychol 25:501–509

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fife BL, Wright ER (2000) The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav 41:50–67

    Article  PubMed  Google Scholar 

  18. Audet CM, McGowan CC, Wallston KA, Kipp AM (2013) Relationship between HIV stigma and self-isolation among people living with HIV in Tennessee. PLoS One 8:e69564

    Article  PubMed  PubMed Central  Google Scholar 

  19. Charles B, Jeyaseelan L, Pandian A, Sam A, Thenmozhi M, Jayaseelan V (2012) Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India–a community based cross sectional study. BMC Public Health 12:463

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zhao G, Li X, Zhao J, Zhang L, Stanton B (2012) Relative importance of various measures of HIV-related stigma in predicting psychological outcomes among children affected by HIV. Community Ment Health J 48:275–283

    Article  PubMed  Google Scholar 

  21. Kim S, Thibodeau R, Jorgensen RS (2011) Shame, guilt, and depressive symptoms: a meta-analytic review. Psychol Bull 137:68–96

    Article  PubMed  Google Scholar 

  22. Shame Lewis M (1995) The exposed self. Simon and Schuster, New York

    Google Scholar 

  23. Tangney JP, Dearing RL (2002) Shame and guilt. Guilford, New York

    Book  Google Scholar 

  24. DeMarco FJ (1998) Coping with the stigma of AIDS: an investigation of the effects of shame, stress, control and coping on depression in HIV-positive and-negative gay men: Michigan State University. Department of Psychology

  25. Li L, Lee S-J, Jiraphongsa C, Khumtong S, Iamsirithaworn S, Thammawijaya P et al (2010) Improving the health and mental health of people living with HIV/AIDS: 12-month assessment of a behavioral intervention in Thailand. Am J Public Health 100:2418–2425

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rodkjaer L, Laursen T, Balle N, Sodemann M (2010) Depression in patients with HIV is under-diagnosed: a cross-sectional study in Denmark. HIV Med 11:46–53

    Article  PubMed  Google Scholar 

  27. Bennett DS, Sullivan MW, Lewis M (2010) Neglected children, shame-proneness, and depressive symptoms. Child Maltreat 15:305–314

    Article  PubMed  PubMed Central  Google Scholar 

  28. Feiring C, Taska L, Lewis M (2002) Adjustment following sexual abuse discovery: the role of shame and attributional style. Dev Psychol 38:79–92

    Article  PubMed  Google Scholar 

  29. Stuewig J, McCloskey LA (2005) The relation of child maltreatment to shame and guilt among adolescents: psychological routes to depression and delinquency. Child Maltreat 10:324–336

    Article  PubMed  Google Scholar 

  30. Tangney JP, Wagner P, Gramzow R (1992) Proneness to shame, proneness to guilt, and psychopathology. J Abnorm Psychol 101:469–478

    Article  PubMed  Google Scholar 

  31. Lewis M (2008) Self-conscious emotions: embarrassment, pride, shame, and guilt. In: Lewis M, Haviland-Jones J, Feldman BL (eds) Handbook of emotions, 3rd edn. Guilford, New York, pp 742–756

    Google Scholar 

  32. De Rubeis S, Hollenstein T (2009) Individual differences in shame and depressive symptoms during early adolescence. Pers Individ Dif 46:477–482

    Article  Google Scholar 

  33. Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE (2010) Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care 22:630–639

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hatzenbuehler ML, Nolen-Hoeksema S, Dovidio J (2009) How does stigma “get under the skin”? The mediating role of emotion regulation. Psychol Sci 20:1282–1289

    Article  PubMed  PubMed Central  Google Scholar 

  35. Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB (2013) Specificity of rumination in anxiety and depression: a multimodal meta-analysis. Clin Psychol 20:225–257

    Google Scholar 

  36. McIntosh RC, Rosselli M (2012) Stress and coping in women living with HIV: a meta-analytic review. AIDS Behav 16:2144–2159

    Article  PubMed  Google Scholar 

  37. Weaver KE, Llabre MM, Duran RE, Antoni MH, Ironson G, Penedo FJ et al (2005) A stress and coping model of medication adherence and viral load in HIV-positive men and women on highly active antiretroviral therapy (HAART). Health Psychol 24:385–392

    Article  PubMed  Google Scholar 

  38. Ironson G, O’Cleirigh C, Fletcher MA, Laurenceau JP, Balbin E, Klimas N et al (2005) Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med 67:1013–1021

    Article  PubMed  PubMed Central  Google Scholar 

  39. Leserman J, Petitto JM, Golden RN, Gaynes BN, Gu H, Perkins DO et al (2000) Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. Am J Psychiatry 157:1221–1228

    Article  PubMed  Google Scholar 

  40. Muris P, Meesters C (2014) Small or big in the eyes of the other: on the developmental psychopathology of self-conscious emotions as shame, guilt, and pride. Clin Child Fam Psychol Rev 17:19–40

    Article  PubMed  Google Scholar 

  41. Mills RS, Hastings PD, Serbin LA, Stack DM, Abela JR, Arbeau KA et al (2015) Depressogenic thinking and shame proneness in the development of internalizing problems. Child Psychiatry Hum Dev 46:194–208

    Article  PubMed  Google Scholar 

  42. Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL (2003) Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. J Consult Clin Psychol 71:692–700

    Article  PubMed  Google Scholar 

  43. Nolen-Hoeksema S, Girgus JS (1994) The emergence of gender differences in depression during adolescence. Psychol Bull 115:424–443

    Article  PubMed  Google Scholar 

  44. Goodman E, Slap GB, Huang B (2003) The public health impact of socioeconomic status on adolescent depression and obesity. Am J Public Health 93:1844–1850

    Article  PubMed  PubMed Central  Google Scholar 

  45. Martin L, Kagee A (2011) Lifetime and HIV-related PTSD among persons recently diagnosed with HIV. AIDS Behav 15:125–131

    Article  PubMed  Google Scholar 

  46. Berger BE, Ferrans CE, Lashley FR (2001) Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 24:518–529

    Article  PubMed  Google Scholar 

  47. Murphy DA, Austin EL, Greenwell L (2007) Correlates of HIV-related stigma among HIV-positive mothers and their uninfected adolescent children. Women Health 44:19–42

    Article  Google Scholar 

  48. Tangney JP, Wagner J, Gavlas J, Gramzow R (1991) The test of self-conscious affect for adolescents (TOSCA-A). George Mason University, Fairfax

    Google Scholar 

  49. Ayers TS, Sandler IN, West SG, Roosa MW (1996) A dispositional and situational assessment of children’s coping: testing alternative models of coping. J Pers 64:923–958

    Article  PubMed  Google Scholar 

  50. Weissman M, Orvaschell H, Padian N (1980) Children’s symptom and social functioning: self-report scales. J Nerv Ment Dis 168:736–740

    Article  PubMed  Google Scholar 

  51. Shahid A, Wilkinson K, Marcu S, Shapiro CM (2012) Stop, that and one hundred other sleep scales. Springer Science & Business Media, Berlin

    Book  Google Scholar 

  52. March JS, Parker JD, Sullivan K, Stallings P, Conners CK (1997) The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36:554–565

    Article  PubMed  Google Scholar 

  53. Goldfield G, Moore C, Henderson K, Buchholz A, Obeid N, Flament M (2010) The relation between weight-based teasing and psychological adjustment in adolescents. Paediatr Child Health 15:283–288

    PubMed  PubMed Central  Google Scholar 

  54. Foa EB, Johnson KM, Feeny NC, Treadwell KR (2001) The Child PTSD Symptom Scale: a preliminary examination of its psychometric properties. J Clin Child Adolesc Psychol 30:376–384

    Article  Google Scholar 

  55. Nixon RD, Meiser-Stedman R, Dalgleish T, Yule W, Clark DM, Perrin S et al (2013) The Child PTSD Symptom Scale: an update and replication of its psychometric properties. Psychol Assess 25:1025–1031

    Article  PubMed  Google Scholar 

  56. Nolan SA, Flynn C, Garber J (2003) Prospective relations between rejection and depression in young adolescents. J Pers Soc Psychol 85:745–755

    Article  PubMed  Google Scholar 

  57. Dickerson SS, Gruenewald TL, Kemeny ME (2004) When the social self is threatened: shame, physiology, and health. J Pers 72:1191–1216

    Article  PubMed  Google Scholar 

  58. Lev-Wiesel R, Nuttman-Shwartz O, Sternberg R (2006) Peer rejection during adolescence: psychological long-term effects—A brief report. J Loss Trauma 11:131–142

    Article  Google Scholar 

  59. Bennett DS, Sullivan MW, Lewis M (2005) Young children’s adjustment as a function of maltreatment, shame, and anger. Child Maltreat 10:311–323

    Article  PubMed  PubMed Central  Google Scholar 

  60. Feiring C, Taska LS (2005) The persistence of shame following sexual abuse: a longitudinal look at risk and recovery. Child Maltreat 10:337–349

    Article  PubMed  Google Scholar 

  61. Tangney JP, Stuewig J, Mashek DJ (2007) Moral emotions and moral behavior. Annu Rev Psychol 58:345–372

    Article  PubMed  PubMed Central  Google Scholar 

  62. Krause ED, Kaltman S, Goodman LA, Dutton MA (2008) Avoidant coping and PTSD symptoms related to domestic violence exposure: a longitudinal study. J Trauma Stress 21:83–90

    Article  PubMed  Google Scholar 

  63. Pineles SL, Mostoufi SM, Ready CB, Street AE, Griffin MG, Resick PA (2011) Trauma reactivity, avoidant coping, and PTSD symptoms: a moderating relationship? J Abnorm Psychol 120:240

    Article  PubMed  PubMed Central  Google Scholar 

  64. Kliewer W (1997) Children’s coping with chronic illness. In: Wolchik SA, Sandler IN (eds) Handbook of children’s coping. Plenum Press, New York, p 275–300

    Chapter  Google Scholar 

  65. Holmes JA, Stevenson CA (1990) Differential effects of avoidant and attentional coping strategies on adaptation to chronic and recent-onset pain. Health Psychol 9:577–584

    Article  PubMed  Google Scholar 

  66. Ironson G, Balbin E, Stuetzle R, Fletcher MA, O’Cleirigh C, Laurenceau JP et al (2005) Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression. Int J Behav Med 12:86–97

    Article  PubMed  PubMed Central  Google Scholar 

  67. Luoma JB, Kohlenberg BS, Hayes SC, Fletcher L (2012) Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. J Consult Clin Psychol 80:43–53

    Article  PubMed  Google Scholar 

  68. Lutgendorf SK, Antoni MH, Ironson G, Starr K, Costello N, Zuckerman M et al (1998) Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV)-seropositive gay men. Psychosom Med 60:204–214

    Article  PubMed  Google Scholar 

  69. Persons E, Kershaw T, Sikkema KJ, Hansen NB (2010) 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 24:571–580

    Article  PubMed  PubMed Central  Google Scholar 

  70. Cunningham RM, Stiffman AR, Doré P, Earls F (1994) The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: implications for public health. Child Abuse Negl 18:233–245

    Article  PubMed  Google Scholar 

  71. Randles D, Tracy JL (2013) Nonverbal displays of shame predict relapse and declining health in recovering alcoholics. Clin Psychol Sci 1:149–155

    Article  Google Scholar 

  72. Bennett DS (1994) Depression among children with chronic medical problems: a meta-analysis. J Pediatr Psychol 19:149–169

    Article  PubMed  Google Scholar 

  73. Pinquart M, Shen Y (2011) Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis. Acta Paediatr 100:1069–1076

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, GLAD Program, Drexel University, 4700 Wissahickon Avenue, Philadelphia, PA, 19144, USA

    David S. Bennett

  2. Psychology Department, Immaculata University, Immaculata, PA, USA

    Jill Hersh

  3. Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA

    Joanna Herres

  4. Government Affairs, Gilead Sciences Inc., Philadelphia, PA, USA

    Jill Foster

Authors
  1. David S. Bennett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jill Hersh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanna Herres
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jill Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David S. Bennett.

Additional information

We greatly appreciate the assistance of Sherira Fernandes, Victoria Marini, David Prado, and Noel Ramirez with data collection and data entry.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bennett, D.S., Hersh, J., Herres, J. et al. HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?. Child Psychiatry Hum Dev 47, 657–664 (2016). https://doi.org/10.1007/s10578-015-0599-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-015-0599-y

Keywords

Search

Navigation