Skip to main content

Advertisement

Log in

The effects of depression, stressful life events, social support, and coping on the progression of HIV infection

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

This article reviews recent findings concerning the role of psychosocial factors on the progression of HIV. Specifically, we examine the role of depression, stressful life events, social support, and coping on changes in CD4 T-lymphocytes and other indicators of HIV disease progression. Studies have yielded important evidence that depression, stressful life events, low social support, and denial coping may have a detrimental impact on HIV disease course. Delineating the role of psychosocial factors on HIV disease progression may aid in the development of new interventions for this devastating disease.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report. 11. 1999.

  2. Hoyert DL, Kochanek KD, Murphy SL: Deaths: final data for 1997. National Vital Statistics Reports 47:Hyattsville: National Center for Health Statistics; 1999.27–51.

    Google Scholar 

  3. Evans DL, Leserman J, Golden RN, et al.: Immune correlates of stress and depression. Psychopharmacol Bull 1989, 25:319–324.

    PubMed  CAS  Google Scholar 

  4. Herbert TB, Cohen S: Stress and immunity in humans: a meta-analytic review. Psychosomatic Med 1993, 55:364–379.

    CAS  Google Scholar 

  5. Herbert TB, Cohen S: Depression and immunity: a meta-analytic review. Psychol Bull 1993, 113:3:472–486.

    Article  Google Scholar 

  6. Stein M, Miller AH, Trestman RL: Depression, the immune system and health and illness. Arch of Gen Psych 1991, 48:171–177.

    CAS  Google Scholar 

  7. Frasure-Smith N, Lesperance F, Talajic M: Depression following myocardial infarction: Impact on 6-month survival. JAMA 1993, 270:1819–1825.

    Article  PubMed  CAS  Google Scholar 

  8. Frasure-Smith N, Lesperance F, Talajic M: Depression and 18-month prognosis after myocardial infarction. Circulation 1995, 91:999–1005.

    PubMed  CAS  Google Scholar 

  9. Fawzy FI, Fawzy NW, Hyun CS, et al.: Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry 1993, 50:681–689.

    PubMed  CAS  Google Scholar 

  10. Spiegel D, Kraemer HC, Bloom JR, Gottheil E: Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989, 2:888–891.

    Article  PubMed  CAS  Google Scholar 

  11. Ramirez AJ, Craig TJK, Watson JP, et al.: Stress and relapse of breast cancer. Br Med J 1989, 298:291–293.

    CAS  Google Scholar 

  12. Rovner BW, German PS, Brant LJ, et al.: Depression and mortality in nursing homes. JAMA 1991, 265:993–996.

    Article  PubMed  CAS  Google Scholar 

  13. Kiecolt-Glaser JK, Glaser R: Psychoneuroimmunology and cancer: fact or fiction?. Eur J Cancer 1999, 35:1603–1607.

    Article  PubMed  CAS  Google Scholar 

  14. Leserman J, Drossman DA, Li Z, et al.: Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med 1996, 58:4–15.

    PubMed  CAS  Google Scholar 

  15. Zorrilla EP, McKay JR, Luborsky L, Schmidt K: Relation of stressors and depressive symptoms to clinical progression of viral illness. Am J Psychiatry 1996, 153:626–635.

    PubMed  CAS  Google Scholar 

  16. Vedhara K, Schifitto G, McDermott M: Disease progression in HIV-positive women with moderate to severe immunosuppression: the role of depression. Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders. Behav Med 1999, 25:43–47.

    PubMed  CAS  Google Scholar 

  17. Eich-Hochli E, Niklowitz MW, Luthy R, Opravil M: Are immunological markers, social and personal resources, or a complaint-free state predictors of progression among HIV-infected patients? Acta Psychiatr Scand 1997, 95:476–484.

    PubMed  CAS  Google Scholar 

  18. Page-Shafer K, Delorenze GN, Satariano W, Winkelstein W Jr: Comorbidity and survival in HIV-infected men in the San Francisco Men’s Health Survey. Ann Epidemiol 1996, 6:420–430.

    Article  PubMed  CAS  Google Scholar 

  19. Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977, 1:386–401.

    Article  Google Scholar 

  20. Burack JH, Barrett DC, Stall RD, et al.: Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. JAMA 1993, 270:2568–2573.

    Article  PubMed  CAS  Google Scholar 

  21. Mayne TJ, Vittinghoff E, Chesney MA, et al.: Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med 1996, 156:2233–2238.

    Article  PubMed  CAS  Google Scholar 

  22. Lyketsos CG, Hoover DR, Guccione M, et al.: Depressive symptoms as predictors of medical outcomes in HIV infection. JAMA 1993, 270:2563–2567.

    Article  PubMed  CAS  Google Scholar 

  23. Lyketsos CG, Hoover DR, Guccione M, et al.: Changes in depressive symptoms as AIDS develops. Am J Psychiatry 1996, 153:1430–1437.

    PubMed  CAS  Google Scholar 

  24. Lyketsos CG, Hoover DR, Guccione M: Depression and survival among HIV-infected persons. JAMA 1996, 275:35–36.

    Article  PubMed  CAS  Google Scholar 

  25. Leserman J, Jackson ED, Petitto JM, et al.: Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosom Med 1999, 61:397–406. This study reports results from the Coping in Health and Illness Project conducted among 82 HIV-infected gay men. Higher scores on stressful life events and depressive symptoms, and lower social support were related to faster progression to AIDS during 5.5-year follow-up, using Cox regression with time-dependent covariates. When examining the psychosocial variable together, only stressful events and social support remained significant. Findings held when controlling for demographic variables, antiretroviral use, and baseline CD4 lymphocytes.

    PubMed  CAS  Google Scholar 

  26. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960, 23:56–62.

    PubMed  CAS  Google Scholar 

  27. Leserman J, Petitto JM, Perkins DO, et al.: Severe stress, depressive symptoms, and changes in lymphocyte subsets in human immunodeficiency virus-infected men. Arch Gen Psychiatry 1997, 54:279–285.

    PubMed  CAS  Google Scholar 

  28. Evans DL, Leserman J, Perkins DO, et al.: Stress-associated reductions of cytotoxic T lymphocytes and natural killer cells in asymptomatic HIV infection. Am J Psychiatry 1995, 152:543–550.

    PubMed  CAS  Google Scholar 

  29. Evans DL, Leserman J, Perkins DO, et al.: Severe life stress as a predictor of early disease progression in HIV infection. Am J Psychiatry 1997, 154:630–634.

    PubMed  CAS  Google Scholar 

  30. Leserman J, Petitto JM, Golden RN, et al.: The impact of stressful life events, depression, social support, coping and cortisol on progression to AIDS. Am J Psychiatry 2000, 157: in press. This study reports results from the Coping in Health and Illness Project conducted among 82 HIV-infected gay men. Higher scores on stressful life events, cortisol, and denial coping, and lower social support were related to faster progression to AIDS during 7.5-year follow-up. Findings held controlling for demographic variables, antiretroviral use, baseline CD4 lymphocytes, baseline viral load, and health habits.

  31. Petitto JM, Leserman J, Perkins DO, et al.: High versus low basal cortisol secretion in asymptomatic, medication-free HIV infected men: differential effects of severe life stress on parameters of immune status. Behav Med 2000, 25:143–151.

    Article  PubMed  CAS  Google Scholar 

  32. Sahs JA, Goetz R, Reddy M, et al.: Psychological distress and natural killer cells in gay men with and without HIV infection. Am J Psychiatry 1994, 151:1479–1484.

    PubMed  CAS  Google Scholar 

  33. Vanham G, Kestens L, Gigase P, et al.: Evidence for circulating activated cytotoxic T cells in HIV-infected subjects before the onset of opportunistic infections. Clin Exp Immunol 1990, 82:3–9.

    Article  PubMed  CAS  Google Scholar 

  34. Vuillier F, Bianco NE, Montagnier L, Dighiero G: Selective depletion of low-density CD8+, CD16+ lymphocytes during HIV infection. AIDS Res Hum Retrovir 1988, 4:2:121–129.

    Google Scholar 

  35. Mansour I, Doinel C, Rouger P: CD16+ NK cells decrease in all stages of HIV infection through a selective depletion of the CD16+ CD8+ CD3-subset. AIDS Res Hum Retrovir 1990, 6:1451–1457.

    PubMed  CAS  Google Scholar 

  36. Margolick JB, Scott ER, Odaka N, Saah AJ: Flow cytometric analysis of T cells and natural killer cells in HIV-1 infection. Clin Immunol Immunopathol 1991, 58:126–138.

    Article  PubMed  CAS  Google Scholar 

  37. Cai Q, Huang XL, Rappocciolo G, Rinaldo CR Jr: Natural killer cell responses in homosexual men with early HIV infection. J Acquir Immune Defic Syndr 1990, 3:669–676.

    PubMed  CAS  Google Scholar 

  38. Price DA, O’Callaghan CA, Whelan JA, et al.: Cytotoxic T lymphocytes and viral evolution in primary HIV-1 infection. Clin Sci 1999, 97:707–718.

    Article  PubMed  CAS  Google Scholar 

  39. Barker E: CD8+ cell-derived anti-human immunodeficiency virus inhibitory factor. J Infect Dis 1999, 179(Suppl 3):S485-S488.

    Article  PubMed  CAS  Google Scholar 

  40. Famularo G, Moretti S, Marcellini S, et al.: CD8 lymphocytes in HIV infection: helpful and harmful. J Clin Lab Immunol 1997, 49:15–32.

    PubMed  CAS  Google Scholar 

  41. Fauci AS: Multifactorial nature of human immunodeficiency virus disease: implications for theory. Science 1993, 262:1011–1018.

    Article  PubMed  CAS  Google Scholar 

  42. Borysiewicz LK, Sissons JGP: Immune response to virusinfected cells. In Clinics in Immunology and Allergy. London: WB Saunders; 1986.

    Google Scholar 

  43. Maghazachi AA, Al-Aoukaty A: Chemokines activate natural killer cells through heterotrimeric G-proteins: implications for the treatment of AIDS and cancer. FASEB J 1998, 12:913–924.

    PubMed  CAS  Google Scholar 

  44. Kemeny ME, Dean L: Effects of AIDS-related bereavement on HIV progression among New York City gay men. AIDS Education Prevent 1995, 7:36–47.

    CAS  Google Scholar 

  45. Bower JE, Kemeny ME, Taylor SE, Fahey JL: Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. J Consult Clin Psychol 1998, 66:979–986.

    Article  PubMed  CAS  Google Scholar 

  46. Ironson G, Friedman A, Klimas N, et al.: Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus. Int J Behav Med 1994, 1:90–105.

    Article  PubMed  CAS  Google Scholar 

  47. Kimerling R, Calhoun KS, Forehand R, et al.: Traumatic stress in HIV-infected women. AIDS Education Prevent 1999, 11:321–330. This study of 67 black women showed reductions in CD4 to CD8 ratio at 1-year follow-up among those with traumatic stressors compared with those without trauma. Among those with trauma, post-traumatic stress disorder was also associated with lower CD4 to CD8 ratio.

    CAS  Google Scholar 

  48. Perry S, Fishman B, Jacobsberg L, Frances A: Relationships over one-year between lymphocyte subsets and psychosocial variables among adults with infection by human immunodeficiency virus. Arch Gen Psychiatry 1992, 49:396–401.

    PubMed  CAS  Google Scholar 

  49. Rabkin JG, Williams JBW, Remien RH, et al.: Depression, distress, lymphocyte subsets, and human immunodeficiency virus symptoms on two occasions in HIV-positive homosexual men. Arch Gen Psychiatry 1991, 48:111–119.

    PubMed  CAS  Google Scholar 

  50. Kessler RC, Foster C, Joseph J, et al.: Stressful life events and symptom onset in HIV infection. Am J Psychiatry 1991, 148:733–738.

    PubMed  CAS  Google Scholar 

  51. Capitanio JP, Mendoza SP, Lerche NW, Mason WA: Social stress results in altered glucocorticoid regulation and shorter survival in simian acquired immune deficiency syndrome. Proc Natl Acad Sci U S A 1998, 95:4714–4719. In this study of 36 adult male rhesus macaques, half were inoculated with SIV. Among the SIV-infected, those in stable social groups survived longer than animals put in unstable social conditions. Animals receiving social threats, regardless of the stability of the social group, had higher SIV RNA in plasma.

    Article  PubMed  CAS  Google Scholar 

  52. Solano L, Costa M, Salvati S, et al.: Psychological factors and clinical evolution in HIV-1 infection: a longitudinal study. J Psychosom Res 1993, 37:39–51.

    Article  PubMed  CAS  Google Scholar 

  53. Theorell T, Blomkvist V, Jonsson H, et al.: Social support and the development of immune function in human immunodeficiency virus infection. Psychosom Med 1995, 57:32–35.

    PubMed  CAS  Google Scholar 

  54. Patterson TL, Shaw WS, Semple SJ, et al.: Relationship of psychosocial factors to HIV disease progression. Ann Behav Med 1996, 18:30–39.

    Google Scholar 

  55. Miller GE, Kemeny ME, Taylor SE, et al.: Social relationships and immune processes in HIV seropositive gay and bisexual men. Ann Behav Med 1997, 19:139–151.

    Article  PubMed  CAS  Google Scholar 

  56. Perry S, Fishman B, Jacobsberg L, Frances A: Relationships over 1 year between lymphocyte subsets and psychosocial variables among adults with infection by human immunodeficiency virus. Arch Gen Psychiatry 1992, 49:396–401.

    PubMed  CAS  Google Scholar 

  57. Straits-Troster KA, Patterson TL, Semple SJ, et al.: The relationship between loneliness, interpersonal competence, and immunological status in HIV-infected men. Psychol Health 1994, 9:205–219.

    Google Scholar 

  58. Persson L, Gullberg B, Hanson BS, et al.: HIV infection: social network, social support, and CD4 lymphocyte values in infected homosexual men in Malmo, Sweden. J Epidemiol Commun Health 1994, 48:580–585.

    Article  CAS  Google Scholar 

  59. Goodkin K, Blaney NT, Feaster D, et al.: Active coping style is associated with natural killer cell cytotoxicity in asymptomatic HIV-1 seropositive homosexual men. J Psychosom Res 1992, 36:635–650.

    Article  PubMed  CAS  Google Scholar 

  60. Carver CS, Scheier MF, Weintraub JK: Assessing coping strategies: A theoretically based approach. J Pers Soc Psych 1989, 56:267–283.

    Article  CAS  Google Scholar 

  61. Antoni MH, Goldstein D, Ironson G, et al.: Coping responses to HIV-1 serostatus notification predict concurrent and prospective immunologic status. Clin Psychol Psychother 1995, 2:234–248.

    Article  Google Scholar 

  62. Mulder CL, Antoni MH, Duivenvoorden HJ, et al.: Active confrontational coping predicts decreased clinical progression over a one-year period in HIV-infected homosexual men. J Psychosom Res 1995, 39:957–965.

    Article  PubMed  CAS  Google Scholar 

  63. Cole SW, Kemeny ME, Taylor SE, et al.: Accelerated course of human immunodeficiency virus infection in gay men who conceal their homosexual identity. Psychosom Med 1996, 58:219–231.

    PubMed  CAS  Google Scholar 

  64. Sherman BF, Bonanno GA, Wiener LS, Battles HB: When children tell their friends they have AIDS: possible consequences for psychological well-being and disease progression. Psychosom Med 2000, 62:238–247.

    PubMed  CAS  Google Scholar 

  65. Mulder CL, de Vroome EM, van Griensven GJ, et al.: Avoidance as a predictor of the biological course of HIV infection over a 7-year period in gay men. Health Psychol 1999, 18:107–113.

    Article  PubMed  CAS  Google Scholar 

  66. Reed GM, Kemeny ME, Taylor SE, Visscher BR: Negative HIV-specific expectancies and AIDS-related bereavement as predictors of symptom onset in asymptomatic HIV-positive gay men. Health Psychol 1999, 18:354–363.

    Article  PubMed  CAS  Google Scholar 

  67. Segerstrom SC, Taylor SE, Kemeny ME, et al.: Causal attributions predict rate of immune decline in HIV-seropositive gay men. Health Psychol 1996, 15:485–493.

    Article  PubMed  CAS  Google Scholar 

  68. Goodkin K, Feaster DJ, Asthana D, et al.: A bereavement support group intervention is longitudinally associated with salutary effects on the CD4 cell count and number of physician visits. Clin Diagnost Lab Immunol 1998, 5:382–391. Seventy-four HIV-infected men and 45 HIV-negative men were randomly assigned to either a 10-week bereavement support group or a standard care control condition. Those in the support group had significantly greater beneficial effects on change in CD4 lymphocyte count and total T-lymphocytes 6 months following treatment. The support group participants had decreased cortisol levels and fewer care visits compared with controls. The findings held for both the HIV-infected and noninfected groups.

    CAS  Google Scholar 

  69. Lutgendorf SK, Antoni M, Ironson G, et al.: 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 1998, 60:204–214.

    PubMed  CAS  Google Scholar 

  70. Mulder CL, Emmelkamp PM, Antoni M, et al.: Cognitivebehavioral and experiential group psychotherapy for HIV-infected homosexual men: a comparative study. Psychosom Med 1994, 56:423–431.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leserman, J. The effects of depression, stressful life events, social support, and coping on the progression of HIV infection. Curr Psychiatry Rep 2, 495–502 (2000). https://doi.org/10.1007/s11920-000-0008-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-000-0008-4

Keywords

Navigation