[Effects of distress and coping on quality of life in HIV-positive patients: results of a longitudinal study]. / Wirkung von Belastung und Krankheitsbewältigung auf die Lebensqualität bei HIV-Positiven. Ergebnisse einer Längsschnittuntersuchung.

Preserving health-related quality of life (QOL) is an important approach with HIV-positive patients. In a longitudinal study over 3 years, with three measurements each 18 months, we examined 56 of these patients for the influence of distress and coping (assessed by interviews) on physical, cognitive-emotional, and social QOL (using the SEL questionnaire). The patients were 32.9 years old on average, with 28.3 months since diagnosis. Seventy percent were male, 82% asymptomatic, 14% with ARC, and 4% with AIDS. Forty-five percent had been infected by homosexual intercourse, 14% by heterosexual intercourse, and 41% by iv drug abuse. The patients reported significantly worse physical and cognitive-emotional QOL than healthy subjects. Those HIV-positive persons with great distress showed significantly lower QOL scores. Multiple analyses of regression showed evasive-regressive coping at the T1, T2, and T3 levels as negative predictors, vs active, problem-focused coping as a positive predictor for nearly all QOL parameters at T3. HIV-positive patients with ARC or AIDS reported more physical complaints and lower physical QOL than asymptomatic persons. Physicians should suggest psychosocial support to patients with poor QOL scores.

Longitudinal development of distress, coping and quality of life in HIV-positive persons.

BACKGROUND: Longitudinal study on burdens, quality of life and coping strategies of HIV-positive persons to identify patterns of successful adaptation to the demands of the infection. METHODS: In a semiprospective multimodal approach, 61 HIV-positive persons in all stages of the infection attending an HIV ambulatorium were assessed by inventories (3 times) and by a half-standardized interview (baseline T1 focussing on first reactions after diagnosis, follow-up T3 1.5 years later). Subjects had a mean age of 35.3 years and 69% were male. Forty-four percent were infected via homosexual intercourse, 46% via intravenous needle sharing and 10% via heterosexual intercourse or an unknown source. RESULTS: Global, psychic and familial distress decreased significantly from the first period after the diagnosis of HIV to the third time of measurement, while somatic complaints increased. Most test persons were able to deal effectively with the demands of the infection and showed a great degree of flexibility in their use of cognitive-actional and emotional-palliative strategies; they achieved a high quality of life. In contrast, highly distressed individuals, mainly drug users, tended to cope in an evasive-regressive way and reported a low quality of life. Correlations between ineffective coping strategies and low quality of life were found to be significant. CONCLUSIONS: After an initial phase of sorrow and lack of orientation regarding their future life, most HIV-positive persons deal effectively with the demands of the HIV infection and report a good quality of life. In contrast, HIV-positive persons with a high degree of distress and an evasive-regressive coping pattern need professional support, such as psychotherapy.