Abstract
Background: Adverse psychological factors such as depression and stressful life events have been found to accelerate HIV disease progression, while positive factors such as optimism and spirituality have been found to slow progression to AIDS. The potentially protective role of the positive psychological factor resilience in HIV/AIDS has not been studied extensively. The relationship of resilience to depression, trauma, stress, and stress-related biological markers in HIV remains to be elucidated. In addition, written emotional expression interventions have shown promise in positively influencing HIV disease course, although the mechanisms require further study. Purpose: The aims of this study were to explore the relationship of resilience to the stress-related biological markers salivary cortisol and the cortisol/DHEA ratio, as well as to perceived stress levels, and symptoms of depression and trauma-related distress. Another aim of this study was to examine the influence of insight- and causation-denoting words used in written emotional expression essays on perceived stress levels over the course of the study. Method: The study population comprised 246 HIV-positive men (57%) and women (43%) who were randomized to either a control writing condition or an experimental writing condition which involved writing about personally traumatic events. Participants were seen for a baseline assessment, four writing intervention sessions, and three follow-up sessions over a one-year period, during which salivary samples and psychological data were collected. HLM was used to examine the relationship of resilience to stress-related biological markers, SEM was used to investigate the relationships between resilience, depression, and trauma-related distress, and linear regression was used to study the relationship of resilience to perceived stress, as well as the relationship of insight and causation words to perceived stress. Results: Trauma-related distress at baseline predicted depression at 6 month follow-up, and this relationship was moderated by high levels of resilience, which buffered against the development of depression following trauma in those with high distress at baseline. Resilience functioned as a mechanism which partially accounted for the relationship between perceived stress levels at baseline and perceived stress levels at 12 month follow-up, in that lower baseline perceived stress is associated with higher resilience, which is in turn associated with lower perceived stress at 12 month follow-up. Cortisol and the ratio of cort/DHEA did not change from baseline to 6 month follow-up. Resilience did not predict the slope of cortisol from baseline to 6 month follow-up, however, resilience was a positive predictor of the slope of cort/DHEA over this period of time. The percentage of insight and causation words used by participants in the traumatic writing condition did not influence the relationship of perceived stress at baseline to perceived stress at 6 month follow-up, either as a mediator or moderator. Conclusions: Resilience has the potential to play a positive role in HIV/AIDS, as high levels of resilience buffered against the development of depression at 6 month follow-up in the presence of trauma-related distress symptoms at baseline. Resilience also influenced perceived stress levels in those with HIV, such that lower baseline perceived stress is associated with higher resilience, which is in turn associated with lower perceived stress at 12 month follow-up. These results indicate that further study of resilience and its relationship to both biological and psychological factors in HIV/AIDS is warranted.