Stress Management Interventions for HIV+ Adults

A Meta-Analysis of Randomized Controlled Trials, 1989 to 2006

Scott-Sheldon, Lori A. J.
Kalichman, Seth C.
Carey, Michael P.
Fielder, Robyn L.

¹Center for Health and Behavior, Syracuse University
²Center for Health, Intervention, and Prevention, University ofConnecticut

³Correspondence concerning this article should be addressed to Lori A. J. Scott-Sheldon, Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244-2340. Email: [email protected]

This researchwas supported by National Institutes of Health Grant R01–MH71164 toSeth C. Kalichman and R01–MH068171 to Michael P. Carey. We thank thefollowing study authors who provided additional intervention details or data:Michael H. Antoni, Thomas J. Birk, Jill E. Borman, Alison Brazier, Margaret A.Chesney, Stacy Cruess, José K. Côté, Fawzy I. Fawzy, Deborah L. Jones, Elizabeth C. Pomeroy, C. J. Segal-Isaacson, and Suzanne C.Lechner.

Health Psychology 27(2):p 129-139, March 2008.

Objective

Numerous studies document that stress accelerates disease processes in avariety of diseases including HIV. As a result, investigators have developed andevaluated interventions to reduce stress as a means to improve health amongpersons living with HIV. Therefore, the current meta-analysis examines theimpact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults.

Design

This meta-analytic review integrated the results of 35 randomizedcontrolled trials examining the efficacy of 46 separate stress-managementinterventions for HIV+ adults (N = 3,077).

Main Outcome Measures

Effect sizes were calculated for stress processes (coping and socialsupport), psychological/psychosocial (anxiety, depression, distress, and qualityof life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, andtestosterone) and other behavioral health outcomes (fatigue).

Results

Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life(d₊s = 0.16 to0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls.

Conclusion

Overall, stress-management interventions for HIV+ adults significantlyimprove mental health and quality of life but do not alter immunological orhormonal processes. The absence of immunological or hormonal benefits mayreflect the studies' limited assessment period (measured typically within 1-weekpostintervention), participants' advanced stage of HIV (HIV+ status known for anaverage of 5 years), and/or sample characteristics (predominately male and Whiteparticipants). Future research might test these hypotheses and refine ourunderstanding of stress processes and their amelioration.