Journal Articles
Abstract:
Objective: Psychosocial research in HIV has
had almost an exclusive focus on predicting
biological markers of HIV disease
progression; however, health-related quality
of life and use of health services may also
be important indicators of HIV disease
progression. The current study examines how
trauma, severe stressful events, PTSD and
depressive symptoms are related to
health-related quality of life (e.g.,
physical functioning) and health utilization
in HIV-infected men and women living in rural
areas of the south.
Methods: We collected data on 611 consecutive
patients from 8 rural HIV clinics in 5
southern states.
Results: We found that patients with more
lifetime trauma, stressful events and PTSD
symptoms reported worse health-related
quality of life, including more bodily pain,
and poorer physical, role and cognitive
functioning. Trauma, recent stressful events
and PTSD explained from 12% to 27% of the
variance in health-related functioning, over
and above that explained by demographic
variables. In addition, patients with more
trauma, including sexual and physical abuse,
and PTSD symptoms were at greater risk for
having bed disability, an overnight
hospitalization, an emergency room visit, and
four or more HIV outpatient clinic visits in
the previous nine months. Patients with a
history of abuse had about twice the risk of
spending five or more days in bed, having an
overnight hospital stay, and visiting the
emergency room, compared to those without
abuse. The effects of trauma and stress were
largely explained by increases in current
PTSD symptoms.
Conclusions: These findings highlight the
importance of addressing past trauma, stress
and current PTSD within clinical care.

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