final program.qxd - Parallels Plesk Panel

PP 4.7
Telephone-Based Coping Improvement Group Intervention for Persons 50 Years of
Age or Older Living with HIV/AIDS in the United States
Timothy G. Heckman
Department of Psychology - Ohio University, Athens, OH 45701, USA
Objectives: Through December 2003, more than 57,000 persons in the United States were
55 years of age or older when they were diagnosed with AIDS. Historically, older adults
have accounted for approximately 10% of all AIDS cases in the United States. However,
it is now believed that 28% of all persons currently living with AIDS in the U.S. are 50-plus
years of age. As the population of older adults living with HIV disease continues to
increase, mental health interventions are urgently needed for this group. In response to
this need, this research examined if a coping improvement group intervention delivered
via teleconference technology could facilitate the adjustment efforts of 90 persons 50-plus
years of age living with HIV/AIDS who were diagnosed with depression.
Methods: The 90 study participants (mean age=54.4 years; 52% White; 62% Male) were
recruited through non-governmental organizations (NGOs) in Pittsburgh, PA; Cincinnati,
OH; Buffalo, NY; and Phoenix, AZ. Recruitment materials were distributed to participants
via mail, home visits, and placement in high traffic areas of NGOs. The study used a
lagged treatment, control group design, in which 44 participants were assigned to an
"Immediate Intervention" condition and 46 to a "Delayed Treatment" condition. Immediate
Treatment participants completed a pre-intervention assessment, received the
intervention, and completed post-intervention and 3-month follow-up assessments.
Delayed Treatment participants completed two pre-intervention assessments, received
the intervention, and then completed a post-intervention assessment. Self-administered
surveys assessed participants' depressive and psychological symptoms, life-stressor
burden, social support, ways of coping, and coping self-efficacy. The telephone-delivered,
12-session coping improvement group intervention was guided by Lazarus and Folkman's
Transactional Model of Stress and Coping and used cognitive-behavioral strategies to
improve participants' skills in stress appraisal, coping decisions, and obtaining social
support.
Results: ANCOVA using intent-to-treat strategies indicated that, relative to Delayed
Treatment participants, Immediate Treatment participants reported greater reductions in
psychological symptoms (p < .08), life-stressor burden (p < .06), and use of avoidant
coping and significant increases in coping self-efficacy (p < .07). Immediate Treatment
participants maintained these changes at 3-month follow-up. Within-group analyses
indicated that, after receiving the intervention, Delayed Treatment participants reported
significant reductions in psychological symptoms (p < .08) and life-stressor burden
(p < .05) and increases in coping self-efficacy (p < .01). A series of post-hoc multiple
regression analyses were conducted to determine if intervention-related increases in
coping self-efficacy and reductions in avoidant coping mediated Immediate Treatment
participants' changes in psychological symptoms and life-stressor burden. These analyses
indicated that participants' increases in coping self-efficacy (and not decreases in the use
of avoidance coping) were responsible for much of the reduction in participants'
psychological symptomatology and perceptions of life stress.
Conclusions: Data from this preliminary randomized clinical trial provide initial evidence
that psychological well-being and coping self-efficacy can be improved in HIV-infected
older adults through participation in an age-appropriate, telephone-delivered, coping
improvement group intervention. Future research evaluating this intervention approach
should be conducted with larger and more geographically-diverse samples of older adults
living with HIV/AIDS.
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