Date Published: November 20, 2017
Publisher: Springer US
Author(s): Jennifer A. McGowan, James Brown, Fiona C. Lampe, Marc Lipman, Colette Smith, Alison Rodger.
Resilience has been related to improved physical and mental health, and is thought to improve with age. No studies have explored the relationship between resilience, ageing with HIV, and well-being. A cross sectional observational study performed on UK HIV positive (N = 195) and HIV negative adults (N = 130). Associations of both age and ‘time diagnosed with HIV’ with resilience (RS-14) were assessed, and the association of resilience with depression, anxiety symptoms (PHQ-9 and GAD-7), and problems with activities of daily living (ADLs) (Euroqol 5D-3L). In a multivariable model, HIV status overall was not related to resilience. However, longer time diagnosed with HIV was related to lower resilience, and older age showed a non-significant trend towards higher resilience. In adults with HIV, high resilience was related to a lower prevalence of depression, anxiety, and problems with ADLs. It may be necessary to consider resilience when exploring the well-being of adults ageing with HIV.
Resilience is a multidimensional concept which seeks to explain how some individuals can attain, maintain, or regain well-being in the face of hardship . It encompasses an individual’s current coping resources in response to stressors, and their ability to effectively adapt these resources to manage new stressful situations [2–6]. Resilience can be broken down into five intrinsic characteristics: purpose/meaning in life [7–9], perseverance , equanimity (balance, composure) [10, 11], self-reliance [1, 7, 8, 10, 12] and ‘authenticity’ (self-acceptance, autonomy) . Often, definitions of resilience also rely on the premise that the individual has experienced stressful life events before and can utilise these experiences to effectively adapt their behaviours [13–15].
The study aimed to recruit a group of PWH and a group of HIV-negative individuals. Individuals with diagnosed HIV attending the ambulatory care service at the Ian Charleson Centre (ICC) HIV clinic between March 2015 and August 2015, and individuals with or without diagnosed HIV attending the Marlborough Sexual Health Clinic over the same period, were approached and invited to participate in the study. Both clinics are situated at the Royal Free London NHS Foundation Trust, and provide HIV testing. The Marlborough clinic has high rates of HIV testing (99% offer and 86% uptake). Participants recruited from the Marlborough Clinic therefore reflect a population that are sexually active, but unlikely to have undiagnosed HIV infection.
Comparable levels of ‘high’ resilience (48.4% vs. 45.6%) were found in adults with and without HIV respectively in this study. In adults with HIV, there was evidence that older age, and shorter time with diagnosed HIV were associated with ‘high’ levels of resilience. Older age and shorter time with diagnosed HIV also tended to be associated with lower prevalence of psychological symptoms (as was found in an earlier study of people with HIV ). High resilience was found to be significantly inversely related to the prevalence of depression, anxiety, and ADL problems in this population, and may, to some extent, mediate the relationship between age, time with diagnosed HIV, and mental health.
There are limitations to this analysis. The HIV-negative group may have included a small number of individuals with undiagnosed HIV (those who had declined HIV-testing, or who tested positive subsequent to completion of the questionnaire). This may have impacted the mental and physical health scores reported in the HIV-negative group. However, the life experiences of those undiagnosed with HIV are likely to be different to those diagnosed and undergoing treatment. As such we consider them to be a distinct and separate group to PWH.
This study provides the first data on resilience among PWH in the UK, and the associations of resilience with age and time with diagnosed HIV. It is the first to explore the relationship between mental and physical well-being with resilience in adults with HIV, and one of the first to explore resilience in comparison to HIV negative adults. The results suggest that, while resilience appears to increase with age, it appears to decline with increasing time diagnosed with HIV. As resilience was found to be inversely related to the prevalence of depression, anxiety, and physical health problems, it may mediate the associations of age and time with diagnosed HIV with mental health. Furthermore, resilience was not associated with HIV status overall, suggesting that it is possible to develop resilience within this population. Resilience and potential interventions to improve resilience are likely, therefore, to become increasingly important as the HIV positive population ages, and may have important implications for the care of HIV positive people in the future.