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05.05.2016 | Original Research | Ausgabe 9/2016

Journal of General Internal Medicine 9/2016

Relationship Between Spiritual Coping and Survival in Patients with HIV

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 9/2016
Autoren:
MD, PhD Gail Ironson, MD, PhD, PhD Heidemarie Kremer, MS Aurelie Lucette
Wichtige Hinweise

Prior Presentations

Select results from this paper were presented at the Annual Meeting of the American Psychological Association (6 August 2015), the International Association of Positive Psychology Meeting (27 June 2015), and the Annual Meeting of the Society of Behavioral Medicine (25 April 2015).

ABSTRACT

BACKGROUND

Studies of spirituality in initially healthy people have shown a survival advantage, yet there are fewer research studies in the medically ill, despite the widespread use of spirituality/religiousness to cope with serious physical illness. In addition, many studies have used limited measures such as religious service attendance.

OBJECTIVE

We aimed to examine if, independent of medication adherence, the use of spirituality/religiousness to cope with HIV predicts survival over 17 years.

DESIGN

This was a longitudinal study, started in 1997. Study materials were administered semi annually.

PARTICIPANTS

A diverse sample of 177 HIV patients initially in the mid-stage of disease (150–500 CD4-cells/mm3; no prior AIDS-defining symptoms) participated in the study.

MAIN MEASURES

Participants were administered a battery of psychosocial questionnaires and a blood draw. They completed interviews and essays to assess current stressors. Spiritual coping (overall/strategies) was rated by qualitative content analysis of interviews regarding stress and coping with HIV, and essays.

KEY RESULTS

Controlling for medical variables (baseline CD4/viral load) and demographics, Cox regression analyses showed that overall positive spiritual coping significantly predicted greater survival over 17 years (mortality HR = 0.56, p = 0.039). Findings held even after controlling for health behaviors (medication adherence, substance use) and social support. Particular spiritual coping strategies that predicted longer survival included spiritual practices (HR = 0.26, p < 0.001), spiritual reframing (HR = 0.27, p = 0.006), overcoming spiritual guilt (HR = 0.24, p < 0.001), spiritual gratitude (HR = 0.40, p = 0.002), and spiritual empowerment (HR = 0.52, p = 0.024), indicating that people using these strategies were 2–4 times more likely to survive.

CONCLUSIONS

To our knowledge this is the first study showing a prospective relationship of spiritual coping in people who are medically ill with survival over such a long period of time, and also specifically identifies several strategies of spirituality that may be beneficial.

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