Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.
OBJECTIVE
Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults.


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


METHODS
Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) 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 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls.


CONCLUSIONS
Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.
Scott-Sheldon
Lori A J
LA
Center for Health and Behavior, Syracuse University, Syracuse, NY 13244-2340, USA. lajss@syr.edu
Kalichman
Seth C
SC
Carey
Michael P
MP
Fielder
Robyn L
RL
D000223:Adaptation, Psychological / Q000502:physiology; D001143:Arousal / Q000502:physiology; D001521:Behavior Therapy / Q000379:methods*; D018791:CD4 Lymphocyte Count; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D006679:HIV Seropositivity / Q000276:immunology / Q000523:psychology*; D006854:Hydrocortisone / Q000097:blood; D011725:Pyridines; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology / Q000628:therapy*; D013739:Testosterone / Q000097:blood; D019562:Viral Load
D011725:Pyridines; C108850:V 10367; D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone