title: Fatigue and Sleep Disturbance Related to Perceived Stress in Chinese HIV-Positive Individuals: A Mixed Methods Study.
abstract: BACKGROUND
  Few studies of HIV+ individuals in China have examined the associations between HIV-related stress with sleep disturbance and fatigue, which are common complaints among people living with HIV/AIDS (PLWHA). We carried out this study to examine the relationships among perceived stress, sleep disturbance, and fatigue in PLWHA in China.
  
  
  METHODS
  A mixed methods study design was used during data collection in Shanghai, China, from December 2009 to March 2010. Qualitative in-depth interviews were conducted with 19 HIV+ females. Additionally, cross-sectional audio computer-assisted self-interviews (ACASI) were conducted to collect quantitative data from a convenience sample of 107 HIV+ patients (84% were male) including the following scales: 1) Perceived Stress Scale for PLWHA, 2) General Sleep Disturbance Scale, and 3) Fatigue Scale.
  
  
  RESULTS
  The major themes that emerged from the in-depth interviews were around life stress with HIV, sleep disturbance, and fatigue. Participants presented varying amounts of stress around worrying about whether to disclose their diagnosis and whether they might transmit the disease to their family. In addition, in the cross-sectional data, 40% of the participants reported clinically significant sleep disturbances (GSDS > 3) with an average of 3 nights of disturbed sleep in the past week (M=2.87,SD=1.21) and moderate fatigue severity (M=5.24, SD=2.27). In mediation analyses, the data suggests that the relationship between perceived stress and fatigue was largely (53%) mediated through sleep disturbance.
  
  
  CONCLUSIONS
  Chinese PLWHA described how stress had caused them to become sleepless and fatigued. The quantitative data also demonstrated significant levels of sleep disturbance and fatigue, where were due to perceived stress with HIV disease. A systematic self-management intervention to decrease perceived stress should be designed and implemented in mental health resource-limited settings such as China in order to reduce sleep disturbance and fatigue.
authors.affiliation: School of Nursing, Yale University, New Haven, CT.
authors.forename: Wei-Ti
authors.initials: WT
authors.lastname: Chen
authors.forename: Cheng-Shi
authors.initials: CS
authors.lastname: Shiu
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Yang
authors.forename: Shih-Yu
authors.initials: SY
authors.lastname: Lee
authors.forename: Tony Szu-Hsien
authors.initials: TS
authors.lastname: Lee
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.forename: Mei-Juan
authors.initials: MJ
authors.lastname: Bao
authors.forename: Hong-Zhou
authors.initials: HZ
authors.lastname: Lu
keywords: China; Cronbach alpha coefficient; Fatigue; PLWHA; Perceived stress; Sleep disturbance