title: Depression and resilience in women with HIV and early life stress: does trauma play a mediating role? A cross-sectional study.
abstract: OBJECTIVE
  The present study sought to assess the relationship between depressive symptomatology and resilience among women infected with HIV and to investigate whether trauma exposure (childhood trauma, other discrete lifetime traumatic events) or the presence of post-traumatic stress symptomatology mediated this relationship.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Western Cape, South Africa.
  
  
  METHODS
  A convenience sample of 95 women infected with HIV in peri-urban communities in the Western Cape, South Africa. All women had exposure to moderate-to-severe childhood trauma as determined by the Childhood Trauma Questionnaire.
  
  
  METHODS
  We examined the relationship between depressive symptomatology and resilience (the Connor-Davidson Resilience Scale) and investigated whether trauma exposure or the presence of post-traumatic stress symptomatology mediated this relationship through the Sobel test for mediation and PLS path analysis.
  
  
  RESULTS
  There was a significant negative correlation between depressive symptomatology and resilience (p=<0.01). PLS path analysis revealed a significant direct effect between depression and resilience. On the Sobel test for mediation, distal (childhood trauma) and proximal traumatic events did not significantly mediate this association (p=> 0.05). However, post-traumatic stress symptomatology significantly mediated the relationship between depression and resilience in trauma-exposed women living with HIV.
  
  
  CONCLUSIONS
  In the present study, higher levels of resilience were associated with lower levels of self-reported depression. Although causal inferences are not possible, this suggests that in this sample, resilience may act as protective factor against the development of clinical depression. The results also indicate that post-traumatic stress symptoms (PTSS), which are highly prevalent in HIV-infected and trauma exposed individuals and often comorbid with depression, may further explain and account for this relationship. Further investigation is required to determine whether early identification and treatment of PTSS in this population may ameliorate the onset and persistence of major depression.
authors.affiliation: South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa.
authors.forename: Georgina
authors.initials: G
authors.lastname: Spies
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D055500:Resilience, Psychological; D012307:Risk Factors; D013019:South Africa; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Psychiatry