title: Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity.
abstract: Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18-73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA. rmcintosh@psy.miami.edu.
authors.forename: Roger C
authors.initials: RC
authors.lastname: McIntosh
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Antoni
authors.affiliation: Department of Clinical Immunology, Institute of Neuro Immune Medicine, Nova Southeastern University, Davie, FL, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Fletcher
authors.affiliation: Department of Health Psychology, University of Miami, Miami, FL, 33124, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
mesh_terms: D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001242:Assertiveness; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D055118:Medication Adherence; D012720:Severity of Illness Index; D012944:Social Support; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Alexithymia; Assertiveness; HIV/AIDS; Psychosocial function