title: Impact of anxiety and depressive symptoms on perceptions of stigma in persons living with HIV disease in rural versus urban North Carolina.
abstract: This analysis examined the relationships between HIV-related stigma, depression, and anxiety in rural and urban sites. Participants were HIV-positive urban (n = 100) and rural (n = 100) adult residents of a US southern state, drawn from a sample for a larger international study of self-esteem and self-compassion. Measures included demographic and health information, the HIV Stigma Scale, the Center for Epidemiology Studies Depression Scale (CES-D), and the Symptom Checklist 90 Revised (SCL-R-90) anxiety scale. Independent sample t-tests showed no significant differences between urban/rural groups on measures of HIV-related stigma, anxiety, or depression, except that rural participants reported greater disclosure concerns (t = 2.11, df = 196, p = .036). Both groups indicated high levels of depression and anxiety relative to published norms and clinically relevant cut-off scores. Hierarchical regression analyses were conducted for the HIV Stigma Scale including its four subscales and total stigma scores. Block 1 (control) contained health and demographic variables known to predict HIV-related stigma. Block 2 included the CES-D and the SCL-R-90, and Block 3 was urban/rural location. Mental health symptom scores contributed a significant amount to explained variance in total stigma scores (5.5%, FΔ = 6.020, p < .01), personalized stigma (4.8%, FΔ = 5.035, p < .01), negative self-image (9.7%, FΔ = 12.289, p < .001), and concern with public attitudes (4.9%, FΔ = 5.228, p < .01), but not disclosure concerns. Urban/rural location made significant additional contributions to the variance for total stigma (1.7%, FΔ = 3.899, p < .05), disclosure concerns (2.6%, FΔ = 5.446, p < .05), and concern with public attitudes (1.9%, FΔ = 4.169, p < .05) but not personalized stigma or negative self-image. Depression scores consistently and significantly predicted perceived stigma total and subscale scores. Findings suggest that mental health symptoms and urban/rural location play important roles in perceived stigma, and treatment implications are presented.
authors.affiliation: a Nursing, Winthrop-University Hospital , Mineola , NY, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Costelloe
authors.affiliation: b School of Nursing , University of North Carolina Wilmington , Wilmington , NC , USA.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Kemppainen
authors.affiliation: c College of Nursing, The Ohio State University , Columbus , OH , USA.
authors.forename: John
authors.initials: J
authors.lastname: Brion
authors.affiliation: d Department of Psychology , University of North Carolina Wilmington , Wilmington , NC , USA.
authors.forename: Sally
authors.initials: S
authors.lastname: MacKain
authors.affiliation: e School of Nursing , University of North Carolina Wilmington , Wilmington , NC , USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Reid
authors.affiliation: f Department of Biology and Marine Biology , University of North Carolina Wilmington , Wilmington , NC , USA.
authors.forename: Art
authors.initials: A
authors.lastname: Frampton
authors.affiliation: g Department of Psychology , University of North Carolina Wilmington , Wilmington , NC , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rigsbee
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D004645:Empathy; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010465:Perception; D012044:Regression Analysis; D012424:Rural Population; D012649:Self Concept; D057545:Social Stigma; D012959:Socioeconomic Factors; D014505:Urban Population
keywords: AIDS; HIV; Stigma; anxiety; depression