title: Bidirectional Relationships Between Fatigue and Everyday Experiences in Persons Living With HIV.
abstract: Fatigue symptoms are very common among persons living with HIV (PLWH). Fatigue is related to functional and psychological problems and to treatment nonadherence. Using secondary data from ecological momentary assessment, we examined fatigue as a predictor of PLWH everyday experiences. In bidirectional analyses based on the shape shifters model, we also examined these experiences as predictors of fatigue. Data were examined from 67 PLWH who completed daily surveys on a handheld computer. Brief validated scales were used to assess participants' control beliefs, mood, stress, coping, social support, experience of stigma, and motivation. At the beginning and end of the study, fatigue was measured with two CES-D items that have been used in past HIV symptom research. Multilevel models and logistic regression were used to test reciprocal predictive relationships between variables. Moderate to severe fatigue affected 45% of PLWH in the study. Initial fatigue predicted PLWH subsequent overall level of control beliefs, mood, stress, coping, and social support, all p < .05. These state variables remained relatively constant over time, regardless of participants' initial fatigue. In tests for reciprocal relationships with 33 PLWH, average daily stress, OR = 4.74, and stigma, OR = 4.86, also predicted later fatigue. Fatigue predicted several daily survey variables including stress and social support. Stress and support in turn predicted fatigue at a later time, suggesting a self-perpetuating cycle but also a possible avenue for intervention. Future studies should examine daily variation in fatigue among PLWH and its relation to other everyday experiences and behaviors. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Associate Professor, College of Nursing, University of Colorado, Campus Box C288-04, Aurora, CO, 80045.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Cook
authors.affiliation: PhD Student, College of Nursing, University of Colorado, Aurora, CO.
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Hartson
authors.affiliation: Associate Professor, College of Nursing, University of Colorado, Aurora, CO.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schmiege
authors.affiliation: Associate Professor, College of Nursing, University of Colorado, Aurora, CO.
authors.forename: Catherine
authors.initials: C
authors.lastname: Jankowski
authors.affiliation: Instructor, School of Medicine, University of Colorado, Aurora, CO.
authors.forename: Whitney
authors.initials: W
authors.lastname: Starr
authors.affiliation: Professor, College of Nursing, University of Colorado, Aurora, CO.
authors.forename: Paula
authors.initials: P
authors.lastname: Meek
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D005221:Fatigue / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D000068997:Smartphone; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: HIV; adherence; coping; ecological momentary assessment; fatigue