Benefit-finding and coherence in the narratives of women with HIV

Abstract

Women with HIV are particularly at risk for poor mental health outcomes and for a number of traumatic experiences, including sexual abuse. Benefit-finding is the ability to generate positive outcomes resulting from trauma and is important for women with HIV, since it is motivated by distress and has demonstrated health benefits among individuals with trauma and/or medical conditions. Qualitative narrative measures, especially those that reflect life stories, are most likely to assess benefit-finding. Narrative coherence, which reflects how well a life story is told, may be associated with benefit-finding and with better mental health outcomes. The current study hypothesized that greater psychological distress (depressive symptoms [CESD] and quality of life [QOL]) HIV disease progression (HIV viral load [VL] and CD4 count), and sexual abuse, and lower levels of substance use, assessed with self-report measures at multiple visits over an average of 10 years (M = 10.05 years, SD = 3.47 years), would predict benefit-finding and coherence, coded from autobiographical narratives of 99 women with HIV (91% African American, mean age = 44.78 years, SD = 8.85 years) who were participants in the Women's Interagency HIV Study, Chicago site. Greater benefit-finding and coherence were also hypothesized to predict higher resilience coded in narratives cross-sectionally and higher CD4 count, QOL, and antiretroviral medication (HAART) adherence, and lower VL and CESD 6 months following narrative administration (M = 5.64 months, SD = 1.49 months). Partial correlations and multiple hierarchical linear and logistic regressions controlling for demographics and other relevant covariates indicated that hypotheses were partially supported. History of sexual abuse predicted greater benefit-finding only. There were no significant longitudinal predictors of narrative coherence. Benefit-finding was positively related to narrative coherence and resilience (cross-sectionally) and positively predictive of HAART adherence, greater likelihood of CD4 >= 350 and undetectable VL, and fewer depressive symptoms 6 months later. Coherence was not significantly related to post-narrative outcomes. Results suggest that benefit-finding has numerous health benefits among women with HIV and that interventions for this population should draw on and enhance benefit-finding, a potential strength in facing adverse circumstances.