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Resilience and optimism may not only have main effects on health outcomes, but may also moderate and buffer negative effects of stressors. We examined whether dispositional resilience and optimism moderate the associations between HIV-related stigma in health care settings and health-related outcomes (trust in HIV health care providers and depression symptoms) among women living with HIV (WLHIV). One thousand four hundred five WLHIV in nine US cities completed validated questionnaires for cross-sectional analyses. Higher self-reported experienced and anticipated stigma and lower resilience and optimism were associated with higher depression symptoms and with lower trust in HIV providers. Importantly, resilience moderated the effects of experienced stigma (but not of anticipated stigma): When resilience was high, the association of experienced stigma with higher depression symptoms and lower trust in HIV providers was weaker compared with when resilience was low. Further, significant moderation effects suggested that when optimism was high, experienced and anticipated stigma was both less strongly associated with depression symptoms and with lower trust in one's HIV care providers compared with when optimism was low. Thus, the effects of experienced stigma on depression symptoms and provider trust were moderated by both resilience and optimism, but the effects of anticipated stigma were moderated only by optimism. Our findings suggest that in addition to their main effects, resilience and optimism may function as buffers against the harmful effects of stigma in health care settings. Therefore, optimism and resilience may be valuable intervention targets to reduce depression symptoms or improve trust in providers among populations that experience or anticipate stigma, such as WLHIV.

In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.

Mindful eating is a phenomenon to describe a nonjudgmental awareness of physical and emotional sensations while eating or being in a food-related environment. Nowadays, weight-related psychological and physiological health problems are gradually increasing. It is considered that mindful eating is one of the key components to struggle against dysfunctional eating patterns. The aim of the current study was to adapt the original five-factor structure of the MEQ and the abbreviated two-factor structure of the MEQ to Turkish culture and to determine its psychometric properties. The sample of the study was 362 university students aged between 18 and 27 (M = 20.82, SD = 3.83). Of the participants 249 (68.8%) were women, 110 (30.4%) were men, and three participants stated their sex as 'other'. Participants were asked to fill the Mindful Eating Questionnaire (MEQ), Eating Disorder Examination Questionnaire (EDE-Q), Intuitive Eating Scale (IES) and Brief Symptom Inventory (BSI). Results of confirmatory factor analysis showed an acceptable model fit for the correlated two-factor structure of the MEQ compared to its original five-factor structure. Internal consistency coefficient values for the overall MEQ and awareness and recognition subscales were .82, .71 and .82, respectively. The MEQ sub-scales' scores were found to be associated with EDE-Q, IES, and BSI scores, confirming the validity of the scale. The Turkish version of the two-factor MEQ could be evaluated as a valid and reliable measurement to assess mindful eating for further research and would also provide support to cross-cultural research., Author(s): Burcu Kömürcü Akik [sup.1] , Ibrahim Yigit [sup.2] Author Affiliations: (1) grid.7256.6, 0000000109409118, Faculty of Languages and History-Geography, Department of Psychology, Ankara University, , PC: 06100, Ankara, Altindag, Turkey [...]

Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.

BackgroundResearch on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns).Setting/methodsOne hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma.ResultsDisclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect.ConclusionsFindings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.

There is limited research on the effects of stigma on health outcomes among new-to-HIV care individuals. We examined the effect of changes in internalized stigma over time on health behaviors and outcomes such as viral suppression, antiretroviral therapy (ART) adherence, and visit adherence among new-to-HIV care individuals. We also analyzed the mediating effects of adherence self-efficacy and depressive symptoms in these associations. Participants were 186 persons living with HIV who initiated care at four HIV clinical sites in the United States and had diverse geographical and ethnic backgrounds. Baseline and 48-week follow-up assessments included measures of internalized stigma, ART adherence, depressive symptoms, and adherence self-efficacy. HIV visit adherence and viral load data were extracted from clinic records. Age, race, gender, insurance status, and site were controlled in all analyses. Logistic regression analyses were used to examine predictors of adherence and viral suppression. Change (decrease) in internalized stigma was calculated by subtracting follow-up internalized stigma scores from baseline scores and served as the main predictor. Mediation analyses included calculation of 95% confidence intervals for the indirect effects using bootstrapping. Decreases in internalized stigma over time were positively associated with viral suppression, ART adherence, and visit adherence. Adherence self-efficacy significantly mediated these effects of decrease in internalized stigma on all outcomes. Depressive symptoms only mediated the association between decrease in internalized stigma and ART adherence. Interventions that address internalized stigma and depressive symptoms, as well as adherence self-efficacy, may significantly improve adherence and viral suppression outcomes for individuals new to HIV care.

ObjectiveConsidering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The 'integrating ENGagement and Adherence Goals upon Entry' (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles.DesignThe iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm.MethodsBaseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined.ResultsThe decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame.ConclusionThe multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.

Resilience is defined as the ability and process to transform adversity into opportunities for growth and adaptation. Resilience may be especially important for people living with HIV (PLWH), who are susceptible to anxiety and depressive disorders, which are commonly linked to risk behaviors (i.e., alcohol and drug abuse), poor adherence to medical regimens, increased risk of morbidity and mortality, and related stigma and discrimination. To date, few studies have examined the impact of resilience on health-related behaviors and outcomes among PLWH, particularly among minority women living with HIV (WLWH) who are dealing with multiple stressors impacting their health. This study used a convergent parallel mixed-methods design to collect, analyze, and integrate qualitative and quantitative data from a subsample of WLWH enrolled in the Women's Interagency HIV Study (WIHS). The aims of the study were to (1) qualitatively examine the resilience perspectives of 76 marginalized WLWH, and; (2) quantitatively assess the associations of resilience with HIV health outcomes-adherence to antiretroviral therapy and viral suppression-in the context of differing levels of internalized HIV-related stigma and depressive symptoms (n = 420). Findings from this mixed-methods study suggest that resilience is an important resource that can aid WLWH in coping constructively with adversity by capitalizing on intrapersonal traits and states, interpersonal and institutional resources, and spiritual and/or religious practices. Given the complex medical and social needs of marginalized WLWH, intervention strategies should focus on mitigating psychosocial burdens of stigma and depression, in addition to building resilience.

Many studies have supported the mediating role of maladaptive schemas in the relationship between early childhood adversity and psychopathology in both clinical and non-clinical adolescent samples. However, to the best of our knowledge, there has been no study to simultaneously test the mediating role of maladaptive schemas in a combined model included in both clinical and non-clinical samples of adolescents. The sample of the study consisted of 132 non-clinical (M = 15.65, SD = 1.15) and 193 clinically referred (M = 15.05, SD = 1.07) adolescents. Criteria for the clinical sample included being diagnosed with generalized anxiety disorder, depressive disorder or mixed anxiety and depressive disorder. Participants were administered The Childhood Trauma Questionnaire, Young Schema Questionnaire, Children's Depression Inventory, and Spielberger State-Trait Anxiety Inventory. The aim of the present study was to test the hypothesized mediation model that Disconnection/Rejection and Impaired Autonomy schema domains would mediate the relationship between childhood maltreatment and psychological symptoms for clinical and non-clinical adolescent samples, separately. Furthermore, we tested whether structural paths of the model were different across the two samples, using multiple-group path analysis. Results showed that Disconnection/Rejection and Impaired Autonomy emerged as significant mediators in both samples. In addition, only the association between Disconnection/Rejection and depression was stronger in the clinical sample compared to the non-clinical sample., Author(s): Ibrahim Yigit [sup.1] , Harun Kiliç [sup.2] , Melike Guzey Yigit [sup.3] , Cihat Çelik [sup.3] Author Affiliations: (1) grid.411548.d, 0000 0001 1457 1144, Faculty of Science and Letters, [...]

This study aimed to investigate the factor structure of the Difficulties in Emotion Regulation Scale-Brief Form (DERS-16) in a Turkish sample. It also aimed to determine whether the factor structure of the scale was equivalent across gender. The sample consisted of 316 undergraduate students (169 females and 147 males) aged between 18 and 28 years. Participants were asked to complete the DERS-16, Brief Symptom Inventory, Acceptance and Action Questionnaire-II, and Berkeley Expressivity Scale. Confirmatory factor analysis was conducted to investigate the factor structure of DERS-16, while multiple-group confirmatory factor analysis was carried out to test measurement invariance across sex. The results showed DERS-16 to exhibit robust psychometric properties, while its five-factor structure was equivalent across gender. DERS-16 scores were found to be significantly correlated with various psychological symptoms, emotional avoidance, and emotional expressivity. Furthermore, female participants scored higher than males on both overall DERS-16 and its Goals, Strategies, and Non-acceptance subscales. Taken together, these findings suggest that DERS-16 is a valid and reliable self-report measure of emotional dysregulation that exhibits cross-cultural validity in a Turkish sample., Author(s): Ibrahim Yigit [sup.1], Melike Guzey Yigit [sup.1] Author Affiliations: (1) grid.7256.6, 0000000109409118, Faculty of Language, History and Geography, Department of Psychology, Ankara University, , Sihhiye, 06100, Ankara, Turkey Emotion [...]

The COVID-19 pandemic has been profound impacts on mental and physical health of individuals with chronic diseases. Thus, it is important to understand the effects of the COVID-19 pandemic on people living with HIV. We aimed to assess the association between COVID-19-related knowledge and worry, HIV-related health practices and outcomes, and adherence to precautions related to COVID-19, and possible associations of these factors with HIV treatment outcomes (ART adherence and viral load). A cross-sectional survey was conducted between October 2020 and February 2021 among 291 PLWH at two large university hospital HIV clinics in Izmir, Turkey. Additionally, the most recent HIV-RNA load, CD4 count was recorded using medical records. Logistic regression analyses were performed to determine predictors of self-reported adherence to COVID-19-related precautions, ART adherence and undetectable viral load. COVID-19-related worry, COVID-19-related knowledge, and ART adherence were significant predictors of adherence to COVID-19-related precautions. Furthermore, adherence to COVID-19-related precautions was a significant predictor of both ART adherence and undetectable viral load. Findings provide a unique aspect of the interrelations of COVID and living with HIV. Since health behaviors and outcomes for COVID-19 and HIV seem to be interrelated, treatment practices and interventions that address these simultaneously may enhance their efficacy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to examine the factor structure and measurement invariance of the Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV), which is used for intellectual assessment in clinical and non-clinical samples, through using the Confirmatory Factor Analysis (CFA) method. Method: The sample of the study consisted of two groups, of which 415 were clinical (those having attention deficit hyperactivity disorder, specific learning disability, and intellectual disability) and 437 were developmentally normal children without any clinical diagnosis. In order to test first-order (the correlated four-factor model) and higher-order factor structure (model including general intelligence factor) of the WISC-IV, CFA was performed separately for each group. Furthermore, multiple group CFA was also performed to examine measurement invariance across groups. Results: Findings of CFA carried out separately for the groups revealed excellent model fit indices for both the correlated firstorder and second-order structure of the WISC-IV in both sample groups. However, as a result of multiple group CFA, model fit indices and factor loadings of the clinical sample were found to be better for the correlated four-factor first-order structure compared to the non-clinical sample. Conclusion: The findings suggest that the WISC-IV index and subtest scores measure the same cognitive structure for both groups. [ABSTRACT FROM AUTHOR]

In this study, variations in permeability of a gold ore by nut shell addition was studied. Ore particle size, nut shell size and volume fraction in the ore were the parameters investigated. Permeability is an important issue in heap leach operations considering the processing duration. Particularly below 6 mm particle size permeability is greatly hampered. Turkey is the leading country in the world in hazelnut production. Therefore, considerable amounts of nut shell are obtained as a by-product. Incerase in the permeability of a finely crushed ore will obviously enable an increase in the leaching efficiency. The finer the particle size the more the liberation of gold is yet the permeability is lower. Therefore, this study focuses on the possibility of improving the permeability of ore heaps with nut shell addition. Optimum amount of nut shell which should be added to the ore was found to be 5% by volume. It was found that the permeability of ore crushed below 2.36 mm considerably increased by the addition of nut shell below 18 mm. [ABSTRACT FROM AUTHOR]

Background: Although cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (antiretroviral therapy [ART] adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States., Setting/methods: Data were obtained from 371 PWH who initiated HIV medical care at 4 HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence, and viral load was obtained from medical records at the final study visit., Results: Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma and then through depression symptoms., Conclusions: These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Research on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns)., Setting/methods: One hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma., Results: Disclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect., Conclusions: Findings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)