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Biomedical subjects

Neil Schneiderman

Publications and source records attributed to Neil Schneiderman.

At least 37 records · Page 2Linked to original sources
PubMed2005

Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression.

The issue of whether optimism may prospectively protect against disease progression is one that has generated much interest, with mixed results in the literature. The purpose of this study was to determine whether dispositional optimism predicts slower disease progression in HIV. Two indicators of disease progression, CD4 counts and viral load, were assessed over 2 years in a diverse group (men, women, White, African American, Hispanic) of 177 people with HIV in the midrange of disease at entry to the study. Optimism predicted slower disease progression (less decrease in CD4 and less increase in viral load) controlling for baseline CD4 and viral load, antiretroviral treatment, gender, race, education, and drug use. Those low on optimism (25th percentile) lost CD4 cells at a rate 1.55 times faster than those high on optimism (75th percentile). Optimists had higher proactive behavior, less avoidant coping, and less depression: These variables mediated the linear optimism-disease progression relationship. Thus, optimists may reap health benefits partly through behavioral (proactive behavior), cognitive (avoidant coping), and affective (depression) pathways. Implications, limitations, and interpretations are discussed.

Adaptation, Psychological↗
PubMed2005

Psychosocial considerations in the European guidelines for prevention of cardiovascular diseases in clinical practice: Third Joint Task Force.

The International Society of Behavioral Medicine (ISBM) was one of eight societies that comprised the Third Task Force of European and Other Societies on Prevention of Cardiovascular Disease in Clinical Practice (2003-2004). This task force considered published knowledge from diverse fields related to preventive cardiology including behavioral medicine to improve risk estimation and risk factor management. The scientific evidence supporting the guidelines included findings on low socioeconomic status, social isolation, psychosocial stress, hostility, depression and negative affect, the clustering of psychosocial and lifestyle risk factors, and lifestyle psychosocial interventions. Recommendations for promoting behavior change and management of psychosocial and lifestyle factors in clinical practice include strategies for promoting healthy lifestyle, improving health care provider-patient interactions, implementing multimodal interventions, and managing psychosocial risk factors.

Affect↗
PubMed2005

Cognitive behavioral stress management effects on mood, social support, and a marker of antiviral immunity are maintained up to 1 year in HIV-infected gay men.

Numerous herpesvirus infections are associated with clinically relevant outcomes as well as an accelerated HIV replication rate and subsequent disease progression. Stress management interventions may improve markers of cellular immune control over latent herpesvirus infections and these changes appear to be mediated by perceptions of increased social support availability. We examined the effects of a group-based cognitive behavioral stress management (CBSM) intervention on distress, dysphoria, perceived social support, and herpesvirus immunoglobulin G (IgG) antibody titers during the 6 to 12 months following the intervention. Of those who were initially randomized, 49 HIV-infected men were followed during the 6- to 12-month period after randomization to either a 10-week CBSM intervention (n = 31) or a modified wait-list control condition (n = 18). Measures of distress, dysphoria, social support, and blood samples for herpesvirus IgG titers were taken at baseline, immediately following CBSM and at 6- to 12-month follow-up. Men in CBSM displayed maintenance of previously observed intervention effects on dysphoria, reliable alliance support, and herpesvirus IgG antibody titers (i.e., Epstein-Barr virus capsid antigen; EBV-VCA). Intervention-related changes in EBV-VCA were unrelated to changes in lymphocyte subsets (i.e., CD4+, CD8+, and CD4+:CD8+) or changes in measures of dysphoria and social support during the investigation period. Data indicate that HIV-infected men participating in a CBSM intervention maintain better psychosocial status and immunologic control of latent EBV infection up to 1 year after its conclusion.

Adult↗
PubMed2004

Cognitive-behavioral stress management improves stress-management skills and quality of life in men recovering from treatment of prostate carcinoma.

BACKGROUND: The current study evaluated the efficacy of a 10-week, group-based, cognitive-behavioral stress management (CBSM) intervention relative to a half-day seminar in improving quality of life (QoL) among men who were treated for localized prostate carcinoma (PC) with either radical prostatectomy (RP) or radiation therapy. METHODS: Ninety-two men were assigned randomly to either the 10-week CBSM group intervention or a 1-day seminar (control group). The intervention was designed to improve QoL by helping participants to identify and effectively manage stressful experiences and was focused on the treatment-related sequelae of PC. RESULTS: A hierarchical regression model was used to predict postintervention QoL. The final model, including all predictors and relevant covariates (i.e., income, baseline QoL, ethnicity, and group condition), explained 62.1% of the variance in QoL scores. Group assignment was a significant predictor (beta = - 0.14; P = 0.03) of QoL after the 10-week intervention period, even after controlling for ethnicity, income, and baseline QoL. Post-hoc analyses revealed that individuals in the CBSM intervention condition showed significant improvements in QoL relative to men in the 1-day control seminar. Improved QoL was mediated by greater perceived stress-management skill. CONCLUSIONS: A 10-week cognitive-behavioral group intervention was effective in improving the QoL in men treated for PC, and these changes were associated significantly with intervention-associated increases in perceived stress-management skills.

Aged↗
PubMed2004

Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire.

OBJECTIVES: To evaluate whether the relationship between sexual desire and quality of life (QOL) is moderated by sexual functioning in 91 men who had received treatment for localized prostate cancer within the past 18 months. METHODS: Items from the University of California, Los Angeles, Prostate Cancer Index and Expanded Prostate Cancer Index Composite were used to assess sexual factors, and the Functional Assessment of Cancer Therapy--General Module was administered to evaluate QOL. Education, income, and the Charlson comorbidity index were significantly related to QOL and controlled in all analyses. We tested a moderated regression model to predict QOL. RESULTS: Although a main effect was detected for sexual functioning, the interaction of sexual desire and sexual functioning added a significant amount to the explained variance in QOL. Post hoc tests of moderation revealed that men with lower sexual functioning had significantly lower QOL scores as the level of sexual desire increased, suggesting that desire in the absence of adequate functioning may result in poorer QOL. Additionally, a tendency was found for men with better sexual functioning to have higher QOL scores as the level of sexual desire increased. CONCLUSIONS: The results of our study suggest that both sexual desire and sexual functioning are necessary for optimal QOL and highlight the utility of considering these two facets of sexuality independently to maximize the prediction of variance in QOL scores.

Aged↗
PubMed2004

Perceived stress mediates the effects of coping on the quality of life of HIV-positive women on highly active antiretroviral therapy.

This study examined the relationship between three HIV-specific coping strategies (cognitive coping strategies, denial, and religious coping) and quality of life (QoL) in 90 HIV+, predominately minority women on highly active antiretroviral therapy. Religious coping was unrelated to QoL; however, use of cognitive coping strategies was related to greater QoL, and denial was related to poorer QoL. Baron and Kenny's model of mediation was then used to test perceived stress as a mediator of the relationships between denial and cognitive coping strategies and QoL. These relationships were both mediated by perceived stress. Results suggest that utilization of certain coping strategies may lessen or heighten perceptions of life stressfulness, thereby influencing QoL in this understudied population.

Adaptation, Psychological↗
PubMed2004

Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS.

Numerous studies have linked social support to better medication adherence among illness groups, but few have examined potential mechanisms for this relationship. Relationships were examined between social support, depression, positive states of mind (PSOM), and medication adherence among HIV positive men who have sex with men (n = 61) and women (n = 29) on highly active antiretroviral therapy. Depression and PSOM were evaluated as potential mediators of the relationship between support and adherence. Cross-sectional data showed that greater social support and PSOM related to better adherence whereas higher depression scores related to nonadherence. PSOM partially mediated the relationship between social support and adherence. PSOM may be an important mechanism through which social support is related to better medication adherence in this population.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Physical activity interventions in the elderly: cancer and comorbidity.

The relationship among age, comorbidity, and physical activity have been relatively understudied among breast, colorectal, and prostate cancer populations despite their known impact on morbidity and mortality. In this article, we review evidence supporting the efficacy of physical activity interventions in improving cardiovascular risk groups, the elderly and cancer patients. Preliminary studies conducted with older patients suggest that physical activity interventions can reduce fatigue, elevate mood, improve physical functioning, reduce physical, role limitations, decrease falls, attenuate losses in bone density, promote weight loss, and modify CHD risk factors. Although relatively few randomized clinical trials have assessed the efficacy of physical activity interventions in cancer patients, the research suggests that these interventions can have both physical and mental health benefits. The implications and limitations of these findings are discussed. Further studies that use larger sample sizes and examine possible moderating variables, such as age, on the efficacy of such interventions are needed.

Aged↗
PubMed2004

HIV, metabolic syndrome X, inflammation, oxidative stress, and coronary heart disease risk : role of protease inhibitor exposure.

Differences on measures of metabolic syndrome X and coronary heart disease (CHD) risk, as well as potential pathophysiological mediators, inflammation, and oxidative stress, were examined as a function of HIV serostatus and highly active antiretroviral therapy (HAART) regimen with and without protease inhibitors (PIs). Data from 164 men and women, aged 18 to 55 yr, were used to compare 82 HIV+ subjects who were free of hepatitis C virus and were on a stable HAART regimen for >/=6 mo, with 82 seronegative subjects matched on age, sex, body mass index, and ethnicity. For the HIV+ subjects, after controlling for diabetes status and HIV disease progression, PI exposure was associated with greater oxidative stress, triglyceridemia, and lipidemia than it was for non-PI-exposed HIV+ subjects, and the risk of a future myocardial infarction was up to 56% greater in PI-exposed than in non-PI-exposed subjects and 129% greater than in controls. Although it is likely that the greatest proportion of CHD risk in the HIV+ subjects may be accounted for by pathological conditions linked to HIV infection in interaction with mediating processes such as inflammation, central obesity, and dyslipidemia, which was greater than in controls, it appears that PI medications may exacerbate oxidative stress and hypertriglyceridemia to enhance this risk.

Adolescent↗
PubMed2004

John Henry Active Coping, education, and blood pressure among urban blacks.

The John Henryism hypothesis posits that individuals who actively cope with psychosocial stressors in the face of low socioeconomic resources are more likely to exhibit higher blood pressure levels than those with greater socioeconomic resources. It has been proposed that John Henryism may contribute to the disproportionately high rates of hypertension among blacks. Previous studies which support the John Henryism hypothesis have been conducted among blacks who reside in primarily southern rural settings. However, more recent studies conducted among urban blacks, have yielded contrasting results. This study examined the John Henryism hypothesis in a middle-aged urban sample of blacks in south Florida. The results of the study confirmed that there is indeed a relationship among John Henry Active Coping, years of education, and blood pressure among urban blacks in south Florida. Upon closer examination, higher John Henry Active Coping scores were associated with higher systolic and diastolic blood pressure among higher educated men, and John Henry Active Coping scores were associated with higher systolic and diastolic blood pressure among women with lower levels of education. The findings are discussed in terms of sociocultural factors that may influence the coping styles of black men and women in different communities and environments.

Adaptation, Psychological↗
PubMed2003

Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.

CONTEXT: Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment. OBJECTIVE: To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI. DESIGN, SETTING, AND PATIENTS: Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention. INTERVENTION: Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks. MAIN OUTCOME MEASURES: Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months. RESULTS: Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients). CONCLUSIONS: The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.

Adaptation, Psychological↗
PubMed2003

Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction.

BACKGROUND: Depression is common in patients with acute myocardial infarction (AMI) and is associated with adverse health outcomes. However, the extent to which clinical depression is related to comorbid medical conditions is unknown. This study examined the degree of association between clinical depression and medical comorbidity in patients hospitalized with AMI. METHODS: Two thousand four hundred and eighty-one depressed or socially isolated patients with AMI were enrolled, as part of the National Heart, Lung, and Blood Institute-sponsored Enhancing Recovery in Coronary Heart Disease clinical trial. A structured interview was used to diagnose major and minor depression and dysthymia; severity of depression was measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Level of social support was measured by the ENRICHD Social Support Instrument. A modified version of the Charlson Comorbidity Index was used to measure the cumulative burden of medical comorbidity. RESULTS: The adjusted odds ratios (ORs) for having major depression increased linearly with medical comorbidity (ORs 1.6, 2.2, 2.7 for each increasing medical comorbidity category). This relationship remained after adjusting for coronary heart disease severity (ORs 1.4, 1.7, 1.9, P <.001). The relationship between severity of depression and medical comorbidity was also maintained after excluding somatic symptoms of depression (F = 21.5, P <.0001). CONCLUSIONS: Patients with AMI and clinical depression have significantly greater levels of medical comorbidity than nondepressed, socially isolated patients. Further research is needed to determine whether comorbid medical illness contributes to the more frequent rehospitalizations and increased risk of mortality associated with depression.

Adult↗
PubMed2003

Cognitive-behavioral interventions improve quality of life in women with AIDS.

OBJECTIVE: We tested the effects of a 10-week group-based cognitive-behavioral stress management/expressive-supportive therapy intervention (CBSM+) and a time-matched individual psychoeducational condition for 330 women with AIDS reporting moderate to poor baseline quality of life (QOL). The goal of this study was to examine treatment effects on total QOL and 11 QOL domains from baseline to post-intervention follow-up. METHODS: Participants were assessed at baseline, randomized to a treatment condition (individual psychoeducation condition n=180, group-based CBSM+ condition n=150), participated in the intervention for 10 weeks and assessed again within 4 weeks following the intervention. QOL was measured using the Medical Outcomes Study-HIV-30. RESULTS: QOL scores increased over the course of both interventions for the total QOL score and three QOL domains: cognitive functioning, health distress and overall health perceptions. While women in the CBSM+ group condition showed a significant improvement in mental health QOL from pre- to post-intervention, women in the individual condition did not change. No changes were observed for energy/fatigue, health transition, single-item overall QOL, pain, physical well-being, role functioning or social functioning in either condition. CONCLUSION: Results suggest that group-based CBSM+ and individual psychoeducational interventions are effective at improving certain aspects of QOL and that group-based CBSM+ may be particularly effective at increasing QOL related to mental health in this population of women with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Personality, quality of life and HAART adherence among men and women living with HIV/AIDS.

Very few studies have documented relations between personality traits and quality of life among individuals living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Some have shown that poor perceived quality of life as determined by a sense of purpose may be associated with inadequate adherence to highly active antiretroviral treatment (HAART) in this population. Although adequate HAART adherence is critical to achieve the full therapeutic effects of newly and highly effective regimens, very little is known of how both personality factors and HIV-specific quality of life may impact adherence to these medication regimens. This study evaluated relations among personality traits, quality of life and HAART adherence among 116 men and women living with HIV/AIDS. Results showed that personality traits such as neuroticism were significantly associated with poorer quality of life, whereas conscientiousness and extraversion were associated with better quality of life. In contrast, personality traits were not directly related to HAART adherence. Both higher overall functioning and lower medication worries scores were significantly associated with HAART adherence. Findings suggest that personality traits are associated with HIV-specific quality of life on the one hand, and that HIV-specific quality of life is related to HAART adherence on the other. Future studies assessing the efficacy of psychosocial interventions in improving quality of life and HAART adherence should consider the role of personality traits in promoting better quality of life.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Sleep disturbance mediates the association between psychological distress and immune status among HIV-positive men and women on combination antiretroviral therapy.

OBJECTIVES: This study examined the relationship between psychological distress, subjective sleep disturbance and immune status among HIV-positive men and women. METHODS: Fifty-seven participants (41 men, 16 women) without AIDS-related illness and currently on combination antiretroviral therapy were recruited through community advertisement and physician referral. Participants completed the Impact of Events Scale (IES) to assess symptoms of psychological distress and the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep over the past month. T-lymphocyte subpopulations were also assessed from early morning blood samples. RESULTS: Participants reporting greater psychological distress also reported more pronounced sleep disruption. Higher levels of distress and greater sleep disturbance were also significantly related to lower T-cytotoxic/suppressor (CD3+CD8+) cell counts. Path analysis revealed that the association between distress level and CD3+CD8+ cell counts was mediated by poorer subjective sleep quality. CONCLUSIONS: These findings suggest that psychological distress may impact upon the immune system through its effects on sleep quality.

Adult↗
PubMed2003

Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS.

OBJECTIVE: This study examined the relationship between emotional expression and depth processing of trauma and long-term survival of patients living with AIDS. A further purpose was to examine the immune, health behavior and psychosocial correlates of emotional disclosure and depth processing. METHOD: Subjects wrote essays describing their reactions to past traumas; these were scored for emotional expression and depth processing (positive cognitive appraisal change, experiential involvement, self-esteem enhancement and adaptive coping strategies). Two HIV-seropositive groups were recruited for this study; long-term survivors (LTS; n=46) patients who had survived at least 4 years past a Category C (AIDS defining) symptom prior to starting protease inhibitors and an equivalent HIV-seropositive comparison group (ECOMP(LTS); n=89) who had CD4+ cells between 150 and 500, and had no history of Category C symptoms. The groups were equivalent on age, gender, ethnicity, education, employment, income, sexual orientation and route of infection. RESULTS: The group LTS were significantly higher than the ECOMP(LTS) group on emotional expression and depth processing. Depth processing mediated the relationship between emotional expression and long-term survival status. Depth processing was positively related to CD4+ cell number for women. Emotional expression was also significantly related to viral load (negatively) and to CD4+ cell number (positively) for women only. Interestingly, only depth processing (and not emotional expression) was related to medication adherence and to psychosocial variables (perceived stress and social support). CONCLUSIONS: Emotional expression and depth processing were related to long-term survival, however, depth processing was the mediator for this relationship and only depth processing was associated with medication adherence, perceived stress and social support. Our results underscore the importance of depth processing (and not just emotional expression) of traumatic experiences for people living with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Assessing the reliability and validity of the John Henry Active Coping Scale in an urban sample of African Americans and white Americans.

OBJECTIVES: The primary focus of this study was to examine the psychometric properties of the John Henry Active Coping scale (JHAC12) among an urban middle-aged sample of African Americans and white Americans. DESIGN: The sample consisted of 75 African Americans and 129 white Americans from South Florida ranging in age from 25 to 54 years. Subjects completed the JHAC12, the Life Orientation Test (LOT), Coping Orientation to Problems Encountered (COPE) subscales, and the Marlowe-Crowne Social Desirability scale. RESULTS: Major findings supported the validity and reliability of the JHAC12 among both African Americans and white Americans. For both the African American and white American subsamples, the JHAC12 was correlated with the active coping and suppression of competing activities subscales of the COPE and negatively correlated with the Marlowe-Crowne Social Desirability scale. In the African American subsample the JHAC12 was positively correlated with the LOT. The JHAC12 was also negatively associated with the behavioral disengagement subscale of the COPE among white Americans. Multiple regression analyses revealed that the proportion of variance in the JHAC12 explained by the various subscales of the COPE, Marlowe-Crowne, and the LOT was 43% for African Americans and 20% for white Americans. Factor analyses suggested two similar and meaningful factors among the African American and white American subsamples. Finally, Cronbach alpha reliabilities revealed similar subsample coefficients. DISCUSSION: The implications of the findings are discussed in terms of the JHAC12's ability to assess the construct of active coping among African Americans and white Americans.

Adaptation, Psychological↗