All ETDs from UAB

Advisory Committee Chair

Magdalena Szaflarski

Advisory Committee Members

Mirjam-Colette Kempf

Sylvie Mrug

Mieke Thomeer McBride

Joseph D Wolfe

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences


Depression among people living with HIV (PLWH) is associated with social factors such as employment, poor adherence to HIV medication and treatment, and HIV disease progression. However, estimates of prevalence rates of depression among PLWH vary widely, from 1% to 48%. Women living with HIV (WLWH) often report spirituality as an important factor in coping with stressors associated with HIV infection. Spirituality has been found to be associated with social involvement, effective coping, decreased stress, psychological adjustment, and positive mental health outcomes among PLWH. The current study aims to longitudinally examine trends of spirituality and mental health/well-being in the lives of WLWH and HIV-negative women at risk for HIV infection and examine the role of potential mediators in the relationship, including stress, stigma, and social support. I hypothesized, for example, that for women in the WIHS cohort, the trajectory of mental health/well-being will differ for HIV+ women compared to HIV-negative women, that change in spirituality will be associated with change in mental health/well-being, and that stress will act as a mediator in the relationship between spirituality and depression/QoL. Data was obtained from the Women’s Interagency HIV Study (WIHS), a longitudinal study of WLWH and women at high risk of HIV infection in the U.S. Women were recruited from 10 sites across the U.S. The study includes detailed and structured interview responses as well as clinical data from physical and gynecological exams and laboratory data. Measures of spirituality were gathered from a 12-item scale used to assess spiritual well-being among people living with chronic illness, the FACIT-Sp. Using a combination of longitudinal and cross-sectional analytic procedures, the study examines the relationship between spirituality and mental health/well-being of life among HIV+ and HIV-negative women in the United States. The study uses data from four waves (visits 38-44) of the WIHS, of which only visits 39 and following include measures of spirituality. Trajectories of and associations between spirituality and mental health/well-being varied by HIV status and mental health/well-being measure assessed. No statistically significant differences were found in spirituality or depression between HIV+ and HIV-negative women, but HIV+ women had higher QoL scores than HIV-negative women. Change in spirituality was associated with change in depression for HIV+ women only; change in QoL for both HIV+ and HIV-negative women. No evidence was found of an effect of proposed mediators in the relationships between spirituality and mental health/well-being outcomes. Findings offer implications for consideration of spirituality in clinical care of PLWH and at risk for HIV.



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