The role of psychological flexibility and self-compassion in mental health and quality of life of HIV-infected adults Alexandra Martins*, Maria Cristina Canavarro, and Marco Pereira** Faculty of Psychology and Education Sciences, University of Coimbra, Portugal *FCT – SFRH/BD/100117/2014 | **FCT – IF/00402/2014
Background Living with HIV may be a stressful and emotionally demanding experience (Brion et al., 2014). People living with HIV (PLWH) face a range of issues, including limited access to care, HIV stigma, and disclosure concerns, impacting their mental health and quality of life (QoL). In turn, this may also impact health outcomes in HIV disease (e.g., Brandt et al., 2015). Two newly constructs are particularly promising as buffers against the distress that individuals experience when confronting HIV: psychological flexibility and selfcompassion. Psychological flexibility is defined as the ability to experience the present moment more aware and actively, changing or persisting with the behavior in function of valued goals (Hayes et al., 2006). Self-compassion involves being open to and moved by one’s own suffering, experiencing feelings of caring and kindness toward oneself, taking an understanding, nonjudgmental attitude toward one’s inadequacies and failures, and recognizing that one’s own experience is part of the common human experience (Neff, 2003). Both psychological flexibility and self-compassion have been consistently associated with increased psychological well-being (e.g., Marshall & Brockman, 2016; Woodruff et al., 2013). However, in the HIV context, studies assessing the associations between these two constructs with mental health and QoL are still scarce (e.g., Kemppainen et al., 2013; Landstra et al., 2013). Thus, the aim of this study was to examine the association between psychological flexibility and self-compassion and the mental health (anxiety and depression) and QoL in HIV-infected adults.
Methods | Participants The study sample consisted of 89 PLWH (49 men, 38 women, and 2 transgender), with a mean age of 41.69 years (SD = 10.80; range: 19-65). Regarding the marital status, 39.3% reported being single, although a significant proportion reported being in a relationship: 13.5% reported being married, 10.1% in cohabitation and 14.6% in a relationship (without living together). Most participants reported having university studies (49.4%), being employed (50.6%) and living in urban areas (89.9%).
| Associations of self-compassion and psychological flexibility with mental health and QoL Both self-compassion and psychological flexibility were significantly and negatively correlated with anxiety and depression, and positively with QoL (cf.Table 1). Table 1. Correlations of self-compassion and psychological flexibility with mental health and QoL
Psychological flexibility
Psychological flexibility
Selfcompassion
Anxiety
Depression
QoL
-
.66***
-.68***
-.62***
.57***
-
-.61***
-.65***
.59***
-
.66***
-.57***
-
-.72***
Self-compassion Anxiety Depression QoL
-
***p < .001
| Multiple Hierarchical Regression Analyses Multiple Hierarchical Regression analyses were performed for each outcome of psychological well-being using total scores of psychological flexibility and selfcompassion. A two-step hierarchical model revealed that psychological flexibility (entered at Step 1) and self-compassion (entered at Step 2) accounted for a significant amount of variance in indices of mental health and QoL (cf. Table 2). In relation to anxiety, psychological flexibility was a significant variable, explaining 45.6% of the variance. When self-compassion was added, psychological flexibility remained significant and self-compassion explained 4.8% of the additional variance. In total, psychological flexibility and self-compassion were associated with reduced levels of anxiety, explaining 50.4% of the total variance. Concerning depression, psychological flexibility was significant, and accounted for 38.7% of the variance. When self-compassion was added, psychological flexibility remained significant and self-compassion explained 9.9% of the additional variance. In total, psychological flexibility and self-compassion were associated with reduced levels of depression, explaining 48.7% of the total variance. Regarding QoL, psychological flexibility was also significantly associated with QoL, explaining 32.4% of the variance. When self-compassion was added, psychological flexibility remained statistically significant and self-compassion accounted for 8.3% of the additional variance. Psychological flexibility and self-compassion were associated with higher QoL, explaining 40.7% of the total variance.
| Measures Self-reported questionnaire on demographic and clinical information Acceptance and Action Questionnaire-II | AAQ-II; Bond et al. 2011; Portuguese Version (PV): Pinto-Gouveia, Gregório, Dinis, & Xavier, 2012
Dimension: Psychological Flexibility
Table 2. Multiple hierarchical regression of psychological flexibility and self-compassion on mental health and QoL
Self-Compassion Scale | SCS; Neff, 2003; PV: Pinto-Gouveia & Castilho, 2006 Dimensions: Self-kindness; Self-judgment; Common humanity; Isolation; Mindfulness; Overidentification
Hospital Anxiety and Depression Scale | HADS; Snaith & Zigmond, 1994; PV: PaisRibeiro, Silva, Ferreira, Martins, Meneses, & Baltar, 2006
Dimensions: Anxiety; Depression
EUROHIS-QOL 8-item index; Power, 2003; Schmidt, Mühlan, & Power, 2006; PV: Pereira, Melo, Gameiro, & Canavarro, 2011
Dimension: Quality of life
| Procedure Data were collected, between January 2016 and January 2017, through an online survey placed on the website of the Faculty of Psychology and Education Sciences, University of Coimbra. A web page was also created on the social network Facebook, where the study goals, the inclusion criteria, and the participants’ and the researchers’ roles were explained. The ethical considerations, particularly the confidentiality and anonymity of the responses, were also on the introductory page.A link to the online survey was disclosed on the same page.
B (SE) Anxiety Step 1 Psychological flexibility Step2 Psychological flexibility Self-compassion Depression Step 1 Psychological flexibility Step 2 Psychological flexibility Self-compassion QoL Step 1 Psychological flexibility Step 2 Psychological flexibility Self-compassion
-0.28 (0.03)
β
-.68 -.48
1.09***
-1.93 (0.67)
-.29
2.84**
-0.14 (0.04) -1.13 (1.08)
0.86 (0.13) 0.48 (0.17) 9.24 (2.66)
-.62 -.34 -.42
.57 .31 .39
R2
72.84***
.456
43.67***
.048
54.97***
.387
40.75***
.099
41.73***
.324
29.57***
.083
-8.54***
-0.20 (0.04)
-0.25 (0.03)
F
t
-7.41*** -3.33** -4.08***
6.46*** 2.83** 3.48**
** p < .01; *** p < .001
Results
Conclusions
| Clinical characteristics associated with HIV infection On average, participants reported approximately 11 years (M = 11.42; SD = 8.15) since HIV diagnosis. PrEP/PEP for the HIV-negative partner in the last 3 monts | Did not receive or know
87.5%
No STD in the last 6 months
87.6%
Most recent CD4 count | > 350 cells/ml
70%
Most recent viral load | Undetectable
87.6%
Stage of HIV infection | Asymptomatic
79.8%
Did not interrupt the treatment in the last 3 months
96.6%
100% of the antiretroviral treatment in the last month
77.5%
Transmission mode | Sexual intercourse with a man Took test on their own initiative
The results of this study reveal that psychological flexibility and self-compassion are significantly associated with mental health indicators (i.e., symptoms of anxiety and depression) and QoL. Self-compassion presents a significant unique variance above and beyond psychological flexibility across study outcomes. This reinforces the importance of understanding the role of self-compassion as a contributor to mental health, adding support to continuing research. In fact, the present study strengthens that third wave cognitive-behavioural approaches, as acceptance and commitment therapy (ACT) and compassion-focused therapy, aimed in increasing both psychological flexibility and self-compassion, may hold promise in the search for effective interventions focused at improving the mental health and QoL of PLWH.
67.4%
List of Acronyms Pre-exposure prophylaxis | PrEP Post-exposure prophylaxis | PEP Sexually transmitted diseases | STD
50.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Fig. 1. Characterization of the sample in relation to the clinical characteristics associated with HIV infection
PRESENTED AT THE 9TH IAS CONFERENCE ON HIV SCIENCE - PARIS, FRANCE
URL I www.fpce.uc.pt/saude E-mail I
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