Stress and Psychosocial Adjustment among People Living with HIV/AIDS in China

Introduction Mental health issues are prevalent among People Living with HIV (PLWH). Instrumentation, conceptualization and theoretical models of stress-coping-mental health relationships among PLWH are important but theoretical and practical differences exist in the context of different cultures and quality of care services.;Objectives The aims of the study were 1) to develop a new Perceived Stress Scale for People Living with HIV (PSSHIV); 2) to validate the Brief COPE inventory among Chinese PLWH; 3) to investigate determinants of perceived stress and psychological well-being.;Subject and Methods To achieve Aim 1, PLWH in two Chinese cities were interviewed for item generation and validation. Aims 2 to 4 were achieved through another survey conducted in the same cities. Participants were recruited from the registry of the Centers for Disease Control and Prevention and from users of hospital services and Methadone Maintenance Treatment clinics. Standard statistical methods were used for validation studies.;Results The newly developed PSSHIV and the rearranged version of the Brief COPE were validated and found to have acceptable psychometric properties. Of all participants, 63.3% showed moderate/severe depressive symptoms. 'Problem-solving and Acceptance' and 'Self-blame and Denial' were commonly used coping strategies. Socioeconomic status (SES), perceived discrimination, and optimism were significantly associated with overall stress and some of the subscales of PSSHIV. Perceived stress appeared to mediate the relationship between perceived discrimination and psychological well-being. In addition to perceived stress, social support and some particular coping strategies were associated with depression. Similar though not identical results were found using quality of life as the outcome.;Conclusions The results showed that depression is prevalent among Chinese PLWH and perceived discrimination is a source of stress. Perceived stress, social support and coping strategies had independent effects on mental health outcomes but there were no interaction effects. The Brief COPE was validated and had a structure different from the original, again supporting the importance of cultural variations. Our results hence provided useful instrumentations (PSSHIV and Brief COPE) as well as a good foundation for the development of theories and interventions specific to the needs of the PLWH in China.