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How Trauma, Recent Stressful Events, and PTSD Affect Functional Health Status and Health Utilization in HIV-Infected Patients in the South

From the Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.L.); Department of Public Policy and Community and Family Medicine, and the Health Inequalities Program, Duke University, Durham, North Carolina (K.W., K.L.); Institute of Statistics and Decision Sciences, Duke University, Durham, North Carolina (D.S.); Department of Psychiatry, Duke University, Durham, North Carolina (M.S.S.); Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina (N.M.T.).

Address correspondence and reprint requests to Jane Leserman, PhD, Department of Psychiatry, CB 7160, Medical School Wing C, Room 233, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160. E-mail: JLes{at}med.unc.edu

Objective: In addition to biological markers of human immunodeficiency virus (HIV) disease progression, physical functioning, and utilization of health care may also be important indicators of health status in HIV-infected patients. There is insufficient understanding of the psychosocial predictors of health-related physical functioning and use of health services among those with this chronic disease. Therefore, the current study examines how trauma, severe stressful events, posttraumatic stress disorder (PTSD), and depressive symptoms are related to physical functioning and health utilization in HIV-infected men and women living in rural areas of the South.

Methods: We consecutively sampled patients from 8 rural HIV clinics in 5 southern states, obtaining 611 completed interviews.

Results: We found that patients with more lifetime trauma, stressful events, and PTSD symptoms reported more bodily pain, and poorer physical, role, and cognitive functioning. Trauma, recent stressful events, and PTSD explained from 12% to 27% of the variance in health-related functioning, over and above that explained by demographic variables. In addition, patients with more trauma, including sexual and physical abuse, and PTSD symptoms were at greater risk for having bed disability, an overnight hospitalization, an emergency room visit, and four or more HIV outpatient clinic visits in the previous 9 months. Patients with a history of abuse had about twice the risk of spending 5 or more days in bed, having an overnight hospital stay, and visiting the emergency room, compared with those without abuse. The effects of trauma and stress were not explained by CD4 lymphocyte count or HIV viral load; however, these effects appear to be largely accounted for by increases in current PTSD symptoms.

Conclusion: These findings highlight the importance of addressing past trauma, stress, and current PTSD within clinical HIV care.

Key Words: HIV • PTSD • trauma • health-related quality of life • sexual abuse

Abbreviations: PTSD = posttraumatic stress disorder; HIV = human immunodeficiency virus; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders; OR = odds ratio; CI = confidence interval; SD = standard deviation.

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