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. 2019 Jan;38(1):33-42.
doi: 10.1037/hea0000688. Epub 2018 Oct 29.

Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV

Caitlin Wei-Ming Watson  1 , Erin E Sundermann  2 , Mariam A Hussain  1 , Anya Umlauf  2 , April D Thames  3 , Raeanne C Moore  2 , Scott L Letendre  4 , Dilip V Jeste  5 , Erin E Morgan  2 , David J Moore  2
Affiliations

Effects of trauma, economic hardship, and stress on neurocognition and everyday function in HIV

Caitlin Wei-Ming Watson et al. Health Psychol. 2019 Jan.

Abstract

Objective: The causes of neurocognitive and everyday functioning impairment among aging people living with HIV (PLWH) are multifactorial. Exposure to stress and trauma can result in neurocognitive deficits via activation of neurological and other biological mechanisms.

Method: PLWH (n = 122) and persons without HIV (n = 95), 35-65 years of age, completed four questionnaires that were used to generate a trauma, economic hardship (food insecurity and low socioeconomic status), and stress composite variable (TES). Participants also completed a comprehensive neuropsychological battery and standardized self-reports of activities of daily living (ADLs). We examined the independent and interactive effects of TES and HIV status on neurocognitive performance and ADL declines.

Results: PLWH had more traumatic events, more food insecurity, lower socioeconomic status, and higher perceived stress compared with HIV- individuals (all ps < .0001). Among PLWH, a higher composite TES score was associated with worse executive functioning (p = .02), worse learning (p = .02), worse working memory (p = .02), and more ADL declines (p < .0001), even after controlling for relevant demographic, psychiatric, substance use, and HIV disease covariates. On their own, individual TES components did not predict these outcomes. Conversely, no significant relationships were observed between TES and cognitive domains nor ADL declines among HIV- individuals.

Conclusions: A composite score of trauma, economic hardship, and stress was significantly associated with worse neurocognitive performance and functional declines among PLWH. These adverse experiences may contribute to neurocognitive and daily functioning difficulties commonly observed among PLWH. Longitudinal studies are needed to elucidate the relationships between economic/psychosocial adversities and cognitive/functional outcomes over time, and examine potential mediators, such as inflammatory biomarkers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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Conflict of interest statement

Disclosures: No conflicts of interest were declared.

Figures

Figure 1.
Figure 1.
Distribution of TES composite by HIV status group Note: TES = Trauma, economic hardship, and stress
Figure 2.
Figure 2.
PLWH with higher TES had significantly lower executive function, learning, and working memory performance Note: PLWH = People living with HIV; TES = Trauma, economic hardship, and stress
Figure 3.
Figure 3.
PLWH with higher TES scores had significantly more declines in activities of daily living compared to individuals without HIV Note: PLWH = People living with HIV; TES = Trauma, economic hardship, stress; ADL = Activities of Daily Living
See this image and copyright information in PMC

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