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. 2021 Sep;25(9):2875-2885.
doi: 10.1007/s10461-021-03340-7. Epub 2021 Jun 11.

Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model

Anna A Rubtsova  1 , Gina Wingood  2 , Ighovwerha Ofotokun  3 , C Christina Mehta  4 , Deborah Gustafson  5 , David E Vance  6 , Anjali Sharma  7 , Adaora A Adimora  8 , Marcia Holstad  9
Affiliations

Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model

Anna A Rubtsova et al. AIDS Behav. 2021 Sep.

Abstract

This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.

Keywords: Aging well; HIV/AIDS; Healthy aging; Older adults; Positive psychosocial factors; Structural equation modeling.

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Conflict of interest statement

Conflicts of interest/Competing interests

Authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Conceptual Psychosocial Model of SRSA with HIV. Note: SRSA=self-rated successful aging
Figure 2.
Figure 2.
Flow diagram for eligibility: older women living with HIV (OWLH) who participated in the FROST substudy and completed assessments for positive and negative psychosocial factors, and neuropsychological assessment
Figure 3.
Figure 3.
Psychosocial mechanisms of SRSA with HIV: Structural equation model with standardized estimates, adjusted for important covariates -- age ≥60 years old, current CD4 ≤200 cells/mm3, non-Hispanic Black, hypertension, and neuropsychological impairment (n=355; *p<0.05, **p<0.01, ***p<0.001). Model fit: χ2(58)=76, p=0.06; RMSEA=0.03; CFI=0.99. Note: Mastery=personal mastery, Stigma=internalized HIV-related stigma, PA=protective attributes, PD=psychological distress, SRSA=self-rated successful aging.
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