Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufŽ cient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS. Chronic illness places unique stressors on one’s mental health by affecting such psychosocial factors as coping, social support, and overall health status.The extent to which one has adjusted to these difŽ culties may be best assessed by their self-reported quality of life. Religious coping as an important mediator of coping and adjustment needed to experience greater life satisfaction and is an important construct as people with HIV infection and AIDS are living longer than ever before. The life quality of people living with HIV/AIDS is an area of burgeoning interest to many health science researchers and practitioners. Early research examining the quality of life of people living with HIV illness focused predominantly on assessment-related issues, while later research sought to identify relationships between life quality and psychosocial variables such as coping, social support, and health status (Cleary et al.,1993; Kaplan et al.,1989).As early as 1984 Lazarus and Mental Health, Religion & Culture,Volume 3, Number 1, 2000 Mental Health, Religion & Culture ISSN 1367-4676 print/ISSN 1469-9737 online © 2000 Taylor & Francis Ltd http://www.tandf .co.uk/journals Correspondence to: Anton M. Somlai, Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; tel.: +1-414-456-7700; fax: +1-414-287-4209. Folkman indicated that quality of life improvement programs for persons living with HIV disease should not only incorporate coping skills training, but also help participants develop a deeper spirituality. One psychosocial domain that has remained largely overlooked during the investigation of life quality among persons living with HIV/AIDS is spirituality/ religiosity. Previous research examining people living with chronic illness has typically investigated religion, spirituality, and religious coping efforts in relation to signiŽ cant negative life events and life stressors (Pargament et al., 1990; Ellison, 1994; Maton & Wells, 1995). In a review of studies investigating religious factors and health status,Mathews et al. (1998) found that religious commitment improved one’s ability to cope with mental and physical illness.This review concluded that religiosity is an effective support mechanism in coping with psychosocial stressors; that religious coping efforts are multidimensional and often involve a search for spiritual meaning and personal support; that faith congregations provide important social networks and support that facilitate personal coping and adjustment efforts; and that these congregations provide an array of instrumental, informational, and emotional support resources (e.g. economic assistance, spiritual assistance, etc.). Recent research has identified moderate relationships between spiritual dimensions and mental health, psychological adjustment, and coping in people living with HIV disease. Somlai et al. (1996) found that persons living with HIV/AIDS were more likely to participate in prayer practices and formal religions than their non-infected counterparts.This is consistent with previous research (e.g. Carson et al., 1990) which found spiritual activities such as meditation, imaging, and prayer were intricately linked to perceptions of well-being among long-term survivors of AIDS. Additional research found that long-term survivors of AIDS who displayed an ability to overcome negative life stressors also demonstrated a positive spiritual health through participation in prayer and meditation (Carson, 1995). Hall (1998) suggested that three major spirituality themes have appeared among people living with HIV: (1) the emergence of new spiritual meanings; (2) incorporating their illness into their self-concept of spiritual being; and (3) a spiritual understanding of their life. Finally, Kendall (1994) identiŽ ed ‘wellness spirituality’ as a possible factor in the process of successful adjustment with HIV infection in homosexual men.This ‘doing well’ relationship has even extended to end-of-life decisions, in which the adjustment efforts of HIV-positive people were facilitated by a belief that God is forgiving and refusal to believe that HIV infection is a punishment (Kaldjian et al., 1998). Recent research has extended beyond investigations of coping at the individual level to the effects of spiritual support provided by faith congregations and one’s ethnic/cultural heritage and traditions. Significant differences have been found among faith congregation’s responses to the spiritual needs of people living with HIV/AIDS, (Somlai et al., 1997).This research revealed that African Americans living with HIV/AIDS appeared to endorse more traditional Christian beliefs and practices (Somlai et al., submitted).This Ž nding suggests that clergy need to take speciŽ c steps to in uence their congregation to provide spiritual support and care to persons living with HIV disease. 58 Anton M. Somlai & Timothy G. Heckman