3529 The main effects of threat appraisal on the well-being of African Americans living with HIV/AIDS in the Washington, D.C. metropolitan area, and the role of religious social support as a buffer

Abstract

OBJECTIVES/SPECIFIC AIMS: This study considered how threat appraisal and religious social support associate with subjective well-being and subjective experience of pain. Appraisal in this study refers to the individual’s perception and interpretation of the significance of learning of his/her HIV status. The study incorporated the stress-buffering model to propose that the beneficial effects of religious social support will modify the association between threat appraisal and well-being for PLHIV in a palliative care setting. Well-being was assessed both as the participant’s subjective report of their well-being, and their subjective report of their experience with bodily pain. Participants’ subjective report of well-being was hypothesized to be inversely associated with threat appraisal, and positively associated with religious social support. Subjective experience with bodily pain was hypothesized to be directly associated with threat appraisal, and inversely associated with religious social support. It was further also hypothesized that religious social support modifies the impact of threat-appraisal on well-being such that higher levels of religious social support reduce the observed effect of threat appraisal. METHODS/STUDY POPULATION: This was a cross-sectional study using baseline data from a randomized clinical trial–the FACE palliative care study in Washington, DC (FACE: FAmily CEntered Advance Care Planning). Participants were PLHIV who received their HIV care from 5 Washington, DC hospital-based HIV-specialty clinics. The FACE 3000 study paired participants into dyads of patient and surrogate decision-maker. The patient is a PLHIV for whom the advanced care planning care study is geared. The surrogate decision-maker is considered the patient’s healthcare proxy who agrees to honor and advocate for the patient’s treatment preferences, if the patient were unable to communicate with the health care team directly. Some surrogates are HIV positive, however due to their role as the patient’s healthcare proxy, some of their surveys contain different content from those of the patient’s. Potentially eligible participants in the FACE study received a secondary screening to determine eligibility to ensure competency to participate in end-of-life decision making. For this analysis, only the patient data was used. RESULTS/ANTICIPATED RESULTS: Subjective well-being showed significant associations with total threat appraisal, and four threat appraisal sub-constructs. Those with lower threat appraisals reported higher values of well-being compared to those with higher threat appraisals. Results from the regression analysis indicated that only one of the threat appraisal sub-constructs was significantly associated with a participant’s subjective experience of pain. Overall, religious social support did not seem to buffer the effect of threat appraisal on well-being or subjective experience of pain. Findings from this study suggest that subjective well-being is associated with cognitive threat appraisal and this finding could assist PLHIV and their caregivers in understanding the coping processes of HIV-infected people. DISCUSSION/SIGNIFICANCE OF IMPACT: Due to stigmatization, an HIV diagnosis can influence a person’s physical, behavioral, psychological, and even spiritual health (McIntosh & Rosselli, 2012). As a stressor, it can compromise immune function to worsen the effects of the infection, while mentally depressing an individual and contributing to adverse coping mechanisms (e.g. alcohol consumption, drug use) (McIntosh & Rosselli, 2012). How someone copes with stress (threat appraisal) may contribute to health-promoting or health-damaging behaviors (Fife, Scott, Fineberg, & Zwickl, 2008). Hence, the quality of life of those managing HIV/AIDS remains a pressing concern. Findings from this study suggest that Lazarus and Folkman’s theoretical framework on the cognitive appraisal of threat could assist PLHIV and their caregivers in understanding the coping processes in PLHIV. For service providers, recognizing early threat appraisals and damaging coping mechanisms can be useful, especially for patients receiving an initial HIV diagnosis. For example, an understanding of the patient’s HIV appraisal can provide insight into the barriers to optimal care and adherence to ART and, potentially, help to reduce these barriers (Anderson, 1995). Furthermore, with the advancements of HIV medication, living with HIV has become a chronic condition, though as a stressor, it also poses long-term effects on the psychopathology of an individual living with HIV(McIntosh & Rosselli, 2012). Studies such as this study can help illuminate interventions aimed at reducing the psychological impact of HIV on a person’s life. For example, support groups have been developed and structured to provide social support and have been demonstrated to increase the perceived well-being among PLHIV (Hyde, Appleby, Weiss, Bailey, & Morgan, 2005). This has further expanded into the consideration of online-based support groups for PLHIV (Blackstock, Shah, Haughton, & Horvath, 2015). In another light, but still within psychosocial interventions for managing HIV infection, mindfulness meditation has been used pervasively in studies assessing its use as an intervention to reduce depression and perceived stress in people living with HIV in order to increase both physical and psychological health (Moskowitz etal., 2015). Interventions, such as mindful meditation, have risen as we understand more about appraisal pathways and coping strategies (such as seeking social support), and how they influence both physiological and psychological responses (Moskowitz etal., 2015) to affect the health of a person. Therefore, longitudinal research aimed toward management of the psychological and social consequences of HIV is central to promoting an accurate understanding of the quality of life for PLWH (Anderson, 1995).