Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV plus Women Following a Stress Management Intervention
Associations Among Trajectories of Sleep Disturbance, Depressive Symptomology and 24-Hour Urinary Cortisol in HIV plus Women Following a Stress Management Intervention
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DOI：
10.1080/15402002.2018.1435545
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发表时间：
2019-09-03
影响因子：
3.1
通讯作者：
Schneiderman, Neil
中科院分区：
文献类型：
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作者：
McIntosh, Roger;Antoni, Michael;Schneiderman, Neil
目的：睡眠障碍和抑郁症的负担是高的艾滋病毒感染者，特别是妇女。虽然认知行为压力管理（CBSM）被证明可以减少HIV阳性男性的抑郁症状和24小时尿游离皮质醇排出量（CORT），但关于CBSM对HIV阳性女性情绪和伴随的睡眠障碍的影响知之甚少。本研究的目的是模拟暴露于12周CBSM干预或对照条件下的HIV+妇女的睡眠障碍、抑郁症和CORT的纵向变化。研究方法：自报的睡眠质量和抑郁症，沿着CORT，从基线调查中收集，此后约每三个月一次，共9个月，来自130名HIV阳性妇女（M-年龄= 38.44，SD = 7.73）。这些数据被用来指定一个并行过程的潜在增长模型与CORT作为随时间变化的协变量。结果：模型拟合良好。对于那些接受干预的人，睡眠障碍呈线性下降（β =-0.32，p <0.05），抑郁症呈对数下降（β =-0.33，p <0.05）。睡眠障碍的下降预示着9个月时CORT的降低。此外，基线时抑郁症状较少与睡眠障碍的初始水平较低以及随着时间的推移睡眠质量的改善更大有关。在对照组中，睡眠和情绪障碍之间没有明显的联系。在各组中，年龄越大，睡眠障碍越严重（r = 0.34，p <0.01）。结论：睡眠障碍似乎是CBSM在HIV+女性中的行为目标，尽管年龄较大、干预前抑郁情绪水平和随时间变化的CORT输出水平可能会限制睡眠质量随时间的改善。
Objective: The burden of sleep disturbance and depressive symptomology is high for persons living with HIV and particularly so for women. While cognitive behavioral stress management (CBSM) is shown to reduce symptoms of depression and 24-hr urinary free cortisol output (CORT) in HIV+ men, less is known about the effects of CBSM on mood and concomitant sleep disturbance in HIV+ women. The study aim is to model longitudinal change in sleep disturbance, depressive symptomology, and CORT for HIV+ women exposed to a 12-week CBSM intervention or control condition. Methods: Self-reported sleep quality and depressive symptomology, along with CORT, was collected from surveys at baseline and approximately every three months thereafter for nine months from 130 HIV+ women (M-age = 38.44, SD = 7.73). The data was used to specify a parallel process latent growth model with CORT as a time-varying covariate. Results: The model showed acceptable fit. There was a linear decline in sleep disturbance (beta = -0.32, p < .05) and logarithmic decline in depressive symptomology (beta = -0.33, p < .05) for those receiving the intervention. Decline in sleep disturbance predicted lower CORT at nine months. Furthermore, having less depressive symptoms at baseline was associated with lower initial levels of sleep disturbance and greater improvement in sleep quality over time. There was no discernible association between sleep and mood disturbance in the control group. Across groups, there was a consistent association between older age and greater sleep disturbance (r = 0.34, p < .01). Conclusion: Sleep disturbance appears to be a behavioral target for CBSM in HIV+ women although older age, preintervention levels of depressive mood, and time-varying levels of CORT output may limit improvement in sleep quality over time.