Copyright 1992 by the American Psychological Association, Inc. 0022-006X/92/S3.00
Journal of Consulting and Clinica! Psychology 1992, Vol. 60, No. 3,463-469
Social Support, AIDS-Related Symptoms, and Depression Among Gay Men Robert B. Hays, Heather Turner, and Thomas J. Coates
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Center for AIDS Prevention Studies, Division of General Internal Medicine University of California, San Francisco This study examined the impact of social support and HIV-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men aged 25-54 years. The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 year later. Satisfaction with each of three types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 year later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the AIDS crisis and have important practical implications for designing mental health services to meet those needs.
& Folkman, 1984). In this study, we examined three critical factors that may be associated with depression among gay men: objective HIV status, being informed that one is HIV-positive, and experiencing physical symptoms of HIV illness. Whereas each of those conditions may contribute to depression, we were interested in assessing the relative impact of each, to identify the factors that place gay men at highest risk for depression. Such information is necessary in order to forecast the mental health needs of gay men in AIDS-affected communities. We were also interested in identifying resources that can mitigate HIV-related depression among gay men. Social support— the comfort, information, and assistance provided informally by friends and family—has been found to buffer the impact of a wide variety of stressful life experiences, including those related to physical illness (DiMatteo & Hays, 1981; Taylor, Falke, Shoptaw & Lichtman, 1986; Wortman & Conway, 1985). However, there has been little research on social support with regard to the AIDS crisis. We hypothesized that gay men's satisfaction •with-the amount-of-social-sapport-they-received Avoald-be-assaciated with reduced depression. In addition, we were particularly interested in identifying whether various types of social support (emotional, informational, or practical) were differentially effective in buffering HIV-related stressors. According to Cohen and McKay (1984), social support will only be effective as a stress buffer if the resources provided match the demands posed by the stressor. Thus, emotional support will not be effective if tangible assistance is needed, and vice versa. Identifying the types of support that are most effective in buffering HIV-related stresses is essential in designing mental health services that will be maximally effective and efficient in meeting the psychological needs of gay men confronting the AIDS crisis.
The acquired immunodeficiency syndrome (AIDS) epidemic exerts a profound psychological toll on gay men. Gay men in AIDS epicenters like San Francisco have been found to have fairly high levels of depression (Hays, Catania, McKusick, & Coates, 1990). A recent study showed that gay men with AIDS living in New York City were found to be 36 times more likely to commit suicide than men who did not have AIDS (Marzuk et al, 1988). The Centers for Disease Control (1990) estimates that between 20 and 30% of the gay men in the United States are infected with the human immunodeficiency virus (HIV) that causes AIDS. In some parts of the country, the prevalence may be much higher (National Academy of Sciences, 1986). For example, in San Francisco, it is estimated that 50% of the gay men are HIV-positive (Winkelstein et al., 1987). In order to design mental health services for gay men in AIDS-aifected communities, it is important to identify factors that place these men at risk for psychological problems, such as depression, and ways to prevent or reduce those psychological problems. •Medical-experts-have-come -to -view- i-I-I-V -illness as a-cantinuum that includes at one end the asymptomatic stage of HIV infection and at the other end full-blown AIDS marked by lifethreatening, opportunistic illnesses (Melbye, 1986; National Academy of Sciences, 1986). As with other serious illnesses such as cancer (e.g., Haney, 1984), the coping demands of HIV illness can be expected to vary at different points in the progression of the illness (Christ & Weiner, 1985; Forstein, 1984). Likewise, the types of coping strategies and the psychosocial resources used in meeting those demands may be differentially effective at varying points along the HIV continuum (Lazarus
This research was supported by the National Institutes of Mental Health and Drug Abuse (Contract Number MH42459) and by the National Institute of Allergy and Infectious Diseases (Contract Number NIH-N01-A182515). Correspondence concerning this article should be addressed to Robert B. Hays, Center for AIDS Prevention Studies, Box 0886, University of California, San Francisco, California 94143-0886.
Method Participants and Procedures The data for this study came from the sixth (January, 1987) and eighth (January, 1988) waves of the San Francisco Men's Health Study 463
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
464
R. HAYS, H. TURNER, AND T. COATES
(SFMHS; Winkelstein et al., 1987), a population-based, prospective study of single men between the ages of 25 and 54, designed to investigate the natural history of AIDS. Participants were recruited by multistage probability sampling from the 19 census tracts in San Francisco with the highest cumulative incidence of AIDS in 1984. All single men between the ages of 25 and 54 living in selected housing units were contacted by survey workers and invited to participate. Fifty-nine percent (n = 1,034) of the men invited to participate entered the study. Analyses of selected demographic characteristics of the study participants and those of comparable men in the same census tracts showed that the sample matched very closely—but not perfectly—the composition of the neighborhoods (see Footnote 1). For example, the study participants were somewhat more educated and more likely to be employed in managerial positions than were nonparticipants, but these differences were judged insufficient to impair the representativeness of the sample (Piazza, 1986; Winkelstein et al., 1987). Seventy-nine percent of the men in the sample identified themselves as gay or bisexual. Eighty-nine percent of the participants were White, 5% Hispanic, and 3% Black. Fifty-three percent were college graduates; 33% had attended graduate school. Eighty-nine percent of the subjects were employed, with the majority (52%) holding professional managerial or technical positions. An additional 29% had sales or clerical jobs, 12% had service jobs, and 6% identified themselves as blue-collar workers. Participants were interviewed and examined by appointment at the outpatient clinic of Children's Hospital in San Francisco. Interviews, lasting approximately 1 hr, focused on sexual behaviors, physical symptoms, health-related behaviors, and psychosocial variables. This was followed by a standardized 20-min physical examination, performed by specially trained physician assistants, designed as a brief screen for signs and symptoms of AIDS and its precursors. Follow-up assessments have taken place every 6 months, with all measures repeated at each assessment. In addition, a self-administered questionnaire assessing psychosocial factors such as stress, social support, and coping was administered in Waves 2 and 6 (January, 1985 and !987). All participants signed statements of informed consent to participate in the study and to have their blood tested for HIV antibodies. The individuals in the present analysis were 508 gay and bisexual men who remained in the sample at Wave 6 (January 1987), 64% of the original participants. The demographic characteristics of these men were essentially similar to the original sample: 90% were White, 58% were college graduates, and their mean age was 38.72 (SD = 6.91). We compared those men who remained in the study with those who dropped out between 1987 and 1988, using analyses of variance and chi-square. The men did not differ in demographic characteristics or levels of social support satisfaction. However, men who reported more HIV symptoms and greater depression in 1987 were less likely to remain in the sample at 1988.
cent antibody assay (IFA; Levy, Hoffman, Kramer, Landis, Shimabukuro, & Oshiro, 1984). Serum samples were examined independently in the laboratories of the University of California Cancer Research Institute and in the Viral and Rickettsial Disease Laboratory of the California Department of Health Services. If antibody to HIV was detected, immunoblot tests were performed for confirmation of the seroconversion. All participants were thus categorized as either HIVpositive or HIV-negative. Knowledge of HIV antibody status. Participants were given the option of learning the results of their antibody test or not. Results were communicated in personal interviews. In addition, participants may have learned their antibody status through sources independent of this study (e.g., private physicians, alternative testing centers). Participants were asked on the self-report questionnaire whether they had ever received their HIV antibody test results (regardless of the source). Because we assumed the impact of knowing one's HIV status would vary depending on what one's status was, responses were scaled as follows: -1 if the participant knew he was HIV-negative, 0 if he did not know his status, and +1 if he knew he was HIV-positive. Number of HIV symptoms. Symptoms were assessed through personal interview. Participants were asked to indicate whether, in the preceding 6 months, they had experienced a variety of physical symptoms commonly associated with HIV infection (lasting for at least 2 weeks). The symptoms assessed included hairy leukoplakia, thrush, shingles, diarrhea, fever, night sweats, bullous impetigo, herpes (facial, genital, rectal), persistent shortness of breath, dry cough, sore throat, skin rash, unusual bruise, fatigue, unintended weight loss, persistent headaches, enlarged glands or lymph nodes, and numbness or tingling. The total number of symptoms reported was the variable used in analyses. Previous investigations with this cohort have shown the self-report symptom score to be highly predictive of laboratory markers of HIV disease progression, including reduced T-helper cells (Lang et al., 1987). Social support. Satisfaction with social support was measured with 12 self-report items adapted from the Social Support Questionnaire (Sarason, Levine, Basham, & Sarason, 1983). For each item, participants rated their degree of satisfaction with the support they received, using a 4-point scale that ranged from very satisfied to not at all satisfied. Three types of support were assessed: emotional (receiving emotional comfort; 3 items), informational (receiving advice or information regarding a variety of issues; 5 items), and practical (counting on others for favors such as borrowing money or helping in a crisis; 4 items). Responses to each scale were scored separately. Each scale demonstrated good internal consistency, with Cronbach alphas of .82 (emotional), .85 (informational), and .88 (practical). As would be expected, the three types of support were fairly highly intercorrelated, with rs ranging from .60 to .66.
Measures
Sample Description
Depression. The Center for Epidemiological Studies Depression Scale (CESD; Radloff, 1977) is a 20-item self-report questionnaire that was developed for use in studies examining the epidemiology of depression in the general population. Respondents are asked to indicate how often they experienced a variety of psychological symptoms during the previous week. Scores can range from 0 to 60, with higher scores indicating greater depression. A cutoff score of 16 or more, corresponding to the 80th percentile in large-scale community surveys, is generally used to designate probable cases of clinical depression. Previous investigations have shown the CESD to have high reliability and validity (Radloff, 1977). In the present study, Cronbach's alpha was .90. HIV antibody status. Blood samples were taken from all participants and tested for HIV antibodies using an indirect immunofluores-
Fifty percent (n = 257) of the men in this study tested positive for HIV antibodies. Sixty-four percent (n = 340) reported know-
Results
1 With respect to age, the 25- to 29-year age group was underrepresented in the sample by 8.2%, and the 35- to 44-year age group was overrepresented by 8.9%. Other age groups, 30-34 years and 45-54 years, were both within 3% of the census distribution. With respect to education, the sample included 89.8% with one or more years of college, 24.6% more than the census. With respect to occupations, executive and professional managers constituted 43.3% of the sample, 9.5% more than reported by the census. For the combined categories of technical and sales, administrative support, and service personnel, the sample included 46.0%, 2.2% less than the census.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
SOCIAL SUPPORT AND AIDS-RELATED SYMPTOMS
465
ing their antibody test results. Whether men knew their antibody test results was not related to their HIV status, x2 = l(N= 508) = .61, p = ns. Forty-eight percent of the men (n = 247) had not experienced any HIV symptoms during the previous 6 months, 25% (n = 127) reported experiencing one symptom, and 27% (n = 136) reported two or more. The mean depression score was 9.99 (SD = 9.18). The norm for adults in the general population is &.7 (SD = 8.4; Sayetta & Johnson, 1980), thus the men in our sample could generally be described as slightly more depressed than normal although not clinically depressed. However, 20% of the men in our sample scored at or above a score of 16, which is considered the cutoff point for clinical depression (Boyd, Weissman, Thompson, & Myers, 1982).
symptoms were entered. The set of social support scores was entered at Step 3. The results are presented in Table 2. As one would expect, 1987 depression scores were highly correlated with depression 1 year later (r = .52). None of the HIV status variables entered at Step 2 contributed to explaining 1988 depression once previous depression was partialed out. In contrast, the social support scores accounted for a significant portion of the variance in depression in 1988, even after controlling for previous depression level. Thus, gay men who were more satisfied with the social support they received in 1987 were less likely to become depressed 1 year later than were men who were not satisfied with the social support they received.
Explaining Depression Cross-Sectionally
Support as a Buffer of Symptoms
Multiple regression analysis was used to explain depression cross-sectionally in 1987. A two-step hierarchical procedure was used. In Step 1, HIV status, knowledge of one's status, and number of HIV symptoms were entered first as a set. In Step 2, the set of social support variables was entered. The results of this analysis are presented in Table 1. Of the first set of variables entered, only the number of HIV symptoms experienced accounted for a significant percentage in the variance in depression. Neither HIV status nor knowledge of one's status was significantly associated with depression. When the social support variables were entered at Step 2, they were able to account for an additional 14% of the variance in depression. Each type of support showed a significant negative correlation with depression. Thus, the more satisfied individuals were with each type of support, the less depressed they were.
We next performed a series of multiple regression analyses to examine the relative impact of the three types of support in buffering the stress associated with HIV symptoms. The predictor variables were the same as before, with HIV status, knowledge, and symptoms entered first as a set. However, each support type was then entered separately, followed by its interaction term with symptoms. A separate regression was performed for each type of support, first cross-sectionally to predict 1987 depression and then longitudinally to predict depression in 1988. The results were consistent both cross-sectionally and longitudinally. Each type of support accounted for a significant percentage of the variance in depression, yet there was a significant interaction between informational support and number of symptoms. In explaining 1987 depression cross-sectionally, the Symptom X Informational Support interaction contributed an additional 1% of the variance in depression, F(5, 502) = 4.67, p < .04. In the longitudinal analysis, the Symptom X Informational Support interaction contributed an additional 1% in explaining the variance in 1988 depression, F(5, 451) = 7.32, p < .007. Figures 1 and 2 graphically display these interactions, showing the regression lines predicting depression from number of symptoms for men with high and low levels of informational support. As the number of HI V symptoms experienced increased, the men with low informational support satisfaction were more depressed than men with high informational support satisfaction. This suggests that satisfaction with informational support can buffer the psychological distress associated with experiencing HIV symptoms.
Predicting Depression Longitudinally To assess changes in depression after 1 year, we performed a three-step hierarchical multiple regression using the 1987 variables to predict 1988 depression. Previous (1987) depression scores were entered in the regression equation at Step 1. At Step 2, HIV status, knowledge of one's status, and number of HIV
Table 1 Cross-Sectional Predictors ofl 98 7 Depression Among Gay Men: Hierarchical Multiple Regression Analyses Step 1 Predictor variable HIV status Knowledge of HIV status Number of HIV symptoms Social support Emotional Informational Practical
Step 2
Discussion
Pearson r .066 .096 .248***
-.097 .088 .246***
-.367*** -.329*** -.284***
R22 R change F change
*p
Journal of Consulting and Clinica! Psychology 1992, Vol. 60, No. 3,463-469
Social Support, AIDS-Related Symptoms, and Depression Among Gay Men Robert B. Hays, Heather Turner, and Thomas J. Coates
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Center for AIDS Prevention Studies, Division of General Internal Medicine University of California, San Francisco This study examined the impact of social support and HIV-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men aged 25-54 years. The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 year later. Satisfaction with each of three types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 year later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the AIDS crisis and have important practical implications for designing mental health services to meet those needs.
& Folkman, 1984). In this study, we examined three critical factors that may be associated with depression among gay men: objective HIV status, being informed that one is HIV-positive, and experiencing physical symptoms of HIV illness. Whereas each of those conditions may contribute to depression, we were interested in assessing the relative impact of each, to identify the factors that place gay men at highest risk for depression. Such information is necessary in order to forecast the mental health needs of gay men in AIDS-affected communities. We were also interested in identifying resources that can mitigate HIV-related depression among gay men. Social support— the comfort, information, and assistance provided informally by friends and family—has been found to buffer the impact of a wide variety of stressful life experiences, including those related to physical illness (DiMatteo & Hays, 1981; Taylor, Falke, Shoptaw & Lichtman, 1986; Wortman & Conway, 1985). However, there has been little research on social support with regard to the AIDS crisis. We hypothesized that gay men's satisfaction •with-the amount-of-social-sapport-they-received Avoald-be-assaciated with reduced depression. In addition, we were particularly interested in identifying whether various types of social support (emotional, informational, or practical) were differentially effective in buffering HIV-related stressors. According to Cohen and McKay (1984), social support will only be effective as a stress buffer if the resources provided match the demands posed by the stressor. Thus, emotional support will not be effective if tangible assistance is needed, and vice versa. Identifying the types of support that are most effective in buffering HIV-related stresses is essential in designing mental health services that will be maximally effective and efficient in meeting the psychological needs of gay men confronting the AIDS crisis.
The acquired immunodeficiency syndrome (AIDS) epidemic exerts a profound psychological toll on gay men. Gay men in AIDS epicenters like San Francisco have been found to have fairly high levels of depression (Hays, Catania, McKusick, & Coates, 1990). A recent study showed that gay men with AIDS living in New York City were found to be 36 times more likely to commit suicide than men who did not have AIDS (Marzuk et al, 1988). The Centers for Disease Control (1990) estimates that between 20 and 30% of the gay men in the United States are infected with the human immunodeficiency virus (HIV) that causes AIDS. In some parts of the country, the prevalence may be much higher (National Academy of Sciences, 1986). For example, in San Francisco, it is estimated that 50% of the gay men are HIV-positive (Winkelstein et al., 1987). In order to design mental health services for gay men in AIDS-aifected communities, it is important to identify factors that place these men at risk for psychological problems, such as depression, and ways to prevent or reduce those psychological problems. •Medical-experts-have-come -to -view- i-I-I-V -illness as a-cantinuum that includes at one end the asymptomatic stage of HIV infection and at the other end full-blown AIDS marked by lifethreatening, opportunistic illnesses (Melbye, 1986; National Academy of Sciences, 1986). As with other serious illnesses such as cancer (e.g., Haney, 1984), the coping demands of HIV illness can be expected to vary at different points in the progression of the illness (Christ & Weiner, 1985; Forstein, 1984). Likewise, the types of coping strategies and the psychosocial resources used in meeting those demands may be differentially effective at varying points along the HIV continuum (Lazarus
This research was supported by the National Institutes of Mental Health and Drug Abuse (Contract Number MH42459) and by the National Institute of Allergy and Infectious Diseases (Contract Number NIH-N01-A182515). Correspondence concerning this article should be addressed to Robert B. Hays, Center for AIDS Prevention Studies, Box 0886, University of California, San Francisco, California 94143-0886.
Method Participants and Procedures The data for this study came from the sixth (January, 1987) and eighth (January, 1988) waves of the San Francisco Men's Health Study 463
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
464
R. HAYS, H. TURNER, AND T. COATES
(SFMHS; Winkelstein et al., 1987), a population-based, prospective study of single men between the ages of 25 and 54, designed to investigate the natural history of AIDS. Participants were recruited by multistage probability sampling from the 19 census tracts in San Francisco with the highest cumulative incidence of AIDS in 1984. All single men between the ages of 25 and 54 living in selected housing units were contacted by survey workers and invited to participate. Fifty-nine percent (n = 1,034) of the men invited to participate entered the study. Analyses of selected demographic characteristics of the study participants and those of comparable men in the same census tracts showed that the sample matched very closely—but not perfectly—the composition of the neighborhoods (see Footnote 1). For example, the study participants were somewhat more educated and more likely to be employed in managerial positions than were nonparticipants, but these differences were judged insufficient to impair the representativeness of the sample (Piazza, 1986; Winkelstein et al., 1987). Seventy-nine percent of the men in the sample identified themselves as gay or bisexual. Eighty-nine percent of the participants were White, 5% Hispanic, and 3% Black. Fifty-three percent were college graduates; 33% had attended graduate school. Eighty-nine percent of the subjects were employed, with the majority (52%) holding professional managerial or technical positions. An additional 29% had sales or clerical jobs, 12% had service jobs, and 6% identified themselves as blue-collar workers. Participants were interviewed and examined by appointment at the outpatient clinic of Children's Hospital in San Francisco. Interviews, lasting approximately 1 hr, focused on sexual behaviors, physical symptoms, health-related behaviors, and psychosocial variables. This was followed by a standardized 20-min physical examination, performed by specially trained physician assistants, designed as a brief screen for signs and symptoms of AIDS and its precursors. Follow-up assessments have taken place every 6 months, with all measures repeated at each assessment. In addition, a self-administered questionnaire assessing psychosocial factors such as stress, social support, and coping was administered in Waves 2 and 6 (January, 1985 and !987). All participants signed statements of informed consent to participate in the study and to have their blood tested for HIV antibodies. The individuals in the present analysis were 508 gay and bisexual men who remained in the sample at Wave 6 (January 1987), 64% of the original participants. The demographic characteristics of these men were essentially similar to the original sample: 90% were White, 58% were college graduates, and their mean age was 38.72 (SD = 6.91). We compared those men who remained in the study with those who dropped out between 1987 and 1988, using analyses of variance and chi-square. The men did not differ in demographic characteristics or levels of social support satisfaction. However, men who reported more HIV symptoms and greater depression in 1987 were less likely to remain in the sample at 1988.
cent antibody assay (IFA; Levy, Hoffman, Kramer, Landis, Shimabukuro, & Oshiro, 1984). Serum samples were examined independently in the laboratories of the University of California Cancer Research Institute and in the Viral and Rickettsial Disease Laboratory of the California Department of Health Services. If antibody to HIV was detected, immunoblot tests were performed for confirmation of the seroconversion. All participants were thus categorized as either HIVpositive or HIV-negative. Knowledge of HIV antibody status. Participants were given the option of learning the results of their antibody test or not. Results were communicated in personal interviews. In addition, participants may have learned their antibody status through sources independent of this study (e.g., private physicians, alternative testing centers). Participants were asked on the self-report questionnaire whether they had ever received their HIV antibody test results (regardless of the source). Because we assumed the impact of knowing one's HIV status would vary depending on what one's status was, responses were scaled as follows: -1 if the participant knew he was HIV-negative, 0 if he did not know his status, and +1 if he knew he was HIV-positive. Number of HIV symptoms. Symptoms were assessed through personal interview. Participants were asked to indicate whether, in the preceding 6 months, they had experienced a variety of physical symptoms commonly associated with HIV infection (lasting for at least 2 weeks). The symptoms assessed included hairy leukoplakia, thrush, shingles, diarrhea, fever, night sweats, bullous impetigo, herpes (facial, genital, rectal), persistent shortness of breath, dry cough, sore throat, skin rash, unusual bruise, fatigue, unintended weight loss, persistent headaches, enlarged glands or lymph nodes, and numbness or tingling. The total number of symptoms reported was the variable used in analyses. Previous investigations with this cohort have shown the self-report symptom score to be highly predictive of laboratory markers of HIV disease progression, including reduced T-helper cells (Lang et al., 1987). Social support. Satisfaction with social support was measured with 12 self-report items adapted from the Social Support Questionnaire (Sarason, Levine, Basham, & Sarason, 1983). For each item, participants rated their degree of satisfaction with the support they received, using a 4-point scale that ranged from very satisfied to not at all satisfied. Three types of support were assessed: emotional (receiving emotional comfort; 3 items), informational (receiving advice or information regarding a variety of issues; 5 items), and practical (counting on others for favors such as borrowing money or helping in a crisis; 4 items). Responses to each scale were scored separately. Each scale demonstrated good internal consistency, with Cronbach alphas of .82 (emotional), .85 (informational), and .88 (practical). As would be expected, the three types of support were fairly highly intercorrelated, with rs ranging from .60 to .66.
Measures
Sample Description
Depression. The Center for Epidemiological Studies Depression Scale (CESD; Radloff, 1977) is a 20-item self-report questionnaire that was developed for use in studies examining the epidemiology of depression in the general population. Respondents are asked to indicate how often they experienced a variety of psychological symptoms during the previous week. Scores can range from 0 to 60, with higher scores indicating greater depression. A cutoff score of 16 or more, corresponding to the 80th percentile in large-scale community surveys, is generally used to designate probable cases of clinical depression. Previous investigations have shown the CESD to have high reliability and validity (Radloff, 1977). In the present study, Cronbach's alpha was .90. HIV antibody status. Blood samples were taken from all participants and tested for HIV antibodies using an indirect immunofluores-
Fifty percent (n = 257) of the men in this study tested positive for HIV antibodies. Sixty-four percent (n = 340) reported know-
Results
1 With respect to age, the 25- to 29-year age group was underrepresented in the sample by 8.2%, and the 35- to 44-year age group was overrepresented by 8.9%. Other age groups, 30-34 years and 45-54 years, were both within 3% of the census distribution. With respect to education, the sample included 89.8% with one or more years of college, 24.6% more than the census. With respect to occupations, executive and professional managers constituted 43.3% of the sample, 9.5% more than reported by the census. For the combined categories of technical and sales, administrative support, and service personnel, the sample included 46.0%, 2.2% less than the census.
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
SOCIAL SUPPORT AND AIDS-RELATED SYMPTOMS
465
ing their antibody test results. Whether men knew their antibody test results was not related to their HIV status, x2 = l(N= 508) = .61, p = ns. Forty-eight percent of the men (n = 247) had not experienced any HIV symptoms during the previous 6 months, 25% (n = 127) reported experiencing one symptom, and 27% (n = 136) reported two or more. The mean depression score was 9.99 (SD = 9.18). The norm for adults in the general population is &.7 (SD = 8.4; Sayetta & Johnson, 1980), thus the men in our sample could generally be described as slightly more depressed than normal although not clinically depressed. However, 20% of the men in our sample scored at or above a score of 16, which is considered the cutoff point for clinical depression (Boyd, Weissman, Thompson, & Myers, 1982).
symptoms were entered. The set of social support scores was entered at Step 3. The results are presented in Table 2. As one would expect, 1987 depression scores were highly correlated with depression 1 year later (r = .52). None of the HIV status variables entered at Step 2 contributed to explaining 1988 depression once previous depression was partialed out. In contrast, the social support scores accounted for a significant portion of the variance in depression in 1988, even after controlling for previous depression level. Thus, gay men who were more satisfied with the social support they received in 1987 were less likely to become depressed 1 year later than were men who were not satisfied with the social support they received.
Explaining Depression Cross-Sectionally
Support as a Buffer of Symptoms
Multiple regression analysis was used to explain depression cross-sectionally in 1987. A two-step hierarchical procedure was used. In Step 1, HIV status, knowledge of one's status, and number of HIV symptoms were entered first as a set. In Step 2, the set of social support variables was entered. The results of this analysis are presented in Table 1. Of the first set of variables entered, only the number of HIV symptoms experienced accounted for a significant percentage in the variance in depression. Neither HIV status nor knowledge of one's status was significantly associated with depression. When the social support variables were entered at Step 2, they were able to account for an additional 14% of the variance in depression. Each type of support showed a significant negative correlation with depression. Thus, the more satisfied individuals were with each type of support, the less depressed they were.
We next performed a series of multiple regression analyses to examine the relative impact of the three types of support in buffering the stress associated with HIV symptoms. The predictor variables were the same as before, with HIV status, knowledge, and symptoms entered first as a set. However, each support type was then entered separately, followed by its interaction term with symptoms. A separate regression was performed for each type of support, first cross-sectionally to predict 1987 depression and then longitudinally to predict depression in 1988. The results were consistent both cross-sectionally and longitudinally. Each type of support accounted for a significant percentage of the variance in depression, yet there was a significant interaction between informational support and number of symptoms. In explaining 1987 depression cross-sectionally, the Symptom X Informational Support interaction contributed an additional 1% of the variance in depression, F(5, 502) = 4.67, p < .04. In the longitudinal analysis, the Symptom X Informational Support interaction contributed an additional 1% in explaining the variance in 1988 depression, F(5, 451) = 7.32, p < .007. Figures 1 and 2 graphically display these interactions, showing the regression lines predicting depression from number of symptoms for men with high and low levels of informational support. As the number of HI V symptoms experienced increased, the men with low informational support satisfaction were more depressed than men with high informational support satisfaction. This suggests that satisfaction with informational support can buffer the psychological distress associated with experiencing HIV symptoms.
Predicting Depression Longitudinally To assess changes in depression after 1 year, we performed a three-step hierarchical multiple regression using the 1987 variables to predict 1988 depression. Previous (1987) depression scores were entered in the regression equation at Step 1. At Step 2, HIV status, knowledge of one's status, and number of HIV
Table 1 Cross-Sectional Predictors ofl 98 7 Depression Among Gay Men: Hierarchical Multiple Regression Analyses Step 1 Predictor variable HIV status Knowledge of HIV status Number of HIV symptoms Social support Emotional Informational Practical
Step 2
Discussion
Pearson r .066 .096 .248***
-.097 .088 .246***
-.367*** -.329*** -.284***
R22 R change F change
*p
