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PSYCHOLOGICAL DISTRESS AND COPING STRATEGIES AMONG PEOPLE LIVING WITH HIV-AIDS IN KADUNA CENTRAL SENATORIAL DISTRICT, NIGERIA.
Background to the study
HIV/AIDS is one of the most complicated and bewildering social challenges faced by contemporary societies due to its strong ties with sexual and societal stigmatized behavior (Asante, 2012). Contracting HIV may lead to difficulties related to self-esteem, coping, social isolation, and poor psychological well-being (Asante, 2012). Besides, Acquired Immuno Deficiency Syndrome (AIDS) is not a disease, it’s a medical condition, and a health problem; it is primarily related to people and society (Chandrasekar, 2012). AIDS by its complexity poses a major threat to physical, mental, cultural, social and economical development in the life of the entire population. It causes not only physical problems but also destroys an individual’s social status and emotional health (Chandrasekar, 2012).
In Nigeria, there are quite a number of people living with HIV/AIDS (PLWHA). In a national survey conducted by the Federal Government for the 2012 National HIV/AIDS and Reproductive Health Survey-Plus (NARHS Plus), Nigeria’s HIV/AIDS prevalence rate is 3.4 per cent. However, Rivers State leads other States in the country with a prevalence rate of 15.2 per cent. A cursory look at the new survey indicated that Taraba State ranked second with a prevalence rate of 10.5 per cent; followed by Kaduna State with 9.2 per cent. Nasarawa State has 8.1 per cent while the Federal Capital Territory (FCT) 7.5 per cent. Ekiti State however has the least prevalence rate of 0.2 per cent, Zamfara 0.4 per cent, Bauchi 0.6 per cent and Ogun 0.6per cent (Bala, 2012)
In addition, by the end of 2009, 33.3 million people worldwide were living with HIV; 2.6 million people became newly infected and 1.8 million people had lost their lives to AIDS in the same year (Asante, 2012). With the alarming increase in the HIV/AIDS pandemic especially in developing countries, and the limited accessibility and availability of highly active antiretroviral therapy (HAART), the majority of people living with HIV/AIDS (PLWHA) continue to suffer with the disease, with a serious impact on their well-being (Asante, 2012).The impact could be deteriorating health condition, poor quality of life, stigma, social withdrawal, change in life roles and psychological distress.
Psychological distress is a major problem of present era, especially for people living with HIV/AIDS (PLWHA). Any situation that evokes negative thoughts and feelings in a person such as unpleasant, frustrating, irritable, worrisome, and anxious situation is considered psychological distress. According to Shaheen & Alam (2010) psychological distress is “a continuous experience of unhappiness, nervousness, irritability and problematic interpersonal relationships”. The same situation is not necessarily stressful for all people and all people do not experience the same negative thoughts and feelings when distressed. One model that is useful in understanding stress among PLWHA is the person- environment model (Shaheen & Alam, 2010). According to this model, stressful events can be appraised by an individual as “challenging” or “threatening”. This indicate that psychological distress is affected by many factors like personality characteristics, demand of situations, type of attributional styles and which kind of coping strategies are opted to deal with a stressful situation.
More so, PLWHA experience serious psychological problems as a result of decreased self-esteem or rejection by the family and friends. AIDS has led to a lot of emotions such as agony, frustration, shame, anger, guilt, fear, panic, loneliness, helplessness, anxiety, insecurity, uncertainty, and depression (Chandrasekar, 2012). HIV/AIDS often can result in stigma and fear for those living with the infection, as well as for those caring for them and may affect the entire family. AIDS also results in loss of socio-economic status, employment, housing, health care and mobility. All these may contribute to psychological distress experienced by PLWHA.
Furthermore, psychological distress like depression and anxiety are potentially dangerous conditions. In the context of HIV/AIDS, this can influence health-seeking behavior or uptake of diagnosis and treatment for HIV/AIDS, add to the burden of disease for HIV patients, create difficulty in adherence to treatment, and increase the risk of mortality and morbidity (Solomon, Tesfaye & Bune, 2014). For both individuals and their partners and families, therefore, psychosocial support can assist them in making informed decisions, coping better with illness and dealing more effectively with discrimination (Chandrasekar, 2012)
Coping refers to the behavioral or cognitive responses that people use to manage stress (Yusoff, Rahim &Yaacob (2010). Its goal is to maintain physical and psychosocial well-being. Problem-focused coping strategies aim to amend or eliminate the causes of stress while emotion-focused coping strategies are meant to get by with the affective effects of the hassle (Yusoff et al., 2011). Theoretically, coping reactions are believed to be situational specific. For example, in conditions where an individual has the ability to control the stressor or resolve the problem, problem-centred approach will be more constructive; whereas when one is not capable of managing the stressors and forced to bear, it is more useful to employ emotional-centred approach. (Yusoff, 2011).
Then again, there are events and occurrences which are known as stressors that can cause threat to one’s coping strategies or resources. Stressor covers a whole range of situations – anything that is perceived as unpleasant can be called a stressor. It can be external factors like the physical environment, occupation, relationships, challenges and expectations of life encountered on a daily basis as well as internal factors like nutritional status, emotion, health and the amount of rest obtained. (Lin &Yusoff, 2013). Stressors are also not uncommon among PLWHA and it affects their stress coping capabilities.
There are, however, inconsistencies in the research focusing on the relationship between coping strategies and psychological distress. While many studies have reported that problem-focused coping is associated with lower levels of emotional distress and emotion-focused coping is linked to higher psychological distress, some studies have indicated the opposite pattern or have not found relationships between some coping strategies and distress (Abraham-Pratt, 2010).
This study therefore, will examine the various coping strategies adopted by PLWHA in Kaduna central senatorial district as a result of the psychological distress experienced from their condition and the findings compared with available literatures.
Statement of the of the problem
Irrespective of obvious political will of government, local and international, non governmental organization (NGOs) and donor agencies to address the scourge and effect of HIV/AIDS, yet there is increase in the prevalence of the condition. In a national survey conducted by the federal government for 2012 National HIV/AIDS and Reproductive Health Survey-plus(NARHS plus),the prevalence of HIV/AIDS is 3.2 per cent in urban and 3.6 per cent in the rural areas Kaduna state is ranked third in Nigeria with a prevalence rate of 9.2 per cent. (Bala, 2012).
Furthermore, from the moment scientists identified HIV, social responses of fear, denial, stigma and discrimination have accompanied it. Discrimination has spread rapidly, fuelling anxiety and prejudice against the people affected with AIDS. Stigma related to AIDS in many societies including Kaduna State, is that people living with AIDS are often seen shameful. AIDS is believed to bring shame upon the family and community. Discrimination is also alarmingly common in the health care sector. Negative attitudes from the society have generated psychological distress among many people living with HIV and AIDS. As a result, many keep their status secret. It is not surprising that among a majority of HIV positive people, AIDS-related fear and anxiety, and at times denial of their HIV status, can be traced to traumatic experiences from the society (Prabhakara, 2010).
These complex situations where a physical condition leads to psychosocial consequences at individual, family and community levels require comprehensive assessment in order to determine their full impact on mental health.Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV (Basavaraj, Navya & Rashmi, 2010). If the PLHA in the district are not using the right coping strategies, this could lead to poor QOL
The researcher therefore examined the psychological distress and the type of coping strategies adopted by PLHA in Kaduna central senatorial district and its implication on their well-being. This will assist in making sustained policies that will improve the social and psychological wellbeing of PLHA in the district and the state at large.
Purpose of the study
The purpose of this study is to examine the psychological distress and the coping strategies adopted by people living with HIV/AIDS in Kaduna central senatorial district. Specifically, the study will look into the level of psychological distress and such coping strategies as problem-focused, emotion focused and avoidant coping strategies.
- What is the level of psychological distress among PLWHA in Kaduna central senatorial district?
- What type of the coping strategies are used by PLWHA? (viz, problem-focused coping, emotion-focused coping and avoidance coping).
- What is the ranking of use of the coping strategies and their degree of impact on psychological distress?
- What is the relationship between psychological distress and the coping strategies adopted by PLWHA in the population?
- There is no significant relationship between psychological distress and problem-focused coping strategies adopted by PLWHA
- There is no significant relationship between psychological distress and emotion-focused coping strategies adopted by PLWHA
- There is no significant relationship between psychological distress and avoidant coping strategies adopted by PLWHA
Significance of the study
This research is significant because, the findings will give information on type of coping strategy adopted by PLHWA in Kaduna central senatorial district in response to the psychological distress developed as a result of their condition. It will assist to give more information on whether they adopt positive or negative coping strategies. The information obtained from this research will be used by nurses, counselors, psychologist and policy makers. The health workers will be informed on the various ways of positive coping strategies hence be able to guide and counsel the PLWHA accordingly.
Furthermore, information obtained from this study will be of great asset to policy makers and government to design appropriate programmes that will assist to improve the well-being of PLWHA in the district and the State at large, bearing in mind the psychological trauma possibly encountered by the PLWHA, hence also improving their quality of life. It will help the counselors in the HIV clinics to have knowledge of the coping strategies used by PLWHA. If these persons are using maladapting coping strategies, it will help the counselors in educating the PLWHA on how to adopt positive coping strategies in order to improve their quality of life.
Also information from this study will help local and international organizations/agencies like NACA, WHO, etc to strategize on guideline and programs design that will improve the physical and psychological well-being of PLWHA, especially in Kaduna State. Finally, information gathered from this study will serve as a source of literature and guide for further researchers as well as empirical references for future studies.
Scope of the study
The study is delimited to people living with HIV/AIDS who reside in Kaduna central senatorial district, and attend clinic in any of the health centres in the district. It is also limited to the assessment of level of psychological distress, type of coping strategies adopted in response to such distress, the most commonly used coping strategies and the relationship between psychological distress and coping strategies.
Operational definition of terms
Psychological distress: refers to a continuous experience of unhappiness, nervousness, irritability and problematic interpersonal relationships as a result of infection from HIV/AIDS. A 10-item questionnaire (K10) developed by Kessler (1992), intended to yield a global measure of distress based on questions about anxiety and depressive symptoms that PLWHA experienced in the most recent 4 week period will be used.K10 Score Level of psychological distress of 10 – 15 means Low level of psychological distress, 16 – 29, Moderate level of psychological distress, 30 – 50, high level of psychological distress.
Coping Strategy: Refers to the behavioral or cognitive responses that people living with HIV/AIDS use to manage psychological distress as a result of their condition. Brief COPE will be used to measure coping strategies. The brief COPE (Coping Inventory) is scored using four likert grading scale. These strategies are: problem-focused coping, emotion-focused coping, and avoidant coping. Overall mean greater than decision mean indicates that the coping strategy is adequately used.
Problem-focused coping: Refers to targeting the causes of stress in practical ways which tackles the problem or stressful situation that is causing stress, conse