Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women

Antoni, Michael H.; Pereira, Deidre B.; Marion, Ilona; Ennis, Nicole; Andrasik, Michele Peake; Rose, Rachel; McCalla, Judith; Simon, Trudi; Fletcher, Mary Ann; Lucci, Joseph; Efantis-Potter, Jonell; O'Sullivan, Mary Jo

doi:10.1016/j.jpsychores.2008.06.002

« Previous Next »Journal of Psychosomatic Research
Volume 65, Issue 4 , Pages 389-401, October 2008

Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women

Michael H. Antoni
- Department of Psychology, University of Miami, Miami, FL, USA
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, FL, USA
- Biobehavioral Oncology Program, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Corresponding author. Department of Psychology, University of Miami, 5665 Ponce DeLeon Blvd, Rm 413, Coral Gables, FL 33124, USA. Tel.: +1 305 284 5466; fax: +1 305 284 1366.
Deidre B. Pereira
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
Ilona Marion
- Department of Psychology, University of Miami, Miami, FL, USA
Nicole Ennis
- Department of Psychology, University of Miami, Miami, FL, USA
Michele Peake Andrasik
- Department of Psychology, University of Miami, Miami, FL, USA
Rachel Rose
- Department of Psychology, University of Miami, Miami, FL, USA
Judith McCalla
- Department of Psychology, University of Miami, Miami, FL, USA
Trudi Simon
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
Mary Ann Fletcher
- Department of Psychology, University of Miami, Miami, FL, USA
- Biobehavioral Oncology Program, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
Joseph Lucci
- Biobehavioral Oncology Program, Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
Jonell Efantis-Potter
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
Mary Jo O'Sullivan
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA

Received 12 August 2007; received in revised form 25 April 2008; accepted 3 June 2008.

Abstract

Objective

Risk for developing cervical neoplastic disease is greatly increased in women infected with oncogenic sexually transmitted human papillomaviruses (HPVs) and who have lowered cellular immunity due to coinfection with human immunodeficiency virus (HIV) infection. The majority of these individuals are low-income minority women. Factors associated with promotion of HPV to cervical neoplasia in HIV-infected populations include degree of immunosuppression as well as behavioral factors such as tobacco smoking and psychological stress. This study examined the effects of a cognitive behavioral stress management (CBSM) intervention on life stress and cervical neoplasia in HIV+ minority women.

Methods

Participants were 39 HIV+ African-American, Caribbean, and Hispanic women with a recent history of an abnormal Papanicolaou smear. Participants underwent colposcopic examination, psychosocial interview, and peripheral venous blood draw at study entry and 9 months after being randomly assigned to either a 10-week CBSM group intervention (n=21) or a 1-day CBSM workshop (n=18).

Results

Women assigned to the 10-week group-based CBSM intervention reported decreased perceived life stress and had significantly lower odds of cervical neoplasia over a 9-month follow-up. CBSM effects on life stress and neoplasia appeared independent of presence of neoplasia at study entry, HPV type, CD4+CD3+ cell count, HIV viral load, and substance use. Furthermore, CBSM intervention effects on cervical neoplasia were especially pronounced among women with residual life stress at follow-up.

Conclusion

These findings suggest that stress management decreases perceived life stress and may decrease the odds of cervical neoplasia in women with HIV and a history of abnormal Papanicolaou smears. Although preliminary, these findings suggest the utility of stress management as a cancer prevention strategy in this high-risk population.

Keywords: HIV, HPV, Cervical cancer, Stress, Stress management