Interactive Effects of Ethnic Identity and a Cognitive Behavioral Stress Management Intervention on Subjective and Objective Stress in Low-Income Minority Women Living with HIV

The HIV/AIDS epidemic is more prevalent among minority ethnic groups, with mortality rates highest among African-American women. Additionally, low-income minority women with a positive HIV diagnosis experience a variety of stressors that influence their psychological and physical well-being. Research has found that ethnic identity, an intrapersonal resiliency factor, is associated with lower perceived stress in low-income minority women living with HIV, in part through greater levels of coping self-efficacy and social support. Given the benefits of group-based interventions in reducing stress in HIV positive populations, it is important to understand whether ethnic identity influences the efficacy of these interventions in reducing stress in minority women with HIV. The present study examined the interactive effects of ethnic identity and a group-based targeted Cognitive Behavioral Stress Management (CBSM) intervention on objective and subjective stress indicators at post-intervention and at 6-month follow-up. It was hypothesized that women with greater ethnic identity randomized to CBSM would experience more reductions in self-reported and physiological stress (urinary-free norepinephrine) than those in the control group and women with a lower ethnic identity. I also hypothesized that women with greater ethnic identity affirmation and ethnic identity search, assigned to CBSM would report more reduction in self-reported and physiological stress than those in the control group and women with lower ethnic identity subscale scores. Finally, it was hypothesized that the ethnic identity X intervention interaction effect on stress outcomes would work through CBSM-associated changes in social support and coping self-efficacy. Women (n=123) were approximately 38 years old, predominantly African-American (87%), on disability (51%), diagnosed with HIV an average of 7.6 years, and earning an average yearly income of $5,000-10,000. Participants underwent a 24-hour urine collection procedure, completed the Multigroup Ethnic Identity Measure (MEIM), Impact of Events Scale (IES), and Perceived Stress Scale (PSS), and were randomized to a 10-week targeted CBSM (i.e. relaxation, CBT, and interpersonal skills training) or psychoeducational control group, and completed the IES, PSS and provided 24-hour urine samples at post-intervention and at 6-month follow-up. Targeted components in CBSM addressed issues relevant for minority women with HIV and introduced coping strategies that HIV positive women of color draw upon, including flexibility, spirituality, endurance, and positive thinking. Latent growth modeling revealed a significant ethnic identity X intervention interaction in explaining decreases in subjective stress. Post-hoc analyses indicated that for women with moderate to higher reports in ethnic identity, CBSM was associated with lower perceived stress and IES intrusive thoughts after the intervention compared to women in the control group. For women lower in ethnic identity CBSM and control groups did not differ on self-reported stress. No significant moderation effects were found for norepinephrine output. Subscale analyses revealed that the ethnic identity X intervention interaction effects on PSS and IES outcomes were also apparent using ethnic identity affirmation to delineate hi/low ethnic identity groups, but not when women were classified on the basis of ethnic identity search. Findings suggest that women with high ethnic identity may benefit more psychologically (self-reported stress) but not physiologically (using 24-hour urinary norepinephrine) than low ethnic identity women from group-based interventions that teach them additional skills to deal with stress. Future research should continue to investigate cultural resiliency factors influencing stress and explore candidate mediating psychosocial resources that may account for the buffering effects of ethnic identity on perceptions of stress in low-income minority women with HIV