The prevalence and adverse mental health consequences of AIDS-related bereavement are well-established, especially for those who are themselves HIV-infected. However, little clinical research attention has focused on ways to meet psychological needs of persons who are HIV positive and attempting to cope with the loss of loved ones to AIDS. This application requests 4 years of support to implement and evaluate an AIDS-related bereavement cognitive-coping and behavioral skills group intervention for the secondary prevention of mental health distress among bereaved people with HIV infection. The intervention model combines elements of grief theory and cognitive theories of stress and coping and includes the following key components: 1) development of social support and group cohesion; 2) identification and expression of emotions; 3) identification of coping difficulties specific to AIDS loss and living with HIV infection; 4) identification of current coping strategies; 5) goal-setting; and 6) implementation of adaptive coping strategies to reduce psychological distress. Two hundred ten HIV-infected men and women experiencing AIDS-related bereavement and psychiatric distress will be randomly assigned and stratified by psychiatric diagnoses and use of psychotropic medication, to the cognitive-coping group intervention or to a control condition. Assessments collected at baseline, at post-intervention, and at 4-, 8-, and 12-month followup points will be used to determine intervention outcome effects. It is hypothesized that the AIDS-related bereavement group intervention condition will result in less severity of grief reaction; reduced psychiatric distress, clinical depression, anxiety, and traumatic stress; increased levels of social support; higher ratings of quality-of-life; decreased substance use; and development and implementation of adaptive ways of coping with HIV infection and AIDS-related bereavement. If successful, this research is expected to identify an AIDS-related bereavement intervention model for the secondary prevention of mental health disorders among HIV-infected persons, which is urgently needed for organizations and mental health programs that serve people with HIV infection.
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