Objective: To investigate the relationship between health locus of control (HLOC), distress, and protease inhibitor (PI) utilization in gay/bisexual men in all stages of HIV illness. Method: A total of 173 men participating in a longitudinal study of the psychological effects of HIV illness were administered a number of psychological distress measures and the HLOC scale. The association between the HLOC subscales, distress, and PI utilization was evaluated. Results: In addition to physical symptoms, the attribution of health status to chance or fate significantly predicted depressive symptoms, feelings of hopelessness, and recent life stress. Results also demonstrated a significant relationship between strong, positive beliefs in doctors and other health care professionals and PI utilization. Conclusion: The results of this study point to a strong association between beliefs that health status is related to chance or fate and distress. In addition, beliefs in physicians and other health care providers appear to contribute to decisions to initiate PI therapy.
Personal control has been linked to self-esteem but not until recently have patient's perceptions of control over the course and treatment of serious illness been studied systematically [1], [2], [3], [4], [5] and [6]. In general, investigators have found that beliefs of personal control are positively and significantly associated with better psychosocial adjustment. Some studies, however, have qualified the relationship of personal control and adjustment, taking into account the nature and severity of disease. For example, Burish et al. [7] report that personal control over a chronic disease can be maladaptive in the face of repeated failures to gain control over the disease and may be especially harmful when the disease is more severe, and relinquishing some control to others may be adaptive. Affleck et al. [1] found in those in-patients with rheumatoid arthritis that the relationship between perceived control over illness and mood was moderated by the severity of the disease. For example, in those with mild disease, perceived personal control was marginally associated with positive mood, while in those with severe disease, beliefs in personal control was significantly associated with negative mood, perhaps because of self-blame for illness progression.
The concept of personal control in HIV illness has been studied in a variety of contexts, with most studies finding a sense of personal control to be adaptive in that it helps people adjust to illness and moderate stress [8], [9], [10], [11] and [12]. Perceptions of control over the course of HIV illness have also been associated with fewer depressive symptoms and less anxiety about death [13]. Conversely, attributions that health is influenced by chance factors have been associated with high levels of depression [14] and problems with psychological adjustment [15]. While these studies suggest that personal control can be helpful, Jenkins and Patterson [16], in a study of HIV-positive military medical beneficiaries, report high levels of depression in “believers of control” and that external attributions of control generally appear more adaptive.
The specific relationships among health locus of control (HLOC), psychological well-being, and the severity of illness in HIV disease have not been systematically studied. In addition, new developments in the treatment of HIV disease, specifically the advent of potent combination antiretroviral therapies including protease inhibitors (PI), which interfere with the replication of the virus, may have significant effects on the perception of personal control in HIV disease. PIs have been associated with durable reduction in the amount of virus in the bloodstream (HIV-1 viral load) and a dramatic reduction in morbidity and mortality [17]. PIs may offer patients with HIV the potential of increased control over the course of their illness.
While PIs have clear advantages to HIV-infected patients with symptomatic illness, numerous factors may influence PI utilization, including difficulty with adherence to complicated regimens, high costs, and adverse effects. Drug resistance to PIs resulting from factors such as prior monotherapy, inadequate adherence, or improperly prescribed medications can develop quickly and is characteristically irreversible; in most cases, the patient will also have broad resistance to other PIs as well. These factors, along with the question of the long-term benefits of PI therapy, may deter some patients from initiating these therapies, entailing a certain “leap of faith” for individuals to accept this treatment. This “leap of faith” may be easier for those people who have the attitude that the status of their health is related to receiving good medical treatment from doctors and health care professionals. Therefore, strong, positive attitude towards physicians who recommend a PI may be a significant factor in people's decision to engage in PI therapy. On the other hand, patients who adhere to strong beliefs that their health status is largely under their own control might be less likely to take PIs because of the belief that their own behavior determines their prognosis.
HLOC is a measure that specifically seeks to tap beliefs regarding the source of reinforcements for health-related behaviors. By assessing the various dimensions of HLOC, the probability of increasing understanding and prediction of health behaviors may be increased.
In this context, the aims of this study were twofold: first, to examine the relationship between HLOC and distress in individuals infected with HIV, taking into account the severity of illness and HIV symptomatology and its manifestations; second, to determine whether particular dimensions of HLOC are associated with the use of PIs.
