STRESS, COPING, AND APPRAISAL IN AN HIV-SEROPOSITIVE RURAL SAMPLE: A TEST OF THE GOODNESS-OF-FIT HYPOTHESIS A thesis presented to the faculty of the College of Arts and Sciences of Ohio University In partial fulfillment of the requirements for the degree Master of Science Dana Mitchell August 2004 This thesis entitled STRESS, COPING, AND APPRAISAL IN AN HIV-SEROPOSITIVE RURAL SAMPLE: A TEST OF THE GOODNESS-OF-FIT HYPOTHESIS BY DANA MITCHELL has been approved for the Department of Psychology and the College of Arts and Sciences by Timothy G. Heckman Associate Professor of Psychology Leslie A. Flemming Dean, College of Arts and Sciences MITCHELL, DANA. M.S. AUGUST 2004. Psychology Stress, Coping, and Appraisal in an HIV-seropositive Rural Sample: A Test of the Goodness-of-Fit Hypothesis (120pp.) Director of Thesis: Timothy G. Heckman This present study tested two theories from Lazarus and Folkman’s (1984) Transaction Model of Stress and Coping. Utilizing a sample of adults living with HIV/AIDS in rural communities of the United States, this secondary data analysis examined the interaction between cognitive appraisals of stressful life events, methods of coping, and depressive symptomology. This study was designed to investigate the proposals that coping strategies tend to match the appraised controllability of a stressor (matching hypothesis) and that the effectiveness of varying coping strategies is dependent on the appraised controllability of a stressful event (goodness-of-fit hypothesis). Self- reported data obtained from 304 HIV-seropositive adults living in non-metropolitan areas indicated that high levels of appraised control significantly predicted use of problem- focused coping. However, no support was found for the goodness-of-fit hypothesis. Study limitations and future directions are proposed. Approved: Timothy G. Heckman Associate Professor of Psychology Acknowledgements This thesis is dedicated to my family and loved ones for their support through my academic and professional endeavors. I would also like to thank Dr. Timothy G. Heckman for his guidance and mentoring, as well as my committee members, Dr. John Garske and Dr. Kenneth Holroyd. 5 Table of Contents Abstract................................................................................................................................3 Acknowledgements..............................................................................................................4 List of Tables .......................................................................................................................7 List of Figures......................................................................................................................8 Overview of Current Study..................................................................................................9 Review of the Literature ....................................................................................................12 HIV/AIDS in Rural America .................................................................................12 Transactional Model of Stress, Appraisal, and Coping .........................................17 Empirical Findings on the Goodness-of-Fit Hypothesis........................................20 Critiques of Prior Goodness-of-Fit Research.........................................................26 The Development of Alternative Coping Measures ..............................................28 Considerations when Testing the Transactional Model.........................................31 Association of Coping to Physical & Psychological Health Outcomes ................35 Psychological Distress Associated with HIV Infection.........................................38 Living with HIV in Urban vs. Rural Communities................................................39 Associations of Coping & Health in HIV-seropositive Samples...........................41 Testing the Goodness-of-Fit in HIV-seropositive Samples...................................44 The Present Study ..............................................................................................................44 Objectives, Hypotheses, and Rationales ................................................................46 Method ...............................................................................................................................47 Project Connect......................................................................................................47 6 Assessment Instruments.........................................................................................51 Statistical Analyses ................................................................................................59 Results ................................................................................................................................60 Data Screening and Preparation.............................................................................60 Descriptive Statistics and Frequencies...................................................................64 Depressive Symptomology in Rural Persons Living with HIV/AIDS ..................65 Differential Stressors among the Sample...............................................................68 Scoring of the Ways of Coping Questionnaire ......................................................70 Hierarchical Regression Modeling .......................................................................71 The Matching Hypothesis......................................................................................72 Goodness-of-Fit Hypothesis ..................................................................................73 Analyses using Mean Item Scores .........................................................................74 Analyses using Relative Percentage Scores...........................................................77 Analyses using Ratio Scores ................................................................................81 Analyses using Standardized Factor Scores ..........................................................85 Analysis with Selected Sample..............................................................................89 Analyses using Varying Outcome Measures .........................................................93 Altering the Order of the Hierarchical Regression Model ....................................94 Discussion..........................................................................................................................96 Summary of Findings.............................................................................................97 Limitations of the Study.......................................................................................101 Future Directions.................................................................................................107 References........................................................................................................................111 7 Tables Table 1. Association of Coping to Health Outcomes: Penley et al. (2002).....................37 Table 2. Sociodemographic Characteristics of Sample ..................................................50 Table 3. Final Factor Loadings for Ways of Coping Questionnaire ...............................55 Table 4. Reliability Coefficients for all Scales and Subscales ........................................61 Table 5. Intercorrelations among Selected Variables .....................................................63 Table 6. Descriptive Statistics for Continuous Variables ...............................................65 Table 7. Psychological indices among HIV+ rural adults ..............................................66 Table 8. Summary of most Frequently Reported Stressors ............................................69 Table 9. Predictors in Hierarchical Regression Analyses ...............................................72 Table 10. Hierarchical Multiple Regression Analysis (mean item) .................................75 Table 11. Hierarchical Multiple Regression Analysis (relative scores) ..........................79 Table 12. Hierarchical Multiple Regression Analysis (ratio scores) ...............................83 Table 13. Hierarchical Multiple Regression Analysis (standardized scores) ..................87 Table 14. Hierarchical Multiple Regression Analysis (gay/bisexual males) ...................91 Table 15. Predictors in Altered Hierarchical Regression Analysis ..................................94 Table 16. Hierarchical Multiple Regression Analysis (altered order) .............................96 8 Figures Figure 1. Expected Goodness-of-Fit Interactions ............................................................46 Figure 2. Ways of Coping Principal Components Screeplot ..........................................54 Figure 3. Emotion-focused Coping x Appraisal Interaction (mean item) .......................76 Figure 4. Problem-focused Coping x Appraisal Interaction (mean item) ......................77 Figure 5. Emotion-focused Coping x Appraisal Interaction (relative scores) .................80 Figure 6. Problem-focused Coping x Appraisal Interaction (relative scores) ................81 Figure 7. Emotion-focused Coping x Appraisal Interaction (ratio scores) .....................84 Figure 8. Problem-focused Coping x Appraisal Interaction (ratio scores) .....................85 Figure 9. Emotion-focused Coping x Appraisal Interaction (standardized