Hardiness, social support, and coping among injection drug users
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Abstract
High rates of psychological distress have been documented among injection drug users (IDUs) in methadone treatment. Psychological distress among these IDUs has been associated with HIV risk behaviors such as continued needle sharing as well as poorer drug treatment outcomes.;One hundred and one IDUs (61% Latino, 60% male, 54% HIV+) in an urban methadone program were interviewed to examine whether coping serves as a mediator of the relationship between two variables, social support and personality hardiness, and psychological distress (a summation of depression and anxiety symptoms). Support and hardiness were also tested for their role as moderators of two life situation stressors--HIV positive status and high number of negative life events. Social support was measured by the Interpersonal Support Evaluation List, hardiness was measured with the Dispositional Resilience Scale, and coping dimensions were assessed using the COPE.;Hardiness and social support had zero-order relationships to lower levels of distress. Mediation was analyzed with structural modeling. Results indicated that the relationship between hardiness and distress was fully mediated through lower levels of a latent construct measured by behavioral disengagement and denial coping: The path from hardiness to coping was significant {dollar}(\beta={lcub}-{rcub}.56,\ p<.001){dollar} as was the path from coping to distress {dollar}(\beta=.34,\ p<.002){dollar}; the path from hardiness to distress was nonsignificant. Direct effects to distress were found for social support {dollar}(\beta={lcub}-{rcub}.30,\ p<.001),{dollar} life events {dollar}(\beta=.47,\ p<.001),{dollar} and gender (female) {dollar}(\beta=.30,\ p<.001).{dollar} The social support X HIV status interaction term was significant for both depression and anxiety, however, the form of these results is inconsistent with previous effects documented in the literature. No moderating effects were demonstrated for the support X events, hardiness X events, or hardiness X HIV status interaction terms.;Research should examine which aspects of hardiness reduce maladaptive coping among these IDUs and how clinical interventions can foster these adaptive characteristics. Research should continue to examine the process by which different coping strategies and aspects of both functional and structural social support affect psychological adjustment to stress in this multi-disadvantaged population.