Skip to main content
Top
Gepubliceerd in: Journal of Behavioral Medicine 5/2009

01-10-2009

Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress

Auteurs: Conall O’Cleirigh, Margie Skeer, Kenneth H. Mayer, Steven A. Safren

Gepubliceerd in: Journal of Behavioral Medicine | Uitgave 5/2009

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

This study examined the relationship of post-traumatic and depressive symptom severity with measures of health-related quality of life (HRQOL), and health care utilization in a sample of 503 HIV-infected men who have sex with men (MSM) recruited in their primary HIV care setting. Participants completed computer assisted assessments of mood and anxiety, HRQOL, and HIV treatment. Peripheral blood CD4 (T helper) lymphocyte count, plasma HIV RNA concentration, and number of medical appointments were extracted from an electronic medical record. Controlling for demographics, disease stage, and antiretroviral medication, post-traumatic stress and depression symptoms accounted for significant variation in general health estimates, and in pain, role, and work-related impairment. Additionally, in multivariable models, post-traumatic stress and depression severity accounted for significant variation in health care utilization whereas symptoms and indices of HIV disease progression did not. These results extend the current research by providing evidence of the relationship between post-traumatic stress and depression symptom severity with measures of functional impairment and health care utilization in a relatively healthy, urban cohort of HIV-infected MSM.
Literatuur
go back to reference Bing, E. G., Burnam, M. D., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., et al. (2001). Psychiatric disorders and drug user among HIV-infected adults in the United States. Archives of General Psychiatry, 58, 721–728. doi:10.1001/archpsyc.58.8.721.PubMedCrossRef Bing, E. G., Burnam, M. D., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., et al. (2001). Psychiatric disorders and drug user among HIV-infected adults in the United States. Archives of General Psychiatry, 58, 721–728. doi:10.​1001/​archpsyc.​58.​8.​721.PubMedCrossRef
go back to reference Bozzette, S. A., Hays, R. D., & Berry, S. H. (1995). Derivation and properties of a brief health status assessment instrument for use in HIV disease. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 8, 253–265. doi:10.1097/00042560-199503010-00006.PubMedCrossRef Bozzette, S. A., Hays, R. D., & Berry, S. H. (1995). Derivation and properties of a brief health status assessment instrument for use in HIV disease. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 8, 253–265. doi:10.​1097/​00042560-199503010-00006.PubMedCrossRef
go back to reference Campsmith, M. L., Nakashima, A. K., & Davidson, A. J. (2003). Self-reported health-related quality of life in persons with HIV infection: Results from a multi-site interview project. Health and Quality of Life Outcomes, 24, 12. doi:10.1186/1477-7525-1-12.CrossRef Campsmith, M. L., Nakashima, A. K., & Davidson, A. J. (2003). Self-reported health-related quality of life in persons with HIV infection: Results from a multi-site interview project. Health and Quality of Life Outcomes, 24, 12. doi:10.​1186/​1477-7525-1-12.CrossRef
go back to reference Centers for Disease Control (CDC). (2007). Fact sheet: HIV/AIDS among men who have sex with men. June 2007. Centers for Disease Control (CDC). (2007). Fact sheet: HIV/AIDS among men who have sex with men. June 2007.
go back to reference Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., & Zwickl, B. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. AIDS Care, 12, 255–266. doi:10.1080/09540120050042891.PubMedCrossRef Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., & Zwickl, B. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. AIDS Care, 12, 255–266. doi:10.​1080/​0954012005004289​1.PubMedCrossRef
go back to reference Cole, S. W., Naliboff, B. D., Kemeny, M. E., Griswold, M. P., Fahey, J. L., & Zack, J. A. (2001). Impaired response to HAART in HIV-infected individuals with high autonomic nervous system activity. Proceedings of the National Academy of Sciences of the United States of America, 98, 12695–12700. doi:10.1073/pnas.221134198.PubMedCrossRef Cole, S. W., Naliboff, B. D., Kemeny, M. E., Griswold, M. P., Fahey, J. L., & Zack, J. A. (2001). Impaired response to HAART in HIV-infected individuals with high autonomic nervous system activity. Proceedings of the National Academy of Sciences of the United States of America, 98, 12695–12700. doi:10.​1073/​pnas.​221134198.PubMedCrossRef
go back to reference Cunningham, W. E., Crystal, S., Bozzette, S., & Hays, R. D. (2007). The associations of health-related quality of life with survival among persons with HIV infection in the United States. Journal of General Internal Medicine, 20, 21–27. doi:10.1111/j.1525-1497.2005.30402.x.CrossRef Cunningham, W. E., Crystal, S., Bozzette, S., & Hays, R. D. (2007). The associations of health-related quality of life with survival among persons with HIV infection in the United States. Journal of General Internal Medicine, 20, 21–27. doi:10.​1111/​j.​1525-1497.​2005.​30402.​x.CrossRef
go back to reference Dew, M. A., Becker, J. T., & Sanchez, J. (1997). Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: A longitudinal evaluation. Psychological Medicine, 27, 395–409. doi:10.1017/S0033291796004552.PubMedCrossRef Dew, M. A., Becker, J. T., & Sanchez, J. (1997). Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: A longitudinal evaluation. Psychological Medicine, 27, 395–409. doi:10.​1017/​S003329179600455​2.PubMedCrossRef
go back to reference Gill, C. J., Griffith, J. L., Jacobson, D., Skinner, S., Grobach, S. L., & Wilson, I. B. (2002). Relationship of HIV viral loads, CD4 counts, and HAART use to health-related quality of life. Journal of Acquired Immune Deficiency Syndrome, 30, 485–492. Gill, C. J., Griffith, J. L., Jacobson, D., Skinner, S., Grobach, S. L., & Wilson, I. B. (2002). Relationship of HIV viral loads, CD4 counts, and HAART use to health-related quality of life. Journal of Acquired Immune Deficiency Syndrome, 30, 485–492.
go back to reference Ibnanez, G. E., Purcell, D. W., Stall, R., Parsons, J. T., & Gomez, C. A. (2005). Sexual risk, substance use, psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS (London, England), 19, S49–S55. Ibnanez, G. E., Purcell, D. W., Stall, R., Parsons, J. T., & Gomez, C. A. (2005). Sexual risk, substance use, psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS (London, England), 19, S49–S55.
go back to reference Ironson, G., O’Cleirigh, C., Kumar, M., Balbin, E., Schneiderman, N., & Fletcher, M. A. (2006). Depression, coping, and neurohormonal predictors of HIV disease progression over 4 years in a diverse sample. Toronto, Canada: Presented at XVI International AIDS Conference. Ironson, G., O’Cleirigh, C., Kumar, M., Balbin, E., Schneiderman, N., & Fletcher, M. A. (2006). Depression, coping, and neurohormonal predictors of HIV disease progression over 4 years in a diverse sample. Toronto, Canada: Presented at XVI International AIDS Conference.
go back to reference Jacobson, D. L., Wu, A. W., & Feinberg, J. (2003). Health-related quality of life predicts survival, cytomegalovirus disease, and study retention in clinical trial participants with advanced HIV disease. Journal of Clinical Epidemiology, 56, 874–879. doi:10.1016/S0895-4356(03)00062-3.PubMedCrossRef Jacobson, D. L., Wu, A. W., & Feinberg, J. (2003). Health-related quality of life predicts survival, cytomegalovirus disease, and study retention in clinical trial participants with advanced HIV disease. Journal of Clinical Epidemiology, 56, 874–879. doi:10.​1016/​S0895-4356(03)00062-3.PubMedCrossRef
go back to reference Jia, H., Uphold, C. R., Wu, S., Reid, K., Findley, K., & Duncan, P. W. (2004). Health-related quality of life among men with HIV infection: Effects of social support, coping, and depression. AIDS Patient Care and STDs, 8, 594–603. doi:10.1089/apc.2004.18.594.CrossRef Jia, H., Uphold, C. R., Wu, S., Reid, K., Findley, K., & Duncan, P. W. (2004). Health-related quality of life among men with HIV infection: Effects of social support, coping, and depression. AIDS Patient Care and STDs, 8, 594–603. doi:10.​1089/​apc.​2004.​18.​594.CrossRef
go back to reference Jones, D. J., Beach, S. R., Forehand, R., & Foster, S. E. (2003). Self-reported health in HIV-positive African American women: The role of family stress and depressive symptoms. Journal of Behavioral Medicine, 26, 57. doi:10.1023/A:1026205919801.CrossRef Jones, D. J., Beach, S. R., Forehand, R., & Foster, S. E. (2003). Self-reported health in HIV-positive African American women: The role of family stress and depressive symptoms. Journal of Behavioral Medicine, 26, 57. doi:10.​1023/​A:​1026205919801.CrossRef
go back to reference Kelly, B., Raphael, B., Judd, F., Kernutt, G., Burnett, P., & Burrows, G. (1998). Suicidal ideation, suicide attempts, and HIV infection. Psychosomatics, 39, 405–415.PubMed Kelly, B., Raphael, B., Judd, F., Kernutt, G., Burnett, P., & Burrows, G. (1998). Suicidal ideation, suicide attempts, and HIV infection. Psychosomatics, 39, 405–415.PubMed
go back to reference Kemeny, M. E., & Dean, L. (1995). Effects of AIDS-related bereavement on HIV progression among New York city gay men. AIDS Education and Prevention, 7(suppl), 36–47.PubMed Kemeny, M. E., & Dean, L. (1995). Effects of AIDS-related bereavement on HIV progression among New York city gay men. AIDS Education and Prevention, 7(suppl), 36–47.PubMed
go back to reference Knauz, R. O., Safren, S. A., O’Cleirigh, C., Capistrant, B. D., Driskell, J. R., Aguilar, D., et al. (2007). Developing an HIV-prevention intervention for HIV-infected men who have sex with men: Project enhance. AIDS and Behavior, 5(Supp.), 117–126.CrossRef Knauz, R. O., Safren, S. A., O’Cleirigh, C., Capistrant, B. D., Driskell, J. R., Aguilar, D., et al. (2007). Developing an HIV-prevention intervention for HIV-infected men who have sex with men: Project enhance. AIDS and Behavior, 5(Supp.), 117–126.CrossRef
go back to reference Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., et al. (1999). Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosomatic Medicine, 61, 397–406.PubMed Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., et al. (1999). Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosomatic Medicine, 61, 397–406.PubMed
go back to reference Leserman, J., Petitto, J. M., Golden, R. N., Gaynes, B. N., Gu, H., Perkins, D. O., et al. (2000). Impact of stressful life events, depression, social support, coping and cortisol on progression to AIDS. The American Journal of Psychiatry, 157(8), 1221–1228. doi:10.1176/appi.ajp.157.8.1221.PubMedCrossRef Leserman, J., Petitto, J. M., Golden, R. N., Gaynes, B. N., Gu, H., Perkins, D. O., et al. (2000). Impact of stressful life events, depression, social support, coping and cortisol on progression to AIDS. The American Journal of Psychiatry, 157(8), 1221–1228. doi:10.​1176/​appi.​ajp.​157.​8.​1221.PubMedCrossRef
go back to reference Leserman, J., Petitto, J. M., Gu, H., Gaynes, B. N., Barroso, J., Golden, R. N., et al. (2002). Progression to AIDS, a clinical AIDS condition and mortality: Psychosocial and physiological predictors. Psychological Medicine, 32, 1059–1073. doi:10.1017/S0033291702005949.PubMedCrossRef Leserman, J., Petitto, J. M., Gu, H., Gaynes, B. N., Barroso, J., Golden, R. N., et al. (2002). Progression to AIDS, a clinical AIDS condition and mortality: Psychosocial and physiological predictors. Psychological Medicine, 32, 1059–1073. doi:10.​1017/​S003329170200594​9.PubMedCrossRef
go back to reference Liebschutz, J. M., Feinman, G., Sullivan, L., Stein, M., & Samet, J. (2000). Physical and sexual abuse in women infected with the human immunodeficiency virus–Increased illness and health care utilization. Archives of Internal Medicine, 160, 1659–1664. doi:10.1001/archinte.160.11.1659.PubMedCrossRef Liebschutz, J. M., Feinman, G., Sullivan, L., Stein, M., & Samet, J. (2000). Physical and sexual abuse in women infected with the human immunodeficiency virus–Increased illness and health care utilization. Archives of Internal Medicine, 160, 1659–1664. doi:10.​1001/​archinte.​160.​11.​1659.PubMedCrossRef
go back to reference Lorenz, K. A., Cunningham, W. E., Spritzer, K. L., & Hays, R. D. (2006). Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV. Quality of Life Research, 15, 951–958. doi:10.1007/s11136-005-6010-x.PubMedCrossRef Lorenz, K. A., Cunningham, W. E., Spritzer, K. L., & Hays, R. D. (2006). Changes in symptoms and health-related quality of life in a nationally representative sample of adults in treatment for HIV. Quality of Life Research, 15, 951–958. doi:10.​1007/​s11136-005-6010-x.PubMedCrossRef
go back to reference Mathews, W. C., & May, S. (2007). EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health and Quality of Life Outcomes, 25, 5. doi:10.1186/1477-7525-5-5.CrossRef Mathews, W. C., & May, S. (2007). EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health and Quality of Life Outcomes, 25, 5. doi:10.​1186/​1477-7525-5-5.CrossRef
go back to reference Mugavero, M. J., Pence, B. W., Whetten, K., Leserman, J., Swartz, M., Stangl, D., et al. (2007). Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort. AIDS Patient Care and STDs, 21, 681–690. doi:10.1089/apc.2006.0167.PubMedCrossRef Mugavero, M. J., Pence, B. W., Whetten, K., Leserman, J., Swartz, M., Stangl, D., et al. (2007). Predictors of AIDS-related morbidity and mortality in a southern U.S. Cohort. AIDS Patient Care and STDs, 21, 681–690. doi:10.​1089/​apc.​2006.​0167.PubMedCrossRef
go back to reference O’Cleirigh, C., Ironson, G., Antoni, M., Fletcher, M. A., McGuffey, L., Balbin, E., et al. (2003). Emotional expression and depth processing: their relation to long-term survival in patients living with HIV/AIDS. Journal of Psychosomatic Research, 54, 225–235. doi:10.1016/S0022-3999(02)00524-X.PubMedCrossRef O’Cleirigh, C., Ironson, G., Antoni, M., Fletcher, M. A., McGuffey, L., Balbin, E., et al. (2003). Emotional expression and depth processing: their relation to long-term survival in patients living with HIV/AIDS. Journal of Psychosomatic Research, 54, 225–235. doi:10.​1016/​S0022-3999(02)00524-X.PubMedCrossRef
go back to reference O’Cleirigh, C., Hart, T. A., & James, C. A. (2007b). HIV and anxiety. In M. J. Zvolensky & J. A. J. Smits (Eds.), Health behaviors and physical illness in anxiety and its disorders: Contemporary theory and research. New York: Springer. O’Cleirigh, C., Hart, T. A., & James, C. A. (2007b). HIV and anxiety. In M. J. Zvolensky & J. A. J. Smits (Eds.), Health behaviors and physical illness in anxiety and its disorders: Contemporary theory and research. New York: Springer.
go back to reference Pence, B. W., Miller, W. C., Whetten, K., Eron, J. J., & Gaynes, B. N. (2006). Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the southeastern United States. Journal of Acquired Immune Deficiency Syndrome, 42, 298–306. doi:10.1097/01.qai.0000219773.82055.aa.CrossRef Pence, B. W., Miller, W. C., Whetten, K., Eron, J. J., & Gaynes, B. N. (2006). Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the southeastern United States. Journal of Acquired Immune Deficiency Syndrome, 42, 298–306. doi:10.​1097/​01.​qai.​0000219773.​82055.​aa.CrossRef
go back to reference Resnick, H. S., Yehuda, R., Pitman, R. K., & Foy, D. W. (1995). Effect of previous trauma on acute plasma cortisol level following rape. The American Journal of Psychiatry, 152, 1675–1677.PubMed Resnick, H. S., Yehuda, R., Pitman, R. K., & Foy, D. W. (1995). Effect of previous trauma on acute plasma cortisol level following rape. The American Journal of Psychiatry, 152, 1675–1677.PubMed
go back to reference Safren, S. A., O’Cleirigh, C., Judy, T., Raminani, S., Reilly, L. C., Otto, M. W., et al. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychology, 28, 1–10. doi:10.1037/a0012715.PubMedCrossRef Safren, S. A., O’Cleirigh, C., Judy, T., Raminani, S., Reilly, L. C., Otto, M. W., et al. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychology, 28, 1–10. doi:10.​1037/​a0012715.PubMedCrossRef
go back to reference Schackman, B. R., Gebo, K. A., Walensky, R. P., Losina, E., Muccio, T., Sax, P. E., et al. (2006). The lifetime cost of Human Immunodeficiency Virus care in the United States. Medical Care, 44, 990–997.PubMedCrossRef Schackman, B. R., Gebo, K. A., Walensky, R. P., Losina, E., Muccio, T., Sax, P. E., et al. (2006). The lifetime cost of Human Immunodeficiency Virus care in the United States. Medical Care, 44, 990–997.PubMedCrossRef
go back to reference Sikkema, K. J., Wilson, P. A., Hansen, N. B., Kochman, A., Neufeld, S., Ghebremichael, M. S., et al. (2008). Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. Journal of Acquired Immune Deficiency Syndrome, 47, 506–513. doi:10.1097/QAI.0b013e318160d727.CrossRef Sikkema, K. J., Wilson, P. A., Hansen, N. B., Kochman, A., Neufeld, S., Ghebremichael, M. S., et al. (2008). Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. Journal of Acquired Immune Deficiency Syndrome, 47, 506–513. doi:10.​1097/​QAI.​0b013e318160d727​.CrossRef
go back to reference Spitzer., R. L., Korenke, K., Williams, J. B., for the Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. Journal of the American Medical Association, 282, 1737–1744. Spitzer., R. L., Korenke, K., Williams, J. B., for the Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. Journal of the American Medical Association, 282, 1737–1744.
go back to reference Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., et al. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942. doi:10.2105/AJPH.93.6.939.PubMedCrossRef Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., et al. (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93, 939–942. doi:10.​2105/​AJPH.​93.​6.​939.PubMedCrossRef
go back to reference Trépanier, L. L., Rourke, S. B., Bayoumi, A. M., Halman, M. H., Krzyzanowski, S., & Power, C. (2005). The impact of neuropsychological impairment and depression on health-related quality of life in HIV-infection. Journal of Clinical and Experimental Neuropsychology, 27, 1–15. doi:10.1080/138033990513546.PubMedCrossRef Trépanier, L. L., Rourke, S. B., Bayoumi, A. M., Halman, M. H., Krzyzanowski, S., & Power, C. (2005). The impact of neuropsychological impairment and depression on health-related quality of life in HIV-infection. Journal of Clinical and Experimental Neuropsychology, 27, 1–15. doi:10.​1080/​138033990513546.PubMedCrossRef
go back to reference van der Kolk, B. A. (1997). The psychobiology of posttraumatic stress disorder. The Journal of Clinical Psychiatry, 58(Suppl 9), 16–24.PubMed van der Kolk, B. A. (1997). The psychobiology of posttraumatic stress disorder. The Journal of Clinical Psychiatry, 58(Suppl 9), 16–24.PubMed
go back to reference Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS and Behavior, 10, 473–482. doi:10.1007/s10461-006-9099-1.PubMedCrossRef Vanable, P. A., Carey, M. P., Blair, D. C., & Littlewood, R. A. (2006). Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS and Behavior, 10, 473–482. doi:10.​1007/​s10461-006-9099-1.PubMedCrossRef
go back to reference Williams, P., Narciso, L., Browne, G., Roberts, J., Weir, R., & Gafni, A. (2005). The prevalence, correlates, and costs of depression in people living with HIV/AIDS in Ontario: Implications for service directions. AIDS Education and Prevention, 17, 119–130. doi:10.1521/aeap.17.3.119.62903.PubMedCrossRef Williams, P., Narciso, L., Browne, G., Roberts, J., Weir, R., & Gafni, A. (2005). The prevalence, correlates, and costs of depression in people living with HIV/AIDS in Ontario: Implications for service directions. AIDS Education and Prevention, 17, 119–130. doi:10.​1521/​aeap.​17.​3.​119.​62903.PubMedCrossRef
go back to reference Wyatt, G. E., Longshore, D., Chin, D., Carmona, J. V., Loeb, T. B., Myers, H. F., et al. (2004). The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS and Behavior, 8, 453–462. doi:10.1007/s10461-004-7329-y.PubMedCrossRef Wyatt, G. E., Longshore, D., Chin, D., Carmona, J. V., Loeb, T. B., Myers, H. F., et al. (2004). The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories. AIDS and Behavior, 8, 453–462. doi:10.​1007/​s10461-004-7329-y.PubMedCrossRef
Metagegevens
Titel
Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress
Auteurs
Conall O’Cleirigh
Margie Skeer
Kenneth H. Mayer
Steven A. Safren
Publicatiedatum
01-10-2009
Uitgeverij
Springer US
Gepubliceerd in
Journal of Behavioral Medicine / Uitgave 5/2009
Print ISSN: 0160-7715
Elektronisch ISSN: 1573-3521
DOI
https://doi.org/10.1007/s10865-009-9217-4

Andere artikelen Uitgave 5/2009

Journal of Behavioral Medicine 5/2009 Naar de uitgave