Coping profiles and subjective well-being among people living with HIV: less intensive coping corresponds with better well-being
Coping profiles and subjective well-being among people living with HIV: less intensive coping corresponds with better well-being
Marcin Rzeszutek 0 1 2 3
Ewa Gruszczyn´ ska 0 1 2 3
Ewa Firla˛g-Burkacka 0 1 2 3
0 Ewa Firla ̨g-Burkacka
1 Warsaw's Hospital of Infectious Diseases , Wolska 37, 01-201 Warsaw , Poland
2 Health Psychology Department, University of Social Sciences and Humanities , Chodakowska 19/31, 03-815 Warsaw , Poland
3 Faculty of Psychology, University of Warsaw , Stawki 5/7, 00-183 Warsaw , Poland
Purpose The aim of this study was to investigate the relationship between coping strategies and subjective wellbeing (SWB) among people living with HIV (PLWH) using the latent profile analysis (LPA) with control for socio-medical covariates. Methods The sample comprised five hundred and thirty people (N = 530) with a confirmed diagnosis of HIV?. The study was cross-sectional with SWB operationalized by satisfaction with life (Satisfaction with Life Scale) and positive and negative affect (PANAS-X). Coping with stress was measured by the Brief COPE Inventory, enriched by several items that assessed rumination and enhancement of positive emotional states. Additionally, the relevant socio-medical variables were collected. Results The one-step model of LPA revealed the following: (1) a solution with five different coping profiles suited the data best; (2) socio-medical covariates, except for education, were not related to the profiles' membership. Further analysis with SWB as a distal outcome showed that higher intensity coping profiles have significantly worse SWB when compared with lower intensity coping profiles. However, the lowest SWB was noted for mixed intensity coping profile (high adaptive/low maladaptive). Conclusions The person-centered approach adopted in this study informs about the heterogeneity of disease-related coping among PLWH and its possible reactive character, as the highest SWB was observed among participants with the lowest intensity of coping.
HIV; Subjective well-being; Stress coping; Latent profile analysis
The literature on coping among people living with HIV
(PLWH) is large but highly heterogeneous with regard to
coping measurements, coping outcomes, and final remarks
. The vast majority of studies on this topic have
concentrated on the role of active and avoidant coping. While active
coping is related to greater level of CD4-cell counts ,
fewer HIV-related symptoms , better quality of life ,
lower frequency of alcohol and drug use  and better
adherence to treatment , avoidant coping have been
associated with deterioration of psychosocial and health
status of PLWH, including worse physical functioning ,
poor quality of life , frequent use of alcohol and drugs ,
and non-adherence to treatment . More specifically,
Moskowitz et al.  found that meaning-focused coping was
consistently linked with better affective, behavior, and
physical health outcomes among PLWH. McIntosh and
Rosselli  observed that spiritual coping and positive
reframing promoted psychological adaptation among
HIVinfected women to a greater degree than social support
seeking. Furthermore, Kraaij et al.  noted that cognitive
coping strategies (e.g., positive reappraisal) and a proper goal
adjustment (e.g., disengagement from unrealistic goals, and
reengaging in alternative meaningful aims) have the
strongest impact on well-being among HIV-infected men.
However, even if there is a generally accepted consensus
that coping matters with regard to how people deal with
adverse life events, little agreement has been reached on
how to conceptualize, measure, and classify different ways
of coping [12–14]. One of the central problems in coping
literature is that many authors neglect that the term
‘‘coping’’ is not a unique, observable behavior, stable trait, or
easily reported specific belief. On the contrary, it is a
dynamic, multidimensional construct that encompasses
various actions, behaviors, emotions, and cognitions often
used by the same person simultaneously [15, 16]. Finally,
the vast majority of authors define ways of coping according
to a variable-oriented approach, in terms of dimensions,
whereas the fact that the same person may have different
positions on each dimension is disregarded [17, 18].
In that light, the central question is not whether some
ways of coping are less or more effective, but rather how a
specific person copes with a particular stressor and what his
or her effectiveness is in doing so. Therefore, a
personcentered approach is likely to bring a new perspective to
examine coping complexities . It is particularly
important since some studies have already demonstrated
that a higher intensity of coping may be related to worse,
instead of better adaptation (e.g., [20, 21]) and the idea of
the possibly defensive nature of intense coping was
introduced by Krohne  more than two decades ago.
Nevertheless, it is worth mentioning that this conceptualization
aligns with the definition of coping as individuals’ efforts
to reduce imbalance between demands and resources,
provided by Folkman and Lazarus . When those efforts
are highly diversified and all of them are performed with a
high intensity, regardless of specific situational demands,
they may actually be a sign of high distress or, in other
terms, an indicator of a strong conflict between demands
and available resources. When such intensity of coping is
performed without goodness of fit to the situational
demands for a longer time, it may lead to significant
psychological consequences. First, it shows that the
aforementioned imbalance has not been resolved despite the
efforts made, so the person is still under stress. Second,
keeping up such efforts is not possible without costs, which
may additionally influence subjective well-being (SWB).
Numerous studies have been conducted on the concept of
well-being not only in psychology, but also in other social
sciences (e.g., [24–26]). Nevertheless, the question of how
well-being should be defined and operationalized still
remains largely unresolved [27, 28]. Despite various
approaches to well-being, a majority of the authors agree that
well-being is a multidimensional construct and there is a
necessity to be clear about what is being measured [29, 30]. In
this study, we concentrated on SWB defined broadly by the
level of satisfaction with life and a combination of positive
and negative affect [31–33] among people living with HIV
(PLWH). The issue of SWB seems to be of special interest
among patients dealing with chronic disease, with significant
psychological and social burden, such as PLHW. The
substantial progress in antiretroviral therapy has changed social
attitudes toward HIV/AIDS from a fatal and terminal illness
to a chronic medical condition and has given great hope to
PLWH for a longer life [34, 35]. However, PLWH still
experience major psychological distress stemming from
being diagnosed with a potentially life-threatening virus
[36, 37], unpredictability of HIV symptoms fluctuation
[38, 39], and social isolation and discrimination [40, 41]. Not
only can HIV-related distress deteriorate SWB, but poor
SWB among this patient group impacts the course of HIV
infection by diminishing CD4 cell counts, which influence
the pace of HIV progression . Therefore, research on
SWB among PLWH has important clinical implications
[43, 44]. Nevertheless, the majority of studies on SWB
among PLWH concentrated solely on the presence or absence
of these negative HIV-related mental health problems (e.g.,
[45, 46]). Therefore, in this study, we focused on the
aforementioned broad definition of SWB among PLWH.
Despite the same medical diagnosis and controlling for
other medical variables, there is a significant
interindividual variability in coping with HIV infection . Further,
although the results from the variable-centered studies
seem reasonably coherent, they do not take into account
these individual differences, that is, each person may
perform a different combination of so-called adaptive and
maladaptive strategies. To address this gap, we
implemented a person-centered approach using a latent profile
analysis (LPA). Thus, the aim of the study was twofold:
First, to investigate heterogeneity of coping with the
disease among PLWH, including possible socio-medical
covariates; and second, to examine whether different
coping profiles are related to SWB in this patient group .
On the basis of the aforementioned studies on coping and
SWB among PLWH, we generated three specific
hypotheses. First, we expected that the sample was heterogeneous in
terms of coping, i.e., different coping profiles can be
observed among the participants. Second, allocation to a
specific coping profile is related to socio-medical status
since this status may serve as a proxy of current level of
resources available to the person . Finally, we assumed
that higher intensity coping profiles are related to worse
SWB when compared with lower intensity coping profiles.
Additionally, participants belonging to the mixed intensity
coping profile (higher intensity on some coping strategies
and lower on others) have higher SWB. More specifically,
for mixed profiles, a combination of higher intensity of
strategies related to more adaptive outcomes (e.g., active
and problem-focused coping, including positive reframing
and positive emotional enhancement) and lower intensity of
so-called maladaptive strategies (e.g., avoidant coping and
palliative forms of emotion-focused coping) should be the
best in terms of well-being .
Participants and procedure
Five hundred and thirty (530) adults with a medical
diagnosis of HIV infection were recruited from patients of the
out-patient clinic of the state hospital for infectious
diseases. The participants completed a paper-and-pencil
version of the measures and participated in the study voluntary
(there was no remuneration). The eligibility criteria were
that participants had to be 18 years of age or older, had to
have a medically confirmed diagnosis of HIV?, and had to
be a recipient of antiretroviral treatment at the out-patient
clinic where the study was conducted. The exclusion
criteria included HIV-related cognitive impairment diagnosed
by medical doctors. In particular, out of the 750 patients
eligible for the study, 530 were approached and agreed to
the filed measures (71%), 152 declined (20%), and 68 (9%)
had missing data to an extent that precluded them from the
Specifically, there were 444 men (84%) and 86 women
(16%) between 18 and 76 years of age (M = 39.81;
SD = 10.54) of whom 57% of were married. Only 16% of
the participants had elementary education, 31% reported
secondary and 53% higher education. Majority of the
participants, declared full employment (72%), 12% were
unemployed, 12% were receiving a pension, and 4% were
retired. When it came to the clinical variables, the HIV
infection duration ranged from 1 to 32 years (M = 7.71;
SD = 6.86). The antiretroviral treatment duration ranged
from 1 to 32 years (M = 5.97; SD = 5.53), and the CD4 cell
count ranged from 100 to 2,000 (M = 589.46;
SD = 222.42). Finally, out of the whole sample, 15%
patients were diagnosed with AIDS.
Subjective well-being indicators
(PANAS-X; Watson and Clark . The SWLS comprises
five items, each with a seven-point scale, ranging from 1
(strongly disagree) to 7 (strongly agree). A higher total
score means a higher level of satisfaction with life. The
Cronbach’s alpha in the current study was satisfactory (.88).
The PANAS-X comprises 10 adjectives for positive affect
(e.g., proud, excited, etc.) and 10 for negative affect (e.g.,
frightened, hostile, etc.). The participants were asked to rate
their general affective states on a five-point response scale
from 1 (not at all) to 5 (extremely). The Cronbach’s alpha
coefficients obtained in this study were .85 for the positive
affect subscale and .86. for the negative affect subscale.
To assess strategies for coping with stress, the Brief COPE
Inventory was used . This tool consists of 28 items and
provides 14 subscales with a different reliability, two items
each with a Likert-like response scale ranging from 0 (I
haven’t been doing this at all) to 3 (I’ve been doing this a
lot). Coping intensity is understood as participants’
selfreport on the magnitude with which their use a given
strategy to deal with health issues caused by being infected
with HIV. The subscales were derived empirically, and
they were not theoretically reassessed afterwards to
propose a more comprehensive systematization of coping
strategies (see ). In particular, as this tool does not
include items directly referring to rumination, which is one
of the most strongly proved maladaptive strategies (see
), and items describing coping efforts focused on
enhancement of positive emotional states during stress, the
relevant two items were added from the Ruminative
Response Styles : I think What am I doing to deserve
this?; I think Why do I have problems other people don’t
have?) and from the Coping with Health Injuries and
Problems Scale after modification : I have nice things
around; I look for simple pleasures (e.g., having a cup of
tea, listening to music, walking, reading a good book)).
Therefore, there were 16 coping indicators in the study:
self-distraction, active coping, denial, substance use, use of
emotional support, use of instrumental support, behavioral
disengagement, venting, positive reframing, planning,
humor, acceptance, religion, self-blame, rumination, and
positive emotion enhancement. The Cronbach’s alpha
ranged from .78 to .86. Due to reasons described in the
introduction, we did not classify the subscales into the
higher order coping indices, as this kind of aggregation
may influence segmentation results.
SWB was measured on the Satisfaction with Life Scale
(SWLS;  along with the Positive and Negative Affect
LPA is a statistical method that enables investigation of
unobserved heterogeneity within a studied sample, that is,
it identifies groups of participants who represent the
greatest similarity on the same set of observed continuous
variables within a given group and the greatest
dissimilarity between other participants’ groups . In our study,
this method allows classifying participants into a number
of exclusive and exhaustive subgroups, characterized by
different coping profiles. A model with an optimal number
of such categories (i.e., profiles) is selected on the basis on
several indicators. For Akaike’s information criterion
(AIC), Bayesian information criterion (BIC), and the
sample-size adjusted BIC (SABIC), lower values indicate a
model with better fit . Another evaluation of goodness
of fit is provided by the results of the bootstrap likelihood
ratio test (BLRT , which compares neighboring
models. An entropy-based criterion indicates a quality of a class
separation from 0 to 1, where 1 evidences a perfect
classification . Finally, a size of the smallest class is a
practical criterion, since classes smaller than 5% of the
sample is considered spurious and unreplicable .
In general, we used LPA with distal outcomes .
First, to select a model with an optimal number of coping
profiles, we adopted the one-step approach with
sociomedical covariates (gender, age, marital status, education,
employment, HIV/AIDS status, HIV infection duration in
years, antiretroviral treatment duration in years, CD4
count) included in the process of segmentation, thus the
obtained coping profiles were adjusted in this regard .
Then we regressed a distal outcome, that is, SWB, on latent
coping profiles using the bias-adjusted three-step analysis
described by Vermunt and Magidson [62, 63]. The
calculations were performed using the Latent GOLD 5.1
(containing a submodule called Step3) and IBM SPSS Statistics
Mean values, standard deviations, and Pearson‘s
correlations of the main study variables are presented in Table 1.
All the variables can be regarded as normally distributed.
Positive affect and negative affect were uncorrelated
(r = -.03) and only up to medium were they related to
satisfaction with life. Thus, it indicates that they these
domains of SWB are indeed separate to a significant degree.
Among coping strategies, the highest correlation was noted
for denial and behavioral disengagement (r = .70).
Coping profiles and their socio-medical correlates
Table 2 summarizes the indices of the model selection
process for one to six profile solutions. BIC, AIC, and
SABIC (see, ‘‘Data analysis’’) indicate on six-profile
model. Also, BLRT informs that adding a profile to each
consecutive model significantly improves goodness of fit
which may also point at the most numerous profile
solutions. Entropy values were similar for all the models so
each of them provides a good separation in the sample.
However, the size of the smallest group in the six-profile
solution was as low as 3% of the sample. Thus, the second
best fitted model, a five-profile solution, was chosen for
further analysis. Figure 1 illustrates this model.
As it can be seen, four out of five coping profiles are
mostly parallel, whereas the remaining one crosses over
from high values to lower ones (profile 3). The most
numerous group consists of 159 participants (30%, profile
1) and can be described as high intensity coping profile.
The second one, represented by 135 participants (25.5%,
profile 2), has a generally lower profile, especially with
regards to denial, substance use and turn to religion
strategies. As already mentioned, mixed profile was
observed for 130 participants (24.5%, profile 3). They have
high values on coping strategies frequently named as
adaptive coping and lower values on strategies named
maladaptive coping. The highest intensity coping profile is
represented by 59 participants (11%, profile 4). Finally, the
smallest group with the lowest intensity coping profile
included 47 participants (9%, profile 5). It is worth
noticing, however, that the highest and the lowest profiles have a
similar number of members. Also, profiles for intense
copers (profile 1 and profile 4) are more flatted whereas
profiles for mild copers (profile 2 and 5) have slightly
higher values in positive reframing, acceptance and
enhancement of positive emotions. The averaged posterior
probability ranged from .89 for the mixed profile to.97 for
the most intensive coping profile.
Finally, it turned out that profiles differed only in terms
of education (Wald = 11.31, p = .02). The pairwise
comparisons revealed that the highest proportion of
patients with university degree was in profile 2 (2.28) and 5
(1.35), while in other profiles this distribution was
statistically equal for all the levels of education. Therefore, the
coping profiles’ membership appeared to be relatively
independent of socio-medical variables, which was also
reflected in standard R squared for a covariate-based
classification equaled only .03.
Relations of coping profiles with well-being
Significant differences between coping profiles with regard
to SWB were noted. Table 3 presents test values and means
for each profile for illustrative purposes.
Additionally, to elaborate on affective well-being, a
positive affect to negative affect ratio was added. As can be
seen, the highest satisfaction with life and positive affect as
Kurtosis Skewness 1
Kurtosis Skewness 10
1 Positive affect
2 Negative affect
3 Satisfaction with Life
4 Active coping
1 Positive affect
2 Negative affect
3 Satisfaction with Life
4 Active coping
6 Positive reframing
3.40 1.35 0–6
3.40 1.35 0–6
2.85 1.57 0–6
All the correlations marked with asterisk are significant at least at p \ .05; M mean, SD standard deviation
Table 2 Summary of model selection indices of latent prolife analysis
Number of parameters
Table 1 continued
19 Positive emotion
Fig. 1 Results of latent profile
analysis: five coping profiles
identified in the studied sample
(N = 530)
Table 3 Results of the
biasadjusted step-three analysis for
coping profiles and subjective
well-being as a distal outcome
Kurtosis Skewness 10
well as the lowest negative affect was noted for profile 5
and then for profile 2, thus the lowest profiles have the
highest SWB. Interestingly, the lowest SWB was observed
among participants with a mixed intensity coping profile.
The results of our study were consistent with the first
hypothesis, that is, we observed the heterogeneity of the
sample of PLWH with regard to coping with the disease, as
five different coping profiles were observed. Thus, our
findings are in line with ideas expressed a long time ago, as
well as with contemporary critical observations on the
nature of coping that it is a multidimensional construct that
operates on the number of different levels [64, 22, 65]. As
far as PLWH is concerned, our results may be interesting in
and of itself, as till now the vast majority of studies among
PLWH were conducted in the variable-oriented model, and
were focused on searching for single sociodemographic or
medical variables that are independently associated with
various coping strategies, neglecting the problem of
heterogeneity of coping in this group of patients [45, 43, 1].
The domination of variable-oriented model may also be the
reason why ambiguous results on well-being among PLWH
exist in the literature. According to Keiser et al. , many
authors disregard how particular socio-medical and
psychosocial variables cluster across different PLWH
subgroups distinguished on the basis of various SWB profiles,
which can be influenced by a large number of factors
simultaneously. Our study addressed these two gaps in the
literature by examining both coping profiles and subjective
well-being among people living with HIV using latent
Secondly, socio-medical variables, with the exception
of education, were not related to the coping profiles
among our participants and, as such, were also irrelevant
for observed SWB differences between these profiles,
which contradicted our second hypothesis. This finding is
contrary to several previous studies, which showed that
coping among HIV? individuals is shaped greatly by
clinical variables, such as a CD4 cell count [67, 68], HIV
infection duration , being diagnosed with AIDS in
particular , being on ART treatment [70, 71] or
sociodemographic data . In our sample, however,
coping profiles and consequently SWB differences as
well were related only to having a university degree. This
finding may be discussed in the context of existing
HIVrelated stigma, and threat of social rejection, including in
particular losing social status, which is still a very
prevalent experience among PLWH [40, 72]. Perhaps
higher education acts here as a personal resource that
offers an opportunity for a greater social participation and
reduces stress level both directly through a lower number
of stressors and indirectly through more effective but less
intense coping . Therefore, education may be a better
proxy of health-related stress and well-being than clinical
variables since the great advancements in HIV/AIDS
treatment have improved substantially the life expectancy
of PLWH . As a result, an increasing number of
PLWH are more concerned with their social status not
only with health outcomes. It is also in accordance
with other studies, which indicated that subjective
wellbeing among chronically ill patients depends more on
psychosocial factors rather than socio-medical variables
Finally, in line with our third hypothesis, higher
intensity coping profiles were related to worse well-being when
compared with lower intensity coping profiles, but contrary
to our expectations, members of the mixed intensity profile
(high adaptive/low maladaptive) have the lowest SWB.
This result is particularly intriguing, as there is a common
assumption in coping literature that more intense adaptive
coping provides better effects for individual’s well-being
across different stressful situations (e.g., [75–77]. Again,
perhaps there is a need to come back to basics, as Krohne
 previously suggested that low- intensity coping and
diversity may just mean a low level of distress. There is the
theoretical argument that coping is a psychological
necessity only when a person is under stress according to
his or her cognitive appraisal. However, at least for some,
their extensive coping efforts do not bring any relief in this
regard. In uncontrollable situations, such as terminal
disease, coping may even be purely reactive, that is, the
process of coping may be initiated only due to experiencing
strong negative emotions, no matter if this specific way of
coping is meaningful in this situation or not . One study
regarding PLWH provided data in accordance with our
findings. Fleishman et al.  in a study on coping in
response to HIV/AIDS proved that PLWH classified as
passive copers had fewer HIV-related symptoms, a better
level of physical functioning, and high affective
well-being. It is likely that in an uncontrollable situation, and
many aspects of being HIV? can be described as such,
intensive coping may elevate more HIV-related distress,
but again, there is no consensus on that in the literature .
However, our study is not free of limitations. First of all,
the cross-sectional design prevents us from making causal
interpretations and future studies should be conducted in a
longitudinal design. Even if well-being was an explanatory
variable here, the possibility that its low values may be a
source of stress itself, thus a cause and not an outcome of
coping, cannot be excluded. Secondly, we did not control
for the level of stress experienced by the participants. In
future research, the intensity of stress should be treated as a
covariate, e.g., participants that experienced more level of
stress may have higher coping intensity. Thirdly, we
assessed, a broad but still selective set of coping strategies,
so it would be advisable in the future to check if the
obtained effects are present for other coping measurements.
Finally, in our sample significant underrepresentation of
women is seen, but the gender ratio was typical for PLWH
population  and this is in line with other studies
pointing at a lack of gender differences in coping among
PLWH [81, 82].
From a clinical point of view, our findings suggest that
when providing psychological help special focused should
be put on patients with very intense coping. Furthermore, a
modification of coping into so-called favorable profile
(high intensity of adaptive strategies accompanied by low
intensity of maladaptive strategies) may not necessary is a
proper direction. Thus, further research is needed as
knowledge about psychological functioning of PLWH is
The person-centered approach adopted in this study
informs about the heterogeneity of disease-related coping
among PLWH and its possible reactive character, as the
highest SWB, was observed among participants with the
lowest intensity of coping. The results of this study
illustrate how a person-centered approach may influence
clinically relevant knowledge regarding the complexities of
dealing with chronic disease as well as elucidate coping
research in general. We have to remember that beyond the
coping strategies, there is always the person who copes.
Compliance with ethical standards
Conflict of interest The corresponding author declares that he has no
conflict of interest. The second author declares that she has no conflict
of interest. The third author also declares that she has no conflict of
Ethical approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://creative
commons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give appropriate
credit to the original author(s) and the source, provide a link to the
Creative Commons license, and indicate if changes were made.
1. Moskowitz , J. , Hult , J. , Bussolari , C. , & Acree , M. ( 2009 ). What works in coping with HIV? A meta-analysis with implications for coping with serious illness . Psychological Bulletin , 135 , 121 - 141 . doi:10.1037/a0014210.
2. Ironson , G. , & Hayward , M. ( 2008 ). Do Positive psychosocial factors predict disease progression in HIV-1? A Review of the evidence . Psychosomatic Medicine , 70 , 546 - 554 . doi:10.1097/ PSY.0b013e318177216c.
3. Chida , Y. , & Vedhara , K. ( 2009 ). Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations . Brain, Behavior, and Immunity , 23 , 434 - 445 . doi:10.1016/j.bbi. 2009 .01.013.
4. Vyavaharkar , M. , Moneyham , L. , Murdaugh , C. , & Tavakoli , A. ( 2012 ). Factors associated with quality of life among rural women with HIV disease . AIDS and Behavior , 16 , 295 - 303 . doi:10.1007/s10461- 011 - 9917 -y.
5. Pence , B. , Thielman , N. , Whetten , K. , Ostermann , J. , Kumar , V. , & Mugavero , M. ( 2008 ). Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the Unites States southeast . AIDS Patient Care STDs , 22 , 777 - 869 . doi:10. 1089/apc.2008.0022.
6. Vervoort , S. , Grypdonck , M. , de Grauwe , A. , Hoepelman , A. , & Borleffs , J. ( 2009 ). Adherence to HAART: Processes explaining adherence behaviour in acceptors and non-acceptors . AIDS Care , 21 , 431 - 438 . doi:10.1080/09540120802290381.
7. Griswold , G. , Evans , S. , Spielman , L. , & Fishman , B. ( 2005 ). Coping strategies of HIV patients with peripheral neuropathy . AIDS Care , 17 , 711 - 720 . doi:10.1080/09540120412331336715.
8. Weaver , K. , Antoni , M. , Lechner , S. , Dura , R. , Penendo , F. , & Fernandez , M. ( 2004 ). Perceived stress mediates the effects of coping on the quality of life in HIV-positive women on highly active antiretroviral therapy . AIDS and Behavior , 8 , 175 - 183 . doi:10.1023/B:AIBE.0000030248.52063.11.
9. Moskowitz , J. ( 2003 ). Positive affect predicts lower risk of AIDS mortality . Psychosomatic Medicine , 65 , 620 - 626 . doi:10.1097/ 01.PSY.0000073873.74829.23.
10. McIntosh , R. , & Rosselli , M. ( 2012 ). Stress and coping in women living with HIV: A meta-analytic review . AIDS and Behavior , 16 , 2144 - 2159 . doi:10.1007/s10461- 012 - 0166 -5.
11. Kraaij , V. , van der Veek , S. , Garnefski , N. , Schroevers , M. , Witlox , R. , & Maes , S. ( 2008 ). Coping, goal adjustment, and psychological well-being in HIV-infected men who have sex with men . AIDS Patient Care STDS , 22 , 395 - 402 . doi:10.1089/apc. 2007.0145.
12. Cheng , C. , Lau , H. , & Chan , M. ( 2014 ). Coping flexibility and psychological adjustment to stressful life changes: A meta-analytic review . Psychological Bulletin , 140 , 1582 - 1607 . doi:10. 1037/a0037913.
13. Parker , J. , & Endler , N. ( 1992 ). Coping with coping assessment: A critical review . European Journal of Personality , 6 , 321 - 344 . doi:10.1002/per.2410060502.
14. Skinner , E. , Edge , K. , Altman , J. , & Sherwood , H. ( 2003 ). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping . Psychological Bulletin , 129 , 216 - 269 . doi:10.1037/ 0033 - 2909 .129.2. 216 .
15. Kato , T. ( 2013 ). Frequently used coping scales: A meta-analysis . Stress & Health , 31 , 315 - 323 . doi:10.1002/smi.2557.
16. Sandler , I. N. , Wolchik , S. A. , MacKinnon , D. , Ayers , T. S. , & Roosa , M. W. ( 1997 ). Developing linkages between theory and intervention in stress and coping processes . In S. A. Wolchik & I. N. Sandler (Eds.), Handbook of children's coping: Linking theory, research, and intervention (pp. 3 - 40 ). New York : Plenum Press.
17. Anusic , I., Yap , S. C. Y. , & Lucas , R. E. ( 2014 ). Testing set-point theory in a Swiss national sample: Reaction and adaptation to major life events . Social Indicators Research , 119 , 1265 - 1288 . doi:10.1007/s11205- 013 - 0541 -2.
18. Brennan , P. L. , Holland, J. M. , Schutte , K. K. , & Moos , R. H. ( 2012 ). Coping trajectories in later life: A 20-year predictive study . Aging & Mental Health , 16 , 305 - 316 . doi:10.1080/ 13607863.2011.628975.
19. Muthe´n , B. , & Muthe´n, L. K. ( 2000 ). Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes . Alcoholism, Clinical and Experimental Research , 24 , 882 - 891 .
20. Folkman , S. ( 1997 ). Positive psychological states and coping with severe stress . Social Science and Medicine , 45 , 1207 - 1221 . doi:10.1016/S0277-9536(97)00040- 3 .
21. Stanton , A. , Revenson , T. , & Tennen , H. ( 2007 ). Health psychology: Psychological adjustment to chronic disease . Annual Review of Psychology , 58 , 565 - 592 . doi:10.1146/annurev.psych. 58 .110405.085615.
22. Krohne , H. W. ( 1993 ). Vigilance and cognitive avoidance as concepts in coping research . In H. W. Krohne (Ed.), Attention and avoidance: Strategies in coping with aversiveness (pp. 19 - 50 ). Seattle, WA: Hogrefe & Huber.
23. Folkman , S. , & Lazarus , R. S. ( 1980 ). An analysis of coping in a middle-aged community sample . Journal of Health and Social Behavior , 21 , 219 - 239 .
24. Ryff , C. D. ( 1989 ). Happiness is everything, or is it? Explorations on the meaning of psychological well-being . Journal of Personality and Social Psychology , 57 , 1069 - 1081 . doi:10.15557/ a00144210.
25. Seligman , M. E. P. ( 2011 ). Flourish-a new understanding of happiness and well-being-and how to achieve them . London: Nicholas Brealey Publishing.
26. Stiglitz , J. , Sen , A. , & Fitoussi , J. P. ( 2009 ). Report by the commission on the measurement of economic performance and social progress .
27. Dodge , R. , Daly , A. , Huyton , J. , & Sanders , L. ( 2012 ). The challenge of defining wellbeing . International Journal of Wellbeing , 2 , 222 - 235 . doi:10.1166/ 20439 - 3338 - 72 - 40 .
28. Steptoe , A. , Deaton , A. , & Stone , A. ( 2015 ). Subjective wellbeing, health, and ageing . Lancet , 14 , 640 - 648 .
29. Diener , E. ( 2009 ). Subjective well-being . In E. Diener (Ed.), The science of well-being (pp. 11 - 58 ). New York : Springer.
30. Michaelson , J. , Abdallah , S. , Steuer , N. , Thompson , S. , & Marks , N. ( 2009 ). National accounts of well-being: Bringing real wealth onto the balance sheet . London: New Economics Foundation.
31. Diener , E. , Emmons , R. A. , Larsen , R. , & Griffin , S. ( 1985 ). The Satisfaction With Life Scale . Journal of Personality Assesment , 49 , 71 - 75 . doi:10.1207/s15327752jpa4901_13.
32. Fredrickson , B. L. ( 2013 ). Updated thinking on positivity ratios . American Psychologist , 68 , 814 - 822 . doi:10.1037/a0033584.
33. Fredrickson , B. L. ( 2013 ). Updated thinking on positivity ratios . American Psychologist , 68 , 814 - 822 . doi:10.1037/a0033584.
34. Deeks , S. , Lewin , S. , & Havlir , D. ( 2013 ). The end of AIDS: HIV infection as a chronic disease . Lancet . doi:10.1016/S0140- 6736(13)61809- 7 .
35. Samji , H. , Cescon , A. , Hogg , R. , Modur , S. , & Althoff , K. ( 2013 ). Closing the gap: Increases in life expectancy among treated HIVpositive individuals in the United States and Canada . PLoS ONE , 18 , 144 - 156 . doi:10.1371/journal.pone.0081355.
36. Rzeszutek , M. , Oniszczenko , W. , & Firla˛g-Burkacka , E. ( 2012 ). Temperament traits, coping style and trauma symptoms in HIV? men and women . AIDS Care , 24 , 1150 - 1154 . doi:10.1080/ 09540121.2012.687819.
37. Rzeszutek , M. , Oniszczenko , W., Z_ ebrowska, M. , & Firla ˛gBurkacka, E. ( 2015 ). HIV infection duration, social support and the level of trauma symptoms in a sample of HIV-positive Polish individuals . AIDS Care , 27 , 363 - 369 . doi:10.1080/09540121. 2014.963018.
38. Jayarajan , N. , & Prabha , S. ( 2010 ). HIV and mental health: An overview of research from India . Indian Journal of Psychiatry , 16 , 23 - 39 . doi:10.4103/ 0019 - 5545 .69245.
39. Theuninck , A. , Lake , N. , & Gibson , S. ( 2010 ). HIV-related posttraumatic stress disorder: Investigating the traumatic events . AIDS Patient Care and STDs , 24 , 458 - 491 . doi:10.1089/apc. 2009.0231.
40. Bogart , L. , Wagner , G. , Galvan , F. , Landrine , H. , & Klein , D. ( 2011 ). Perceived discrimination and mental health symptoms among black men with HIV. Cultural diversity and ethnic minority . Psychology , 17 , 295 - 302 . doi:10.1037/a0024056.
41. Emlet , C. ( 2006 ). A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS . AIDS Patient Care and STDs , 20 , 350 - 358 . doi:10.1089/apc. 2006.20.350.
42. Pacella , M. , Armelie , A. , Boarts , J. , Wagner , G. , Jones , T. , Feny , N. , et al. ( 2012 ). The impact of prolonged exposure on PTSD symptoms and associated psychopathology in people living with HIV: A randomized test of concept . AIDS and Behavior , 16 , 1327 - 1340 . doi:10.1007/s10461- 011 - 0076 -y.
43. Mekuria , L. , Sprangers , M. , Prins , J. , Alemayehu , W. , & Yalew , P. ( 2015 ). Health-related quality of life of HIV-infected adults receiving combination antiretroviral therapy in Addis Ababa . AIDS Care , 27 , 934 - 945 . doi:10.1080/09540121.2015.1020748.
44. Tsevat , J. , Leonard , A. , Szaflarski , M. , Sherman , S. , & Cotton , S. ( 2009 ). Change in quality of life after being diagnosed with HIV: A multicenter longitudinal study . AIDS Patient Care STDS , 23 , 931 - 937 . doi:10.1089/apc.2009.0026.
45. Degroote , S. , Vogelaers , D. , & Vandijck , D. ( 2014 ). What determines health-related quality of life among people living with HIV: an updated review of the literature . Archives of Public Health , 72 , 40. doi:10.1186/ 2049 - 3258 - 72 - 40 .
46. Logie , C. , & Gadalla , T. ( 2009 ). Meta-analysis of health and demographic correlates of stigma towards people living with HIV . AIDS Care , 21 , 742 - 753 . doi:10.1080/09540120802511 877.
47. Gruszczyn´ ska , E. , & Knoll , N. ( 2015 ). Meaning-focused coping, pain, and affect: A diary study of hospitalized women with rheumatoid arthritis . Quality Of Life Research: An International Journal Of Quality Of Life Aspects Of Treatment, Care & Rehabilitation , 24 , 2873 - 2883 . doi:10.1007/s11136- 015 - 1031 -6.
48. Hobfoll , S. E. ( 2002 ). Social and psychological resources and adaptation . Review of General Psychology , 6 ( 4 ), 307 - 324 . doi:10.1037/ 1089 - 2680 .6.4. 307 .
49. Schuler , M. S. , Leoutsakos , J.-M. S. , & Stuart , E. A. ( 2014 ). Addressing confounding when estimating the effects of latent classes on a distal outcome . Health Services and Outcomes Research Methodology , 14 ( 4 ), 232 - 254 . doi:10.1007/s10742- 014 - 0122 -0.
50. Vermunt , J. K. ( 2010 ). Latent class modelling with covariates: Two improved three-step approaches . Political Analysis , 18 , 450 - 469 .
51. Watson , D. , Clark , L. , & Tellegen , A. ( 1988 ). Development and validation of brief measures of positive and negative affect . The PANAS Scales. Journal of Personality and Social Psychology , 54 , 1063 - 1070 .
52. Carver , C. , & Scheier , M. ( 1994 ). Situational coping and coping dispositions in a stressful transaction . Journal of Personality and Social Psychology , 66 , 184 - 195 .
53. Nolen-Hoeksema , S. , Wisco , B. E. , & Lyubomirsky , S. ( 2008 ). Rethinking rumination . Perspectives on Psychological Science , 3 , 400 - 424 . doi:10.1111/j.1745- 6924 . 2008 .00088.x.
54. Treynor , W., Gonzalez , R. , & Nolen-Hoeksema , S. ( 2003 ). Rumination reconsidered: A psychometric analysis . Cognitive Therapy and Research , 27 , 247 - 259 . doi:10.1023/A:1023910 315561.
55. Endler , N. , Parker , J. , & Summerfeldt , L. ( 1998 ). Coping with health problems: Developing a reliable and valid multidimensional measure . Psychological Assessment , 10 , 195 - 205 . doi:10. 1037/ 1040 - 3590 .10.3. 195 .
56. Lubke , G. H., & Neale , M. C. ( 2006 ). Distinguishing between latent classes and continuous factors: Resolution by maximum likelihood . Multivariate Behavioral Research , 4 , 499 - 532 . doi:10.1207/s15327906mbr4104_4.
57. Tofghi , D. , & Enders , C. K. ( 2007 ). Identifying the correct number of classes in mixture models . In G. R. Hancock & K. M. Samulelsen (Eds.), Advances in latent variable mixture models (pp. 317 - 341 ). Greenwich, CT: Information Age.
58. McLachlan , G. J. , & Peel , D. ( 2000 ). Finite mixture models . New York : Wiley.
59. Hipp , J. R. , & Bauer , D. J. ( 2006 ). Local solutions in the estimation of growth mixture models . Psychological Methods , 11 , 36 - 53 . doi:10.1037/ 1082 -989X.11.1. 36 .
60. Asparouhov , T. , & Muthe´n, B. ( 2014 ). Variable-specific entropy contribution . Retrieved from https://www.statmodel. com/down load/UnivariateEntropy .pdf.
61. Lanza , S. T. , Tan , X. , & Bray , B. C. ( 2013 ). Latent class analysis with distal outcomes: A flexible model-based approach . Structural Equation Modeling , 20 ( 1 ), 1 - 26 . doi:10.1080/10705511. 2013.742377.
62. Vermunt , J. K. , & Magidson , J. ( 2004 ). Latent class analysis . In M. S. Lewis-Beck , A. Bryman , & T. F. Liao (Eds.), The sage encyclopedia of social sciences research methods (pp. 549 - 553 ). Thousand Oaks, CA: Sage Publications.
63. Vermunt , J. K. , & Magidson , J. ( 2016 ). Technical guide for latent GOLD 5 . 1 : Basic, advanced, and syntax. Belmont, MA: Statistical Innovations Inc.
64. Gruszczyn´ ska , E. ( 2013 ). State affect and emotion-focused coping: Examining correlated change and causality . Anxiety, Stress & Coping: An International Journal , 26 , 103 - 119 . doi:10.1080/ 10615806.2011.633601.
65. Pearlin , L. , & Schooler , C. ( 1978 ). The structure of coping . Journal of Health and Social Behavior , 19 , 2 - 21 .
66. Keiser , O. , Spycher , B. , Rauch , A. , Calmy , A. , Cavassini , M. , Glass , T. , et al. ( 2012 ). Outcomes of antiretroviral therapy in the Swiss HIV cohort study: Latent class analysis . AIDS and Behavior , 16 , 244 - 255 . doi:10.1007/s10461- 011 - 9971 -5.
67. Armon , C. , & Lichtenstein , K. ( 2012 ). The associations among coping, nadir CD4 ? T-cell count, and non-HIV-related variables with health-related quality of life among an ambulatory HIV-positive patient population . Quality of Life Research , 21 , 993 - 1003 . doi:10.1007/s11136- 011 - 0017 .
68. Ballester-Arnal , R. , Martınez , S. , Fumaz , C. , Gonza´lez-Garcıa , G. , Remor , E. , & Fuste , M. ( 2016 ). A Spanish study on psychological predictors of quality of life in people with HIV . AIDS and Behavior , 20 , 281 - 291 . doi:10.1007/s10461- 015 - 1208 -6.
69. Preau , M. , Marcellin , F. , Carrieri , M. , Lert , F. , Obadia , Y. , & Spire , B. ( 2007 ). Health-related quality of life in French people living with HIV in 2003: Results from the national ANRS-EN12- VESPA Study . AIDS, 21 , 19 - 27 .
70. Hansen , N. , Vaughan , A. , Cavanaugh , C. , & Connell , C. ( 2009 ). Health-related quality of life in bereaved HIV-positive adults: Relationships between HIV symptoms, grief, social support, and axis II indication . Health Psychology , 28 , 249 - 257 . doi:10.1037/ a0013168.
71. Liu , C. , Ostrow , D. , Detels , R. , Hu , Z. , Johnson , L. , Kingsley , L. , et al. ( 2006 ). Impacts of HIV infection and HAART use on quality of life . Quality of Life Research , 15 , 941 - 949 . doi:10. 1007/s11136- 005 - 5913 -x.
72. Breet , E. , Kagee , A. , & Seedat , S. ( 2014 ). HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: Does social support play a mediating or moderating role ? AIDS Care , 26 , 947 - 951 . doi:10.1080/ 09540121.2014.901486.
73. O'Leary , A. , Jemmott , J. B. , Stevens , R. , et al. ( 2014 ). Optimism and education buffer the effects of syndemic conditions on HIV status among African American Men who have sex with men . AIDS and Behavior , 18 , 2080 - 2088 . doi:10.1007/s10461- 014 - 0708 -0.
74. Simmons , Z. , Bremer , B. , Robbins , R. , Walsh , S. M. , & Fischer , B. ( 2000 ). Quality of life in ALS depends on factors other than strength and physical function . Neurology , 55 , 388 - 392 . doi:10. 1212/WNL.55.3. 388 .
75. Duangdao , K. , & Roesch , S. ( 2008 ). Coping with diabetes in adulthood: A meta-analysis . Journal of Behavioral Medicine , 31 , 291 - 300 . doi:10.1007/s10865- 008 - 9155 -6.
76. Prati , G. , & Pietrantoni , L. ( 2009 ). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis . Journal of Loss and Trauma , 14 , 364 - 368 . doi:10.1080/15325020902724271.
77. Roesch , S. , & Weiner , B. ( 2001 ). A meta-analytic review of coping with illness: Do causal attributions matter ? Journal of Psychosomatic Research , 50 , 205 - 219 . doi:10.1007/ 76 - 007667 .
78. So¨llner , W., Maislinger , S. , DeVries , D. , Steixner , E. , Rumpold , G. , & Lukas , P. ( 2000 ). Use of complementary and alternative medicine by cancer patients is not associated with perceived distress or poor compliance with standard treatment but with active coping behavior . Cancer , 89 , 873 - 880 .
79. Fleishman , J. A. , Sherbourne , C. D. , Cleary , P. D. , Wu , A. W. , Crystal , S. , & Hays , R. D. ( 2003 ). Patterns of coping among persons with HIV infection: Configurations , correlates, and change. American Journal of Community Psychology , 32 , 187 - 204 .
80. Bor , J. , Rosen , S. , Chimbindi , N. , Haber , N. , Herbst , K. , Mutevedzi , T. , et al. ( 2015 ). Mass HIV treatment and sex disparities in life expectancy: Demographic surveillance in rural south Africa . PLOS Medicine . doi:10.1371/journal.pmed.1001905.
81. Ashton , E. , Vosvick , M. , Chesney , M. , Gore-Felton , C. , Koopman , C. , O'Shea , K. , et al. ( 2005 ). Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS . AIDS Patient Care STDS , 19 , 587 - 598 . doi:10.1089/apc.2005.19.587.
82. Gore-Felton , C. , Koopman , C. , Turner-Cobb , J. M. , Duran , R. E. , Israelski , D. , & Spiegel , D. ( 2002 ). The influence of social support, coping, and mood on sexual risk behavior among HIVpositive men and women . Journal of Health Psychology , 7 , 713 - 722 . doi:10.1177/1359105302007006874.