Document Type : Research Article


M.A. in Clinical Psychology, Tehran University


The pattern of change in HIV from fatal diseases to chronic diseases due to improvement of treatment made a new challenge for diagnosis and care for the needs of people who live with HIV. This study reviews the role of health hardiness and anxiety on the immune system and quality of life in HIV patients. 125 men with HIV infected through injection participated in this study. They were asked to complete the revised health hardiness inventory, Spielberg state-trait anxiety inventory, and WHOQOL-brief. Data from four times of cd4 experiment with three-month intervals was obtained from the dossier. Data analysis was conducted using Pearson correlation, dependent t-test, multiple regression, and logistic regression. Results of this study show no statistically significant relationship between health hardiness, anxiety, and the immune system. The regression analysis indicates that the total score of quality of life with health hardiness and anxiety was statistically significant (0.0001). Subscales of perceived health (β=0.302), state anxiety (β=-0.305) and trait anxiety (β=-0.449) in equation relative to prediction quality of life were statistically significant (0.0001). Health hardiness and anxiety are not associated with a lowered immune system. The patients with higher anxiety had lower quality of life and those with higher health hardiness had higher quality of life


Main Subjects

Aburuz, M. E. (2018). Anxiety and depression predicted quality of life among patients with heart failure. Multidisciplinary health care dove press, 11, 367-373. [DOI: 10.2147%2FJMDH.S170327]
Alacaciogla, A., Binicier, O., Gungor, O., Oztop, I., Dirioz, M., & Yilmaz, U. (2010). Quality of life, anxiety and depression in Turkish colorectal cancer patients. Support care cancer, 18, 417-421. [DOI: 10.1007/s00520-009-0679-2]
Antoni, M., Cruess, D., Wagner, S., Latgendrof, S., Kumar, M., Ironson, G., Klimas, N., Flitcher, M., & Schneiderman, N. (2000). Cognitive behavioral stress management reduces anxiety and 24-hour urinary catecholamine output among symptomatic HIV-infected gay men. Journal of Consulting and Clinical Psychology, 66: 31-45. [DOI: 10.1007/bf02895165]
Arranze, L., Guayerbas, N., & Dela Fonte, M. (2007). Impairment of several immune functions in anxious women. Journal of Psychosomatic Research, 62(1): 1-8. [DOI: 10.1016/j.jpsychores.2006.07.030]
Asadi Sadeghi Azar, I., Vasudeva, P., Abdollahi, M. (2006). Relationship between quality of life, hardiness, self-efficacy and self-esteem amongst employed and unemployed married women in Zabol. Iranian Journal of Psychiatry, 1: 104-111.
Bahrami, M. Mohamadrizi, S. (2018). Hardiness and optimism in women with breast cancer. Iranian Journal of nursing and midwifery research, 23: 105-110. [DOI: 10.4103%2Fijnmr.IJNMR_200_16]
Bartone, P.Eid, J. Hystad, S. W. (2016). Training hardiness for stress resilience. Military psychology. 1: 231-248. [DOI: 10.4135/9789353885854.n12]
Brenes, G. A. (2007). Anxiety, depression and quality of life in primary care patients. Prim care companion. Journal of Clinical Psychiatry, 9(6), 437-443. [DOI: 10.4088%2Fpcc.v09n0606]
Brown Jr, W. E. H. (2002). A cognitive behavioral intervention to decrease symptoms to depression, anxiety and somatic complaints in adults diagnosed with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). PhD, Dissertation, Carols Albizu University.
Buseh, A. G., Kelber, S. T., Stevense, P. E., & Park, C. G. (2008). Relationships of symptoms, perceived health and stigma with quality of life among urban HIV infected African-American men. Public health nursing, 25(5): 409-419. [DOI: 10.1111/j.1525-1446.2008.00725.x]
Chandra, p. s., Deepthivarma, S., Jairma, K. R., & Thomas, T. (2003). Relationship of psychological morbidity and quality of life to illness related disclosure among HIV-infected persons. Journal of psychosomatic research, 54(3), 199-203. [DOI: 10.1016/s0022-3999(02)00567-6]
Dantzer, R., Cohen, S., Russo, S., Dinan, T. G. (2018). Resilience and immunity. Brain behave immune. 74, 28-42. [DOI: 10.1016/j.bbi.2018.08.010]
Dehdari, T., Heidarnia, A., Ramazankhani, A., Sadeghian, S., Ghofranipour, F., Babaei rouchi, G. (2007). Effects of progressive muscular relaxation training on anxiety level and health related quality of life in anxious patients after coronary artery bypass surgery. Medical Sciences. 17(4), 205-211.
Deribew, A., Tesfaye, M., Hailmichael, Y., Negussu, N., Daba, S., Wogi, A., Belachew, T., Apers, L., & Colebunders, R. (2009). Tuberculosis and HIV co-infection: its impact on quality of life. Health and quality of life outcomes, 7, 105. [DOI: 10.1186/1477-7525-7-105]
Diego, A. M., Field, T., Hernandez, M., Rief, S. K., Friedman, L., & Ironson, G. (2001). HIV adolescent show improved immune function following massage therapy. International Journal of Neuroscience, 106, 35-45. [DOI: 10.3109/00207450109149736]
Dolbier, C. L., Cock, R. R., Leiferman, J. A., Steinhardet, M. A., Schapiro, S. J., Nehete, P. N., Perlman, J. E., & Sastry, J. (2001). Differences in functional immune responces of high vs low hardy healthy individuals. Journal of behavioral medicine, 24(3): 219-229.s In AIDS Care, 10(3), 74-86. [DOI: 10.1023/A:1010762606006]
Farber, E. W., Schwartz, J. A. J., Schaper, P. E., Moonen, D. J., & Mc Daniel, J. S. (2000). Resilience factors associated with adaption to HIV disease. Psychosomatics, 41, 140-146. [DOI: 10.1176/appi.psy.41.2.140]
Gebhardet, W. A., Vander Doef, M. P. & Paul, L. B. (2001). The revised health hardiness inventory (RHHI-24): psychometric properties and relationship with self-reported health and health behavior in two Dutch samples. Health education research, 16, 579-592. [DOI: 10.1093/her/16.5.579]
Hohls, J. K., König H-H, Quirke, E., Hajek, A. (2019). Association between anxiety, depression and quality of life: study protocol for a systematic review of evidence from longitudinal studies. BMJ Open, 9(3), 1-5. [DOI: 10.1136/ bmjopen-2018-027218]
Kawamura, N., Kim, Y., & Asukai, N. (2001). Suppression of cellular immunity in men with a past history of post traumatic stress disorder. American Journal of Psychiatry, 158(3), 484-486. [DOI: 10.1176/appi.ajp.158.3.484]
Khayam Nekoueiz, Z., Yoasefi, A., Khayam Nekouiz, A. R., & Sadeghi, M. (2009). The relation between anxiety and quality of life in heart patients. Arya Atherosclerosis Journal, 5(1), 19-24.
Kobasa, S. C. (1979). Stressful life events, personality and health: An inquiry in to hardiness. Journal of personality and social psychology, 37(1), 1-11. [DOI: 10.1037//0022-3514.37.1.1]
Kowalsk, C. M., Schermer, J. A. (2018). Hardiness, perseverative cognition, anxiety and health related outcomes: a case for and against psychological hardiness. Psychological Report, 122 (6), 2096-2118. [DOI: 10.1177%2F0033294118800444]
Lang, S. S. (2001). Social work, psychoneuroimmunology and HIV/AIDS. An examination of the relationship among health related hardiness, HIV/AIDS, locus of control, stigma, culture and immune function in persons with HIV/AIDS. PhD, Dissertation, University of Denver.
Leaudoin, P. (1992). Living with AIDS, PhD Dissertation, University of Toronto.
Li, S., Wang, Y., Xue, J., Zhao, N., Zhu, T. (2020). The impact of COVID 19 epidemic declaration on psychological consequences' study on active weibo users. Environmental researched and public health article, 17(6), 20-32. [DOI: 10.3390/ijerph17062032]
Locke, S. (1987). Stress adaptation and immunity: studies in human. General hospital psychiatry, 4, 49-58. [DOI: 10.1016/0163-8343(82)90027-5]
Lutgendrof, S. K., Kamkin, D. M., Geest, K. D., Anderson, B., Dao, W., McGinn, S., Zimmerman, B., Maiseri, H., Sood, A. K., & Lubaroff, D.M. (2008). Depressed and anxious mood and T-cell cytokine expressing populations in ovarian cancer patients. Brian, behavior and immunity, 22(6), 890-900. [DOI: 10.1016/j.bbi.2007.12.012]
Mak, W. W. S., Cheuny, R. Y. M., Law, R. W., Woo, J., Li, P. C. K., & Chung, R. W. Y. (2007). Examining attribution model of self-stigma on social support and psychological well-being among people with HIV/AIDS. Social Science & Medicine, 64, 1549-1559. [DOI: 10.1016/j.socscimed.2006.12.003]
Mc Coy, P. A. (2001). Psychological hardiness and biochemical markers of acute stress. PhD, Dissertation, University of North texas.
Morey, J.N., Bogger, I, A., Scott, A, B., Segerstroww, S. C. (2015). Current directions in stress and human immune function. Current opinion in Psychiatry, 5, 13-17 [DOI: 10.1016%2Fj.copsyc.2015.03.007]
Nickolas, P. K., Webster, A. (1993). Hardiness and social support in human immunodeficiency virus. Applied nursing research, 6, 132-136. [DOI: 10.1016/s0897-1897(05)80174-0]
Pandey, D. Srivastava, D. (2015). A comparative study of social support and hardiness among HIV diagnosed men and women. The Asian man, 9, 59-63. [DOI: 10.5958/0975-6884.2015.00008.0]
Pollock, S. E. (1990). Response to learned self-help response to chronic illness experience: a test of three alternative learning theories. Scholarly Inquiry for Nursing Practice: An International Journal, 4(1), 43-45.
Rafie, N. Sharifian, M. Rafiey, H. Behnampour, N. Forozesh, K. (2014). Reliability and validity of Persian version of quality of life. Journal of Mazandaran University of Medical Sciences, 24(116), 25-83.
Renacoba-Puenta, C., Fernandez-De-Las-Penas, C., Gonzalez-Gutierrez, J. C., Miangolarra-Page, J. C., & Pareja, J. A. (2008). Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache. European Journal of Pain, 12, 886-894. [DOI: 10.1016/j.ejpain.2007.12.016]
Rendina, H. J. Wearer, L. Millar, B. M. (2019). Psychosocial well-being and HIV-related immune health outcomes among HIV- positive older adults. Journal of the International Association of Providers of AIDS Care. 18, 1-11. [DOI: 10.1177%2F2325958219888462]
Saevarsdottir, T., Fridriksdottir, N., & Gunnarsdottir, S. (2010). Quality of life and symptom of anxiety and depression of patients receiving cancer chemotherapy: longitudinal study. Cancer Nursing, 33(1), 1-10. [DOI: 10.1097/ncc.0b013e3181b4adb5]
Seiler, A., Fagundes, C. D., Cgristian, L. M. (2019). The Impact of Everyday Stressors on the Immune System and Health. In: Choukèr A. (eds) Stress Challenges and Immunity in Space. Springer, Cham. [DOI: 10.1007/978-3-030-16996-1_6]
Skevington, S. M., Lotfy, M, Q., & O,connel, K. A. (2004). The word health organizations WHOQOL-BREFF quality of life assessment: psychometrics properties and results of the international field trail, A report from the WHOQOL- group. Quality of life research, 13, 299-310. [10.1023/b:qure.0000018486.91360.00]
Spielberger, C. D. (1983). Manual of the state–trait anxiety inventory, Palo Alto, CA: Consulting Psychologist Press.
Sprangers, M. A. G. De Regt, E. B. Andries, F. Van Agt, H. M. E. Bijl, R. V., et. al. (2000). Which chronic conditions are associated with better or poorer quality of life?  Journal of Clinical Epidemiology. 53(9), 895-907. [DOI: 10.1016/s0895-4356(00)00204-3]
Sttine, T. W., Chapman, D. P., Kobau,R., Balluz, L.,& Mokdad, A. H. (2004). Depression, anxiety and physical impairments and quality of life in the U.S. noninstitutionalized population. Psychiatric services, 55(12), 1408-1413. [DOI: 10.1176/]
Thornton, L. M., Andersen, B. L., Crespin T, R., & Carson, W. E. (2007). Individual trajectories in stress covary with immunity during recovery from cancer diagnosis and treatments. Brain, Behavior, and Immunity, 21, 185-194. [DOI: 10.1016/j.bbi.2006.06.007]
Thu Vu, G. tran, B. X. hoang, C.H. hall, B. J. (2020). Global research on quality of life of patients with HIV/AIDS: is if socio culturally addressed. International Journal of Environmental Research and Public Health, 17(6), 21-27. [DOI: 10.3390/ijerph17062127]
Torshabi, M. (2007). Comparison of health hardiness, characteristics in chronic patients and normal people and evaluation of psychometric characteristics of health hardiness inventory (RHHI_24), Master’s theses, Tehran University.
Vetter, C. J. (2009). Living long term with HIV/AIDS: An examination of health status, quality of life and employment concerns. PhD, Dissertation, University of New York.
Whetsell, M. (2006). Quality of life and spirituality: the elderly in Mexico and the U.K. The 17th international nursing research congress focusing on evidence based practice.
Zhao, L., Chan, K., Leung, K. F., Liu, F., Fung, J., & Lang, J. (2006). Reliability and validity of the Chinese quality of life instrument. Focus on Alternative and Complementary Therapies, 9(1), 62.
Zimple, R., Fleck, M. P. (2007). Quality of life in HIV positive Brazilian: Application and validation of the WHOQOL-HIV, Brazilian version. AIDS care, 19(7), 923-930. [DOI: 10.1080/09540120701213765]