{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:18:17Z","timestamp":1792466297225,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,1,24]]},"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The present study sought to assess the relationship between depressive symptomatology and resilience among women infected with HIV and to investigate whether trauma exposure (childhood trauma, other discrete lifetime traumatic events) or the presence of post-traumatic stress symptomatology mediated this relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Western Cape, South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A convenience sample of 95 women infected with HIV in peri-urban communities in the Western Cape, South Africa. All women had exposure to moderate-to-severe childhood trauma as determined by the Childhood Trauma Questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>We examined the relationship between depressive symptomatology and resilience (the Connor-Davidson Resilience Scale) and investigated whether trauma exposure or the presence of post-traumatic stress symptomatology mediated this relationship through the Sobel test for mediation and PLS path analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was a significant negative correlation between depressive symptomatology and resilience (p=&lt;0.01). PLS path analysis revealed a significant direct effect between depression and resilience. On the Sobel test for mediation, distal (childhood trauma) and proximal traumatic events did not significantly mediate this association (p=&gt;\u20090.05). However, post-traumatic stress symptomatology significantly mediated the relationship between depression and resilience in trauma-exposed women living with HIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the present study, higher levels of resilience were associated with lower levels of self-reported depression. Although causal inferences are not possible, this suggests that in this sample, resilience may act as protective factor against the development of clinical depression. The results also indicate that post-traumatic stress symptoms (PTSS), which are highly prevalent in HIV-infected and trauma\u00a0exposed individuals and often comorbid with depression, may further explain and account for this relationship. Further investigation is required to determine whether early identification and treatment of PTSS in this population may ameliorate the onset and persistence of major depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2013-004200","type":"journal-article","created":{"date-parts":[[2014,2,25]],"date-time":"2014-02-25T14:58:46Z","timestamp":1393340326000},"page":"e004200","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":59,"title":["Depression and resilience in women with HIV and early life stress: does trauma play a mediating role? A cross-sectional study"],"prefix":"10.1136","volume":"4","author":[{"given":"Georgina","family":"Spies","sequence":"first","affiliation":[{"name":"South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soraya","family":"Seedat","sequence":"additional","affiliation":[{"name":"South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa"},{"name":"MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,2,24]]},"reference":[{"key":"2025121509190909000_4.2.e004200.1","unstructured":"UNAIDS. Worldwide HIV & AIDS statistics. http:\/\/www.avert.org\/worldstats.htm (accessed 9 Sep 2013)."},{"key":"2025121509190909000_4.2.e004200.2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/01.aids.0000341778.73038.86","article-title":"Gender-based violence and HIV: relevance for HIV prevention in hyperendemic countries of southern Africa","volume":"22","author":"Andersson","year":"2008","journal-title":"AIDS"},{"key":"2025121509190909000_4.2.e004200.3","first-page":"421","article-title":"Prevalence of emotional, physical and sexual abuse of women in three South African provinces","volume":"91","author":"Jewkes","year":"2001","journal-title":"S Afr Med J"},{"key":"2025121509190909000_4.2.e004200.4","doi-asserted-by":"publisher","DOI":"10.1080\/09540120410331269530"},{"key":"2025121509190909000_4.2.e004200.5","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.27.2.149"},{"key":"2025121509190909000_4.2.e004200.6","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.27.1.4"},{"key":"2025121509190909000_4.2.e004200.7","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.58.8.721"},{"key":"2025121509190909000_4.2.e004200.8","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.158.5.725"},{"key":"2025121509190909000_4.2.e004200.9","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.5.789"},{"key":"2025121509190909000_4.2.e004200.10","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/00002030-199704000-00015","article-title":"Psychopathology in male and female HIV-positive and negative injecting drug users: longitudinal course over 3\u2005years","volume":"11","author":"Rabkin","year":"1997","journal-title":"AIDS"},{"key":"2025121509190909000_4.2.e004200.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(03)00318-4"},{"key":"2025121509190909000_4.2.e004200.12","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2007.0102"},{"key":"2025121509190909000_4.2.e004200.13","first-page":"928","article-title":"Psychopathology and coping in recently diagnosed HIV","volume":"93","author":"Olley","year":"2003","journal-title":"S Afr Med J"},{"key":"2025121509190909000_4.2.e004200.14","doi-asserted-by":"publisher","DOI":"10.1089\/1087291041703700"},{"key":"2025121509190909000_4.2.e004200.15","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1080\/09540120412331319741","article-title":"Post-traumatic stress disorder among recently diagnosed patients with HIV\/AIDS in South Africa","volume":"17","author":"Olley","year":"2005","journal-title":"AIDS Care"},{"key":"2025121509190909000_4.2.e004200.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2006.03.010"},{"key":"2025121509190909000_4.2.e004200.17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-1-30","article-title":"Mental health outcomes in HIV and childhood maltreatment: a systematic review","volume":"1","author":"Spies","year":"2012","journal-title":"Syst Rev"},{"key":"2025121509190909000_4.2.e004200.18","first-page":"1630","article-title":"Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population","volume":"98","author":"Alim","year":"2006","journal-title":"J Natl Med Assoc"},{"key":"2025121509190909000_4.2.e004200.19","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6394(1999)9:4<169::AID-DA4>3.0.CO;2-2"},{"key":"2025121509190909000_4.2.e004200.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2007.02.004"},{"key":"2025121509190909000_4.2.e004200.21","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.104.1.132"},{"key":"2025121509190909000_4.2.e004200.22","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.08m04510"},{"key":"2025121509190909000_4.2.e004200.23","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2008.07121939"},{"key":"2025121509190909000_4.2.e004200.24","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2649"},{"key":"2025121509190909000_4.2.e004200.25","doi-asserted-by":"publisher","DOI":"10.1126\/science.1222942"},{"key":"2025121509190909000_4.2.e004200.26","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3389\/fnbeh.2013.00010","article-title":"Understanding resilience","volume":"7","author":"Wu","year":"2013","journal-title":"Front Behav Neurosci"},{"key":"2025121509190909000_4.2.e004200.27","doi-asserted-by":"publisher","DOI":"10.1002\/da.10113"},{"key":"2025121509190909000_4.2.e004200.28","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1177\/070674370505001206","article-title":"Psychosocial and clinical predictors of symptom persistence vs remission in major depressive disorder","volume":"50","author":"Enns","year":"2005","journal-title":"Can J Psychiatry"},{"key":"2025121509190909000_4.2.e004200.29","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.11020335"},{"key":"2025121509190909000_4.2.e004200.30","doi-asserted-by":"publisher","DOI":"10.1097\/00004850-200501000-00009"},{"key":"2025121509190909000_4.2.e004200.31","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jad.2011.12.026","article-title":"Low trait anxiety, high resilience, and their interaction as possible predictors for treatment response in patients with depression","volume":"137","author":"Min","year":"2012","journal-title":"J Affect Disord"},{"key":"2025121509190909000_4.2.e004200.32","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry"},{"key":"2025121509190909000_4.2.e004200.33","doi-asserted-by":"publisher","DOI":"10.1177\/014662167700100306"},{"key":"2025121509190909000_4.2.e004200.34","doi-asserted-by":"publisher","DOI":"10.1177\/1073191104269954"},{"key":"2025121509190909000_4.2.e004200.35","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291796004229"},{"key":"2025121509190909000_4.2.e004200.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0145-2134(02)00541-0"},{"key":"2025121509190909000_4.2.e004200.37","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"2025121509190909000_4.2.e004200.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2010.04.009"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2013-004200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:19:18Z","timestamp":1765819158000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2013-004200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2014,2,24]]},"published-print":{"date-parts":[[2014,2]]}},"alternative-id":["10.1136\/bmjopen-2013-004200"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2013-004200","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}