Spiritual transformation, psychological well-being, health, and survival in people with HIV

Gail Ironson, Heidemarie Kremer

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Objectives: Although Spiritual Transformation (ST) occurs in a sizable proportion of people with HIV (about 39%), there is little research on the potential benefits of ST with respect to psychological well-being, health, and survival in this population. Our study attempts to fill this gap. Method: Using a mixed method approach, we related interviews of 147 people with HIV (identifying the presence/absence of ST) to questionnaires measuring demographics, medical history, treatment adherence, physical symptoms, and psychological well-being (i.e., stress, coping, life attitude, and spirituality), and assessments of CD4-counts and viral load and survival 3 to 5 years later. Results: At comparable times since HIV-diagnosis and antiretroviral medications prescribed, the presence of ST was significantly associated with better treatment success (undetectable viral loads, higher CD4 counts), better medication adherence, fewer symptoms, less distress, more positive coping, different life attitudes (i.e., existential transcendence, meaning/purpose in life, optimism, death acceptance), more spiritual practices, and increased spirituality. ST was also associated with substance-use recovery and with being African American. Survival up to 5 years was 5.35 times more likely among participants with ST (pf = .044). According to a Cox-regression adjusted for baseline CD4-counts, age, race-ethnicity, gender, education, years since HIV-diagnosis, and a history of substance-use problems, ST still reduced the risk of death (HR = 0.07, 95% CI = 0.01-0.53, p = .010). Conclusions: ST has associated benefits for psychological well-being, health, and survival.

Original languageEnglish (US)
Pages (from-to)263-281
Number of pages19
JournalInternational Journal of Psychiatry in Medicine
Issue number3
StatePublished - Jan 1 2009


  • Attitude
  • Coping
  • Depression
  • Spiritual transformation
  • Spirituality
  • Stress
  • Survival

ASJC Scopus subject areas

  • Psychiatry and Mental health


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