1. Mental Health Mediates the Relation Between Interpersonal Violence and Physical Health in HIV-Positive Outpatients David W. Pantalone, PhD, Hunter College, City University of New York Danielle M. Hessler, PhD, & Jane M. Simoni, PhD, University of Washington, Seattle Abstract High rates of interpersonal violence (IPV) among HIV+ individuals have been identified in multiple studies. To date, the literature has focused almost exclusively on partner violence (PV) among HIV+ women. Recent studies have begun to emphasize the physical and mental health impact of IPV, study men who have sex with men (MSM), and examine the combined effects of multiple types of IPV. This study contributes data to all three areas. HIV+ MSM (N=175) were recruited from two public, outpatient HIV clinics. Participants answered questions in a cross-sectional, computer assisted self-interview that inquired about multiple forms of IPV (physical, sexual, psychological) throughout the lifespan (childhood, adulthood, PV) and current mental health status (anxiety, depression, PTSD). Physical health status – HIV biomarkers, health care utilization – was extracted from participants’ electronic medical records. Results indicate that: (1) this sample exhibits prevalence similar to analogous studies; (2) at the bivariate level, more frequent physical, sexual, and psychological PV were related to more negative mental and physical health indicators; and (3) our efforts at model testing were reasonably successful. We found support for a mediational hypothesis – violence had a significant, indirect effect on physical health through mental health. No direct effects of violence on physical health were observed in the final model. Providers treating HIV+ MSM should routinely assess for exposure to all types of IPV and may wish to focus treatment on mental health concerns to improve both mental and physical health. Future research should focus on elucidating more clearly the mechanisms of these relations. Goals and Objectives  High rates of partner violence (PV) among HIV+ individuals have been identified in multiple studies.  Recent studies have begun to emphasize the physical and mental health impact of PV, study men who have sex with men (MSM), and examine the combined effects of multiple types of interpersonal violence (IPV) more generally experienced throughout the lifespan. This study contributes novel findings to all three areas.  The primary aims of the study were both applied—to document the relative frequency of different types of IPV as well as notable physical and mental health correlates—and theoretical.  Regarding the latter, a key objective was to use latent structural equation modeling (SEM) techniques to test a mediational model, based on theory and relevant data, exploring the role of mental health in the direct and indirect associations between violence victimization generally (PV, child abuse, adult abuse perpetrated by non-partners) and physical health and functioning (e.g., Resnick et al., 1997). Methods  HIV+ MSM (N=178) were recruited from two public, outpatient HIV clinics for a study on “stress and health” (no mention of IPV).  Eligible patients were active clinic patients, over 18, biologically male at birth, English-speaking, and identified as MSM.  Using a computer assisted self-interview format, participants answered questions about multiple forms of IPV (physical, sexual, psychological) throughout the lifespan (childhood, adulthood, PV) and current mental health status (e.g., anxiety, depression, PTSD) and drug use.  Well-validated measures with established psychometric properties were used when possible.  Indicators of physical health status—HIV biomarkers, health care utilization— were extracted from participants’ electronic medical records.  Participants were paid $20.  Bivariate analyses were run in SPSS 14.0; SEM procedures used Amos 5.0 to test the sample’s conformity to the hypothesized causal model through a standard two-step procedure (e.g., Anderson & Gerbing, 1988). Findings and Conclusions  Complete data were available from 171 participants.  Results indicate that: o (1) this sample exhibits IPV prevalence similar to analogous studies; o (2) participants reported relatively little HIV-specific PV; o (3a) at the bivariate level, more frequent PV was related to more negative mental and physical health indicators; o (3b) more freqent child abuse or adult abuse experiences predicted higher frequency of PV, indicating that revictimization was relatively common; and o (4) our efforts at model testing were reasonably successful.  In the final trimmed model, we found support for a mediational hypothesis.  Specifically, the latent construct PV was related to various health-related outcomes, including CD4 count, viral load, number of ER visits in the previous year, and self-reported physical health quality of life.  These effects were indirect only—the relation was fully mediated by the latent construct of mental health (depression, anxiety, PTSD, negative coping) and the frequency of the participants’ use of club drugs. Implications  Providers treating HIV+ individuals should routinely assess for exposure to all types of IPV as well as mental health and substance use.  Practitioners may wish to focus treatment efforts on mental health concerns— especially mood and anxiety disorders, trauma exposure, and substance use—in an effort to improve both mental and physical health.  Fortunately, evidence-based interventions exist for these disorders, although research efforts likely need to focus attention on dissemination of such treatments.  Future research should focus on more clearly elucidating the mechanisms of these relations. Knowledge about the long-lasting consequences of exposure to violence may motivate the field to focus more on developing violence prevention programs for implementation at the individual, dyadic, family, and community levels. F31 MH71179 Analytic sample (N=171) Sample characteristics:  Mean age 44 years  Mean time since dx 12 years  2% trans  63% White, 18% Black, 13% Latino  89% finished HS, 15% college degree  56% on disability  80% annual income <$18,000  Relationship status 38% currently involved 54% in past year 83% in past 5 years adherence drug use social support.19* Child Abuse sex psych phys.83***.33***.26*.56***.73***.28+.79***.49***.67*** Adult Abuse sexpsych HIV phys.41*** Partner Violence physsexpsych.50***.79***.86*** VL CD4 QOL ER visits.21** -.19** -.19*.27** -.73***.13+ -.26**.42*** Mental Health anx PTSD coping dep.64***.79***.60***.73***.51*** <.10+.05*.01**.001*** age income soc des.24**.23* -.30* -.33*** -.32*** -.22*** -.25*** Trimmed Model Model fit χ 2 [242] = 310.456, p =.002 CFI =.910, RMSEA =.042 Model Theoretical Trimmed Comparison Theoretical vs. Trimmed dfΧ2Χ2 pΧ 2 / dfCFIRMSEA 256.453 310.456 54.001 Χ 2 diffdfp 192 242 52.001.002 ns 1.34 1.28.916.910.046.042 Physical 21% 45% 31% 29% 41% 39% Psych 51% 73% 62% 39% 74% 33% HIV-Spec 8.8% 11.3% 14.4% Sexual 19% 33% 23% 6% 33% 32% Past 1 year Past 5 years Ever Comparison of Measured Rates of PV with Published Rates Assessing Model Fit –Theoretical vs. Trimmed Models