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Vol. 16. Issue 3.
Pages 256-265 (September - December 2016)
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Vol. 16. Issue 3.
Pages 256-265 (September - December 2016)
DOI: 10.1016/j.ijchp.2016.07.001
Open Access
Affectivity as mediator of the relation between optimism and quality of life in men who have sex with men with HIV
Afectividad como mediador de la relación entre optimismo y calidad de vida en hombres que tienen sexo con hombres con VIH
Pablo Vera-Villarroel
Corresponding author

Corresponding author: Escuela de Psicología, Universidad de Santiago de Chile, USACH, Avenida Ecuador 3650, 3° Piso. Santiago de Chile, Chile.
, Arturo Valtierra, Daniela Contreras
Universidad de Santiago de Chile (USACH) and Centro de Innovación en Tecnologías de la Información para Aplicaciones Sociales (CITIAPS), Chile
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Figures (2)
Tables (5)
Table 1. Sample characteristics.
Table 2. Summary of variable correlation evaluated.
Table 3. Mediating effects on overall quality of life.
Table 4. Mediating effects on psychological health.
Table 5. Mediating effects on the environment.
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Background/Objective: Increased life expectancy has made quality of life the primary objective in the care of chronic patients and people living with HIV. It found evidence of the link between optimism, quality of life and well-being. This article aimed to determine whether affectivity in its two dimensions (positive and negative) played a mediating role in the association between optimism and quality of life in men living with HIV. Method: 116 men living with HIV (the average age was 36.8 years (SD=9.06), and the average time from the diagnosis was 8.2 years) responded to three instruments: Life Orientation Test revised version (LOT-R), the Positive and Negative Affect Schedule (PANAS) and the World Health Organization Quality of Life-Bref (WHOQoL-Bref). Results: The results showed that positive affect had no mediating effect, whereas negative affect mediated the relation of optimism with two quality-of-life dimensions (overall quality of life and environment). Conclusion: In conclusion, negative affect was found to participate only partially, acting as a mediating variable.

Positive affect
Negative affect
Quality of life
Ex post facto study

Antecedente/Objetivos: El aumento de la esperanza de vida ha hecho de la calidad de vida (CV) el objetivo fundamental en el cuidado de pacientes crónicos y en personas que viven con VIH. Se ha encontrado evidencia del vínculo entre optimismo, calidad de vida y bienestar. El propósito del presente estudio fue determinar si la afectividad en sus dos dimensiones (positiva y negativa) desempeña un rol mediador en la asociación entre optimismo y calidad de vida en hombres viviendo con VIH que tienen sexo con hombres. Método: Cientodieciséis hombres con VIH (edad promedio fue de 36,8 años; DT = 9,06; tiempo medio desde el diagnóstico de 8,2 años) contestaron tres instrumentos: Life Orientation Test Revised Version (LOT-R), Positive and Negative Affect Schedule (PANAS) y World Health Organization Quality of Life-Bref (WHOQoL-Bref). Resultados: Los resultados mostraron que el afecto positivo no tuvo efecto mediador, mientras el afecto negativo medió la relación entre optimismo y dos dimensiones de la calidad de vida (calidad de vida general y ambiente). Conclusiones: Se encontró que el afecto negativo participa parcialmente como una variable mediadora entre el optimismo y calidad de vida.

Palabras clave:
afecto positivo
afecto negativo
calidad de vida
estudio ex post facto
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Thanks to the current availability of highly active anti-retroviral therapy (HAART), HIV/Aids has been “transformed from a progressive fatal disease to a manageable chronic disease” (Mrus et al., 2006, p. S39). The development of HAART has managed to extend longevity, among others benefits (Harrison, Song, & Zhang, 2010; Nakagawa et al., 2012). This increase in life expectancy has made quality of life (QL) the fundamental aim in the care of chronic patients. The term quality of life is used in numerous contexts and is perceived as a character trait, attitude or response to an emotional stimulus. It is associated with activities that promote health, a positive attitude toward life and satisfaction with life (Mukolo & Wallston, 2012; Szramka-Pawlak et al., 2014). According to WHO guidelines, any reference to QL must include a person's physical and mental state, social relationships, environment, religion, beliefs and opinions, including positive and negative feelings (Kreis et al., 2015).

Research has shown that QL is lower in people living with HIV than with other chronic diseases (Stutterheim et al., 2012). Studies into the behavioral and psycho-social dimensions of the human immunodeficiency virus (HIV) have shown that low levels in a person's QL are the cause of poor outcomes in the prognosis and treatment of the disease (Mukolo & Wallston, 2012). Recent investigations have also referred to a strong link between depressive states and perceived stress in people with HIV and adherence to antiretroviral treatment (ART), commitment to the prevention of infection by HIV and the person'sQL in general (Ballester-Arnal et al., 2016; Mukolo & Wallston, 2012).

At the moment there is a perception that positive thought leads to an improvement in both mental and physical health (Chaves, Vazquez, & Hervas, 2013; Fernandes de Araujo, Teva, & Bermúdez, 2015; López, 2015; Park, Peterson, & Sun, 2013). Studies in the field of psychology have described how some positive emotional capacities in individuals make them better able to adapt to stress factors. Adaptive coping would lead to a sensation of well-being and better perception of QL, whereas mal adaptation would be associated with greater states of distress or depression (Ballester-Arnal et al., 2016; Mukolo & Wallston, 2012).

One of the positive psychological resourcesis optimism, defined as the generalized and stable expectation that one's own life will see good and not bad results (Gázquez Linares, Pérez Fuentes, Mercader Rubio, & Inglés Saura, 2014; Londoño, Velasco, Alejo, Botero, & Vanegas, 2014; Scheier & Carver, 1985; Szramka-Pawlak et al., 2014). Several studies have endeavored to ascertain the relationship between optimism and QL, and an important correlation has been reported (Carver, Scheier, & Segerstrom, 2010; Mannix, Feldman, & Moody, 2009), which may be explained by the expectations or general cognitions of a good prognosis for the future that optimistic people exhibit, which would impact on their perception of QL. In the area of health, most studies have been conducted with people with cancer, epilepsy, hemodialysis and with patients who have had a coronary bypass, and it was observed in all these cases that the people with higher optimism levels have desirable, positive and viable expectations in terms of the prognosis or treatment of their disease, which they continue by extending their efforts to heal, even when this implies a difficult or painful process (Kreis et al., 2015).

There has been less development in studies that assess the relationship between optimism and QL in people who suffer from HIV. These studies have observed mainly a positive link between optimism and QL, where people with an optimistic attitude have a better perception of health and well-being and fewer depressive symptoms (Brydon, Walker, Wawrzyniak, Chart, & Steptoe, 2009; Ironson & Hayward, 2008; Mukolo & Wallston, 2012; Wagner, Hilker, Hepworth, & Wallston, 2010). In theoretical terms, positive psychological attributes, such as optimism, may make it easier to deal with stress factors and minimize the inappropriate behaviors that could affect the course and treatment of a chronic health condition like HIV (Mukolo & Wallston, 2012).

The study of positive and negative affects has also increased in recent years. Watson, Clark and Carey (1988) warned that although these denominations may suggest they are polar opposites of the same dimension, positive affect (PA) and negative affect (NA) are highly distinctive dimensions that can be represented as orthogonal factors. It has been suggested that PA improves health because it has been associated with better health practices and a lower risk of premature death (Dockray & Steptoe, 2010). While negative thought reduces cerebral coordination, hampering thought processes and problem solving (Aubele, Wenck, & Reynolds, 2011). There is considerable evidence that psychological states with a greater presence of NA are related to bad health and a poor adjustment to disease (Morris, Yelin, Panopalis, Julian, & Katz, 2011), including HIV(Mukolo & Wallston, 2012; Schuster, Bornovalova, & Hunt, 2012).

Therefore, affectivity can have negative but also positive effects on health. This combined with the linking of affectivity to cognitive processes could have an influence on the perception of QL (McCabe, Firth, & O¿Connor, 2009; Pérez-San-Gregorio et al., 2012; Vera-Villarroel & Celis-Atenas, 2014). There are studies that have reported a positive correlation between PA and QL in chronic diseases (Mazzoni & Cicognani, 2011; Quiceno & Vinaccia, 2014; Urzúa & Caqueo-Urízar, 2012; Urzúa et al., 2015), as well as a negative correlation between NA and QL in HIV (Mrus et al., 2006; Reis et al., 2011).

But positive and negative affects might also play a mediating role (Vera-Villarroel, Urzúa, Pavez, Celis-Atenas, & Silva, 2012), which has been evaluated in studies that considered optimism as a predictive variable, and health results (Baker, 2007; Lench, 2010; Mera & Ortiz, 2012), stress and self-efficacy (Schönfeld, Brailovskaia, Bieda, Zhang, & Margraf, 2016), happiness, health, and subjective sexual well-being (Contreras, Lillo, & Vera-Villarroel, 2016) or satisfaction with life (Chang, Sanna, & Yang, 2003; Vera-Villarroel & Celis-Atenas, 2014; Vera-Villarroel et al., 2012) as criterion variables among the student population, but not among the diseased population and even less so among patients with HIV. Ammirati, Lamis, Campos and Farber (2015) found that optimism was positively associated with psychological well-being and psychological well-being was negatively associated with the stigma associated with HIV. It has also been found the environmental well-being and mental health are the main predictors of subjective well-being in among people living with HIV (Oberje, Dima, van Hulzen, Prins, & de Bruin, 2015). It also remains to be clarified that both PA and NA, being independent factors, might present differences in their relation to QL, which has usually not been considered in investigations dealing with their impact on health outcomes.

Bearing this in mind, the aim of this study was: (a) to evaluate the existing relation between optimism and QL in people living with HIV; (b) to determine if both PA and NA act as mediators; and (c) to evaluate if there are differences determined by the two types of affect based on their relation with the other variables and on their mediating role.


The sample was non-probabilistic or haphazard. We chose this alternative based on Chile's legal and institutional framework that ensures strict confidentiality, being AIDS a condition that produces discrimination and stigmatization (Ferrer, 2008). Therefore, the researchers only worked with groups and individuals that voluntarily agreed to collaborate in this project. The sample was comprised of 116 men who have sex with men living with HIV belonging to different groups from the city of Santiago, Chile. Table 1 presents the characteristics of the sample. The main data show that the average age was 36.8 years (SD=9.06), and the average time from the diagnosis was 8.2 years (SD= 4.72).

Table 1.

Sample characteristics.

  n  Minimum  Maximum  Mean  SD  Percentage 
Education (years)  112  19  12.02  2.48  – 
Time since diagnosis  111  20  8.23  4.72  – 
Age  113  21  67  36.89  9.05  – 
Job yes  41  –  –  –  –  35.3 
No  75  –  –  –  –  64.7 

  • Adhoc survey of demographic variables. Personal questions regarding age, sexual orientation, education (years), period of infection (years), and job were included.

  • Life Orientation Test Revised Version (LOT-R) (Cano-García et al., 2015; Scheier, Carver, & Bridges, 1994). The LOT-R consists of 10 items, where the participants indicate their level of agreement with each question on a 5-point scale, from “strongly agree” to “strongly disagree”(Scheier, Carver, & Bridges, 2001). It has 4 “filler” items that serve to make less evident the content of the test. Realiability was assessed with a Cronbach's alpha of .51. There is a Chilean validation with a reliability of α= .65, and in terms of the construct validity, the exploratory factor analysis revealed two factors related to two of their dimensions, a model that explained 55.55% of the variance (Vera-Villarroel, Córdova-Rubio, & Celis-Atenas, 2009).

  • Positive and Negative Affect Schedule (PANAS). Created by Watson, Clark and Tellegen (1988), it contains two affectivity dimensions: NA and PA. A validation was conducted in Chile by Dufey and Fernández (2012) in which adequate reliability indices were obtained as well as an adequate internal validity. It consists of 40 adjectives that describe the emotional state, which are assigned a punctuation ranging from 1 (nothing or almost nothing) to 5 (a lot). It comprises two dimensions: Negative affect which is defined as a general factor of subjective distress that includes a wide variety of negative moods, including fear, anxiety, hostility, disgust, loneliness and sadness. The other dimension is Positive affect which refer to pleasant sentiments in relation to the environment. The PANAS is characterized by a high internal consistency, with alphas of .86 to .90 for Positive affect and .84 to .87 for Negative affect, the correlation between the two affections is invariably low, ranging from -0.12 to -0.23. In the present shows a Cronbach's alpha of .71 and .82 for the Positive and Negative Affective respectively was obtained.

  • World Health Organization Quality of Life-Bref (WHOQOL-Bref). Developed by the WHOQoL Group (1996), of its 26 questions, two are general on the overall rating of QL (item 1) and satisfaction with health (item 2). The other 24 questions are a multidimensional rating of QL grouped into four areas that evaluate Physical Health, Psychological Health, Social Relations, and Environment. These studies usually base their analyses on the four domains of the questionnaire; however, some studies have also considered general indicators (Lai, Chen, Chen, Chen, & Wang, 2006). The internal consistency of the scale is α=.98 (The WHOQoL Group, 1996). Urzúa (2008) applied the instrument to the Chilean population, reporting an internal consistency (from .69 to .77).


Several support groups for people living with HIV/Aids were contacted, of which four gave their approval to work with their members. To protect anonymity, the instruments contained only a code instead of a name. Three organizations participated, all of them community based organizations (CBOs). Participants signed an informed consent form in which the purpose of the investigation, procedure and rights were specified. After the form was signed, the participants completed the questionnaires. The study was part of a larger project on wellbeing funded by two government offices (The Chilean Ministry of Education and the National Commission of Science and Technology). As such, it followed the standards of the Chilean scientific research, being approved by the ethics boards of Fondecyt and the Universidad de Santiago de Chile-USACH.

Data analysis

Descriptive analysis. In order to know the behavior of each of the variables: optimism, affection, and quality of life, and demographic variables: age, schooling, years living with illness and employment. This was obtained by computing means and standard deviations of the different scales or using frequencies for the case of qualitative variables like employment.

Correlation Analysis. It was determined whether the expected associations between the variable (as proposed) predictor with the (proposed as) a result, between the variable (as proposed) predictor variables and the (proposed as) mediators met; and among variables (as proposed) and mediating variables (as proposed) result. Also they took into account the demographic variables in order to determine its intervention in the previous results. Measurements were made based on the two types of correlation coefficients: biserial point for employment variable (real dichotomous) and Pearson for the rest of the variables.

Analysis of mediation. The existence of mediation of positive and negative affect was determined independently, in addition to prove the significance. Baron and Kenny (1986) causal steps methodology was used to prove the aforementioned. Three equations using regressions were performed. First, the criteria variable on the predictor to establish that there is an effect to mediate (via c). Second, the mediator on the predictor to establish via a. In the third equation, the variable criteria on both the predictor and the mediator. This provides a test of whether the mediator is related to the approach (via b) and an estimate of the relationship between the predictor and the criterion controlling the mediator (via c’). The method of Kenny, Kashy and Bolger (1998), to test the significance of the mediating effect is as follows: because the difference between the total effect of the predictor on the criterion (via c) and the direct effect of the predictor on the criterion is equal to the product of the way predictor the mediator (via a) and the mediator to the criteria (via b), the significance of the difference between channels can be evaluated by testing the significance of the products of the tracks a and b. Specifically, the product of the routes to a and b is divided by a standard error term. Sobel in 1982 proposed a test of significance for the indirect effect of the independent variable on the dependent via the mediator (z-value = a * b / SQRT (b2 * SA2 + a2 * SB2). The route of the independent variable with the mediator is “a” and its standard error is Sa, the way of the mediator to the dependent is “b” and standard error would Sb the mediating effect divided by its standard error is a z score of the mediating effect. If the z-score is greater than 1.96 the effect is significant at the .05 level.


Relation between optimism, affectivity and QL. In the first analysis, it was observed that optimism was associated significantly with four of the QL sub-scales or indicators: overall quality of life (r=.21, p=.023), overall health (r=.18, p=.045), psychological health (r=.47, p=.000) and environment (r=.51, p=.000); there was no correlation with the rest: physical health (r=.13, p=.143) and social relations(r=.17, p=.061). In a second analysis, the correlations between optimism and the mediating variables were evaluated: PA and NA. The results indicated an association of the predictive variable with the mediators: PA (r=.21, p=.021), and NA (r=-.28, p=.002). A summary of the all the correlations is shown in Table 2.

Table 2.

Summary of variable correlation evaluated.

1 Optimism  –  –  –  –  –  –  –  –  – 
2 Positive affectivity  .21*  –  –  –  –  –  –  –  – 
3 Negative affectivity  −.28**  −.24**  –  –  –  –  –  –  – 
4 Overall quality of life  .21*  .14  .28**  –  –  –  –  –  – 
5 Overall health  .18*  .21*  −.39**  .59**  –  –  –  –  – 
6 Physical health  .13  .19*  −.23**  .25**  .42**  –  –  –  – 
7 Psychological health  .47**  .15  −.17  .26**  .28**  .37**  –  –  – 
8 Social relations  .17  .09  −.09  .03  .23*  .18*  .22*  –  – 
9 Enviroment  .51**  .202*  −.40**  .32**  .32**  .28**  .36**  .39**  – 
10 Education (years)  .013  −.13  .05  .08  −.00  .01  .14  .04  .06 
11 Period of infection  −.03  .16  −.18  .04  .22*  .21*  .09  .07  .15 
12 Age  −.10  .17  −.16  .09  .18*  .00  −.06  −.06  .01 
13 Job  .02  −.06  −.00  .09  .03  −.00  .03  .06  .12 

There were variables that could not be controlled a priori that might influence the analyses. Age and time of infection were controlled in the optimism-overall Health relation; once controlled, this association ceased to be significant (r=.18, p=.065), which is why it remained outside the subsequent analyses.

Affectivity as mediator. Table 3 contains the process with reference to the overall quality of life as a criterion variable following the causal steps proposed by Baron and Kenny (1986). Of the two mediators proposed, only NA satisfied the requirements to be able to determine mediation, there being an association between optimism and overall quality of life (β=.211; p=.023), between optimism and NA (β=-.285; p=.002), and between NA and overall quality of life (β= -.244; p=.010); however, the relation between optimism and overall quality of life when including NA decreased (β from .052 to .035) and even ceased to be significant (p=.133). By contrast, PA fulfilled the first two steps (β=.211; p=.023; β=.214; p=.021), but not the third (β=.104; p=.268).

Table 3.

Mediating effects on overall quality of life.

Mediating effects  SE B  t  ΔR2 
Positive affect
Step 1
Result: Overall quality of life
Predictor: Optimism  .052
Model R2=.044 F (1, 114)=5.28 
.022  2.30*   
Step 2
Result: Positive affect
Predictor: Optimism  .357
Model R2= .046 F (1, 114)=5.48 
.152  2.34*   
Step 3
Result: Overall quality of life
Mediator: Positive affect  .015  .014  1.11   
Predictor: Optimism  .046
Model R2= .055 F (2, 113)=3.26 
.023  2.01*  .011 
Negative affect
Step 1
Result: Overall quality of life
Predictor: Optimism  .052
Model R2=.044 F (1, 114)=5.28 
.022  2.30*   
Step 2
Result: Negative affect
Predictor: Optimism  −.587
Model R2= .081 F (1, 114)= 10.10 
.185  −3.17**   
Step 3
Result: Overall quality of life
Mediator:Negative affect  −.029  .011  −2.62**   
Predictor: Optimism  .035
Model R2= .099 F (2, 113)=6.21 
.023  1.51  .055 




With respect to psychological health as a criterion variable (Table 4), neither PA (β=.053; p=.536) nor NA (β =-.044; p=.612) were potential mediators as they were not associated with the criterion variable.

Table 4.

Mediating effects on psychological health.

Mediating effects  SE B  t  ΔR2 
Positive affect
Step 1
Result: Psychological health
Predictor: Optimism  .511
Model R2=.226 F (1, 114)=33.19 
.089  5.76**   
Step 2
Result: Positive affect
Predictor: Optimism  .357
Model R2= .046 F (1, 114)=5.48 
.152  2.34*   
Step 3
Result: Psychological health
Mediator: Positive affect  .034  .055  .62   
Predictor: Optimism  .499
ModeloR2= .228 F (2, 113)=16.70 
.091  5.48**  .002 
Negative affect
Step 1
Result: Psychological health         
Predictor: Optimism  .511
Model R2=.226 F (1, 114)=33.19 
.089  5.76**   
Step 2
Result: Negative affect
Predictor: Optimism  −.587
Model R2= .081 F (1, 114)=10.10 
.185  −3.17**   
Step 3
Result: Psychological health
Mediator: Negative affect  −.023  .045  −.50   
Predictor: Optimism  .497
Model R2= .227 F (2, 113)=16.62 
.093  5.35**  .001 




Finally, the mediation analyses for the third variable proposed as a criterion (environment) are summarized in Table 5. This time, PA had no mediating role as it did not fulfill step three (β=.097; p=.242), whereas NA fulfilled the mediation requirements. There was an association between optimism and environment (β=.511; p=.000), between optimism and NA (β =-.285; p=.002), between NA and environment (β =-.282; p=.001), and between optimism and environment when adding NA (β=.430; p=.000); however, this association decreased due to this inclusion (ß from .85 to .72).

Table 5.

Mediating effects on the environment.

Mediating effects  SE B  t  ΔR2 
Positive affect
Step 1
Result: Environment
Predictor: Optimism  .855
Model R2=.261 F (1, 114)=40.20 
.135  6.34**   
Step 2
Result: Positive affect
Predictor: Optimism  .357
Model R2= .046 F (1, 114)=5.48 
.152  2.34*   
Step 3
Result: environment
Mediator: Positive affect  .097  .083  1.17   
Predictor: Optimism  .820
Model R2= .270 F (2, 113)=20.86 
.138  5.95**  .009 
Negative affect
Step 1
Result: Environment
Predictor: Optimism  .855
Model R2=.261 F (1, 114)=40.20 
.135  6.34**   
Step 2
Result: Negative affect
Predictor: Optimism  −.587
Model R2= .081 F (1, 114)=10.10 
.185  −3.17**   
Step 3
Result: Environment
Mediator: Negative affect  −.229  .065  −3.51**   
Predictor: Optimism  .720
Model R2= .334 F (2, 113)=28.28 
.134  5.37**  .073 




The results showed the existence of two mediation options (Figures 1 and 2), and in order to determine whether they were significant, a z point score was obtained using Sobel's test. The two options were significant: 1) NA was a significant mediator of the optimism-overall quality of life relation (z=2.02; p=.043), mediating 33.09% of this relation. NA was again a significant mediator, this time of the optimism-environment relation (z=2.35; p=.018), mediating 15.73% of the relation. Causal steps of Baron and Kenny (1986) were followed. In both cases the z scores was superior to 1.96. As the result in the mediation scores was not zero, a partial mediation was assumed.

Figure 1.

Positive affect as mediator of the optimism-quality of life relation.

Figure 2.

Negative affect as mediator of the optimism-quality of life relation.


This study sought to ascertain whether affectivity played a mediating role in the association between optimism and QL. Optimism was associated with the variables proposed as mediators, which is consistent with the literature both in relation to PA (Marshall, Wortman, Kuslas, Hervig, & Vickers, 1992) and NA (Ben-Zur, 2003; Yan & Wong, 2011). Moreover, it was determined that optimism was partially associated with QL (overall quality of life, psychological health and environment).

The lack of correlation between optimism and the other QL dimensions such as overall health and physical health are not consistent with most of the studies that have found a strong association between optimism and health (Rasmussen,Wrosch, Scheier, & Carver, 2006) even with HIV (Ironson & Hayward, 2008). Likewise, the correlation with social relations was not expected, given that such this dimension is very similar to social support, which is known to be associated with optimism (Bastardo & Kimberlin, 2000). Directly related to the aim, it was discovered that PA did not mediate any of the associations of optimism with the QL dimensions, and that NA participated more in mediating the relation between optimism and two of the QL domains (overall quality of life and environment).

What is new is that as far as the mediating role of the affect is concerned, NA alone turned out to be significant, considering that there are studies that have evaluated the two affects, with both being mediators of the optimism-satisfaction with life relation in another type of population (Chang et al., 2003). Possible explanations might refer to Lench (2010), who mentioned that negative emotions seem to be particularly detrimental to mental and physical health. Another reason is the possible involvement of stress, since this variable has been linked to NA but not to PA (Clark & Watson, 1986), and it is also well known that it is common to find stress in chronic diseases (Christensen, Turner, Smith, Holman, & Gregory, 1991) including HIV (Piña, Sánchez-Sosa, Fierros, Ybarra, & Cázeres, 2011). Finally it must be consider that certain positive variables including optimism operates relatively according to the context and sample (McNulty & Finchman, 2012) occasionally resulting in the opposite way.

The results of the present study provide evidence of the need to design intervention programs for patients with HIV (Fernandes de Araujo, Teva, & Bermúdez, 2014) aimed at increasing optimism and reducing NA so as to improve QL. Although optimistic thinking can be difficult to change (Ironson & Hayward, 2008), there are studies that have tried to increase their levels through interventions centered on stress and coping.

The results presented here might support the premise that people sometimes have patterns of negative mental distortions that promote NA and lead the person to stop trying to reach their goals. In this sense, cognitive-behavioral interventions, in addition to promoting an increase in optimism levels, also have an impact on the reduction of NA, which has proven to be effective in people living with HIV compared to control groups (Carrico et al., 2006; Yu et al., 2014).

In addition, the results of this study contribute evidence in the area of clinical practice for the design of customized treatment plans. Specifically our results underscore the importance of optimism in improving QL in people living with HIV, which can be integrated into both individual and group treatments and intervention guidelines. This influence could also be enhanced by intervention at the level of positive and/or negative affects. This evidence reinforces the need to develop and improve emotional cognitive strategies in the management of the related affects in people who live with HIV. Thus, the effects of optimism on well-being and the immune system for which there is already evidence could be boosted even more by explicitly incorporating affects and optimism in quality of life interventions.

This study does have some limitations. First is the reliability index of the instrument used to evaluate optimism (α=.51). This implicate that the internal reliability in this sample is low which was unexpected considering that there is a validation of this test in a Chilean sample, although not in a population with a chronic disease. According with George and Mallery (2003) criteria, it is still acceptable. Future studies should consider to improve this or other instruments to use specifically in populations with chronic diseases.

Second is the sample size, since a larger sample would allow for greater accuracy and evaluation of the results. Another limitation is related to the type of design (cross-section), because in longitudinal designs, optimism has shown variations (see McNulty & Finchman, 2012).

Finally, it must be mentioned that although the primary focus has commonly been the role of NA (Hofer et al., 2005), thereby neglecting the role of PA (Denollet et al., 2008), it would not be advisable to focus solely on PA either, particularly given the results of this study. Both aspects (negative and positive) must be included in order to have the fullest picture of the situation that people are experiencing (Pelechano, González-Leandro, García, & Morán, 2013).

Specifically what this study suggests is the importance of considering positive and negative aspects in the health-disease processes of people with HIV, but at the same time there is a need to analyze and explain how are health-related.


Project FONDECYT Regular N° 1140211.

[Ammirati et al., 2015]
R.J. Ammirati, D.A. Lamis, P.E. Campos, E.W. Farber.
Optimism, well-being, and perceived stigma in individuals living with HIV.
AIDS CARE-Psychological and Socio-Medical aspects of AIDS/HIV, 27 (2015), pp. 926-933
[Aubele et al., 2011]
T. Aubele, S. Wenck, S. Reynolds.
Think Your Way Happiness.
Train Your Brain to Get Happy: The Simple Program That Primes Your Grey Cells for Joy, Optimism, and Serenity, pp. 65-89
[Baker, 2007]
S.R. Baker.
Dispositional optimism and health status, symptoms, and behaviours: Assessing idiothetic relationships using a perspective daily diary approach.
Psychology & Health, 22 (2007), pp. 431-455
[Ballester-Arnal et al., 2016]
R. Ballester-Arnal, S. Gómez-Martínez, C. Fumaz, M. González-García, E. Remor, M.J. Fuster.
A Spanish study on psychological predictors of quality of life in people with HIV.
AIDS and Behavior, 20 (2016), pp. 281-291
[Baron and Kenny, 1986]
R.M. Baron, D.A. Kenny.
The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.
Journal of Personality & Social Psychology, 51 (1986), pp. 1173-1182
[Bastardo and Kimberlin, 2000]
Y.M. Bastardo, C.L. Kimberlin.
Relationship between quality of life, social support and disease related factors in HIV-infected persons in Venezuela.
AIDS Care, 12 (2000), pp. 673-684
[Ben-Zur, 2003]
H. Ben-Zur.
Happy adolescents: The link between subjective well-being, internal resources, parental factors.
Journal of Youth and Adolescence, 32 (2003), pp. 67-79
[Brydon et al., 2009]
L. Brydon, C. Walker, A.J. Wawrzyniak, H. Chart, A. Steptoe.
Dispositional optimism and stress-induced changes in immunity and negative mood.
Brain, Behavior, and Immunity, 23 (2009), pp. 810-816
[Cano-García et al., 2015]
F.J. Cano-García, S. Sanduvete-Chaves, S. Chacón-Moscoso, L. Rodríguez-Franco, J. García-Martínez, M.A. Antuña-Bellerín, J.A. Pérez-Gil.
Factor structure of the Spanish version of the Life Orientation Test-Revised (LOT-R): Testing several models.
International Journal of Clinical and Health Psychology, 15 (2015), pp. 139-148
[Carrico et al., 2006]
A.W. Carrico, G. Ironson, M.H. Antoni, S.C. Lechner, R.E. Durán, M. Kumar, N. Schneiderman.
A path model of the effects of spirituality on depressive symptoms and 24-hurinary-free cortisol in HIV-positive persons.
Journal of Psychosomatic Research, 61 (2006), pp. 51-58
[Carver et al., 2010]
C. Carver, M. Scheier, S. Segerstrom.
Clinical Psychology Review, 30 (2010), pp. 879-889
[Chang et al., 2003]
E.C. Chang, L.J. Sanna, K.M. Yang.
Optimism, pessimism, affectivity, and psychological adjustment in US and Korea: A test of a mediation model.
Personality and Individual Differences, 34 (2003), pp. 1195-1208
[Chaves et al., 2013]
C. Chaves, C. Vazquez, G. Hervas.
Benefit finding and well-being in children with threatening illnesses: An integrative.
Terapia Psicológica, 31 (2013), pp. 59-68
[Christensen et al., 1991]
A.J. Christensen, C.W. Turner, T.W. Smith, J.M. Holman, M.C. Gregory.
Health locus of control and depression in end stage renal disease.
Journal of Consulting and Clinical Psychology, 53 (1991), pp. 419-424
[Clark and Watson, 1986]
Clark, L.A., & Watson, D. (1986, August). Diurnal variation in mood: Interaction with daily events and personality. Paper presented at theme eting of the American Psychological Association, Washington, DC.
[Contreras et al., 2016]
D. Contreras, S. Lillo, P. Vera-Villarroel.
Subjective sexual well-being in Chilean adults: Evaluation of a predictive model.
Journal of Sex & Marital Therapy, (2016), pp. 1-15
[Denollet et al., 2008]
J. Denollet, S.S. Pedersen, J. Daemen, P.T. Jaegere, P.W. de Serruys, R.T. Van Domburg.
Reduced positive affect (anhedonia) predicts major clinical events following implantation of coronary-artery stents.
Journal of Internal Medicine, 263 (2008), pp. 203-211
[Dockray and Steptoe, 2010]
S. Dockray, A. Steptoe.
Positive affect and psychobiological processes.
Neuroscience & Biobehavioral Reviews, 35 (2010), pp. 69-75
[Dufey and Fernández, 2012]
M. Dufey, A.M. Fernández.
Validez y confiabilidad del Positive Affect and Negative Affect Schedule (PANAS) en estudiantes universitarios chilenos.
Revista Iberoamericana de Diagnóstico y Evaluación Psicológica, 34 (2012), pp. 157-173
[Fernandes de Araujo et al., 2014]
L. Fernandes de Araujo, I. Teva, M.P. Bermúdez.
Psychological and socio-demographic variables associated with sexual risk behavior for sexually transmitted infections/HIV.
International Journal of Clinical and Health Psychology, 14 (2014), pp. 120-127
[Fernandes de Araujo et al., 2015]
L. Fernandes de Araujo, I. Teva, M.P. Bermúdez.
Resiliencia en adultos: una revisión teórica.
Terapia Psicológica, 33 (2015), pp. 257-276
[Ferrer, 2008]
Ferrer, M. (2008). VIH/Sida en Chile: una mirada desde las Ciencias Sociales. Reportajes Facultad de Ciencias Sociales, Universidad de Chile. Retrieved http://www.facso.uchile.cl/voz/voz40.html, May 18, 2016.
[Gázquez Linares et al., 2014]
J. Gázquez Linares, M. Pérez Fuentes, I. Mercader Rubio, C. Inglés Saura.
Repercusión del optimismo y de los Cinco Grandes factores de la personalidad sobre la salud de personas mayores.
Universitas Psychologica, 13 (2014), pp. 995-1004
[George and Mallery, 2003]
D. George, P. Mallery.
SPSS for Windows step by step: A Simple Guide and Reference. 11. 0 Update.
4th ed., Allyn & Bacon, (2003),
[Harrison et al., 2010]
K. Harrison, R. Song, X. Zhang.
Life expectancy after HIV diagnosis based on National HIV Surveillance Data from 25 states, United States.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 53 (2010), pp. 124-130
[Hofer et al., 2005]
S. Hofer, W. Benzer, H. Alber, E. Ruttmann, M. Kopp, G. Schüssler, S. Doering.
Determinants of health-related quality of life in coronary artery disease patients: A prospective study generating a structural equation model.
Psychosomatics, 46 (2005), pp. 212-223
[Ironson and Hayward, 2008]
G. Ironson, H. Hayward.
Do positive psychosocial factors predict disease progression in HIV-1?. A review of the evidence.
Psychosomatic Medicine, 70 (2008), pp. 546-554
[Kenny et al., 1998]
D.A. Kenny, D.A. Kashy, N. Bolger.
Data analysis in social psychology.
4th ed., pp. 233-265
[Kreis et al., 2015]
S. Kreis, A. Molto, F. Bailly, S. Dadoun, S. Fabre, C. Rein, C. Hudry, F. Zenasni, S. Rozenberg, E. Pertuiset, B. Fautrel, L. Gossec.
Relationship between optimism and quality of life in patients with two chronic rheumatic diseases: Axial spondyloarthritis and chronic low back pain. A cross sectional study of 288 patients.
Health and Quality of Life Outcomes, 13 (2015), pp. 78
[Lai et al., 2006]
J.N. Lai, H.J. Chen, C.M. Chen, P.C. Chen, J.F. Wang.
Quality of life and climacteric complaints amongst women seeking medical advice in Taiwan: Assessment using the WHOQOL-BREF questionnaire.
Climacteric, 9 (2006), pp. 119-128
[Lench, 2010]
H.C. Lench.
Personality and health outcomes: Making positive expectations a reality.
Journal of Happiness Studies, 12 (2010), pp. 493-507
[Londoño et al., 2014]
C. Londoño, M. Velasco, I. Alejo, P. Botero, J. Vanegas.
¿Qué nos hace optimistas?.: Factores psicosociales predictores al optimismo disposicional en jóvenes.
Terapia Psicológica, 32 (2014), pp. 153-164
[López, 2015]
J.A.P. López.
Un análisis crítico del concepto de resiliencia en psicología.
Anales de Psicología, 31 (2015), pp. 751-758
[Mannix et al., 2009]
M. Mannix, J.M. Feldman, K. Moody.
Optimism and health-related quality of life in adolescents with cancer.
Child: Care, Health and Development, 35 (2009), pp. 482-488
[Marshall et al., 1992]
G.N. Marshall, C.B. Wortman, J.W. Kuslas, L.K. Hervig, R.R. Vickers.
Distinguishing optimism from pessimism: Relations to fundamental dimensions of mood and personality.
Journal of Personality and Social Psychology, 62 (1992), pp. 1067-1074
[Mazzoni and Cicognani, 2011]
D. Mazzoni, E. Cicognani.
Social support and health in patients with systemic lupus erythematosus: A literature review.
Lupus, 20 (2011), pp. 1117-1125
[McCabe et al., 2009]
M.P. McCabe, L. Firth, E. O¿Connor.
Mood and quality of life among people with progressive neurological illnesses.
International Journal of Clinical and Health Psychology, 9 (2009), pp. 21-35
[McNulty and Finchman, 2012]
J.K. McNulty, F.D. Finchman.
Beyond Positive Psychology? Toward a contextual view of psychological processes and well-being.
American Psychologist, 67 (2012), pp. 101-110
[Mera and Ortiz, 2012]
P.C. Mera, M. Ortiz.
La relación del optimismo y las estrategias de afrontamiento con la calidad de vida de mujeres con cáncer de mama.
Terapia Psicológica, 30 (2012), pp. 69-78
[Morris et al., 2011]
A. Morris, E.H. Yelin, P. Panopalis, L. Julian, P.P. Katz.
Long-term patterns of depression and associations with health and function in a panel study of rheumatoid arthritis.
Journal of Health Psychology, 16 (2011), pp. 667-677
[Mukolo and Wallston, 2012]
A. Mukolo, K. Wallston.
The relationship between positive psychological attributes and psychological well-being in persons with HIV/AIDS.
AIDS and Behavior, 16 (2012), pp. 2374-2381
[Mrus et al., 2006]
J.M. Mrus, A.C. Leonard, M.S. Yi, S.N. Sherman, S.L. Fultz, A.C. Justice, J. Tsevat.
Health-related quality of life in veterans and vonveterans with HIV/AIDS.
Journal of General Internal Medicine, 21 (2006), pp. S39-S47
[Nakagawa et al., 2012]
F. Nakagawa, R.K. Lodwick, C.J. Smith, R. Smith, V. Cambiano, J.D. Lundgren, V. Delpech, A.N. Phillips.
Projected life expectancy of people with HIV according to timing of diagnosis.
[Oberje et al., 2015]
E.J. Oberje, A.L. Dima, A.G. van Hulzen, J.M. Prins, M. de Bruin.
Looking beyond health-related quality of life: Predictors of subjective well-being among people living with HIV in the Netherlands.
Aids and Behavior, 19 (2015), pp. 1398-1407
[Park et al., 2013]
N. Park, C. Peterson, J.K. Sun.
La psicología positiva: investigación y aplicaciones.
Terapia Psicológica, 31 (2013), pp. 11-19
[Pelechano et al., 2013]
V. Pelechano, P. González-Leandro, L. García, C. Morán.
Is it possible posible to be too happy? Happiness, personality, and psychopathology.
International Journal of Clinical and Health Psychology, 13 (2013), pp. 18-24
[Pérez-San-Gregorio et al., 2012]
M.A. Pérez-San-Gregorio, A. Martín-Rodríguez, E. Domínguez-Cabello, E. Fernández-Jiménez, M. Borda-Más, A. Bernardos-Rodríguez.
Mental health and quality of life in liver transplant and cirrhotic patients with various etiologies.
International Journal of Clinical and Health Psychology, 12 (2012), pp. 203-218
[Piña et al., 2011]
J.A. Piña, J.J. Sánchez-Sosa, L.E. Fierros, J.L. Ybarra, O. Cázeres.
Variables psicológicas y adhesión en personas con VIH: evaluación en función del tiempo de infección.
Terapia Psicológica, 29 (2011), pp. 149-157
[Quiceno and Vinaccia, 2014]
J.M. Quiceno, S. Vinaccia.
Calidad de vida en adolescentes: análisis desde las fortalezas personales y las emociones negativas.
Terapia Psicológica, 32 (2014), pp. 185-200
[Rasmussen et al., 2006]
H.N. Rasmussen, C. Wrosch, M.F. Scheier, C.S. Carver.
Self-regulation processes and health: The importance of optimism and goal adjustment.
Journal of Personality, 74 (2006), pp. 1721-1748
[Reis et al., 2011]
R.K. Reis, V.J. Haas, C.B. dos Santos, S. Araujo, M.T. Gimenez, E. Gir.
Síntomas de depresión y calidad de vida de personas viviendo con HIV/Sida.
Revista Latino-Americana de Enfermagem, 19 (2011), pp. 1-8
[Scheier and Carver, 1985]
M.F. Scheier, C.S. Carver.
Optimism, coping and health: Assessment and implications of generalized outcome expectancies.
Health Psychology, 4 (1985), pp. 219-247
[Scheier et al., 1994]
M.F. Scheier, C. Carver, M.W. Bridges.
Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test.
Journal of Personality and Social Psychology, 67 (1994), pp. 1063-1078
[Scheier et al., 2001]
M.F. Scheier, C.S. Carver, M.W. Bridges.
Optimism, pessimism and psychological well-being.
Optimism and pessimism: Implications for theory, research, and practice, pp. 31-51
[Schönfeld et al., 2016]
P. Schönfeld, J. Brailovskaia, A. Bieda, X.C. Zhang, J. Margraf.
The effects of daily stress on positive and negative mental health: Mediation through self-efficacy.
International Journal of Clinical and Health Psychology, 16 (2016), pp. 1-10
[Schuster et al., 2012]
R. Schuster, M. Bornovalova, E. Hunt.
The influence of depression on the progression of HIV: Direct and indirect effects.
Behavior Modification, 36 (2012), pp. 123-145
[Sobel, 1982]
M.E. Sobel.
Asymptotic intervals for indirect effects in structural equations models.
pp. 290-312
[Stutterheim et al., 2012]
S.E. Stutterheim, A.E.R. Bos, I. Shiripinda, M. de Bruin, J.B. Pryor, H.P. Schaalma.
HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: Manifestations, consequences and coping.
Psychology & Health, 27 (2012), pp. 395-411
[Szramka-Pawlak et al., 2014]
B. Szramka-Pawlak, A. Dańczak-Pazdrowska, T. Rzepa, A. Szewczyk, A. Sadowska-Przytocka, R. Żaba.
Quality of life and optimism in patients with morphea.
Applied Research Quality Life, 9 (2014), pp. 863-870
[Urzúa, 2008]
A. Urzúa.
Calidad de vida y factores biopsicosociales en patologías médicas crónicas.
Terapia Psicológica, 26 (2008), pp. 207-214
[Urzúa and Caqueo-Urízar, 2012]
A. Urzúa, A. Caqueo-Urízar.
Calidad de vida: una revisión teórica del concepto.
Terapia Psicológica, 30 (2012), pp. 61-71
[Urzúa et al., 2015]
A. Urzúa, M. Vega, A. Jara, S. Trujillo, R. Muñoz, A. Caqueo-Uríza.
Calidad de vida percibida en inmigrantes sudamericanos en el norte de Chile.
Terapia Psicológica, 33 (2015), pp. 139-156
[Vera-Villarroel and Celis-Atenas, 2014]
P. Vera-Villarroel, K. Celis-Atenas.
Afecto positivo y negativo como mediador de la relación optimismo y salud: evaluación de un modelo estructural.
Universitas Psychologica, 13 (2014), pp. 1017-1026
[Vera-Villarroel et al., 2009]
P. Vera-Villarroel, N. Córdova-Rubio, K. Celis-Atenas.
Evaluación del optimismo: un análisis preliminar del Life Orientation Test versión revisada (LOT-R) en población chilena.
Universitas Psychologica, 8 (2009), pp. 61-67
[Vera-Villarroel et al., 2012]
P. Vera-Villarroel, A. Urzúa, P. Pavez, K. Celis-Atenas, J. Silva.
Evaluation of subjective well-being: Analysis of the Satisfaction with Life Scale in the Chilean population.
Universitas Psychologica, 11 (2012), pp. 719-727
[Wagner et al., 2010]
L.J. Wagner, K.A. Hilker, J.T. Hepworth, K.A. Wallston.
Cognitive adaptability as a moderator of expressive writing effects in an HIV sample.
AIDS and Behavior, 14 (2010), pp. 410-420
[Watson et al., 1988a]
D. Watson, L.A. Clark, G. Carey.
Positive and negative affectivity and their relation to anxiety and depressive disorders.
Journal of Abnormal Psychology, 97 (1988), pp. 346-353
[Watson et al., 1988b]
D. Watson, L.A. Clark, A. Tellegen.
Development and validation of brief measures of positive and negative affect: The PANAS scales.
Journal of Personality & Social Psychology, 54 (1988), pp. 1063
[WHOQoL Group, 1996]
WHOQoL Group (1996). WHOQoL-Bref: Introduction, Administration, Scoring, and Generic Version of the Assessment. Geneve: Programme on Mental Health, World Health Organization.
[Yan and Wong, 2011]
C. Yan, W.S. Wong.
The effect of optimism on depression: The mediating and moderating role of insomnia.
Journal of Health Psychology, 16 (2011), pp. 1251-1258
[Yu et al., 2014]
X.N. Yu, J.T.F. Lau, W.W.S. Mak, Y.M. Cheng, Y.H. Lv, J.X. Zhang.
A pilot theory-based intervention to improve resilience, psychosocial well-being, and quality of life among people living with HIV in rural China.
Journal of Sex & Marital Therapy, 40 (2014), pp. 1-16
Copyright © 2016. Asociación Española de Psicología Conductual
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