The resilience-distress paradox in HIV: latent profiles reveal that resilience compensates for low mindfulness.

Abstract

Background: People living with HIV (PLWH) face elevated risks for anxiety and depression, yet not all develop clinically significant distress-a phenomenon we term the resilience-distress paradox, whereby individuals with high psychological resilience (the capacity to adapt positively to adversity) nonetheless experience severe distress. Drawing on a person-centered approach, this study identified distinct psychological adaptation profiles based on mindfulness, resilience, anxiety, and depression, and examined their associations with quality of life, social support, and sociodemographics.

Methods: A cross-sectional survey of 403 people living with HIV (mean age 35.5 years; 86.1% male) was conducted. Latent profile analysis (LPA) was based on the Mindful Attention Awareness Scale, the Brief Resilience Scale, the GAD-7, and the PHQ-9. Analysis of variance and chi-square tests examined profile differences in quality of life, social support, and clinical variables; hierarchical regressions tested the mindfulness × resilience interaction on distress.

Results: Three profiles emerged: Well-Adapted (52.4%), Moderate (39.7%), and Distressed (7.9%). Mindfulness showed a strict gradient across profiles (all p <0.001), whereas resilience did not differ between the Moderate and Distressed profiles (p = 0.073, d = 0.44). Quality of life followed the same gradient. Perceived social support was higher in the Well-Adapted than in the Moderate profile, but neither profile differed significantly from the Distressed profile. Sexual orientation distribution also differed across profiles: heterosexual individuals were significantly underrepresented and homosexual individuals significantly overrepresented in the Distressed profile, whereas identity-uncertain individuals showed only a non-significant trend toward overrepresentation.

Conclusion: PLWH exhibit substantial heterogeneity in psychological adaptation. Interaction analyses revealed that resilience buffered anxiety and depression at all levels of mindfulness, with the strongest protection where mindfulness was lowest. This compensatory pattern, rather than a threshold effect, suggests that resilience can partially substitute for limited mindfulness, whereas the absence of both resources creates the greatest vulnerability. These findings support stratified interventions tailored to individuals' resource profiles.