Health Psychology 1996, Vol. 15, No. 6,485-493 Copyright 1996 by the American Psychological Association, Inc. 0278-6133/96/$3.00 Causal Attributions Predict Rate of Immune Decline in HIV-Seropositive Gay Men Suzanne C. Segerstrom, Shelley E. Taylor, Margaret E. Kemeny, Geoffrey M. Reed, and Barbara R. Visscher University of California, Los Angeles Research has suggested that attributions—the perceived causes of events—may affect psychological and physical health and the immune system. The authors hypothesized that attributions reflecting negative beliefs about the self, the future, and control would affect helper T cell (CD4) decline and onset of AIDS in individuals with HIV, either directly or through associations with psychological states such as depression. HIV+ gay men (N = 86) participated in a structured interview from which causal attributions were extracted and coded. Attributing negative events to aspects of the self significantly predicted faster CD4 decline over 18 months following the interview, controlling for potential psychological, behavioral, social, and health mediators such as depression and health behavior. However, attributions did not predict AIDS diagnosis during the study period. The results support the idea that causal attributions related to beliefs about the self may have an influence on the immune system. Key words: attributions, self, HIV, immune decline There has been increasing interest in the possibility that psychological factors could function as cofactors in the progression of HIV infection through their impact on the immune system (Kemeny, 1994). In mis study, we examined the role of causal beliefs, or attributions, on immune decline in HIV-seropositive gay men. Our focus on attributions as potential cofactors in HIV was derived from attribution theory (Abramson, Metalsky, & Alloy, 1989; Abramson, Seligman, & Teasdale, 1978; Weiner, 1986), which suggests that perceived causes of events have implications for both psychological adjustment and physical health (Peterson & Seligman, 1987). The impact of any given attribution is thought to be determined by its characteristics on three Suzanne C. Segerstrom and Shelley E. Taylor, Department of Psychology, University of California, Los Angeles; Margaret E. Kemeny, Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Geoffrey M. Reed, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; Barbara R. Visscher, Department of Epidemiology, University of California, Los Angeles. This research was supported by funding from the National Institute of Mental Health (NIMH; Grant MH42918) and the National Institute of Allergy and Infectious Diseases (Grant N01A172631), as well as NIMH Training Grant MH15750 and NIMH Research Scientist Development Awards MH00311 and MH00820. We thank Paul Chamberlain, Donte Henry, Cynthia Y. Ho, Elizabeth Kelly, Leticia Keusayan, Julie Regan, and Holly Wilson for their time and diligence in attribution coding and Wei-Ling Joanie Chung for her assistance in coordinating and managing data. Correspondence concerning this article should be addressed to Suzanne C. Segerstrom, Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90095. dimensions. The first dimension assesses the attribution's implications for the self (self or nonself as cause; the internal dimension). For example, attributing an event to "something I did" (internal) would have different implica- tions for the self than would attributing an event to "the bad weather" (external). The second dimension assesses implica- tions for the future (a stable, lasting or transitory, brief cause; the generality dimension). For example, an attribution to "my personality" (general) would have different implica- tions for the future than would an attribution to "my mood" (specific). The third dimension assesses control (a control- lable or uncontrollable cause; the controllability dimen- sion). An attribution to "something I did" (controllable), as opposed to "fate" (uncontrollable), would affect one's sense of the controllability of events. The tendency to attribute negative events to the self, to stable factors, and to uncontrollable factors is known as pessimistic attributional style and is thought to result in a number of negative psychological phenomena, including low self-esteem, helplessness, hopelessness, and depression (Abramson et al., 1978, 1989; Sweeney, Anderson, & Bailey, 1986). In addition, a number of studies have linked pessimistic attributions and pessimistic attributional style to compromised physical health. Increased probability of ill- ness and disease has been shown to be associated with pessimistic attributional style in Harvard University gradu- ates from the classes of 1942-1944, members of the baseball Hall of Fame, and college students (Peterson, 1988; Peterson & Seligman, 1987; Peterson, Seligman, & Valliant, 1988). Follow-up periods in these studies ranged from 1 year to more than 50 years. In addition, pessimistic attributional style has been shown to be associated cross-sectionally with lower helper to suppressor T cell ratios and T cell responsive- ness in elderly adults after controlling for depression and 485 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.