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Li Y, Guo Y, Hong YA, Zhu M, Zeng C, Qiao J, Xu Z, Zhang H, Zeng Y, Cai W, Li L, Liu C. Mechanisms and Effects of a WeChat-Based Intervention on Suicide Among People Living With HIV and Depression: Path Model Analysis of a Randomized Controlled Trial. J Med Internet Res 2019; 21:e14729. [PMID: 31774411 PMCID: PMC6906623 DOI: 10.2196/14729] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/25/2019] [Accepted: 08/31/2019] [Indexed: 01/03/2023] Open
Abstract
Background People living with HIV and depression have high rates of suicide. Studies of mobile health (mHealth) interventions have shown feasibility, acceptability, and efficacy in improving mental health in people living with HIV and depression. However, few studies have examined the mechanisms and effects of mHealth interventions on suicide. Objective This study was designed to examine the mechanisms and effects of a WeChat-based intervention, Run4Love, on suicide among people living with HIV and depression in China, while considering perceived stress and depressive symptoms as mediators. Methods A sample of 300 People living with HIV and depression was recruited from the outpatient clinic of a large HIV or AIDS treatment hospital and was randomized to the Run4Love group or a control group. Data were collected at baseline, 3-, 6-, and 9-month follow-ups. Path analysis modeling, with longitudinal data, was used in data analyses. Results The Run4Love mHealth intervention had a direct effect on reducing suicide rate at the 6-month follow-up (beta=−.18, P=.02) and indirect effect through reducing perceived stress and depressive symptoms at the 3-month follow-up (beta=−.09, P=.001). A partial mediating effect between perceived stress and depressive symptoms accounted for 33% (–0.09/–0.27) of the total effect. Conclusions Through path analyses, we understood the mechanisms and effects of an mHealth intervention on suicide prevention. The findings underscored the importance of stress reduction and depression treatment in such a program. We call for more effective suicide prevention, especially mHealth interventions targeting the vulnerable population of people living with HIV and depression. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showprojen.aspx?proj=21019
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Affiliation(s)
- Yiran Li
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Center for Migrant Health Policy, Guangzhou, China.,Sun Yat-sen Center for Global Health, Institute of State Governance, Guangzhou, China
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Mengting Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jiaying Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhimeng Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hanxi Zhang
- National Center of AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiping Cai
- Department of Infectious Diseases, Eight People's Hospital, Guangzhou, China
| | - Linghua Li
- Department of Infectious Diseases, Eight People's Hospital, Guangzhou, China
| | - Cong Liu
- Department of Infectious Diseases, Eight People's Hospital, Guangzhou, China
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van der Heijden I, Abrahams N, Sinclair D. Psychosocial group interventions to improve psychological well-being in adults living with HIV. Cochrane Database Syst Rev 2017; 3:CD010806. [PMID: 28291302 PMCID: PMC5461871 DOI: 10.1002/14651858.cd010806.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person's well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis. OBJECTIVES To examine the effectiveness of psychosocial group interventions for improving the psychological well-being of adults living with HIV/AIDS. SEARCH METHODS We searched the following electronic databases up to 14 March 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) published in the Cochrane Library (Issue 2, 2016), PubMed (MEDLINE) (1996 to 14 March 2016), Embase (1996 to 14 March 2016), and Clinical Trials.gov. SELECTION CRITERIA Randomized controlled trials (RCTs) or quasi-RCTs that compared psychosocial group interventions with versus control (standard care or brief educational interventions), with at least three months follow-up post-intervention. We included trials that reported measures of depression, anxiety, stress, or coping using standardized scales. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, applied the inclusion criteria, and extracted data. We compared continuous outcomes using mean differences (MD) with 95% confidence intervals (95% CIs), and pooled data using a random-effects model. When the included trials used different measurement scales, we pooled data using standardized mean difference (SMD) values. We reported trials that we could not include in the meta analysis narratively in the text. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 16 trials (19 articles) that enrolled 2520 adults living with HIV. All the interventions were multifaceted and included a mix of psychotherapy, relaxation, group support, and education. The included trials were conducted in the USA (12 trials), Canada (one trial), Switzerland (one trial), Uganda (one trial), and South Africa (one trial), and published between 1996 and 2016. Ten trials recruited men and women, four trials recruited homosexual men, and two trials recruited women only. Interventions were conducted with groups of four to 15 people, for 90 to 135 minutes, every week for up to 12 weeks. All interventions were conducted face-to-face except two, which were delivered by telephone. All were delivered by graduate or postgraduate trained health, psychology, or social care professionals except one that used a lay community health worker and two that used trained mindfulness practitioners.Group-based psychosocial interventions based on cognitive behavioural therapy (CBT) may have a small effect on measures of depression, and this effect may last for up to 15 months after participation in the group sessions (SMD -0.26, 95% CI -0.42 to -0.10; 1139 participants, 10 trials, low certainty evidence). Most trials used the Beck Depression Inventory (BDI), which has a maximum score of 63, and the mean score in the intervention groups was around 1.4 points lower at the end of follow-up. This small benefit was consistent across five trials where participants had a mean depression score in the normal range at baseline, but trials where the mean score was in the depression range at baseline effects were less consistent. Fewer trials reported measures of anxiety, where there may be little or no effect (four trials, 471 participants, low certainty evidence), stress, where there may be little or no effect (five trials, 507 participants, low certainty evidence), and coping (five trials, 697 participants, low certainty evidence).Group-based interventions based on mindfulness have not demonstrated effects on measures of depression (SMD -0.23, 95% CI -0.49 to 0.03; 233 participants, 2 trials, very low certainty evidence), anxiety (SMD -0.16, 95% CI -0.47 to 0.15; 62 participants, 2 trials, very low certainty evidence), or stress (MD -2.02, 95% CI -4.23 to 0.19; 137 participants, 2 trials, very low certainty evidence). No mindfulness based interventions included in the studies had any valid measurements of coping. AUTHORS' CONCLUSIONS Group-based psychosocial interventions may have a small effect on measures of depression, but the clinical importance of this is unclear. More high quality evidence is needed to assess whether group psychosocial intervention improve psychological well-being in HIV positive adults.
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Affiliation(s)
- Ingrid van der Heijden
- Medical Research CouncilGender and Health UnitFrancie van Zijl DriveTygerbergWestern CapeSouth Africa7505
| | - Naeemah Abrahams
- Medical Research CouncilGender and Health UnitFrancie van Zijl DriveTygerbergWestern CapeSouth Africa7505
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
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Tate KA, Rivera ET, Conwill WL, Miller MD, Puig A. Conceptualizing Group Dynamics From Our Clients' Perspective: Development of the Conceptualization of Group Dynamics Inventory. JOURNAL FOR SPECIALISTS IN GROUP WORK 2013. [DOI: 10.1080/01933922.2013.775206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Challenges in addressing depression in HIV research: assessment, cultural context, and methods. AIDS Behav 2011; 15:376-88. [PMID: 21046221 DOI: 10.1007/s10461-010-9836-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Depression is one of the most common co-morbidities of HIV infection. It negatively impacts self-care, quality of life, and biomedical outcomes among people living with HIV (PLWH) and may interfere with their ability to benefit from health promotion interventions. State-of-the-science research among PLWH, therefore, must address depression. To guide researchers, we describe the main diagnostic, screening, and symptom-rating measures of depression, offering suggestions for selecting the most appropriate instrument. We also address cultural considerations in the assessment of depression among PLWH, emphasizing the need to consider measurement equivalence and offering strategies for developing measures that are valid cross-culturally. Finally, acknowledging the high prevalence of depression among PLWH, we provide guidance to researchers on incorporating depression into the theoretical framework of their studies and employing procedures that account for participants with depression.
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Gold SD, Dickstein BD, Marx BP, Lexington JM. Psychological Outcomes Among Lesbian Sexual Assault Survivors: An Examination of the Roles of Internalized Homophobia and Experiential Avoidance. PSYCHOLOGY OF WOMEN QUARTERLY 2009. [DOI: 10.1111/j.1471-6402.2008.01474.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study explored the relations among internalized homophobia (IH), experiential avoidance, and psychological symptom severity in a community sample of 72 lesbian sexual assault survivors. Results indicated that IH is associated with both experiential avoidance and posttraumatic stress disorder (PTSD) symptom severity. In addition, experiential avoidance is related to both PTSD and depression symptom severity. Finally, experiential avoidance completely mediated the relation between IH and PTSD symptom severity. The implications of these findings are discussed and suggestions for future research are provided.
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Affiliation(s)
| | | | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, and Boston University School of Medicine
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Brown JL, Vanable PA. Cognitive-behavioral stress management interventions for persons living with HIV: a review and critique of the literature. Ann Behav Med 2008; 35:26-40. [PMID: 18347902 PMCID: PMC2435192 DOI: 10.1007/s12160-007-9010-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Psychological adjustment and coping are central to human immunodeficiency virus (HIV) management. To improve HIV-infected patients' ability to cope with stress, a variety of stress management interventions have been designed and evaluated. PURPOSE This paper provides a review and critique of the stress management literature, including a: (1) synthesis of core components of interventions for HIV-infected people, (2) summary of stress, coping, psychological, and health outcomes, and (3) methodological critique and guidance for future research. METHODS We reviewed 21 stress management interventions designed for HIV-infected individuals that included both cognitive and behavioral skills training. RESULTS Most studies noted positive changes in perceived stress, depression, anxiety, global psychological functioning, social support, and quality of life. However, results were mixed for coping and health status outcomes, and a majority of studies employed only brief follow-up periods, focused on HIV-infected MSM, and did not address HIV-specific stressors. CONCLUSIONS Stress management interventions for HIV-infected persons are a promising approach to facilitate positive adjustment. However, this literature is limited by measurement problems, research design features, a narrow focus on HIV-infected men who have sex with men, and feasibility concerns for intervention dissemination. Future stress management interventions should address these limitations and the unique psychosocial needs of HIV-infected patients using briefer, more cost-effective formats.
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Affiliation(s)
- Jennifer L. Brown
- Center for Health and Behavior, Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA, e-mail:
| | - Peter A. Vanable
- Center for Health and Behavior, Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, USA, e-mail:
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Gold SD, Marx BP, Lexington JM. Gay male sexual assault survivors: the relations among internalized homophobia, experiential avoidance, and psychological symptom severity. Behav Res Ther 2008; 45:549-62. [PMID: 17258041 DOI: 10.1016/j.brat.2006.05.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Revised: 05/02/2006] [Accepted: 05/09/2006] [Indexed: 10/23/2022]
Abstract
This study explored the relations among internalized homophobia (IH), experiential avoidance, and psychological symptom severity in a community sample of 74 gay male sexual assault survivors. Results indicated that IH is associated with both depressive and posttraumatic stress disorder (PTSD) symptom severity. IH accounted for more variance than assault severity in predicting both PTSD and depression symptom severity. IH and experiential avoidance similarly predicted PTSD symptom severity. In comparison with IH, however, experiential avoidance is a stronger predictor of depression symptom severity. Results also showed that experiential avoidance partially mediated the relation between IH and both depressive and PTSD symptom severity. The implications of these findings are discussed and suggestions for future research are provided.
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Affiliation(s)
- Sari D Gold
- Department of Psychology, Temple University, Weiss Hall, Philadelphia PA 19122, USA.
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Berger-Greenstein JA, Cuevas CA, Brady SM, Trezza G, Richardson MA, Keane TM. Major depression in patients with HIV/AIDS and substance abuse. AIDS Patient Care STDS 2007; 21:942-55. [PMID: 18154491 DOI: 10.1089/apc.2006.0153] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Previous research has been inconsistent in documenting a strong relationship between depression and HIV/AIDS, although a recent meta-analysis of studies examining this issue indicates that rates of depression are modestly higher for this population. For the current study, conducted from 2001-2004, we sought to examine rates and types of depressive symptoms in a cohort of patients receiving HIV care at two urban medical centers. These patients were participants in an intervention study examining adherence and mental health in persons triply diagnosed with psychiatric disorders, substance use disorders, and HIV/AIDS. Nearly three quarters of these participants were people of color, two thirds described their sexual orientation as heterosexual, and the vast majority were unemployed. We sought to examine the relationship of depression to patients' adherence to antiretroviral medication regimens (highly active antiretroviral therapy [HAART]). Results obtained from structured clinical interviews and self-report questionnaires indicated that study participants experienced high rates of depressive symptoms, and that 72.9% of participants met criteria for major depressive disorder (MDD). The results of this study offer a detailed view of the incidence and nature of MDDs and depressive symptoms for an urban sample of substance-abusing adults with HIV/AIDS. Given the degree to which depressive symptoms and MDD appear to be prevalent for this group, as well as the observation that these symptoms are amenable to treatment, future research should focus on identifying helpful strategies and interventions for treating these symptoms, effective ways of providing linkages to care, and ways in which standardized assessment and treatment protocols might be adapted to better suit this population.
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Affiliation(s)
| | - Carlos A. Cuevas
- College of Criminal Justice, Northeastern University, Boston, Massachuetts
| | - Stephen M. Brady
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Glenn Trezza
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Mark A. Richardson
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Terence M. Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
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Rousaud A, Blanch J, Hautzinger M, De Lazzari E, Peri JM, Puig O, Martinez E, Masana G, De Pablo J, Gatell JM. Improvement of psychosocial adjustment to HIV-1 infection through a cognitive-behavioral oriented group psychotherapy program: a pilot study. AIDS Patient Care STDS 2007; 21:212-22. [PMID: 17428189 DOI: 10.1089/apc.2006.0077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study evaluated the efficacy of a group therapy program in improving psychosocial adjustment to HIV infection, and tried to identify variables predictive of greater improvement. The outcome of 47 completing patients was analyzed, comparing the measures between T1 (1 month before therapy), and T2 (first session), and between T2 and T3 (last session) using the Wilcoxon matched-pairs signed-ranks test for each dimension of the Psychosocial Adjustment to Illness Scale (PAIS). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioral group psychotherapy program. During the intervention (between T2 and T3) a significant improvement was observed in health care orientation, vocational environment, domestic environment, sexual relation, extended family relationships, social environment, and total PAIS. There were no changes during baseline (between T1 and T2) in any of the PAIS subscales, or in the total PAIS score. Sexual route of transmission was independently associated with an improvement in health care orientation (beta = 2.525). Time since HIV diagnosis (beta = 0.022) and being employed (beta = 2.548) were independently associated with an improvement in adjustment to vocational environment. Men who have sex with men showed a poorer improvement in adjusting to family relations after the intervention (beta = -2.548). Finally, a lower CD4 count (beta = -0.005) and being employed (beta = 3.054) were independently associated with an improvement in adjustment to social environment. Our psychotherapy program improved psychosocial functioning in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.
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Affiliation(s)
- Araceli Rousaud
- Fundació Clínic per la Recerca Biomèdica-IDIBAPS, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Hospital Clínic de Barcelona, Barcelona, Spain.
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Colibazzi T, Hsu TT, Gilmer WS. Human immunodeficiency virus and depression in primary care: a clinical review. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2006; 8:201-11. [PMID: 16964315 PMCID: PMC1557477 DOI: 10.4088/pcc.v08n0403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 11/07/2005] [Indexed: 10/20/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected individuals are at increased risk of developing depression. Depressive syndromes in these patients pose a challenge both diagnostically and therapeutically. These syndromes reflect both the presence of preexisting mood disorders and the development of depressive syndromes subsequent to HIV infection. DATA SOURCES A search of the literature to 2005 was performed using the PubMed and Ovid search engines. English- and Portuguese-language articles were identified using the following keywords: HIV or AIDS and depression, mental illness, suicide, fatigue, psychiatry, and drug interactions. Additional references were identified through bibliography reviews of relevant articles. DATA SYNTHESIS The clinical presentation and differential diagnosis of depressive symptoms in HIV illness and the role of HIV in the development of these conditions are reviewed. Management issues including suicide assessment and treatment options are then discussed, and potentially important pharmacokinetic interactions are reviewed. CONCLUSIONS Individuals with HIV show higher rates of depression. This phenomenon may be due to a preexisting psychiatric disorder or to the HIV infection. Untreated depression symptoms may lead to non-compliance with drug regimens or increased high-risk behaviors. Given the adverse sequelae of untreated depressions in HIV illness, identification and management of depression are integral components of comprehensive HIV care.
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Affiliation(s)
- Tiziano Colibazzi
- New York State Psychiatric Institute/Columbia University, New York, USA.
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Himelhoch S, Medoff DR. Efficacy of antidepressant medication among HIV-positive individuals with depression: a systematic review and meta-analysis. AIDS Patient Care STDS 2005; 19:813-22. [PMID: 16375613 DOI: 10.1089/apc.2005.19.813] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Depression is highly prevalent among HIV-positive individuals yet some, but not all, have not found antidepressant medication to be efficacious in this population. We performed a systematic review and meta-analysis of double-blinded, randomized controlled trials to examine efficacy of antidepressant treatment among HIV-positive depressed individuals and evaluate whether the results are generalizable to women and minorities. We used PubMed, the Cochrane Database, a search of bibliographies, and consultation with experts to find double-blinded, controlled clinical trials with random assignment to antidepressants or control condition for which HIV-positive patients met standard diagnostic criteria for depression. The principal measure of effect size was the standard difference between means on the Hamilton Depression Score (HDS). We identified 7 studies that included 494 subjects. Three of the 7 studies reported significant antidepressant effects. The pooled effect size from the random effects model was 0.57 (95% confidence interval [CI]: [0.28-0.85]). Heterogeneity across studies was significant (Q, 13.22; p = 0.07; I(2) = 47.1%). When stratified by placebo response, the pooled effect size for placebo response greater than 33% was 0.20 (-0.11-0.52) and not significant while the pooled effect size for placebo response greater than 33% was 0.80 (0.52-1.08) and was significant. Placebo response explained nearly 62% of the variance in effect sizes across studies. Women were nearly absent from and minorities were underrepresented in the studies investigated. Antidepressant medication is efficacious in treating depression among depressed, HIV-positive individuals. However, the underrepresentation of women and minorities limits the generalizability of these findings and suggests that future studies be directed to address this disparity.
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Affiliation(s)
- Seth Himelhoch
- Department of Psychiatry, Divisdion of Services Research, University of Maryland School of Medicine, 737 Lombard Street, Rm. 516, Baltimore, MD 21201, USA.
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Fulk LJ, Kane BE, Phillips KD, Bopp CM, Hand GA. Depression in HIV-infected patients: allopathic, complementary, and alternative treatments. J Psychosom Res 2004; 57:339-51. [PMID: 15518668 DOI: 10.1016/j.jpsychores.2004.02.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Accepted: 02/24/2004] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this review article is to synthesize the current knowledge related to depression and HIV disease. METHODS The research literature was critically evaluated for several selected therapies that are prescribed for HIV-infected persons to treat depression. These therapies included pharmacotherapy, psychotherapy, alternative, and complementary therapies. RESULTS Several therapies are currently available for the treatment of depression in HIV disease. When prescribing treatments, clinicians should be aware of problems associated with diagnoses, drug-drug interactions, and the benefits of some of the new therapies that are now available. Treatment regimes should be carefully designed to meet the individual needs of the patient and will optimally include a combination of approaches including psychotherapy, pharmacotherapy, education, and/or complementary therapies. CONCLUSIONS Although HIV is now a treatable disease, the prevalence of depression in the HIV population remains high and should be continually addressed.
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Affiliation(s)
- L J Fulk
- Department of Exercise Science, University of South Carolina, 1300 Wheat Street, Columbia, SC 29208, USA
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Marcus KS, Kerns RD, Rosenfeld B, Breitbart W. HIV/AIDS-related Pain as a Chronic Pain Condition: Implications of a Biopsychosocial Model for Comprehensive Assessment and Effective Management. PAIN MEDICINE 2000; 1:260-73. [PMID: 15101893 DOI: 10.1046/j.1526-4637.2000.00033.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper reviews the current literature focusing on pain in HIV/AIDS, including prevalence, pathophysiology, substance abuse, treatment issues, and psychosocial contributions. In light of the high prevalence of pain among individuals with HIV/AIDS, attention is paid to the negative psychosocial impacts of pain in this population and to psychosocial barriers to optimal HIV/AIDS-related pain treatment. The paper conceptualizes HIV/AIDS pain as chronic pain. Subsequently, a biopsychosocial model of chronic pain assessment and treatment is applied. A multidimensional framework is presented for appropriate assessment and treatment of HIV/AIDS patients with pain, and specific recommendations and guidelines are offered for assessment and multimodal treatment of HIV/AIDS-related pain informed by the model.
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Affiliation(s)
- K S Marcus
- VA Connecticut Healthcare System, West Haven, CT, USA.
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Abstract
Patients with psychiatric illnesses may be at higher risk for the development of certain medical problems. Those with more severe psychiatric illnesses may encounter barriers to promoting good health and to obtaining good health care when comorbid illnesses do occur. This paper reviews some of the recent literature on health care practices and health system access for the mentally ill; HIV care and its relationship to mental disorders; drug interactions between general medical drugs and psychotropics; and certain medical conditions that appear to co-occur more frequently with psychiatric disorders.
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Affiliation(s)
- L S Goldman
- Department of Psychiatry, University of Chicago, 5841 South Maryland Avenue, MC3077, Chicago, IL 60637, USA.
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