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Stanton AM, Hornstein BD, Musinguzi N, Dolotina B, Orrell C, Amanyire G, Asiimwe S, Cross A, Psaros C, Bangsberg D, Hahn JA, Haberer JE, Matthews LT. Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda. J Int Assoc Provid AIDS Care 2023; 22:23259582231161029. [PMID: 36945860 PMCID: PMC10034296 DOI: 10.1177/23259582231161029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Identifying factors associated with alcohol use changes during pregnancy is important for developing interventions for people with HIV (PWH). Pregnant PWH (n = 202) initiating antiretroviral therapy in Uganda and South Africa completed two assessments, 6 months apart (T1, T2). Categories were derived based on AUDIT-C scores: "no use" (AUDIT-C = 0 at T1 and T2), "new use" (AUDIT-C = 0 at T1, >0 at T2), "quit" (AUDIT-C > 0 at T1, =0 at T2), and "continued use" (AUDIT-C > 0, T1 and T2). Factors associated with these categories were assessed. Most participants had "no use" (68%), followed by "continued use" (12%), "quit" (11%), and "new use" (9%). Cohabitating with a partner was associated with lower relative risk of "continued use." Borderline significant associations between food insecurity and higher risk of "new use" and between stigma and reduced likelihood of "quitting" also emerged. Alcohol use interventions that address partnership, food security, and stigma could benefit pregnant and postpartum PWH.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychological and Brain Sciences, 1846Boston University, Boston, USA
- 446213The Fenway Institute, Boston, USA
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, USA
| | - Benjamin D Hornstein
- Department of Medicine, 9967University of Alabama at Birmingham, Birmingham, USA
| | - Nicholas Musinguzi
- Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda
- 108123Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brett Dolotina
- Department of Epidemiology, 33638Mailman School of Public Health, Columbia University, New York, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gideon Amanyire
- Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda
- 560159Africa Health Research Institute, Durban, South Africa
| | - Stephen Asiimwe
- Global Health Collaborative, Mbarara, Uganda
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | - Anna Cross
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christina Psaros
- Department of Psychiatry, 2348Massachusetts General Hospital, Boston, USA
- 1811Harvard Medical School, Boston, USA
| | - David Bangsberg
- School of Public Health, Oregon Health and Science University/Portland State, Portland, USA
| | - Judith A Hahn
- Department of Medicine, 8785University of California San Francisco, San Francisco, USA
| | - Jessica E Haberer
- 1811Harvard Medical School, Boston, USA
- Center for Global Health, 2348Massachusetts General Hospital, Boston, USA
| | - Lynn T Matthews
- Department of Medicine, 9967University of Alabama at Birmingham, Birmingham, USA
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2
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Whitsett MP, Goswami Banerjee A, Serper M. Assessment of mental health in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2022; 20:52-56. [PMID: 36033429 PMCID: PMC9405502 DOI: 10.1002/cld.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
| | | | - Marina Serper
- Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Mutumba M, Woolf-King S, Carrico AW, Emenyonu NI, Fatch R, Kekibiina A, Muyindike W, Hahn JA. Correlates and Effects of Alcohol Use Expectancies Among Persons Living with HIV in Uganda. AIDS Behav 2022; 26:1110-1125. [PMID: 34599420 DOI: 10.1007/s10461-021-03465-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
Unhealthy alcohol use fuels difficulties with HIV disease management and potentiates secondary transmission of HIV but less is known about how these alcohol use expectancies may shape alcohol use behaviors, particularly in the presence of depressive symptomatology. In this paper, we utilize data from a prospective study of 208 people living with HIV in Southwest Uganda, to examine the correlates of alcohol use expectancies and their association with unhealthy alcohol use. Affective depressive symptoms were positively associated with alcohol use expectancies. Gender moderation was observed such that depression was more strongly associated with alcohol use expectancies among women. In unadjusted analyses, alcohol use expectancies were marginally associated with unhealthy alcohol use and this association was not significant in adjusted analyses. Findings underscore the need to strengthen screening for depression and alcohol use within HIV care services, particularly among women.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA. .,Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA.
| | - Sarah Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Adam W Carrico
- Department of Public Health Sciences and Psychology, University of Miami, Coral Gables, FL, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Allen Kekibiina
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, CA, USA
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Araujo RA, Amaral S, Tolentino A, Zeballos D, Montaño I, Souza LS, Lins-Kusterer L, Brites C. Low Quality of Life, Falls, and Pre-Frailty are Associated with Depressive Symptoms in Virologically Suppressed PLWHIV in Salvador, Brazil. AIDS Behav 2022; 26:397-406. [PMID: 34312738 DOI: 10.1007/s10461-021-03393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
Depression is the leading cause of years lived with disability worldwide and PLWHIV present a higher risk of developing depressive symptoms. We aimed to evaluate depressive symptoms and their predictors in virologically suppressed PLWHIV. We conducted a cross-sectional study with 200 PLWHIV. Depressive symptoms were defined as scoring ≥ 14 points in the Beck Depression Inventory II. Most of the participants (58.5%) were men, with a median age of 54 years (IQR: 46.25-59.00). Depressive symptoms' prevalence was 19.5% and they were associated with being divorced/widowed (aOR: 2.93, CI 95%: 1.17-7.37), recurrent falls (aOR: 4.24, CI 95%: 1.07-16.85), pre-frailty (aOR: 3.55, CI 95%: 1.47-8.57), and lower scores in all HRQoL dimensions. Although virologically suppressed PLWHIV presented lower prevalence of depressive symptoms than reported in previous studies in Brazil and South America, they were associated with falls and frailty, highlighting the need for screening.
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Affiliation(s)
- Rafael Antonius Araujo
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Dr. Augusto Viana Street, Salvador, BA, 40.110-060, Brazil
| | - Sávio Amaral
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
- Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil.
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Dr. Augusto Viana Street, Salvador, BA, 40.110-060, Brazil.
| | - Arthur Tolentino
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Dr. Augusto Viana Street, Salvador, BA, 40.110-060, Brazil
| | - Diana Zeballos
- Programa de Pós-graduação em Saúde Coletiva (PPgSC), Universidade Federal da Bahia, Salvador, Brazil
| | - Iris Montaño
- Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Dr. Augusto Viana Street, Salvador, BA, 40.110-060, Brazil
| | - Lucca S Souza
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Liliane Lins-Kusterer
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Dr. Augusto Viana Street, Salvador, BA, 40.110-060, Brazil
| | - Carlos Brites
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Dr. Augusto Viana Street, Salvador, BA, 40.110-060, Brazil
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Andersen LS, Joska JA, Magidson JF, O'Cleirigh C, Lee JS, Kagee A, Witten JA, Safren SA. Detecting Depression in People Living with HIV in South Africa: The Factor Structure and Convergent Validity of the South African Depression Scale (SADS). AIDS Behav 2020; 24:2282-2289. [PMID: 31965430 PMCID: PMC8021389 DOI: 10.1007/s10461-020-02787-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Screening measures for depression developed in high-income countries have not always demonstrated strong psychometric properties in South Africa and with people living with HIV (PLWH). The present study explored the psychometric properties of the 16-item South African Depression Scale (SADS) comprised of idioms of distress specific to isiXhosa culture in PLWH. The SADS was administered to 137 Xhosa-speaking PLWH who met diagnostic criteria for major depressive disorder (MDD) together with the Hamilton Depression Scale (HAM-D) and the Center for Epidemiological Studies Depression Scale (CES-D). We conducted exploratory factor analysis, correlation, and reliability statistics. Four factors of the SADS emerged: Sadness, lethargy/burdened, anhedonia/withdrawal, and cognitive/somatic. All factors correlated significantly with the HAM-D and CES-D. Internal consistency of the overall measure was high (α = .89). The SADS promises to be a robust measure of depression in isiXhosa-speaking PLWH in South Africa likely due to the inclusion of local idioms of distress.
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Affiliation(s)
- L S Andersen
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - J A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J F Magidson
- Department of Psychology, University of Maryland, College Park, MA, USA
| | - C O'Cleirigh
- Behavioral Medicine Service, Massachusetts General Hospital/Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - J S Lee
- Department of Psychology, University of Miami, Florida, USA
| | - A Kagee
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - J A Witten
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S A Safren
- Department of Psychology, University of Miami, Florida, USA
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Raggio GA, Psaros C, Fatch R, Goodman G, Matthews LT, Magidson JF, Amanyire G, Cross A, Asiimwe S, Hahn JA, Haberer JE. High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda. J Acquir Immune Defic Syndr 2019; 82:443-451. [PMID: 31567551 PMCID: PMC6857734 DOI: 10.1097/qai.0000000000002156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions. METHODS Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive). RESULTS Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23-29], median gestational age was 20 weeks [interquartile range: 16-26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045). CONCLUSIONS Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.
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Affiliation(s)
- Greer A. Raggio
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- National Center for Weight and Wellness, Washington, DC
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lynn T. Matthews
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Anna Cross
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa;
| | - Stephen Asiimwe
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; and
- Kabwohe Clinical Research Center, Kabwohe, Uganda.
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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7
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Finkelstein-Fox L, Park CL, Kalichman SC. Health benefits of positive reappraisal coping among people living with HIV/AIDS: A systematic review. Health Psychol Rev 2019; 14:394-426. [PMID: 31284849 DOI: 10.1080/17437199.2019.1641424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
People living with HIV/AIDS (PLWHA) often face significant stress, ranging from perceiving identity changes to encountering barriers to daily health behavior engagement. To manage these experiences, many people use positive reappraisal coping (including benefit finding and perceiving growth). Effective coping is highly important for PLWHA; stress reduction has salutary effects on multiple indicators of health. The present systematic review, conducted in PubMed, PsycINFO, and CINAHL, synthesises findings from 33 studies of PLWHA, addressing effects of positive reappraisal on health-related outcomes for adults living with HIV as a chronic illness. Studies were evaluated based on methodological considerations, measurement of key variables, and implications for specific aspects of health. Results suggest that positive reappraisal is often beneficial when dealing with the implications of a potentially traumatic HIV diagnosis on one's identity, although effects may be contextually bound. Implications of these findings are reviewed, emphasizing the importance of positive reappraisal for enhancing health promotion and self-management of HIV. Although the present review is limited by inclusion of multiple disparate outcomes and exclusion of non-English-language articles, these findings inform a comprehensive model of direct and indirect effects of positive reappraisal on emotional, functional, physiological, and behavioural aspects of health useful for guiding future research.
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Affiliation(s)
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
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Reliability, Validity, and Factor Structure of the Hopkins Symptom Checklist-25: Population-Based Study of Persons Living with HIV in Rural Uganda. AIDS Behav 2018; 22:1467-1474. [PMID: 28667469 DOI: 10.1007/s10461-017-1843-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Depression and anxiety are highly comorbid among people living with HIV (PLHIV), but few instruments for screening or measurement have been validated for use in sub-Saharan Africa. The objective of this study was to determine the reliability, validity, and factor structure of the 25-item Hopkins Symptom Checklist (HSCL) in a population-based sample of PLHIV in rural Uganda. This study was nested within an ongoing population-based cohort of all residents living in Nyakabare Parish, Mbarara District, Uganda. All participants who identified as HIV-positive by self-report were included in this analysis. We performed parallel analysis on the scale items and estimated the internal consistency of the identified sub-scales using ordinal alpha. To assess construct validity we correlated the sub-scales with related constructs, including subjective well being (happiness), food insecurity, and health status. Of 1814 eligible adults in the population, 158 (8.7%) self-reported being HIV positive. The mean age was 41 years, and 68% were women. Mean HSCL-25 scores were higher among women compared with men (1.71 vs. 1.44; t = 3.6, P < 0.001). Parallel analysis revealed a three-factor structure that explained 83% of the variance: depression (7 items), anxiety (5 items), and somatic symptoms (7 items). The ordinal alpha statistics for the sub-scales ranged from 0.83 to 0.91. Depending on the sub-scale, between 27 and 41% of the sample met criteria for caseness. Strong evidence of construct validity was shown in the estimated correlations between sub-scale scores and happiness, food insecurity, and self-reported overall health. The HSCL-25 is a reliable and valid measure of mental health among PLHIV in rural Uganda. In cultural contexts where somatic complaints are commonly elicited when screening for symptoms of depression, it may be undesirable to exclude somatic items from depression symptom checklists administered to PLHIV.
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Ironson G, Fitch C, Stuetzle R. Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education. Psychosom Med 2017; 79:749-756. [PMID: 28498278 PMCID: PMC8233157 DOI: 10.1097/psy.0000000000000488] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The prevalence of clinically significant depressive symptoms is three times higher in people living with HIV than in the general population. Although studies have shown that depression predicts worse course with HIV, few have investigated its relationship with mortality, and none have had a 17-year follow-up period and been conducted entirely during the time since the advent of protease inhibitors. METHODS We followed a diverse sample of HIV-positive people (N = 177) in the mid-range of illness for a study on stress and coping. Participants were assessed every 6 months (for 12 years) via blood draw, questionnaires, and interview. Depression was measured using the Beck Depression Inventory. The study began in March 1997 and mortality was assessed in April 2014. RESULTS In the primary analysis depression, analyzed as a continuous variable, significantly predicted all-cause mortality (hazard ratio = 1.038, 95% confidence interval = 1.008-1.068). With Beck Depression Inventory scores dichotomized, the hazard ratio was 2.044 (95% confidence interval = 1.176-3.550). Furthermore, this result was moderated by race and educational attainment such that depression only predicted worse survival for non-African Americans and those with a college education or higher. CONCLUSION Depression is associated with worse long-term survival in people with HIV during 17 years of follow-up. Interventions targeting depression may improve well-being and potentially survival in individuals with HIV. However, since depression did not predict survival in African Americans or those with low education, more research is needed to identify risk factors for long term outcomes in these groups.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL
- Department of Psychiatry, University of Miami, Miami, FL
| | - Calvin Fitch
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Rick Stuetzle
- Department of Psychology, University of Miami, Coral Gables, FL
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10
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Fatch R, Emenyonu NI, Muyindike W, Kekibiina A, Woolf-King S, Hahn JA. Alcohol Interactive Toxicity Beliefs and ART Non-adherence Among HIV-Infected Current Drinkers in Mbarara, Uganda. AIDS Behav 2017; 21:1812-1824. [PMID: 27198557 DOI: 10.1007/s10461-016-1429-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapy (ART) may influence ART adherence. HIV-infected patients in Uganda completed quarterly visits for 1 year, or one visit at 6 months, depending on study randomization. Past month ART non-adherence was less than daily or <100 % on a visual analog scale. Participants were asked if people who take alcohol should stop taking their medications (belief) and whether they occasionally stopped taking their medications in anticipation of drinking (behavior). Visits with self-reported alcohol use and ART use for ≥30 days were included. We used logistic regression to examine correlates of the interactive toxicity belief and behavior, and to determine associations with ART non-adherence. 134 participants contributed 258 study visits. The toxicity belief was endorsed at 24 %, the behavior at 15 %, and any non-adherence at 35 % of visits. In multivariable analysis, the odds of non-adherence were higher for those endorsing the toxicity behavior [adjusted odds ratio (AOR) 2.06; 95 % confidence interval (CI) 0.97-4.36] but not the toxicity belief (AOR 0.63; 95 % CI 0.32-1.26). Clear messaging about maintaining adherence, even if drinking, could benefit patients.
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Affiliation(s)
- Robin Fatch
- Department of Medicine, University of California San Francisco, Box 1224, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Nneka I Emenyonu
- Department of Medicine, University of California San Francisco, Box 1224, 550 16th Street, San Francisco, CA, 94158, USA
| | - Winnie Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Allen Kekibiina
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sarah Woolf-King
- Department of Medicine, University of California San Francisco, Box 1224, 550 16th Street, San Francisco, CA, 94158, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, Box 1224, 550 16th Street, San Francisco, CA, 94158, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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11
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Millar BM, Starks TJ, Gurung S, Parsons JT. The Impact of Comorbidities, Depression, and Substance Use Problems on Quality of Life Among Older Adults Living With HIV. AIDS Behav 2017; 21:1684-1690. [PMID: 27864625 DOI: 10.1007/s10461-016-1613-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Older adults living with HIV (OALWH) comprise a growing population with a range of complex and interconnecting medical and psychosocial needs. Based on the biopsychosocial model with its emphasis on a holistic approach to various aspects of people's lives, the current study explored associations between physical health, psychological health, substance use, and overall quality of life. Drawing on data from 114 substance-using OALWH (aged 50 or older), we employed linear regression to show associations between the number of current comorbid health conditions on quality of life, over and above depression, substance use problems, and demographic characteristics (age, race/ethnicity, gender, sexual orientation, education, and relationship status). In both bivariate and multivariable contexts, the number of comorbid conditions was associated with reduced quality of life. Depression and substance use were also negatively associated with quality of life. These findings indicate that clinical and supportive care for OALWH, particularly when related to mental health and substance use, should also include an integrated focus on the comparatively high number of current comorbid conditions that often accompany, and potentially complicate, HIV treatment and quality of life.
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Affiliation(s)
- Brett M Millar
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center, CUNY, New York, NY, USA
| | - Tyrel J Starks
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center, CUNY, New York, NY, USA
- Department of Psychology, Hunter College, CUNY, 695 Park Ave., New York, NY, 10065, USA
| | - Sitaji Gurung
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, USA.
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center, CUNY, New York, NY, USA.
- Department of Psychology, Hunter College, CUNY, 695 Park Ave., New York, NY, 10065, USA.
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12
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Phillips KD, Sowell RL, Rojas M, Tavakoli A, Fulk LJ, Hand GA. Physiological and Psychological Correlates of Fatigue in HIV Disease. Biol Res Nurs 2016; 6:59-74. [PMID: 15186708 DOI: 10.1177/1099800404264846] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper’s integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson’s r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.
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Affiliation(s)
- Kenneth D Phillips
- College of Nursing, University of South Carolina, 1601 Green Street, Columbia, SC 29208, USA.
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Sweeney SM, Vanable PA. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature. AIDS Behav 2016; 20:29-50. [PMID: 26303196 DOI: 10.1007/s10461-015-1164-1] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.
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Affiliation(s)
- Shannon M Sweeney
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA.
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244-2340, USA.
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Sweeney SM, Mitzel LD, Vanable PA. Impact of HIV-related stigma on medication adherence among persons living with HIV. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abler L, Sikkema KJ, Watt MH, Hansen NB, Wilson PA, Kochman A. Depression and HIV Serostatus Disclosure to Sexual Partners Among Newly HIV-Diagnosed Men Who Have Sex with Men. AIDS Patient Care STDS 2015; 29:550-8. [PMID: 26430721 DOI: 10.1089/apc.2015.0122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV disclosure to sexual partners facilitates joint decision-making and risk reduction strategies for safer sex behaviors, but disclosure may be impacted by depression symptoms. Disclosure is also associated with disclosure self-efficacy, which in turn may also be influenced by depressive symptoms. This study examined the relationship between depression and HIV disclosure to partners following diagnosis among men who have sex with men (MSM), mediated by disclosure self-efficacy. Newly HIV-diagnosed MSM (n=92) who reported sexual activity after diagnosis completed an assessment soon after diagnosis which measured depressive symptoms, and another assessment within 3 months of diagnosis that measured disclosure self-efficacy and disclosure. Over one-third of the sample reported elevated depressive symptoms soon after diagnosis and equal proportions (one-third each) disclosed to none, some, or all partners in the 3 months after diagnosis. Depressive symptoms were negatively associated with disclosure self-efficacy and disclosure to partners, while disclosure self-efficacy was positively associated with disclosure. Disclosure self-efficacy partially mediated the relationship between depression and disclosure, accounting for 33% of the total effect. These findings highlight the importance of addressing depression that follows diagnosis to enhance subsequent disclosure to sexual partners.
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Affiliation(s)
- Laurie Abler
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Melissa H. Watt
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Nathan B. Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, Georgia
| | - Patrick A. Wilson
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York
| | - Arlene Kochman
- Duke Global Health Institute, Duke University, Durham, North Carolina
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Food Insecurity is Longitudinally Associated with Depressive Symptoms Among Homeless and Marginally-Housed Individuals Living with HIV. AIDS Behav 2015; 19:1527-34. [PMID: 25351185 DOI: 10.1007/s10461-014-0922-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Depression and food insecurity are prevalent among people with HIV (PLHIV) and contribute to poor HIV outcomes. Longitudinal data can help clarify the effect of food insecurity on depression among PLHIV in the United States. We assessed the longitudinal association of food insecurity with symptoms of depression using validated measures among participants living with HIV from the Research on Access to Care in the Homeless cohort in San Francisco. We followed 346 participants for a median of 28 months. Over half of participants (55.0 %) were food insecure and 35.8 % had symptoms of depression. In adjusted models, severe food insecurity in the previous period was associated with increased depressive symptom severity (b = 1.22; p < 0.001). The association remained statistically significant in models including participant fixed effects. Severe food insecurity was also longitudinally associated with a binary variable indicating probable depression. Efforts to increase access to and participation in food security safety net programs for PLHIV could improve depression.
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Lovejoy TI, Heckman TG. Depression moderates treatment efficacy of an HIV secondary-prevention intervention for HIV-positive late middle-age and older adults. Behav Med 2015; 40:124-33. [PMID: 25090365 DOI: 10.1080/08964289.2014.893982] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
An estimated one-third of HIV-positive older adults continues to engage in sexual behaviors that risk HIV transmission or the acquisition of other sexually transmitted infections. A recently completed pilot randomized controlled trial of telephone-administered motivational interviewing (Tele-MI) targeting sexual risk behavior in 100 HIV-positive late middle-age and older adults found that a four-session Tele-MI intervention reduced episodes of non-condom-protected anal and vaginal intercourse. This secondary analysis examined the moderating effect of baseline depressive symptoms on intervention efficacy. When compared to one session of Tele-MI or standard of care, four sessions of Tele-MI produced greater reductions in sexual risk behavior in participants with subsyndromal depression at baseline but was no more efficacious than the other two conditions for participants with no or elevated baseline depressive symptoms. Large-scale studies that further elucidate the role of depression in sexual risk reduction interventions for HIV-positive persons are needed.
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Affiliation(s)
- Travis I Lovejoy
- a Portland VA Medical Center and Oregon Health & Science University
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Takada S, Weiser SD, Kumbakumba E, Muzoora C, Martin JN, Hunt PW, Haberer JE, Kawuma A, Bangsberg DR, Tsai AC. The dynamic relationship between social support and HIV-related stigma in rural Uganda. Ann Behav Med 2015; 48:26-37. [PMID: 24500077 DOI: 10.1007/s12160-013-9576-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support. PURPOSE The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma. METHODS We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma. RESULTS Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations. CONCLUSIONS Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.
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Affiliation(s)
- Sae Takada
- Harvard Medical School, Boston, MA, USA,
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Psaros C, Haberer JE, Boum Y, Tsai AC, Martin JN, Hunt PW, Bangsberg DR, Safren SA. The factor structure and presentation of depression among HIV-positive adults in Uganda. AIDS Behav 2015; 19:27-33. [PMID: 24854877 DOI: 10.1007/s10461-014-0796-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is one of the most prevalent psychiatric comorbidities of HIV and one of the greatest barriers to HIV self-care and adherence. Despite this, little consensus exists on how to best measure depression among people living with HIV/AIDS (PLWHA) in African settings. Measurement of depression among PLWHA may be confounded by somatic symptoms. Some research recommends excluding these items to enhance measurement validity; sensitivity may be lost with this approach. We sought to characterize depression among a cohort (N = 453) of PLWHA initiating antiretroviral therapy in Uganda via factor analysis of a widely used measure of depression, the Hopkins Symptom Checklist (HSCLD). Common factor analysis was performed, associations between HSCLD and the Mental Health subscale of the Medical Outcomes Study HIV (MOS-HIV) estimated, and a Cronbach's alpha calculated to examine validity. Factor analysis yielded two factors: (1) somatic-cognitive symptoms and (2) behavioral disengagement. Persons with more versus less advanced disease (CD4 cell count of ≤200 cells/mm(3)) showed no statistically significant differences in depression scores (1.7 vs. 1.7, P ≥ 0.5). Both factors were significantly associated with the MOS-HIV (P < .01). Factor one was highly reliable (α = .81); factor two had only modest reliability (α = .65). Somatic-cognitive symptoms of depression and disengagement from life's activities appear to be distinct components of depression in this sample. Consideration of somatic items may be valuable in identifying depression in this setting.
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20
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Tsai AC. Reliability and validity of depression assessment among persons with HIV in sub-Saharan Africa: systematic review and meta-analysis. J Acquir Immune Defic Syndr 2014; 66:503-11. [PMID: 24853307 PMCID: PMC4096047 DOI: 10.1097/qai.0000000000000210] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the reliability and validity of instruments used to screen for major depressive disorder or assess depression symptom severity among persons with HIV in sub-Saharan Africa. DESIGN Systematic review and meta-analysis. METHODS A systematic evidence search protocol was applied to 7 bibliographic databases. Studies examining the reliability and/or validity of depression assessment tools were selected for inclusion if they were based on the data collected from HIV-positive adults in any African member state of the United Nations. A random-effects meta-analysis was used to calculate pooled estimates of depression prevalence. In a subgroup of studies of criterion-related validity, the bivariate random-effects model was used to calculate pooled estimates of sensitivity and specificity. RESULTS Of 1117 records initially identified, I included 13 studies of 5373 persons with HIV in 7 sub-Saharan African countries. Reported estimates of Cronbach alpha ranged from 0.63 to 0.95, and analyses of internal structure generally confirmed the existence of a depression-like construct accounting for a substantial portion of variance. The pooled prevalence of probable depression was 29.5% [95% confidence interval (CI): 20.5 to 39.4], whereas the pooled prevalence of major depressive disorder was 13.9% (95% CI: 9.7 to 18.6). The Center for Epidemiologic Studies Depression scale was the most frequently studied instrument, with a pooled sensitivity of 0.82 (95% CI: 0.73 to 0.87) for detecting major depressive disorder. CONCLUSIONS Depression-screening instruments yielded relatively high false positive rates. Overall, few studies described the reliability and/or validity of depression instruments in sub-Saharan Africa.
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Affiliation(s)
- Alexander C. Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, United States
- MGH Center for Global Health, Boston, United States
- Harvard Medical School, Boston, United States
- Mbarara University of Science and Technology, Mbarara, Uganda
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Aljassem K, Raboud JM, Hart TA, Benoit A, Su D, Margolese SL, Rourke SB, Rueda S, Burchell A, Cairney J, Shuper P, Loutfy MR. Gender Differences in Severity and Correlates of Depression Symptoms in People Living with HIV in Ontario, Canada. ACTA ACUST UNITED AC 2014; 15:23-35. [DOI: 10.1177/2325957414536228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the differences in severity and correlates of depression symptoms among 1069 men and 267 women living with HIV in Ontario, Canada, who completed the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Women had higher CES-D scores than that of men (median [interquartile range]: 13 [5-26] versus 9 [3-20], P = .0004). More women had total CES-D scores >15 (mild-moderate depression; 44% versus 33%, P = .002) and >21 (severe depression; 31% versus 23%, P = .003). Unlike men, at age 40, women’s scores increased yearly (0.4 per increased year, P = .005). The distribution of scores differed by gender: There was no difference in the 10th percentile of depression scores, 0 (95% confidence interval [CI]: 1.0-1.0) but the 75th percentile of depression scores for women was 6 (95% CI: 2.0-10.0) points higher than that of men. Important gender differences exist in depression symptoms and in correlates of symptoms in people living with HIV.
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Affiliation(s)
- Kinda Aljassem
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Janet M. Raboud
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A. Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto Ontario, Canada
| | - Anita Benoit
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - DeSheng Su
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shari L. Margolese
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Sean B. Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Sergio Rueda
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, St. Michaels Hospital, Toronto, Ontario, Canada
| | - Ann Burchell
- Department of Psychology, Ryerson University, Toronto Ontario, Canada
| | - John Cairney
- Department of Family Medicine and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Paul Shuper
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Mona R. Loutfy
- Department of Medicine, University of Toronto, Toronto, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Gold JA, Grill M, Peterson J, Pilcher C, Lee E, Hecht FM, Fuchs D, Yiannoutsos CT, Price RW, Robertson K, Spudich S. Longitudinal characterization of depression and mood states beginning in primary HIV infection. AIDS Behav 2014; 18:1124-32. [PMID: 24385231 DOI: 10.1007/s10461-013-0688-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Though depression is known to frequently afflict those with chronic HIV, mood during the early course of HIV is not well characterized. In a prospective study we assessed mood during primary HIV infection [primary HIV infection (PHI), <1 year duration], its association with neuropsychological performance and markers of neurological disease, and its longitudinal course including effects of antiretroviral therapy (ART). The Beck Depression Inventory (BDI) and Profile of Mood States (POMS) subscales were longitudinally administered prior to and after ART in PHI subjects. This evaluation of mood was done concurrently with blood, cerebrospinal fluid (CSF) and neuropsychological [total z and global deficit score (GDS)] evaluation at each visit. Analysis employed Spearman's rho, logistic regression, and linear mixed models. 47.7 % of the 65 men recruited at a median 3.5 months HIV duration met BDI criteria for clinical depression at baseline, classified as 'mild' (n = 11), 'moderate' (n = 11), or 'severe' (n = 9). Drug, alcohol, and depression history did not associate with BDI score. Proportional somatic-performance scores were worse than cognitive-affective scores (p = .0045). Vigor subscore of POMS was reduced compared to norms and correlated with total z (r = 0.33, p = 0.013) and GDS (r = -0.32, p = 0.016). BDI and POMS correlated with one another (r = 0.85, p < .0001), but not with CSF or plasma HIV RNA, WBC, albumin ratio or neopterin. Improvement was not observed in BDI and POMS over 330 total follow-up visits, even after initiation of ART. Depression was prevalent during PHI in our subjects, associated with abnormal somatic-performance and vigor scores. Neither neuropsychological performance nor disease biomarkers correlated with depressed mood. Mood indices did not improve over time in the presence of ART.
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Affiliation(s)
- Jessica A Gold
- Department of Neurology, Yale University School of Medicine, 300 George Street, Room 8300c, New Haven, CT, USA,
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Martinez P, Tsai AC, Muzoora C, Kembabazi A, Weiser SD, Huang Y, Haberer JE, Martin JN, Bangsberg DR, Hunt PW. Reversal of the Kynurenine pathway of tryptophan catabolism may improve depression in ART-treated HIV-infected Ugandans. J Acquir Immune Defic Syndr 2014; 65:456-62. [PMID: 24220289 PMCID: PMC3943704 DOI: 10.1097/qai.0000000000000062] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Major depressive disorder is highly prevalent among HIV-infected persons, and depression symptom severity improves during the course of HIV antiretroviral therapy (ART). The potential biologic pathways explaining these phenomena remain unclear. We investigated the extent to which ART-mediated suppression of the kynurenine pathway of tryptophan catabolism (via indoleamine 2,3-dioxygenase-1 and potentially other sources) may correlate with improvements in depression symptom severity in this setting. METHOD We used the first year of data from the Uganda AIDS Rural Treatment Outcomes Study, a prospective cohort of 504 HIV-infected individuals initiating their first ART regimen in rural Uganda. We fitted random-effects regression models to estimate the associations between plasma tryptophan, plasma kynurenine, dietary diversity, and self-reported depression symptom severity. RESULTS Greater depressive symptoms were associated with both lower plasma tryptophan and higher plasma kynurenine/tryptophan (KT) ratio over 12-month follow-up. In multivariable-adjusted models, declines in KT ratio and increases in plasma tryptophan levels partially explained ART-mediated improvements in depressive symptom severity. The association between KT ratio and depression symptom severity was stronger among persons with protein-deficient diets than among those with protein-rich diets. CONCLUSIONS Indoleamine 2,3-dioxygenase-1-mediated tryptophan catabolism may contribute to depression symptom severity among HIV-infected individuals, particularly among those with poor dietary protein intake. ART-mediated improvements in depressive symptom severity may also be at least partially mediated by immunologic mechanisms. Interventions to reduce immune activation, and dietary protein supplementation, may be promising strategies to further reduce depression in this setting.
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Affiliation(s)
- Priscilla Martinez
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
- Alcohol Research Group, School of Public Health, University of California, Berkeley, CA, USA
| | - Alexander C. Tsai
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
- Chester M. Pierce MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Annet Kembabazi
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Yong Huang
- University of California at San Francisco, CA, USA
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Jeffrey N. Martin
- University of California at San Francisco, CA, USA
- Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, CA, USA
| | - David R. Bangsberg
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard School of Public Health
- Ragon Institute of Massachusetts General Hospital, MIT and Harvard, Boston, MA, USA
| | - Peter W. Hunt
- University of California at San Francisco, CA, USA
- Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, CA, USA
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Palfai T, Cheng D, Coleman S, Bridden C, Krupitsky E, Samet J. The influence of depressive symptoms on alcohol use among HIV-infected Russian drinkers. Drug Alcohol Depend 2014; 134:85-91. [PMID: 24120857 PMCID: PMC4524808 DOI: 10.1016/j.drugalcdep.2013.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depressive symptoms have been linked to HIV progression through a number of biobehavioral mechanisms including increased alcohol use. Although research supports an association between alcohol use and depressive symptoms among HIV patients, there have been few studies that have examined whether depressive symptoms predict subsequent drinking, especially among heavy drinking HIV-infected patients. METHOD Heavy drinking Russian HIV-infected patients (n=700) were recruited from addiction and HIV care settings for a randomized controlled trial of a risk reduction intervention [HERMITAGE]. GEE overdispersed Poisson regression analyses were conducted to assess the association between depressive symptoms and alcohol consumption 6-months later. RESULTS In adjusted analyses, depressive symptom severity was significantly associated with drinks per day (global p=.02). Compared to the non-depressed category, mild depressive symptoms were significantly associated with more drinks per day [IRR=1.55, (95% CI: 1.14, 2.09)], while moderate [IRR=1.14, (95% CI: 0.83, 1.56)] and severe [IRR=1.48, (95% CI: 0.93, 2.34)] depressive symptoms were not. Associations between depressive symptom severity and heavy drinking days were not statistically significant (global p=.19). Secondary analyses using the BDI-II screening threshold (BDI-II>14) and the BDI-II cognitive subscale suggested an association between depressive symptoms and drinks per day over time but not heavy episodic drinking. CONCLUSIONS Among heavy drinking HIV-infected patients, elevated depressive symptoms were associated with greater subsequent alcohol use. These findings suggest that depressive symptoms may be important to address in efforts to reduce alcohol-related risks among HIV-infected populations.
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Affiliation(s)
- T.P. Palfai
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02021, USA,Corresponding author. Tel.: +1 617 353 9345; fax: +1 617 353 9609. (T.P. Palfai)
| | - D.M. Cheng
- Department of Biostatistics, School of Public Health, Boston University, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - S.M. Coleman
- Department of Biostatistics, School of Public Health, Boston University, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - C. Bridden
- Department of Medicine, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - E. Krupitsky
- St. Petersburg Bekhterev Research Psychoneurological Institute, 3 Bekhterev Street, St. Petersburg 192019, Russia
| | - J.H. Samet
- Department of Medicine, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
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Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med 2012; 74:2012-9. [PMID: 22513248 DOI: 10.1016/j.socscimed.2012.02.033] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 01/03/2012] [Accepted: 02/17/2012] [Indexed: 11/21/2022]
Abstract
Depression is common among people living with HIV/AIDS and contributes to a wide range of worsened HIV-related outcomes, including AIDS-related mortality. Targeting modifiable causes of depression, either through primary or secondary prevention, may reduce suffering as well as improve HIV-related outcomes. Food insecurity is a pervasive source of uncertainty for those living in resource-limited settings, and cross-sectional studies have increasingly recognized it as a critical determinant of poor mental health. Using cohort data from 456 men and women living with HIV/AIDS initiating HIV antiretroviral therapy in rural Uganda, we sought to (a) estimate the association between food insecurity and depression symptom severity, (b) assess the extent to which social support may serve as a buffer against the adverse effects of food insecurity, and (c) determine whether the buffering effects are specific to certain types of social support. Quarterly data were collected by structured interviews and blood draws. The primary outcome was depression symptom severity, measured by a modified Hopkins Symptom Checklist for Depression. The primary explanatory variables were food insecurity, measured with the Household Food Insecurity Access Scale, and social support, measured with a modified version of the Functional Social Support Questionnaire. We found that food insecurity was associated with depression symptom severity among women but not men, and that social support buffered the impacts of food insecurity on depression. We also found that instrumental support had a greater buffering influence than emotional social support. Interventions aimed at improving food security and strengthening instrumental social support may have synergistic beneficial effects on both mental health and HIV outcomes among PLWHA in resource-limited settings.
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26
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Martin EG, Barry CL. The adoption of mental health drugs on state AIDS drug assistance program formularies. Am J Public Health 2011; 101:1103-9. [PMID: 21493949 DOI: 10.2105/ajph.2010.300100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought state-level factors associated with the adoption of medications to treat mental health conditions on state formularies for the AIDS Drug Assistance Program. METHODS We interviewed 22 state and national program experts and identified 7 state-level factors: case burden, federal dollar-per-case Ryan White allocation size, political orientation, state wealth, passage of a mental health parity law, number of psychiatrists per population, and size of mental health budget. We then used survival analysis to test whether the factors were associated with faster adoption of psychotropic drugs from 1997 to 2008. RESULTS The relative size of a state's federal Ryan White HIV/AIDS Program allocation, the state's political orientation, and its concentration of psychiatrists were significantly associated with time-to-adoption of psychotropic drugs on state AIDS Drug Assistance Program formularies. CONCLUSIONS Substantial heterogeneity exists across states in formulary adoption of drugs to treat mental illness. Understanding what factors contribute to variation in adoption is vital given the importance of treating mental health conditions as a component of comprehensive HIV care.
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Affiliation(s)
- Erika G Martin
- Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY 12222, USA.
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Puffer ES, Kochman A, Hansen NB, Sikkema KJ. An evidence-based group coping intervention for women living with HIV and history of childhood sexual abuse. Int J Group Psychother 2011; 61:98-126. [PMID: 21244204 PMCID: PMC3569722 DOI: 10.1521/ijgp.2011.61.1.98] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Women living with HIV/AIDS and a history of childhood sexual abuse often exhibit sexual trauma symptoms and elevated rates of HIV-risk behaviors. In this paper, we describe a coping skills group intervention that reduced traumatic stress and sexual-risk behavior in a recent randomized clinical trial. We focused on clinical issues that emerged among female participants receiving the intervention. Clinical observations showed that recognizing connections between trauma, psychological distress, and high risk behaviors was a new and powerful experience for many participants. Participants successfully applied psychoeducational material, expressing an increased sense of power and control over their relationships and behaviors as they developed more adaptive cognitive and behavioral skills. Women expressed high levels of satisfaction with the intervention. Recommendations for clinical practice are provided.
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Affiliation(s)
- Eve S Puffer
- Duke Global Health Institute, Duke University Medical Center Department of Psychiatry, Durham, NC 27708, USA.
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Patterson AL, Morasco BJ, Fuller BE, Indest DW, Loftis JM, Hauser P. Screening for depression in patients with hepatitis C using the Beck Depression Inventory-II: do somatic symptoms compromise validity? Gen Hosp Psychiatry 2011; 33:354-62. [PMID: 21762832 PMCID: PMC8362901 DOI: 10.1016/j.genhosppsych.2011.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/12/2011] [Accepted: 04/12/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of the study was to evaluate the validity of the Beck Depression Inventory-II (BDI-II) when used to measure depression in patients with hepatitis C virus (HCV). METHOD Factor analysis was utilized to validate the BDI-II in a sample of 671 patients with HCV recruited from a large Veterans Affairs medical center. The data were split randomly: the first half was subjected to exploratory factor analysis, and confirmatory factor analysis was used with the second half to confirm the model. Diagnostic data were retrieved from the electronic medical records. RESULTS Subjects were 97.0% male, average age was 52.8 years, 16.1% had a cirrhosis diagnosis, 62.9% had a current major depressive disorder diagnosis, and 42.3% endorsed significant depressive symptoms on the BDI-II. A two-factor model was an excellent fit for the data; the factors were labeled Cognitive-Affective and Somatic. Patients scored significantly higher on the Somatic factor than on the Cognitive-Affective factor (P<.001), and this discrepancy increased when comparing patients based on whether they had a diagnosis of cirrhosis. CONCLUSIONS When screening for depression in HCV patients, questions targeting cognitive and affective symptoms of depression may provide a more valid measurement of depression than questions targeting somatic symptoms of depression, particularly for patients with more advanced liver disease.
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Affiliation(s)
- Alexander L. Patterson
- Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, OR, USA,Corresponding author. Tel.: +1 503 220 8262x58435; fax: +1 503 402 2830. (A.L. Patterson)
| | - Benjamin J. Morasco
- Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, OR, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Bret E. Fuller
- Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, OR, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - David W. Indest
- Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, OR, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer M. Loftis
- Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Portland, OR, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Peter Hauser
- Long Beach VA Medical Center, Long Beach, CA, USA
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Onwumere J, Holttum S, Hirst F. Determinants of quality of life in black African women with HIV living in London. PSYCHOL HEALTH MED 2010. [DOI: 10.1080/13548500120101568] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chan I, Chan E, Au A, Leung P, Li P, Lee MP, Chung R, Yu P. Subjective memory complaints of Chinese HIV-infected patients in Hong Kong: Relationships with social support, depressive mood and medical symptoms. AIDS Care 2010; 19:1149-56. [PMID: 18058399 DOI: 10.1080/09540120701402780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- I. Chan
- a AIDS Clinical Service , Queen Elizabeth Hospital , Hong Kong , China
| | - E. Chan
- b Psychology Department , The Chinese University of Hong Kong , Hong Kong , China
| | - A. Au
- c Department of Applied Social Science , Hong Kong Polytechnic University , Hong Kong , China
| | - P. Leung
- b Psychology Department , The Chinese University of Hong Kong , Hong Kong , China
| | - P. Li
- a AIDS Clinical Service , Queen Elizabeth Hospital , Hong Kong , China
| | - M. P. Lee
- a AIDS Clinical Service , Queen Elizabeth Hospital , Hong Kong , China
| | - R. Chung
- a AIDS Clinical Service , Queen Elizabeth Hospital , Hong Kong , China
| | - P. Yu
- a AIDS Clinical Service , Queen Elizabeth Hospital , Hong Kong , China
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Gonzalez A, Solomon SE, Zvolensky MJ, Miller CT. The interaction of mindful-based attention and awareness and disengagement coping with HIV/AIDS-related stigma in regard to concurrent anxiety and depressive symptoms among adults with HIV/AIDS. J Health Psychol 2009; 14:403-13. [PMID: 19293302 DOI: 10.1177/1359105309102193] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This investigation examined the interaction of disengagement coping with HIV/AIDS-related stigma and mindful-based attention and awareness in regard to anxiety and depressive symptoms among people with HIV/AIDS. There was a significant interaction in regard to anxiety symptoms. Higher levels of disengagement coping paired with lower levels of mindful-based attention and awareness was related to the greatest degrees of anxiety symptoms, while lower levels of disengagement coping paired with higher levels of mindful-based attention and awareness was related to the lowest levels of anxiety symptoms. Although the interaction for depressive symptoms was not significant, a similar pattern of results was observed.
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Mosack KE, Weinhardt LS, Kelly JA, Gore-Felton C, McAuliffe TL, Johnson MO, Remien RH, Rotheram-Borus MJ, Ehrhardt AA, Chesney MA, Morin SF. Influence of coping, social support, and depression on subjective health status among HIV-positive adults with different sexual identities. Behav Med 2009; 34:133-44. [PMID: 19064372 PMCID: PMC2653049 DOI: 10.3200/bmed.34.4.133-144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
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Affiliation(s)
- Katie E. Mosack
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Lance S. Weinhardt
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Jeffrey A. Kelly
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Cheryl Gore-Felton
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Timothy L. McAuliffe
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Mallory O. Johnson
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Robert H. Remien
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Mary Jane Rotheram-Borus
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Anke A. Ehrhardt
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Margaret A. Chesney
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Stephen F. Morin
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
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Martinez P, Andia I, Emenyonu N, Hahn JA, Hauff E, Pepper L, Bangsberg DR. Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in southwest Uganda. AIDS Behav 2008; 12:605-12. [PMID: 17968651 DOI: 10.1007/s10461-007-9312-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 08/26/2007] [Indexed: 11/30/2022]
Abstract
Alcohol use and depressive symptoms are associated with reduced access to antiretroviral therapy (ART) in the developed world. Whether alcohol use and depressive symptoms limit access to ART in resource-limited settings is unknown. This cross-sectional study examined the association between alcohol use, depressive symptoms and the receipt of ART among randomly selected HIV-positive persons presenting for primary health care services at an outpatient HIV clinic in Uganda. Depressive symptoms were defined by the Hopkins Symptom Checklist and alcohol use was measured through frequency of consumption questions. Antiretroviral use was assessed using a standardized survey and confirmed by medical record review. Predictors of ART use were determined via logistic regression. Among 421 HIV-infected patients, factors associated with the receipt of ART were having at least primary education, having an opportunistic infection in the last 3 months, and not drinking within the last year.
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Affiliation(s)
- Priscilla Martinez
- Section for International Health, Department of General Practice and Community Medicine, University of Oslo, Oslo 0407, Norway.
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Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. J Acquir Immune Defic Syndr 2008; 47:506-13. [PMID: 18176319 DOI: 10.1097/qai.0b013e318160d727] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the effect of a 15-session coping group intervention compared with a 15-session therapeutic support group intervention among HIV-positive men and women with a history of childhood sexual abuse (CSA) on sexual transmission risk behavior. DESIGN A randomized controlled behavioral intervention trial with 12-month follow-up. METHODS A diverse sample of 247 HIV-positive men and women with histories of CSA was randomized to 1 of 2 time-matched group intervention conditions. Sexual behavior was assessed at baseline; immediately after the intervention; and at 4-, 8-, and 12-month follow-up periods (5 assessments). Changes in frequency of unprotected anal and vaginal intercourse by intervention condition were examined using generalized linear mixed models for all partners, and specifically for HIV-negative or serostatus unknown partners. RESULTS Participants in the HIV and trauma coping intervention condition decreased their frequency of unprotected sexual intercourse more than participants in the support intervention condition for all partners (P < 0.001; d = 0.38, 0.32, and 0.38 at the 4-, 8-, and 12-month follow-up periods, respectively) and for HIV-negative and serostatus unknown partners (P < 0.001; d = 0.48, 0.39, and 0.04 at the 4-, 8-, and 12-month follow-up periods, respectively). CONCLUSION A group intervention to address coping with HIV and CSA can be effective in reducing transmission risk behavior among HIV-positive men and women with histories of sexual trauma.
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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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Cha E, Erlen JA, Kim KH, Sereika SM, Caruthers D. Mediating roles of medication-taking self-efficacy and depressive symptoms on self-reported medication adherence in persons with HIV: a questionnaire survey. Int J Nurs Stud 2007; 45:1175-84. [PMID: 17949723 DOI: 10.1016/j.ijnurstu.2007.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 08/12/2007] [Accepted: 08/18/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND To date, only a few studies have examined the mediating role of self-efficacy on the relationship between depressive symptoms or perceived social support and medication adherence in persons with HIV. OBJECTIVES The purpose of this study was to examine the impact of perceived social support, depressive symptoms and medication-taking self-efficacy on self-reported medication adherence in persons with HIV. A proposed comprehensive model included three mediation hypotheses in order to examine the mediating roles of medication-taking self-efficacy and depressive symptoms. METHOD Baseline data from "Adherence to Protease Inhibitors" were used. The 215 persons with HIV aged 19-61 (mean=40.7, S.D.=7.58) were recruited from multiple sites in Pittsburgh, PA (USA) and through self-referral. The participants were assessed using the Beck Depression Inventory, Interpersonal Support Evaluation List, the Medication Taking Self-Efficacy Scale, and the modified Morisky Self-report Medication Taking Scale. Structural equation modeling (EQS version 6.1) was used. The Satorra-Bentler Scaled chi(2) test statistics (S-B chi(2)), Comparative Fit Index (CFI), and the Standardized Root Mean Squared Residual (SRMR) were used to assess the fit of a comprehensive model including three mediation hypotheses. RESULTS A comprehensive model with the three hypotheses showed a good model fit (S-B chi(2) (24, N=215)=69.06, p<.001; CFI=.95; SRMR=.057). Medication adherence self-efficacy fully mediated the prediction of self-reported medication adherence by perceived social support and depressive symptoms. Depressive symptoms partially mediated the prediction of medication-taking self-efficacy by perceived social support. CONCLUSIONS The findings of this study provide researchers with increased understanding of the mediating role of medication-taking self-efficacy beliefs between selected psychological variables and self-reported medication adherence in persons with HIV. Future studies need to test the moderating effect of gender, ethnicity and risk factors for HIV on this model and the intervention effect of self-efficacy beliefs using longitudinal data.
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Affiliation(s)
- Eunseok Cha
- Chung-Ang University, Department of Nursing School of Medicine, Seoul 156-756, South Korea.
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Webb MS, Vanable PA, Carey MP, Blair DC. Cigarette smoking among HIV+ men and women: examining health, substance use, and psychosocial correlates across the smoking spectrum. J Behav Med 2007; 30:371-83. [PMID: 17570050 PMCID: PMC2570223 DOI: 10.1007/s10865-007-9112-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 05/01/2007] [Indexed: 10/23/2022]
Abstract
The prevalence of cigarette smoking among HIV+ individuals is greater than that found in the general population. However, factors related to smoking within this population are not well understood. This study examined the associations between smoking and demographic, medical, substance use, and psychosocial factors in a clinic-based sample of HIV+ men and women. Two hundred twelve participants completed self-report measures of tobacco use, HIV-related symptoms, viral load, CD4, alcohol and illicit drug use, depression, and social support. Multinomial logistic regression (MLR) analyses modeled the independent associations of the cross-sectional set of predictors with smoking status. Results indicated that 74% of the sample smoked at least one cigarette per day; using standard definitions, 23% of the sample were light smokers, 22% were moderate smokers, and 29% smoked heavily. Smoking was associated with more HIV-related symptoms, greater alcohol and marijuana use, and less social support. Light smoking was related to minority race/ethnicity and less income; moderate smoking was associated with less education; and heavy smoking was related to less education and younger age. Viral load, CD4 count, and depression were not associated with smoking status. Psychosocial interventions targeting this population should consider the relationships between biopsychosocial factors and smoking behavior.
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Affiliation(s)
- Monica S Webb
- Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244-2340, USA.
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Au A, Cheng C, Chan I, Leung P, Li P, Heaton RK. Subjective memory complaints, mood, and memory deficits among HIV/AIDS patients in Hong Kong. J Clin Exp Neuropsychol 2007; 30:338-48. [PMID: 17852611 DOI: 10.1080/13803390701416189] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Diagnosis of HIV-associated neurobehavioral disorders often heavily relies upon patient complaints of cognitive difficulties. Yet, research in North America suggests that such complaints may be heavily influenced by affective factors. However, no work in this area has been done in China. The present study examined the relationships among depressed mood, anxiety, memory performance and subjective memory complaints among HIV/AIDS patients in Hong Kong. A total of 90 individuals with HIV were administered the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory, Patient's Assessment of Own Functioning Inventory (PAOF), and Hong Kong List Learning Test. Forward regression analysis indicated that the BDI Cognitive-Affective score was the most significant predictor of subjective memory complaints on the PAOF. Furthermore, present results also supported previous findings that some individuals with HIV infection are more "accurate" than others in the self-appraisal of their memory ability. Given inaccuracies that exist in subjective memory complaints, these findings highlight the importance of comprehensive cognitive assessment when evaluating the neuropsychological status of individuals of HIV.
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Affiliation(s)
- Alma Au
- Department of Applied Social Science, Hong Kong Polytechnic University, Hong Kong, China.
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Heckman TG, Barcikowski R, Ogles B, Suhr J, Carlson B, Holroyd K, Garske J. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med 2006; 32:27-38. [PMID: 16827627 DOI: 10.1207/s15324796abm3201_4] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND By 2015, the Centers for Disease Control and Prevention predicts that 50% of all cases of HIV/AIDS in the United States will be in persons 50 years of age or older. PURPOSE This pilot research tested whether a 12-session, coping improvement group intervention delivered via teleconference technology could improve life quality in 90 middle-age and older adults living with HIV/AIDS. METHOD This research used a lagged-treatment control group design. Forty-four HIV-infected persons 50-plus years of age participated in a coping improvement group intervention immediately after study enrollment, whereas 46 individuals received the intervention after their time-matched immediate treatment participants completed the intervention. Participants completed self-administered surveys that assessed depressive and psychological symptoms, life-stressor burden, ways of coping, coping self-efficacy, and loneliness. RESULTS Outcome analyses indicated that, compared to their delayed treatment counterparts, immediate treatment participants reported fewer psychological symptoms, lower levels of life-stressor burden, increased coping self-efficacy, and less frequent use of avoidance coping. After receiving the intervention, delayed treatment participants reported greater coping self-efficacy and less psychological symptomatology, life-stressor burden, and loneliness. However, the intervention demonstrated little ability to reduce depressive symptoms in this sample of HIV-infected older adults diagnosed with depression. CONCLUSIONS Although findings from this research suggest that telephone-delivered, coping improvement group interventions have potential to facilitate the adjustment efforts of HIV-infected older adults, more rigorous evaluations of this intervention modality for this group are needed.
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Patterson K, Young C, Woods SP, Vigil O, Grant I, Atkinson JH. Screening for major depression in persons with HIV infection: the concurrent predictive validity of the Profile of Mood States Depression-Dejection Scale. Int J Methods Psychiatr Res 2006; 15:75-82. [PMID: 19722288 PMCID: PMC6878440 DOI: 10.1002/mpr.184] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Major Depressive Disorder (MDD) is among the most prevalent but underdiagnosed psychiatric disorders in persons with HIV infection. Given the known adverse impact of comorbid MDD on HIV disease progression and health-related quality of life, it is important both for research and for efficient, effective clinical care, to validate existing screening measures that may discriminate between MDD and the somatic symptoms of HIV (such as fatigue). In the current study, we evaluated the concurrent predictive validity of the Profile of Mood States (POMS) Depression-Dejection scale in detecting current MDD in 310 persons with HIV infection. The Structured Clinical Interview for DSM-IV (SCID) diagnosis of MDD and the Cognitive-Affective scale from the Beck Depression Inventory (BDI-CA) served as comparative diagnostic and severity measures of depression, respectively. Results demonstrated that the POMS Depression-Dejection scale accurately classified persons with and without MDD SCID diagnoses, with an overall hit rate of 80%, sensitivity of 55%, specificity of 84%, and negative predictive power of 91% using a recommended cutpoint of 1.5 standard deviations above the normative mean. Moreover, the POMS performed comparably to the BDI-CA in classifying MDD. Findings support the predictive validity of the POMS Depression-Dejection scale as a screening instrument for MDD in persons with HIV disease.
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Affiliation(s)
- Katherine Patterson
- Department of Psychiatry, University of California-San Diego, 150 West Washington Street, San Diego, CA 92103, USA
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Henderson M, Safa F, Easterbrook P, Hotopf M. Fatigue among HIV-infected patients in the era of highly active antiretroviral therapy. HIV Med 2006; 6:347-52. [PMID: 16156883 DOI: 10.1111/j.1468-1293.2005.00319.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the prevalence of operationally defined fatigue in an ethnically diverse HIV-infected population in south London, and to examine the association of fatigue with demographic characteristics, stage of disease, antiretroviral therapy and psychological factors. METHODS A descriptive comparative cross-sectional study of HIV-infected patients attending a London HIV clinic over a 5-month period in 2002 was performed. Demographic and clinical data were obtained from the local database. Participants completed four self-administered questionnaires-the Chalder Fatigue Scale (CFS), a measure of physical and mental fatigue; the General Health Questionnaire (GHQ-12) to detect anxiety and depression; the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to measure functional status, and the Illness Perception Questionnaire (IPQ). Fatigue 'cases' were defined as those scoring at least 4 on the CFS. Multivariate logistic regression was used to identify factors associated with the presence of fatigue. RESULTS Two hundred and five patients were approached and 148 (72%) agreed to participate. Overall, 65% of patients were defined as fatigued. Significant psychological distress on the GHQ-12, functional impairment on the SF-36 and a higher CD4 count were all independently associated with the presence of fatigue. There was no association with use of antiretroviral therapy or demographic characteristics. CONCLUSIONS The presence of fatigue in HIV-infected patients is most strongly associated with psychological factors and not with more advanced HIV disease or the use of highly active antiretroviral therapy. This highlights the importance of investigation and management of underlying depression and anxiety in patients presenting with fatigue.
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Affiliation(s)
- M Henderson
- Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK.
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Gibbie T, Mijch A, Ellen S, Hoy J, Hutchison C, Wright E, Chua P, Judd F. Depression and neurocognitive performance in individuals with HIV/AIDS: 2-year follow-up. HIV Med 2006; 7:112-21. [PMID: 16420256 DOI: 10.1111/j.1468-1293.2006.00350.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to follow a cohort of HIV-infected individuals for 2 years to assess changes in depression and neuropsychological performance over time, to explore the relationship between depression, HIV illness and neuropsychological performance, and to examine the natural history of the effect of highly active antiretroviral therapy (HAART) on depression and neurocognitive performance. METHODS HIV-seropositive out-patients were assessed at baseline and at 2-year follow-up. At each assessment, patients were assessed for depression [using the Beck Depression Inventory (BDI) and Structured Clinical Interview (SCID-CV)] and completed a battery of neuropsychological tests including the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Hopkins HIV Dementia Scale (HDS). RESULTS At baseline, 34.8% scored > or =14 on the BDI [> or =14 suggests depressive symptoms (DS)]. The SCID-CV revealed that 27% of participants met the criteria for current mood disorder. Seven per cent of the participants' scores on the HDS indicated HIV-associated cognitive changes. Eighty participants were re-tested at 2-year follow-up and were split into two groups based on BDI scores at baseline. CANTAB results revealed that the cohort were significantly impaired on nine of 10 measures compared with age-matched normative data. Neurocognitive performance significantly improved for participants with no DS at baseline, whereas participants with DS at baseline did not show as much improvement. Multivariate analysis revealed that 40% of the change in cognitive performance was attributable to the variables age, AIDS and HAART regimen. CONCLUSION These results suggest a significant decline in depression scores and an improvement in several neurocognitive domains over time, with a relationship between HIV illness, HAART, symptoms of depression and neurocognitive performance.
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Affiliation(s)
- T Gibbie
- Victorian HIV Service, The Alfred Hospital, Victoria, Australia
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Muir Bowers J, Mourani JP, Ampel NM. Fatigue in coccidioidomycosis. Quantification and correlation with clinical, immunological, and nutritional factors. Med Mycol 2006; 44:585-90. [PMID: 17071551 DOI: 10.1080/13693780600794533] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
While described in the past, the frequency and degree of fatigue associated with symptomatic coccidioidomycosis has never been quantified. Using the Fatigue Severity Scale (FSS), severe fatigue (FSS score = 41) was found in 65% of cases of active coccidioidomycosis compared to 42% in cohort of control subjects with chronic medical diseases (P=0.024). Fatigue in patients with symptomatic coccidioidomycosis declined significantly over four months (P=0.023). Severe fatigue in patients with symptomatic coccidioidomycosis was significantly associated with low body mass index (BMI; P=0.024) but was not significantly associated with either serum leptin (r2=0.078, P=0.261) or serum TNF-alpha (r2=0.028, P=0.504) concentrations. Severe fatigue is a common condition among patients with active coccidioidomycosis and is associated with a declining BMI.
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Affiliation(s)
- Jennifer Muir Bowers
- Valley Fever Center for Excellence and the Department of Medicine of the University of Arizona, and the Southern Arizona Veterans Affairs Health Center System, Tucson, Arizona, USA
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Ashton E, Vosvick M, Chesney M, Gore-Felton C, Koopman C, O'Shea K, Maldonado J, Bachmann MH, Israelski D, Flamm J, Spiegel D. Social support and maladaptive coping as predictors of the change in physical health symptoms among persons living with HIV/AIDS. AIDS Patient Care STDS 2005; 19:587-98. [PMID: 16164385 DOI: 10.1089/apc.2005.19.587] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study examined social support and maladaptive coping as predictors of HIV-related health symptoms. Sixty-five men and women living with HIV/AIDS completed baseline measures assessing coping strategies, social support, and HIV-related health symptoms. The sample was primarily low-income and diverse with respect to gender, ethnicity, and sexual orientation. Three, 6, and 12 months after completing baseline assessments, physical health symptoms associated with HIV disease were assessed. After controlling for demographic characteristics, CD4 T-cell count, and baseline HIV-related health symptoms, individuals reporting lower increase in HIV-related health symptoms used less venting (expressing emotional distress) as a strategy for coping with HIV. However, when satisfaction with social support was added to the model, the use of this coping strategy was no longer significant, and individuals reporting more satisfying social support were more likely to report lower increase in their HIV-related health symptoms, suggesting that social support is a robust predictor of health outcomes over time independent of coping style and baseline medical status. These findings provide further evidence that social support can buffer deleterious health outcomes among individuals with a chronic illness. Future research needs to examine mediating pathways that can explain this relationship.
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Affiliation(s)
- Eric Ashton
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California 94305-5718, USA
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Trépanier LL, Rourke SB, Bayoumi AM, Halman MH, Krzyzanowski S, Power C. The impact of neuropsychological impairment and depression on health-related quality of life in HIV-infection. J Clin Exp Neuropsychol 2005; 27:1-15. [PMID: 15814439 DOI: 10.1080/138033990513546] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neuropsychological impairment and depression are common among individual with HIV-infection, resulting in significantly altered everyday functioning. The objective of this study was to examine the impact of these two important neurobehavioural complications on health-related quality of life in adults with HIV-infection. Participants (n = 155) received a 3-hours comprehensive neuropsychological examination, the Beck Depression Inventory, and the Medical Outcomes Study HIV Quality of Life instrument. Four groups were formed based on the presence or absence of depression and neuropsychological impairment. Results suggest that neuropsychological impairment and depression can differentially affect dimensions of health-related quality of Life. Specifically, depression has a significant impact on mental health dimensions of health-related quality of life. Some evidence exists for an impact of neuropsychological impairment, or a combined impact of depression and neuropsychological impairment, on the Physical Health dimensions of health-related quality of life. These results confirm the importance of depression as a determinant of health-related quality of life in HIV/AIDS and provide a potential avenue for improving health-related quality of life in adults with HIV-infection.
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Affiliation(s)
- Lisa L Trépanier
- Lakeridge Health-Oshawa, Corporate Mental Health Program, Oshawa ,Ontario, Canada
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Carter SL, Rourke SB, Murji S, Shore D, Rourke BP. Cognitive complaints, depression, medical symptoms, and their association with neuropsychological functioning in HIV infection: a structural equation model analysis. Neuropsychology 2003; 17:410-9. [PMID: 12959507 DOI: 10.1037/0894-4105.17.3.410] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The main objective of this study was to use structural equation modeling (SEM) to clarify the relationship between subjective cognitive complaints and neuropsychological functioning in 160 adults with HIV infection. Participants completed questionnaires assessing cognitive complaints, symptoms of depression, and HIV-related medical symptoms. Neuropsychological tests included measures of attention, verbal fluency, psychomotor skills, learning, memory, and executive skills. SEM was used to test models of the relationships among cognitive complaints, mood, and medical symptoms with neuropsychological functioning. The model indicated that although depressed mood (beta = 0.32, p < .01) and medical symptoms (beta = 0.31, p < .01) influenced cognitive complaints, cognitive complaints were independently associated with poorer neuropsychological performance (beta = 0.39, p < .01). Mood and medical symptoms were significantly correlated but were not significantly associated with neuropsychological skills.
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Affiliation(s)
- Sherri L Carter
- Department of Psychology, University of Windsor and St. Michael's Hospital, Ontario, Canada
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Komiti A, Judd F, Grech P, Mijch A, Hoy J, Williams B, Street A, Lloyd JH. Depression in people living with HIV/AIDS attending primary care and outpatient clinics. Aust N Z J Psychiatry 2003; 37:70-7. [PMID: 12534660 DOI: 10.1046/j.1440-1614.2003.01118.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Our aim was to gain an estimate of the rate of depressive disorder in patients with HIV/AIDS attending general practice and to investigate factors associated with depression. A further objective was to determine the ability of non-mental health medical practitioners to detect depressive symptoms in their patients with HIV/AIDS. METHODS Participants comprised 322 persons living with HIV/AIDS ( (PLWHA); 13 females, 309 males; mean age 41.4, SD = 8.9) who were recruited from four general practice clinics specializing in HIV medicine and from an infectious diseases clinic. Medical, psychiatric and sociodemographic data were obtained. In addition, participants completed the Inventory to Diagnose Depression (IDD), a self-report measure to detect depression. RESULTS Twenty-two per cent of the sample met criteria for a current Major Depressive Episode (DSM-IV defined) on the IDD. Overall, there was moderate agreement between treating doctors' diagnosis of depression and patients' self-report of depressive symptoms. A multivariate model indicated that being in a current relationship was associated with lowered odds of depression (OR = 0.43; CI = 0.23-0.81). The factors strongly associated with increased odds of depression were a past history of illicit drug use (OR = 2.98; CI = 1.60-5.54) and a diagnosis of 'stress' by treating doctors (OR = 5.65; CI = 2.50-12.77). HIV-related medical variables such as immune function, use of antiretro-viral medication and duration of HIV infection were not associated with depression. CONCLUSIONS There was a high rate of self-reported depression in this group of PLWHA which was also recognized by treating clinicians. Being in a relationship appeared to afford protection against depression while having a history of illicit drug use and current 'stress' were highly associated with depression. Interestingly, HIV-related medical variables including laboratory markers of HIV disease, duration of illness and antiretroviral medication regimen were not related to depression.
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Affiliation(s)
- Angela Komiti
- Department of Psychiatry, University of Melbourne, Australia.
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Kaaya SF, Fawzi MCS, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand 2002; 106:9-19. [PMID: 12100343 PMCID: PMC6300056 DOI: 10.1034/j.1600-0447.2002.01205.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To validate the Hopkins Symptom Checklist-25 (HSCL-25) for use as a depression screen amongst human immuno-deficiency virus (HIV) positive pregnant women. METHOD Amongst 903 (mean age 24.8 years) HIV-positive pregnant women, a two-phased design included measures for health-related quality of life, perceived social support, and the HSCL-25 screen for depressive (HSCL-15 subscale) and anxiety symptoms. The Structured Clinical Interview for DSM-IV (SCID) was independently administered on a stratified random subsample. RESULTS Internal consistency of the HSCL-25 (alpha 0.93) and HSCL-15 (alpha 0.9) was adequate, with expected findings demonstrated in discriminant validity analysis. A depression-anxiety construct explained nearly 40% of the variance. Eight individual HSCL-25 items demonstrated an area under the curve (AUC) greater than 0.6 for DSM-IV major depression and the HSCL-25 and HSCL-revised had an optimal depression cut-off score of 1.06 and 1.03 for the HSCL-15. CONCLUSION The HSCL-25 demonstrated utility as a screen for depression; its inability to gauge severity of symptoms in this cultural context is discussed.
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Affiliation(s)
- S F Kaaya
- Department of Psychiatry, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
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Kalichman SC, Graham J, Luke W, Austin J. Perceptions of health care among persons living with HIV/AIDS who are not receiving antiretroviral medications. AIDS Patient Care STDS 2002; 16:233-40. [PMID: 12055031 DOI: 10.1089/10872910252972285] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Antiretroviral medications are effective at improving the health and increasing the survival of people living with HIV/AIDS. However, studies have shown that a substantial number of HIV-infected people do not receive antiretroviral treatments. The current study examined the physical and mental health, substance use, and perceptions of medical care of 163 men and 78 women living with HIV/AIDS. Results of a confidential survey showed that 79 (33%) were not currently treated for HIV. These persons did not differ from those who were treated in chart-abstracted CD4 cell counts, years living with HIV infection, HIV-related symptoms, and HIV-related hospitalizations. Unlike past studies, gender was not found to be a factor in treatment status. However, untreated persons had higher chart-abstracted viral loads and were more likely to be ethnic minorities, have a lower level of education, greater level of depression, and greater pessimistic attitude. They were significantly more likely to have used alcohol, powder cocaine, and crack cocaine in the previous 3 months, were likely to know their own viral load and CD4 count, and held significantly more negative views of their health care and their health care providers. There were no differences between untreated and treated persons in their meeting the year 1999 antiretroviral treatment guidelines that were in effect at the time of data collection. These results suggest that persons who are not receiving antiretroviral medications may be in need of mental health and substance use interventions and may benefit from interventions designed to engage and retain them in medical treatment.
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Johnson JM, Endler NS. Coping with human immunodeficiency virus: Do optimists fare better? CURRENT PSYCHOLOGY 2002. [DOI: 10.1007/bf02903156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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