Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.     

The Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.     

An indigenous community mental health service on the Tohono O'odham (Papago) Indian reservation: Seventeen years later

The status of a fully indigenous mental health program serviced and controlled by the Tohono O'odham (Papago) Indian tribe is reviewed from the perspective of its 17-year history. The program functions in large measure in a crisis intervention model, with suicidal or acutely disturbed cases being most frequent. However, a whole range of disorders and ages are seen. Traditional Medicine Men and Women are often used as consultants, as are some professionals. In recent years child sex abuse and abuse of drugs among youth are prominent problems. The program experienced problems of obtaining services off reservations for patients in need, and in establishing credibility of the Indian Mental Health workers with the outside service providers.     

Self-help and child abuse: Victims,victimizers, and the development of self-control

Study of child abusers reveals that many victimizers were once victims and that the behaviors underlying the perspectives of victims and victimizers are related. Three groups of abusing parents using directed self-help were studied at Parents Anonymous by participant observation methodology for two and-a-half years. Four of the 52 participating parents read and commented on a draft of the research. Their violence appeared to be an attempt to gain a sense of control or to deal with the frustration of not feeling in control. Suggestions are made for developing social services that enhance individuals' sense of control.Paper presented at the Groves Conference on Marriage and the Family, London, England, July, 1986.     

Rorschach object relations of adolescents who committed homicide.

We investigated the object relations of adolescents who committed homicide. A clinical sample of 55 adolescents who committed homicide did not differ from a comparison group of nonviolent delinquents on Rorschach measures of object differentiation, mutuality of autonomy, and aggressive content. However, the subgroup of adolescents who committed homicides in the context of another crime (e.g., robbery or burglary) did manifest significantly lower object relations (poorer object differentiation and more victim responses) than the subgroup of adolescents whose homicides were committed in the context of an interpersonal conflict or dispute with the victim. These findings support the need for differentiated classification of violent individuals as urged by Megargee (1970) over 20 years ago.