A stress and coping model of medication adherence and viral load in HIV-positive men and women on highly active antiretroviral therapy (HAART).

The authors tested a structural model that incorporated age, time since diagnosis, social support, coping, and negative mood as predictors of medication adherence and HIV viral load on 188 men and 134 women on highly active antiretroviral therapy (HAART). The authors used psychosocial latent factors formed from baseline measures to predict latent factors of adherence, as assessed by electronic monitoring and self-report, and viral load defined by indicators assessed over a 15-month period. Results from the model indicate that greater negative mood and lower social support are related to greater use of avoidance-oriented coping strategies. Use of these coping strategies by patients on HAART is related to poorer medication adherence and, subsequently, higher viral load. This model advances researchers' understanding of the contribution of psychosocial variables in predicting treatment adherence and disease progression in HIV-positive men and women.     

The roles of dispositional optimism and pessimism in hiv disease progression

Relationships between dispositional optimism and pessimism and the course of HIV infection, determined by changes in viral load and CD4 counts, were studied in a longitudinal cohort of 412 patients on antiretroviral therapy (ART). Multiple regression analyses controlling for baseline levels of disease status, ethnicity, and depressive symptoms demonstrated that higher pessimism at baseline was associated with higher viral load at follow-up (average of 18 months later). Optimism at baseline had a curvilinear relationship with CD4 counts at follow-up. Moderate levels of optimism at baseline predicted the highest CD4 counts at follow-up. Although optimism and pessimism were associated with specific health behaviors (e.g., ART adherence, cigarette use, drug use, dietary practices), none of these behaviors mediated the optimism/pessimism effects. The biologic and behavioral mediators of associations of personality variables with the course of treated HIV infection deserve continued investigation.     

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.     

Social support,social integration,and health-related quality of life over time: Results from the Fitness and Arthritis in Seniors Trial (FAST)

The present study tested whether baseline perceived social support and social integration predicted baseline and follow-up measures of health-related quality of life for 364 older adults with osteoarthritis. The findings are secondary analyses of a randomized controlled trial of an exercise intervention. Multiple regression analyses indicate that perceived social support was related to baseline measures of functioning in psychological (depressive symptoms, social functioning, and life satisfaction) and physical domains (self-rated disability, observed physical function, and perceived health), after accounting for demographic and clinical status factors. At 18-month follow-up (additionally controlling for exercise intervention and baseline outcomes), social support significantly predicted changes in psychosocial functioning, but was unrelated to changes in self-reported and observed physical health. The findings indicate that social support is an important predictor of long-term psychosocial outcomes, but is less important than baseline clinical status for physical health endpoints in this cohort of older adults. In contrast, social integration was not a consistent predictor of outcomes.     

A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice.     

An information-motivation-behavioral skills model of adherence to antiretroviral therapy.

HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.     

Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring

Advances in the medical treatment of HIV have made it clear that adherence to highly active antiretroviral treatment is a crucial feature for treatment success. The present paper had two goals: (1) to examine psychosocial predictors of adherence in persons receiving HIV antiretroviral therapy; (2) to compared two minimal-treatment interventions to increase HIV medication adherence in a subset of persons who self-reported less than perfect adherence. One of the interventions, Life-Steps, is a single-session intervention utilizing cognitive-behavioral, motivational interviewing, and problem-solving techniques. The other intervention, self-monitoring, utilizes a pill-diary and an adherence questionnaire alone. Significant correlates of adherence included depression, social support, adherence self-efficacy, and punishment beliefs about HIV. Depression was a significant unique predictor of adherence over and above the other variables. Both interventions yielded improvement in adherence from baseline, and the Life-Steps intervention showed faster improvements in adherence for persons with extant adherence problems.     

Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to predict adherence to highly active antiretroviral therapy (HAART) medication regimens among HIV-positive men and women

Psychosocial and behavioral factors may be strong predictors of adherence to medications in a wide variety of diseases. Newly emerging antiretroviral medications for HIV have been shown to be effective but require near perfect adherence to offer clinically significant benefits. There is currently great interest in deriving patient factors that may predict optimal medication adherence in HIV-positive persons. In this study, we examined the association of psychosocial and behavioral characteristics using the Millon Behavioral Medicine Diagnostic (MBMD; Millon, Antoni, Millon, Meagher, & Grossman, 2001) and adherence to highly active antiretroviral therapy (HAART) among 117 HIV-positive individuals on HAART regimens. Specific indexes of the MBMD were associated with HAART adherence as assessed through patient interview, at baseline assessment, and at 3-month follow-up at a point after which participants had received medication adherence training. As hypothesized, the Medication Abuse scale of the MBMD was uniquely associated with overall adherence at baseline assessment and also predictive of adherence at 3-month follow-up. Additional MBMD scales were also related to overall adherence as well as specific adherence behaviors such as missed doses, following specific instructions, and overmedicating, although the Medication Abuse scale emerged as the most consistent predictor of adherence in the study. These results suggest that the MBMD can be used to predict adherence to HAART medication in a sample of HIV-positive men and women and may subsequently be used to identify those in need of adherence counseling at the point when medications are initiated.     

Depressive Symptomatology among HIV-Positive Women in the Era of HAART: A Stress and Coping Model

Objective: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace. Method: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood.     

Presentation of Depression and Response to Group Cognitive Therapy with Older Patients

Concerned with response prediction, this research examines the relationships between pre-treatment components of depressive symptomatology and outcome of short-term group cognitive therapy for depression with older adults. Aspects of depressive symptomatology under examination were initial intensity of self-reported depressive symptomatology, profile of melancholic depression, perceived health status, perceived social support, and intensity of negative view of self. Findings indicate that perceived social support is not related to outcome but that a more intense depressive symptomatology, a more negative health evaluation, and a more negative view of self are variables associated with a less favorable outcome. Despite showing a sizable decrease in depressive symptoms over the course of intervention, severely depressed subjects still presented residual depressive symptoms at the conclusion of intervention. There was a tendency for subjects with a melancholic profile to show a poorer response to this intervention.     

Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease.

New treatments for HIV can improve immune functioning and decrease mortality. However, lapses in adherence may render these complex regimens ineffective. Sixty-three men and 9 women on highly active antiretroviral therapy completed measures of medication adherence, psychological characteristics, and barriers to adherence. HIV viral load, a health outcome measure of virus amount present in blood, was also obtained. The sample was 36% African American and 56% Caucasian, with 35% reporting disability. Nearly one third of patients had missed medication doses in the past 5 days, and 18% had missed doses weekly over the past 3 months. Frequency of missed doses was strongly related to detectable HIV viral loads. Depression, side-effect severity, self-efficacy, and social support distinguished patients with good and poor adherence. Barriers also varied with adherence level. Implications for interventions promoting HIV treatment adherence are discussed.     

Adult Attachment and High-Risk Sexual Behavior Among HIV-Positive Patients

The present study investigated the relationship between adult attachment style and sexual behavior among HIV-positive patients. HIV-positive (HIV+) participants ( N = 48) completed questionnaires assessing number of sexual partners, adult attachment, self-esteem, and depressive symptoms. Results revealed that insecure attachment styles (particularly negative attachment representations of self and fearful attachment) were associated with having multiple sexual partners, including at-risk HIV-negative (HIV-) partners. These relationships remained significant after controlling for sexual orientation, self-esteem, and depressive symptomatology. These results suggest that interpersonal issues may play a key role in high-risk sexual behavior among HIV+ individuals.     

A randomized trial to evaluate the course of effects of a program to prevent adolescent depressive symptoms over 12 months

Although few prevention studies have been designed to investigate the course of prevention effects over time, it seems that the effects on depressive symptoms increase from post-intervention to 6-month follow-up but then decrease with longer lags to follow-up. Furthermore, previous prevention studies have found differential intervention effects for boys and girls without testing possible explanations for this effect. The present randomized control group study with 301 8th-grade students examined the effects of a depression prevention program from baseline until 12-month follow-up. As expected, while positive intervention effects were found on girls’ depressive symptoms, no such effects were found on boys’ depressive symptoms. Further, the positive intervention effects on girls’ depressive symptoms increased to the 6-month follow-up and remained stable through the 12-month follow-up, while depression symptoms in control-group girls increased from 6-month to 12-month follow-up. Further exploratory analyses revealed that neither baseline conduct problems nor cognitive or social knowledge of the prevention program at 12-month follow-up alone explained the sex effect. However, some limited evidence was found indicating that total knowledge (cognitive and social) might partially explain the effect but there was significant variability remaining to be explained.     

Interpersonal factors and perinatal depressive symptomatology in a low-income Latina sample

Interpersonal factors are among the risk factors that predispose women to experiencing mood disturbances during the childbearing years. This study investigates the trajectory of change in depressive symptomatology over the course of the perinatal period as related to interpersonal risk factors (marital quality and social support) in a sample of 69 low-income, mostly immigrant Latina mothers at high and low risk for depression. We found a significant linear change in depressive symptomatology from baseline (pregnancy) through the postpartum period. This decline was steeper for high-risk women who reported high levels of social support compared with those who reported low levels of social support. In addition, a greater decline in depressive symptom scores was found for women who reported better postnatal marital quality, irrespective of risk group status. The results suggest the importance of considering marital quality and social support in estimations of risk for depression. These findings also have implications for targeting social support and marital quality in preventive interventions for perinatal depression in Latinas.     

Positive Events and Social Supports as Buffers of Life Change Stress1

A perceived availability of social support measure (the ISEL) was designed with independent subscales measuring four separate support functions. In a sample of college students, both perceived availability of social support and number of positive events moderated the relationship between negative life stress and depressive and physical symptomatology. In the case of depressive symptoms, the data fit a “buffering” hypothesis pattern, i.e., they suggest that both social support and positive events protect one from the pathogenic effects of high levels of life stress but are relatively unimportant for those with low levels of stress. In the case of physical symptoms, the data only partially support the buffering hypothesis. Particularly, the data suggest that both social support and positive events protect one from the pathogenic effects of high levels of stress but harm those (i.e., are associated with increased symptomatology) with low levels of stress. Further analyses suggest that self-esteem and appraisal support were primarily responsible for the reported interactions between negative life stress and social support. In contrast, frequency of past social support was not an effective life stress buffer in either the case of depressive or physical symptomatology. Moreover, past support frequency was positively related to physical symptoms and unrelated to depressive symptoms, while perceived availability of support was negatively related to depressive symptoms and unrelated to physical symptoms.     

Social support and postpartum depressive symptomatology: The mediating role of maternal self‐efficacy

Research shows that social support and maternal self‐efficacy are inversely related to postpartum depression; however, little is known about the mechanisms by which these variables impact on depressive symptomatology. This study uses path analysis to examine the proposal that maternal self‐efficacy mediates the effects of social support on postpartum depressive symptomatology. Primiparous women (n=247) completed questionnaires during their last trimester and then again at 4 weeks' postpartum (n=192) . It was hypothesized that higher levels of parental support, partner support, and maternal self‐efficacy would be associated with lower levels of depressive symptomatology postpartum and that the relationship between social support and depressive symptomatology would be mediated by maternal self‐efficacy. Results indicated that as expected, higher parental support and maternal self‐efficacy were associated with lower levels of depressive symptomatology postpartum. Partner support was found to be unrelated to both depressive symptomatology and maternal self‐efficacy. Results from the path analysis supported the mediation model. Findings suggest that parental support lowers depressive symptomatology by the enhancement of maternal self‐efficacy.     

A 2-year longitudinal study of depression among Alzheimer's caregivers.

Results from a 2-year (4 waves) longitudinal study show strong evidence for patient decline and high levels of depressive symptomatology among caregivers. Female caregivers reported high, stable rates of depressive symptomatology throughout the study, whereas male caregivers exhibited significant increases in depression over time. Cross-sectional multivariate analyses revealed significant positive relationships between depression and number of patient problem behaviors, negative social support, and concern about financial resources; negative relationships were found between depression and social support, quality of prior relationship, and satisfaction with social contacts. Three significant independent predictors of change in depression were found: Lower depression scores at Time 1 were related to increases in depression over time; men were more likely than women to experience increases; and a decline in social support resulted in increased depression.     

Prayer Coping,Disclosure of Trauma,and Mental Health Symptoms Among Recently Deployed United States Veterans of the Iraq and Afghanistan Conflicts

U.S. military veterans of the Iraq and Afghanistan conflicts are at risk for developing adverse mental health symptoms. This study was conducted to examine the associations between prayer coping, attitudes toward trauma disclosure, and mental health symptoms (posttraumatic stress disorder [PTSD] and depression) among 110 U.S. veterans who had returned from deployments in Operation Enduring Freedom and Operation Iraqi Freedom within the previous 6 months. Bivariate analyses revealed that prayer coping was positively correlated with an urge to talk about potentially traumatic experiences. When controlling for combat exposure, social support, and disclosure attitudes, multivariate regression analyses indicated that two of the prayer functions—praying for assistance and for calm and focus—were each uniquely linked with less PTSD and depressive symptomatology. In addition, a reliance on avoidant prayer was uniquely correlated with greater depressive symptomatology. These findings support emerging ideas about prayer as a form of trauma disclosure and highlight the relevance of this approach to coping for veterans as they readjust to civilian life.     

The relationship of marital satisfaction and social support to depressive symptomatology

The relationship between depressive symptomatology, as measured by the short-form Beck Depression Inventory (BDI), and two social support variables was assessed. Based on a sample of 131 married men and 136 married women, the results indicated that the quality of the marital relationship and the frequency of positive social contact with adults other than the spouse were significantly related to depressive symptomatology for both men and women. These two variables accounted for 16% of the variance in BDI scores. Further, analyses of risk for high BDI scores showed that individuals having the least support were 13 times more likely to be in the high-BDI group than individuals with the highest levels of social support. These results suggest that social isolation and marital discord are related to high BDI scores among married adults.     

Conscientiousness predicts disease progression (CD4 number and viral load) in people living with HIV.

OBJECTIVE: Psychosocial factors (e.g., depression, avoidant coping, life stress) have been related to disease progression in HIV. This study examined the relationship between the Big Five Conscientiousness factor and HIV disease progression (CD4 cell and viral load) over 1 year in 119 seropositive participants. The study also examined whether Conscientiousness effects were mediated by adherence, perceived stress, depression, or coping measures. DESIGN: In a 1-year longitudinal design, participants completed the NEO Five-Factor Inventory Conscientiousness scale (P. T. Costa & R. R. McCrae, 1992). Participants also completed psychosocial assessments and underwent blood draws at initial assessments and 1-year follow-up. MAIN OUTCOME MEASURES: Multiple hierarchical regression models were used to predict change in CD4 cell numbers and viral load log 10, controlling for demographic variables, initial disease status, and antiretroviral medications. RESULTS: Conscientiousness predicted significant increases in CD4 number and significant decreases in viral load at 1 year. Conscientiousness was related positively to medication adherence and active coping and negatively to depression and perceived stress. Only perceived stress emerged as a possible mediator. CONCLUSION: The significant relationship between Conscientiousness and medication adherence, distress, and coping suggests that an assessment of Conscientiousness in patients with HIV may help specify or target behavioral interventions to promote optimal disease management.