HIV and depression--a systematic review of interventions

HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.     

Nonconcurrently presented auditory tones reduce distraction

Recent research has demonstrated that task-irrelevant stimuli presented simultaneously with a target-distractor stimulus reduce distraction and improve selective attention. In studies examining this reduced interference effect, visual selective attention tasks and concurrently presented task-irrelevant stimuli are used. We report first evidence for a similar effect in the auditory domain and with nonconcurrent stimuli (i.e., the task-irrelevant stimuli are presented before the target). The effect of nonconcurrently presented auditory tones on an auditory Stroop task developed by Leboe and Mondor (Psychological Research, 71, 568--575, 2007) was investigated. Stroop interference was reduced when task-irrelevant tones were presented before the Stroop stimulus. We conclude that task-irrelevant stimuli can improve selective attention not only when presented concurrently, but also when presented before the selective attention task. Our results are consistent with the hypothesis that interference reduction is due to perceptual dilution caused by task-irrelevant stimuli.     

Bonus of rebate?: the impact of income framing on spending and saving

All income increases a person's absolute wealth, but consumption decisions may be based more heavily on perceived changes in wealth. Change is computed by comparing a current state with a former state, and we predicted that people would be more likely to spend income framed as a gain from a current wealth state than income framed as a return to a prior state. Four experiments confirmed this prediction on people's memory for spending of a government tax rebate (Experiment 1), on unobtrusive self‐report measures of spending an unexpected windfall (Experiments 2 and 3), and on actual spending on items for sale in a laboratory experiment (Experiment 4). These results can be explained, at least in part, by the reference points implied in the framing of income (follow‐ups to Experiments 1 and 4). Discussion focuses on implications for the consumption of other commodities, assessments of risk, and government tax policies. Copyright © 2006 John Wiley & Sons, Ltd.     

The sad truth about depressive realism

In one form of a contingency judgement task individuals must judge the relationship between an action and an outcome. There are reports that depressed individuals are more accurate than are nondepressed individuals in this task. In particular, nondepressed individuals are influenced by manipulations that affect the salience of the outcome, especially outcome probability. They overestimate a contingency if the probability of an outcome is high—the “outcome-density effect”. In contrast, depressed individuals display little or no outcome-density effect. This apparent knack for depressives not to be misled by outcome density in their contingency judgements has been termed “depressive realism”, and the absence of an outcome-density effect has led to the characterization of depressives as “sadder but wiser”. We present a critical summary of the depressive realism literature and provide a novel interpretation of the phenomenon. We suggest that depressive realism may be understood from a psychophysical analysis of contingency judgements.*     

A support group for couples who have terminated a pregnancy after prenatal diagnosis: Recurrent themes and observations

Genetic Counselors are increasingly becoming involved in organizing and facilitating support groups for couples who have terminated a pregnancy because of an abnormal fetal diagnosis. This paper discusses recurrent themes which have emerged in the FATE (Feelings After the Termination Experience) support group which was founded in New Jersey in 1990. By becoming familiar with the issues we have observed in our support group, genetic counselors should be better able to understand and empathize with their patients who make the decision to terminate a much wanted pregnancy. They may also feel better prepared to become involved in organizing and facilitating such support groups.     

The Gradual Deterioration of Syntax and Semantics in a Patient with Progressive Aphasia

FM is a progressive aphasic patient whose language comprehension we studied over a 4-year period. We developed a variety of implicit and explicit tasks to chart progressive changes in the representation of linguistic knowledge (in particular, syntax and semantics) and the automatic and controlled processes which operate on that knowledge. The representation of FM's semantic knowledge remained essentially intact over the years, but she became increasingly impaired at combining the meanings of words. She also showed progressive impairments in the processes of syntactic combination. Thus, FM's disease resulted in a progressive inability to engage in those combinatorial processes necessary for the normal comprehension of a spoken utterance. This is not a selective deficit in the traditional sense of the term, since aspects of both syntax and semantics are implicated; but it is selective in the sense that other aspects of language comprehension remain intact.     

Research as a family therapy intervention technique

The utilization of the research process as an intervention has recently been described in the family therapy literature. However, it is important to draw a distinction between research as intervention and research as a unique family therapy intervention technique. From a family systems perspective, research as an intervention technique may make therapy more palatable for some families. A case study is presented in which this technique created the context for change for a family involved in a chronic illness research project.The author would like to thank Dr. Wendy L. Watson for her participation as a member of the clinical team and Drs. Fabie Duhamel and Wendy L. Watson for their helpful critiques on earlier drafts of this paper.Supported by a grant from the Albert Foundation for Nursing Research.     

Second guesses and the attention-switching model for successiveness discrimination

The present note demonstrates that Baron’s (1971) second-guess data are not inconsistent with the basic assumptions of Kristofferson’s attention-switching model.