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 effects of room management and small-group procedures on the behavior of older adults who have Alzheimer's disease

The effects of room management and small groups procedures on the behavior of five older adults with Alzheimer's Disease was experimentally evaluated by a multielement design with replications across five subjects. Engagement during both room management and small groups was higher than during no treatment baselines. The effects on affective and maladaptive behaviors were of small magnitude. Evidence of individual differences was found both with respect to absolute proportions of time spent in various behaviors and with respect to interactions between individual differences and experimental conditions.     

Socioeconomic status and insomnia

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80+ years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia.     

A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers,chaplains, and leaders

The purpose of this qualitative study was to investigate the use of strategies for managing suicide-related events (SREs; i.e., suicide deaths, suicide attempts, and suicidal ideation with a plan and intent to die) during deployment from the perspective of Army decision makers: behavioral health providers (BHPs), chaplains, and leaders. A total of 76 Army personnel participated in individual interviews or focus groups. Participants identified unit watch, weapon removal, medical evacuations, and debriefings as common strategies used to manage SREs in deployed settings. Many of these strategies were highlighted as short-term solutions only. Participants also underscored the importance of unit cohesion and communication among leaders, BHPs, and chaplains to effectively manage SREs. The need for structured guidelines for successfully managing SREs in deployed settings is discussed.     

Engaging African American men in empirically based marriage enrichment programs: lessons from two focus groups on the ProSAAM project

To better meet the needs of eligible African American men who were reluctant to enroll in a 5-year study called the Program for Strong African American Marriages (ProSAAM), we employed two focus groups to listen to the voices of a sample of the population being recruited and to explore their feedback about taking part in such a marriage enrichment program and how best to recruit other African American men. We explain our application of the focus group results to our recruitment of African American married couples for ProSAAM. The positive outcomes from the implementation of these results can provide potential ideas for those seeking innovative means to improve recruitment of African American men to programs that strengthen marital relationships.     

Bibliotherapy for low sexual desire: evidence for effectiveness

This study examines the effectiveness of bibliotherapy for low sexual desire among women, which is the most frequent sexual concern brought to counselors. Forty-five women responded to an advertisement for participation in a study on low sexual desire and were assigned to either the intervention or the wait-list control group. The intervention group completed the Hurlbert Index of Sexual Desire (HISD; Apt & Hurlbert, 1992) and the Female Sexual Function Index (FSFI; R. Rosen et al., 2000), read the self-help book under study in 6 weeks, and completed the measures a second time. The control group completed the same measures 6 weeks apart. Results demonstrated that the intervention group made statistically greater gains over time as compared with the control group on measures of sexual desire (HISD and FSFI Desire subscale), sexual arousal (FSFI Arousal subscale), sexual satisfaction (FSFI Satisfaction subscale), and overall sexual functioning (FSFI Total Score). A subset of participants in the intervention group participated in a 7-week follow-up study, and these participants maintained their gains in sexual desire and overall sexual functioning. Findings have important implications for future research on the efficacy of bibliotherapy generally and for low sexual desire specifically. Results also have vital implications for the treatment of low sexual desire.     

The reciprocal cycle of self‐concealment and trust in romantic relationships

We propose that perceived partner concealment, self‐concealment from one's partner (i.e., keeping secrets from one's partner), and trust in one's partner form a reciprocal cycle in romantic relationships. In Study 1, participants in a romantic relationship (N = 94) completed a two‐time point survey within a span of 8 to 10 weeks. Results revealed that perceived partner concealment was associated with a loss of trust in partner, and low trust in partner was associated with an increase in self‐concealment from one's partner. Furthermore, the association between perceived partner concealment and self‐concealment from one's partner was mediated by trust. In Study 2, couples (N = 50) completed daily records for 14 consecutive days. Multilevel analyses indicated that on the days the individuals reported more self‐concealment, their partners reported lower trust in them. Moreover, on the days the partners reported lower trust, the partners also reported higher self‐concealment. These findings suggest that self‐concealment in romantic relationships can create a reciprocal cycle that involves loss of trust and more self‐concealment between partners, which would slowly deteriorate the relationship well‐being. Copyright © 2012 John Wiley & Sons, Ltd.     

Temperament Variation in Sensitivity to Parenting: Predicting Changes in Depression and Anxiety

Temperament was examined as a moderator of maternal parenting behaviors, including warmth, negativity, autonomy granting, and guidance. Observations of parenting and questionnaire measures of temperament and adjustment were obtained from a community sample (N = 214; ages 8–12). Trajectories of depression and anxiety were assessed across 3 years. The pattern of parenting as a predictor of internalizing symptoms depended on temperament. Maternal negativity predicted increases in depression for children low in fear. Effortful control moderated sensitivity to maternal negativity, autonomy granting, and guidance. Children low in effortful control reported more symptoms in the presence of negative or poor-fitting parenting. The results support differential responding, but also suggest that temperament may render children vulnerable for the development of problems regardless of parenting.     

A Clinical Intervention in Chronic Pain and Insomnia with a Combined Model of Treatment: A Test of Concept

Co-occurring chronic pain and insomnia are common in a clinical setting. Cognitive–behavioral theoretical (CBT) frameworks exist for both conditions independently. The purpose of this study was to address the problem of co-occurring chronic pain and insomnia with an integrated CBT model based on empirical support. One-hundred eleven individuals (age range 21–65 years) meeting the general criteria for chronic pain and insomnia were included in this study. Participants completed a demographic form, the Dysfunctional Beliefs and Attitudes about Sleep—16-item version, Insomnia Severity Index, Sleep Hygiene Index, Sleep Associated Monitoring Index, Pain Catastrophizing Scale, Pain Disability Questionnaire, Modified Somatic Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support. Significant positive bivariate relationships were observed for pain catastrophizing (PC) and dysfunctional beliefs and attitudes about sleep (DBAS), as well as somatic awareness and sleep-associated monitoring. Two backward stepwise regression models were utilized to determine a model for predicting insomnia severity and pain disability respectively using a combination of sleep and pain-associated measures. Insomnia severity was predicted by DBAS, PC, and somatic awareness. Pain disability was predicted by PC, DBAS, depression, and social support. Maladaptive thought patterns related to pain and insomnia and associated features appear to have a synergistic effect on both insomnia severity and pain disability and support a combined cognitive–behavioral model.