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.     

Self-Discrepancies as Predictors of Vulnerability to Distinct Syndromes of Chronic Emotional Distress

Two types of self-discrepancy differing in both domain and standpoint of self-guide were examined as predictors of vulnerability to chronic emotional syndromes. Study 1 assessed discrepancy between the actual/own self-state and the ideal/own self-guide and between the actual/own self-state and the ought/other self-guide in predicting syndromes of dejection and agitation as well as different types of anger. Actual/own: ideal/own discrepancy (AI) was uniquely related to dejection, frustration, and anger at self as measured 2 months later; actual/own:ought/other discrepancy (AOO) was uniquely related to agitation and to anger at others and resentment. Study 2 used structural equation modeling of the relations between AI and AOO discrepancy and social anxiety versus depression as measured weeks later. A model in which AOO was more strongly associated with social anxiety and AI was more strongly associated with depressive symptoms provided the best fit. The results support the convergent and discriminant validity of a self-discrepancy model of vulnerability to chronic emotional syndromes.     

A "change-of-standard" perspective on the relations among context, judgment, and memory

We conducted three studies that tested a "change-of-standard" perspective on the relations among context, judgment, and recall. Each study consisted of two or three sessions held a few days apart. All subjects read about the sentencing decisions of one or two target trial judges and of six nontarget trial judges who consistently gave either higher or lower sentences than the target judge(s). Each study varied both the standard that was available when subjects initially judged the sentencing decisions of a target judge and the standard available when subjects subsequently recalled those decisions. To accomplish this, we varied the context of judgment, the timing of judgment, and the overall category norm for trial judges' sentencing decisions that was available at recall. We found that although subjects had been exposed to the same target information and had initially judged it in the same way, their recall of the information was different depending on whether and how a change-of-standard had occurred between judgment and recall. Unique predictions of the change-of-standard perspective were confirmed that could not be accounted for in terms of other types of context effects on judgment and memory.     

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.