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.     

Explaining Choices in Procedural and Distributive Justice Across Cultures

A previous study (Leung, Bond, & Schwartz, 1990) established that an expectancy-valence model could be used effectively to explain behaviours in three social domains both within and across cultures. In this study the model was applied to the domains of resource allocation and conflict resolution in order to pinpoint which expectancies and which valences were carrying the explanatory weight of the respondents' behavioural strategies. For both Israeli and Hong Kong students the expectancies and, less strongly, the valences tapping harmony and performance quality were important for resource allocation; those tapping animosity reduction and process control, for conflict resolution. Suggestions were offered for broadening the net of explanatory constructs for future work aimed at specifying subjective factors associated with justice-related behaviours.     

The valuing process: A study of favorite songs and the inner experience of persons diagnosed with schizophrenia

Since valuing is a process grounded in the organizational tendency of human behavior, the characteristics of a highly valued object should reflect the experience of the individual who selects it. This research compared the favorite songs of fourteen individuals diagnosed with schizophrenia to their inner experience as assessed in a standard interview. Many relationships were revealed between the two, often pertaining to important issues identified in theories of schizophrenia. Results may have therapeutic applications and shed light on processes through which psychological difficulties persist.     

As If Your Life Depended on It: Promoting Cognitive Development to Promote Wellness

In this article the authors discuss key elements of the cognitive-developmental perspective and the need to integrate it as an important component of the wellness model. Each speaks to the personal empowerment of every person to live a rewarding and responsible life. Each also emphasizes the ongoing promotion of growth rather than secondary prevention or remediation.     

Ethical dilemmas in context: Some preliminary questions

I have tried to build on O'Neill's thought-provoking paper by examining two influences that shape and define ethical dilemmas in the community: our personal agendas and the broader context. The first influence is the way in which our personal and professional values shape our agendas for community work. The way these agendas frame the choices for action are a force to be recognized separate from the question of who constitutes our community constituency. Our values may push us into proactive roles and we must face the way our actions make personal/political statements. The broader context of the community situation and the ways in which resource limitations frame the ethical question also need to be actively recognized. Otherwise there is a danger of making the psychologist the victim by posing the ethical dilemma as a question of how they alone should find a solution. The nature of our personal agenda must be clear before we ask “responsible to whom?” The broader context must be considered before we ask “responsible for what?”     

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.This study was supported in part by NIMH Grants 41852, 30915, 18269, and 16884.     

The Depressive Experiences Questionnaire: revision and validation

The present study presents a new, unit-weight scoring system for the Depressive Experiences Questionnaire (DEQ). One hundred thirty-one college students completed the DEQ, the Bem Sex-Role Inventory (BSRI), and the Beck Depression Inventory (BDI). The revised DEQ scales were shown to have substantial levels of internal consistency. The three subscales of the revised DEQ were significantly correlated with the BSRI masculinity and femininity scales but not with gender. Significant correlations were also obtained between DEQ anaclitic, DEQ introjective scales and the BDI.     

Vocal frequency and person perception: Effects of perceptual salience and nonverbal sensitivity

Previous research has demonstrated that changes in vocal frequency (pitch) influence judgments made about a speaker, although there is some question as to the relative importance of frequency to message content in person perception. Moreover, these studies have failed to examine the possible joint effect of frequency and individual differences in nonverbal sensitivity on person perception. The purpose of the present investigation was to examine the independent and joint effects of vocal frequency, perceptual salience, and nonverbal sensitivity (assessed by the Profile of Nonverbal Sensitivity) on person perception. Participants were assigned to one of nine experimental conditions and were asked to rate two male and two female speakers on seven unipolar adjective scales. The nine conditions were produced by factorially combining three levels each of salience (content, voice, control) and vocal frequency (decreased, increased, unmanipulated). The results of hierarchical multiple regression analyses indicated that variations in frequency did influence evaluative judgments of the speakers (competent, honest, persuasive), but that the magnitude of the influence varied as a function of the participants' levels of nonverbal sensitivity. The analyses, however, yielded no significant effects for participants' affective judgments, nor any significant effects involving perceptual salience.     

Learning and motivation: Computer simulations of the Rescorla-Wagner,Solomon-Corbit,and Schull models

A suite of programs is described for simulating the Rescorla-Wagner (1972) model of associative learning, the Solomon and Corbit (1974) opponent-process theory, and Schull’s (1979) extension of the latter. The programs are written for the Commodore 64 computer.