Background Despite high rates of post-cardiac surgery depression, studies of depression treatment in this population have been limited. Objective To evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. Methods From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and one month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV (SCID-I); those who met criteria for clinical depression (n=81) were randomized to CBT (n=45) or usual care (UC; n=36). After completion of the UC period, 25 individuals were offered later CBT (UC+CBT). Results Main outcomes (depressive symptoms [BDI] and clinical depression [SCID-I]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. In the CBT group compared to the UC group, there was greater decline in BDI scores (β=1.41 [95% CI 0.81–2.02], p = <.001) and greater remission of clinical depression (29 [64%] vs. 9 [25%], number need to treat, 2.5 [95% CI, 1.7–4.9], p < .001). Compared to the early CBT group, (median time from surgery to CBT = 45.5 days) the later UC+CBT group (median time from surgery to CBT = 122 days) also experienced a reduction in BDI scores, but the group x time effect was smaller (β=0.79 [95% CI 0.101.47], p = .03) and remission rates between the two groups did not differ. Conclusions Early home CBT is effective in depressed post-cardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.

HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N = 600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one's diagnosis a secret may make it more difficult to take one's medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.

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Frailty is a deficit accumulation in physical, psychological and social domains. Correlates of frailty were explored among formerly incarcerated, homeless women (N=130, M age = 38.9). Significant correlates of physical frailty were age, years homeless, prior violence, witnessing less violence, drug dependence, PTSD symptoms and tangible support. Significant correlates of psychological frailty were age, years homeless, witnessed violence, jail time, divorced less, drug use/dependence, prison time, methamphetamine use, and bodily pain. Significant correlates of social frailty were drug use, emotional regulation, and daily alcohol use. Reentry interventions are needed for formerly incarcerated, homeless women who experience physical, psychological and social frailty.

Cervical cancer is a leading cause of death among women in low- and middle-income countries, and women living with HIV are at high risk for cervical cancer. The objective of this study was to estimate the prevalence and correlates of cervical cancer and pre-cancer lesions and to examine cervical cancer knowledge among women living with HIV receiving antiretroviral therapy in rural Andhra Pradesh, India. We conducted cytology-based screening and administered a standardized questionnaire among 598 HIV-infected women. We found 5 (0.8%), 39 (6.5%), 29 (4.9%), and 4 (0.7%) had atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cervical carcinoma (SCC), respectively. In multivariable logistic regression analysis, ASCUS/LSIL was independently associated with age >16 years old at first sexual encounter and smokeless tobacco use. We found no factors associated with HSIL/SCC. In total, 101 women (16.9%) had heard of cervical cancer and 28 (27.7%) of them correctly identified HIV infection as a risk factor. In light of the high prevalence of pre-cancer lesions and low level of cervical cancer knowledge in our study population, focused interventions are needed to improve cervical cancer literacy and prevention among rural women living with HIV.

Despite the availability of cure for hepatitis C virus (HCV), people experiencing homelessness (PEH) are challenged with initiating and completing HCV treatment. The design of culturally sensitive HCV treatment programs is lacking. The objective was to employ community-based participatory research methods to understand perceptions of HCV-positive PEH, and providers, on the design and delivery of a culturally sensitive, nurse-led community health worker (RN/CHW) HCV initiation and completion program. Four focus group sessions were conducted with HCV-positive PEH ( n = 30) as well as homeless service providers (HSP; n = 7) in Skid Row, Los Angeles. An iterative, thematic approach provided the themes of essentials of successful participant engagement and retention: Role of nurse-Led CHW in promoting: (a) tangible and emotional support; (b) cognitive and behavioral support; and (c) financial and structural resources. The goal of this study is to provide the groundwork for future research of HCV program design to support HCV cure among homeless populations.

Adults experiencing homelessness experience a disproportionate burden of health disparities which has further exacerbated mental health, substance use, and coping during the COVID-19 pandemic. As limited data is available to understand the experience of adults experiencing homelessness and their health during this time, the purpose of this study was to explore how COVID-19 may have impacted their mental health, substance use, and ways of coping in this population. Using community-based participatory research, a community advisory board was established and remote individual interviews with 21 adults experiencing homelessness and 10 providers were conducted in Skid Row, Los Angeles. Using a qualitative, data analytic approach, the following major themes emerged: (1) Negative Impact of COVID-19 on Mental Health; (2) Negative Impact of COVID-19 on Limitation of Harm Reduction Services; and (3) Coping Strategies Utilized During the COVID-19 Pandemic. More research is needed to understand the impact of this pandemic on underserved communities.

Background: Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve depressive symptoms in older adults with comorbid insomnia and depression. However, it remains unclear whether brief CBT-I is effective for improving depressive symptoms in communitydwelling older adults with insomnia symptoms of varying severity.Aim: This study sought to examine the effectiveness of a brief CBT-I intervention delivered by public health nurses to improve depressive symptoms among older adults recruited from a community setting.Methods: This randomized controlled study compared sleep status and depression at baseline and a 3-month follow-up using a wait-list control design. Depression was evaluated using the Geriatric Depression Scale short form (GDS-SF). Results: The GDS-SF scores in the CBT-I group improved over time (p < .01), with an effect size (Cohen's d) of 0.34 (95% CI [0.16, 0.58]). The results demonstrated the effectiveness of a brief CBT-I intervention for depression, although the effect size was small.Linking Evidence to Action: A brief CBT-I intervention consisting of sleep hygiene education, stimulus control, sleep restriction, cognitive restructuring, and relaxation is effective for improving depressive symptoms among older adults in the community.