Association of Depressive Symptoms with Lapses in Antiretroviral Medication Adherence Among People Living with HIV: A Test of an Indirect Pathway

Abstract

Viral suppression, a critical component of HIV care, is more likely when individuals initiate antiretroviral therapy (ART) early in disease progression and maintain optimal levels of adherence to ART regimens. Although several studies have documented the negative association of depressive symptoms with ART adherence, less is known about how depressed mood relates to intentional versus unintentional lapses in adherence as well as the mechanisms underlying this association. The purpose of the current study was to examine the association of depressive symptoms with ART adherence, assessed as a multidimensional construct. Secondarily, this study conducted preliminary indirect path models to determine if medication self-efficacy could explain the depressed mood-adherence relationship. Depressive symptoms were not associated with 95% ART taken, self-reported viral load, deliberate adjustments to ART regimens or skipped ART doses. However, the indirect association of depressive symptoms via decrements in medication self-efficacy was significant for 95% ART taken, self-reported viral load and skipped ART doses, but not deliberate changes to ART regimens. In this sample of HIV-positive outpatients, there is evidence to support medication self-efficacy as a potential mechanism underlying the association between depressive symptoms and ART adherence. Additional longitudinal studies are needed to formally examine medication taking self-efficacy as a mediator.

Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV

“…We did not find support for the cognitive attributes of adherence self-efficacy and adherence motivation as explanatory mediators in the relationship between depressive symptoms and ART adherence in this population of recently incarcerated PLHIV. Previous studies have found support for adherence self-efficacy as a mediator of this relationship in clinical populations in the U.S. [19,61], and Uganda [18]. While we did find that greater depressive symptoms were associated with lower adherence self-efficacy in this population, greater adherence self-efficacy was not associated with higher ART adherence.…”

Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men

“…A systematic review of 52 studies on the impact of depression on ART adherence found inconsistent results, with 30 studies indicating a direct negative effect of depression on adherence and 22 studies finding no conclusive effect [71]. More recent studies have also reported that depression was not directly associated with ART adherence [46,72]. Our initial model also revealed our data was not compatible with an association between HIV-related stigma and severity of drug dependence or between social support and anxiety.…”