Development and Implementation of Health and Wellness CBT for Individuals With Depression and HIV

Abstract

Rates of depression are reported to be between 22–33% in adults with HIV, which is double that of the general population. Depression negatively affects treatment adherence and health outcomes of those with medical illnesses. Further, it has been shown in adults that reducing depression may improve both adherence and health outcomes. To address the issues of depression and non-adherence, Health and Wellness (H&W) Cognitive Behavioral Therapy (CBT) and medication management (MM) treatment strategies have been developed specifically for youth living with both HIV and depression. H&W CBT is based on other studies with uninfected youth and upon research on adults with HIV. H&W CBT uses problem-solving, motivational interviewing, and cognitive-behavioral strategies to decrease adherence obstacles and increase wellness. The intervention is delivered in 14 planned sessions over a 6-month period, with three different stages of CBT. This paper summarizes the feasibility and acceptability data from an open depression trial with 8 participants, 16–24 years of age, diagnosed with HIV and with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of depression, conducted at two treatment sites in the Adolescent Trials Network (ATN). Both therapists and subjects completed a Session Evaluation Form (SEF) after each session, and results were strongly favorable. Results from The Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) also showed noteworthy improvement in depression severity. A clinical case vignette illustrates treatment response. Further research will examine the use of H&W CBT in a larger trial of youth diagnosed with both HIV and depression.

Subtypes of depressive symptoms and inflammatory biomarkers: An exploratory study on a sample of HIV-positive patients

“…Based on our depressive symptoms subtypes, diagnostic algorithms may be developed to help in the differential diagnosis between idiopathic depression and HIV-related symptoms and target appropriate treatments. Further understanding of the inflammatory factors underlying the different subtypes of depressive symptoms in HIV-positive individuals will help to identify new approaches targeting inflammation to employ as adjuvant to anti-depressants or stimulants (Udina et al, 2014; Breitbart et al, 2001; Hill and Lee, 2013) in association with psychotherapy (Crane et al, 2005; Kennard et al, 2014) among HIV positive depressed patients. In addition to Il-6, TNF-α, and monocytes, future longitudinal studies should be conducted to test the effect of Il-1, Il-2, HMGB1, CRP, cortisol, kynurenine, and genes expression on depressive symptoms CD4+ levels and virus replication (Zunszain et al, 2011, 2012; Valkanova et al, 2013; Boasso et al, 2007).…”

Mental health challenges among adolescents living with HIV

“…Few mental health interventions, specifically for HIVinfected adolescents, have been studied. One pilot study from a resource-rich setting used health and wellness cognitive behavioural therapy for 8 HIV-infected participants aged 16-24 years and found significant improvement in depression symptoms as measured over 14 sessions by the Quick Inventory of Depressive Symptomatology-Clinician measure, as well as improved self-reported adherence [82]. In a literature review of studies evaluating the impact of service delivery interventions to improve the health of perinatally HIV-infected adolescents, the overall conclusion from the 12 studies examined was that youth-focused health services and individual-level interventions would improve adherence and retention in care; however, these were small studies with limited follow-up times, and the impact of the service delivery interventions on mental health were largely unexamined [83].…”

Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV

“…66,68,69 Fortunately, intervention researchers have started to demonstrate the feasibility of incorporating motivational interviewing and cognitivebehavioral interventions into integrated HIV youth treatment settings. 36,[63][64][65][66] However, much work is still needed in the development of such interventions to best serve the psychosocial and medical needs of young African American males living with HIV.…”

“…Thus, there is a robust need for the development of efficacious substance use reduction programs for this population that can be embedded within interdisciplinary care teams and delivered in a culturally and developmentally sensitive framework. Fortunately, recent research has begun to evaluate interventions such as motivational interviewing 63,64 and cognitive-behavioral therapy 65,66 to reduce the deleterious effects that substance use and psychological distress can have on adherence for YLH.…”