Effective Treatment of Depressive Disorders in Medical Clinics for Adolescents and Young Adults Living With HIV

Abstract

Objective Preliminary test of a manualized, measurement-guided treatment for depression for adolescents and young adults in care at four sites of the Adolescent Trials Network for HIV/AIDS Interventions (ATN). Design The U.S. sites were randomly assigned to either a 24-week, combination cognitive behavioral therapy and medication management algorithm (COMB) tailored for youth living with HIV (YLWH) or to treatment as usual (TAU). Methods Youth at TAU sites had access to therapists and medication management as needed. COMB site clinicians were trained in the manualized intervention and participated in supervision calls to monitor intervention fidelity. Results Over the course of the study with 44 participants, those in COMB, compared to those in TAU, reported fewer depressive symptoms, p<0.01 (as measured by the Quick Inventory for Depression Symptomatology) and were more likely to be in remission, p<0.001, (65% vs.10% at week 24 end of treatment, and 71% vs. 7% at week 48 final follow-up). A greater proportion of COMB participants received psychotherapy (95% vs. 45%, p<0.001) and attended more sessions (12.6 vs. 5, p<0.001) than those in TAU. Viral load decreased in both groups and was associated (p<0.05) with reduction in depressive symptoms. Conclusions A 24-week manualized, measurement-guided psychotherapy and medication management algorithm tailored for YLWH was more effective in achieving and sustaining remission from depression than treatment as usual at HIV care clinic sites. Given observed treatment efficacy, this structured combination treatment could be disseminated to medical clinics in order to successfully treat YLWH, who are at particular risk for depression.

A group-based mental health intervention for young people living with HIV in Tanzania: results of a pilot individually randomized group treatment trial

“…Stigma was measured using a truncated (10 question) Berger HIV Stigma Scale. Included questions related to both internal or 'negative self-image' (four questions, 2,3, 7,12) and external stigma or 'public attitudes' (six questions, 9,10,14,16,20,32) and were analyzed in these two categories as well as the total score for interpreting results (scale range 10-40) [40] and were used in our prior research [9].…”

“…Across two sites in Moshi, Tanzania, 25–45% of YPLWH self-reported significant difficulties with depression, post-traumatic stress, and/or emotional/behavioral challenges [ 9 , 13 ]. Prior studies have demonstrated that mental health interventions can effectively improve ART adherence in high income countries [ 14 , 15 ] and proof of concept has been demonstrated for adults in low resource settings [ 16 – 18 ]. However, evidence-based interventions designed to address the unique mental health challenges faced by YPLWH in low resource settings are lacking [ 19 , 20 ].…”

The Relationship Between Automatic Thoughts and Depression in a Cognitive-Behavioral Treatment for People Living with HIV/AIDS: Exploring Temporality and Causality

“…Fortunately, depression in PLWHA is amenable to change via psychotherapeutic interventions, especially cognitive behavioral therapies (Brown et al 2016; see Olatunji et al 2006 for a review). One evidenced-based approach, cognitive-behavioral therapy for adherence and depression (CBT-AD), has a growing evidence base in individuals with chronic illness, such as in PLWHA (Brown et al 2016; Safren et al 2009, 2012, 2016; Simoni et al 2013) and diabetes (Safren et al 2014), despite its challenges in application (Simoni et al 2011).…”

“…One evidenced-based approach, cognitive-behavioral therapy for adherence and depression (CBT-AD), has a growing evidence base in individuals with chronic illness, such as in PLWHA (Brown et al 2016; Safren et al 2009, 2012, 2016; Simoni et al 2013) and diabetes (Safren et al 2014), despite its challenges in application (Simoni et al 2011). CBT-AD contains interventions that specifically address medication adherence and, for depression, modules for behavioral activation, cognitive restructuring with a particular focus on negative automatic thoughts (ATs), problem-solving, and relaxation training.…”

Características de personalidade e adesão ao tratamento em pacientes jovens portadores de HIV: estudo comparativo

“…Surge a necessidade de mudança de postura em relação ao paciente na prática da equipe de saúde, ampliando o olhar para questões individualizadas. Evidencia-se a importância do psicólogo hospitalar na equipe e o acompanhamento psicológico frequente para os pacientes, pois as características de personalidade são passíveis de ajustamento e melhoria através de técnicas de psicoterapia (73,76). O profissional especializado poderá avaliar detalhadamente quais fatores psicológicos estão influenciando a baixa adesão, minimizando seus impactos no sucesso terapêutico.…”