Challenges in Addressing Depression in HIV Research: Assessment, Cultural Context, and Methods

Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA.
AIDS and Behavior (Impact Factor: 3.49). 11/2010; 15(2):376-88. DOI: 10.1007/s10461-010-9836-3
Source: PubMed


Depression is one of the most common co-morbidities of HIV infection. It negatively impacts self-care, quality of life, and biomedical outcomes among people living with HIV (PLWH) and may interfere with their ability to benefit from health promotion interventions. State-of-the-science research among PLWH, therefore, must address depression. To guide researchers, we describe the main diagnostic, screening, and symptom-rating measures of depression, offering suggestions for selecting the most appropriate instrument. We also address cultural considerations in the assessment of depression among PLWH, emphasizing the need to consider measurement equivalence and offering strategies for developing measures that are valid cross-culturally. Finally, acknowledging the high prevalence of depression among PLWH, we provide guidance to researchers on incorporating depression into the theoretical framework of their studies and employing procedures that account for participants with depression.

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Available from: Michael Blank, Oct 14, 2015
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    • "Most of the studies that did not report a significant association with adherence utilized more standard diagnostic tools of depressive disorder such as the SCID, MINI, and CIDI. It would be important for future research evaluations of depression in HIV adherence research to improve data harmonization by utilizing the categorization of depression instruments that Simoni et al. [42] described as follows: [1] standardized diagnostic interviews, that are commonly used to assess the categorical diagnosis of depression based on DSM or ICD criteria, (including in this category CIDI, MINI, SCID, HADS, BDI etc.) [2] depression screening instruments, that provide empirically based cut-offs and are useful as the basis for referrals to more comprehensive evaluations or to estimate the prevalence of possible depression (including in this category CES-D and HSCL etc.), and [3] symptom-rating scales, that are useful for monitoring change in depression symptoms over time (including in this category BDI, CES-D, HSCL, MADRS etc.) [42]. Although there is no gold-standard for evaluation of depression, it has been recommended that researchers need to make informed choices based on the characteristics of the study population and the purpose of the research [42]. "
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    ABSTRACT: This is a systematic review of eighty-two published studies investigating the impact of DSM-IV mental disorders on combination antiretroviral therapy (cART) adherence and persistence among persons living with HIV/AIDS (PLWHA). Sixty-two articles examined depression, with 58 % (N = 32/62) finding lower cART adherence and persistence. Seventeen articles examined one or more anxiety disorders, with the majority finding no association with cART adherence or persistence. Eighty percent of the studies that evaluated the impact of psychotic (N = 3), bipolar (N = 5) and personality disorders (N = 2) on cART adherence and persistence also found no association. Seven out of the nine studies (78 %) evaluating the impact of antidepressant treatment (ADT) on cART adherence found improvement. Adherence and depression measurements varied significantly in studies; common research measurements would improve data harmonization. More research specifically addressing the impact of other mental disorders besides depression on cART adherence and RCTs evaluating ADT on cART adherence are also needed. Electronic supplementary material The online version of this article (doi:10.1007/s10461-012-0212-3) contains supplementary material, which is available to authorized users.
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    ABSTRACT: Depression consistently predicts nonadherence to human immunodeficiency virus antiretroviral therapy, but which aspects of depression are most influential are unknown. Such knowledge could inform assessments of adherence readiness and the type of depression treatment to utilize. We examined how depression severity, symptom type, and change over time relate to adherence. Microelectronic adherence and self-reported depression data from 1,374 participants across merged studies were examined with cross-sectional and longitudinal analyses. Depression variables included a continuous measure, categorical measure of severity, cognitive and vegetative subscales, and individual symptoms. At baseline, mean adherence was 69%, and 25% had mild/moderate and 18% had severe depression. In cross-sectional multivariate analyses, continuous depression, cognitive depressive symptoms, and severe depression were associated with lower adherence. In longitudinal analysis, reductions in both continuous and categorical depression predicted increased adherence. The relationship between global continuous depression and nonadherence was statistically significant, but relatively weak compared to that of cognitive depressive symptoms and severe depression, which appear to pose strong challenges to adherence and call for the need for early detection and treatment of depression.
    Annals of Behavioral Medicine 08/2011; 42(3):352-60. DOI:10.1007/s12160-011-9295-8 · 4.20 Impact Factor
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    ABSTRACT: Mental health problems are prevalent among HIV-infected individuals, with some estimates that 50% likely meet criteria for one or more psychiatric disorders. The mental health of HIV-infected individuals is important not only for quality-of-life concerns, but also in regard to HAART adherence and biological disease progression. The current review focuses on research published between 2009 and April of 2011, exploring mental health, coping, and stress in relation to HIV care behaviors including HAART adherence, quality of life, treatment retention, health care utilization, and disease progression amongst HIV-infected individuals. Specifically, we reviewed the most prevalent and interfering concerns among HIV-infected individuals-depression, post-traumatic stress disorder, interpersonal violence, stigma and shame, and body image concerns. Despite advances over the last 2 years documenting the deleterious effects of mental health on important HIV self-care behaviors, there is continued need for developing and disseminating evidence-based psychosocial interventions that integrate treating mental health problems with improving self-care behaviors for those living with HIV.
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