Article

The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS and Behavior, 10, 253-261

Department of Psychology, Kent State University, Kent, Ohio 44240, USA.
AIDS and Behavior (Impact Factor: 3.49). 06/2006; 10(3):253-61. DOI: 10.1007/s10461-006-9069-7
Source: PubMed

ABSTRACT Despite high rates of comorbidity, research has typically focused on the independent impact of posttraumatic stress disorder (PTSD) and depression symptoms in people living with HIV (PLWH). The present study examined the independent and comorbid influence of PTSD and depression symptoms on medication adherence, CD4 cell counts, and viral load, over the course of 3 months in 57 PLWH (82% men, 54% Caucasian, 44% African American) recruited from a clinic or social service agency. Both PTSD and depressive symptoms predicted lower subsequent adherence. However, only depressive symptoms predicted lower CD4 counts and presence of a detectable viral load. Participants reporting symptoms consistent with diagnostic levels of comorbid PTSD and depression were less likely to adhere to HAART and were more likely to have a detectable viral load. These results highlight the influences of PTSD and depression on adherence and HIV disease markers, and underscore the importance of examining comorbid symptomatology in PLWH.

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    • "gs , African Americans and men are more likely to have a mental health problem that is undetected by their healthcare providers ( Borowsky et al . , 2000 ) . Given the high rate of self - reported childhood trauma , PTSD , and alcohol and substance use problems in this sample—and considering the associated health - related consequences ( e . g . , Boarts et al . , 2006 ; Felitti et al . , 1998 ; Mokdad et al . , 2004 ; Walker et al . , 1999 ) —providers should consider including trauma history and mental health screenings as part of routine medical appointments . In addition , health professionals in both general medical settings and traditional mental health settings should consider the possibility o"
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    • "It is the most prevalent mental disorder among HIV-infected individuals [5] with prevalent rates two to four times higher than those found in the general population [5] [6] [7]. It is also key predictors of poor adherence to HIV medication [8] [9], and negatively impact on clinical outcomes [10]. There are nine symptoms listed in the Diagnostic and Statistical Manual IV (DSMIV) [11] for depressive disorder namely, sleep disturbance, interest/pleasure reduction , guilt feelings or thoughts of worthlessness, energy changes/fatigue, concentration/attention impairment, appetite/weight changes, psychomotor disturbances, suicidal thoughts and depressed mood. "
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    • "In a larger sample, Zen et al. showed that PTSD was associated with decreased medication adherence in patients with stable coronary heart disease, however this association did not remain significant after adjusting for depression (Zen et al., 2011). PTSD has also been associated with decreased adherence in patients with HIV, but the comorbidity between PTSD and depression was so high in one study that investigators were unable to test whether PTSD was associated with non-adherence independent of depression (Boarts et al., 2006). In contrast, our study examines the association between PTSD and medication adherence in a broad group of outpatients without any specific medical illnesses and includes sufficient patients without comorbid depression to test the independent association of PTSD and medication adherence. "
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    ABSTRACT: BACKGROUND: Patients with post-traumatic stress disorder (PTSD) are at increased risk for adverse outcomes from comorbid medical conditions. Medication non-adherence is a potential mechanism explaining this increased risk. METHODS: We examined the association between PTSD and medication adherence in a cross-sectional study of 724 patients recruited from two Department of Veterans Affairs Medical Centers between 2008 and 2010. PTSD was assessed using the Clinician Administered PTSD Scale. Medication adherence was assessed using a standardized questionnaire. Ordinal logistic regression models were used to calculate the odds ratios (ORs) for medication non-adherence in patients with versus without PTSD, adjusting for potential confounders. RESULTS: A total of 252 patients (35%) had PTSD. Twelve percent of patients with PTSD reported not taking their medications as prescribed compared to 9% of patients without PTSD (unadjusted OR 1.85, 95% CI 1.37-2.50, P<0.001). Forty-one percent of patients with PTSD compared to 29% of patients without PTSD reported forgetting medications (unadjusted OR 1.90, 95% CI 1.44-2.52, P<0.001). Patients with PTSD were also more likely to report skipping medications (24% versus 13%; unadjusted OR 2.01, 95% CI 1.44-2.82, P<0.001). The association between PTSD and non-adherence remained significant after adjusting for demographics, depression, alcohol use, social support, and medical comorbidities (adjusted OR 1.47, 95% CI 1.03-2.10, P=0.04 for not taking medications as prescribed and 1.95, 95% CI 1.31-2.91, P=0.001 for skipping medications). CONCLUSIONS: PTSD was associated with medication non-adherence independent of psychiatric and medical comorbidities. Medication non-adherence may contribute to the increased morbidity and mortality observed in patients with PTSD.
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