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.
"We did not aim to parcel out depression from the effect of PTSD but instead treated both depression and PTSD as two independent variables and found that each contributed its own substantial relationship. Our findings are consistent with studies demonstrating that PTSD and depression have independent (but additive) effects on suicidal thoughts and behavior (Cougle et al., 2009), uniquely predict different HIV indicators and adherence behaviors (Boarts et al., 2006), and differentially impact the burden of physical illness and use of mental health services (Possemato et al., 2010). Likewise, an analysis of motor vehicle accident survivors concluded that although PTSD and depression are correlated and highly co-prevalent, they have independent effects (Blanchard et al., 1998). "
[Show abstract][Hide abstract] ABSTRACT: Both posttraumatic stress disorder (PTSD) and depression are highly comorbid with chronic pain and have deleterious effects on pain and treatment outcomes, but the nature of the relationships among chronic pain, PTSD, and depression has not been fully elucidated. This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psychological status, quality of life, and disability, it is important for clinicians to recognize and treat both mental disorders in patients with chronic pain.
Journal of Behavioral Medicine 03/2015; 38(3). DOI:10.1007/s10865-015-9628-3 · 3.10 Impact Factor
"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"
[Show abstract][Hide abstract] ABSTRACT: Previous studies demonstrate that PTSD mediates the relationship between childhood trauma and alcohol and substance use disorders and that PTSD and alcohol/substance use comorbidity is greater in men than in women. We sought to replicate and extend these findings in a predominantly low-income, African-American sample recruited from a public hospital. We administered measures of childhood trauma, PTSD symptoms, problematic alcohol use, and problematic substance use to 803 men and 2084 women. We examined rates of comorbidity in men and women. Next, two bootstrap analyses were used to test whether PTSD is a mediator between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. Finally, two bootstrap analyses were used to test whether gender would moderate the indirect effect of PTSD in both the alcohol and substance use models. Results showed that although men and women reported similar overall PTSD symptom frequency, men were more likely than women to report PTSD comorbid with alcohol and/or substance use problems. In addition, PTSD partially mediated the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use. The indirect effects of PTSD on the relationship between childhood trauma and problematic alcohol use and between childhood trauma and problematic substance use were greater in men. This study demonstrates the important interplay of gender, childhood trauma, PTSD, and alcohol and substance use. Mental health providers should consider childhood trauma histories and diagnostic comorbidities when treatment planning.
"It is the most prevalent mental disorder among HIV-infected individuals  with prevalent rates two to four times higher than those found in the general population   . It is also key predictors of poor adherence to HIV medication  , and negatively impact on clinical outcomes . There are nine symptoms listed in the Diagnostic and Statistical Manual IV (DSMIV)  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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