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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    • "Among HIV-positive samples, inflated depression rates may in part occur due to HIV symptom overlap. The CES-D's sensitivity to clinically significant depression in this population has been previously demonstrated (Eller et al., 2010; Kalichman, Rompa, & Cage, 2000; Simoni et al., 2011). The CES-D is often used as a screening instrument, with total scores of ≥16 and ≥26 indicative of mild and moderate to severe depression, respectively (Radloff, 1977). "
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    ABSTRACT: We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.
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    • "They are more likely to initiate antiretroviral therapy at lower CD41 T cell counts and higher viral loads, have decreased adherence and retention, and delayed viral suppression leading to accelerated progression toward AIDS and AIDS-related mortality , compared to those PLWH who are not depressed (Atkinson et al., 2008;Lall, Lim, Khairuddin, & Kamarulzaman, 2015; World Health Organization[WHO], 2008). Specifically, one study found that PLWH who were depressed and had suboptimal adherence experienced a six-times greater mortality risk (Simoni et al., 2011). Limited programmatic findings available in the literature have revealed promising results for mental health and HIV care integration in low-resource settings (Chibanda et al., 2011;Chibanda et al., 2015;Mpungu et al., 2015;Pence et al., 2014). "
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    ABSTRACT: Alcohol use and depression negatively impact adherence, retention in care, and HIV progression, and people living with HIV (PLWH) have disproportionately higher depression rates. In developing countries, more than 76% of people with mental health issues receive no treatment. We hypothesized that stepped-care mental health/HIV integration provided by multiple service professionals in Zimbabwe would be acceptable and feasible. A three-phase mixed-method design was used with a longitudinal cohort of 325 nurses, community health workers, and traditional medicine practitioners in nine communities. During Phase 3, 312 PLWH were screened by nurses for mental health symptoms; 28% were positive. Of 59 PLWH screened for harmful alcohol and substance use, 36% were positive. Community health workers and traditional medicine practitioners screened 123 PLWH; 54% were positive for mental health symptoms and 29% were positive for alcohol and substance abuse. Findings indicated that stepped-care was acceptable and feasible for all provider types.
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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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