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Akay-Espinoza C, Newton SEB, Dombroski BA, Kallianpur A, Bharti A, Franklin DR, Schellenberg GD, Heaton RK, Grant I, Ellis RJ, Letendre SL, Jordan-Sciutto KL. Genetic Variations in EIF2AK3 are Associated with Neurocognitive Impairment in People Living with HIV. J Neuroimmune Pharmacol 2024; 19:25. [PMID: 38789639 PMCID: PMC11126443 DOI: 10.1007/s11481-024-10125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Based on emerging evidence on the role for specific single-nucleotide variants (SNVs) in EIF2AK3 encoding the integrated stress response kinase PERK, in neurodegeneration, we assessed the association of EIF2AK3 SNVs with neurocognitive performance in people with HIV (PWH) using a candidate gene approach. This retrospective study included the CHARTER cohort participants, excluding those with severe neuropsychiatric comorbidities. Genome-wide data previously obtained for 1047 participants and targeted sequencing of 992 participants with available genomic DNA were utilized to interrogate the association of three noncoding and three coding EIF2AK3 SNVs with the continuous global deficit score (GDS) and global neurocognitive impairment (NCI; GDS ≥ 0.5) using univariable and multivariable methods, with demographic, disease-associated, and treatment characteristics as covariates. The cohort characteristics were as follows: median age, 43.1 years; females, 22.8%; European ancestry, 41%; median CD4 + T cell counts, 175/µL (nadir) and 428/µL (current). At first assessment, 70.5% used ART and 68.3% of these had plasma HIV RNA levels ≤ 200 copies/mL. All three noncoding EIF2AK3 SNVs were associated with GDS and NCI (all p < 0.05). Additionally, 30.9%, 30.9%, and 41.2% of participants had at least one risk allele for the coding SNVs rs1805165 (G), rs867529 (G), and rs13045 (A), respectively. Homozygosity for all three coding SNVs was associated with significantly worse GDS (p < 0.001) and more NCI (p < 0.001). By multivariable analysis, the rs13045 A risk allele, current ART use, and Beck Depression Inventory-II value > 13 were independently associated with GDS and NCI (p < 0.001) whereas the other two coding SNVs did not significantly correlate with GDS or NCI after including rs13045 in the model. The coding EIF2AK3 SNVs were associated with worse performance in executive functioning, motor functioning, learning, and verbal fluency. Coding and non-coding SNVs of EIF2AK3 were associated with global NC and domain-specific performance. The effects were small-to-medium in size but present in multivariable analyses, raising the possibility of specific SNVs in EIF2AK3 as an important component of genetic vulnerability to neurocognitive complications in PWH.
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Affiliation(s)
- Cagla Akay-Espinoza
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S. 40th St, Rm 312 Levy, Philadelphia, PA, 19104, USA
| | - Sarah E B Newton
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S. 40th St, Rm 312 Levy, Philadelphia, PA, 19104, USA
| | - Beth A Dombroski
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Asha Kallianpur
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ajay Bharti
- Departments of Medicine, University of California, San Diego, CA, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Kelly L Jordan-Sciutto
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 S. 40th St, Rm 312 Levy, Philadelphia, PA, 19104, USA.
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Weinstein ER, Mendez NA, Jones MA, Safren SA. The impact of syndemic burden, age, and sexual minority status on internalized HIV stigma among people living with HIV in South Florida. J Health Psychol 2024:13591053241249633. [PMID: 38738485 DOI: 10.1177/13591053241249633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Internalized HIV stigma has been associated with several poor mental and physical health outcomes among people living with HIV (PLWH); yet, little research has explored how internalized HIV stigma may be affected by syndemic burden. This study sought to examine the relationship between syndemic conditions and HIV stigma over and above the potential effects of two social determinants of health, age and sexual minority status, using a linear regression approach (N = 1343). Syndemic burden was significantly positively associated with internalized HIV stigma above and beyond the effects of age and sexual minority status (b = 0.23). Additionally, age (b = -0.02) and being a sexually minority (b = -0.31) were significantly negatively associated with internalized HIV stigma. Findings should inform future treatment targets for this population by specifically working to reduce internalized HIV stigma for people with a greater syndemic burden and, potentially, among young adults and heterosexual PLWH.
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Affiliation(s)
| | | | - Megan A Jones
- Milken Institute School of Public Health, George Washington University, USA
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Saputra R, Waluyo A, Edison C. The Relationship between Distress Tolerance and Spiritual Well-Being towards ARV Therapy Adherence in People Living with HIV/AIDS. Healthcare (Basel) 2024; 12:839. [PMID: 38667601 PMCID: PMC11050109 DOI: 10.3390/healthcare12080839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
A crucial factor in the success of treatment for patients with Human Immunodeficiency Virus (HIV) is adherence to antiretroviral (ARV) therapy among People Living with HIV/AIDS (PLWHA). Adherence issues remain a persisting problem with multifaceted causes. There are many studies on variables related to ARV therapy adherence, but no study has been found on spiritual well-being and distress tolerance in ARV therapy adherence. This study aims to determine the relationship between distress tolerance and spiritual well-being on adherence to ARV therapy in PLWHA. This research used a quantitative approach with a cross-sectional design. The sample collection process followed a consecutive sampling technique, with data gathered from 129 participants at the South Lampung Regional General Hospital located in Indonesia. Data collection was conducted using three questionnaires administered by the interviewer, which assessed distress tolerance using the Miller-Smith Rating Scale For Stress Tolerance (MSRS-ST), evaluated spiritual Well-Being using the Spiritual Well-Being Scale (SWBS), and gauged ARV therapy adherence using the Medication Adherence Rating Scale (MARS). Data analysis using a simple logistic regression with a 95% confidence interval (CI) showed a significant relationship between distress tolerance (p-value 0.002) and spiritual well-being (p-value 0.036) towards ARV therapy adherence in PLWHA. The results of multiple logistic regression yielded distress tolerance as the most dominant and influential variable in this research. Distress tolerance and spiritual well-being impact adherence to ARV therapy in PLWHA. Suggestions for healthcare services should consider these factors to decrease the risk of non-adherence to therapy and inadvertently heighten mortality risk.
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Affiliation(s)
| | - Agung Waluyo
- Faculty of Nursing, Universitas Indonesia, Depok 16424, Indonesia; (R.S.); (C.E.)
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Nabunya P, Cavazos-Rehg P, Mugisha J, Kasson E, Namuyaba OI, Najjuuko C, Nsubuga E, Filiatreau LM, Mwebembezi A, Ssewamala FM. An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54635. [PMID: 38457202 PMCID: PMC10960218 DOI: 10.2196/54635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. OBJECTIVE The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths' outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. METHODS Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. RESULTS Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants' feedback. CONCLUSIONS This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54635.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Erin Kasson
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Claire Najjuuko
- Division of Computational & Data Sciences, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Edward Nsubuga
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Lindsey M Filiatreau
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Manavalan P, Li Y, Mills JC, Kwara A, Zhou Z, Ritter AS, Spencer E, Pence BW, Cook RL. Depression and Anxiety Symptoms and Treatment Utilization, and Associated HIV Outcomes among Adults with HIV in Rural Florida. AIDS Behav 2024; 28:164-173. [PMID: 37566153 DOI: 10.1007/s10461-023-04147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
Persons living with HIV (PLWH) and depression or anxiety in the rural South may have suboptimal HIV outcomes. We sought to examine the proportion of PLWH from rural Florida with symptoms of depression or anxiety, the proportion who received depression or anxiety treatment, and the relationship between untreated and treated symptoms of depression or anxiety and HIV outcomes. Cross-sectional survey data collected between 2014 and 2018 were analyzed. Among 187 PLWH residing in rural Florida (median age 49 years, 61.5%, male 45.5% Black), 127 (67.9%) met criteria for symptoms of depression and/or anxiety. Among these 127 participants, 60 (47.2%) were not on depression or anxiety treatment. Participants with untreated symptoms of depression and anxiety (OR 3.2, 95% CI 1.2-9.2, p = 0.03) and treated depression and anxiety with uncontrolled symptoms (OR 1.4, 95% CI 0.5-4.0, p = 0.52) were more likely to have viral non-suppression compared to those without depression or anxiety in an unadjusted bivariate analysis. Only the association between untreated symptoms of depression and anxiety and viral non-suppression was statistically significant, and when adjusting for social and structural confounders the association was attenuated and was no longer statistically significant. This suggests that social and structural barriers impact both mental health and HIV outcomes. Our findings support the need for increased mental health services and resources that address the social and structural barriers to care for PLWH in the rural South.
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Affiliation(s)
- Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
| | - Yancheng Li
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Jon C Mills
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
| | - Awewura Kwara
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Zhi Zhou
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Alaina S Ritter
- Division of Infectious Diseases and Global Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Emma Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Ha T, Shi H, Gaikwad SS, Joshi K, Padiyar R, Schensul SL. Longitudinal trajectories of depressive symptoms among alcohol consuming men with HIV in India. J Affect Disord 2024; 344:674-681. [PMID: 37832732 PMCID: PMC10873019 DOI: 10.1016/j.jad.2023.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Depression and alcohol use are common among people living with HIV (PLWH) and associated with adverse outcomes. However, there is a paucity of studies exploring trajectories of depressive symptom presence over time among alcohol consuming men PLWH. METHODS Men PLWH were repeatedly assessed for depressive symptoms from baseline through 27 months using the 10-item Center for Epidemiologic Studies-Depression scale. Group-based trajectory modeling was used to identify trajectories of depressive symptoms over time among control (n = 188) and intervention participants (n = 564). Multinomial logistic regression was used to explore the relationship between trajectory subgroups and baseline independent variables. RESULTS Among intervention participants, the three subgroups were characterized as 'low' (85.8 % of the participants), 'fluctuating' (8.7 %), and 'persistently increasing' symptoms (5.5 %). Similarly, three trajectory subgroups among control participants were labeled as: "low" (54.4 %); "fluctuating" (33.5 %) and "persistently increasing'" (12.1 %). Among intervention participants, longer duration since HIV diagnosis (aOR: 1.05, 95 % CI: 1.01-1.12) and HIV-related stigma (aOR: 1.09, 95 % CI: 1.02-1.18) were associated with persistently increasing depressive symptoms trajectory. Further, alcohol drinking problems (aOR: 1.10, 95 % CI: 1.04-1.17) was associated with fluctuating depressive symptoms trajectory. Among control participants, only lower overall self-rated health status was associated with persistently increasing depressive symptoms trajectory (aOR: 0.96, 95 % CI: 0.93-0.99). LIMITATIONS Selection bias; Information bias; Lack of causal interference; Generalizability. CONCLUSION Identifying subgroups of men PLWH with different depressive symptoms trajectories may inform effective and tailored intervention approaches to address mental health treatment and prevention among alcohol consuming men PLWH in India and elsewhere.
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Affiliation(s)
- Toan Ha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Hui Shi
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Rupal Padiyar
- Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Stephen L Schensul
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
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Wiehe SE, Nelson TL, Aalsma MC, Rosenman MB, Gharbi S, Fortenberry JD. HIV Care Continuum Among People Living With HIV and History of Arrest and Mental Health Diagnosis. J Acquir Immune Defic Syndr 2023; 94:403-411. [PMID: 37949443 PMCID: PMC10642694 DOI: 10.1097/qai.0000000000003296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Justice involvement and psychiatric comorbidities contribute to excess HIV morbidity, yet their interaction is poorly understood. We examined associations of this overlap with HIV outcomes among people living with HIV (PLWH). METHODS We conducted a retrospective cohort study of PLWH aged 13 years and older residing in Marion County (Indianapolis), IN, during 2018 (n = 5730) using linked HIV surveillance, arrest, and clinical data. We used univariable and multivariable regression to evaluate main and interaction effects of 2010-2017 arrest and mental health diagnosis on 2018 linkage to care (LTC), retention in care (RIC), and undetectable viral load (UVL). RESULTS LTC decreased among those with, versus without, an arrest (P = 0.02), although mental health diagnoses had no significant effect on LTC. When controlling for demographics and substance use disorder, analyses indicated a protective effect of arrest history on odds of RIC (adjusted odds ratio [aOR] = 1.54) and UVL (aOR = 1.26). Mental health diagnosis also increased odds of RIC (aOR = 2.02) and UVL (aOR = 1.95). Post hoc tests demonstrated that these results were mediated by outpatient care utilization, although an arrest or mental health diagnosis did increase odds of RIC among PLWH and a history of low outpatient utilization. CONCLUSIONS Outpatient care utilization improves HIV outcomes, even among those with justice involvement and psychiatric comorbidities. Holistic approaches to care can increase utilization. Implementation of "no wrong door" approaches, such as integration of mental health care in the primary care setting, simplifies health care navigation and improves access. Among those arrested, access to a Behavioral Court program can improve, rather than disrupt, HIV care.
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Affiliation(s)
- Sarah E. Wiehe
- Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN
| | - Tammie L. Nelson
- Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew C. Aalsma
- Pediatrics, Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN; and
| | - Marc B. Rosenman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sami Gharbi
- Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN
| | - J. Dennis Fortenberry
- Pediatrics, Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN; and
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Davoudi M, Heydari A, Manzari ZS. Psychosocial Interventions by Nurses for Patients with HIV/ AIDS: A Systematic Review. J Caring Sci 2023; 12:94-102. [PMID: 37469749 PMCID: PMC10352634 DOI: 10.34172/jcs.2023.30726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/05/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Providing psychological support is one of the traditional roles of nurses for patients with HIV/AIDS. Searching the literature showed that various psychological interventions have been performed by nurses to support HIV/AIDS patients; however, no summary of these interventions is available. We aimed to systematically review the interventional studies which investigated the effectiveness of psychosocial interventions delivered by nurses to HIV/AIDS patients. Methods This systematic review was performed based on Cochrane's handbook of systematic reviews of interventional studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were used in this study. The databases of PubMed, Web of Science, Cochrane, Scopus and World Health Organization were searched from January 2009 to December 2022. Based on inclusion criteria, nine studies included in this systematic review. Cochrane data extraction form was used for the systematic review and the article's information was summarized using the modified Jadad scale. Results The interventions provided by the nurses included: virtual and face-to-face educational programs, written information resources, palliative care, motivational interview, case management, home visit, and care services, along with face-to-face and telephone follow-up. These interventions have a significant positive effect on the quality of life and management of high-risk behaviors, disease management, symptoms and complications, adherence to treatment, immune function, and mental health in patients with HIV/AIDS. Conclusion The results of the present study show that despite the fact that the interventions have a purely psychological content and can be done with various methods, they are able to have positive consequences in physical, psychological, behavioral, and laboratory health in HIV/AIDS patients.
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Affiliation(s)
- Malihe Davoudi
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Sadat Manzari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Lopez CM, Baker NL, Moreland AD, Bisca E, Wilson T, Slick N, Danielson CK, Eckard AR, Madisetti M, Resick PA, Safren SA. Development and feasibility testing of an integrated PTSD and adherence intervention cognitive processing therapy-life steps (CPT-L) to improve HIV outcomes: Trial protocol. Contemp Clin Trials Commun 2023; 33:101150. [PMID: 37273831 PMCID: PMC10238849 DOI: 10.1016/j.conctc.2023.101150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 04/24/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023] Open
Abstract
Despite high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual models posit that avoidant behavior (hallmark symptom of PTSD) demonstrated by PLWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may address internalized stigma with targeted modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. This study will be the first pilot open-label randomized control trial (RCT) to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve PTSD symptoms, adherence to ART, and retention in HIV care. Primary aims are to (1) conduct theater testing of the CPT and Lifesteps research protocol and evaluate acceptability (n = 12) and (2) deliver a modified CPT protocol (CPT-Lifesteps, or CPT-L) in 60 PLWH/PTSD exploring impact of CPT-L on PTSD symptoms and HIV outcomes compared to a Lifesteps + Standard of Care condition. This innovative research extends PTSD treatment approaches as a paradigm to reduce barriers to ART adherence. Findings of this innovative study are significant because they support the Undetectable = Untransmittable (U[bond, double bond]U) campaign and can help prevent the transmission of HIV infection through increased viral suppression.
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Affiliation(s)
- Cristina M. Lopez
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Angela D. Moreland
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Bisca
- Medical University of South Carolina, USA
| | | | - Nathalie Slick
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Carla K. Danielson
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Allison R. Eckard
- Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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10
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Haddadi S, Jordan-Sciutto KL, Akay-Espinoza C, Grelotti D, Letendre SL, Tang B, Ellis RJ. PKR-like ER kinase (PERK) Haplotypes Are Associated with Depressive Symptoms in People with HIV. JOURNAL OF NEUROLOGY AND PSYCHOLOGY 2023; 10:07. [PMID: 37206541 PMCID: PMC10194542 DOI: 10.13188/2332-3469.1000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Depression is a debilitating and difficult-to-treat condition in people with HIV (PWH) despite viral suppression on antiretroviral therapy (ART). Depression is associated with activation of the PKR-like ER kinase (PERK) pathway, which regulates protein synthesis in response to metabolic stress. We evaluated common PERK haplotypes that influence PERK expression in relation to depressed mood in PWH. Methods PWH from 6 research centers were enrolled in the study. Genotyping was conducted using targeted sequencing with TaqMan. The major PERK haplotypes A, B, and D were identified. Depressive symptom severity was assessed using the Beck Depression Inventory-II (BDI-II). Covariates including genetically-defined ancestry, demographics, HIV disease/treatment parameters and antidepressant treatments were assessed. Data were analyzed using multivariable regression models. Results A total of 287 PWH with a mean (SD) age of 57.1±7.8 years were enrolled. Although the largest ethnic group was non-Hispanic white (n=129, 45.3%), African-American (n=124, 43.5%) and Hispanic (n=30, 10.5%) made up over half the sample. 20.3% were female and 96.5% were virally suppressed. Mean BDI-II was 9.6±9.5, and 28.9% scored above the cutoff for mild depression (BDI-II>13). PERK haplotype frequencies were AA57.8%, AB25.8%, AD 10.1%, and BB4.88%. PERK haplotypes were differentially represented according to genetic ancestry (p=6.84e-6). BDI-II scores were significantly higher in participants with the AB haplotype (F=4.45, p=0.0007).This finding was robust to consideration of potential confounds. Conclusion PERK haplotypes were associated with depressed mood in PWH.Consequently, pharmacological targeting of PERK-related pathways might amelioratedepression in PWH.
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Affiliation(s)
- S Haddadi
- Warren College, University of California, San Diego, La Jolla, CA 92093, USA
| | - K L Jordan-Sciutto
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - C Akay-Espinoza
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - D Grelotti
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - S L Letendre
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - B Tang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - R J Ellis
- Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093, USA
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11
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Petroll AE, Quinn KG, John SA, Nigogosyan Z, Walsh JL. Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States. J Rural Health 2023; 39:477-487. [PMID: 36482508 PMCID: PMC10038837 DOI: 10.1111/jrh.12732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. METHODS We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement. FINDINGS Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. CONCLUSIONS Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.
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Affiliation(s)
- Andrew E. Petroll
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine G. Quinn
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven A. John
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Zack Nigogosyan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer L. Walsh
- Health Intervention Sciences Group/Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Agegn Gwadu A, Abebe Tegegne M, Belay Mihretu K, Tegegne AS. Predictors of Viral Load Status Over Time Among HIV Infected Adults Under HAART in Zewditu Memorial Hospital, Ethiopia: A Retrospective Study. HIV AIDS (Auckl) 2023; 15:29-40. [PMID: 36785672 PMCID: PMC9921434 DOI: 10.2147/hiv.s396030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Background HIV attacks the CD4 cells which are responsible for the body's immune response to infectious agents. The main objective of this study was to identify predictors of viral load status over time among HIV patients under HAART in Zewditu Memorial Hospital. Methods A retrospective institutional-based cohort study design was conducted on 161 HIV-infected adults under HAART whose follow-ups were from January 2014 up to December 2017. A generalized linear mixed-effects model was conducted to infer predictors of the status of viral load at 95% of CI). Results The descriptive statistics revealed that about 55.9% of the adults under treatment had a detected viral load status. Among the potential predictors, visiting time of patients (AOR = 0.731, 95%: (0.634,0.842) and p-value <0.01), age of patients (AOR = 1.0666, 95% CI: (1.0527,1.0917) and p-value <0.01), weight (AOR=. 0.904, 95% CI: (0.862, 0.946) and p-value <0.01), baseline CD4 cell count (AOR = 0.996, 95% CI: (0.994, 0.998) and P-value <0.01), educated patients (AOR = 0.030, 95% CI: (0.002, 0.385) and p-value=0.0053), rural patients (AOR = 6.30,95% CL: (1.78, 2.25) and p-value=0.0043), working status patients (AOR = 0.5905, 95% CI: (0.547,0.638), p-value <0.01), poor adherent patients (AOR = 1.120, 95% CI; (1.035,1.391) and p-value = 0.016) and patients disclosed the disease status (AOR = 0.195, 95% CI: (0.023, 0.818) and p-value=0.0134) significantly affected the detection status of viral loads, keeping all other covariates constant. Conclusion The predictor variables; visiting times, the weight of patients, residence area, age of patients, educational level, clinical stages, functional status, baseline CD4 cell count, adherence status, and disclosure status of the disease statistically and significantly affected the status of viral load. Hence, health-related education should be given for patients to disclose their disease status, to be good adherents based on the prescription given to the health staff. Due attentions should be given for rural and uneducated patients. Attention should be forwarded to for non-adherent patients to follow the instruction given by the health staff.
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Affiliation(s)
| | | | | | - Awoke Seyoum Tegegne
- Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia,Correspondence: Awoke Seyoum Tegegne, Email
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13
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Wang D, Deng Q, Chen H, Wang M, Liu Z, Wang H, Ouyang X. Profiles of depressive symptoms and influential factors among people living with HIV in China. BMC Public Health 2023; 23:151. [PMID: 36690976 PMCID: PMC9869583 DOI: 10.1186/s12889-023-15057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent among people living with HIV (PLWH). We leveraged Latent Profile Analysis (LPA) to identify profiles of depressive symptoms among PLWHs. We also investigated differences in psychological factors of interest, demographic characteristics, and HIV-related factors across patients' profiles. METHODS A cross-sectional study was conducted at one hospital and two designated prison facilities in Hunan province, China. A total sample of 533 PLWHs (320 recruited from the hospital, 213 recruited from prisons) completed the survey. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). Family function, resilience, childhood trauma, demographic characteristics, and HIV-related factors were also evaluated. We conducted LPA and multinomial logistic regression analyses to: 1) identify distinct profiles for depressive symptoms; 2) identify demographic characteristics, and HIV-related, and psychological factors predicting PLWHs' likelihood to express a specific profile. RESULTS We identified three distinct profiles of depressive symptoms among PLWHs: severe symptoms (11.8%), moderate symptoms (40.5%), and low/no symptoms (47.7%). Moderate/ severe family dysfunction, low resilience, experiencing emotional abuse and neglect were more likely to fall in the "severe symptoms" rather than the "low/no symptoms" profile. In addition, severe family dysfunction, low resilience, and experiencing emotional neglect indicated a higher likelihood of being classified in the "moderate symptoms" profile, compared to the "low/no symptoms" profile. CONCLUSION Identifying profiles of depressive symptoms among PLWHs using the PHQ-9 items allows for understanding of the distinct paths of development of depressive symptoms and for developing tailored prevention and intervention programs for PLWHs.
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Affiliation(s)
- Dongfang Wang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Huilin Chen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Min Wang
- Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
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Psychological Distress Increases 30-Fold Among People with HIV in the First Year on ART in Nigeria-a Call for Integrated Mental Health Services. Int J Behav Med 2023; 30:38-48. [PMID: 35226343 PMCID: PMC8883753 DOI: 10.1007/s12529-022-10068-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have longitudinally assessed psychological distress among people with HIV (PWH) initiating ART in resource-limited settings. METHOD Baseline, 6-month, and 12-month psychological distress were measured in a Nigerian cohort newly initiating therapy; the relationship between baseline factors and psychological distress at 12 months was assessed; and the association between psychological distress at 12 months and care retention or immunologic failure was determined. RESULTS Among 563 patients, median age was 38 years (IQR: 33-46 years), 62% were female, and 51% were married. Psychological distress increased from 3% at baseline to 34% at 12 months. Age (aOR 1.28, 95% CI 1.06-1.56), female sex (aOR 2.89, 95% CI 1.93-4.33), lack of disclosure (aOR 4.32, 95% CI 2.48-7.51), and time on ART (6 months [aOR 6.91, 95% CI 3.14-15.18] and 12 months [aOR 32.63, 95% CI 16.54-64.36]) were associated with psychological distress while being married (OR 0.42, 95% CI 0.30-0.61) was associated with reduced odds. Tweve-month psychological distress was associated with increased risk of immunologic failure (aOR 2.22, 95% CI 1.31-3.82). CONCLUSION The risk of psychological distress increased 30-fold in the first year on therapy in PWH in Nigeria.
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Ellis RJ, Fan Y, Grelotti D, Tang B, Letendre S, He JJ. Astrocyte Activation is A Potential Mechanism Underlying Depressed Mood and Apathy in People with HIV. JOURNAL OF NEUROLOGY AND PSYCHOLOGY 2022; 9:05. [PMID: 37205974 PMCID: PMC10194432 DOI: 10.13188/2332-3469.1000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Astrocytes become activated with certain infections, and this might alter the brain to trigger or worsen depressed mood. Indeed, astrocytes are chronically activated in people with HIV infection (PWH), who are much more frequently depressed than people without HIV (PWoH). A particularly disabling component of depression in PWH is apathy, a loss of interest, motivation, emotion, and goal-directed behavior. We tested the hypothesis that depression and apathy in PWH would be associated with higher levels of a biomarker of astrocyte activation, glial fibrillary acidic protein (GFAP), in cerebrospinal fluid (CSF). Methods We evaluated PWH in a prospective observational study using the Beck Depression Inventory-II (BDI-II) and additional standardized assessments, including lumbar puncture. We measured GFAP in CSF with a customized direct sandwich ELISA method. Data were analyzed using ANOVA and multivariable regression. Results Participants were 212 PWH, mean (SD) age 40.9±9.14 years, median (IQR) nadir and current CD4 199 (57, 326) and 411 (259, 579), 65.1% on ART, 67.3% virally suppressed. Higher CSF GFAP correlated with worse total BDI-II total scores (Pearson correlation r=0.158, p-value=0.0211), and with worse apathy scores (r=0.205, p=0.0027). The correlation between apathy/depression and GFAP was not in fluenced by other factors such as age or HIV suppression status. Conclusions Astrocyte activation, reflected in higher levels of CSF GFAP, was associated with worse depression and apathy in PWH. Interventions to reduce astrocyte activation -- for example, using a peptide-1 receptor (GLP-1R) agonist -- might be studied to evaluate their impact on disabling depression in PWH.
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Affiliation(s)
- Ronald J. Ellis
- Departments of Neurosciences and Psychiatry, University of California, San Diego, CA, United States
| | - Yan Fan
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas TX, United States
| | - David Grelotti
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Scott Letendre
- Departments of Medicine and Psychiatry, University of California, San Diego, CA, United States
| | - Johnny J. He
- Department of Microbiology and Immunology, Chicago Medical School Rosalind Franklin University, North Chicago, IL, United States
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Kang CR, Yang SJ. Risk factors for depressive symptoms by age group among human immunodeficiency virus-infected adults in Korea. AIDS Care 2022; 34:1522-1529. [PMID: 34612099 DOI: 10.1080/09540121.2021.1981225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.
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Affiliation(s)
- Cho Ryok Kang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea.,Infectious Disease Control Division, Seoul Metropolitan Government, Seoul, Korea
| | - Sook Ja Yang
- Division of Nursing Science, Ewha Womans University, Seoul, Korea
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Chu L, Liu S, Wu Y, Yang J, Qiao S, Zhou Y, Deng H, Li X, Shen Z. Hair levels of steroid, endocannabinoid, and the ratio biomarkers predict viral suppression among people living with HIV/AIDS in China. Clin Chim Acta 2022; 535:143-152. [PMID: 36041548 DOI: 10.1016/j.cca.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Predicting viral suppression early is crucial to improving treatment outcomes among people living with HIV/AIDS (PLWH) in clinics. Viral suppression is affected by stress, making stress indicators a potential predictive factor. Most of previous studies used the self-report questionnaire as stress indicators, but there were great drawbacks due to its subjective. In contrast, end products of neuroendocrine systems such as hypothalamic-pituitaryadrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes and endogenous cannabinoid system (ECS) that involved in regulating stress as objective stress indicators are urgently needed to predict viral suppression. Therefore, this study aimed to investigate whether neuroendocrine indictors can strongly predict viral suppression among PLWH in China. METHODS This cross-sectional study recruited 1198 PLWH on antiretroviral therapy (ART) in Guangxi, China. The concentrations of steroids (i.e., cortisol, cortisone, dehydroepiandrosterone, testosterone and progesterone) and endocannabinoids (i.e., N-arachidonoyl-ethanolamine and 1-arachidonyl glycerol) in hair were quantitated using the LC-APCI+-MS/MS method. To screen biomarkers that were used to predict viral suppression, association between hair biomarkers and viral suppression was examined by Mann-Whitney U test and partial correlation analyses. Receiver operating characteristic (ROC) curves and binary logistic regression based on the optimal classification threshold determined with ROC curves were used to estimate the prediction effects of the screened biomarkers on viral suppression (HIV-1 RNA < 200 copies/mL). RESULTS Hair levels of dehydroepiandrosterone (DHEA), and N-arachidonoyl-ethanolamine (AEA), and the cortisol to DHEA ratio exhibited significant intergroup differences (ps < 0.05) and were correlated with HIV viral load (ps < 0.05). Hair DHEA concentrations strongly predicted viral suppression, showing good classification performance (area under the ROC curve = 0.651, p < 0.01) and strong predictive utility (adjusted odd ratio = 2.324, 95 % confidence interval = 1.211-4.899, p < 0.05) with an optimal threshold of 10.5 pg/mg. A hair AEA concentration of 2.4 pg/mg was the optimal threshold for predicting viral suppression based on good classification performance (area under the ROC curve = 0.598, p < 0.05) and predictive power (adjusted odd ratio = 2.124, 95 % confidence interval = 1.045-4.244, p < 0.05). In hair levels of cortisol to DHEA, viral suppression was observed to be highly predictive, with a threshold of 10.5 pg/mg being optimal for classification (area under the ROC curve = 0.624, p < 0.05) and prediction (adjusted odd ratio = 0.421, 95 % confidence interval = 0.201-0.785, p < 0.05). CONCLUSION Hair levels of DHEA, and AEA and the cortisol to DHEA ratio were screened and verified to have significant predictive power with optimal thresholds for predicting viral suppression in a large-scale cohort. The data may provide new insights into predictors of successful virological outcomes and inform public health intervention and clinical practice to assist PLWH in achieving and sustaining viral suppression.
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Affiliation(s)
- Liuxi Chu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 210096, China; Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China
| | - Shuaifeng Liu
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China
| | - Yan Wu
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 210096, China; Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China
| | - Jin Yang
- Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China; School of Public Health, Southeast University, Nanjing 210009, China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China
| | - Huihua Deng
- Department of Brain and Learning Science, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing 210096, China; Institute of Child Development and Education, Research Center for Learning Science, Southeast University, Nanjing 210096, China.
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China.
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Ironson G, Ahmad SS. Praying for People You Know Predicts Survival over 17 Years Among People Living with HIV in the U.S. JOURNAL OF RELIGION AND HEALTH 2022; 61:4081-4095. [PMID: 35999335 PMCID: PMC9398051 DOI: 10.1007/s10943-022-01622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
Most studies predicting the effects of prayer on health have examined intercessory prayer (prayers by others who often don't know you), yet most people pray for their own health and the health of others who they know. Our study, conducted in Miami, USA, differentiated praying for self, known others, and unknown others in people living with HIV, a virus with clearly defined biological markers of progression, enabling control for initial CD4-count and viral load. Only praying for known others predicted greater survival. People with HIV who prayed for known others were twice as likely to survive over 17 years compared to those who did not.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Salman Shaheen Ahmad
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
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Ghanooni D, Carrico AW, Williams R, Glynn TR, Moskowitz JT, Pahwa S, Pallikkuth S, Roach ME, Dilworth S, Aouizerat BE, Flentje A. Sexual Minority Stress and Cellular Aging in Methamphetamine-Using Sexual Minority Men With Treated HIV. Psychosom Med 2022; 84:949-956. [PMID: 35980781 PMCID: PMC9553259 DOI: 10.1097/psy.0000000000001123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 06/22/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sexual minority men (e.g., gay, bisexual, and other men who have sex with men) experience stigma and sexual minority stress, which are theorized to drive negative health outcomes. Sexual minority men with treated HIV display persistent immune dysregulation, which could be amplified by sexual minority stress responses to potentiate cellular aging. METHODS This cross-sectional study included 52 sexual minority men living with HIV who had undetectable viral load (<40 copies/mL) and biologically confirmed recent methamphetamine use. Participants completed measures assessing sexual minority stress and openness about sexual minority status (i.e., outness). DNA methylation-derived outcomes included the following: the extrinsic epigenetic age acceleration clock, telomere length, naive CD4+ T-helper cells, and naive CD8+ T-cytotoxic/suppressor cells. RESULTS After adjusting for negative affect and recent stimulant use, higher sexual minority stress was associated with a faster extrinsic epigenetic age acceleration clock ( β = 0.29, p = .030), shorter telomere length ( β = -0.43, p = .002), and fewer naive CD4+ (β = -0.57, p < .001) and naive CD8+ T cells ( β = -0.57, p < .001). Greater outness was associated with higher naive CD4+ ( β = 0.32, p = .030) and naive CD8+ T cells ( β = 0.38, p = .008) as well as lower plasma interleukin 6 ( β = -0.33, p = .027). CONCLUSIONS Sexual minority stress processes are associated with markers of cellular aging and inflammation in methamphetamine-using sexual minority men living with HIV. Longitudinal research should elucidate biobehavioral mechanisms linking sexual minority stress processes with accelerated cellular aging in those with and without HIV.
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Church D, Yang A, Fannin J, Blickheuser K. The biological dimensions of transcendent states: A randomized controlled trial. Front Psychol 2022; 13:928123. [PMID: 36160577 PMCID: PMC9498345 DOI: 10.3389/fpsyg.2022.928123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
This study evaluated the biological dimension of meditation and self-transcendent states. A convenience sample of 513 participants was drawn from attendees at a 4-day guided meditation workshop. Half were randomly assigned to an active placebo control intervention. All were assessed on a variety of measures, both psychological [anxiety, pain, posttraumatic stress disorder (PTSD), positive emotions, and transcendent states], and physiological (physical functioning). Additional biological assessments including salivary immunoglobulin-A (SIgA), cortisol, and Quantitative Electroencephalography (qEEG) were obtained from subset of the Experimental group (N = 117). No significant difference in psychological symptoms or positive emotions was observed between Experimental and placebo groups at baseline. At post-test, significant improvements were noted in the Experimental group, including a 49.5% median increase in SIgA (p = 0.01), though cortisol remained unchanged. qEEG z-score analysis identified sustained stress reduction, including delta frequency band amplitude increases, high beta decreases, and faster acquisition of sustained alpha states (all p < 0.001). Psychological symptoms also improved on all measures. At 6-month follow-up (N = 140), PTSD and somatic symptoms significantly improved from baseline, and post-test versus 6-month follow-up results indicated significant increases in happiness and spiritual and physical oneness, along with decreases in depressive symptoms. These findings suggest that autonomic self-regulation and transcendent states may be measured in both biological and psychological dimensions and are associated with pervasive health benefits.
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Affiliation(s)
- Dawson Church
- National Institute for Integrative Healthcare, Petaluma, CA, United States
- *Correspondence: Dawson Church,
| | - Amy Yang
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Jacob AE, Fazeli PL, Crowe MG, Vance DE. Correlates of subjective and objective everyday functioning in middle-aged and older adults with human immunodeficiency virus. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-13. [PMID: 36002029 DOI: 10.1080/23279095.2022.2109418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with human immunodeficiency virus (HIV) (PWH) are at an increased risk for impaired everyday functioning and they may also experience poor awareness of their functional status. This study identified factors associated with (1) subjective and objective instrumental activities of daily living (IADLs) and (2) awareness of functional capacity in PWH. In this cross-sectional study, 236 PWH completed a neurobehavioral assessment, including self-report and performance-based measures of IADLs. Multiple regressions were performed to identify demographic, personality, and cognitive factors contributing to subjective and objective evaluation of everyday functioning, as well as discrepancy between self-report and performance-based measures of IADLs. Results indicated that increased depression was associated with worsened self-report of everyday functioning but not performance of IADLs. Cognitive function and age were associated with IADL performance. Most participants (58.1%) demonstrated a discrepancy between self-report and actual performance of IADLs. Worse processing speed was correlated with greater discrepancy. Inaccurate self-reporters had worse overall cognitive functioning and lower levels of personality traits, including openness, conscientiousness, and agreeableness. In conclusion, self-report and actual performance of IADLs in PWH is influenced by different factors. Self-report may be more affected by psychological variables, such as mood and personality, while actual performance is more sensitive to age and cognitive function.
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Affiliation(s)
- Alexandra E Jacob
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael G Crowe
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Ironson G, Hylton E, Verhagen R. A New Attitude Towards Treatment Measure Predicts Survival Over 17 Years. J Gen Intern Med 2022; 37:2351-2357. [PMID: 35296979 PMCID: PMC9360262 DOI: 10.1007/s11606-021-07245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients diagnosed with chronic illness, attitude towards treatment may play an important role in health and survival. For example, negative attitudes towards treatment have been related to poorer adherence to treatment recommendations and prescribed medication across a range of chronic illnesses. In addition, prior research has shown that attitude towards treatment assessed through a psychiatric interview predicted survival at 1 year after bone marrow transplantation with great accuracy (> 90%). OBJECTIVE The purpose of this study was to determine the relationship between a self-report attitude to a treatment measure that operationalized a psychiatric interview, and survival over 17 years in a sample of people living with HIV (PLWH). PARTICIPANTS AND DESIGN Participants (N = 177) who were in the mid-range of HIV illness at baseline (CD4s 150 to 500, no prior AIDS-defining clinical symptom) were administered the Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale and followed longitudinally to determine survival at 17 years. MEASURES The Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale is a 20-item self-report questionnaire designed to survey multiple factors that contribute to an overall psychological construct of the treatment process. RESULTS The MMAT-20/HIV predicted survival over 17 years controlling for biomedical (baseline CD4, viral load, antiretroviral medications, age) and psychosocial (race, education, antiretroviral medications) variables. Those in the top half on the MMAT-20/HIV were almost twice as likely to survive than those in the lower half. Scores on the MMAT-20/HIV were significantly but modestly correlated with adherence (r = .20, p < .05), but adherence was not a mediator of the relationship between the MMAT-20/HIV and survival. CONCLUSIONS An individual's attitude towards the treatment process predicted survival, raising the possibility that optimal clinical management would include ways to probe these attitudes and intervene where possible. The ease of administering the MMAT-20 and adaptability to other illnesses could facilitate this endeavor.
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Affiliation(s)
| | - Emily Hylton
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA
| | - Rachel Verhagen
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA
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Mohamad Fisal ZA, Minhat HS, Mohd Zulkefli NA, Ahmad N. Biopsychosocial approach to understanding determinants of depression among men who have sex with men living with HIV: A systematic review. PLoS One 2022; 17:e0264636. [PMID: 35286312 PMCID: PMC8920233 DOI: 10.1371/journal.pone.0264636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) living with HIV are more likely to be depressed than MSM without HIV. The AIDS epidemic will not end if the needs of people living with HIV and the determinants of health are not being addressed. Compared to HIV individuals without depression, depressed HIV individuals have worse clinical outcomes and higher mortality risk. Depression is caused by a complex combination of social, psychological, and biological variables. This systematic review, thereby motivated by the need to address this gap in the literature, aims to articulate determinants of depression among MSM living with HIV according to the biopsychosocial approach. METHODOLOGY We systematically searched four databases from 2011 to 2021. We searched for observational studies on determinants of depression among MSM living with HIV. The outcome is depression based on the categorical or numerical outcome. Two reviewers independently extracted data and assessed study risks of bias. Any disagreements are consulted with the third reviewer. RESULTS We identified 533 articles, of which only eight studies are included. A total of 3,172 MSMs are included in the studies. We found the determinants of depression and categorized them according to biological, psychological, and social approaches. CONCLUSION The determinants of depression with the strongest evidence across studies were enacted HIV-related stigma, unemployment, sleep disturbance, current smoker, black ethnicity, born overseas, ART initiation, and access to mental health care. Despite weaker evidence, the other relevant determinants to be included were older age, internalized stigma, self-efficacy, and social support. Efforts to improve or prevent depression among MSM living with HIV could benefit from addressing the determinants of depression based on the biopsychosocial approach immediately after HIV diagnosis. Integrating mental health screening and care into HIV treatment settings would strengthen HIV prevention and care outcomes and improve access to mental healthcare.
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Affiliation(s)
- Zul Aizat Mohamad Fisal
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail:
| | - Halimatus Sakdiah Minhat
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Norliza Ahmad
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Banerjee N, Goodman ZT, McIntosh R, Ironson G. Cognition, Coping, and Psychological Distress in HIV. AIDS Behav 2022; 26:1074-1083. [PMID: 34537911 DOI: 10.1007/s10461-021-03462-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
Interrelationships among HIV-associated neurocognitive dysfunction, avoidant coping, cognitively-oriented coping, and psychological distress were examined using structural equation modeling in an ethnically diverse sample of 209 adults predominantly in the mid-range of illness. Global neurocognitive deficits, assessed with the HIV-dementia scale, were associated with higher levels of avoidant coping, lower levels of cognitive coping, and a higher avoidant/cognitive coping ratio, which were each in turn associated with higher psychological distress measured by a latent factor comprising symptoms of depression, anxiety, and HIV-related distressing thoughts. There were significant indirect effects through avoidant coping and a higher avoidant/cognitive coping ratio. Results suggest the presence of HIV-associated neurocognitive deficits may interfere with the utilization of cognitive-based coping strategies and increase reliance on more maladaptive strategies, which in turn may translate to elevated reports of psychological distress. Findings may help inform interventions aimed at reducing avoidant coping and psychological distress, two factors associated with accelerated HIV disease progression.
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Affiliation(s)
- Nikhil Banerjee
- Department of Neurology, University of Miami Miller School of Medicine, Don Soffer Clinical Research Building, #1336, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Zachary T Goodman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Roger McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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25
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Le SM, Trouiller P, Duong TH, Khuat THO, Pham MK, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, Nham TTT, Hoang TG, Feelemyer J, Vu HV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N, Michel L. Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs. Drug Alcohol Rev 2022; 41:697-705. [PMID: 34786755 PMCID: PMC10150937 DOI: 10.1111/dar.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. METHODS We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST. RESULTS CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)]. DISCUSSION AND CONCLUSIONS The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.
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Affiliation(s)
- Sao M Le
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Philippe Trouiller
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Thi H Duong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Thi H O Khuat
- Supporting Community Development Initiatives, Hanoi, Vietnam
| | - Minh K Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Thuy L Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Quang D Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Thi G Hoang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hai V Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Hong Q Doan
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, Nîmes, France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
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26
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Yen YF, Lai HH, Kuo YC, Chan SY, Chen LY, Chen CC, Wang TH, Wang CC, Chen M, Yen TF, Kuo LL, Kuo ST, Chuang PH. Association of depression and antidepressant therapy with antiretroviral therapy adherence and health-related quality of life in men who have sex with men. PLoS One 2022; 17:e0264503. [PMID: 35213633 PMCID: PMC8880848 DOI: 10.1371/journal.pone.0264503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
UNAIDS’ HIV treatment targets require that 90% of people living with HIV/AIDS (PLWHA) receiving antiretroviral treatment (ART) achieve viral suppression and 90% of people with viral suppression have good health-related quality of life (HRQOL). This study aimed to examine the association of depression and antidepressant therapy with ART adherence and HRQOL in HIV-infected men who have sex with men (MSM). From 2018 through 2020, HIV-infected MSMs were consecutively recruited (N = 565) for the evaluation of ART adherence and HRQOL at Taipei City Hospital HIV clinics. Non-adherence to ART was defined as a Medication Adherence Report Scale score of < 23. HRQOL in PLWHHA was evaluated using WHOQOL-BREF, Taiwan version. Overall, 14.0% had depression and 12.4% exhibited non-adherence to ART. The nonadherence proportion was 21.8% and 10.5% in depressed and nondepressed HIV-infected MSM, respectively. After adjusting for other covariates, depression was associated with a higher risk of nonadherence to ART (adjusted odds ratio = 2.02; 95% confidence interval: 1.02–4.00). Physical, psychological, social, and environmental HRQOL were significantly negatively associated with depression. Considering antidepressant therapy, ART nonadherence was significantly associated with depression without antidepressant therapy but not with antidepressant therapy. The depressed HIV-infected MSM without antidepressant therapy had worse psychological, social, and environmental HRQOL than those with antidepressant therapy. Our study suggests that depression is associated with poor ART adherence and HRQOL, particularly in those without antidepressant therapy. Adequate diagnosis and treatment of depression should be provided for PLWHA to improve their ART adherence and HRQOL.
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Affiliation(s)
- Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- * E-mail:
| | - Hsin-Hao Lai
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Chun Kuo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Shang-Yih Chan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Department of Internal Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
| | - Lian-Yu Chen
- Kunming Prevention Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Teng-Ho Wang
- Section of Infectious Diseases, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Chien Chun Wang
- Section of Infectious Diseases, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Tsen-Fang Yen
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Li-Lan Kuo
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Shu-Ting Kuo
- Department of Nursing, Taipei City Hospital, Linsen, Chinese Medicine, and Kunming Branch, Taipei, Taiwan
| | - Pei-Hung Chuang
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
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27
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Wu Q, Zhao J, Zhao G, Li X, Du H, Chi P. Long-Term Trajectories of Depressive Symptoms Among Children Affected by Parental HIV: A 12-Year Follow-Up Study. AIDS Behav 2022; 26:2713-2722. [PMID: 35165794 DOI: 10.1007/s10461-021-03572-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 01/07/2023]
Abstract
The present study explored the trajectories of depressive symptoms over 12 years spanning from childhood to emerging adulthood and the between-trajectory differences in psychosocial adjustment among Chinese children (N = 492, 52.8% boys, aged 6 to 18 years at baseline) affected by parental HIV. Rebounding (12.6%), resilient (64.8%), and improving (22.6%) trajectories were identified. Individuals in the rebounding trajectory reported the highest levels of psychological distress and the lowest levels of subjective well-being, positive self-regard, and personal strengths in adulthood. Individuals in the resilient trajectory reported lower levels of psychological distress and negative affect than those in the improving trajectory. The findings support the development of programs by policymakers and practitioners to improve the psychosocial adjustment of children who have been affected by parental HIV while considering individual differences in the trajectories of depressive symptoms.
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A Systematic Review of Risk Factors for Suicide Among Persons Living with HIV (1996-2020). AIDS Behav 2022; 26:2559-2573. [PMID: 35107660 DOI: 10.1007/s10461-022-03591-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/01/2022]
Abstract
Persons living with HIV (PWH) are at elevated risk for suicide. We conducted a systematic literature review following PRISMA-P guidelines to examine risk factors associated with suicide as a cause of morbidity among PWH. We searched six electronic databases using search terms (suicide, suicide attempt, self-harm, self-injurious behavior, HIV, AIDS, PWH). We focused on factors that were specific to HIV infection (CD4 count, HIV-1 RNA, and antiretroviral therapy [ART]). The initial search yielded N = 2657 studies. Eligible studies included suicide as an outcome, quantitative study design, and publication in peer-reviewed journals from 1996 through 2020. Fourteen studies met inclusion criteria. PWH share risk factors for suicide found in the general population: psychiatric illness, previous suicide attempt, drug and alcohol misuse. PWH also have HIV-specific risk factors for suicide. HIV diagnosis in the past two years and transmission related to injection drug use were associated with increased risk; HIV-1 RNA, ART, and AIDS-defining illness were not.
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29
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Bartels SM, Guzmán Guevara K, Pajarito Rompich Y, Barrington C. Narratives of Change From Gay and Bisexual Men Living With HIV in an Emotional Well-Being Intervention. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:53-68. [PMID: 35192393 PMCID: PMC9164147 DOI: 10.1521/aeap.2022.34.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The emotional burden of an HIV diagnosis can impact HIV outcomes and overall well-being. We piloted a four-session individual-level emotional well-being intervention, offered during HIV care visits, for gay and bisexual men living with HIV in Guatemala City who were recently diagnosed or reengaged in care. To assess intervention impact in a contextualized manner, we conducted longitudinal qualitative interviews (n = 3) with study participants (n = 10) over 12 months. Data analysis included thematic coding using NVivo and longitudinal narrative summaries and matrices to identify narratives of change and assess intervention impact. Participants experienced changes in their view of self and diagnosis perceptions, improved physical and mental health, increased interest in sex and relationships, and a clarification of their life goals. The intervention helped participants reach diagnosis acceptance, improve self-esteem, and gain self-efficacy for managing life with HIV. Findings support the importance of integrating emotional well-being into HIV care.
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Affiliation(s)
- Sophia M Bartels
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Karla Guzmán Guevara
- HIV Central America Regional Program, Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Yolanda Pajarito Rompich
- National Program for the Prevention and Control of STIs, HIV, and AIDS, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Clare Barrington
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
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Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100337. [PMID: 35024661 PMCID: PMC8669310 DOI: 10.1016/j.lanwpc.2021.100337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam Methods In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention. Findings Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally. Interpretation Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding : This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
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Key Words
- ANRS, French Agency for Research on AIDS and Viral Hepatitis
- CBO, community-based organization
- CGI, clinical global impression scale
- DRIVE, Drug-Related Infections in ViEtnam
- EQ5D5L, 5 levels/5 dimensions EuroQol instrument
- HIV, human immunodeficiency virus
- LMICs, low-middle income countries
- MINI, MINI international neuropsychiatric interview
- MMT, methadone maintenance treatment
- NIDA, National Institute on Drug Abuse
- PHQ, patient health questionnaire
- PWID, people who inject drugs
- RDS, respondent driven sampling
- SCDI, Supporting Community Development Initiatives
- VND, Vietnamese dong
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Wang D, Deng Q, Ross B, Wang M, Liu Z, Wang H, Ouyang X. Mental health characteristics and their associations with childhood trauma among subgroups of people living with HIV in China. BMC Psychiatry 2022; 22:13. [PMID: 34986834 PMCID: PMC8729148 DOI: 10.1186/s12888-021-03658-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV (PLWH) carry a high risk for mental health problems, which has been extensively reported in the literature. However, an understanding of mental health characteristics in different subgroups of PLWH is still limited. In the present study, we conducted a cross-sectional survey to explore mental health characteristics and their associations with childhood trauma in two major subgroups of PLWH in China. METHODS A total of 533 PLWH (213 prisoners in the prison system, and 320 outpatients) were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Childhood Trauma Questionnaire (CTQ). RESULTS From the total sample, 22.0% PLWH frequently experienced psychotic-like experiences (PLEs), 21.8% had clinically significant anxiety syndrome, 34.0% had clinically significant depressive syndrome, and 63.6% experienced at least one type of traumatic exposure during their childhood, with physical neglect being the most common. Compared to outpatients with HIV, prisoners living with HIV reported more severe mental health problems and a higher frequency of childhood trauma, with childhood trauma in turn predicting higher risk for mental health problems. Similarly, among outpatients living with HIV, both childhood emotional and sexual abuse had predictive effects on all the three mental health problems. CONCLUSIONS The study suggests that PLWH have higher risk of anxiety, depression and PLEs, and childhood trauma could serve as predicting factors for such risks. In addition, childhood trauma may play distinct roles in predicting the risk for the mental health problems, depending on different subgroup of PLWH.
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Affiliation(s)
- Dongfang Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.263785.d0000 0004 0368 7397School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Brendan Ross
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine, McGill University, Montreal, QC Canada
| | - Min Wang
- grid.508008.50000 0004 4910 8370Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Honghong Wang
- grid.216417.70000 0001 0379 7164Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.
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Fryburg DA. Kindness as a Stress Reduction-Health Promotion Intervention: A Review of the Psychobiology of Caring. Am J Lifestyle Med 2022; 16:89-100. [PMID: 35185431 PMCID: PMC8848115 DOI: 10.1177/1559827620988268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 03/28/2024] Open
Abstract
Chronic stress is a ubiquitous problem shouldered by many people worldwide. Although the stressors are myriad (eg, loneliness, finances, health, discrimination), the corporal response to them either causes or exacerbates mental and physical illness, including depression, anxiety, and cardiovascular disease. Identifying efficient ways to help people buffer their response and promote resilience and wellness is critical to improving overall health. Positive interpersonal connection is a proven way to promote resilience and happiness. It is associated with decreased mortality and markers of better health. Kindness and caring are prosocial behaviors that build positive interpersonal connections and can uplift both the giver and receiver. Simply seeing kindness and caring activates the neuropsychology of kindness, elevating the viewer and promoting generosity, interpersonal connection, and inclusion. That augmenting positive emotions, enhancing interpersonal connection, and inducing prosocial behavior change are possible through seeing kindness opens the opportunity to bolster resilience in higher stress settings like health care. In a recent study, watching kindness media in a health care setting rapidly increased self-reported feelings of happiness, calm, gratitude, and being inspired. Viewers were significantly more generous. Providing staff and patients with a nonjudgmental lift to enhance caring interactions through kindnesses media can be an important, low-cost adjunct to improving the healthcare environment.
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Brody LR, Firpo-Perretti Y, Bruck-Segal D, Dale SK, Ruffing EG, Cassiello-Robbins C, Weber KM, Cohen MH. Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV. Int J Behav Med 2021; 29:469-479. [PMID: 34713412 PMCID: PMC9046468 DOI: 10.1007/s12529-021-10032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (< 80 copies/ml). METHOD Ninety-eight WLWH from the Women's Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses. RESULTS Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence. CONCLUSION Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.
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Affiliation(s)
- Leslie R Brody
- Department of Psychological and Brain Sciences, Boston University, Boston, USA.
| | | | - Dana Bruck-Segal
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Elizabeth G Ruffing
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Kathleen M Weber
- Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital, Cook County Health and Hospitals System and Rush Medical School, Chicago, USA
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Ironson G, Verhagen R, da Rosa B, Hylton E. Interview-Rated Meaning and Survival Over 17 Years in People Living With HIV. Psychosom Med 2021; 83:671-678. [PMID: 34267088 DOI: 10.1097/psy.0000000000000963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary purpose of this study was to determine whether meaning in life predicts survival in people living with HIV (PLWH) over 17 years. This study also examined whether interviewer- and transcript-rated meanings predict survival equivalently. A third purpose of the study was to investigate whether meaning in life adds to the prediction of survival over positive emotional expression. METHODS A diverse sample of people with HIV (n = 177) completed an interview on stress and coping at baseline and were followed up for survival up to 17 years. Meaning was measured by interviewer rating of four items (meaningful purpose, unfinished business, finding new meaning, and meaningful activities). Transcript-rated meaning was assessed by two independent raters. Cox proportional hazards regression was used to determine whether meaning predicted survival over 17 years. RESULTS Meaning in life predicted significantly greater survival, adjusting for biomedical and sociodemographic variables whether assessed by interviewer or by transcript raters. Hazard ratios suggest that the effect is moderate to large (2.66-3.45 for top versus bottom third; 2.05-2.49 for top versus bottom half). Significance was maintained after adjusting for positive emotion. CONCLUSIONS Meaning assessed by interview (by both interviewer and transcript ratings) predicted greater survival over 17 years in PLWH and did so above positive emotion. This adds to a literature that is primarily based on self-report questionnaires. Meaning may have beneficial effects for both psychological and physical health in PLWH.
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Affiliation(s)
- Gail Ironson
- From the Department of Psychology, University of Miami, Coral Gables, Florida
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Effect of suicidality on clinical and behavioural outcomes in HIV positive adults in Uganda. PLoS One 2021; 16:e0254830. [PMID: 34415901 PMCID: PMC8378732 DOI: 10.1371/journal.pone.0254830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Suicidality is a risk of a person committing suicide often characterized by suicidal ideation, intent or attempts. Despite the high burden of suicidality among individuals living with HIV and HAIDS, there is paucity of data on the impact of suicidality on clinical (such as CD4 counts and HIV disease progression) and behavioural outcomes (such as adherence to HIV Medications). Cross-sectional investigations of these associations are often complicated by bidirectional causal relationships and hence the need for longitudinal study designs. We conducted a cohort study to determine the impact of suicidality on clinical and behavioural outcomes among adults living with HIV/AIDS in Uganda. Materials and methods We conducted the study among 1099 ART naïve adults living with HIV/AIDS in Uganda. Data were collected at three time points: baseline, 6 and 12 months. Multiple regression and discrete time survival models were used to determine the relationship between suicidality and indices of HIV outcomes. Results Majority of the participants were female and the participant mean age was 35 years. Most of them (73%) had primary or no formal education. The proportion of participants with suicidality decreased from 2.9% at baseline to roughly 1% both at month 6 and month 12. Of the investigated clinical and behavioural outcomes, baseline suicidality only had a negative impact on missing a dose of ART where the odds of missing a dose of ART were 8.25 (95% CI 2.45–27.71, p>0.01) times higher for participants with suicidality compared to those without suicidality. The following outcomes were not significantly impacted by baseline suicidality: HIV clinical stage, CD4 count and risky sexual behaviour. Conclusions The fact that baseline suicidality significantly negatively impacted ART adherence calls for the incorporation of psychosocial interventions to target indices of psychological distress such as suicidality to improve HIV related outcomes.
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Kalungi A, Womersley JS, Kinyanda E, Joloba ML, Ssembajjwe W, Nsubuga RN, Seedat S, Hemmings SMJ. The 5-HTTLPR-rs25531 S-A-S-A Haplotype and Chronic Stress Moderate the Association Between Acute Stress and Internalizing Mental Disorders Among HIV+ Children and Adolescents in Uganda. Front Genet 2021; 12:649055. [PMID: 33968131 PMCID: PMC8104030 DOI: 10.3389/fgene.2021.649055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Internalizing mental disorders (IMDs) among HIV-positive (HIV+) children and adolescents are associated with poor disease outcomes, such as faster HIV disease progression. Although it has been suggested that the development of IMDs is moderated by interaction of stressful life events and vulnerability factors, the underlying etiology is largely unknown. Serotonin transporter gene [solute carrier family 6 member A4 (SLC6A4)] and human tryptophan hydroxylase 2 gene (TPH2) polymorphisms have been implicated in the development of IMDs. This study investigated the association between acute stress and IMDs, and moderation by chronic stress and genetic variants in SLC6A4 and TPH2. Hypothesis: Acute stress acts through genetic and environmental vulnerability factors to increase the risk of developing IMDs. Methods: Polymorphisms in SLC6A4 (5-HTTLPR, rs25531, 5-HTTLPR-rs25531, and STin2 VNTR) and TPH2 (rs1843809, rs1386494, rs4570625, and rs34517220) were genotyped in 368 HIV+ children and adolescents (aged 5-17 years) with any internalizing mental disorder (depression, anxiety disorders, or posttraumatic stress disorder), and 368 age- and sex-matched controls, who were also HIV+. Chronic and acute stress categories were derived by hierarchical cluster analysis. Logistic regression analysis was used to assess the independent moderating effect of chronic stress and each selected polymorphism on the association between acute stress and IMDs. Results: We observed a statistically significant association between severe acute stress and IMDs (p = 0.001). Children and adolescents who experienced severe acute stress were twice as likely to develop IMDs, compared to children and adolescents who experienced mild acute stress (p = 0.001). Chronic stress interacted with severe acute stress to increase the risk of IMDs (p = 0.033). Acute stress was found to interact with 5-HTTLPR-rs25531 S-A-S-A haplotype to increase the risk for IMDs among Ugandan HIV+ children and adolescents (p = 0.049). We found no evidence for a combined interaction of acute stress, chronic stress, and 5-HTTLPR-rs25531 on IMDs. Conclusion: The odds of having an internalizing mental disorder (IMD) were higher among HIV+ children and adolescents who experienced severe acute stress compared to HIV+ children and adolescents who experienced mild acute stress. Chronic stress and 5-HTTLPR-rs25531 independently moderated the association between acute stress and IMDs.
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Affiliation(s)
- Allan Kalungi
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Mental Health Project, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Psychiatry, Makerere University, Kampala, Uganda
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Jacqueline S. Womersley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Cape Town, South Africa
| | - Eugene Kinyanda
- Mental Health Project, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Moses L. Joloba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Wilber Ssembajjwe
- Mental Health Project, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Statistics and Data Science Section, Entebbe, Uganda
| | - Rebecca N. Nsubuga
- MRC/UVRI and LSHTM Uganda Research Unit, Statistics and Data Science Section, Entebbe, Uganda
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Cape Town, South Africa
| | - Sian M. J. Hemmings
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Cape Town, South Africa
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Psychiatric Problems Among Adolescents With HIV. Indian Pediatr 2021. [PMID: 33713078 PMCID: PMC8005280 DOI: 10.1007/s13312-021-2182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Borran M, Dashti-Khavidaki S, Khalili H. The need for an integrated pharmacological response to the treatment of HIV/AIDS and depression. Expert Opin Pharmacother 2021; 22:1179-1192. [PMID: 33586560 DOI: 10.1080/14656566.2021.1882419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The coexistence of depression and HIV infection affects more than 9 million people worldwide. A literature review revealed a large gap regarding the pharmacotherapy of depression among patients dually diagnosed with HIV and depression.Areas covered:In this review, the authors covered the various dimensions of deploying integrated pharmacological treatment of HIV/AIDS and depression. This topic was addressed in two ways; first, the direct results of integrated pharmacotherapy in syndemic patients; second, the indirect effects of the integrated model on other outcomes of HIV care.Expert opinion: An integrated pharmacological response to the treatment of HIV and depression can bring substantial benefits to HIV outcomes and reduce the burden of both diseases. The direct advantages regarding pharmacological response to the treatment of depression along with HIV care are improving adherence to antiretroviral therapy, optimizing pharmacotherapy, minimizing drug interaction, and prevention of additive adverse drug reactions. Furthermore, in some cases, medication can target both depression and other neuropsychiatric or somatic comorbidities among people living with HIV/AIDS. The integrated pharmacotherapy also has some potential indirect advantages on HIV care outcomes like minimizing loss of care, reducing ongoing HIV transmission, and improving the outcomes of both diseases.
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Affiliation(s)
- Mina Borran
- Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Simin Dashti-Khavidaki
- Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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The Effects of Perceived Stress and Cortisol Concentration on Antiretroviral Adherence When Mediated by Psychological Flexibility Among Southern Black Men Living with HIV. AIDS Behav 2021; 25:645-652. [PMID: 32902770 DOI: 10.1007/s10461-020-03016-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This pilot study investigates the correlation between psychological stress and antiretroviral therapy (ART) adherence and plasma HIV RNA (viral load) as mediated by psychological flexibility among Black men in the south. Data were collected from 48 HIV-positive, low income Black men. Results indicate a strong positive correlation between perceived stress and psychological inflexibility (adjusted for age and income rs = 0.67; p < 0.001), a negative correlation between psychological inflexibility and ART adherence (adjusted rs = - 0.32; p = 0.03), a negative correlation between perceived stress and ART adherence (adjusted rs = - 0.45; p = 0.006), and a negative correlation between ART adherence and viral load (adjusted rs = - 0.37; p = 0.04). Our findings suggest stress decreases adherence to ART and viral suppression among Black men living with HIV. However, psychological flexibility did not mediate the relationship between stress and treatment adherence. Hair cortisol concentrations were high (mean of 34.2 pg/mg), but uncorrelated with adherence.
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Kalungi A, Kinyanda E, Womersley JS, Joloba ML, Ssembajjwe W, Nsubuga RN, Kaleebu P, Levin J, Kidd M, Seedat S, Hemmings SMJ. TERT rs2736100 and TERC rs16847897 genotypes moderate the association between internalizing mental disorders and accelerated telomere length attrition among HIV+ children and adolescents in Uganda. BMC Med Genomics 2021; 14:15. [PMID: 33407441 PMCID: PMC7789327 DOI: 10.1186/s12920-020-00857-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Internalizing mental disorders (IMDs) (depression, anxiety and post-traumatic stress disorder) have been associated with accelerated telomere length (TL) attrition; however, this association has not been investigated in the context of genetic variation that has been found to influence TL. We have previously reported an association between IMDs and accelerated TL attrition among Ugandan HIV+ children and adolescents. This study investigated the moderating effects of selected single nucleotide polymorphisms in the telomerase reverse transcriptase gene (TERT) (rs2736100, rs7726159, rs10069690 and rs2853669) and the telomerase RNA component gene (TERC) (rs12696304, rs16847897 and rs10936599) on the association between IMDs and TL, among Ugandan HIV+ children (aged 5-11 years) and adolescents (aged 12-17 years). RESULTS We found no significant interaction between IMDs as a group and any of the selected SNPs on TL at baseline. We observed significant interactions of IMDs with TERT rs2736100 (p = 0.007) and TERC rs16847897 (p = 0.012), respectively, on TL at 12 months. CONCLUSIONS TERT rs2736100 and TERC rs16847897 moderate the association between IMDs and TL among Ugandan HIV+ children and adolescents at 12 months. Understanding the nature of this association may shed light on the pathophysiological mechanisms underlying advanced cellular aging in IMDs.
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Affiliation(s)
- Allan Kalungi
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
- Mental Health Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
- Department of Medical Microbiology, Makerere University, Kampala, Uganda.
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Eugene Kinyanda
- Mental Health Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jacqueline S Womersley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Moses L Joloba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
- School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Wilber Ssembajjwe
- Mental Health Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Statistics and Data Science Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Rebecca N Nsubuga
- Statistics and Data Science Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Jonathan Levin
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sian M J Hemmings
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Prabhu S, McFall AM, Mehta SH, Srikrishnan AK, Kumar MS, Anand S, Shanmugam S, Celentano DD, Lucas GM, Solomon SS. Psychosocial Barriers to Viral Suppression in a Community-based Sample of Human Immunodeficiency Virus-infected Men Who Have Sex With Men and People Who Inject Drugs in India. Clin Infect Dis 2021; 70:304-313. [PMID: 30840989 DOI: 10.1093/cid/ciz175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/26/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Little is known about the impact of psychosocial factors and substance use on viral suppression among human immunodeficiency virus (HIV)-infected key populations in resource-limited settings. Accordingly, we examined the association and interactions between depression, alcohol use, and recreational drug use on viral suppression among men who have sex with men (MSM) and people who inject drugs (PWID) in India. METHODS MSM and PWID were recruited across India using respondent-driven sampling (RDS). Correlates of viral suppression were determined using Poisson regression models incorporating RDS-II weights. Two-way multiplicative interactions were assessed with separate models of all combinations of the 3 variables of interest using interaction terms; 3-way interactions were evaluated by stratifying 2-way interactions by the third variable. RESULTS Among 1454 treatment-eligible HIV-infected MSM and 1939 PWID, older age (adjusted prevalence ratio [aPR], 1.14 for MSM; 1.41 for PWID) and higher HIV treatment literacy (aPR, 1.58 for MSM; 3.04 for PWID) were positively associated with viral suppression. Among MSM, there was evidence of a synergistic negative association between severe depression and recreational drug use (aPR, 0.37 [95% confidence interval {CI}, .16-.84]), alcohol dependence and recreational drug use (aPR, 0.45 [95% CI, .20-.99]), and severe depression, alcohol dependence, and recreational drug use (aPR, 0.23 [95% CI, .09-.57]). Among PWID, daily injection (aPR, 0.51 [95% CI, .31-.82]) was the primary barrier to suppression. CONCLUSIONS Incorporating psychosocial and harm-reduction services into differentiated care models targeting MSM and PWID in low-resource settings is critical to achieving the 90-90-90 HIV/AIDS targets.
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Affiliation(s)
- Sandeep Prabhu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,School of Medicine, University of California, San Diego
| | - Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Santhanam Anand
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | - David D Celentano
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunil S Solomon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland
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Positive and negative emotional expression measured from a single written essay about trauma predicts survival 17 years later in people living with HIV. J Psychosom Res 2020; 136:110166. [PMID: 32559504 DOI: 10.1016/j.jpsychores.2020.110166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether expression of positive and negative emotions measured within a single written trauma essay predicts survival over 17 years in people living with HIV. METHODS This is a longitudinal, observational study of a volunteer sample of HIV-seropositive individuals at the mid-range of disease (150-500 CD4-cells/mm3 with no prior AIDS-defining symptoms). Exclusion criteria included substance dependence, dementia, and/or psychosis. Baseline assessments occurred between 1997 and 1999 and survival data was collected in 2014 (17 year follow up). At baseline, participants wrote an essay about the most traumatic event in their life. Emotional expression was measured by the number of positive and negative emotional words in the essay. The primary study outcome measure was survival from baseline. Biomedical covariates included CD4 count, viral load, age, and antiretroviral medications. Sociodemographic covariates included gender, race, and education. RESULTS The sample was diverse in terms of age (M [SD] 37.60 [9.07]), sex (70.7% male), sexual orientation (55.5% gay or bisexual), and race/ethnicity (37.2% African American, 30.5% white, 28.0% Hispanic, and 4.3% other). Positive, negative, and total emotional expression predicted greater survival (ps < 0.015). Those in the top third of total emotional expression had 3.83 times the survival rate (95% CI: 1.62, 9.02) of those in the bottom third. Odds ratios were 1.85 for positive emotion expression and 2.18 for negative emotion expression. CONCLUSIONS Both positive and negative emotions expressed in a written trauma essay predict survival over 17 years in people living with HIV. Expressing emotions may have benefits for health.
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Ellis RJ, Letendre SL, Atkinson JH, Clifford D, Collier AC, Gelman BB, Marra C, McCutchan JA, Morgello S, Sacktor N, Tang B, Heaton RK. Higher levels of plasma inflammation biomarkers are associated with depressed mood and quality of life in aging, virally suppressed men, but not women, with HIV. Brain Behav Immun Health 2020; 7:100121. [PMID: 34589877 PMCID: PMC8474567 DOI: 10.1016/j.bbih.2020.100121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 02/01/2023] Open
Abstract
Background and objectives People with HIV (PWH) often suffer from depressive symptoms which have a deleterious impact on numerous domains including antiretroviral adherence and quality of life. In the general population, a treatment-resistant phenotype of depression is associated with systemic inflammation, which is of considerable importance as it responds favorably to anti-inflammatory medications. Aging PWH experience increasing inflammation. We sought to evaluate the impact of chronic inflammation in aging PWH on depressed mood. Methods PWH were recruited at 6 U.S. academic medical centers. Depressed mood was assessed using the Beck Depression Inventory (BDI)-II. Inflammatory biomarkers measured at the 12-year follow-up visit in blood plasma using immunoassays were neopterin, sTNFRII, d-dimer, IL-6, CRP, MCP-1, sCD14 and sCD40L. Factor analyses with oblique Equamax rotation were employed to reduce the dimensionality of the biomarkers. Results Participants were 78 PWH, 14 (17.9%) women, 40 (51.3%) non-White, mean age 55.3 (±SD 8.29), with a nadir and current CD4 of 134 (IQR 36, 204) and 567 (316, 797), respectively. 80.5% were virally suppressed. A factor analysis of the eight inflammatory biomarkers in plasma at the 12-year follow-up visit yielded 3 Factors, with Factor 1 loading on neopterin and sTNFRII, Factor 2 loading on d-dimer, IL-6 and CRP, and Factor 3 loading on sCD40L (MCP-1 and sCD14 did not appear in any of the factors). Univariate regressions of each factor vs BDI-II scores yielded significance only for Factor 2 (r = 0.295; p = 0.0083 (Bonferroni-adjusted p = 0.0261). Of the Factor 2 component biomarkers, BDI-II scores correlated significantly with d-dimer and IL-6, but not CRP. Women had worse BDI-II scores (p = 0.0127). In a logistic regression with sex and Factor 2, both variables were significant (sex p = 0.0246, Factor 2 p = 0.0168). The relationship between Factor 2 and BDI was significant for men (r = 0.348 [95% CI 0.111, 0.547]; p = 0.0049), but not women (r = 0.0580 95% CI -0.488, 0.571]; p = 0.844). Viral suppression was not significant in the multivariate model. Conclusions Some PWH with depressed mood have elevated markers of inflammation in blood. Men showed this relationship, while women did not. Together with previous findings that an inflammatory depression phenotype responds to treatment with anti-inflammatory medications, our findings suggest that treatment with anti-inflammatory medications might benefit at least a subset of depressed PWH who have a high inflammatory biomarker profile, as well as poor response to antidepressant medications alone, and that the pathophysiology of depression in men and women with HIV may differ.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ned Sacktor
- Johns-Hopkins University, Baltimore, MD, USA
| | - Bin Tang
- University of California, San Diego, USA
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Rendina HJ, Weaver L, Millar BM, López-Matos J, Parsons JT. Psychosocial Well-Being and HIV-Related Immune Health Outcomes among HIV-Positive Older Adults: Support for a Biopsychosocial Model of HIV Stigma and Health. J Int Assoc Provid AIDS Care 2020; 18:2325958219888462. [PMID: 31795813 PMCID: PMC6893929 DOI: 10.1177/2325958219888462] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Evidence suggests that psychosocial stress negatively impacts immunological health in HIV-positive individuals. However, few studies have explored this association in substance-using older adults living with HIV (OALWH). We evaluated the effect of depression, loneliness, substance use problems, and HIV stigma on primary markers of immune function in a sample of 120 OALWH with substance-related issues. HIV stigma correlated with the greatest number of factors, including depression, loneliness, and substance use problems. Older age and antiretroviral adherence were associated with viral suppression, which was in turn associated with higher percentage of CD4 count. Multivariate path analyses demonstrated that lower HIV stigma and viral suppression were the only factors independently associated with higher percentage of CD4 count, with a significant indirect effect of adherence on CD4 through viral suppression. HIV stigma emerged as the most salient factor associated with both psychosocial well-being and immune health in the current study, suggesting that it is a critical factor to consider in future interventions for the rapidly growing population of OALWH.
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Affiliation(s)
- H Jonathon Rendina
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Laurel Weaver
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Brett M Millar
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
| | - Jonathan López-Matos
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA.,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
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45
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Harrison A, Scott W, Timmins L, Graham CD, Harrison AM. Investigating the potentially important role of psychological flexibility in adherence to antiretroviral therapy in people living with HIV. AIDS Care 2020; 33:337-346. [PMID: 32468841 DOI: 10.1080/09540121.2020.1771263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Antiretroviral therapy (ART) has significantly improved immune health and survival rates in HIV, but these outcomes rely on near perfect adherence. While many psychosocial factors are related to sub-optimal adherence, effectiveness of associated interventions are modest or inconsistent. The Psychological Flexibility (PF) model underlying Acceptance and Commitment Therapy (ACT) identifies a core set of broadly applicable transdiagnostic processes that may be useful to explain and improve non-adherence. However, PF has not previously been examined in relation to ART adherence. Therefore, this cross-sectional study (n = 275) explored relationships between PF and intentional/unintentional ART non-adherence in people with HIV. Adults with HIV prescribed ART were recruited online. Participants completed online questionnaires assessing self-reported PF, adherence and emotional and general functioning. Logistic regressions examined whether PF processes were associated with intentional/unintentional non-adherence. Fifty-eight percent of participants were classified as nonadherent according to the Medication Adherence Rating Scale, of which 41.0% reported intentional and 94.0% unintentional non-adherence. Correlations between PF and adherence were small. PF did not significantly explain intentional/unintentional non-adherence after controlling for demographic and disease factors. Further clarification of the utility of PF in understanding ART non-adherence is warranted using prospective or experimental designs in conjunction with more objective adherence measures.
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Affiliation(s)
- Anja Harrison
- School of Psychology, University of Central Lancashire, Preston, UK
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Liadh Timmins
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | - Anthony M Harrison
- Leeds and York Partnership National Health Service Foundation Trust, Leeds, UK
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Bengtson AM, Pence BW, Mimiaga MJ, Gaynes BN, Moore R, Christopoulos K, O'Cleirigh C, Grelotti D, Napravnik S, Crane H, Mugavero M. Depressive Symptoms and Engagement in Human Immunodeficiency Virus Care Following Antiretroviral Therapy Initiation. Clin Infect Dis 2020; 68:475-481. [PMID: 29901695 DOI: 10.1093/cid/ciy496] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Abstract
Background The effect of depressive symptoms on progression through the human immunodeficiency virus (HIV) treatment cascade is poorly characterized. Methods We included participants from the Centers for AIDS Research Network of Integrated Clinic Systems cohort who were antiretroviral therapy (ART) naive, had at least 1 viral load and HIV appointment measure after ART initiation, and a depressive symptom measure within 6 months of ART initiation. Recent depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized using a validated cut point (PHQ-9 ≥10). We followed participants from ART initiation through the first of the following events: loss to follow-up (>12 months with no HIV appointment), death, administrative censoring (2011-2014), or 5 years of follow-up. We used log binomial models with generalized estimating equations to estimate associations between recent depressive symptoms and having a detectable viral load (≥75 copies/mL) or missing an HIV visit over time. Results We included 1057 HIV-infected adults who contributed 2424 person-years. At ART initiation, 30% of participants reported depressive symptoms. In multivariable analysis, recent depressive symptoms increased the risk of having a detectable viral load (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.07, 1.53) over time. The association between depressive symptoms and missing an HIV visit (RR, 1.20; 95% CI, 1.05, 1.36) moved to the null after adjustment for preexisting mental health conditions (RR, 1.00; 95% CI, 0.85, 1.18). Conclusions Recent depressive symptoms are a risk factor for unsuppressed viral load, while preexisting mental health conditions may influence HIV appointment adherence.
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Affiliation(s)
- Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health.,Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.,Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Baltimore, Maryland
| | - Richard Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - David Grelotti
- Department of Psychiatry, University of California, San Diego
| | - Sonia Napravnik
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Heidi Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Michael Mugavero
- Department of Medicine and UAB Center for AIDS Research, University of Alabama at Birmingham
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47
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Moitra E, Anderson BJ, Herman DS, Hayaki J, Pinkston MM, Kim HN, Stein MD. Examination of using alcohol to cope, depressive symptoms, and perceived social support in persons with HIV and Hepatitis C. AIDS Care 2020; 32:1238-1245. [PMID: 32098484 DOI: 10.1080/09540121.2020.1734177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is common among people living with HIV (PLWH) and some likely turn to alcohol to cope with this emotional distress. Using alcohol to cope is associated with increased alcohol use, persistent longitudinal alcohol use, and alcohol-related problems. This association is particularly concerning among PLWH who are co-infected with Hepatitis C (HCV) because alcohol adds to the damage already caused by HCV. Despite data showing the associated risks of using alcohol to cope, scant research has examined factors that might contribute to coping-based alcohol use in HIV-HCV patients, such as limited social support. Baseline data from a randomized trial of strategies to reduce alcohol use in co-infected HIV and HCV adult patients (n=110) were analyzed. Multiple linear regression models were used to estimate the association between using alcohol to cope, depression, and four aspects of social support, controlling for demographic variables. Results showed that using alcohol to cope was not significantly correlated with social support but was significantly correlated with depressive symptoms. In fact, depressive symptoms and severity of alcohol consumption accounted for nearly 45% of the variance related to coping-based alcohol use. These data highlight the central role of depression in the coping motives-alcohol use relationship among co-infected patients.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence RI, USA
| | - Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.,Lifespan Physicians Group, Providence RI, USA
| | - H Nina Kim
- Department of Global Health, University of Washington, Seattle WA, USA.,Department of Medicine, University of Washington, Seattle WA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston MA, USA
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48
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Mills JC, Pence BW, Edmonds A, Adedimeji A, Schwartz RM, Kassaye S, Cocohoba J, Cohen MH, Neigh G, Fischl MA, Kempf MC, Adimora AA. The Impact of Cumulative Depression Along the HIV Care Continuum in Women Living With HIV During the Era of Universal Antiretroviral Treatment. J Acquir Immune Defic Syndr 2019; 82:225-233. [PMID: 31335585 PMCID: PMC6791755 DOI: 10.1097/qai.0000000000002140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US. METHODS This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL). RESULTS The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent. CONCLUSIONS Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.
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Affiliation(s)
- Jon C Mills
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Seble Kassaye
- Department of Infectious Diseases, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA
| | - Mardge H Cohen
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Gretchen Neigh
- Department of Anatomy and Neurobiology, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Margaret A Fischl
- Department of Medicine/Infectious Diseases, Miami Center for AIDS Research, University of Miami, Miller School of Medicine, Miami, FL
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
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49
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Abstract
There has been limited study of the syndemic link between HIV and intimate partner violence (IPV) among rural populations in the United States. We utilized the Revised Conflict Tactics Scale-2 to examine the past year prevalence, type (psychological aggression, physical assault, and sexual assault), and the impact of IPV on HIV clinical outcomes among men living with HIV in rural Appalachia. Approximately 39% of participants experienced some type of IPV in the preceding year, with 67% of those individuals experiencing more than 1 type of IPV. Approximately 77% of participants endorsing IPV exposure experienced psychological aggression. Most participants exposed to psychological aggression (70%) and/or physical assault (57%) were both victims and perpetrators, and those experiencing sexual assault reported being exclusively victims (65%). There were no significant differences in clinical outcomes including viral load and CD4 count, which may be secondary to small sample size derived from a clinic population with a high rate of virologic suppression (94%). This study demonstrates the need to assess IPV exposure in men living with HIV and further highlights the intricacies of relationship violence in these individuals.
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50
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Heissel A, Zech P, Rapp MA, Schuch FB, Lawrence JB, Kangas M, Heinzel S. Effects of exercise on depression and anxiety in persons living with HIV: A meta-analysis. J Psychosom Res 2019; 126:109823. [PMID: 31518734 DOI: 10.1016/j.jpsychores.2019.109823] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to examine the effects of exercise on depression and anxiety in people living with HIV (PLWH), and to evaluate, through subgroup analysis, the effects of exercise type, frequency, supervision by exercise professionals, study quality, and control group conditions on these outcomes. METHOD A literature search was conducted through four electronic databases from inception to February 2019. Considered for inclusion were randomized controlled trials (RCTs) investigating exercise interventions and depression or anxiety as outcomes in people living with HIV (≥ 18 years of age). Ten studies were included (n = 479 participants, 49.67% females at baseline), and the standardized mean difference (SMD) and heterogeneity were calculated using random-effect models. An additional pre-post meta-analysis was also conducted. RESULTS A large effect in favor of exercise when compared to controls was found for depression (SMD = -0.84, 95%CI = [-1.57, -0.11], p = 0.02) and anxiety (SMD = -1.23, 95%CI = [-2.42, -0.04], p = 0.04). Subgroup analyses for depression revealed large effects on depression for aerobic exercise only (SMD = -0.96, 95%CI = [-1.63, -0.30], p = 0.004), a frequency of ≥3 exercise sessions per week (SMD = -1.39, 95%CI = [-2.24, -0.54], p < 0.001), professionally supervised exercise (SMD = -1.40, 95%CI = [-2.46, -0.17], p = 0.03]), and high-quality studies (SMD = -1.31, 95%CI = [-2.46, -0.17], p = 0.02). CONCLUSION Exercise seems to decrease depressive symptoms and anxiety in PLWH, but other larger and high-quality studies are needed to verify these effects.
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Affiliation(s)
- Andreas Heissel
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany.
| | - Philipp Zech
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany
| | - Felipe B Schuch
- Departamento de métodos e técnicas desportivas, Universidade Federal de Santa Maria, Brazil
| | - Jimmy B Lawrence
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Germany
| | - Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Stephan Heinzel
- Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Germany
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