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Safren SA, Harkness A, Lee JS, Rogers BG, Mendez NA, Magidson JF, Blashill AJ, Bainter S, Rodriguez A, Ironson G. Addressing Syndemics and Self-care in Individuals with Uncontrolled HIV: An Open Trial of a Transdiagnostic Treatment. AIDS Behav 2020; 24:3264-3278. [PMID: 32410049 PMCID: PMC7546114 DOI: 10.1007/s10461-020-02900-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Interventions addressing syndemics and ART adherence are needed for individuals with uncontrolled HIV and psychosocial problems. Twenty-seven participants with detectable HIV plasma viral load (PVL) or recent STI participated in an open trial of transdiagnostic adherence counseling and cognitive behavioral therapy. Outcomes were collected at baseline, 4-, and 8-months. Log PVL improved from baseline to 4-month (γ = - 1.13, 95% CI - 1.72, - 0.55, p < 0.001) and 8-month (γ = - 0.93, 95% CI - 1.57, - 0.30, p = 0.006), with more participants suppressed at 4- (χ2(1) = 9.09, p = 0.001) and 8-month (χ2(1) = 5.14, p = 0.016). Self-reported adherence improved across major assessments (γ = 0.87, 95% CI 0.28, 1.46, p = .005); Wisepill adherence did not. Negative affect declined during treatment (γ = - 0.28, 95% CI - 0.40, - 0.16, p < 0.001), with improvement at 4- (γ = - 4.34, 95% CI - 6.99, - 1.69, p = 0.002) but not 8-month. Positive affect trended positively during treatment and from baseline to 4-month, with significant 8-month improvement (γ = 3.84, 95% CI 0.33, 7.44, p = 0.04). Depressive symptoms did not change. In a complicated sample of participants selected for uncontrolled HIV, the intervention yielded improved PVL and self-reported adherence. Efforts to end HIV should improve upon strategies such as these, addressing syndemics. Registration: clinicaltrial.gov: NCT02696681.
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Affiliation(s)
- S A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA.
| | - A Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - J S Lee
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - B G Rogers
- Department of Medicine, Brown University, Providence, RI, USA
| | - N A Mendez
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - J F Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - A J Blashill
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - S Bainter
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - A Rodriguez
- Department of Medicine, University of Miami, Miami, FL, USA
| | - G Ironson
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA
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Andersen LS, Joska JA, Magidson JF, O'Cleirigh C, Lee JS, Kagee A, Witten JA, Safren SA. Detecting Depression in People Living with HIV in South Africa: The Factor Structure and Convergent Validity of the South African Depression Scale (SADS). AIDS Behav 2020; 24:2282-2289. [PMID: 31965430 PMCID: PMC8021389 DOI: 10.1007/s10461-020-02787-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Screening measures for depression developed in high-income countries have not always demonstrated strong psychometric properties in South Africa and with people living with HIV (PLWH). The present study explored the psychometric properties of the 16-item South African Depression Scale (SADS) comprised of idioms of distress specific to isiXhosa culture in PLWH. The SADS was administered to 137 Xhosa-speaking PLWH who met diagnostic criteria for major depressive disorder (MDD) together with the Hamilton Depression Scale (HAM-D) and the Center for Epidemiological Studies Depression Scale (CES-D). We conducted exploratory factor analysis, correlation, and reliability statistics. Four factors of the SADS emerged: Sadness, lethargy/burdened, anhedonia/withdrawal, and cognitive/somatic. All factors correlated significantly with the HAM-D and CES-D. Internal consistency of the overall measure was high (α = .89). The SADS promises to be a robust measure of depression in isiXhosa-speaking PLWH in South Africa likely due to the inclusion of local idioms of distress.
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Affiliation(s)
- L S Andersen
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - J A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J F Magidson
- Department of Psychology, University of Maryland, College Park, MA, USA
| | - C O'Cleirigh
- Behavioral Medicine Service, Massachusetts General Hospital/Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - J S Lee
- Department of Psychology, University of Miami, Florida, USA
| | - A Kagee
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - J A Witten
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S A Safren
- Department of Psychology, University of Miami, Florida, USA
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Everitt-Penhale B, Kagee A, Magidson JF, Joska J, Safren SA, O’Cleirigh C, Witten J, Lee JS, Andersen LS. 'I went back to being myself': acceptability of a culturally adapted task-shifted cognitive-behavioural therapy (CBT) treatment for depression (Ziphamandla) for South African HIV care settings. PSYCHOL HEALTH MED 2019; 24:680-690. [PMID: 30652921 PMCID: PMC6484450 DOI: 10.1080/13548506.2019.1566624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 12/25/2018] [Indexed: 12/22/2022]
Abstract
There is a need for a culturally adapted, evidence-based, psychotherapy treatment that is effective, acceptable, and feasible for integration into primary care in South Africa. This qualitative study used exit interviews to examine participants' experiences of an adapted cognitive-behavioural therapy treatment for adherence and depression, task-shifted and delivered by nurses in two peri-urban HIV clinics near Cape Town. Nine semi-structured exit interviews were conducted with isiXhosa-speaking females and analysed using thematic analysis. Overall, participants responded positively to the treatment, viewing it as acceptable and beneficial and as a catalyst to returning to normalcy. Results indicated that participants viewed the treatment as being effective in ameliorating their depressive symptoms and improving their adherence to ART . Additional benefits described included improvements in subjective wellbeing and social and occupational functioning. Several began or resumed employment, an important behavioural indicator of the treatment's capacity to facilitate positive change and cost saving. Recommendations to improve the treatment included using video material and educating others about depression. These findings have positive implications regarding the acceptability and cultural applicability of the treatment for use in South Africa.
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Affiliation(s)
- B. Everitt-Penhale
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - A. Kagee
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - J. F. Magidson
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - J. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S. A. Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C. O’Cleirigh
- Behavioral Medicine, Massachusetts General Hospital/Department of Psychiatry, Harvard University, Boston, MA, USA
| | - J. Witten
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J. S. Lee
- Department of Psychology, University of Miami, Miami, FL, USA
| | - L. S. Andersen
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Magidson JF, Lejuez CW, Kamal T, Blevins EJ, Murray LK, Bass JK, Bolton P, Pagoto S. Adaptation of community health worker-delivered behavioral activation for torture survivors in Kurdistan, Iraq. Glob Ment Health (Camb) 2015; 2:e24. [PMID: 27478619 PMCID: PMC4962865 DOI: 10.1017/gmh.2015.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/12/2015] [Accepted: 10/25/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolton et al. 2014a) supported the efficacy of two CHW-delivered interventions, cognitive processing therapy (CPT) and brief behavioral activation treatment for depression (BATD), for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq. METHODS This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial (Bolton et al.2014a), informed by the Assessment-Decision-Administration-Production-Topical experts-Integration-Training-Testing (ADAPT-ITT) framework for intervention adaptation (Wingood & DiClemente, 2008). Cultural modifications, adaptations for low-literacy, and tailored training and supervision for non-specialist CHWs are presented, along with two clinical case examples to illustrate delivery of the adapted intervention in this setting. RESULTS Eleven CHWs, a study psychiatrist, and the CHW clinical supervisor were trained in BATD. The adaptation process followed the ADAPT-ITT framework and was iterative with significant input from the on-site supervisor and CHWs. Modifications were made to fit Kurdish culture, including culturally relevant analogies, use of stickers for behavior monitoring, cultural modifications to behavioral contracts, and including telephone-delivered sessions to enhance feasibility. CONCLUSIONS BATD was delivered by CHWs in a resource-poor, conflict-affected area in Kurdistan, Iraq, with some important modifications, including low-literacy adaptations, increased cultural relevancy of clinical materials, and tailored training and supervision for CHWs. Barriers to implementation, lessons learned, and recommendations for future efforts to adapt behavioral therapies for resource-limited, conflict-affected areas are discussed.
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Affiliation(s)
- J. F. Magidson
- Department of Psychiatry, Massachusetts General Hospital (MGH)/Harvard Medical School, Boston, MA, USA
| | - C. W. Lejuez
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, USA
| | - T. Kamal
- Fine Arts Institute, University of Sulaimani, Kurdistan Region, Iraq
| | - E. J. Blevins
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, College Park, MD, USA
| | - L. K. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J. K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P. Bolton
- Center for Refugee and Disaster Response and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S. Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Magidson JF, Collado-Rodriguez A, Madan A, Perez-Camoirano NA, Galloway SK, Borckardt JJ, Campbell WK, Miller JD. Addressing narcissistic personality features in the context of medical care: integrating diverse perspectives to inform clinical practice. Personal Disord 2011; 3:196-208. [PMID: 22452761 DOI: 10.1037/a0025854] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Narcissistic personality disorder (NPD) is characterized by an unrealistic need for admiration, lack of empathy toward others, and feelings of superiority. NPD presents a unique and significant challenge in clinical practice, particularly in medical settings with limited provider contact time, as health professionals treat individuals who often require excessive admiration and have competing treatment needs. This practice review highlights real case examples across three distinct medically oriented clinical settings (inpatient and outpatient behavioral medicine and a Level I trauma center) to demonstrate the difficult and compromising situations that providers face when treating patients with general medical conditions and comorbid narcissistic personality features. The main goal of this article is to discuss the various challenges and obstacles associated with these cases in medical settings and discuss some strategies that may prove successful. A second goal is to bridge diverse conceptualizations of narcissism/NPD through the discussion of theoretical and empirical perspectives that can inform understanding of the clinical examples. Despite differing perspectives regarding the underlying motivation of narcissistic behavior, this practice review highlights that these paradigms can be integrated when sharing the same ultimate goal: to improve delivery of care across medically oriented clinical settings for patients with narcissistic features.
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Affiliation(s)
- J F Magidson
- Department of Psychology, University of Maryland College Park, 2103R Cole Field House, College Park, MD 20742, USA.
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