“Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa”
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“Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa”. / Joska, John A.; Lee, Jasper S.; Andersen, Lena S.; Stanton, Amelia M.; O’ Clereigh, Conall; Safren, Steven.
In: Journal of Affective Disorders, Vol. 343, 2023, p. 136-143.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - “Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa”
AU - Joska, John A.
AU - Lee, Jasper S.
AU - Andersen, Lena S.
AU - Stanton, Amelia M.
AU - O’ Clereigh, Conall
AU - Safren, Steven
N1 - Publisher Copyright: © 2023 The Authors
PY - 2023
Y1 - 2023
N2 - Background: People with HIV (PHW) are at greater risk of depression than the general population. Insight into the time-to-treatment-response and predictors of response to psychotherapy may improve implementation in primary care. Methods: We assessed depression treatment response among 80 participants in a trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal antiretroviral therapy (ART) adherence. Participants self-reported depressive symptoms (CES[sbnd]D) at each therapy session. Clinicians assessed participants' depression (HAM[sbnd]D), along with potential predictors of response, every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each phase. Results: During the active treatment phase (CES[sbnd]D) we identified an early response (at session 2 and with continued trajectory of improvement) and a non-response group. There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR = 0.74, 95%CI[0.56–0.90], p = .009), and social support was associated with increased likelihood of early response (aOR = 2.24, 95%CI[1.07–5.46], p = .045). Limitations: Self-reported depression during the treatment phase may have resulted from social desirability bias. Conclusions: Most participants responded to CBT-AD early during treatment (89 %) and had sustained improvements in depression by 4 months (80 %). Distress aversion was a risk factor for late response, and social support was protective. Future research is needed to assess the optimal dose of CBT-AD in resource limited settings.
AB - Background: People with HIV (PHW) are at greater risk of depression than the general population. Insight into the time-to-treatment-response and predictors of response to psychotherapy may improve implementation in primary care. Methods: We assessed depression treatment response among 80 participants in a trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal antiretroviral therapy (ART) adherence. Participants self-reported depressive symptoms (CES[sbnd]D) at each therapy session. Clinicians assessed participants' depression (HAM[sbnd]D), along with potential predictors of response, every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each phase. Results: During the active treatment phase (CES[sbnd]D) we identified an early response (at session 2 and with continued trajectory of improvement) and a non-response group. There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR = 0.74, 95%CI[0.56–0.90], p = .009), and social support was associated with increased likelihood of early response (aOR = 2.24, 95%CI[1.07–5.46], p = .045). Limitations: Self-reported depression during the treatment phase may have resulted from social desirability bias. Conclusions: Most participants responded to CBT-AD early during treatment (89 %) and had sustained improvements in depression by 4 months (80 %). Distress aversion was a risk factor for late response, and social support was protective. Future research is needed to assess the optimal dose of CBT-AD in resource limited settings.
KW - Cognitive-behavioral therapy (CBT)
KW - Depression
KW - Global mental health
KW - Intervention
KW - Randomized controlled trial
KW - Task-sharing
KW - Task-shifting
KW - Treatment response
U2 - 10.1016/j.jad.2023.10.001
DO - 10.1016/j.jad.2023.10.001
M3 - Journal article
C2 - 37797752
AN - SCOPUS:85173264461
VL - 343
SP - 136
EP - 143
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -
ID: 374269866