Labbe Allison K, O'Cleirigh Conall M, Stein Michael, Safren Steven A
a Massachusetts General Hospital , Boston , MA , USA.
Psychol Health Med. 2015;20(7):870-7. doi: 10.1080/13548506.2014.999809. Epub 2015 Jan 14.
Depression and substance use, the most common comorbidities with HIV, are both associated with poor treatment outcomes and accelerated HIV disease progression. Though previous research has demonstrated short-term and follow-up success for cognitive behavioral therapy for adherence and depression (CBT-AD) on depression outcomes among patients with HIV in care and among patients with HIV in active substance abuse treatment for injection drug use (IDU), there is little information regarding possible moderating effects of active use versus abstinence on depression treatment gains. The present study aimed to examine recent substance use at treatment initiation as a moderator of the acute and maintenance effects of CBT-AD on depression. We used data from a two-arm, randomized controlled trial (N = 89) comparing CBT-AD to enhanced treatment as usual in individuals in treatment for IDU. To test whether depression at time of presentation affected outcomes, repeated-measures ANOVAs were conducted for two time frames: (1) acute phase (baseline to post-treatment) (acute) and (2) maintenance phase (baseline to 12-month follow-up). To further examine maintenance of gains, we additionally looked at post-treatment to 12-month follow-up. Depression scores derived from the clinical global impression for severity and the Montgomery-Asberg depression rating scale (MADRS) served as the primary outcome variables. Acute (baseline post treatment) moderation effects were found for those patients endorsing active drug use at baseline in the CBT-AD condition, who demonstrated the greatest reductions in MADRS scores at post-treatment (F[1,76] = 6.78, p = .01) and follow-up (F[1,61] = 5.46, p = .023). Baseline substance use did not moderate differences from post-treatment to 12-month follow-up as depression treatment gains that occurred acutely from baseline to post-treatment were maintained across both patients engaged in substance use and abstainers. We conclude that CBT-AD for triply diagnosed patients (i.e. HIV, depression, and substance dependence) is useful for treating depression for both patients with a history of substance use, as well as patients currently engaged in substance use.
抑郁症和物质使用是与艾滋病毒最常见的共病，二者均与治疗效果不佳和艾滋病毒疾病进展加速相关。尽管先前的研究已证明，针对接受护理的艾滋病毒患者以及接受注射吸毒（IDU）的活跃物质滥用治疗的艾滋病毒患者，认知行为疗法改善依从性和治疗抑郁症（CBT-AD）在抑郁症治疗结果方面取得了短期和随访成功，但关于活跃使用与戒断对抑郁症治疗效果可能的调节作用的信息却很少。本研究旨在探讨治疗开始时最近的物质使用情况，作为CBT-AD对抑郁症的急性和维持效应的调节因素。我们使用了一项双臂随机对照试验（N = 89）的数据，该试验比较了CBT-AD与针对IDU治疗个体的强化常规治疗。为了测试就诊时的抑郁症是否影响治疗结果，针对两个时间框架进行了重复测量方差分析：（1）急性期（基线至治疗后）（急性）和（2）维持期（基线至12个月随访）。为了进一步检查治疗效果的维持情况，我们还观察了治疗后至12个月随访期间的情况。源自临床总体印象严重程度和蒙哥马利-艾斯伯格抑郁评定量表（MADRS）的抑郁评分作为主要结局变量。在CBT-AD组中，那些在基线时认可活跃药物使用的患者在急性期（基线至治疗后）存在调节效应，这些患者在治疗后（F[1,76] = 6.78，p = 0.01）和随访时（F[1,61] = 5.46，p = 0.023）MADRS评分下降幅度最大。从治疗后到12个月随访期间，基线物质使用并未调节差异，因为从基线到治疗后急性出现的抑郁症治疗效果在物质使用患者和戒断者中均得以维持。我们得出结论，针对三重诊断患者（即艾滋病毒、抑郁症和物质依赖）的CBT-AD对于治疗有物质使用史的患者以及目前正在使用物质的患者的抑郁症均有用。
