Wagner Glenn J, Ghosh-Dastidar Bonnie, Robinson Eric, Ngo Victoria K, Glick Peter, Mukasa Barbara, Musisi Seggane, Akena Dickens
RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
Mildmay Uganda, Kampala, Uganda.
AIDS Behav. 2017 Jun;21(6):1655-1664. doi: 10.1007/s10461-016-1500-0.
With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors.
由于已知抑郁症会妨碍艾滋病病毒治疗的依从性和持续性，我们研究了缓解抑郁症是否能改善这些疾病管理行为。乌干达的1028名感染艾滋病病毒的抑郁症患者参与了一项关于两种抑郁症护理模式的整群随机对照试验，并在12个月内接受了调查。系列回归分析检验了在第12个月时抑郁症缓解是否与自我报告的抗逆转录病毒疗法（ART）依从性及门诊就诊率相关，以及这些关系是否由自我效能感和动机介导。在患有重度抑郁症的患者中，抑郁症缓解与第12个月时更好的ART依从性及门诊就诊率相关；这些关系在第12个月时完全由自我效能感介导，而依从动机部分介导了抑郁症缓解与ART依从性之间的关系。当同时纳入这两种中介因素时，只有自我效能感是一个显著的预测因素，并且仍然完全介导了抑郁症缓解与依从性之间的关系。这些发现表明，缓解抑郁症对ART依从性和门诊就诊率均有益处，很大程度上是通过增强参与这些疾病管理行为的信心和动机实现的。
