a Department of Psychology , University of Utah , Salt Lake City , UT , USA.
b Department of Psychology , Drexel University , Philadelphia , PA , USA.
Psychother Res. 2019 May;29(4):492-502. doi: 10.1080/10503307.2017.1380863. Epub 2017 Oct 9.
The mental health burden among people living with HIV/AIDS (PLWHA) is high and often involves multiple comorbid psychological and substance use-related psychosocial problems. These co-occurring problems, or syndemics, additively impair engagement in HIV disease management. Existing psychotherapies for mental health and HIV health have generally focused on a single psychosocial problem and little research exists to guide future psychotherapies that address multiple mental health issues.
To address this gap in understanding, we conducted qualitative interviews with multiply comorbid PLWHA (N = 30) who completed cognitive-behavioural therapy (CBT) for depression and medication adherence.
Themes emerged regarding participants' perspectives on how overlapping substance use and mood disorders interacted to reduce the benefit of CBT. Substance use was a dominant theme compared to other syndemics, highlighting the need for integrated mental health and substance use interventions. Interviews also suggested modifications of which psychosocial concerns participants felt should be prioritized in treatment delivery. Finally, participants described content they would want in a psychotherapy intervention, including intimacy and sexual health.
Future psychotherapeutic interventions for syndemic problems and HIV self-care will need to comprehensively address complex concerns, including issues salient to the overall well-being of PLWHA. This may improve client engagement and, ultimately, mental, and physical health outcomes. Clinical or methodological significance of this article: Although mental health comorbidity is common and often complex among clients living with HIV, little research exists to guide psychotherapy for such intricate mental health concerns. The current study used content analysis of in-depth qualitative interviews with clients living with HIV and multiple mental health comorbidities who had recently completed cognitive-behavioural therapy. Recommendations based on these findings suggest strategies for clinicians working with similar clients to consider and offers suggestions for future treatment development research.
艾滋病毒/艾滋病感染者（PLWHA）的心理健康负担很高，通常涉及多种合并的心理和与物质使用相关的社会心理问题。这些同时发生的问题，或综合征，会加重他们参与艾滋病毒疾病管理的难度。现有的心理健康和艾滋病毒健康心理疗法通常侧重于单一的社会心理问题，几乎没有研究可以指导解决多种心理健康问题的未来心理疗法。
为了解决这一理解上的差距，我们对 30 名同时患有多种疾病的 PLWHA 进行了定性访谈，这些患者完成了认知行为疗法（CBT）治疗抑郁症和药物依从性。
主题涉及参与者对重叠的物质使用和情绪障碍如何相互作用，从而降低 CBT 益处的看法。与其他综合征相比，物质使用是一个主要主题，突出了需要进行综合的心理健康和物质使用干预。访谈还表明，需要对参与者认为在治疗中应优先考虑的哪些社会心理问题进行修改。最后，参与者描述了他们希望在心理治疗干预中包含的内容，包括亲密关系和性健康。
未来针对综合征问题和艾滋病毒自我保健的心理治疗干预将需要全面解决复杂的问题，包括对 PLWHA 整体健康至关重要的问题。这可能会提高客户的参与度，并最终改善心理健康和身体健康的结果。本文在临床或方法学方面的意义：尽管精神健康合并症在感染艾滋病毒的患者中很常见，而且通常很复杂，但很少有研究可以指导此类复杂精神健康问题的心理治疗。本研究使用了对最近完成认知行为疗法的患有多种精神健康合并症的艾滋病毒感染者进行深入定性访谈的内容分析。基于这些发现的建议为与类似患者合作的临床医生提供了一些需要考虑的策略，并为未来的治疗发展研究提供了建议。
