Ironson Gail, Hylton Emily, Verhagen Rachel
Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA.
Department of Psychiatry, University of Miami, Coral Gables, USA.
J Gen Intern Med. 2022 Aug;37(10):2351-2357. doi: 10.1007/s11606-021-07245-y. Epub 2022 Mar 16.
For patients diagnosed with chronic illness, attitude towards treatment may play an important role in health and survival. For example, negative attitudes towards treatment have been related to poorer adherence to treatment recommendations and prescribed medication across a range of chronic illnesses. In addition, prior research has shown that attitude towards treatment assessed through a psychiatric interview predicted survival at 1 year after bone marrow transplantation with great accuracy (> 90%).
The purpose of this study was to determine the relationship between a self-report attitude to a treatment measure that operationalized a psychiatric interview, and survival over 17 years in a sample of people living with HIV (PLWH).
Participants (N = 177) who were in the mid-range of HIV illness at baseline (CD4s 150 to 500, no prior AIDS-defining clinical symptom) were administered the Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale and followed longitudinally to determine survival at 17 years.
The Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale is a 20-item self-report questionnaire designed to survey multiple factors that contribute to an overall psychological construct of the treatment process.
The MMAT-20/HIV predicted survival over 17 years controlling for biomedical (baseline CD4, viral load, antiretroviral medications, age) and psychosocial (race, education, antiretroviral medications) variables. Those in the top half on the MMAT-20/HIV were almost twice as likely to survive than those in the lower half. Scores on the MMAT-20/HIV were significantly but modestly correlated with adherence (r = .20, p < .05), but adherence was not a mediator of the relationship between the MMAT-20/HIV and survival.
An individual's attitude towards the treatment process predicted survival, raising the possibility that optimal clinical management would include ways to probe these attitudes and intervene where possible. The ease of administering the MMAT-20 and adaptability to other illnesses could facilitate this endeavor.
对于被诊断患有慢性病的患者，对治疗的态度可能在健康和生存中发挥重要作用。例如，对治疗的消极态度与一系列慢性病中对治疗建议和处方药的较差依从性有关。此外，先前的研究表明，通过精神病学访谈评估的对治疗的态度能非常准确地预测骨髓移植后1年的生存率（>90%）。
本研究的目的是确定一种自我报告的对治疗措施的态度（该态度将精神病学访谈操作化）与一组艾滋病毒感染者（PLWH）17年的生存率之间的关系。
基线时处于艾滋病毒疾病中等范围（CD4细胞计数为150至500，无先前的艾滋病定义临床症状）的参与者（N = 177）接受了蒙特利尔 - 迈阿密治疗态度（MMAT - 20/HIV）量表的评估，并进行纵向随访以确定17年的生存率。
蒙特利尔 - 迈阿密治疗态度（MMAT - 20/HIV）量表是一份20项的自我报告问卷，旨在调查促成治疗过程整体心理结构的多个因素。
在控制了生物医学（基线CD4、病毒载量、抗逆转录病毒药物、年龄）和社会心理（种族、教育程度、抗逆转录病毒药物）变量后，MMAT - 20/HIV预测了17年的生存率。MMAT - 20/HIV得分处于上半部分的人存活的可能性几乎是下半部分人的两倍。MMAT - 20/HIV得分与依从性显著但适度相关（r = 0.20，p < 0.05），但依从性不是MMAT - 20/HIV与生存率之间关系的中介因素。
个体对治疗过程的态度预测了生存率，这增加了最佳临床管理应包括探索这些态度并在可能的情况下进行干预的方法的可能性。MMAT - 20易于实施以及对其他疾病的适应性可能有助于这一努力。
