HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Affect Disord. 2023 Dec 15;343:136-143. doi: 10.1016/j.jad.2023.10.001. Epub 2023 Oct 4.
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.
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 (CESD) at each therapy session. Clinicians assessed participants' depression (HAMD), 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.
During the active treatment phase (CESD) 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).
Self-reported depression during the treatment phase may have resulted from social desirability bias.
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.
HIV 感染者（PHW）患抑郁症的风险高于一般人群。深入了解治疗反应的时间和心理治疗反应的预测因素可能会改善初级保健中的实施。
我们评估了一项针对 PHW 中认知行为治疗依从性和抑郁（CBT-AD）的试验中的 80 名参与者的抑郁治疗反应，这些参与者患有 MDD 和不理想的抗逆转录病毒治疗（ART）依从性。参与者在每次治疗会议上自我报告抑郁症状（CESD）。临床医生每四个月评估一次参与者的抑郁（HAMD）以及反应的潜在预测因素，为期一年。潜在类别分析检查了活跃期和治疗后阶段的反应者类别。回归分析确定了每个阶段的类别成员的预测因素。
在积极治疗阶段（CESD），我们确定了一个早期反应（在第 2 次治疗和持续改善的轨迹）和一个无反应组。在治疗后阶段（HAMD）也有两个类别：早期反应者（4 个月）和晚期反应者（12 个月）。痛苦回避与 CBT-AD 早期反应的可能性降低相关（aOR=0.74，95%CI[0.56-0.90]，p=0.009），社会支持与早期反应的可能性增加相关（aOR=2.24，95%CI[1.07-5.46]，p=0.045）。
治疗阶段的自我报告抑郁可能源于社会期望偏差。
大多数参与者在治疗早期（89%）对 CBT-AD 有反应，并且在 4 个月时（80%）抑郁持续改善。痛苦回避是反应延迟的危险因素，社会支持具有保护作用。需要进一步研究以评估资源有限环境中 CBT-AD 的最佳剂量。
