Ongoing life stressors and suicidal ideation among HIV-infected adults with depression

Suicidal ideation is the most proximal risk factor for suicide and can indicate extreme psychological distress; identification of its predictors is important for possible intervention. Depression and stressful or traumatic life events (STLEs), which are more common among HIV-infected individuals than the general population, may serve as triggers for suicidal thoughts

When “Need Plus Supply” Does Not Equal Demand: Challenges in Uptake of Depression Treatment in HIV Clinical Care

Depression is common among patients in HIV care and predicts worse HIV-related health behaviors and outcomes. Effective depression treatment is available, yet depression remains widely underdiagnosed and undertreated in HIV care

Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country.

As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding the effect of psychosocial experiences and mental health symptomatology on ART adherence can help maximize the benefit of expanded ART programs by indicating types of services, which could be offered in combination with HIV care. The Coping with HIV/AIDS in Tanzania (CHAT) study is a longitudinal cohort study in the Kilimanjaro Region that included randomly selected HIV-infected (HIV+) participants from two local hospital-based HIV clinics and four free-standing voluntary HIV counselling and testing sites. Baseline data were collected in 2008 and 2009; this paper used data from 36 month follow-up interviews (N = 468). Regression analyses were used to predict factors associated with incomplete self-reported adherence to ART. INCOMPLETE ART ADHERENCE WAS SIGNIFICANTLY MORE LIKELY TO BE REPORTED AMONGST PARTICIPANTS WHO EXPERIENCED A GREATER NUMBER OF CHILDHOOD TRAUMATIC EVENTS: sexual abuse prior to puberty and the death in childhood of an immediate family member not from suicide or homicide were significantly more likely in the non-adherent group and other negative childhood events trended toward being more likely. Those with incomplete adherence had higher depressive symptom severity and post-traumatic stress disorder (PTSD). In multivariable analyses, childhood trauma, depression, and financial sacrifice remained associated with incomplete adherence.\ud This is the first study to examine the effect of childhood trauma, depression and PTSD on HIV medication adherence in a low income country facing a significant burden of HIV. Allocating spending on HIV/AIDS toward integrating mental health services with HIV care is essential to the creation of systems that enhance medication adherence and maximize the potential of expanded antiretroviral access to improve health and reduce new infections

Exile Vol. XXIX No. 2

Photo by John Taylor 2 Poem by Ezra Pound 3 Photo by James Lundy 4 Balanced Budget by August West 5 The Lighter by John Zarchen 6-7 Photo by Theodore Granberg 8 Uptown by Christopher B. Brougham 9 Photo by Jeff Russell 9 Heartstrings by Pete Waters 10 Spell by Eric Stevenson 10 Mums by Mandy Wilson 10 A New Day by Chad Hussey 11 Photo by Chad Hussey 12 Solitare by Gordon Black 13-14 Photo by James Lundy 15 A Grave Day-Dream by John Zarchen 16 Photo by James Lundy 17 Photo by Pauela Theodotou 18 Reconciliation by R. T. Hayashi 19 Michigan Rt. 37 by Ruth Wick 20 Shenango Valley by August West 20 Photo by James Lundy 21 Drawing by Adrienne Wehr 22 Ultraviolet Blues by Kathy Shelton 23 New Orleans & The Silky Black Seams Of My Stockings by Kate Reynolds 23 Refraction by Pam Houston 23-31 Photo by James Lundy 32 A Midsummer Night\u27s... by R. T. Hayashi 33 Couch sleeping by Eric Stevenson 33 Before We Could Build by Kim Kiefer 34 Photo by Chad Hussey 35 The Legend Of The Bear Mother by Amy Pence 36 Photo by James Lundy 37 Cover Drawing by Peter Brooke -title pag

Exile Vol. XXIX No. 1

Once by Kate Silliman 1 Mute by Robert Youngblood 1 Photo by Walter Gunn 2 Cactus Man by Bruce Pedretti 3 From Years On Nauset Beach by 4 Lazy Days of The Matter That Fills You With Guild (And Ecstacy) by Eric Stevenson 5 Tennessee Friday by Becky Hinshaw 6 Photo by Jenny Gardner 7 Street Opera by Bill Hayes 7 Antonia by Ruth Wick 8 Photo by Sheila Waters 9 Tunnel Vision by Jeff Reynold 10 Mrs. Matthews by Kate Reynolds 10 A White Mountain by Ruth Wick 11 The Last Days Of Oliver Descantes by Jeff Hamilton 12-23 Photo by Christopher Hooper 24 Baptism by Becky Hinshaw 25 Sunday Afternoon by August West 26 The Joke\u27s On by Christopher B. Broughm 26 Photo by Mark Baganz 27 Blues by Dave Rheingold 28 Speaking To You Through Derision by Jeff Hamilton 29 Photo by Jenny Gardner 30 Northern Lights by Adrienne Wehr 31 Tripping On The Yawn Of Tomorrow by Kate Reynolds 32 Cleo by Kim Kiefer 33 Kuei Mei by Amy Pence 34 Drawing by Peter Brooke 35 Cover Drawing by Peter Brooke -title pag

Implementation of PHQ-9 Depression Screening for HIV-Infected Patients in a Real-World Setting

The prevalence of depression is 20%-30% for people living with HIV, and while it is associated with poorer adherence to antiretrovirals, it is often unrecognized by medical providers. Although it has been challenging for some health care settings to develop consistent depression screening mechanisms, it is feasible to create screening protocols using the 9-item Patient Health Questionnaire (PHQ-9). Establishing a depression screening and response protocol is an iterative process that involves preparing staff, determining screening frequency, and developing procedures for response and appropriate medical record documentation. While there are multiple issues and potential challenges during implementation, it is possible to incorporate systematic depression screening into HIV primary care in a manner that achieves staff buy-in, minimizes patient burden, streamlines communication, and efficiently uses the resources available in the medical setting

Improvements in depression and changes in quality of life among HIV-infected adults

Improving QOL for HIV-infected individuals is an important objective of HIV care, given the considerable physical and emotional burden associated with living with HIV. Although worse QOL has been associated with depression, no research has quantified the potential of improvement in depression to prospectively improve QOL among HIV-infected adults. We analyzed data from 115 HIV-infected adults with depression enrolled in a randomized controlled trial to evaluate the effectiveness of improved depression care on antiretroviral drug adherence. Improvement in depression, the exposure of interest, was defined as the relative change in depression at 6 months compared to baseline and categorized as full response (≥50% improvement), partial response (25%–49% improvement) and no response (<25% improvement). Multivariable linear regression was used to investigate the relationship between improvement in depression and four continuous measures of QOL at 6 months: physical QOL, mental QOL, HIV symptoms, and fatigue intensity. In multivariable analyses, physical QOL was higher among partial responders (MD=2.51, 95% CI −1.51, 6.54) and full responders (MD=3.68, 95% CI −0.36, 7.72) compared to individuals who did not respond. Mental QOL was an average of 4.01 points higher (95% CI −1.01, 9.03) among partial responders and 14.34 points higher (95% CI 9.42, 19.25) among full responders. HIV symptoms were lower for partial responders (MD=−0.69; 95% CI −1.69, 0.30) and full responders (MD=−1.51; 95% CI −2.50, −0.53). Fatigue intensity was also lower for partial responders (MD=−0.94; 95% CI −1.94, 0.07) and full responders (MD=−3.00; 95% CI −3.98, −2.02). Among HIV-infected adults with depression, improving access to high-quality depression treatment may also improve important QOL outcomes