ABSTRACT
UNLABELLED: This pilot randomized controlled trial evaluated a previously developed manualized telephone based cognitive behavioral therapy (T-CBT) intervention compared to face-to-face (f2f) therapy among low-income, urban dwelling HIV infected depressed individuals. The primary outcome was the reduction of depressive symptoms as measured by the Hamliton rating scale for depression scale. The secondary outcome was adherence to HAART as measured by random telephone based pill counts. Outcome measures were collected by trained research assistants masked to treatment allocation. Analysis was based on intention-to-treat. Thirty-four participants met eligibility criteria and were randomly assigned to receive T-CBT (n = 16) or f2f (n = 18). There was no statistically significant difference in depression treatment outcomes comparing f2f to T-CBT. Within group evaluation demonstrated that both the T-CBT and the f2f psychotherapy groups resulted in significant reductions in depressive symptoms. Those who received the T-CBT were significantly more likely to maintain their adherence to antiretroviral medication compared to the f2f treatment. None of the participants discontinued treatment due to adverse events. T-CBT can be delivered to low-income, urban dwelling HIV infected depressed individuals resulting in significant reductions in depression symptoms and improved adherence to antiretroviral medication. TRIAL REGISTRY: Clinical Trial.gov identifier: NCT01055158.
Subject(s)
Antiretroviral Therapy, Highly Active , Cognitive Behavioral Therapy , Depressive Disorder, Major/therapy , HIV Infections/psychology , Telephone , Adult , Depressive Disorder, Major/ethnology , Depressive Disorder, Major/etiology , Educational Status , Feasibility Studies , Female , HIV Infections/complications , HIV Infections/therapy , Humans , Male , Medication Adherence , Middle Aged , Patient Compliance , Patient Satisfaction , Pilot Projects , Poverty , Psychiatric Status Rating Scales , Severity of Illness Index , Treatment Outcome , Urban PopulationABSTRACT
Given the burden of depression among those with HIV, and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care. This single site, uncontrolled, pilot study sought to determine the feasibility and depression outcomes of an 11-session telephone-based cognitive behavioral therapy intervention delivered over 14 weeks targeting low-income, urban-dwelling, HIV-infected African-American people with major depression. The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview. The primary outcome was the Hamilton Depression Rating Scale (HAM-D) and the secondary outcome was the Quick Inventory of Depression Symptomatology-Self Report (QIDS-SR). Feasibility and satisfaction were also assessed. Assessments occurred at baseline, midpoint and at study conclusion (14 weeks). Fifteen people were screened for the study. Six HIV-infected, low-income, African-American people individuals (five females and one male) were eligible and participated in the study. All patients finished the study. On average, participants completed nine sessions. The sessions lasted for an average of 48 min (SD = 11.5). Compared to mean HAM-D score at baseline (HAM-D = 22.8 (SD = 3.1), the mean HAM-D score was significantly reduced at study conclusion (HAM-D = 9.8 (SD = 7.4); (t (5) = 4.6, p = 0.006); (Cohen d = 1.9)). Compared to the mean QIDS-SR score at baseline (QIDS-SR = 15.5 (SD = 4.2) the mean QIDS score was significantly reduced at study conclusion (QIDS = 7.0 (SD = 5.4);(t (5) = 3.2, p = 0.02); (Cohen d = 1.3)).The mean satisfaction scores across all participants at post-treatment was 5.7 (SD = 0.3) with of a maximum score of 6. Telephone-based CBT can be delivered to low-income, urban-dwelling ethnic minority HIV-infected people resulting in significant reductions in depression symptoms with high satisfaction. The efficacy of this intervention will be assessed in a planned randomized control trial.
Subject(s)
Black or African American/psychology , Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/therapy , HIV Infections/psychology , Poverty , Telephone , Urban Population , Adult , Aged , Depressive Disorder, Major/ethnology , Depressive Disorder, Major/psychology , Feasibility Studies , Female , HIV Infections/ethnology , Humans , Male , Middle Aged , Personality Inventory , Pilot ProjectsABSTRACT
OBJECTIVE: Experiments have found that pressure to be thin from the media promotes body dissatisfaction and negative affect, but the effects of social pressure to be thin have not been examined experimentally. Thus, this study tested whether social pressure to be thin fosters body dissatisfaction and negative affect. METHOD: Young women (N = 120) were randomly assigned to a condition wherein an ultra-thin confederate complained about how fat she felt and voiced intentions to lose weight or a control condition wherein she discussed a neutral topic. RESULTS: Exposure to social pressure to be thin resulted in increased body dissatisfaction but not negative affect. The effects were not moderated by initial thin-ideal internalization, body dissatisfaction, or social support. DISCUSSION: Results support the assertion that peer pressure to be thin promotes body dissatisfaction but suggest that this factor may not contribute to negative affect.
