Transcript Powerpoint template for scientific poster

The Association of PTSD to ART Adherence and Depression in HIV
Steven A. Safren,
1 Massachusetts
1,2
Ph.D. ,
Helene Hardy,
3
PharmD ,
General Hospital and Harvard Medical
Paul R. Skolnick,
2
School, Fenway
INTRODUCTION
• Being diagnosed with HIV, a chronic, and potentially lifethreatening disease, can be a traumatic event
• PTSD centers around 3 core areas:
1.Avoidance (e.g. of stimuli that are reminders of the
traumatic event)
2.Re-experiencing (e.g. flashbacks, dissociation,
nightmares)
3.Physiological Arousal (e.g. sweating, physical
symptoms of anxiety)
• These symptoms can interfere with adherence (e.g. pills can
be a reminder of the diagnosis)
• PTSD may be prevalent in HIV (e.g. Gore-Felton, 2004;
Safren et al., 2003), and may influence depression
• Depression is associated with ART adherence in several
studies (e.g. Safren et al., 2001; Catz et al., 2000; Patterson
et al., 2000)
• Having PTSD may therefore affect adherence both on its
own, and because it can cause depression
Minyi Lu,
Community Health,
4
Ph.D .,
3B.U.
William Coady,
Medical School,
4
MPH ,
4Tufts/New
& Ira Wilson, MD,
4
MSC
England Medical Center; Boston, MA
ASSESSMENTS
RESULTS (CONTINUED)
Assessment of adherence
Electronic pill caps (MEMs) yielding scores for
1. Number of uncovered minutes (minutes for which pills were
taken late or not at all)
2. Number of correct days
3. Number of correct doses
Multivariate analyses predicting adherence
Three hierarchical regression analyses were run, entering PTSD
first, followed by depression.
In each, PTSD was significant at the first step. When entering
depression, however, the overall model was still significant, but
neither PTSD nor depression were unique predictors of
adherence (i.e. common variance between these two constructs
accounted for the significant overall R2s)
Assessment of PTSD
The SPAN (Meltzer-Brody et al., 1999), a 4-item (Startle,
Physiological arousal, Anger, and Numbness) validated screening
measure. The criterion stressor was open-ended, but using
“Being diagnosed with HIV” as one of the example potential
stressors.
Assessment of Depression
A DSM-IV symptom checklist assessment developed by members
or our team for use in the primary care setting (PC-SAD)©
(Rogers et al., 2002)
SAMPLE
Inclusion Criteria (N=158)
• HIV positive
• Detectable viral load
• Participants in a two-arm randomized controlled trial of
provider feedback on adherence and psychosocial assessment
data to increase adherence to ART
Sexual orientation and sex
• Men: 56% gay, 38% heterosexual, 6% other
• Women 5% lesbian, 89% heterosexual, 5% other
History of injection drug use
18% reported acquiring HIV through IDU
Age: Mean age was 42.2, SD 7.6
Education: 7% Grade school only; 50% High School; 39% College;
5% Graduate School
Relationship Status: 55.7% Single; 9.5% Married; 34.8% “other”
Race/Ethnicity: 50% white non-Hispanic, 26.8% Black nonHispanic; 1.2% Asian, 19% Hispanic, 3% other
3
MD ,
DISCUSSION AND CONCLUSIONS
RESULTS
PTSD and Depression: Descriptive statistics and their
association to each other
45.6% (n=72) of the sample screened in for PTSD
24.7% (n=39) of the sample screened in for Depression
Those who screened in for PTSD were 14.5 times more likely to also
have depression than those who did not screen in for PTSD
(OR=14.5, Chi sq(1)=35.15, p < .000) and continuous PTSD
severity scores were significantly associated with continues
depression severity scores (r = .62, p = .0000)
Screening in for PTSD or depression was not associated with HIV
risk group (MSM vs IDU) or Sex
Correlations of PTSD and Depression with Adherence
Adherence
measure
Uncovered
minutes
Correct days
Correct doses
Medication treatment of PTSD and Depression
• Only about half (49%) of those who screened in for depression
were on an antidepressant
• 40% of those who screened in for PTSD were on an
antidepressant
• 89% of those who screened in for both PTSD and Depression
were on an antidepressant.
PTSD
Depression
.21 (p<.01)
.20 (p<.02)
-.22 (p<.01)
-.24 (p<.01)
-.23 (p<.01)
-.25 (p<.01)
• PTSD symptoms may be prevalent and interfering for individuals
diagnosed with HIV.
• Although PTSD and depression were correlated, they represent
separate problems.
• Having PTSD symptoms may influence the emergence of depression,
which may influence poor self care behaviors such as adherence - this
could be tested longitudinally.
• The effects of PTSD on ART adherence may be a result of shared
variance with depression.
• Despite the frequency of PTSD and depression, and their individual
association with adherence, many individuals with these disorders were
not being treated with an antidepressant.
• Identifying and treating individuals with depression and/or PTSD may
not only help relieve the distressing symptoms of each of these mental
disorders, but may also allow for greater adherence to ARV.
Notes: Poster presented at the annual meeting of the society of
behavioral medicine, April 2005, Boston, MA. For more
information contact Dr. Safren at [email protected]
Funding from this project is from grant DA015679-03 awarded
to Dr. Ira Wilson from the National Institute of Drug Abuse.