Psychological and Behavioral Outcomes Associated with Stressful or Traumatic Life Events Among HIV-Infected Persons with Depression Public Deposited

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  • March 19, 2019
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  • O'Donnell, Julie
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Stressful or traumatic life events (STLEs) are common among HIV-infected individuals (particularly individuals who also have depression) and may affect both behavioral outcomes such as adherence to antiretroviral (ARV) therapy, and psychological outcomes such as suicidal ideation. The associations between 1) STLEs and ARV adherence, and 2) STLEs and suicidal ideation were examined among 289 US-based participants active in the SLAM DUNC study between 7/1/2011 and 9/1/2013, a randomized controlled trial of the effect of evidence-based decision support for depression treatment on ARV adherence. Participants received monthly telephone calls to assess STLEs and pill count-based ARV adherence, and three-monthly telephone calls to assess suicidal ideation, for up to 12 months. Inverse-probability-of-observation weighting was combined with multiple imputation to address missing data. Participants were mostly male (71%) and black (63%), with a median age of 45 years. In Aim 1, participants experienced a mean of 2.48 STLEs (range: 0-14) in the previous month. The presence of ≥2 STLEs was associated with a mean change in adherence of -3.67% (95% confidence interval (CI): -7.12%, -0.21%) and decreased likelihood of achieving ≥95% adherence (prevalence ratio (PR) (95% CI)=0.82 (0.71, 0.95)). For each additional STLE, the mean adherence change was -0.90% (95% CI: -1.79%, 0.00%). STLEs were associated with poorer ARV adherence, including decreased likelihood of adhering to ≥95% of ARV doses. This level of adherence has a critical role in regimen effectiveness and prevention of resistance. Participants assessed in Aim 2 experienced a mean of 2.36 overall STLEs (range: 0-12) in the previous month. Every additional STLE was associated with an increase in suicidal ideation prevalence of 22% (PR (95% confidence interval (CI)): 1.22 (1.01, 1.48)), and every additional severe STLE with an increase in prevalence of 70% (PR (95% CI): 1.70 (1.01, 2.87)). STLEs were associated with increased prevalence of experiencing SI, which is an important risk factor for suicide attempts and completions. STLEs were common in this population of HIV-infected adults with depression, and they were associated with negative behavioral and psychological outcomes.
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  • In Copyright
Advisor
  • Gaynes, Bradley
  • Cole, Stephen
  • Edmonds, Andrew
  • Thielman, Nathan
  • Pence, Brian
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
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  • Chapel Hill, NC
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