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      Effects of cognitive behavioral therapy on improving depressive symptoms and increasing adherence to antiretroviral medication in people with HIV

      systematic-review

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          Abstract

          The incidence of depression is higher in PLWH (people living with HIV) than in the general population. It is of clinical significance to explore effective measures to improve depression in patients. But the available evidence is still quite limited. CBT (cognitive behavioral therapy) is considered to be one of the effective methods to improve depression, medication adherence and quality of life in PLWH. Therefore, this study aimed to systematically evaluate the effect of cognitive behavioral therapy on improving depressive symptoms and increasing adherence to antiretroviral therapy (ART) in people living with HIV (Human Immunodeficiency Virus). The Cochrane Library, Embase, PubMed, and Web of Science databases were searched by computer to collect randomized controlled trials on the effects of cognitive behavioral therapy on improving depression and increasing ART medication adherence in PLWH, and the retrieval time was from the inception of each database to January 10, 2022. Meta-analysis was performed by two researchers using Stata 15.0 software after screening the literature, extracting data and evaluating quality according to inclusion and exclusion criteria. A total of 16 studies with 1,998 patients were included. Meta-analysis results showed that CBT improved depressive symptoms in PLWH (SMD = −0.09, 95% CI [−0.13 to −0.04], P < 0.001) with better long-term (<6 months) depression improvement (SMD = −0.09, 95% CI [−0.15 to −0.02], P = 0.006) than short-term (0–6 months); the difference in improved ART medication adherence in the CBT group compared to the control group was not statistically significant (SMD = 0.04, 95% CI [−0.06 to 0.13], P = 0.490). There may be publication bias due to incomplete inclusion of literature as only published literature was searched. Cognitive behavioral therapy is effective in improving depressive symptoms in people living with HIV, with better long-term (>6 months) results than short-term (0–6 months).

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          Most cited references53

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          Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence.

          Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression. Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it). Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89). Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.
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            The 52 symptoms of major depression: Lack of content overlap among seven common depression scales.

            Depression severity is assessed in numerous research disciplines, ranging from the social sciences to genetics, and used as a dependent variable, predictor, covariate, or to enroll participants. The routine practice is to assess depression severity with one particular depression scale, and draw conclusions about depression in general, relying on the assumption that scales are interchangeable measures of depression. The present paper investigates to which degree 7 common depression scales differ in their item content and generalizability.
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              A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals.

              To evaluate cognitive-behavioral therapy to enhance medication adherence and reduce depression (CBT-AD) in individuals with HIV. A two arm, randomized, controlled, cross-over trial comparing CBT-AD to enhanced treatment as usual only (ETAU). ETAU, which both groups received, included a single-session intervention for adherence and a letter to the patient's provider documenting her or his continued depression. The intervention group also received 10 to 12 sessions of CBT-AD. Adherence to antiretroviral therapy as assessed by Medication Event Monitoring Systems (MEMs) and depression as assessed by blinded structured evaluation. At the acute outcome assessment (3-months), those who received CBT-AD evidenced significantly greater improvements in medication adherence and depression relative to the comparison group. Those who were originally assigned to the comparison group who chose to cross over to CBT-AD showed similar improvements in both depression and adherence outcomes. Treatment gains for those in the intervention group were generally maintained at 6- and 12-month follow-up assessments. By the end of the follow-up period, those originally assigned CBT-AD demonstrated improvements in plasma HIV RNA concentrations, though these differences did not emerge before the cross-over, and hence there were not between-groups differences. CBT-AD is a potentially efficacious approach for individuals with HIV struggling with depression and adherence. Replication and extension in larger efficacy trials are needed. (c) 2009 APA, all rights reserved.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                09 November 2022
                2022
                : 13
                : 990994
                Affiliations
                [1] 1School of Politics and Public Administration, Guangxi Normal University , Guilin, China
                [2] 2School of Management, Jinan University , Guangzhou, China
                [3] 3School of Social and Public Administration, East China University of Science and Technology , Shanghai, China
                [4] 4Population Research Institute, Peking University , Beijing, China
                Author notes

                Edited by: Veena Kumari, Brunel University London, United Kingdom

                Reviewed by: Han Qi, Capital Medical University, China; Itziar Familiar, Michigan State University, United States

                *Correspondence: Keke Qin qinkeke@ 123456stu.gxnu.edu.cn

                This article was submitted to Psychological Therapy and Psychosomatics, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2022.990994
                9682157
                36440403
                4e7022a5-9cf1-4ba8-a5e8-458949c51785
                Copyright © 2022 Qin, Zeng, Liu and Cai.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 July 2022
                : 28 October 2022
                Page count
                Figures: 9, Tables: 2, Equations: 0, References: 55, Pages: 17, Words: 7470
                Categories
                Psychiatry
                Systematic Review

                Clinical Psychology & Psychiatry
                cognitive behavioral therapy,human immunodeficiency virus,depression,medication adherence,meta-analysis

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