Published:
January 06, 2014, PlosONE More at:
Depression and depressive symptoms
predict poor adherence to medical therapy, but the association is complex,
nonspecific, and difficult to interpret. Understanding this association may
help to identify the mechanism explaining the results of interventions that
improve both medical therapy adherence and depressive symptoms as well as
determine the importance of targeting depression in adherence interventions. We
previously demonstrated that Managed Problem Solving (MAPS) focused on HIV
medication adherence improved adherence and viral load in patients initiating a
new antiretroviral regimen. Here, we assessed whether MAPS improved depressive
symptoms and in turn, whether changes in depressive symptoms mediated changes
in adherence and treatment outcomes. We compared MAPS to usual care with
respect to presence of depressive symptoms during the trial using logistic
regression. We then assessed whether MAPS’ effect on depressive symptoms
mediated the relationship between MAPS and adherence and virologic outcomes
using linear and logistic regression, respectively. Mediation was defined by
the disappearance of the mathematical association between MAPS and the outcomes
when the proposed mediator was included in regression models. Although MAPS
participants had a lower rate of depressive symptoms (OR = 0.45, 95% confidence
interval 0.21–0.93), there was no evidence of mediation of the effects of MAPS
on adherence and virological outcome by improvements in depression. Thus,
interventions for medication adherence may not need to address depressive
symptoms in order to impact both adherence and depression; this remains to be
confirmed, however, in other data.
Full Article: http://ht.ly/skrUV
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