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

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).

Depression, psychosocial factors, and laboratory routine testing in people living with HIV in Northeastern Mexico: prevalence, correlations, and its associations

“…Firstly, in our study, most subjects showed cooperativeness and even interest in filling up questionnaires and complying to follow ups, differing from results in research by Gutiérrez-Veililla and collaborators [14]. Another difference found in our investigation from others, is that there's a well-documented association of age progression and the development of depressive episodes in PLWHIV, due to psychosocial, virulent and neurohormonal factors [23]. However, in our study, this association was not found, and to the contrary, negative correlation was found.…”

“…Depression has a relation with treatment non-adherence behavior [23]. This was also seen in our results.…”

“…The distribution of sociodemographic characteristics found among our study population were comparable to others described in another study on Mexican population. One of these factors include higher risk of depression among cisgender women living with HIV, while in our investigation, one third of cisgender women participating presented positive scores for depression [23].…”

Process evaluation of the HIV+D intervention for integrating the management of depression in routine HIV care in Uganda

“…The intervention model consisted of psychoeducation, Behavioural Activation, antidepressant medication and referral to mental health workers; delivered in a stepped care fashion. The therapies have previously been shown to be effective against depression in primary care settings including in HIV care [26][27][28][29].…”