Feasibility of telephone-based cognitive behavioral therapy targeting major depression among urban dwelling African-American people with co-occurring HIV

Abstract

Given the burden of depression among those with HIV, and the impact of HIV on urban minority communities there is an urgent need to assess innovative treatment interventions that not only treat depression but do so in a way that allows for increased access to mental health care. This single site, uncontrolled, pilot study sought to determine the feasibility and depression outcomes of an 11 session telephone based cognitive behavioral therapy intervention delivered over 14 weeks targeting low income, urban dwelling, HIV infected African-Americans with major depression. The diagnosis of major depression was made using the Mini International Neuropsychiatric Interview. The primary outcome was the HAM-D and the secondary outcome was the Quick Inventory of Depression Symptomatology -Self Report (QIDS-SR). Feasibility and satisfaction were also assessed. Assessments occurred at baseline, midpoint and at study conclusion (14 weeks). Fifteen people were screened for the study. Six HIV infected, low-income, African American individuals (5 Female, 1 Male) were eligible and participated in the study. All patients finished the study. On average, participants completed 9 sessions. The sessions lasted for an average of 48 minutes (SD=11.5). Compared to mean HAM-D score at baseline (HAM-D= 22.8 (SD =3.1), the mean HAM-D score was significantly reduced at study conclusion (HAM-D= 9.8 (SD =7.4);(t (5) =4.6, p=.006);(Cohen d=1.9)). Compared to the mean QIDS-SR score at baseline (QIDS-SR=15.5 (SD =4.2) the mean QIDS score was significantly reduced at study conclusion (QIDS=7.0 (SD =5.4);(t (5) = 3.2, p=.02); (Cohen d=1.3)). The mean satisfaction scores across all participants at post treatment was 5.7 (SD=.3) with of a maximum score of 6. Telephone based CBT can be delivered to low-income, urban dwelling ethnic minority HIV infected people resulting in significant reductions in depression symptoms with high satisfaction. The efficacy of this intervention will be assessed in a planned randomized control trial.

Effect of Telephone-Administered vs Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes Among Primary Care Patients

“…The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individu-als who otherwise have barriers to treat-ment. 14,39 Telephone psychotherapy would also meet at least 1 of the key attributes of the advanced medical home, namely, to “provide enhanced and convenient access to care not only through face-to-face visits but also via telephone, e-mail, and other modes of communication.” 40 However, the increased risk of posttreatment deterioration in telephone-delivered treatment relative to face-to-face treatment underscores the importance of continued monitoring of depressive symptoms even after successful treatment.…”

Relationships Between Dimensions of Disability Experienced by Adults Living with HIV: A Structural Equation Model Analysis

“…Findings also suggest that physical symptoms experienced frequently by people living with HIV, such as pain and loss of energy, may not necessarily lead to challenges to social inclusion, such as problems with income, housing, or employment, without concurrent mental health problems such as depression and anxiety. This suggests that empirically supported mental health interventions for people living with HIV, such as cognitive behavioral therapies, may not only reduce psychological distress but also may be associated with reductions in social 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 aspects of disability [56][57][58].…”

“…Adopting lifestyle modifications to maximize health (getting adequate nutrition and sleep, reducing substance use, adhering to medications, exercising, avoiding external stressors and ensuring financial security); establishing a sense of purpose in life; creating a daily structure or routine, and prioritizing tasks and planning for and anticipating the future, offer possible interventions clinicians may consider with their patients [15]. Specifically, cognitive-behavioral 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 and stress management interventions have been used to address anxiety and depression and enhance coping among people with HIV [56][57][58][62][63][64]. Overall findings highlight the importance for health providers and policy makers to consider the role of extrinsic and intrinsic contextual factors (programs, services and interventions) in addressing disability experienced by people living with HIV.…”

Acceptability of Mobile Phone Technology for Medication Adherence Interventions among HIV-Positive Patients at an Urban Clinic

“…The utilization of technology-based health applications for disease prevention and management has been progressively explored and expanded upon [7–11]. Promising results have been found for a number of conditions (e.g., diabetes mellitus, asthma, nicotine use, and obesity) with use of mobile phone technology [12, 13] as well as more specifically with text messaging [14, 15].…”