Longitudinal Study of Mental Health and Psychosocial Predictors of Medical Treatment Adherence in Mothers Living with HIV Disease

Abstract

Cross-sectional studies to date that examine psychosocial correlates of antiretroviral adherence have insufficiently addressed the challenges of long-term adherence. This longitudinal study examined mental health, substance abuse, and psychosocial predictors of long-term adherence to antiretroviral medications and medical appointments among HIV-seropositive mothers recruited from an infectious disease clinic of a large urban medical center. Individual interviews were conducted at baseline and two follow-up points, 8 to 18 months after enrollment. Based on a model of health behavior, we examined psychiatric and psychosocial predictors of adherence to antiretroviral medications and medical appointments over time. Presence of a psychiatric disorder, negative stressful life events, more household members, and parenting stress were significantly associated with both missed pills and missed medical appointments at follow-up. Baseline substance abuse was associated with missed pills at follow-up and lack of disclosure to family members at baseline was associated with missed medical appointments at follow-up. These findings suggest that interventions that integrate mental health, substance abuse and medical care may be important to improving the medical adherence and health of HIV-seropositive women, particularly in multistressed populations with substantial caregiving and other life demands.

Mental Health of Caribbean Women with HIV/AIDS

“…Pre-existing psychological and psychiatric disorders can become aggravated with a diagnosis of HIV, or may develop during the course of living with HIV/AIDS (Mellins, Kang, Leu, Havens, & Chesney, 2003). The most common are mood disorders, such as depression, dysthymia, mania and, anxiety disorders, such as generalized anxiety, panic and post-traumatic stress (Mellins et al, 2003;Golub et al, 2003;Cook et al, 2004;Hamer, 2000;Sikkema, 2003).…”

“…The most common are mood disorders, such as depression, dysthymia, mania and, anxiety disorders, such as generalized anxiety, panic and post-traumatic stress (Mellins et al, 2003;Golub et al, 2003;Cook et al, 2004;Hamer, 2000;Sikkema, 2003). HIV/AIDS disease progression can impact neurological and neurocognitive status.…”

“…Dube and colleagues (2005) emphasized the need to treat existing psychiatric symptoms when diagnosed, in order to facilitate adherence to HIV/AIDS disease management regimens. Mellins et al (2003) studied 97 mothers living with HIV in a large city in the US and found that half met the criteria for a psychiatric disorder, and 25% were positive for a substanceabuse disorder. Researchers further identified significant correlations between mental health symptoms (e.g., depression, post traumatic stress disorder [PTSD], and anxiety), parenting stress and substance abuse with failure to take medication and missed medical appointments.…”

Life Stress and Adherence to Antiretroviral Therapy among HIV-Positive Individuals: A Preliminary Investigation

“…A recent study with HIV-positive mothers found that experience of acute stressful life events was associated with missed pills and appointments at follow-up. 22 The present study investigated the role of both aspects of stress on treatment adherence among HIV-positive adults.…”

Barriers to Adherence to Antiretroviral Treatment Among Inmates of a Prison in Tehran, Iran: A Qualitative Study

“…A variety of factors was reported regarding nonadherence to medication in patients with HIV such as substance abuse (8)(9)(10)(11)(12), health beliefs (13-15), psychiatric status (12,(16)(17)(18)(19)(20)(21), demographic characteristics (10,20), social factors (22), familial factors (23)(24)(25), medication side effects (17,26), and cognitive functioning (10,14,26). Although previous studies drawn a comprehensive picture of barriers and facilitators of adherence to medication among patients with HIV, such studies mostly relied on the quantitative designs that fail to adequately explain the ecological factors influencing the adherence.…”