Psychiatric Diagnosis and Antiretroviral Adherence Among Adolescent Medicaid Beneficiaries Diagnosed With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome

Walkup, James; Akincigil, Ayşe; Bilder, Scott; Rosato, Nancy Scotto; Crystal, Stephen

doi:10.1097/nmd.0b013e3181a208af

Cited by 13 publications

(10 citation statements)

References 54 publications

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“…21 Emotional and behavioral problems, including depression, conduct problems, and alcohol use have been associated with nonadherence in older adolescents and adults with HIV infection. 13,[22][23][24] Although there is evidence suggesting emotional and behavioral problems are related to adherence in children with other chronic illnesses, 25 the relationship between such problems and adherence in children with HIV disease is not well-described. Clarifying this relationship is critical since emotional and behavioral problems in the context of chronic illness may reduce the ability to take medications as directed and affect a youth's assumption of responsibility for this important health maintenance behavior.…”

Section: Introductionmentioning

confidence: 98%

Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

Malee

Williams

Montepiedra

et al. 2011

AIDS Patient Care and STDs

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The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000-2007). A total of 1134 participants, aged 3-17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p < 0.001), learning problems (22%, z = 12.2, p < 0.001), somatic complaints (22%, z = 12.6, p < 0.001), impulsivity-hyperactivity (20%, z = 11.1, p < 0.001), and hyperactivity (19%, z = 10.6, p < 0.001). Children with behavioral impairment in one or more areas had significantly increased odds of nonadherence [adjusted odds ratio (aOR) = 1.49, p = 0.04]. The odds of nonadherence were significantly higher for those with conduct problems and general hyperactivity (aOR = 2.03, p = 0.005 and aOR = 1.68, p = 0.02, respectively). Psychosocial and health factors, such as recent stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence.

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Section: Introductionmentioning

confidence: 98%

Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

Malee

Williams

Montepiedra

et al. 2011

AIDS Patient Care and STDs

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“…Mental health problems co-occur with suboptimal adherence [11]. Behavioral impairment [12], diagnosis of depression [13] or anxiety, or conduct disorder [12,14] have been associated with non-adherence, although findings have been mixed [15–17]. …”

Section: Introductionmentioning

confidence: 99%

“…In two longitudinal studies of adherence in youth with PHIV, one (n=138) showed no association between emotional problems and non-adherence [17], another (n=108) did not evaluate psychiatric conditions [19]; neither evaluated predictors of becoming non-adherent. Almost all studies examining mental health and ARV adherence have either been cross-sectional [12,14–16], focused on youth with non-perinatally-acquired HIV [13] or did not distinguish between HIV acquisition modes [14], used one ARV adherence measure [12, 14, 16–17], or relied on psychiatric information from claims or medical records [14–16]. …”

Section: Introductionmentioning

confidence: 99%

Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV

Kacanek

Angelidou

Williams

et al. 2015

Aids

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Objectives The relationship of specific psychiatric conditions to adherence has not been examined in longitudinal studies of youth with perinatal HIV infection (PHIV). We examined associations between psychiatric conditions and ARV non-adherence over two years. Design Longitudinal study in 294 PHIV youth, 6–17 years old, in the US and Puerto Rico. Methods We annually assessed three non-adherence outcomes: missed >5% of doses in past 3 days, missed a dose within the past month, and unsuppressed viral load (VL) (>400 copies/mL). We fit multivariable logistic models for non-adherence using Generalized Estimating Equations and evaluated associations of psychiatric conditions (ADHD, disruptive behavior, depression, anxiety) at entry with incident non-adherence using multivariable logistic regression. Results Non-adherence prevalence at study entry was 14% (3-day recall), 32% (past month non-adherence), and 38% (unsuppressed VL), remaining similar over time. At entry, 38% met symptom cutoff criteria for ≥1 psychiatric condition. Greater odds of 3-day recall non-adherence were observed at Week 96 for those with depression (Adjusted Odds Ratio (aOR)=4.14; 95% confidence interval (CI): 1.11–15.42) or disruptive behavior (aOR=3.36; 95% CI: 1.02–11.10) but not at entry. Those with vs. without ADHD had elevated odds of unsuppressed VL at Weeks 48 (aOR=2.46; 95% CI: 1.27–4.78) and 96 (aOR=2.35; 95% CI: 1.01–5.45) but not at entry. Among 232 youth adherent at entry, 16% reported incident 3-day recall non-adherence. Disruptive behavior conditions at entry were associated with incident 3-day recall non-adherence (aOR=3.01; 95% CI: 1.24–7.31). Conclusions In PHIV youth, comprehensive adherence interventions that address psychiatric conditions throughout the transition to adult care are needed.

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“…IMDs are associated with psychological distress (Musisi and Kinyanda, 2009), impaired quality of life, and non-adherence to ART (Walkup et al, 2009; Malee et al, 2011). In addition, patients with IMDs have higher mortality rates than have the general population (Cuijpers and Smit, 2002; Colton and Manderscheid, 2006; Ahmadi et al, 2011; Druss et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Internalizing Mental Disorders and Accelerated Cellular Aging Among Perinatally HIV-Infected Youth in Uganda

et al. 2019

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Introduction: Internalizing mental disorders (IMDs) in HIV+ children and adolescents are associated with impaired quality of life and non-adherence to anti-retroviral treatment. Telomere length is a biomarker of cellular aging, and shorter telomere length has been associated with IMDs. However, the nature of this association has yet to be elucidated. Objective: We determined the longitudinal association between IMDs and relative telomere length (rTL) and the influence of chronic stress among Ugandan perinatally HIV-infected youth (PHIY). Methods: IMDs (depressive disorders, anxiety disorders, and post-traumatic stress disorder) and IMDs were assessed using the locally adapted Child and Adolescent Symptom Inventory-5. In 368 PHIY with any IMD and 368 age- and sex-matched PHIY controls without any psychiatric disorder, rTL was assessed using quantitative polymerase chain reaction. Hierarchical cluster analysis was used to generate the three chronic stress classes (mild, moderate, and severe). t -tests were used to assess the difference between baseline and 12 month rTL and the mean difference in rTL between cases and controls both at baseline and at 12 months. Linear regression analysis was used to model the effects of chronic stress on the association between IMDs and rTL, controlling for age and sex. Results: We observed longer rTL among cases of IMDs compared with controls ( p < 0.001). We also observed a statistically significant reduction in rTL between baseline and 12 months in the combined sample of cases and controls ( p < 0.001). The same statistical difference was observed when cases and controls were individually analyzed ( p < 0.001). We found no significant difference in rTL between cases and controls at 12 months ( p = 0.117). We found no significant influence of chronic stress on the association between IMDs and rTL at both baseline and 12 months. Conclusion: rTL is longer among cases of IMDs compared with age- and sex-matched controls. We observed a significant attrition in rTL over 12 months, which seems to be driven by the presence of any IMDs. There is a need for future longitudinal and experimental studies to understand the mechanisms driving our findings.

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Psychiatric Diagnosis and Antiretroviral Adherence Among Adolescent Medicaid Beneficiaries Diagnosed With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome

Cited by 13 publications

References 54 publications

Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV

Internalizing Mental Disorders and Accelerated Cellular Aging Among Perinatally HIV-Infected Youth in Uganda

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