The Effect of Cognitive Behavioral Therapy and Changes of Depressive Symptoms Among Thai Adult HIV-Infected Patients

Abstract

Background: In Thailand, the therapeutic effect of cognitive behavioral therapy (CBT) for depression among adult HIV-infected patients has been limitedly studied. Objectives: To determine the association of CBT and changes of de-pression both immediately post treatment and at 3-month post-treatment.Materials and Methods: A prospective cohort study was conducted at the University Hospital in Thailand. Forty and eighty HIV-infected adults who voluntarily received and did not receive CBT were recruited from the immunology clinic and sexually transmitted diseases clinic between September 2010 and February 2011. Sociodemographic characteristics and medical histories of the participants were collected. A standard Thai Depression Inventory (TDI) was used for evaluation of depressive symptoms. TDI score of 21 or above was interpreted as depression. Other questionnaires included a Montreal Cognitive Assessment questionnaire, standard questionnaire for evaluating life stress event and questionnaire for HIV social support. Results: The mean ages of participants were 44.8 and 43.4 years in the CBT and non-CBT groups respectively. In both group, about half of the subjects were females. Life stress event score in CBT group was significantly higher than the non-CBT group (p <0.01). At baseline, the mean TDI scores of the CBT group and non-CBT group were 26.7 and 25.3 respectively. After adjustment for age, gender, social support, life stress event and current opportunistic infection; the mean changes of TDI scores in the CBT group were significantly higher than the non-CBT group both immediately [12.13 (95%CI ,10.00 -14.26)] (p <0.001) and at 3-month post-treatment [15.94 (95%CI, 13.69-18.18)] (p < 0.001). Conclusion: CBT is beneficial for treatment of depression among adult HIV-infected patients in Thailand. The beneficial effect of CBT was not only immediate but also sustained at 3-month post-treatment.

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I. Jayasvasti, N. Hiransuthikul, N. Pityaratstian, V. Lohsoonthorn, B. Kanchanatawan and B. Triruangworawat, "The Effect of Cognitive Behavioral Therapy and Changes of Depressive Symptoms Among Thai Adult HIV-Infected Patients," World Journal of AIDS, Vol. 1 No. 2, 2011, pp. 15-22. doi: 10.4236/wja.2011.12003.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] World Health Organization, “Depression,” 2011. http://www.who.int/mental_health/mamagement/depression/definition/en/.
[2] A.F. Angelino and G.J. Treisman, “Management of psychiatric disorders in patients infected with human immunodeficiency virus,” Clinical Infectious Disease, Vol.33, No. 6, September 2001, pp.847-856. doi:10.1086/322679
[3] N. Crepaz, W.F. Passin, J.H. Herbst, S.M. Rama, R.M. Malow, D.W. Purcell, et al., “Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning,” Health Psychology, Vol. 27, No. 1, 2008, pp. 4-14. doi:10.1037/0278-6133.27.1.4
[4] P. Tangtulyankul and T. Nilchaikovit, “Anxiety and depression in patients with HIV/AIDS ,” Final program and abstracts 6th congress of asean federation for psychiatry and mental health&10th asean forum on child and adolescent psychiatry, vol(?), Bangkok, November 1996, p. 50.
[5] S. Reungtrakul, “Acquired Immunodeficiency Syndrome : A psychiatric symptoms and therapy,” Ruankhaw Press, 2005.
[6] C. Zilber, “Psychotherapeutic strategies,” In: F. Fernandez, Ed., Psychiatric aspects of HIV/AIDS, Lippincott Williams & Wilkins, Philadelphia, 2006, pp. 355-364.
[7] R. Rabkin and J.G. Rabkin, “Management of depression in patients with hiv infection,” In : W. Odets, ED., The second decade of aids : A mental health practice handbook, Hatherleigh Press, New York, 1995, pp. 1-25.
[8] L. Cheever, “What do we know about adherence levels in different populations?,” Proceedings HRSA, The Forum for Collaborative HIV Research and NIH of AIDS Research workshop of Adherence to HIV Therapy: Building a bridge to success, Vol.(?), Washington DC, November 1999, p. 9.
[9] J. Leserman, G. Ironson, C. O’Cleirigh, J.M. Fordiani and E. Balbin, “Stressful life events and adherence in HIV,” AIDS Patient Care and STDs, Vol. 22, No. 5, 2008, pp. 403-411. doi:10.1089/apc.2007.0175
[10] V. Gordillo, J.D. Amo, V. Soriano, J. Gonzalez-Lahoz, “Sociodemographic and psychological variables influencing adherence to antiretroviral therapy,” AIDS, Vol.13, No. 13, May 1999, pp. 1763-1769. doi:10.1097/00002030-199909100-00021
[11] S.L. Catz, J.A. Kelly, L.M. Bogart, E.G. Benotsch and T.L. McAuliffe, “Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease,” Health Psychology, Vol. 19, No. 2, March 2000, pp. 124-133. doi:10.1037/0278-6133.19.2.124
[12] S.R. Penzak, Y.S. Reddy and S.R. Grimsley, “Depression in patients with HIV infection,” American Journal of Health-System Pharmacists, Vol. 57, February 2000, pp. 376-386.
[13] N. Buathong, N. Hiransuthikul, S. Tangwongchai and C. Komoltri, “Association between depression and adherence to highly active antiretroviral therapy among adult HIV infected patients in Thailand,” Asian Biomedicine, Vol. 3, 2009, pp.1-7.
[14] J.A. Bartlett, “Addressing the challenges of adherence,” Journal of Acquired Immune Deficiency Syndromes, Vol. 29(Suppl1), 2002, pp. S2-10. doi:10.1097/00126334-200202011-00002
[15] P. Williams, L. Narciso, G. Browne, J. Roberts, R. Weir and A. Gafni, “The prevalence, correlates, and costs of depression in people living with HIV/AIDS in Ontario: implications for service directions,” AIDS Education and Prevention, Vol. 17, No. 2, April 2005, pp. 119-130. doi:10.1521/aeap.17.3.119.62903
[16] J.D. Hartzell, I.E. Janke and A.C. Weintrob, “Impact of depression on HIV outcomes in the HAART era,” Journal of Antimicrobial Chemotherapy, Vol. 2, May 2008, pp. 1-10.
[17] C.D. Sherbourne, R.D. Hays, J.A. Fleishman, B. Vitiello, K.M. Magruder, E.G. Bing, et al., “Impact of psychiatric conditions on health-related quality of life in persons with HIV infection,” American Journal of Psychiatry, Vol. 157, No. 2, February 2000, pp. 248-254. doi:10.1176/appi.ajp.157.2.248
[18] G. Ironson, C. O’Cleirigh, M.A. Fletcher, J.P. Laurenceau, E. Balbin, N. Klimas, et al., “Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment,” Psychosomatic Medicine, Vol. 67, 2005, pp. 1013-1021. doi:10.1097/01.psy.0000188569.58998.c8
[19] J. Leserman, J.M. Petitto, H. Gu, B.N. Gaynes, J. Barroso, R.N. Golden, et al., “Progression to AIDS, a clinical AIDS condition and mortality: psychosocial and physiological predictors,” Psychological Medicine, Vol. 32, No. 6, August 2002, pp. 1059-1073. doi:10.1017/S0033291702005949
[20] S. Himelhoch, D.R. Medoff and G. Oyeniyi, “Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals : A systematic review and meta analysis,” AIDS Patient Care and STDs, Vol. 21, No. 10, 2007, pp. 732-739. doi:10.1089/apc.2007.0012
[21] L.J. Fulk, B.E. Kane, K.D. Phillips, C.M. Bopp, G.A. Hand, “Depression in HIV-infected patients: allopathic, complementary and alternative treatments,” Journal of Psychosomatic Research, Vol. 57, 2004, pp. 339-351. doi:10.1016/S0022-3999(04)00070-4
[22] J.E. Young, J.L. Rych, A.D. Weinberger and A.T. Beck, “Cognitive therapy for depression,” In : D.H. Barlow, Ed., Clinical handbook of psychological disorders :A step-by-step treatment manual, The Guilford Press, New York, 2008, pp. 250-305.
[23] P. DeRoche and K. Citron, “Psychotherapy,” In: K. Citron, Ed., HIV and psychiatry : A training and resource manual, Cambridge University Press, Cambridge, 2005, pp. 153-169. doi:10.1017/CBO9780511543586.010
[24] M.R. Lee, L. Cohen, S.W. Hadley and F.K. Goodwin, “Cognitive-behavioral group therapy with medication for depressed gay men with aids or symptomatic hiv infection,” Psychiatric Services, Vol. 50, No. 7, July 1999, pp. 948-952.
[25] S.D. Maat, J. Dekker, R. Schoevers and F.D. Jonghe, “Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression : A meta-analysis,” Psychotherapy Research, Vol. 16, No. 5, October 2006, pp. 566-578. doi:10.1080/10503300600756402
[26] L.A. Panther and H. Libman, “Medical overview,” In: K. Citron, Ed., HIV and psychiatry : A training and resource manual, Cambridge University Press, Cambridge, 2005, pp.1-29. doi:10.1017/CBO9780511543586.002
[27] J.S. Beck, “In session with Judith S. Beck: Cognitive-Behavioral Therapy,” Primary Psychiatry, Vol. 13, No. 4, April 2006, pp. 31-34.
[28] A.T. Beck, “Cognitive therapy of depression,” Guilford Press, 1979.
[29] D.D. Burns and S.N. Hoeksema, “Coping styles, homework compliance and the effectiveness of cognitive-behavioral therapy,” Journal of Consulting and Clinical Psychology, Vol. 59, No. 2, 1991, pp. 305-311. doi:10.1037/0022-006X.59.2.305
[30] M. Lotrakul and P. Sukanich, “Development of the Thai Depression Inventory,” Journal of Medical Association of Thailand, Vol. 82, No. 12, December 1999, pp. 1200-1207.
[31] Z.S. Nasreddine, N.A. Phillips and V. Bedirian, “The montreal cognitive assessment (MoCA) : A screening tool for mild cognitive impairment,” Journal of the American Geriatrics Society, Vol. 53, No. 4, April 2004, pp. 695-699. doi:10.1111/j.1532-5415.2005.53221.x
[32] S. Nakrapanich, “Life events and adaptation during pregnancy of women with and without obstetric complication in chulalongkorn hospital,” MSc. thesis, Chulalongkorn University,1988.
[33] S.A. Safren, C. O’Cleirigh, J.Y. Tan, S.R. Raminani, L.C. Reilly, M.W. Otto, et al. “A randomized controlled trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) in hiv-infected individuals,” Health Psychology, Vol. 28, No. 1, January 2009, pp. 1-10. doi:10.1037/a0012715
[34] S. Lemeshow, D.W. Hosmer, J. Klar, S.K. Lwanga, “Adequacy of sample size in health studies,” John Wiley&Sons, 1990.
[35] S.C. Kalichman, T. Heckman, A. Kochman, K. Sikkema and J. Bergholte, “Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS,” Psychiatric Services, Vol. 51, No. 7, July 2000, pp. 903-907. doi:10.1176/appi.ps.51.7.903
[36] M.F. Morrison, J.M. Petitto, H.T. Ten, D.R. Gettes, M.S. Chiappini, A.L. Weber, et al., “Depressive and anxiety disorders in women with HIV infection,” American Journal of Psychiatry, vol. 159, 2002, pp. 789-796. doi:10.1176/appi.ajp.159.5.789
[37] S. Crystal and R.C. Kersting, “Stress, social support, and distress in a statewide population of persons with AIDS in New Jersey,” Social Work in Health Care, Vol. 28, No. 1, 1998, pp. 41-60. doi:10.1300/J010v28n01_03
[38] W. Odets and M. Shernoff, “The second decade of AIDS: A mental health practice handbook,” Hatherleigh Press, 1995.
[39] A. Laperriere, G.H. Ironson, M.H. Antoni, H. Pomm, D. Jones, M. Ishii, et al., “Decreased depression up to one year following CBSM + intervention in depressed women with aids : The smart/EST women’s project,” Journal of Health Psychology, Vol. 10, No. 2, 2005, pp. 223-231. doi:10.1177/1359105305049772
[40] I. Chan, P. Kong, P. Leung, A. Au, P. Li, R. Chung, et al., “Cognitive-behavioral group program for chinese heterosexual hiv-infected men in hong kong,” Patient Education and Counseling, Vol.56, 2005, pp. 78-84. doi:10.1016/j.pec.2003.12.010
[41] N. Soroudi, G.K. Perez, J.S. Gonzalez, J.A. Greer, M.H. Pollack, M.W. Otto, et al., “CBT for medication adherence and depression (CBT-AD) in hiv-infected patients receiving methadone maintenance therapy,” Cognitive and Behavioral Practice, Vol. 15, 2008, pp. 93-106. doi:10.1016/j.cbpra.2006.11.006
[42] J.A. Kelly, D.A. Murphy, R. Bahr, S.C. Kalichman, M.G. Morgan, Y. Stevenson, et al., “Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons,” American Journal of Psychiatry, Vol. 150, No. 11, November 1993, pp. 1679-1686.
[43] J.S. Beck, “Cognitive therapy: Basics and beyond,” Guilford Press, 1995.
[44] S.K. Lutgendorf, M.H. Antoni, G. Ironson, K. Starr, N. Costello, M. Zuckerman, et al., “Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress outcomes in symptomatic human immunodeficiency virus (HIV)-seropositive gay men,” Psychosomatic Medicine, Vol. 60, No. 2, March-April 1998, pp. 204-214.
[45] N. Kazantzis, F.P. Deane, K.R. Ronan, “Homework assignments in cognitive and behavioral therapy: A meta-analysis,” Clinical Psychology: Science and Practice, Vol. 7, 2000, pp. 189-202. doi:10.1093/clipsy.7.2.189
[46] B. Haarhoff and N. Kazantzis, “How to supervise the use of homework in cognitive behavior therapy : The role of trainee therapist beliefs,” Cognitive and behavioral practice, Vol. 14, 2007, pp. 325-332. doi:10.1016/j.cbpra.2006.08.004
[47] I. Jayasvasti, “A cognitive behavioral therapy manual for HIV-infected patients with depression: CBT-D for HIV-infected patients treatment manual,” Department of preventive and social medicine, Faculty of medicine, Chulalongkorn University, 2010.
[48] T.J. D’Zurilla and A.M. Nezu, “Problem-solving therapy: A positive approach to clinical intervention,” Springer publishing company, 2007.
[49] T.G. Heckman and B. Carlson, “A randomized clinic trial of two telephone-delivered, mental health interventions for HIV-infected persons in rural areas of the United States,” AIDS and Behavior, Vol.11, 2007, pp. 5-14. doi:10.1007/s10461-006-9111-9

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