Introduction
Methods
Data Search
Study Selection and Inclusion/Exclusion Criteria
Data Extraction
Author, publication year, location | Study design and evaluation period | PLWHA population, sample size | Adherence: measurement (M), definition (D) and time period (T) | Depressive disorder and scale used to measure depressive disorder | Impact of depressive disorder on adherence |
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I. Depressive disorders associated with decreased adherence to cART
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Arnsten, J. H., X. Li, et al. (2007) USA | Cross-sectional study (2001–2005) | 636 adults reporting recent IDU and sexual activity with an opposite-gender partner | M: Self-report D: >90 % adherence T : Previous 1 day | Depression-7-item depression component of the BSI | Multivariate analysis (MVA): Depression was significantly associated with poorer adherence, (OR = 0.74, 95 % CI = 0.58–0.94, p < 0.05) |
Boarts, J. M., E. M. Sledjeski, et al. (2006) USA | Prospective cohort study (3-month follow-up) | 57 participants | M: Self-report (AACTG adapted questionnaire) D: Continuous variable T: Previous week | Depression—CES-D | MVA: Depressive symptoms at baseline predicted lower levels of adherence at follow-up (R
2 = 0.076, p ≤ 0.05) |
Buathong, N., N. Hiransuthikula, et al. (2009) Thailand | Cross-sectional study (Oct 2007–Jan 2008) | 379 participants on cART recruited from the immunology and sexual transmitted disease clinics | M: Self-report D: ≥95 % adherence T: Previous 1 month | Depression—BDI–II | MVA: Depression was significantly associated with non-adherence (AOR = 4.68; 95 % CI = 2.77–7.88, p < 0.001) |
Carrieri, M. P., M. A. Chesney, et al. (2003) France | Cohort study (Oct 1995; followed up for the first 18 months on cART) | 96 IDU participants (initially adherent to cART) | M: Self-report D: Adherence failure: <80 % adherence or did not “totally” follow their prescribed regimen T: Previous week or at any visit before the 18th month of treatment | Depression—CES–D | MVA: Depression was significantly related to adherence failure (OR = 2.5, 95 % CI = 1.0–6.0, p = 0.044) |
Carrieri, M. P., C. Leport, et al. (2006) France | Cohort study (May 1997–Jun 1999; 5-year follow-up) | 970 participants | M: Self-report (ACTG questionnaire) D: High (100 % adherence), Moderate (80–99.9 % adherence) and Poor (<80 % adherence) T: Previous 4 days | Depression—CES-D (score >16) | MVA: Depression was independently associated with moderate or poor adherence but not with high adherence (Coeff = 0.18, 95 % CI = 0.07–0.29) |
Cruess, D. G., S. C. Kalichman, et al. (2011) USA | Prospective cohort study (Mar 2005–Oct 2008) | 324 participants | M: Unannounced pill count D: Continuous variable (percentage adherence) T: Previous 3 months | Depression—CES-D | MVA: Higher mean depression score was significantly associated with lower antiretroviral medication adherence (β (4,300) = −0.22, p < 0.001) |
Diiorio, C., F. McCarty, et al. (2009) USA | Cross-sectional study | 236 participants | M: UCSF Adherence Questionnaire D: Reasons for missing medication T: Previous 30 days | Depression—CES-D | MVA: Significant negative association was found between depression and poor adherence (fewer depressive symptoms supported greater adherence) |
Do, N. T., K. Phiri, et al. (2010) Botswana (Afrika) | Cross-sectional study (Apr–May 2005) | 300 participants | M: Self-report, institutional adherence (pharmacy refill rate), and a culturally modified Morisky scale D: [1] 100 % adherence in the past 4 days, [2] 100 % adherence in the past 1 month, and [3] 100 % refill in the past 3 months T: Previous 4 days, 1 month and prior consecutive 3 months | Depression—BDI | MVA: Depression was a significant predictor of non-adherence (p < 0.02) |
Etienne, M., M. Hossain, et al. (2010) Kenya, Uganda, Zambia, Nigeria, Rwanda | Cross-sectional study (Aug 2004–Apr 2005) | 921 participants | M: Self-report T: Previous week (for doses); previous 3 months (for appointments) | Depression—Factor scores (low, medium, high) constructed from three questions | MVA: Only high depression score was associated with non-adherence (OR = 0.57, 95 % CI = 0.39–0.84, p < 0.01) |
Gonzalez, J. S., C. Psaros, et al. (2011) USA | Cohort study | 91 participants in methadone maintenance | M: EDMs D: 100 % adherence (no missed doses) T: Previous 2 weeks | Depression: clinician ratings (MINI, Clinical Global Impression Scale and MADRS) and self-report (BDI-SF) | MVA: Each unit increase in the Clinical Global Impression Scale was associated with 75 % increased odds of non-adherence (OR = 1.75, p = 0.002, 95 % CI = 1.23–2.48). For each SD MADRS increase, there was a 2.6-fold increased odds of non-adherence (OR = 2.60, p = 0.001, 95 % CI = 1.45–4.67) |
Kacanek, D., D. L. Jacobson, et al. (2010) USA | Longitudinal cohort study (Feb 1995–Dec/2004) | 225 participants | M: Self-report D: Suboptimal adherence: missing >5 % of cART doses T: Previous 7 days | Incident depression- Burnam’s interviewer administered 8-item screening tool | MVA: Subjects who developed depressive symptoms had a twofold greater risk of suboptimal adherence at follow up (RR = 1.8, 95 % CI = 1.1–3.0) |
Kleeberger, C. A., J. Buechner, et al. (2004) USA | Longitudinal cohort study (Oct 1998–Oct 2000) | 597 men | M: Self-report D: Dichotomized: 100 % adherence or less than 100 % adherence T: Previous 4 days | Depression—CES-D | MVA: CES-D score >16 was an independent predictor of decreasing adherence (OR = 1.8, p = 0.03) |
Lazo, M., S. J. Gange, et al. (2007) USA | Longitudinal cohort study (1999–2004) | 1,904 participants (640 men and 1,304 women) | M: Self-report (AACTG questionnaire) D: Dichotomized: 100 % adherence or less than 100 % adherence T : Previous 4 days (men) or 3 days (women) | Symptoms of depression were measured using the CES-D | MVA: Symptoms of depression were a significant independent predictor of decreased adherence among men (OR = 1.44, 95 % CI = 1.06–1.95, p < 0.05), but not women |
Li, L., S. J. Lee, et al. (2010) Thailand | Cross-sectional study 2007 | 386 participants | M: Self-report (of failing to adhere to cART) D: <100 % adherence T: Previous 1 month | Depressive symptoms: 15-item screening test developed and used previously in Thailand (Thai Department of Mental Health, 2006) | MVA: Depression was a significant predictor of poor adherence to cART (OR = 0.69, p = 0.03) |
Olisah, V. O., O. Baiyewu, et al. (2010) Zaria | Cross-sectional study (Sep–Dec 2006) | 310 participants | M: Self-report D: Poor adherence: <100 % adherence T: Previous 7 days | Depression—CES-D and SCAN to confirm depression diagnosis | Bivariate analysis (BVA): cART adherence in participants with depressive disorder (36.4 %) was significantly poorer than that in non-depressed participants (78.9 %), (χ2 = 34.657, df = 1, p < 0.05) |
Phillips, K. D., L. Moneyham, et al. (2005) USA | Cross-sectional study | 173 low-income, women living with HIV/AIDS in the rural southeastern United States | M: Self-report (AACTG questionnaire) D: Continuous variable T: Previous 1 and 3 months | Depression—CES-D, classified as mild depressive symptoms (CES-D score 8–15) and severe depressive symptoms (CES-D score 16 or greater) | BVA: Severe depressive symptoms were significantly associated with non-adherence (p = 0.0002) |
Protopopescu, C., F. Raffi, et al. (2009) France | 10 year Cohort study (enrolled May 1997–June 1999) | 1,010 participants | M: Self-report (AACTG questionnaire) D: Non-adherence: <100 % adherence T: Previous 4 weeks | Depression—CES-D, participants were classified as having depressive symptoms if their CES-D score was >17 for men and >23 for women | MVA: Depressive symptoms were independently associated with non-adherence (Coeff = 0.171, 95 % CI = 0.087–0.283, p < 0.001) |
Rao, D., B. J. Feldman, et al. (2011) USA | Cross-sectional study (Feb–Nov 2009) | 720 participants | M: Self-report (AACTG questionnaire) and VAS D: VAS adherence item was converted into 4-category ordinal scale, perfect adherence = 100 % adherence on VAS T: Previous 4 days and 4 weeks | Depressive symptoms: PHQ-9 | MVA: Depressive symptoms had a moderate negative effect on HIV medication adherence (stand. b = −0.17, p < 0.01) |
Rodkjaer, L., T. Laursen, et al. (2010) Denmark | Cross-sectional study (May 2005–Sep 2005) | 205 participants | M: Self-report (AACTG questionnaire) D: Non-adherence: <100 % adherence T: Previous 4 days | Depression—BDI-II | MVA: Participants at risk of depression (BDI > 20) were more likely to be non-adherent (OR = 5.7, 95 % CI = 1.7–18.6) |
Rodkjaer, L., T. Laursen, et al. (2011) Denmark | Longitudinal cohort study (May 2005–Sep 2008) | 205 participants at baseline (in 2005) and 148 participants at follow-up (in 2008) | M: Self-report (AACTG questionnaire) D: Non-adherence: <100 % adherence (in 2005) or stopping cART for 7 days or more during the last 12 months (in 2008) T: Previous 4 days | Depression—BDI-II | MVA: Participants at risk of moderate to major depression (BDI > 20) were more likely to be non-adherent to cART in the 4 days prior to assessment in 2005, and more likely to have stopped cART for 7 days or more during the last 12 months in 2008 |
Royal, S. W., D. P. Kidder, et al. (2009) USA | Cross-sectional study (July 2004–May 2005) | 644 homeless or unstably housed PLWHA | M: Self-report D: Continuous variable T: Previous 2 and 7 days | Depression—CES-D | MVA: Depression was associated with decreased 2 day (AOR = 1.73, 95 % CI = 1.28–2.34, p = 0.0003) and 7 days (AOR = 1.91, 95 % CI = 1.35–2.72, p = 0.0003) adherence |
Sarna, A., S. Pujari, et al. (2008) India | Cross-sectional study (May–Aug 2004) | 310 participants | M: Self-report (AACTG questionnaire) D: ≥90 % adherence T: Previous 4 days | Depression-BDI II | MVA: Severe depression (AOR = 4.48, 95 % CI = 1.64–12.27, p = 0.003) was associated with lower adherence |
Schuman, P. (2001) USA | Cross-sectional study (Dec 1996–Dec 1997) | 371 women with advanced HIV disease | M: Self-reported cART adherence D:Self-report of taking >75 % of their cART (as frequently as prescribed or almost all the time) T: Previous 2 weeks | Depression—CES-D (CES-D >15) | MVA: Depressive mood was significantly associated with poorer adherence (OR = 0.34, 95 % CI = 0.18–0.64, p < 0.001) |
Singh, N., C. Squier, et al. (1996) USA | Longitudinal observational study | 46 VA Medical Center participants | M: Computerized pharmacy refill records D: Non-compliant: filling <80 % of medication T: Previous 1 month | Depression—BDI and POMS | MVA: POMS > 42 was significantly associated with non-compliance (OR = 1.4, 95 % CI = 1.1–1.8, p < 0.01) but BDI score was not |
Spire, B., S. Duran, et al. (2002) France | Prospective cohort study with (May–Oct 1997; follow-up visit after 4 months) | 445 participants who were started on PI | M: Self-report D: 100 % adherence T: Previous 4 days | Depression—CES-D | BVA: Baseline depression was not associated with future non-adherence; but an increase in CES-D score during the 4-months period of treatment was significantly associated with non-adherence |
Tadios, Y. and G. Davey (2006) Ethiopia | Cross-sectional study (Dec 2004–Jan 2005) | 431 participants on cART | M: Self-report D: ≥95 % adherence T: Previous 1, 3 and 7 days | Depression—BDI (cut-off = 14) (depression used as dependent variable) | MVA: Adherence to cART was significantly associated with not being depressed (AOR = 2.8, 95 % CI = 1.5–5.4, p = 0.002) |
Tucker, J. S., M. A. Burnam, et al. (2003) USA | Cohort study (Jan 1996–Jan 1998) | 1910 participants | M: Self-report to 3 adherence questions D: 100 % adherence T: Previous week | Major depression—CIDI-SF of the WHO | MVA: Participants with depression were more likely to be non-adherent than those without a MI. (OR = 1.7, 95 % CI = 1.3–2.3) |
Vranceanu, A. M., S. A. Safren, et al. (2008) | Randomized cohort crossover trial (Nov 2002-Jan 2005; total of six study visits, enrollment and five follow-up visits) | 156 participants Group 1: Two physician visits with depression screening then crossover to Group 2 Group 2: Two physician visits without depression screening then crossover to Group 1 | M: EDMs adherence D: Continuous variable (percent adherence) T: Previous 30 days (which represents the 30-day period after depression measurement) | Depression- Brief (self-report) screening measures of depression (PC-SAD) | MVA: Continuous Depression score was significantly associated with decreased percent adherence (p = 0.015). Dichotomous depression score was not |
Waldrop-Valverde, D. and E. Valverde (2005) USA | Cross-sectional study | 58 IDU participants | M: Self-report D: 100 % adherence T: Previous day | Depression- BDI | MVA: Depression was significantly related to decreasing adherence (OR = 0.924, 95 % CI = 0.863–0.989, p = 0.023) |
Wagner, G. J., K. Goggin, et al. (2011) USA | Cross-sectional and longitudinal analyses of 10 merged studies (1997–2009) | 1,374 participants | M: EDMs (in all studies) D: Continuous variable and dichotomous variable (good adherence: >90 %) T: Previous 2 weeks | Depression—BDI(×1), BDI-II (×4), BSI(×2) and CES-D(×3) | MVA: In cross-sectional multivariate analyses, continuous depression, cognitive depressive symptoms, and severe depression were associated with lower cART adherence. In longitudinal analysis, reductions in both continuous and categorical depression predicted increased cART adherence (b(SE) = −0.015, p < 0.01) |
II. Depressive disorder not significantly associated with adherence to cART
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Berger-Greenstein, J. A., C. A. Cuevas, et al. (2007) USA | Cross-sectional study | 85 participants diagnosed with drug abuse & psychiatric disease | M: Self-report (ACTG-adapted questionnaire) D: Continuous variable T: Previous 3 days | MDD–SCID & BDI-II | BVA: MDD was not significantly associated with non-adherence to cART |
Bottonari, K. A., S. A. Safren, et al. (2010) USA | Prospective cohort study (3-month follow-up) | 87 participants | M: Self-report (AACTG questionnaire) D: Continuous variable; subsequent analyses utilized Box-Cox transformed variables to improve the normality of adherence T: Previous 30 days (1 month) | Depression—MINI and MADRAS | MVA: Neither depression nor depressive severity predicted HIV treatment adherence when controlling for the impact of acute life events |
Campos, L. N., M. D. Guimaraes, et al. (2010) Brazil | Prospective cohort study (May 2001–May 2002) | 293 participants | M: Self-report D: ≥ 95 % adherence T: Previous 3 days | Depression—HADS | BVA: Depression was not independently associated with non-adherence |
Catz, S. L., J. A. Kelly, et al. (2000) USA | Cross-sectional study (Dec 1997 –Aug 1998) | 72 participants | M: Self-report (7-point scale) D: Non-adherence: <100 % adherence T: Previous 5 days and 3 months | Depression—CES-D | MVA: No significant association was found between non-adherence and depression |
Gibbie, T., M. Hay, et al. (2007) Australia | Longitudinal cohort study (recruited from Jan 2003 to Mar 2004; followed-up for 24 months) | 72 participants | M: Self-report D: ≥95 % adherence T: Previous 24 h, 4 days and 7 days | Depression- BDI (cut-off = 10), and SCID | MVA: SCID diagnosis of current major depression was not significantly related to adherence (b = −0.99, 95 % CI = 0.052–2.64, p = 0.322). BDI was not included in the analysis |
Gonzalez, J. S., F. J. Penedo, et al. (2004)USA | Cross-sectional study | 90 HIV(+) MSM and women (of any sexual orientation) | M: Self-report (ACTG questionnaire) D: Non-adherence: <100 adherence T: Previous 4 days | Depression—BDI | MVA: BDI score was not significantly related to medication adherence |
Gordillo, V., J. del Amo, et al. (1999) Spain | Cross-sectional study (Dec 1997 –May 1998) | 366 participants | M: Self-report and pill count method (Returning those pills that had not been taken in the previous month to the pharmacist) D: >90 % adherence T: Previous 1 week and 1 month | Depression—BDI, (cut-off = 14) | MVA: Depression was not an independent predictor of non-adherence |
Ingersoll, K. (2004) USA | Cross –sectional study | 120 participants | M1: Electronic medical record and self-report D: Four dichotomous non-adherent behaviors: [1] running out of medications, [2] not always taking medications as directed, [3] ≤95 % adherence or [4] having notations of non-compliance in the medical record T: Previous week | Major Depression -CIDI-SF | MVA: Major Depression was not an independent predictor of all four non-adherent behaviors |
Johnson, M. O., S. E. Dilworth, et al. (2011) USA | Cross-sectional study (Jan 2009–Sep 2010) | 295 HIV-positive men (data were collected from 210 male couples or 420 men) | M: Self-report (AACTG questionnaire and the visual analog (VAS) scale) D: 100 % versus <100 % adherence T: Previous 3 and 30 days | Depression—CES-D | MVA: Depressive symptoms were not associated with suboptimal 3-day or 30-day adherence |
Kalichman, S. C., J. Pellowski, et al.(2011) USA | Longitudinal cohort study (Jan 2008–Jun 2009) | 179 participants | M: Unannounced pill counts D: Non-adherent: taking <85 % of medications T: For 8 consecutive months | Depression—CES-D | MVA: Depression was not associated with non- adherence |
Keuroghlian, A. S., C. S. Kamen, et al. 2011) USA | Cross-sectional study | 38 participants | M: Self-report (AACTG questionnaire) D: Adherent: no missed doses T: Previous 4 days | Depression—CES-D | MVA: Depression was not significantly associated with cART adherence (p > 0.05) |
Kyser, M., K. Buchacz, et al. (2011) USA | Cross-sectional analysis of a prospective cohort study (The SUN study, Mar 2004 - Jun 2006 | 528 participants | M: Self-report D: Non-adherence: missing at least one dose of medications T: Previous 3 days | Depression—PHQ-9 | BVA: Depression was not an independent predictor of non-adherence |
Leserman, J., G. Ironson, et al. (2008) USA | Cross-sectional study (Feb 2004–Feb 2007) | 105 participants | M: Self-report (AACTG questionnaire) D: Non-adherence: missing at least one dose of medications T: Previous 2 weeks | Depression—BDI | MVA: Depressive symptoms were not associated with non-adherence |
Mellins, C. A., J. F. Havens, et al. (2009) USA | Cross-sectional study | 542 participants | M: Self-report (AACTG questionnaire) D: 100 % adherence T: Previous 3 days | Major Depression -SCID | BVA: The presence or absence of major depression on the SCID was not associated with adherence |
Mohammed, H., L. Kieltyka, et al. (2004) USA | Cross-sectional study (Mar 1999–Aug 2001) | 273 participants | M: Self-report D: Non-adherence: <100 adherence T: Previous week | MVA: Depression was not found to be significantly associated with non-adherence | |
Moore, D. J., C. Posada, et al. (2011) USA | Cross-sectional analysis of a cohort study | 77 participants | M: EDMs D: Adherent: >90 % adherence T: Previous 30 days | MDD–BDI | BVA: Current or past diagnosis of MDD was not associated non-adherence (p > 0.05) |
Moss, A. R., J. A. Hahn, et al. (2004) USA | 12-month prospective cohort study (Mar 1998 Apr 2001) | 148 participants | M: Pill count self-report and EDMs D: [1] Continuous variable [2] cART discontinuation: no pills were taken for 1 month T: Previous 3 days and 1 month | Depressive symptoms—BDI (score >15) | BVA: BDI >15 was not significantly associated with cART discontinuation or with adherence |
Mugavero, M., J. Ostermann, et al. (2006) USA | Cross-sectional analysis (Dec 2001–Apr 2002) | 474 participants | M: Self-reported D: Non-adherence: <100 % adherence T: Previous 7 days | Depression—BSI | MVA: Depression was not significantly associated with non-adherence (when trauma variable was in the model) |
Palmer, N. B., J. Salcedo, et al. (2003) USA | Cross-sectional study | 107 participants diagnosed with substance abuse and psychiatric diseases (all on methadone) | M: Self-report (AACTG questionnaire) D: ≥ 95 % adherence T: Previous 3 days | Depression -SCID-I | BVA: Depression was not associated with HIV medication adherence |
Shin, S., M. Munoz, et al. (2008) Peru | Cross-sectional study (Nov 2005–Nov 2006) | 43 participants with tuberculosis | M: Self-report D: Non-adherence: <100 % adherence T: Previous 4 weeks | Depression—HSCL | MVA: Depression by HSCL (score >1.75) was not significantly associated with non-adherence |
Van Servellen, G., B. Chang, et al. (2002) USA | Cross-sectional study | 182 participants | M: Self-report and medical records D: Non-adherence: self-report or presence of non-adherence behavior in the medical records T: Previous 3 months | Depression—HADS | MVA: Depression was not shown to be associated with non-adherence |
Wagner, G. J., L. M. Bogart, et al. (2011) USA | Cohort study | 214 African American males | M: EDMs D: Continuous variable T: Previous 6 months | Depression: 8-item depression scale from the Medical Outcomes Study | BVA: Depression was not associated with adherence |
III. Adherence variable predicts change in depressive symptoms
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Ammassari, A., A. Antinori, et al. (2004) Italy | Multicenter Cross-sectional study (Nov 1999–Feb 2000) | 135 participantsa
| M: Self-report D: Non-adherence: Missing at least 1 dose of cART T: Previous 1 week | Depression—MADRAS (score >19) | MVA: Depression scores were significantly higher in the non-adherent group, compared with the adherent group (p = 0.03) |
Bianco, J. A., T. G. Heckman, et al. (2011) USA | Cross-sectional study (Jun 2008–Jul 2009) | 242 participants (>50 years old adults enrolled in a RCT who had a score of >5 on the GDS) | M: Self-report (ACTG questionnaire) D: Non-adherent: skipping medication at least once and/or taking a medication late at least twice T: Previous 7 days | Depression—Geriatric Depression Scale (GDS) | MVA: Non-adherent participants were significantly more depressed (b = −0.05, Wald’s χ2 = 4.52, p < 0.033) |
Catz, S. L., T. G. Heckman, et al. (2001) USA | Cross-sectional study (1997) | 84 participants | M: Self-report (six-point Likert scale) D: Dichotomized as ‘consistent adherence’ (No skipped doses) or ‘inconsistent adherence’ (at least 1 skipped dose) T: Previous 7 days | Depression –BDI | BVA: Adherence was not associated with depression |
Farley, J., E. Miller, et al. (2010) Nigeria | Cross-sectional study (June-July 2007) | 399 participants (222 cART-experienced and 177 cART-naive) | M: Pharmacy refill adherence rate D: Non-adherence: pharmacy refill rate <95 % T: From the time cART was first dispensed until a cutoff date shortly after the study ended | Depression -CES-D Binary cut-off for CES-D scores are defined as ≥16 and ≥21 | MVA: Having a pharmacy refill rate <95 %, was associated with a CES-D ≥ 16 (p = 0.004) and a CES-D ≥ 21 (p < 0.001) |
Herrmann, S., E. McKinnon, et al. (2008) Australia | Longitudinal cohort study (Jul 2003-Dec 2005; >6 months follow-up) | 357 participants | M: Self-report (AACTG questionnaire) D: 100 % adherence T: Previous month | Depression-CES-D scale (depression used as dependent variable) | BVA: Non-adherent participants scored higher values on the depression indicator scale (p = 0.03) |
Springer, S. A., S. Chen, et al. (2009) USA | 6-month RCT | 89 IDU participants | M: Self-report (ACTG questionnaire) D: Continuous variable (reported as a mean change in percentage adherence) T: Previous 3 days | Depression—CES-D, MDD was defined as having a CES-D score >16 (depression used as dependent variable) | MVA: Adherence to cART was associated with improved depressive symptoms. Increased adherence was significantly associated to decreased CES-D score (p = 0.01) |
IV. Depressive disorder associated with decreased persistence on cART
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Carrico, A. W., E. D. Riley, et al. (2011) USA | Cohort study (using data from a RCT) | 603 participants | M: Self-report D: cART utilization classified as: [1] continuous cART utilization-being on cART at baseline and remaining on cART; [2] cART discontinuation-stopping cART and remaining off during any subsequent follow-up assessments; and [3] intermittent cART utilization-stopping and restarting cART at least once T: 25 months of follow-up | Depression—BDI-I | MVA: Depression at baseline independently predicted a 39 % increase in the odds of cART discontinuation (OR = 1.39, 95 % CI = 1.08–1.78, p < 0.01) |
Li, X., J. B. Margolick, et al. (2005) USA | Cohort study (Apr 1999–Mar 2002) | 687 MSM | M: Self-report (of cART persistence) D: [1] Continuing cART— not stopping medications for 2 or more consecutive days [2] Interrupted cART—stopping cART for >2 consecutive days at least once; and [3] Discontinued cART—stopping all ART between and still off cART at end of assessment period T: Previous 6 months (time between Vi and Vi+1) | Depression—CES-D | MVA: CES-D score >16 was an independent predictor for Interrupting cART, (OR = 1.97, 95 % CI = 1.38–2.80), and Discontinuing cART, (OR = 2.03, 95 % CI = 1.24–3.32) but not for continuing cART |
Maru, D. S., R. D. Bruce, et al. (2008) USA | 6-month RCT of 2:1 to DAART versus SAT | 141 drug users | M: EDMs, observed doses, and self-report. Both persistence and adherence were measured D: The time-to-drop-out (persistence) was considered to be the duration from the first observed dose of DAART to the last DAART visit the participant received T: Previous 6 months | Depression—CES-D | BVA: The presence of severe score on the CES-D scale predicted time-to-DAART discontinuation (HR = 2.4, 95 % CI = 1.0–6.0, Gehan statistic = 4.4; p < 0.05) |
V. Depressive disorder associated with increased persistence on cART
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Himelhoch, S., C. H. Brown, et al. (2009) USA | Longitudinal cohort study (2000–2005) | 4989 participants | M: Self-report D: cART discontinuation: the participant either went off cART but remained active in care or dropped out of active care T: Previous year | Depressive disorder was defined using ICD-9 | MVA: The hazard probability for cART discontinuation among those with depressive disorders was significantly lower in the first year (AOR = 0.61, 95 % CI = 0.54–0.69); but it did not significantly differ in subsequent years |