Is the Glass Half Full or Half Empty? Treatment of Depression and HIV/AIDS Medication Adherence: a Comment on Sin and Di
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INVITED COMMENTARY
Is the Glass Half Full or Half Empty? Treatment of Depression and HIV/AIDS Medication Adherence: a Comment on Sin and DiMatteo Jeffrey S. Gonzalez, Ph.D.
# The Society of Behavioral Medicine 2013
In 2000, DiMatteo and colleagues published a major metaanalysis of 30 years of observational research relating to depression and treatment adherence in various chronic illnesses; 12 studies were identified and none focused on HIV/AIDS [1]. Just twelve years later, a meta-analysis limited to treatment adherence in HIV/AIDS collected 95 studies [2]. The new meta-analysis by Sin and DiMatteo [3] reflects the current state of the science in this rapidly growing literature and makes a timely contribution to future progress. Analyses test whether treatment of depression in individuals with HIV/AIDS would result in improved antiretroviral therapy (ART) adherence. The analysis includes 29 observational studies and intervention trials that vary considerably in their measurement and treatment methods. Although a significant relationship between depression treatment and better ART adherence was found overall, the effect was quite variable. Thus, comprehensive moderator analyses provide an important guide to evaluating the evidence. Three findings most relevant to future work emerge. First, treatments specifically targeting depression are more likely to be associated with ART adherence than those that address depression as a secondary matter. Second, treatments of longer duration are significantly more likely to be associated with adherence than shorter treatments. Third, and most important, observational studies are likely to yield stronger effects than randomized controlled trials (RCTs). In fact, among RCTs included because they employed at least one intervention element aimed at reducing depression or distress, the effect J. S. Gonzalez (*) Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Avenue, Rousso Building, Bronx, NY 10461, USA e-mail: [email protected] J. S. Gonzalez Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
of depression treatment on ART adherence was not significant. Methodological limitations of these trials suggest a closer look is warranted. Of the 15 RCTs, only two used a diagnosis of a depressive disorder as an entry criterion [4, 5]; one used a positive screening result for major depressive disorder (MDD) [6]. Those remaining did not require that participants endorse any depression; seven did not even measure depression. Trials infrequently used formal, empirically supported depression treatments, with the following exceptions. One trial tested collaborative-stepped care, where antidepressant pharmacotherapy was the most common treatment [6]; two smaller trials used 10–12 individually delivered sessions of cognitive behavioral therapy for depression, adapted to also address ART non-adherence as a primary, well-measured outcome [4, 5]. This integrative approach makes it impossible to isolate depression treatment-relat
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