Supportive-expressive and coping group teletherapies for HIV-infected older adults: a randomized clinical trial

Timothy G Heckman, Bernadette D Heckman, Timothy Anderson, Travis I Lovejoy, David Mohr, Mark Sutton, Joseph A Bianco, Jen-Tzer Gau, Timothy G Heckman, Bernadette D Heckman, Timothy Anderson, Travis I Lovejoy, David Mohr, Mark Sutton, Joseph A Bianco, Jen-Tzer Gau

Abstract

This clinical trial tested whether telephone-administered supportive-expressive group therapy or coping effectiveness training reduce depressive symptoms in HIV-infected older adults. Participants from 24 states (N = 361) completed the Geriatric Depression Scale at pre-intervention, post-intervention, and 4- and 8-month follow-up and were randomized to one of three study arms: (1) 12 weekly sessions of telephone-administered, supportive-expressive group therapy (tele-SEGT; n = 122); (2) 12 weekly sessions of telephone-administered, coping effectiveness training (tele-CET; n = 118); or (3) a standard of care (SOC) control group (n = 121). Tele-SEGT participants reported fewer depressive symptoms than SOC controls at post-intervention (MSEGT = 11.9, MSOC = 14.3) and 4- (MSEGT = 12.5, MSOC = 14.4) and 8-month follow-up (MSEGT = 12.7, MSOC = 14.5) and fewer depressive symptoms than tele-CET participants at post-intervention (MSEGT = 12.4, MCET = 13.6) and 8-month follow-up (MSEGT = 12.7, MCET = 14.1). Tele-CET participants reported no statistically significant differences from SOC controls in GDS values at any assessment period. Tele-SEGT constitutes an efficacious treatment to reduce depressive symptoms in HIV-infected older adults.

Trial registration: ClinicalTrials.gov NCT00365690.

Figures

Fig. 1
Fig. 1
The CONSORT flowchart of study participants. SOC standard of care, LOCF last observation carried forward

References

    1. Centers for Disease Control and Prevention [Accessed 23 Aug 2012];HIV Surveillance Report. 2010
    1. Centers for Disease Control and Prevention [Accessed 2 Jan 2013];HIV Surveillance Report. 2010
    1. Lovejoy TI, Heckman TG, Sikkema KJ, et al. Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS Behav. 2008;12:943–56.
    1. Palelle FJ, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43:27–34.
    1. Justice A. HIV and Aging: time for a new paradigm. Curr HIV/AIDS Rep. 2010;7:69–76.
    1. Centers for Disease Control and Prevention [Accessed 14 Dec 2012];HIV Surveillance Report. 2010
    1. Crystal S, Sambamoorthi U. Health care needs and services delivery for older persons with HIV/AIDS. Res Aging. 1998;20:739–59.
    1. Skiest DJ. The importance of co-morbidity in older HIV-infected patients. AIDS. 2003;17:1577.
    1. Grov C, Golub SA, Parsons JT, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care. 2010;22:630–9.
    1. Kalichman SC, Heckman TG, Kochman AR, Sikkema KJ, Bergholte J. Suicidal ideation among midlife and older adults living with HIV/AIDS. Psychiatr Serv. 2000;51:903–7.
    1. Siegel K, Schrimshaw EW, Dean L. Symptom interpretation and medication adherence among late middle-age and older HIV-infected adults. J Health Psychol. 1999;4:247–57.
    1. Crystal S, Akincigil A, Sambamoorthi U, et al. The diverse older HIV-positive population: a national profile of economic circumstances, social support, and quality of life. J Acquir Immune Defic Syndr. 2003;33:S76–83.
    1. Zarate CA, Weinstock L, Cukor P, et al. Applicability of telemedicine for assessing patients with schizophrenia: acceptance and reliability. J Clin Psychiatry. 1997;58:22–5.
    1. Baer L, Cukor P, Jenike MA, Leahy L, O’Laughlin J, Coyle JT. Pilot studies of telemedicine in psychiatric patients with obsessive compulsive disorder. Am J Psychiatry. 1995;152:1383–5.
    1. Bouchard S, Paquin B, Payeur R, Allard M, Rivard V, Fournier T. Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. Telemed J E Health. 2004;10:13–25.
    1. Frueh BC, Monnier J, Yim E, et al. A randomized trial of telepsychiatry for post-traumatic stress disorder. J Telemed Telecare. 2007;13:142–7.
    1. Hilty DM, Marks SL, Urness D, Yellowless PM, Nesbit TS. Clinical and educational telepsychiatry applications: a review. Can J Psychiatry. 2004;49:12–23.
    1. Mohr D, Vella L, Hart SL, Heckman T, Simon GE. The effect of telephone-administered psychotherapy on symptoms of depression and attrition: a meta-analysis. Clin Psychol. 2008;15:243–53.
    1. Mohr DC, Ho J, Duffecy J, et al. Effect of telephone-administered vs. face-to-face cognitive behavior therapy on adherence to therapy and depression outcomes among primary care patients: a randomized clinical trial. JAMA. 2012;307:2278–85.
    1. Lovejoy TI, Heckman TG, Suhr JA, Anderson T, Heckman BD, France CR. Telephone-administered motivational interviewing reduces risky sexual behavior in HIV-positive late middle-age and older adults: a pilot randomized controlled trial. AIDS Behav. 2011;15:1623–34.
    1. Cosio D, Heckman TG, Anderson T, Heckman BD, Garske J, McCarthy J. Telephone-administered motivational interviewing to reduce risky sexual behavior in HIV-infected rural persons: a pilot randomized clinical trial. Sex Transm Dis. 2010;37:140–6.
    1. Picciano J, Roffman R, Kalichman S, et al. A telephone based brief intervention using motivational enhancement to facilitate HIV risk-reduction among MSM: a pilot study. AIDS Behav. 2001;5:251–62.
    1. Collier AC, Ribaudo H, Mukherjee AL, et al. A randomized study of serial telephone calls support to increase adherence and thereby improve virologic outcome in persons initiating antiretroviral therapy. J Infect Dis. 2005;15:1398–406.
    1. Reynolds NR, Testa MA, Su M, et al. Telephone support to improve antiretroviral medication adherence: a multisite, randomized clinical trial. J Acquir Immune Defic Syndr. 2008;47:62–8.
    1. Vidrine DJ, Marks RM, Arduino RC, Gritz ER. Efficacy of cell phone-delivered smoking cessation counseling for persons living with HIV/AIDS: 3-month outcomes. Nicotine Tob Res. 2012;14:106–10.
    1. Chesney MA, Chambers DB, Taylor JM, Johnson LM, Folkman S. Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention. Psychosom Med. 2003;2003(65):1038–46.
    1. Johnson MO, Dilworth SE, Taylor JM, Neilands TB. Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV. Ann Behav Med. 2011;41:83–91.
    1. Meade CS, Drabkin AS, Hansen NB, Wislon PA, Kochman A, Sikkema KL. Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories. Addiction. 2010;2010(105):1942–51.
    1. Sikkema KJ, Wilson PA, Hansen NB, et al. Effects of a coping intervention on transmission risk behavior among people living with HIV/AIDS and a history of childhood sexual abuse. J Acquir Immune Defic Syndr. 2008;47:506–13.
    1. Heckman TG, Sikkema KJ, Hansen N, et al. A randomized clinical trial of a coping improvement intervention for HIV-infected older adults. J Behav Med. 2010;34:102–11.
    1. Heckman TG, Barcikowski R, Ogles B, et al. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med. 2006;32:27–38.
    1. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet. 1989;14:888–91.
    1. Kissane DW, Grabsch B, Clarke DM, et al. Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized clinical trial. Psychooncology. 2007;16:277–86.
    1. Walker LM, Bischoff TF, Robinson JW. Supportive-expressive group therapy for women with advanced ovarian cancer. Int J Psychother. 2010;60:407–27.
    1. Kelly JA, Murphy DA, Bahr GR, et al. Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. Am J Psychiatry. 1993;150:1679–86.
    1. Belanoff JK, Sund B, Koopman C, et al. A randomnized clinical trial of the efficacy of group therapy in changing viral load and CD4 counts in individuals living with HIV infection. Int J Psychiatry Med. 2005;35:349–62.
    1. Weiss JJ, Mulder CL, Antoni MH, de Vroome EM, Garssen B, Goodkin K. Effects of a supportive-expressive group intervention on long-term psychosocial adjustment in HIV-infected gay men. Psychother Psychosom. 2003;72:132–40.
    1. Dobkin PL, Da Costa D, Joseph L, et al. Counterbalancing patient demands with evidence: results from a pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus. Ann Behav Med. 2002;24(2):88–99.
    1. Mohr DC, Boudewynh AC, Goodkin DE, Bostrom A, Epstein L. Comparative outcomes for individual cognitive-behavioral therapy, supportive-expressive group psychotherapy, and sertaline for the treatment of depression in multiple sclerosis. J Consult Clin Psychol. 2001;69(6):942–9.
    1. Yesavage J, Brink T, Rose TL, Leirer VO. Development and validation of the geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17:37–49.
    1. Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer; New York: 1984.
    1. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;1986(73):13–22.
    1. Streiner D, Geddes J. Intention to treat analysis in clinical trials when there are missing data. Evid Based Ment Health. 2001;4:70–1.
    1. Ruskin PE, Silver-Aylaian M, Kling MA, et al. Treatment outcomes in depression: comparison of remote treatment through telepsychiatry to in-person treatment. Am J Psychiatry. 2004;161:1471–6.
    1. Ransom D, Heckman TG, Anderson T, Garske J, Holroyd K, Basta T. Telephone-delivered, interpersonal psychotherapy for HIV-infected rural persons diagnosed with depression: a pilot randomized clinical trial. Psychiatr Serv. 2008;59:871–7.
    1. Shea MT, Elkin I, Imber SD, Sotsky SM, Watkins JT, Collins JF, et al. Course of depressive symptoms over follow-up: findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch Gen Psychiatry. 1992;49:782–7.
    1. Yalom ID. The theory and practice of group psychotherapy. Basic Books; New York: 1995.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa