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Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

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Abstract

Medication adherence is highly predictive of health outcomes across chronic conditions, particularly HIV/AIDS. Depression is consistently associated with worse adherence, yet few studies have sought to understand how depression relates to adherence. This study tested three components of behavioral depression theory—goal-directed activation, positive reinforcement, and environmental punishment—as potential indirect effects in the relation between depressive symptoms and medication nonadherence among low-income, predominantly African American substance users (n = 83). Medication nonadherence was assessed as frequency of doses missed across common reasons for nonadherence. Non-parametric bootstrapping was used to evaluate the indirect effects. Of the three intermediary variables, there was only an indirect effect of environmental punishment; depressive symptoms were associated with greater nonadherence through greater environmental punishment. Goal-directed activation and positive reinforcement were unrelated to adherence. Findings suggest the importance of environmental punishment in the relation between depression and medication adherence and may inform future intervention efforts for this population.

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Acknowledgments

This study was supported by Grants R01DA022974 (PI: Daughters) and R36DA034513 (PI: Magidson). Dr. Magidson’s work on this manuscript was also supported by T32MH093310 (PIs: Henderson and Fricchione). Dr. Safren is supported by Grant K24MH094214.

Conflict of interest

Jessica F. Magidson, Alyson Listhaus, C.J. Seitz-Brown, Steven A. Safren, C.W. Lejuez, and Stacey B. Daughters declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA

    Jessica F. Magidson & Steven A. Safren

  2. University of Maryland, College Park, MD, USA

    Jessica F. Magidson, Alyson Listhaus, C. J. Seitz-Brown & C. W. Lejuez

  3. Columbia University, New York, NY, USA

    Alyson Listhaus

  4. University of North Carolina, Chapel Hill, NC, USA

    Stacey B. Daughters

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  1. Jessica F. Magidson
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Correspondence to Jessica F. Magidson.

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Magidson, J.F., Listhaus, A., Seitz-Brown, C.J. et al. Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?. J Behav Med 38, 337–347 (2015). https://doi.org/10.1007/s10865-014-9606-1

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