Journal of Behavioral Medicine

, Volume 37, Issue 1, pp 166–172

Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use

  • Aaron J. Blashill
  • Janna R. Gordon
  • Steven A. Safren
Article

DOI: 10.1007/s10865-012-9476-3

Cite this article as:
Blashill, A.J., Gordon, J.R. & Safren, S.A. J Behav Med (2014) 37: 166. doi:10.1007/s10865-012-9476-3

Abstract

Appearance concerns are common among HIV-infected individuals, and previous cross-sectional and longitudinal data indicate that these concerns are associated with antiretroviral therapy (ART) non-adherence. However, to date, no known prospective data have explored the mechanism behind this relationship. Thus, the aim of the current study was to test depression severity as a prospective mediator of the relationship between appearance concerns and ART non-adherence in HIV-infected individuals with a history of injection drug use (IDU). Participants were 89 HIV-infected individuals with a history of IDU who participated in a prospective, randomized controlled trial of cognitive behavioral therapy for depression and medication adherence. Clinician-administered measures of depression severity and appearance concerns, along with electronic monitoring of ART non-adherence were included. Data were analyzed using longitudinal linear mixed-level modeling, and mediation was tested via the Monte Carlo Method of Assessing Mediation. Appearance concerns were predictive of depression severity, γ = .31, SE = .076, 95 % CI [.16, .46], t = 4.1, p = .0001, and depression severity was predictive of ART non-adherence, γ = 3.3, SE = 1.3, 95 % CI [.8, 5.8], t = 2.6, p = .01. The effect of appearance concerns on ART non-adherence, however, was significantly mediated by depression severity, γ = 1.02, 95 % CI [.21, 2.1]. Appearance concerns are associated with depression severity, which in turn is associated with ART non-adherence. Integrative interventions addressing appearance concerns, depression and ART adherence are needed, as this is one potential pathway towards worse health outcomes in HIV-infected individuals.

Keywords

HIV/AIDS Appearance Body image Depression ART adherence Lipodystrophy 

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Aaron J. Blashill
    • 1
    • 2
  • Janna R. Gordon
    • 1
  • Steven A. Safren
    • 1
    • 2
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

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