Annals of Behavioral Medicine

, Volume 42, Issue 1, pp 120–126

Clinician-Assessed Depression and HAART Adherence in HIV-Infected Individuals in Methadone Maintenance Treatment

  • Jeffrey S. Gonzalez
  • Christina Psaros
  • Abigail Batchelder
  • Allison Applebaum
  • Howard Newville
  • Steven A. Safren
Rapid Communication



The impact of measurement methods on the relationship between depression and HIV treatment adherence has not been adequately examined.


The purpose of this paper is to examine the relationship between clinician- and patient-rated depression and HIV medication adherence.


The participants were 91 HIV-infected individuals in methadone maintenance. Depression was assessed via clinician ratings (Clinical Global Impression Scale and Montgomery Asberg Depression Rating Scale) and self-report (Beck Depression Inventory-Short Form). Clinicians rated substance abuse using the Clinical Global Impression Scale and a structured interview. HIV medication adherence was measured over the following 2 weeks using electronic caps.


Each unit increase in the Clinical Global Impression Scale was associated with 75% increased odds of nonadherence (OR = 1.75, p = 0.002, 95% CI = 1.23–2.48). Similarly, for each standard deviation Montgomery Asberg Depression Rating Scale increase, there was a 2.6-fold increased odds of nonadherence (OR = 2.60, p = 0.001, 95% CI = 1.45–4.67). Substance abuse and self-reported depression severity were not significantly related to adherence.


Clinician-rated depression severity was a strong predictor of nonadherence. Assessment methods may influence the relationship between depression and HIV nonadherence.


HIV Depression Adherence Assessment Methadone maintenance HAART 


  1. 1.
    Crum NF, Riffenburgh RH, Wegner S, et al. Comparisons of causes of death and mortality rates among HIV infected persons: Analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acq Immun Def Synd. 2006; 41(2): 194–200.CrossRefGoogle Scholar
  2. 2.
    Glass TR, De Geest S, Hirschel B, et al. Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients. Antivir Ther. 2008; (13): 77–85.Google Scholar
  3. 3.
    DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment - Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000; 160(14): 2101–2107.PubMedCrossRefGoogle Scholar
  4. 4.
    Bing EG, Burnam A, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiat. 2001; 58(8): 721–728.PubMedCrossRefGoogle Scholar
  5. 5.
    Tucker JS, Burnam MA, Sherbourne CD, Kuong F, Gifford AL. Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med. 2003; 114(7): 573–580.PubMedCrossRefGoogle Scholar
  6. 6.
    Wagner GJ. Predictors of antiretroviral adherence as measured by self-report, electronic monitoring, and medication diaries. AIDS Patient Care ST. 2002; 16(12): 599–608.CrossRefGoogle Scholar
  7. 7.
    Gibbie T, Hay M, Hutchison CW, Mijch A. Depression, social support and adherence to highly active antiretroviral therapy in people living with HIV/AIDS. Sexual Health. 2007; 4(4): 227–232.PubMedCrossRefGoogle Scholar
  8. 8.
    Gonzalez JS, Penedo FJ, Antoni MH et al. Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS. Health Psychol. 2004; 23(4): 413–418.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Cleirigh C, Ironson G, Weiss A, Costa PT. Conscientiousness predicts disease progression (CD4 Number and Viral Load) in people living with HIV. Health Psychol. 2007; 26(4): 473–480.PubMedCrossRefGoogle Scholar
  10. 10.
    Ammassari A, Antinori A, Aloisi MS, et al. Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics. 2004; 45(5): 394–402.PubMedCrossRefGoogle Scholar
  11. 11.
    Arnsten JH, Li X, Mizuno Y, et al. Factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users. J Acq Immun Def Synd. 2007; 46: S64–S71.CrossRefGoogle Scholar
  12. 12.
    Avants SK, Margolin A, Warburton LA, Hawkins KA. Predictors of nonadherence to HIV-related medication regimes during methadone stabilization. Am J Addiction. 2001; 10:69–78.CrossRefGoogle Scholar
  13. 13.
    Arnsten JH, Demas PA, Grant RW, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV+ drug users. J Gen Intern Med. 2002; 17(5): 377–381.PubMedGoogle Scholar
  14. 14.
    Berg K, Demas P, Howard A, Schoenbaum E, Gourevitch M, Arnsten J. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Intern Med. 2004; 19(11): 1111–1117.PubMedCrossRefGoogle Scholar
  15. 15.
    Beck AT. Cognitive therapy of depression. 1979; The Guilford Press: New York, NY.Google Scholar
  16. 16.
    Matt GE, Vázquez C, Campbell KW. Mood-congruent recall of affectively toned stimuli: A meta-analytic review. Clin Psychol Rev. 1992; 12(2): 227–255. Google Scholar
  17. 17.
    Hansen RA, Dusetzina SB, Song L, Gaynes BN, Tu W, Murray MD. Depression affects adherence measurement but not the effectiveness of an adherence intervention in heart failure patients. J Am Pharm Assoc. 2009, 49(6): 760–768.CrossRefGoogle Scholar
  18. 18.
    Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiat. 1998; 59(Suppl 20): 22–33.Google Scholar
  19. 19.
    Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiat. 1979; 13(4): 382–389.CrossRefGoogle Scholar
  20. 20.
    Guy W. Clinical Global Impression. ECDEU Assessment Manual for Psychopharmacology. U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH. 1976; 218–222.Google Scholar
  21. 21.
    Beck AT, Rial WY, Rickels K. Short form of depression inventory: Cross-validation. Psychol Rep. 1974; 34(3):1184–1186.PubMedGoogle Scholar
  22. 22.
    Reynolds WM, Gould JW. A psychometric investigation of the standard and short form Beck Depression Inventory. J Consult Clin Psych. 1981; 49(2): 306–307.CrossRefGoogle Scholar
  23. 23.
    McLellan AT, Luborsky L, Woody GE, O’Brien CP. An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. J Nerv Ment Dis. 1980; 168(1): 26–33.PubMedCrossRefGoogle Scholar
  24. 24.
    The World Health Organization. The Management of Substance Abuse Page. Accessibility verified December 4, 2010.
  25. 25.
    Cohen J. A power primer. Psychol Bull. 1992; 112(1): 155–159.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2011

Authors and Affiliations

  • Jeffrey S. Gonzalez
    • 1
    • 2
    • 3
  • Christina Psaros
    • 3
    • 4
  • Abigail Batchelder
    • 1
  • Allison Applebaum
    • 5
  • Howard Newville
    • 1
  • Steven A. Safren
    • 3
    • 4
  1. 1.Ferkauf Graduate School of PsychologyYeshiva UniversityBronxUSA
  2. 2.Albert Einstein College of MedicineYeshiva University, Rousso BuildingBronxUSA
  3. 3.Massachusetts General HospitalBostonUSA
  4. 4.Harvard Medical SchoolBostonUSA
  5. 5.Memorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations