Abstract
Purpose
This is a secondary analysis of a multi-site, cluster (site) randomized trial of the efficacy of a combined Health and Wellness Cognitive Behavior Therapy (H&W CBT) and medication management approach for depression in youth with HIV (YWH) compared to standard care. In this study, we explored the association between H&W CBT factors and depression outcomes after 24 weeks of treatment to discover treatment elements associated with symptom reduction.
Methods
Participants (12–24 years of age) were YWH in the United States (US) diagnosed with moderate to severe depression [Quick Inventory of Depressive Symptomatology (QIDS), Clinician-Rated score ≥ 11]. Thirteen US sites were randomly assigned to either the combination treatment approach or standard care. For site-level analyses, site-specific summary scores were used to account for the within site correlation.
Results (all scores are site-level)
The number of depressive symptoms [QIDS-Self Reported (QIDS-SR) score] after 24 weeks of H&W CBT was significantly negatively correlated with the mean total session duration (ρ = − 0.94), the total homework assigned (ρ = − 0.83), the total number of practice modules used (ρ = − 0.83), and the mean total booster sessions given (ρ = − 0.82).
Conclusions
Specific elements of the H&W CBT (e.g., dose, assignment of homework, greater skills practice, and use of booster sessions) were associated with improvement of depression outcomes in YWH. A focus on these elements in treatment may improve symptom reduction for YWH with depression.
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Acknowledgements
We gratefully acknowledge the contributions of the site investigators and staff who conducted the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network’s IMPAACT 2002 study across the United States: BronxCare Health System, Bronx, NY: Luz Holguin, LMSW; Marvin Alvarado, MD; Martha Cavallo, CPNP; Mahboobullah Mirza Baig, MBBS. Jacobi Medical Center, Bronx, NY: Michael G. Rosenberg, MD, PhD; Marlene Burey, NP; Raphaelle Auguste, RN, BSN. University of Colorado School of Medicine, Children’s Hospital Colorado, Denver, CO: Daniel Reirden, MD; Kim Pierce DNP, RN, CPNP; Carrie Chambers BSN, RN; Christine Kwon, BS. University of California, San Diego, CA: Sharon Nichols, PhD; Veronica, Figueroa, M.S; Megan Loughran, B.A. Johns Hopkins University, Baltimore, MD: Mary Anne Knott-Grasso, CRNP; Aleisha Collinson-Streng, RN, BSN; Thuy Anderson, RN, BSN; Bonnie Addison, BA. David Geffen School of Medicine at the University of California, Los Angeles, CA: Jaime G. Deville, MD; Michele F. Carter, RN; Shellye Jones, LCSW; Patricia Tan, PhD. Rush University Cook County Hospital, Chicago, IL: Mariam Aziz, MD; Maureen McNichols RN, MS, CRC; Ixchell Ortiz Estes, NP; Katy Howe, LCSW. Children’s Diagnostic and Treatment Center, Fort. Lauderdale, FL: Lisa-Gaye Robinson, MD, MPH; Patricia A. Garvie, PhD; Kathleen Graham, PharmD; Hanna Major-Wilson, ARNP. Emory University School of Medicine, Atlanta, GA: Andres Camacho-Gonzalez, MD, MSc; Chanda Graves, PhD; LaTeshia Thomas-Seaton, MS, APRN; Nisha George, MPH. St. Jude Children’s Research Hospital, Memphis, TN: Megan L. Wilkins, PhD; Colin Quillivan, MS; Shelley Ost, MD; Sandra Jones, DNP. Texas Children’s Hospital/Baylor College of Medicine, Houston, TX: Mary Paul, MD; Chivon McMullen-Jackson, RN, BSN, CCRP; Kathy Pitts, PhD, APRN, CPNP, MPH; Terry Raburn, RN. Stony Brook Medicine, Stony Brook, NY: Sharon Nachman, MD; Allison Eliscu, MD; Melissa Shikora, LMSW; Barsha Chakraborty. Los Angeles County and University of Southern California Medical Center, Keck School of Medicine, Alhambra, CA: Yvonne Morales, LVN; LaShonda Spencer, MD; Allison Bearden, MD.
Funding
Overall support for the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) was provided by the National Institute of Allergy and Infectious Diseases (NIAID) with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Mental Health (NIMH), all components of the National Institutes of Health (NIH), under Award Numbers UM1AI068632 (IMPAACT LOC), UM1AI068616 (IMPAACT SDMC) and UM1AI106716 (IMPAACT LC), and by NICHD contract number HHSN275201800001I. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Dr. Kennard has research support from American Foundation for Suicide Prevention, National Institutes of Health, Patient-Centered Outcomes Research Institute, and the State of Texas. Dr. Kennard receives royalties from Guilford Press and is on the board of the Jerry M. Lewis MD Research Foundation and the George G. and Alva Hudson Smith Foundation. Dr. Emslie is a consultant for Lundbeck, Neuronetics, and Otsuka, and he receives research support from American Foundation for Suicide Prevention, Janssen Research & Development, LLC, National Institutes of Health, Patient-Centered Research Outcomes Institute (PCORI), and the State of Texas. Dr. Baltrusaitis and Dr. Shapiro have research support (to their institution) from National Institutes of Health (for this study) and from ViiV/GSK and Gilead (for other IMPAACT studies). Larry K. Brown, Miriam Chernoff, Jessica Jones, Sarah Buisson, Jaime Deville, Megan Wilkins, Amber Bunch, Chivon McMullen Jackson, Christy Beneri declare that they have no conflict of interest.
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Kennard, B.D., Brown, L.K., Baltrusaitis, K. et al. Cognitive Behavioral Therapy Factors Related to Outcomes in Depression Among Youth with HIV. Cogn Ther Res (2024). https://doi.org/10.1007/s10608-024-10474-0
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DOI: https://doi.org/10.1007/s10608-024-10474-0