title: A closer look at depression and its relationship to HIV antiretroviral adherence.
abstract: BACKGROUND
  Depression consistently predicts nonadherence to human immunodeficiency virus antiretroviral therapy, but which aspects of depression are most influential are unknown. Such knowledge could inform assessments of adherence readiness and the type of depression treatment to utilize.
  
  
  OBJECTIVE
  We examined how depression severity, symptom type, and change over time relate to adherence.
  
  
  METHODS
  Microelectronic adherence and self-reported depression data from 1,374 participants across merged studies were examined with cross-sectional and longitudinal analyses. Depression variables included a continuous measure, categorical measure of severity, cognitive and vegetative subscales, and individual symptoms.
  
  
  RESULTS
  At baseline, mean adherence was 69%, and 25% had mild/moderate and 18% had severe depression. In cross-sectional multivariate analyses, continuous depression, cognitive depressive symptoms, and severe depression were associated with lower adherence. In longitudinal analysis, reductions in both continuous and categorical depression predicted increased adherence.
  
  
  CONCLUSIONS
  The relationship between global continuous depression and nonadherence was statistically significant, but relatively weak compared to that of cognitive depressive symptoms and severe depression, which appear to pose strong challenges to adherence and call for the need for early detection and treatment of depression.
authors.affiliation: RAND Corporation, Health Unit, Santa Monica, CA 90407, USA. gwagner@rand.org
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
authors.forename: Marc I
authors.initials: MI
authors.lastname: Rosen
authors.forename: Jane
authors.initials: J
authors.lastname: Simoni
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D003072:Cognition Disorders / Q000150:complications / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012044:Regression Analysis; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents