title: Depressive symptoms, lifestyle structure, and ART adherence among HIV-infected individuals: a longitudinal mediation analysis.
abstract: Despite the well-documented relationship between depression and antiretroviral therapy (ART) nonadherence, few studies have identified explanatory pathways through which depression affects adherence. The current study tested lifestyle structure-the degree of organization and routinization of daily activities-as a mediator of this relationship, given previous evidence of lifestyle structure being associated with both depression and ART nonadherence. HIV-infected individuals starting or re-starting ART in the California Collaborative Treatment Group 578 study (n = 199) were assessed over 48 weeks. Adherence was measured using electronic monitoring caps to determine dose timing and doses taken, and viral load was assessed. The mediating role of lifestyle structure was tested using generalized linear mixed-effects modeling and bootstrapping. Lifestyle significantly mediated the relationship between depression and both measures of ART adherence behavior. Interventions that minimize disruptions to lifestyle structure and link adherence to daily activities may be useful for individuals with depression and ART nonadherence.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA, jmagidson@partners.org.
authors.forename: Jessica F
authors.initials: JF
authors.lastname: Magidson
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Blashill
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D017008:Negotiating; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents