Skip to main content

Advertisement

SpringerLink
Log in

Anxiety and Depression Symptoms as Risk Factors for Non-adherence to Antiretroviral Therapy in Brazil

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Depression and anxiety are common among HIV-infected people and rank among the strongest predictors of non-adherence to antiretroviral therapy (ART). This longitudinal study aimed to assess whether symptoms of anxiety and depression are predictors of non-adherence among patients initiating ART at two public referral centers (n = 293) in Belo Horizonte, Brazil. Prevalence of severe anxiety and depression symptoms before starting ART was 12.6% and 5.8%, respectively. Severe anxiety was a predictor of non-adherence to ART during follow-up period (RH = 1.87; 95% CI = 1.14–3.06) adjusted for low education, unemployment, alcohol use in the last month and symptoms of AIDS; while a history of injection drug use had borderline statistical significance with non-adherence. These findings suggest that using a brief screening procedure to assess anxiety and depression symptoms before initiating ART help identify individuals for interventions to improve adherence and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Acurcio, F. A., Puig-Junoy, J., Bonolo, P. F., Ceccato, M. G. B., & Guimarães, M. D. C. (2006). Cost-effectiveness of initial adherence to antiretroviral therapy among HIV infected patients in Belo Horizonte, Brazil. Revista Espanola de Salud Publica, 80, 41–54. doi:10.1590/S1135-57272006000100005.

    Google Scholar 

  • Ammassari, A., Antinori, A., Aloisi, M. S., Trotta, M. P., Murri, R., Bartoli, L., et al. (2004). Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons. Psychosomatics, 45, 394–402. doi:10.1176/appi.psy.45.5.394.

    Article  PubMed  Google Scholar 

  • Arnsten, J. H., Demas, P. A., Farzadegan, H., Grant, R. W., Gourevitch, M. N., Chang, C. J., et al. (2002). Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring. Clinical Infectious Diseases, 33, 1417–1423. doi:10.1086/323201.

    Article  Google Scholar 

  • Au, A., Chan, I., Li, P., Chung, R., Po, L. M., & Yu, P. (2004). Stress and health-related quality of life among HIV-infected persons in Hong Kong. AIDS and Behavior, 8, 119–129. doi:10.1023/B:AIBE.0000030243.50415.c0.

    Article  PubMed  Google Scholar 

  • Barfod, T. S., Gerstoft, J., Rodkjaer, L., Pedersen, C., Nielsen, H., Moller, A., et al. (2005). Patient’s answers to simple questions about treatment satisfaction and adherence and depression are associated with failure of HAART: A cross-sectional survey. AIDS Patient Care and STDs, 19, 317–325. doi:10.1089/apc.2005.19.317.

    Article  PubMed  Google Scholar 

  • Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An update literature review. Journal of Psychosomatic Research, 52, 69–77. doi:10.1016/S0022-3999(01)00296-3.

    Article  PubMed  Google Scholar 

  • Blanco, J. M. S., Pérez, I. R., Lima, A. O. L., Recio, J. M. C., López, E. G., & Lasanta, J. J. A. (2005). Adherent to antiretroviral treatment in prisons. AIDS Research and Human Retroviruses, 21, 683–688. doi:10.1089/aid.2005.21.683.

    Article  PubMed  Google Scholar 

  • Bonolo, P. F., César, C. C., Acúrcio, F. A., Ceccato, M. G. B., Pádua, C. A. M., Álvares, J., et al. (2005). Non-adherence among patients initiating antiretroviral therapy: A challenge for health professionals in Brazil. AIDS (London, England), 19, S5–S13. doi:10.1097/01.aids.0000191484.84661.2b.

    Google Scholar 

  • Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia, C., & Pereira, W. A. B. (1995). Mood disorders among medical in-patients: A validation study of the hospital anxiety and depression scale (HAD). Journal of Public Health, 29, 355–363.

    CAS  PubMed  Google Scholar 

  • Botega, N. J., Pondé, M. P., Medeiros, P., Lima, M. G., & Guerreiro, C. A. M. (1998). Validação da escala hospitalar de ansiedade e depressão (HAD) em pacientes epilépticos ambulatoriais. Jornal Brasileiro de Psiquiatria, 47, 285–289.

    Google Scholar 

  • Braithwaite, R. S., Mcginnis, K. A., Conigliaro, J., Maisto, S. A., Crystal, S., Day, N., et al. (2005). A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcoholism, Clinical and Experimental Research, 29, 1190–1197. doi:10.1097/01.ALC.0000171937.87731.28.

    Article  PubMed  Google Scholar 

  • Brasil, Ministério da Saúde. (2000). Recomendações para terapia anti-retroviral em adultos e adolescentes infectados pelo HIV. Brasília: Ministério da Saúde.

    Google Scholar 

  • Brasil, Ministério da Saúde. (2008). UNGASS. Resposta brasileira 2005/2007. Relatório de progresso do país. Brasília: Ministério da Saúde.

    Google Scholar 

  • Campos, L. N., Bonolo, P. F., & Guimarães, M. D. C. (2006). Anxiety and depression assessment prior to initiating antiretroviral treatment in Brazil. AIDS Care, 18, 529–536. doi:10.1080/09540120500221704.

    Article  Google Scholar 

  • Carballo, E., Cadarso-Suárez, C., Carrera, I., Fraga, J., De La Fuente, J., Ocampo, A., et al. (2004). Assessing relationships between health-related quality of life and adherence to antiretroviral therapy. Quality of Life Research, 13, 587–599. doi:10.1023/B:QURE.0000021315.93360.8b.

    Article  CAS  PubMed  Google Scholar 

  • Carrieri, M. P., Raffi, F., Lewden, C., Sobel, A., Michelet, C., Cailleton, V., et al. (2003). Impact of early versus late-adherence to highly active antiretroviral therapy on immuno-virological response: A 3-year follow-up study. Antiviral Therapy, 8, 585–594.

    CAS  PubMed  Google Scholar 

  • Carvalho, C. V., Duarte, D. B., Merchán-Hamann, E., Bicudo, E., & Laguardia, J. (2003). Predictors of compliance with highly active antiretroviral therapy in Brasília, Distrito Federal, Brazil, 1999–2000. Reports in Public Health, 19, 593–604.

    Google Scholar 

  • Centers for Disease Control and Prevention. (1992). 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR, 41(RR-17), 1–19.

    Google Scholar 

  • Chesney, M. (2004). Adherence to HAART regimens. In J. Laurence (Ed.), Medication adherence in HIV/AIDS (pp. 17–25). Larchmont: Mary Ann Liebert.

    Google Scholar 

  • Cohen, M., Hoffman, R. G., Cromwell, C., Schmeidler, J., Ebrahim, F., Carrera, G., et al. (2002). The prevalence of distress in persons with Human Immunodeficiency Virus infection. Psychosomatics, 43, 10–15. doi:10.1176/appi.psy.43.1.10.

    Article  PubMed  Google Scholar 

  • Cook, R. L., Sereika, S. M., Hunt, S. C., et al. (2001). Problem drinking and medication adherence among persons with HIV infection. Journal of General Internal Medicine, 16, 83–88. doi:10.1111/j.1525-1497.2001.00122.x.

    Article  CAS  PubMed  Google Scholar 

  • Cove, J., & Petrak, J. (2004). Factors associated with sexual problems in HIV-positive gay men. International Journal of STD & AIDS, 15, 732–736. doi:10.1258/0956462042395221.

    Article  Google Scholar 

  • Cox, D. R., & Oakes, D. (1984). Analysis of survival data. New York: Chapman and Hall.

    Google Scholar 

  • Crawford, J. R., Henry, J. D., Crombie, C., & Taylor, E. P. (2001). Brief report. Normative data for the HADS from a large non-clinical sample. The British Journal of Clinical Psychology, 40, 429–434. doi:10.1348/014466501163904.

    Article  CAS  PubMed  Google Scholar 

  • Evans, D. L., Ten Have, T. R., Douglas, S. D., Gettes, D. R., Morrison, M., Chiappini, M. S., et al. (2002). Association of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. The American Journal of Psychiatry, 159, 752–759. doi:10.1176/appi.ajp. 159.10.1752.

    Article  Google Scholar 

  • Falagas, M. E., Zarkadoulia, E. A., Pliatsika, P. A., & Panos, G. (2008). Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: A systematic review of the literature. Retroviroloy, 5, 13. doi:10.1186/1742-4690-5-13.

    Article  Google Scholar 

  • Ford, J. D., Trestman, R. L., Steiberg, K., Tennen, H., & Allen, S. (2004). Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical care. Social Science and Medicine, 58, 2145–2148. doi:10.1016/j.socscimed.2003.08.017.

    Article  PubMed  Google Scholar 

  • Freitas, G. V. S., & Botega, N. J. (2002). Gravidez na adolescência: prevalência de depressão, ansiedade e ideação suicida. Revista da Associação Médica Brasileira, 48, 245–249.

    Article  PubMed  Google Scholar 

  • Gifford, A. L., Bormann, J. E., Shively, M. J., Wright, B. C., Richman, D. D., & Bozzette, S. A. (2000). Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. Journal of Acquired Immune Deficiency Syndromes, 23, 386–395.

    CAS  PubMed  Google Scholar 

  • Haubrich, R. H., Little, S. J., Currier, J. S., Forthal, D. N., Kemper, C. A., Beall, G. N., et al. (1999). The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Group. AIDS (London, England), 13, 1099–1107. doi:10.1097/00002030-199906180-00014.

    CAS  Google Scholar 

  • Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale: A review of validation data and clinical results. Journal of Psychosomatic Research, 42, 17–41. doi:10.1016/S0022-3999(96)00216-4.

    Article  CAS  PubMed  Google Scholar 

  • Hosmer, D. W., & Lemeshow, S. (1999). Applied survival analysis: Regression modeling of time to event data. New York: Wiley.

    Google Scholar 

  • Lambert, S., Keegan, A., & Petrak, J. (2005). Sex and relationships for HIV positive women since HAART: A quantitative study. Sexually Transmitted Infections, 81, 333–337. doi:10.1136/sti.2004.013516.

    Article  CAS  PubMed  Google Scholar 

  • Lucas, G. M., Gebo, K. A., Chaisson, R. E., & Moore, R. D. (2002). Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS (London, England), 16, 767–774. doi:10.1097/00002030-200203290-00012.

    Google Scholar 

  • Mantel, N. (1963). Chi-square tests with one degree of freedom: Extensions of the Mantel–Haenszel procedure. Journal of the American Statistical Association, 58, 690–700. doi:10.2307/2282717.

    Article  Google Scholar 

  • Mendes, M. F., Tilbery, C. P., Balsimelli, S., Moreira, M. A., & Barão-Cruz, A. M. (2003). Depressão na esclerose múltipla forma remitente-recorrente. Arquivos de Neuro-Psiquiatria, 61, 591–595. doi:10.1590/S0004-282X2003000400012.

    Article  PubMed  Google Scholar 

  • Melo, A. P. S., & Guimarães, M. D. C. (2005). Factors associated with psychiatric treatment dropout in a mental health reference center, Belo Horizonte. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999), 27, 113–118. doi:10.1590/S1516-44462005000200008.

    Google Scholar 

  • Miller, N. H. (1997). Compliance with treatment regimens in chronic asymptomatic diseases. The American Journal of Medicine, 102, 4–49. doi:10.1016/S0002-9343(97)00467-1.

    Article  Google Scholar 

  • Molassiotis, A., Nahas-Lopez, V., Chung, W. Y. R., Lam, S. W. C., Li, C. K. P., & Lau, T. F. J. (2002). Factors associated with adherence to antiretroviral medication in HIV-infected patients. International Journal of STD and AIDS, 13, 301–310. doi:10.1258/0956462021925117.

    Article  PubMed  Google Scholar 

  • Murri, R., Ammassari, A., Gallicano, K., De Luca, A., Cingolani, A., Jacobson, D., et al. (2000). Patient-reported non-adherence to HAART is related to protease inhibitor levels. Journal of Acquired Immune Deficiency Syndromes, 24, 123–128.

    CAS  PubMed  Google Scholar 

  • Nemes, M. I. B., Carvalho, H. B., & Souza, M. F. M. (2004). Antiretroviral therapy adherence in Brazil. AIDS (London, England), 18, S15–S20. doi:10.1097/00002030-200406003-00004.

    Google Scholar 

  • Nieuwkerk, M. A., & Oort, F. J. (2005). Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response. A meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 38, 445–448. doi:10.1097/01.qai.0000147522.34369.12.

    Article  PubMed  Google Scholar 

  • Olsson, I., Kykletun, A., & Dahl, A. (2005). The hospital anxiety and depression rating scale: A cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry, 5, 46. doi:10.1186/1471-244X-5-46.

    Article  PubMed  Google Scholar 

  • Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.

    CAS  PubMed  Google Scholar 

  • Pence, B. W., Miller, W. C., Gaynes, B. N., & Eron, J. J. (2007). Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome, 44, 159–166. doi:10.1097/QAI.0b013e31802c2f51.

    Article  Google Scholar 

  • Pinheiro, C. A. T., De-Carvalho-Leite, J. C., Drachler, M. L., & Silveira, V. L. (2002). Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: A cross-sectional study in Southern Brazil. Brazilian Journal of Medical and Biological Research, 35, 1173–1181.

    CAS  PubMed  Google Scholar 

  • Rodrigues-Júnior, A. L., & Castilho, E. A. (2004). A epidemia de AIDS no Brasil, 1991–2000: descrição espaço-temporal. Revista da Sociedade Brasileira de Medicina Tropical, 37, 312–317.

    Article  PubMed  Google Scholar 

  • Santos, F. R. M., Kozasa, E. H., Chauffaille, M. L. L. F., Colleoni, G. W. B., & Leite, J. R. (2006). Psychosocial adaptation and quality of life among Brazilian patients with different hematological malignancies. Journal of Psychosomatic Research, 60, 505–511. doi:10.1016/j.jpsychores.2005.08.017.

    Article  PubMed  Google Scholar 

  • Simoni, J. M., Kurth, A. E., Pearson, C. R., Merrill, J. O., & Frick, P. A. (2006). Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS and Behavior, 10, 227–245. doi:10.1007/s10461-006-9078-6.

    Article  PubMed  Google Scholar 

  • Spire, B., Duran, S., Souville, M., Leport, C., Raffi, F., & Moatti, J. P. (2002). Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: From a predictive to a dynamic approach. Social Science and Medicine, 54, 1481–1496. doi:10.1016/S0277-9536(01)00125-3.

    Article  PubMed  Google Scholar 

  • Tostes, M. A., Chalub, M., & Botega, N. J. (2004). The quality of life of HIV-infected women is associated with psychiatric morbidity. AIDS Care, 16, 177–186. doi:10.1080/09540120410001641020.

    Article  CAS  PubMed  Google Scholar 

  • Tucker, J. S., Burnam, M. A., Sherbourne, C. D., Kung, F. Y., & Gifford, A. L. (2003). Substance use and mental health correlates of non-adherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. The American Journal of Medicine, 114, 573–580. doi:10.1016/S0002-9343(03)00093-7.

    Article  PubMed  Google Scholar 

  • Tucker, J. S., Orlando, M., Burnam, M. A., Sherbourne, C. D., Kung, F. Y., & Gifford, A. L. (2004). Psychosocial mediators of antiretroviral non-adherence in HIV-positive adults with substance use and mental health problems. Health Psychology, 23, 363–370. doi:10.1037/0278-6133.23.4.363.

    Article  PubMed  Google Scholar 

  • Turner, B. J. (2002). Adherence to antiretroviral therapy by human immunodeficiency virus-infected patients. The Journal of Infectious Diseases, 185, S143–S151. doi:10.1086/340197.

    Article  PubMed  Google Scholar 

  • Wagner, G., & Miller, L. G. (2004). Is the influence of social desirability on patients’ self-reported adherence overrated? Journal of Acquired Immune Deficiency Syndrome, 35, 203–204. doi:10.1097/00126334-200402010-00016.

    Article  Google Scholar 

  • Wolf, M. S., Davis, T. C., Arozullah, A., Penn, R., Arnold, C., Sugar, M., et al. (2005). Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS Care, 17, 863–873.

    CAS  PubMed  Google Scholar 

  • World Health Organization. (2001). Adherence to long-term therapies: Policy for action. Geneva: World Health Organization.

    Google Scholar 

  • World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization.

    Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 370–376. doi:10.1111/j.1600-0447.1983.tb09716.x.

    Article  Google Scholar 

Download references

Acknowledgements

This study was financed in the framework of the ATAR Project (Adherence Study Among Patients Initiating Antiretroviral Treatment), sponsored by the Pan-American Health Organization and the AIDS National Program of the Brazilian Ministry of Health (PN-DST/AIDS Brasil—UNESCO 914/BRA/3014) and was developed by the Research Group on Epidemiology and Health Services Evaluation (Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde—GPEAS) from the Federal University of Minas Gerais, Brazil.

Author information

Authors and Affiliations

  1. Department of Preventive and Social Medicine, School of Medicine, Federal University of Minas Gerais, Av. Prof. Alfredo Balena 190, Bairro Santa Efigênia, CEP 30130-100, Belo Horizonte, MG, Brazil

    Lorenza Nogueira Campos & Mark Drew Crosland Guimarães

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York City, NY, USA

    Lorenza Nogueira Campos, Mark Drew Crosland Guimarães & Robert H. Remien

Authors
  1. Lorenza Nogueira Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Drew Crosland Guimarães
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert H. Remien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenza Nogueira Campos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campos, L.N., Guimarães, M.D.C. & Remien, R.H. Anxiety and Depression Symptoms as Risk Factors for Non-adherence to Antiretroviral Therapy in Brazil. AIDS Behav 14, 289–299 (2010). https://doi.org/10.1007/s10461-008-9435-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-008-9435-8

Keywords

Search

Navigation