Self-efficacy and depression as mediators of the relationship between pain and antiretroviral adherence.
Self-efficacy and depression as mediators of the relationship between pain and antiretroviral adherence.
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DOI：
10.1080/09540120802001697
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发表时间：
2009-02
期刊：
影响因子：
1.7
通讯作者：
Arnsten JH
中科院分区：
文献类型：
--
作者：
Berg KM;Cooperman NA;Newville H;Arnsten JH
这项研究的目的是检验疼痛和抗逆转录病毒依从性之间的关系，并估计依从性自我效能和抑郁症状严重程度的中介作用。使用音频计算机辅助自访对70名登记参加美沙酮计划的艾滋病毒感染的现任和前任吸毒者进行了调查。我们使用成人临床试验小组调查中的问题来评估抗逆转录病毒依从性和依从性自我效能。如果参与者报告在过去七天内至少服用了95%的处方抗逆转录病毒药物，我们认为他们是依从者。我们使用简明症状问卷中的抑郁分量表评估抑郁症状的严重程度。参与者在回答简短疼痛清单中的问题时报告了任何持续时间的疼痛。与没有疼痛的参与者相比，报告疼痛的参与者被归类为粘连性的可能性低87%[ORunadj=0.13(95%CI 0.03-0.52)]。当我们检查坚持自我效能作为疼痛和坚持之间关系的中介时，部分调解的标准被满足。调整自我效能后，疼痛的β系数下降了23%，但疼痛与抗逆转录病毒依从性之间的独立关系保持不变。当我们检验抑郁症状严重程度对疼痛和坚持之间的关系的中介作用时，中介标准不满足。调整了抑郁症状的严重程度，疼痛的β系数下降了9%，疼痛与抗逆转录病毒依从性之间的关系仍然显著。我们的结果表明，坚持自我效能感和抑郁症状严重性都不能完全中介疼痛和坚持之间的关系。艾滋病毒提供者应该认识到疼痛对现任和前任吸毒者坚持抗逆转录病毒的潜在影响。
The goals of this study were to examine the association between pain and antiretroviral adherence, and to estimate the mediating effect of adherence self-efficacy and depression symptom severity. Surveys using audio computer-assisted self-interview were conducted among 70 HIV-infected current and former drug users enrolled in a methadone program. We assessed antiretroviral adherence and adherence self-efficacy using questions from the Adult Clinical Trials Group survey. We considered participants adherent if they reported taking at least 95% of prescribed antiretrovirals over the past seven days. We assessed depression symptom severity using the depression subscale of the Brief Symptom Inventory. Participants reported pain of any duration in response to a question from the Brief Pain Inventory. Participants reporting pain were 87% less likely to be classified as adherent compared to those without pain [ORunadj = 0.13 (95%CI 0.03–0.52)]. When we examined adherence self-efficacy as a mediator of the relationship between pain and adherence, criteria for partial mediation were met. Adjusting for self-efficacy, the beta coefficient for pain decreased by 23% but the independent relationship between pain and antiretroviral adherence was maintained. Mediation criteria were not met when we examined the mediating effect of depression symptom severity on the relationship between pain and adherence. Adjusting for depression symptom severity, the beta coefficient for pain decreased by 9% and the relationship between pain and antiretroviral adherence remained significant. Our results indicate that neither adherence self-efficacy nor depression symptom severity fully mediated the relationship between pain and adherence. HIV providers should recognize the potential impact of pain on antiretroviral adherence among current and former drug users.
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