A randomized controlled trial of an HIV/AIDS Symptom Management Manual for depressive symptoms

Abstract

Depressive symptoms are highly prevalent, underdiagnosed, and undertreated in people living with HIV/AIDS (PLWH), and are associated with poorer health outcomes. This randomized controlled trial examined the effects of the HIV/AIDS Symptom Management Manual self-care symptom management strategies compared with a nutrition manual on depressive symptoms in an international sample of PLWH. The sample consisted of a sub-group (N=222) of participants in a larger study symptom management study who reported depressive symptoms. Depressive symptoms of the intervention (n=124) and control (n=98) groups were compared over three months: baseline, one-month, and two-months. Use and effectiveness of specific strategies were examined. Depressive symptom frequency at baseline varied significantly by country (χ ² 12.9; p=0.04). Within the intervention group there were significant differences across time in depressive symptom frequency [F(2, 207) = 3.27, p=0.05], intensity [F(2, 91) = 4.6, p=0.01], and impact [F(2, 252) = 2.92, p= 0.05), and these were significantly lower at one month but not at two months, suggesting that self-care strategies are effective in reducing depressive symptoms, however effects may be short term. Most used and most effective self-care strategies were distraction techniques and prayer. This study suggests that people living with HIV can be taught and will employ self-care strategies for management of depressive symptoms and that these strategies are effective in reducing these symptoms. Self-care strategies are noninvasive, have no side-effects, and can be readily taught as an adjunct to other forms of treatment. Studies are needed to identify the most effective self-care strategies and quantify optimum dose and frequency of use as a basis for evidence-based practice.

Keywords:

• depressive symptoms
• HIV disease
• self-management
• symptom management
• randomized controlled trial

Acknowledgements

This project was supported in part by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131; NIH/NINR T32NR007081 (HIV/AIDS Nursing Care and Prevention); Case Western Reserve University/Cleveland Clinic & CTSA Grant Number UL1 RR024989; Academic Research Enhancement Award, NIH 1R15NR011130; International Pilot Award, University of Washington Center for AIDS Research; University of British Columbia School of Nursing Helen Shore Fund; A Small Project Grant from the Duke University School of Nursing Office of Research Affairs; a faculty grant from the MGH Institute for Health Professions. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or any other funders.