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Sunday, November 1, 2009: 3:05 PM
Learning Objective 1: understand the triangle relationships derived from the Cognitive Behavior Therapy model
Learning Objective 2: explain the mediating role of depressive symptoms on prediction of self-reported medication adherence by perceived social stigma in persons with HIV
This study examined the relationships among perceived social stigma (thinking), depressive symptoms and anxiety (feeling), and self-reported medication adherence (behaving) using the Cognitive Behavior Therapy model. Specifically, we examined 1) the mediation of depressive symptoms and anxiety on the prediction of self-reported medication adherence by perceived social stigma, and 2) the relationship between anxiety and depressive symptoms in persons with HIV. Baseline data from “Improving Adherence to Antiretroviral Therapy" (2R01 NR04749) were used. The 346 persons with HIV (male =243, female= 103) ranging in age from 20 to 66 were recruited from multiple sites in western Pennsylvania and Ohio. HIV related social stigma (Social and Emotional Aspects Scale), depressive symptoms (Beck Depression Inventory), anxiety (Beck Anxiety Inventory), and self-reported medication adherence (Morisky Self-report Medication Taking Scale) were measured. Structural equation modeling (EQS version 6.1) was used to estimate both direct (regression coefficients) and indirect effects. Depressive symptoms fully mediated the prediction of self-reported medication adherence by perceived social stigma (β= -0.33→- 0.07, z = -4.99, p<.001). However, anxiety did not predict self-reported medication adherence: the Wald test suggested deleting the direct path between anxiety and medication adherence ( χ2(1)=.229, p=. 632). Only a positive correlation between depressive symptoms and anxiety was identified (r =.50, p<.001). Therefore, the final model including a mediator (depressive symptoms) on self-reported medication adherence and a positive correlation between depressive symptoms and anxiety was tested. The final model showed a good fit: S-B χ2(13)=25.81, p=. 018, CFI=-.98, RMSEA=.053. Understanding the influence of depressive symptoms and anxiety between perceived social stigma and self-reported medication adherence in persons with HIV may be important to develop better medication adherence strategies for this specific population. Future work needs to examine moderation effects (e.g., socio-demograpic and cultural variables) on the same model.