Objective: Given the complexity of human behavior, multiple determinants including patient characteristics may affect medication adherence. There is strong evidence to support the role of self-efficacy (confidence in ability to follow treatment regimen) as a significant predictor of adherence. However, less certainty exists in regard to what factors affect self-efficacy. Using social cognitive theory, the purpose of this study was to describe the relationship between depression, self-efficacy, and adherence in persons living with HIV (PLWHIV). Design: This study used a descriptive cross-sectional design. Population: HIV-positive adults on antiretroviral therapy. Sample: Seventy-three PLWHIV (47 males, 26 females) living in western Pennsylvania were recruited into this study. Forty-six (63%) of the subjects were white and 27 (37%) were African-American. The mean age was 40.4 years. Exposure categories included: gay-bisexual (31), gay-bisexual injection drug use (5), injection drug use (15), heterosexual (23), and transfusion (1). Setting: The participants were recruited from a community sites (HIV/AIDS clinics, HIV/AIDS service organizations) in western Pennsylvania. Years: 1999-2001 Methods: Descriptive statistics and parametric procedures were used to analyze these data. Depression was measured using the Beck Depression Inventory (BDI), and self-efficacy(SES)(perceived self-efficacy regarding the ability to carry out regimen (SE) and perceived efficacy outcomes (EO)) was measured using an investigator-developed instrument. Adherence was measured using the Self-Reported Medication-Taking Scale (SEL). Findings: The mean score on the BDI was 13.64 (SD=2.37). The mean score on the SES (total) was 136.83 (SD=26.36), while the mean scores on the subscales were 136.83 (SD=26.36) (SE), and 72.49 (SD=16.77) (OE). A mean of 9.55 (SD=2.37) was found on the SEL. The correlation between these variables was analyzed using Pearson R. The findings demonstrated significant negative association between depression and perceived self-efficacy (r=-.586, p=.000), and between depression and perceived efficacy outcomes (r=-.326, p=.005). Likewise, a significant negative relationship was found between depression and adherence (r=-.494, p=.000). A positive correlation was found between self-efficacy (total) and adherence (r=.569, p=.000). Conclusions: Adherence to antiretroviral therapy continues to a problem of significant complexity in PWHIV. Although the sample was found to be only mildly depressed, these mental health challenges may influence an individual's confidence in their ability to adhere, thus preventing them from managing their treatment regimen. Implications: Practitioners should consider conducting a mental health assessment before initiating therapy. Understanding the relationships between mental health, self-efficacy, and adherence will enable health care providers to provide evidence-based care to this population and give patients the best opportunity for an optimal response to HIV therapies. Future research needs to include larger studies on the interaction between mental health indicators, adherence, and other contextual factors that affect adherence in this population.
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