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A Systematic Review and Meta-analysis of Telephone-Based Therapy Targeting Depressive Symptoms Among Low-Income People Living with HIV

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Abstract

People living with human immunodeficiency virus (PLWH) has been reported to have a high prevalence of depressive symptoms. Low-income populations account for a large proportion of PLWH, hence indicating a high level of depressive symptoms in low-income PLWH. Telephone-based therapy has been shown to be effective for treating PLWH’s depressive symptoms, but its effects among low-income PLWH remain unclear. The purpose of this meta-analysis was to evaluate the effects of telephone-based therapy targeting depressive symptoms among low-income PLWH. Six databases (PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, VIP Database and Wanfang Data) were searched until May 2020 using search terms related to telephone-based therapy, depressive symptoms, and PLWH. Eight studies were included in the meta-analysis. Both postintervention effects (primary outcome) and long-term effects (secondary outcome) were evaluated using a random effects model. The meta-analysis revealed a small to moderate effect size (ĝ = − 0.29, 95% CI − 0.51, − 0.06) on reducing depressive symptom scores (Z = 2.51, p = 0.01) in telephone-based intervention group compared with the control group at postintervention. However, there was no statistically significant long-term effects (Z = 0.77, p = 0.44) at follow-up. For postintervention effects, calculation of the I2 index indicated moderate heterogeneity (I2 = 50%); sensitivity analysis and subgroup analysis were performed to explore the source of heterogeneity. Ethnic group was classified into minority and majority which refers to most of the population were ethnic minority and majority respectively. Between-group differences were found across ethnic groups. The results suggested that there was a slightly stronger effect of telephone-based therapy in low-income PLWH than among PLWH in general, but its long-term effect requires future investigation. The effects of the intervention were better among the ethnic majority subgroups of low-income PLWH. Treatment format and intervention duration might also influence the intervention effects. However, the overall quality of evidence was low and directly impacted on the interpretation of our results, suggesting that more high-quality random controlled trial (RCT)/longitudinal studies with less selection and detection bias, less inconsistency and less indirectness are needed when applying telephone-based therapy to low-income PLWH with depressive symptoms in further studies.

Resumen

Se ha informado de que las personas con el virus de la inmunodeficiencia humana (PLWH) tienen un alto riesgo de síntomas depresivos, y las personas de bajos ingresos ocupan una gran proporción de PLWH. El objetivo de este análisis es evaluar los efectos de la terapia telefónica para los síntomas depresivos en personas con PLWH de bajos ingresos. Se realizaron búsquedas en seis bases de datos hasta mayo de 2020, incluidos ocho estudios. En comparación con el grupo de control, el análisis reveló que en el grupo de intervención telefónica contaba con un efecto pequeño a moderado (ĝ = -0.29, IC 95% -0.51, -0.06) en la reducción de las puntuaciones de síntomas depresivos (Z = 2.51, p = 0.01). Sin embargo, no hubo efectos estadísticamente significativos a largo plazo (Z = 0.77, p = 0.44) en el seguimiento. Se encontraron diferencias entre grupos desde los grupos étnicos. Los resultados mostraron que el efecto de la terapia telefónica era levemente más fuerte que el de PLWH general en las PLWH de bajos ingresos, pero la evidencia general de baja calidad impactó en la interpretación de nuestros resultados.

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Abbreviations

PLWH:

People living with HIV

UNAIDS:

The Joint United Nations Programme on HIV/AIDS

HIV:

Human immunodeficiency virus

OECD:

Organisation for Economic Cooperation and Development

LMICs:

Low and middle-income countries

HICs:

High-income countries

PTSD:

Post-traumatic stress disorder

ART:

Antiretroviral therapy

RCT:

Random controlled trial

SMD:

Standardized mean difference

CI:

Confidence interval

SD:

Standard deviation

SE:

Standard error

tele-SEGT:

Telephone-administered, supportive-expressive group therapy

tele-CET:

Telephone-administered, coping effectiveness training

f2f:

Face to face

GDS:

Geriatric depression scale

BDI-II:

Beck depression inventory-II

HAM-D:

Hamilton rating scale for depression

QID-SR:

The quick inventory of depression-self report

CES-D:

Center for Epidemiologic Studies Depression Scale

SDS:

Self-rating depression scale

References

  1. UNAIDS. 2019. UNAIDS fact sheet—World AIDS Day 2019; https://www.unaids.org/en/resources/fact-sheet. Accessed 12 Jan 2020.

  2. Poverty Nattrass N. Sex and HIV. AIDS Behav. 2009;13:833–40.

    Google Scholar 

  3. Gibson C, Grande K, Schumann C, Gasiorowicz M. Census tract poverty and racial disparities in hiv rates in milwaukee county, wisconsin, 2009–2014. AIDS Behav. 2018;22(1):2994–3002.

    PubMed  Google Scholar 

  4. Springer YP, Samuel MC, Bolan G. Socioeconomic gradients in sexually transmitted diseases: a geographic information system-based analysis of poverty, race/ethnicity, and gonorrhea rates in California, 2004–2006. Am J Public Health. 2010;100(6):1060–7.

    PubMed  PubMed Central  Google Scholar 

  5. Krieger N, Waterman PD, Chen JT, Soobader MJ, Subramanian SV. Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures–the public health disparities geocoding project (US). Public Health Rep. 2003;118(3):240–60.

    PubMed  PubMed Central  Google Scholar 

  6. OECD. 2020. OECD Data; https://data.oecd.org. Accessed 28 July 2020.

  7. Chibanda D. Depression and HIV: integrated care towards 90-90-90. Int Health. 2017;9(2):77–9.

    PubMed  PubMed Central  Google Scholar 

  8. Alexander B, Adimora AA, Daniel W. Women and HIV in the united states. PLoS ONE. 2017;12(2):e0172367.

    Google Scholar 

  9. Khan MR, Golin CE, Friedman SR, et al. STI/HIV sexual risk behavior and prevalent STI Among incarcerated African American men in committed partnerships: the significance of poverty, mood disorders, and substance use. AIDS Behav. 2015;19(8):1478–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Kidia K, Machando D, Bere T, et al. ‘I was thinking too much’: experiences of HIV-positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe. Trop Med Int Health. 2015;20(7):903–13.

    PubMed  PubMed Central  Google Scholar 

  11. Kang E, Delzell DA, McNamara PE, Cuffey J, Cherian A, Matthew S. Poverty indicators and mental health functioning among adults living with HIV in Delhi, India. AIDS Care. 2016;28(4):416–22.

    PubMed  Google Scholar 

  12. Spies G, Afifi TO, Archibald SL, Fennema-Notestine C, Sareen J, Seedat S. Mental health outcomes in HIV and childhood maltreatment: a systematic review. Syst Rev. 2018;1(1):30.

    Google Scholar 

  13. Musisi S, Wagner GJ, Ghosh-Dastidar B, Nakasujja N, Dickens A, Okello E. Depression and sexual risk behaviour among clients about to start HIV antiretroviral therapy in Uganda. Int J STD AIDS. 2014;25(2):130–7.

    PubMed  Google Scholar 

  14. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101–7.

    CAS  PubMed  Google Scholar 

  15. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530.

    PubMed  Google Scholar 

  16. Ayano G, Solomon M, Abraha M. A systematic review and meta-analysis of epidemiology of depression in people living with HIV in east Africa. BMC Psychiatry. 2018;18(1):254.

    PubMed  PubMed Central  Google Scholar 

  17. Patel P, Rose CE, Collins PY, et al. Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS. 2018;32(Suppl 1):S5–20.

    PubMed  Google Scholar 

  18. Wang T, Fu H, Kaminga AC, et al. Prevalence of depression or depressive symptoms among people living with HIV/AIDS in China: a systematic review and meta-analysis. BMC Psychiatry. 2018;18(1):160.

    PubMed  PubMed Central  Google Scholar 

  19. Orlando M, Burnam MA, Beckman R, et al. Re-estimating the prevalence of psychiatric disorders in a nationally representative sample of persons receiving care for HIV: results from the HIV Cost and Services Utilization Study. Int J Methods Psychiatr Res. 2002;11(2):75–82.

    PubMed  Google Scholar 

  20. Illangasekare S, Burke J, Chander G, Gielen A. The syndemic effects of intimate partner violence, HIV/AIDS, and substance abuse on depression among low-income urban women. J Urban Health. 2013;90(5):934–47.

    PubMed  PubMed Central  Google Scholar 

  21. Golin CE, Haley DF, Wang J, et al. Post-traumatic stress disorder symptoms and mental health over time among low-income women at increased risk of HIV in the US. J Health Care Poor Underserved. 2016;27(2):891–910.

    PubMed  PubMed Central  Google Scholar 

  22. Scott-Sheldon LAJ, Balletto BL, Donahue ML, et al. Mindfulness-based interventions for adults living with HIV/AIDS: a systematic review and meta-analysis. AIDS Behav. 2019;23(1):60–75.

    PubMed  PubMed Central  Google Scholar 

  23. Scott-Sheldon LA, Kalichman SC, Carey MP, Fielder RL. Stress management interventions for HIV + adults: a meta-analysis of randomized controlled trials, 1989 to 2006. Health Psychol. 2008;27(2):129–39.

    PubMed  PubMed Central  Google Scholar 

  24. Shi Y, Zhao M, Chen S, et al. Effects of cognitive behavioral therapy on people living with HIV and depression: a systematic review and meta-analysis. Psychol Health Med. 2019;24:578–94.

    PubMed  Google Scholar 

  25. Crepaz N, Passin WF, Herbst JH, et al. Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning. Health Psychol. 2008;27(1):4–14.

    PubMed  Google Scholar 

  26. O’Brien K, Nixon S, Tynan AM, Glazier R. Aerobic exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev. 2010;8:CD001796.

    Google Scholar 

  27. O’Brien KK, Tynan AM, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis. 2016;16:182.

    PubMed  PubMed Central  Google Scholar 

  28. Himelhoch S, Medoff DR, Oyeniyi G. Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis. AIDS Patient Care STDS. 2007;21(10):732–9.

    PubMed  Google Scholar 

  29. Cheng LJ, Kumar PA, Wong SN, Lau Y. Technology-delivered psychotherapeutic interventions in improving depressive symptoms among people with HIV/AIDS: a systematic review and meta-analysis of randomised controlled trials. AIDS Behav. 2019. https://doi.org/10.1007/s10461-019-02691-6.

    Article  Google Scholar 

  30. Passchier RV, Abas MA, Ebuenyi ID, Pariante CM. Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: a systematic review & meta-analysis of psychological & immunological outcomes. Brain Behav Immun. 2018;73:261–73.

    PubMed  Google Scholar 

  31. Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JG. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015;10:CD007228.

    Google Scholar 

  32. Suh SR, Lee MK. Effects of Nurse-Led Telephone-Based Supportive Interventions For Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum. 2017;44(4):E168–84.

    PubMed  Google Scholar 

  33. Hudson JL, Bower P, Kontopantelis E, et al. Impact of telephone delivered case-management on the effectiveness of collaborative care for depression and anti-depressant use: a systematic review and meta-regression. PLoS ONE. 2019;14(6):e0217948.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Proctor BJ, Moghaddam N, Vogt W, das Nair R. Telephone psychotherapy in multiple sclerosis: a systematic review and meta-analysis. Rehabil Psychol. 2018;63(1):16–28.

    PubMed  Google Scholar 

  35. Ross R, Sawatphanit W, Suwansujarid T, Stidham AW, Drew BL, Creswell JW. The effect of telephone support on depressive symptoms among HIV-infected pregnant women in Thailand: an embedded mixed methods study. J Assoc Nurses AIDS Care. 2013;24(5):e13–24.

    PubMed  Google Scholar 

  36. Wang H, Zhou J, Huang L, Li X, Fennie KP, Williams AB. Effects of nurse-delivered home visits combined with telephone calls on medication adherence and quality of life in HIV-infected heroin users in Hunan of China. J Clin Nurs. 2010;19(3–4):380–8.

    CAS  PubMed  Google Scholar 

  37. Guo Y, Xu Z, Qiao J, et al. Development and feasibility testing of an mHealth (Text Message and WeChat) intervention to improve the medication adherence and quality of life of people living with HIV in China: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2018;6(9):e10274.

    PubMed  PubMed Central  Google Scholar 

  38. Heckman TG, Heckman BD, Anderson T, et al. Supportive-expressive and coping group teletherapies for HIV-infected older adults: a randomized clinical trial. AIDS Behav. 2013;17(9):3034–44.

    PubMed  Google Scholar 

  39. Heckman TG, Heckman BD, Anderson T, et al. Tele-interpersonal psychotherapy acutely reduces depressive symptoms in depressed HIV-infected rural persons: a randomized clinical trial. Behav Med. 2017;43(4):285–95.

    PubMed  Google Scholar 

  40. Himelhoch S, Medoff D, Maxfield J, et al. Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV/AIDS: results of a randomized controlled trial. AIDS Behav. 2013;17(8):2756–64.

    PubMed  Google Scholar 

  41. Heckman TG, Markowitz JC, Heckman BD, et al. A randomized clinical trial showing persisting reductions in depressive symptoms in HIV-infected rural adults following brief telephone-administered interpersonal psychotherapy. Ann Behav Med. 2018;52(4):299–308.

    PubMed  PubMed Central  Google Scholar 

  42. Simoni JM, Pantalone DW, Plummer MD, Huang B. A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. Health Psychol. 2007;26(4):488–95.

    PubMed  PubMed Central  Google Scholar 

  43. Abas M, Nyamayaro P, Bere T, et al. Feasibility and acceptability of a task-shifted intervention to enhance adherence to HIV medication and improve depression in people living with HIV in Zimbabwe, a low income Country in Sub-Saharan Africa. AIDS Behav. 2018;22(1):86–101.

    PubMed  Google Scholar 

  44. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    PubMed  Google Scholar 

  45. McNeill LH, Puleo E, Bennett GG, Emmons KM. Exploring social contextual correlates of computer ownership and frequency of use among urban, low-income, public housing adult residents. J Med Internet Res. 2007;9(4):e35.

    PubMed  PubMed Central  Google Scholar 

  46. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration. 2011; 2015.

  47. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490–4.

    PubMed Central  Google Scholar 

  48. Orwin RG. Evaluating coding decisions. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Russell Sage Foundation; 1994.

    Google Scholar 

  49. Hedges LV, Olkin I. Statistical methods for meta-analysis. New Directions Prog Eval. 1985;1984(24):25–42.

    Google Scholar 

  50. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    PubMed  PubMed Central  Google Scholar 

  51. Van Luenen S, Garnefski N, Spinhoven P, Spaan P, Dusseldorp E, Kraaij V. The benefits of psychosocial interventions for mental health in people living with hiv: a systematic review and meta-analysis. AIDS Behav. 2018;22:9–42.

    PubMed  Google Scholar 

  52. Heckman TG, Barcikowski R, Ogles B, et al. A telephone-delivered coping improvement group intervention for middle-aged and older adults living with HIV/AIDS. Ann Behav Med. 2006;32(1):27–38.

    PubMed  Google Scholar 

  53. Horrell SCV. Effectiveness of cognitive-behavioral therapy with adult ethnic minority clients: a review. Prof Psychol Res Pract. 2008;39(2):160–8.

    Google Scholar 

  54. Markowitz JC, Spielman LA, Sullivan M, Fishman B. An exploratory study of ethnicity and psychotherapy outcome among HIV-positive patients with depressive symptoms. J Psychother Pract Res. 2000;9(4):226–31.

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Post-graduate, The First Affiliated Hospital, China Medical University, Shenyang, 110001, Liaoning, People’s Republic of China

    Yao Xiao, Yining Shao, Wenhui Zhao, Ruoxi Wang, Shijun Fang, Xin Tan & Luhe Shan

  2. Department of Post-graduate, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, People’s Republic of China

    Zhijing Na

  3. School of Pharmacy, University College London, London, WC1N 1AX, UK

    Guangjiao Yu

  4. Department of Social Medicine, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, People’s Republic of China

    Jiana Wang

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  1. Yao Xiao
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Contributions

YX, YNS and ZJN wrote the manuscript together; JNW edited the manuscript for submission; YNS and ZJN statistically analyzed the research data; WHZ and RXW did data extraction; SJF, XT, LHS and GJY searched for relevant articles and did inclusion and exclusion. All authors read and approved the final manuscript. All authors read and approved the final submitted manuscript.

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Correspondence to Jiana Wang.

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Xiao, Y., Shao, Y., Na, Z. et al. A Systematic Review and Meta-analysis of Telephone-Based Therapy Targeting Depressive Symptoms Among Low-Income People Living with HIV. AIDS Behav 25, 414–426 (2021). https://doi.org/10.1007/s10461-020-02999-8

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