Compared to their urban counterparts, HIV-rural persons are more likely to be diagnosed with depression, less likely to seek assistance from mental health professionals, and appear to have shorter periods of survival. This application responds to PA-07-103 ("Research on Rural Mental Health and Drug Abuse Disorders") and the PA's stated need for research that will "Study whether individuals with various mental disorders can be treated effectively via telemedicine." A pilot RCT recently completed by our team showed that a 6-session telephone-delivered, interpersonal psychotherapy (IPT) intervention reduced depressive symptoms in 79 HIV- infected rural persons (Ransom, Heckman, et al., 2008, Psychiatric Services). This follow-up RCT will enroll 180 persons living with HIV/AIDS in rural counties in the United States who are diagnosed with depression via telephone interviews. Participants will complete self-administered surveys at pre-intervention, post- intervention, and 4- and 8-month follow-up that assess depressive symptoms (the primary outcome measure), interpersonal problems, social support, and ART adherence. Participants will also provide weekly data (for 41 weeks) via interactive voice response (IVR) systems that assess depressive symptoms (41 weeks) and therapeutic alliance (9 weeks). Ninety (n=90) participants will be randomly assigned to a 9-session, one-on- one, telephone-delivered, IPT intervention and 90 will be assigned to a usual care comparison group. Linear mixed models (LMM) will test if IPT participants report greater reductions in depressive symptoms compared to usual care controls. Analyses of reliable change will test if a greater proportion of IPT participants report clinically-significant reductions in depressive symptoms compared to usual care controls. Using weekly data collected via IVR systems, time series analyses will test if IPT participants report greater decreases in depressive symptoms over a 41-week follow-up period compared to usual care control. Mixed models analyses will assess the importance of therapeutic alliance in telephone-delivered IPT. Public Health Significance: This study will test if nine sessions of telephone-administered interpersonal psychotherapy can reduce depressive symptoms in HIV-infected rural persons, a group that is increasing in size and that experiences great difficulty accessing mental health support services.

Public Health Relevance

HIV-infected rural persons are 1.3 times more likely than their urban counterparts to be diagnosed with depression. This randomized clinical trial will test if a nine-session, telephone-administered, interpersonal psychotherapy intervention can reduce depressive symptoms in HIV-infected persons living in rural counties of the United States who are diagnosed with depression.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
7R01MH087462-04
Application #
8374403
Study Section
Special Emphasis Panel (ZRG1-AARR-F (08))
Program Officer
Grossman, Cynthia I
Project Start
2009-12-01
Project End
2014-11-30
Budget Start
2012-12-01
Budget End
2014-11-30
Support Year
4
Fiscal Year
2013
Total Cost
$379,281
Indirect Cost
$118,902
Name
University of Georgia
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
004315578
City
Athens
State
GA
Country
United States
Zip Code
30602
Heckman, Timothy G; Halkitis, Perry N (2014) Biopsychosocial aspects of HIV and aging. Behav Med 40:81-4
Heckman, Bernadette Davantes; Lovejoy, Travis I; Heckman, Timothy G et al. (2014) The moderating role of sexual identity in group teletherapy for adults aging with HIV. Behav Med 40:134-42