Influence of depressive symptoms on within-session change talk and HIV antiretroviral medication adherence in a motivational interviewing based adherence intervention
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Although a number of studies have demonstrated that patients' verbal language in favor of change within a Motivational Interviewing (MI) session, known as “change talk,” is related to behavior change and intervention outcomes, few have investigated whether change talk (CT) mediates the effects of other patient characteristics on outcomes. This is the first study to investigate whether CT mediates the effect of patient depressive symptoms on HIV antiretroviral therapy (ART) adherence outcomes. MI session tapes for 100 HIV-positive patients participating in an ART adherence intervention study were coded for frequency of utterances expressing desire, ability, reason, need and commitment to adhere/not adhere to an ART medication regimen. Strength of commitment language was also coded and mean strength of commitment and commitment strength change across the course of the session were calculated. There was a weak but significant negative relationship between patient depressive symptoms and ART adherence rate at week 12. Bootstrap mediation analyses showed no mediation effects for any CT variables on the relationship between depressive symptoms and week 12 ART adherence. Despite the lack of a causal mediation role for CT variables, CT frequency and strength of commitment to change was related to depressive symptoms and ART adherence. Clinically, modified MI strategies for depressed patients may be warranted. Findings from this study support the need for more complex moderator mediator models to investigate whether CT variables mediate the effect of depression on ART adherence outcomes within particular subgroups of depressed patients.
Table of Contents
Introduction -- Review of literature -- Methodology -- Analyses -- Results -- Discussion -- Appendix A. Center for Epidemiologic Study of Depression Scale (CES-D) -- Appendix B. Manual for the Motivational Interviewing Skill Code v. 2.1 -- Appendix C. Manual for the Motivational Interviewing Skill Code: Addendum to v. 1.0 -- Appendix D. Change Talk Commitment Language Coding Sheet