Bernadette Davantes Heckman

Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States

The current study delineated patterns and predictors of adherence to antiretroviral therapy in 329 persons living with HIV disease in rural areas of 12 US states. Participants provided self-report data on patterns of HIV medication adherence, reasons for missing medication doses, psychological symptomatology, life-stressor burden, social support, ways of coping, coping self-efficacy, the quality of their relationship with their main physician, and barriers to health care and social services. Based on adherence data collected via retrospective, self-report assessment instruments, only 50% of participants adhered consistently to antiretroviral therapy regimens in the past week. Consistent adherence was more common in White participants, persons who had progressed to AIDS, and ‘native infections’ (i.e. persons who were born, raised, and infected in their current place of residence). Logistic regression analyses indicated that consistent adherence was reported by persons who drank less alcohol, had a good relationship with their main physician, and engaged in more active coping in response to HIV-related life stressors. As the number of rural persons living with HIV disease continues to increase, research that identifies correlates of non-adherence and conceptualizes approaches to optimize adherence in this group is urgently needed.

Do psychiatric comorbidities influence headache treatment outcomes? Results of a naturalistic longitudinal treatment study

ABSTRACT This study examined if the presence of one or more psychiatric disorders influences headache treatment outcomes in patients in headache specialty treatment centers. Using a naturalistic, longitudinal design, 223 patients receiving preventive therapy for headache disorders completed 30‐day daily diaries that assessed headache days/month and severity at acute therapy baseline and 6‐month evaluation and also provided data on headache disability and quality of life at acute therapy baseline, preventive therapy initiation, preventive therapy adjustment, and 6‐month evaluation visits. Psychiatric diagnoses were determined using the Primary Care Evaluation for Mental Disorders (PRIME MDs). Of the 223 patients, 34% (n = 76) had no psychiatric disorder, 21% (n = 46) were diagnosed with Depression‐Only; 13% (n = 29) were diagnosed with Anxiety‐Only; and 32% (n = 72) were diagnosed with Depression‐and‐Anxiety. Prior to initiating new preventive therapy, patients with one or more psychiatric disorders reported more frequent and disabling headaches and poorer life quality compared to patients with no psychiatric disorders. Rates of improvement in headache days/month, disability, and quality of life were significant and comparable across the four groups. Contrary to clinical wisdom, patients with psychiatric disorders respond very favorably to contemporary headache treatments administered in headache specialty treatment centers.

Race Differences in Adherence to Headache Treatment Appointments in Persons with Headache Disorders

PURPOSE This research characterized patterns and predictors of adherence to headache treatment appointments in patients presenting at headache specialty treatment clinics throughout Ohio. BASIC PROCEDURES Participants were 186 patients (118 white, 68 African Americans, 89% female) in headache treatment clinics in Cincinnati, Cleveland, Columbus and Toledo, OH. The study used a naturalistic longitudinal cohort design and assessed patients during four treatment visits (pretreatment, one-month follow-up, two-month follow-up and six-month follow-up). During the 30 days prior to initiating new headache treatments, patients used a daily diary to record data on headache severity, frequency and disability; headache treatment locus of control and headache management self-efficacy; social support; and demographic characteristics. The Primary Care Evaluation for Mental Disorders interview was administered to all patients at pretreatment to screen for psychiatric diagnoses. Patient attendance at the four treatment appointments was used to create a dichotomous measure of treatment appointment adherence (i.e., 0 = completed treatment; 1 = terminated treatment prematurely). MAIN FINDINGS African Americans were more likely to be diagnosed with depression than whites and were more likely to prematurely terminate their headache treatment appointments regardless of their socioeconomic status (SES). White patients with SES values above the median reported the lowest rate of premature treatment termination. PRINCIPAL CONCLUSIONS Higher SES enables whites (but not African Americans) to attend all headache treatment appointments. Interventions that enable African-American headache patients to complete their prescribed headache treatments are urgently needed.

Preventive Medication Adherence in African American and Caucasian Headache Patients

(Headache 2011;51:520‐532)

Whites and African-Americans in headache specialty clinics respond equally well to treatment

This study sought to determine if Whites and African-Americans respond similarly to headache treatment administered in ‘real-world’ headache specialty treatment clinics. Using a naturalistic, longitudinal design, 284 patients receiving treatment for headache disorders completed 30–day daily diaries that assessed headache frequency and severity at pretreatment and 6–month follow-up and also provided data on their headache disability and quality of life at pretreatment and 1–, 2– and 6–month follow-up. Controlling for socioeconomic status and psychiatric comorbidity, hierarchical linear models found that African-Americans and Whites reported significant reductions in headache frequency and disability and improvements in life quality over the 6–month treatment period. African-Americans, unlike Whites, also reported significant decreases in headache severity. Nevertheless, Africans-Americans had significantly more frequent and disabling headaches and lower quality of life after treatment relative to Whites. Although Whites and African Americans responded favourably to headache treatments, more efficacious treatments are needed given the elevated level of headache frequency that remained in both racial groups following treatment.

Multinomial logistic regression analysis for differentiating 3 treatment outcome trajectory groups for Headache-associated Disability

&NA; Growth mixture modeling (GMM) identified latent groups based on treatment outcome trajectories of headache disability measures in patients in headache subspecialty treatment clinics. Using a longitudinal design, 219 patients in headache subspecialty clinics in 4 large cities throughout Ohio provided data on their headache disability at pretreatment and 3 follow‐up assessments. GMM identified 3 treatment outcome trajectory groups: (1) patients who initiated treatment with elevated disability levels and who reported statistically significant reductions in headache disability (high‐disability improvers; 11%); (2) patients who initiated treatment with elevated disability but who reported no reductions in disability (high‐disability nonimprovers; 34%); and (3) patients who initiated treatment with moderate disability and who reported statistically significant reductions in headache disability (moderate‐disability improvers; 55%). Based on the final multinomial logistic regression model, a dichotomized treatment appointment attendance variable was a statistically significant predictor for differentiating high‐disability improvers from high‐disability nonimprovers. Three‐fourths of patients who initiated treatment with elevated disability levels did not report reductions in disability after 5 months of treatment with new preventive pharmacotherapies. Preventive headache agents may be most efficacious for patients with moderate levels of disability and for patients with high disability levels who attend all treatment appointments. Preventive headache therapies are effective for headache patients with moderate disability and for high‐disability patients who attend all treatment appointments.

Race, psychiatric comorbidity, and headache characteristics in patients in headache subspecialty treatment clinics

Objective. This research examined how race, psychiatric comorbidity, and headache characteristics are inter-related in patients with severe headache disorders. Design. This study used a naturalistic cohort design and assessed 114 Black and 173 White patients receiving treatment in headache subspecialty clinics in Cincinnati, Cleveland, Columbus, and Toledo, OH. Face-to-face interviews yielded headache and psychiatric diagnoses; 30-day daily diaries collected data on headache frequency, severity, and disability; and self-administered surveys obtained data on headache management self-efficacy, headache locus of control, and quality of life. Results. Compared with Whites, Blacks reported more frequent and severe headaches, were more likely to be diagnosed with depressive disorders, and were more likely to be diagnosed with chronic headaches. White and Black patients diagnosed with both depression and anxiety reported the most frequent headache days per month and the lowest levels of life quality and headache management self-efficacy. Conclusions. Additional research on race, psychiatric comorbidity, and headache characteristics is needed that can inform culturally contextualized interventions for persons with severe headache disorders.

High-Risk Sexual Behavior Among Persons Living With HIV Disease in Small Towns and Rural Areas

Most investigations describing sexual behavior patterns among persons living with HIV / AIDS have been conducted in large urban centers. However, it is also likely that some individuals in small towns and rural areas who are aware of their HIV infection continue to engage in high-risk sexual behaviors that place their partners at risk for HIV infection. The present study examines rates and predictors of high-risk sexual behavior among 79 persons living with HIV / AIDS in nonmetropolitan areas of a midwestern state. In late 1995, an anonymous self-report survey assessing health-related quality of life, social support, access to health care services, illness-related coping strategies, substance use, and sexual behavior was distributed to persons living with HIV/AIDS in communities with populations under 50,000. One-third of HIV-infected persons reported they had engaged in unprotected sex in the preceding 6 months. Individuals who were more likely to have unprotected sex lived with their partners, reported ...

The moderating role of sexual identity in group teletherapy for adults aging with HIV.

Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV.

Psychosocial headache measures in Caucasian and African American headache patients: psychometric attributes and measurement invariance.

Introduction: As research increasingly examines differences in headache characteristics between Caucasian and African American headache patients, it is requisite to determine the equivalence of existing headache measures for both racial groups. Methods: This study examined the psychometric properties and measurement invariance of four widely used psychosocial headache measures. Caucasians (N = 173) and African Americans (N = 114) receiving treatment in four headache subspecialty clinics throughout Ohio completed the Headache Disability Inventory (HDI), the Migraine-Specific Quality of Life (MSQL) measure, the Headache Management Self-Efficacy (HMSE) scale, and the Headache-Specific Locus of Control (HSLC) scale prior to initiating new preventive therapies. Conclusion: All measures demonstrated good internal consistency and measurement invariance. Despite adequate measurement invariance, the recommended factor structure of the HMSE scale yielded a poor fit for both African American and Caucasian patients. With perhaps the exception of the HMSE scale, the HDI, MSQL scale and HSLC scale are psychometrically sound and can be used with both Caucasian and African American headache patients.