Treating depression in rural adults with HIV/AIDS

Tim Heckman receives $1.6 million NIH grant to test telepsychiatry program

 

By Anita Martin

Friday, Dec. 18, 2009

 

Living in a small town, you can learn a lot about your neighbors; you see them at the grocery store, the pharmacy, the doctor’s office. The lack of anonymity helps explain why HIV-infected rural residents are less likely to visit health professionals, says Tim Heckman, Ph.D., and the resulting lack of care takes a toll not only on their physical health, but also on their psychological and emotional well-being.

According to Heckman, HIV-infected people in rural areas are 1.3 times more likely to be diagnosed with depression than those in urban areas. “People with HIV living in rural areas are more isolated, emotionally and physically,” he says. “There’s often a greater stigma associated with HIV and AIDs and reduced access to care.”

To help combat depression among HIV-infected rural residents, Heckman, OU-COM professor of geriatric medicine, is leading a nationwide study to test whether telephone-administered psychotherapy can reduce depression in this group.  

“Telepsychiatry provides access to mental health services for people with geographical or physical limitations, and it offers greater confidentiality for people in small towns who may experience less privacy and greater stigma,” he says.

To support his efforts, the National Institutes of Health (NIH) recently awarded Heckman a four-year, $1,630,785 grant. In this first year, NIH will provide $388,382 to help launch the program. The first year of the project will involve recruiting rural persons with HIV/AIDS and screening them for major depressive disorder, as well as training clinical psychologists in telephone-administered interpersonal psychotherapy (IPT).

“IPT is a short-term psychotherapy that focuses on interpersonal relationships, which often cause or contribute to one’s depression,” says Heckman, explaining that interpersonal dilemmas that can lead to depression include bereavements; “role transitions,” which can range from divorce to job loss to being diagnosed with a serious illness; interpersonal disputes; and “interpersonal deficits” defined as ongoing difficulties in forming and maintaining close relationships.

Heckman’s study will recruit 90 HIV-infected rural persons diagnosed with major depressive disorder who will receive nine sessions of one-on-one telephone-administered ITP. The participants will also provide weekly data on their depressive symptoms for 41 weeks, before, during and following the intervention.  Ninety additional HIV-infected rural persons with depression will also be recruited into the study but will not receive any active treatment from the study team. 

Although this study is focused primarily on depression, studies have correlated depression in HIV-infected individuals with reduced adherence to HAART (highly active antiretroviral therapy), increased high HIV-transmission risk behaviors and shorter survival periods.

“This study is about reducing depression, but secondarily, we hope to see greater HAART adherence and Heckman says.

To develop the program, Heckman is collaborating with professionals at Northwestern University, Indiana University and Columbia University, including two of the founders of IPT, John Markowitz, M.D., and Myrna Weissman, Ph.D. To conduct the telephone psychotherapy, Heckman plans to work with clinical psychologists primarily from Southeastern Ohio.

In addition to this grant, Heckman recently received $371,573 from the NIH to complete a related four-year project, “Telephone-delivered coping improvement intervention for HIV-infected older adults.” To read about this study, which addresses the psychological needs of HIV-infected adults 50 years of age and older, go to www.oucom.ohiou.edu/OUM/Winter-09/AgingOfAids.htm.