Antiretroviral therapy adherence in a sample of men with low socioeconomic status: The role of task-specific treatment self-efficacy.

Disparities continue to persist in HIV care and treatment outcomes among racial/ethnic minorities, men who have sex with men (MSM), and individuals with low socioeconomic status. Much research has identified treatment self-efficacy as a key factor in antiretroviral therapy adherence and subsequent treatment outcomes. Few studies, however, have elaborated on these links and their potential in reducing HIV treatment disparities by examining the role of task-specific types of treatment self-efficacy. In this study, we examined the effect of four types of task-specific treatment self-efficacy on antiretroviral adherence among patients in a predominantly racial/ethnic minority sample of HIV-seropositive MSM with low socioeconomic status. We grouped participants by duration of treatment to determine whether certain types of self-efficacy were more salient based on treatment experience. We found that participants with optimal adherence tended to have higher levels of task-specific self-efficacy related to medication management and mood management than participants with suboptimal adherence. After a Bonferroni correction for multiple comparisons, only task-specific self-efficacy for medication management showed significant effects on adherence. Findings suggest that using focused, task-specific measures of treatment self-efficacy could strengthen our ability to aid patients at risk for adherence difficulties and tailor interventions to more effectively meet their needs.

The effects of pity on self- and other-perceptions of mental illness.

Previous research has demonstrated that pity may have a positive influence on public perceptions of individuals with a mental illness but has not adequately addressed the potential negative impacts of pity perceptions. Seventy-five research participants with serious mental illness completed measures of pity, public stigma, shame, hopelessness, personal empowerment, self-esteem, depression, and quality of life at baseline. Measures of hopelessness, personal empowerment, self-esteem, and depression were repeated six months later. Bivariate correlations found significant associations between pity and "other" effects of stigma including dangerousness, fear, segregation, avoidance and perceived stigma. Baseline pity was significantly correlated with self-effects of stigma such as shame, hopelessness, lower empowerment, lower self-esteem, depression, and decreased quality of life. At six-month follow-up, baseline pity was still associated with increased hopelessness and depression along with decreased empowerment and self-esteem. Anger, avoidance, perceived stigma, shame, and self-esteem were significantly related to pity in multiple linear regressions. Outcomes of path analyses suggest that the significant positive relationship between pity at baseline and depression at six-month follow-up was mediated by self-esteem and hopelessness. Individuals who view mental illness with pity experience negative self- and other-effects of stigma. These effects persist 6-months later. These findings have important implications for stigma-reducing advertising programs.

Stigma by Any Other Name.

OBJECTIVE: Some advocates argue that the word "stigma" is itself stigmatizing and contributes to further denigration of people with mental illness. This brief report presents results of a nationwide survey comparing terminology related to stigma in regard to mental illness. METHODS: A total of 340 Amazon Mechanical Turk survey takers read variations of a vignette depicting an individual with schizophrenia and then completed a brief stigma measure. The vignette varied in a single sentence in which three different words-"stigma," "prejudice," and "reactions"-were used to describe coworkers' possible attitudes toward the depicted individual. RESULTS: Stigma ratings did not differ by vignette group. "Reactions" was viewed as significantly less disrespectful than both "stigma" and "prejudice" (p<.001). CONCLUSIONS: Further research is needed to support replacing the word "stigma" in public arenas. Current efforts to remove the word may unnecessarily distract advocates and policy makers from the primary mission of erasing stigma.

Another look at depressive symptoms and antiretroviral therapy adherence: The role of treatment self-efficacy.

Depression has been strongly associated with poor HIV treatment adherence, but little research has explored how individuals manage to follow their regimens despite symptoms of major depression. Using a sample of antiretroviral therapy patients with clinically significant depressive symptoms (n = 84), we examined whether patients with optimal adherence differed from those with suboptimal adherence in terms of the types of depressive symptoms experienced and treatment self-efficacy. There were no significant differences between participants with regard to types of depressive symptoms. Findings indicate that patients with high treatment self-efficacy were more likely to report optimal levels of adherence than patients with low self-efficacy.