Cognitive Behavioral Therapy Factors Related to Outcomes in Depression Among Youth with HIV

Purpose This is a secondary analysis of a multi-site, cluster (site) randomized trial of the efficacy of a combined Health and Wellness Cognitive Behavior Therapy (H&W CBT) and medication management approach for depression in youth with HIV (YWH) compared to standard care. In this study, we explored the association between H&W CBT factors and depression outcomes after 24 weeks of treatment to discover treatment elements associated with symptom reduction. Methods Participants (12–24 years of age) were YWH in the United States (US) diagnosed with moderate to severe depression [Quick Inventory of Depressive Symptomatology (QIDS), Clinician-Rated score ≥ 11]. Thirteen US sites were randomly assigned to either the combination treatment approach or standard care. For site-level analyses, site-specific summary scores were used to account for the within site correlation. Results (all scores are site-level) The number of depressive symptoms [QIDS-Self Reported (QIDS-SR) score] after 24 weeks of H&W CBT was significantly negatively correlated with the mean total session duration (ρ = − 0.94), the total homework assigned (ρ = − 0.83), the total number of practice modules used (ρ = − 0.83), and the mean total booster sessions given (ρ = − 0.82). Conclusions Specific elements of the H&W CBT (e.g., dose, assignment of homework, greater skills practice, and use of booster sessions) were associated with improvement of depression outcomes in YWH. A focus on these elements in treatment may improve symptom reduction for YWH with depression.