Depressive Symptoms, Lifestyle Structure, and ART Adherence Among HIV-Infected Individuals: A Longitudinal Mediation Analysis

Jessica F. Magidson, Aaron J. Blashill, Steven Safren, Glenn J. Wagner

Research output: Contribution to journalArticle

19 Scopus citations


Despite the well-documented relationship between depression and antiretroviral therapy (ART) nonadherence, few studies have identified explanatory pathways through which depression affects adherence. The current study tested lifestyle structure—the degree of organization and routinization of daily activities—as a mediator of this relationship, given previous evidence of lifestyle structure being associated with both depression and ART nonadherence. HIV-infected individuals starting or re-starting ART in the California Collaborative Treatment Group 578 study (n = 199) were assessed over 48 weeks. Adherence was measured using electronic monitoring caps to determine dose timing and doses taken, and viral load was assessed. The mediating role of lifestyle structure was tested using generalized linear mixed-effects modeling and bootstrapping. Lifestyle significantly mediated the relationship between depression and both measures of ART adherence behavior. Interventions that minimize disruptions to lifestyle structure and link adherence to daily activities may be useful for individuals with depression and ART nonadherence.

Original languageEnglish (US)
Pages (from-to)34-40
Number of pages7
JournalAIDS and Behavior
Issue number1
StatePublished - 2014
Externally publishedYes



  • Adherence
  • Antiretroviral therapy
  • Depression
  • Lifestyle structure
  • Mediation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Social Psychology

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