Affiliations: [a] Department of Mood, Anxiety, Eating and Related Disorders New York State Psychiatric Institute New York, NY, USA
| [b] Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center New York, NY, USA
| [c] Department of Translational Epidemiology New York State Psychiatric Institute New York, NY, USA
| [d] Department of Mental Health Data Science New York State Psychiatric Institute New York, NY, USA
Correspondence:
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Address for correspondence: Martin C. McElhiney 1051 Riverside Drive, Unit 51, USA. Tel.: +1 646 774 8035; Fax: +1 646 774 8034; E-mail: martin.mcelhiney@nyspi.columbia.edu.
Abstract: BACKGROUND:Despite improved health and during a strong job market (pre-COVID-19), a substantial proportion of HIV+ adults remained unemployed. This study sought to provide time-limited counseling to promote employment goals. OBJECTIVE:To determine whether behavioral activation (BA) or supportive counseling (SC), would be more effective in promoting vocational goals (full or part-time, paid or volunteer). METHODS:The study included two groups: those with clinically significant fatigue, who were first treated with armodafinil. Once their fatigue diminished, they were enrolled in the counseling program. Those without fatigue were enrolled directly. Both BA and SC interventions were manualized, consisting of eight individual sessions plus a follow-up. RESULTS:116 participants entered counseling, including 87 assigned to BA and 29 to SC. Of these, 79 completed counseling or found a job by session eight. By follow-up, 51%of BA versus 41%of SC participants had found jobs, a non-significant difference either clinically or statistically. CONCLUSIONS:Multiple issues contributed to difficulty in employment, including gaps in resumes, loss of contact with former colleagues, and uncertainty about career direction. Ongoing barriers included substance use, housing instability, ambivalence about forfeiting government benefits, as well as inadequately treated depression. Success in employment for about half of participants is, in this context, a reasonable outcome.
Keywords: Return to work, behavioral activation, HIV/AIDS
