Family mechanisms of structural ecosystems therapy for HIV-seropositive women in drug recovery

Abstract

Objective: Examined the effects of Structural Ecosystems Therapy (SET), a family intervention for women living with HIV or AIDS, compared to a psycho-educational health group (HG) intervention, and reciprocal relationships between women and family members.

Method: Women (n = 126) and their family members (n = 269) were randomized to one of two conditions and assessed every 4 months for 12 months. Family functioning, drug use, and psychological distress was reported by multiple family members.

Results: Multilevel growth curve modeling showed a different family functioning trajectory between SET and HG, B = -0.05, SE = 0.02, p < .01. There was no intervention effect on the trajectory of family-level drug abstinence or psychological distress, but there was a significant difference in the trajectory of psychological distress after controlling for change in family functioning, B = -0.28, SE = 0.13, p < .05. There was an indirect effect from treatment through change in family functioning to change in psychological distress, B = 0.29, SE = 0.12, p < .05. With respect to reciprocal effects, family drug abstinence significantly predicted women's abstinence 4 months later, B = 0.22, SE = 0.06, p < .001.

Conclusion: Findings demonstrated the interdependence of family members and the impact of family in relapse prevention and partially supported SET's potential for maintaining family functioning and well-being for women living with HIV or AIDS in drug recovery.

Figure 1

Participant flowchart following CONSORT guidelines. SET = Structural Ecosystems Therapy.

Figure 2

Change in family functioning was hypothesized to mediate the effect of intervention on the change psychological distress. Latent growth model without the path from the family functioning trajectory to the psychological distress trajectory (Hypotheses 1 and 2) (a). Latent growth model with the path from the family functioning trajectory to the psychological distress trajectory (Hypothesis 3) (b). HG = health group; SET = Structural Ecosystems Therapy. ^* p < .05. ^** p < .01. ^*** p < .001.

Figure 3

Final model of reciprocal relationships between drug abstinence of the women living with HIV or AIDS and drug abstinence of her family members. The final model was modified to have two additional autoregressive paths than the original model. 0 = baseline. 4 = 4 months. 8 = 8 months. 12 = 12 months. Assumptions of consistency constraints were not rejected (χ² = 14.89, p = .09). The model with paths constrained to be equal across all times fit the data better (Bayesian information criterion [BIC] = 761.40) than an equivalent model with paths free to vary across time (BIC = 784.97). CFI = Comparative Fit Index; RMSEA = root mean square error of approximation. ^** p < .01. ^*** p < .001.