• Gail Ironson, MdDepartment of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA. g.ironson@miami.edu.Department of Psychiatry, University of Miami, Coral Gables, USA. g.ironson@miami.edu., Emily Hylton, and Rachel Verhagen.
• Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA. g.ironson@miami.edu.
• J Gen Intern Med. 2022 Aug 1; 37 (10): 235123572351-2357.

BackgroundFor patients diagnosed with chronic illness, attitude towards treatment may play an important role in health and survival. For example, negative attitudes towards treatment have been related to poorer adherence to treatment recommendations and prescribed medication across a range of chronic illnesses. In addition, prior research has shown that attitude towards treatment assessed through a psychiatric interview predicted survival at 1 year after bone marrow transplantation with great accuracy (> 90%).ObjectiveThe purpose of this study was to determine the relationship between a self-report attitude to a treatment measure that operationalized a psychiatric interview, and survival over 17 years in a sample of people living with HIV (PLWH).Participants And DesignParticipants (N = 177) who were in the mid-range of HIV illness at baseline (CD4s 150 to 500, no prior AIDS-defining clinical symptom) were administered the Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale and followed longitudinally to determine survival at 17 years.MeasuresThe Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale is a 20-item self-report questionnaire designed to survey multiple factors that contribute to an overall psychological construct of the treatment process.ResultsThe MMAT-20/HIV predicted survival over 17 years controlling for biomedical (baseline CD4, viral load, antiretroviral medications, age) and psychosocial (race, education, antiretroviral medications) variables. Those in the top half on the MMAT-20/HIV were almost twice as likely to survive than those in the lower half. Scores on the MMAT-20/HIV were significantly but modestly correlated with adherence (r = .20, p < .05), but adherence was not a mediator of the relationship between the MMAT-20/HIV and survival.ConclusionsAn individual's attitude towards the treatment process predicted survival, raising the possibility that optimal clinical management would include ways to probe these attitudes and intervene where possible. The ease of administering the MMAT-20 and adaptability to other illnesses could facilitate this endeavor.© 2021. The Author(s) under exclusive licence to Society of General Internal Medicine.

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