Background: Economic evaluations of generalized anxiety disorder (GAD) have been limited to ≤18 months. A decision model was developed; quantifying the lifetime cost-of-illness (COI) of GAD. Methods: An incidence-based Markov-model was developed using TreeAge® software, reflecting 9 health-states (HS): physician-assessed patients (3HS), maintenance therapies(4HS), discontinuation(1HS) and death(1HS). Onset probability (ages 18-80) determined model entry. Canadian Psychiatric Association (CPA) guidelines determined pharmaco-therapy, with revisions/validation by an expert panel. Response, remission based on pooled-analysis of CPA-cited evidence. Remaining clinical rates, absenteeism and hospitalization retrieved from literature. Direct (clinician, pharmacotherapy, hospitalization) and indirect costs (wage rate) retrieved from government publications. Results discounted at 5%. Results: The mean COI was 2008 Canadian $31,213(SD=$9,100)/patient; 96% attributed to absenteeism. Mean age=31years, discontinued treatment=85% by 2nd year, treatment discontinuation duration, 14(SD=9) years. CONCLUSION: GAD is a costly disease with a lifetime COI<$32k/patient; absenteeism exerts a significant impact. Limited prospective data contributes to uncertainty of estimate.

Master of Arts / Department of English / Elizabeth C. Dodd / At the age of 12, I developed a condition that caused me to hyperventilate, black out, and on occasion, experience horrific visions. Though the visions were sparse at first, they quickly increased in number as weeks progressed. In the eighth grade, they became a daily occurrence. Though at the time I knew there was something wrong with me, I had no idea what was causing my symptoms. Because the episodes caused many inconveniences and embarrassments, I withdrew from social activities and stopped attending school altogether. Believing that my problems were the result of a physical illness, my parents had my blood tested for diseases such as mononucleosis. I also underwent an MRI, which checked for any tumors or abnormalities in my brain. When all of my tests came back negative, I was referred to a psychiatrist. I told the psychiatrist about my inclination to avoid social activities, but refrained from telling her about the hallucinations. Despite my withheld information, she determined I had an extreme case of clinical depression and agoraphobia. Though I was comforted by the notion that I had been granted a diagnosis, I still found it impossible to leave my bedroom without having the strange episodes. As my symptoms of depression increased, my interest in living decreased. But with the help of family and close friends, I was able to persevere and accept my circumstances despite the discomfort they created in my world.

Doctor of Philosophy / Department of Family Studies and Human Services / Briana S. Goff / The purpose of this study was to review state disaster mental health response plans and actual disaster mental health responses to examine not only adherence to identified disaster mental health best practices, but also to highlight procedures being performed during deployment of disaster mental health response teams. This research study was developed to gain a thorough understanding of disaster mental health response in both the planning and implementation phases. Interviews with three state disaster mental health officials were completed and a review of each state’s disaster mental health state plan was completed. The study investigated the conclusiveness of state plans and their adherence to published best practices in three post 9/11 disasters: 2005 Hurricane Katrina response in Mississippi; 2007 Greensburg, Kansas tornado; and 2008 Indiana flooding. A phenomenological approach was used to identify themes in disaster mental health response that should be considered for future disaster mental health planning. Each state’s disaster mental health plan varied in compliance to identified best practices; however, it was noted that all states were more compliant to best practices in their response than in the written state disaster mental health state plan. Several themes for disaster mental health responses were identified that were not previously fully addressed in the published best practices. Such themes addressed issues in disaster mental health teams and training, local disaster mental health response, communication, research and data collection, relationships with external organizations, and long-term recovery. This research may serve as a guide for those developing disaster mental health plans and encourage further considerations in disaster mental health response.

Master of Science / Department of Family Studies and Human Services / Candyce S. Russell / As the number of Americans aged 60 and over increases substantially in the coming years, so is the incidence of depression among this age group. The purpose of this report is to explore the mental health needs of older Americans, the ways in which they are undiagnosed or under-diagnosed for depression, the clinical challenges associated with treating depression in the elderly, and the barriers that are in place due to social, psychological, financial and governmental factors. With the “Baby Boom” generation (those born between 1946-1964) entering their senior years, there will be an increased need for Marriage and Family Therapists to be cognizant of the rise in depression and familiar with the treatment options and limitations. Marriage and Family Therapists adhere to the Systems Theory and thus are uniquely qualified to act as a bridge between the medical and mental health communities. This report will promote the collaborative approach to healthcare and the way in which Marriage and Family Therapists can contribute to the treatment of depression in the aged.

Depression is highly prevalent in coronary artery disease (CAD) and confers an increased risk of morbidity and mortality, yet mechanisms are unknown. Platelet activating factor (PAF) lipids are associated not only with CAD but also with inflammation, oxidative/nitrosative stress, vascular endothelial dysfunction and platelet reactivity which are proposed etiopathological mechanisms for depression. This study investigated the relationship between PAF species and depressive symptoms in 20 CAD patients. Plasma analyses were performed using electrospray ionization mass spectrometry (precursor ion scan). Primary analysis revealed no association between the potent pro-inflammatory PAF PC(O-16:0/2:0) and depressive symptoms measured by the Hamilton Depression Rating Scale [HAM-D] (F=0.405, p=0.533) or Beck Depression Inventory [BDI]-II (F=0.120, p=0.733) in a linear regression. Exploratory analyses revealed potential associations between greater PC(O-18:1/0:0) and greater HAM-D score and greater PC(O-22:6/2:0) concentrations with a greater BDI-II score. This study suggests that specific PAFs might be biomarkers for depressive symptoms in CAD patients.

Depression is highly prevalent in coronary artery disease (CAD) and confers an increased risk of morbidity and mortality, yet mechanisms are unknown. Platelet activating factor (PAF) lipids are associated not only with CAD but also with inflammation, oxidative/nitrosative stress, vascular endothelial dysfunction and platelet reactivity which are proposed etiopathological mechanisms for depression. This study investigated the relationship between PAF species and depressive symptoms in 20 CAD patients. Plasma analyses were performed using electrospray ionization mass spectrometry (precursor ion scan). Primary analysis revealed no association between the potent pro-inflammatory PAF PC(O-16:0/2:0) and depressive symptoms measured by the Hamilton Depression Rating Scale [HAM-D] (F=0.405, p=0.533) or Beck Depression Inventory [BDI]-II (F=0.120, p=0.733) in a linear regression. Exploratory analyses revealed potential associations between greater PC(O-18:1/0:0) and greater HAM-D score and greater PC(O-22:6/2:0) concentrations with a greater BDI-II score. This study suggests that specific PAFs might be biomarkers for depressive symptoms in CAD patients.

Although many advances in the treatment of schizophrenia have been made over the past decade, little is known about the process of recovery from a first episode of schizophrenia (FES). To date, the study of recovery in the field of mental health has focused on long-term mental illness. This in depth qualitative study drew upon Charmaz’s (1990) constructivist grounded theory methodology to address the following questions: How do individuals who have experienced a FES describe their process of recovery? How does an identified individual (e.g. friend, family member, teacher, or clinician) describe their role during the participant’s process of recovery, and their perception of the recovery process? Ten primary participants (who self-identified as recovering from a FES) had two interviews; in addition, there was a one-time interview with a secondary participant, for a total of 30 interviews. Data collection sources included participant semi-structured interviews, participant selected personal objects that symbolized their recovery, and clinical records. The results provide a substantive theory of the process of recovery from a FES. The emergent process of recovery model for these participants is comprised of the following phases: ‘Lives prior to the illness’, ‘Lives interrupted: Encountering the illness’, ‘Engaging in services and supports’, ‘Re-engaging in life’, ‘Envisioning the future’; and the core category, ‘Re-shaping an enduring sense of self,’ that occurred through all phases. A prominent distinctive feature of this model is that participants’ enduring sense of self were reshaped versus reconstructed throughout their recovery. The emergent model of recovery from a FES is unique, and as such, provides implications for clinical care, future research, and policy development specifically for these young people and their families.

Siblings of children with cancer encounter stressors and challenges that can lead to severe distress and a host of psychological difficulties. Factors including age, gender, and disease characteristics of the child with cancer are reported to influence sibling adjustment. The majority of research, however, is dated, inconsistent, and marred by methodological problems. Guided by the disability-stress-coping model, the study examined the: (a) frequency of sibling and parent reported symptoms of anxiety and depression, internalizing and externalizing behavior problems, and somatic problems, (b) influence of sibling, family, and disease factors on sibling adjustment, (c) moderating effects of age on the relationship between sibling factors and sibling adjustment, and (d) mediating effect of primary cognitive appraisal on the relationship between self-esteem and sibling adjustment. One hundred and eight siblings (7-17 years; 51 males; 57 females) participated. Siblings completed the State-Trait Anxiety Inventory for Children and the Children’s Depression Inventory to provide measures of sibling reported symptoms of anxiety and depression. Parents completed the Child Behavior Checklist to provide measures of parent reported internalizing behavior problems, externalizing behavior problems, and somatic problems. The communication and intrapersonal thoughts and feelings subscales of the Sibling Perception Questionnaire, completed by siblings, were used to assess perceived social support and primary cognitive appraisal. Self-esteem was assessed with the global self-worth subscale of the Self Perception Profile for Children/Adolescents, completed by siblings. Hierarchical regression analyses were conducted to assess the direct and indirect effects of sibling, family, and disease factors on psychological outcomes. Siblings and parents reported higher incidents of clinically significant symptoms of anxiety, internalizing behavior problems, and somatic problems than expected in a normative population. Sibling age and gender, diagnosis of the child with cancer, social support, self-esteem, and primary cognitive appraisal were significantly associated with sibling and parent reported psychological adjustment measures. Age moderated the relationship between gender, social support, and primary cognitive appraisal and several adjustment outcomes. Lastly, primary cognitive appraisal partially mediated the relationship between self-esteem and sibling reported anxiety and depression symptoms. These findings highlight the need for sibling psychosocial interventions and provide direction for the development and implementation of such groups.

The purpose of this study was to explore protective factors that help women resist societal pressures for thinness. The present study used a qualitative life history methodology to examine the experiences of women who identified themselves as resilient to pressures to be thin and as liking their bodies regardless of size. In-depth semi-structured interviews were conducted with 14 women, ages 18 to 25, representing diverse social and ethno-cultural backgrounds and body physiques. In the interviews, the participants were inquired about their experiences related to anything they felt was helpful for them in developing a positive body image from childhood, adolescence, and to present day. The interviews were transcribed and analyzed for themes using constructivist grounded theory methodology. Data analysis was informed by the feminist theoretical approach, with attention paid to social and contextual factors. Three core categories emerged from the analysis, which included protective factors associated with participants’ experiences of identity, ways of inhabiting their bodies, and the nature of social influences in their lives. This research highlighted the women’s active role in maintaining a resilient stance in the face of pressures for thinness as well as the importance of social factors that assist them in this process.

Introduction: Using an animal model, we examined weight gain in rats exposed to olanzapine, as well as whether increased weight was associated with food intake, visceral fat and/or locomotion. Methods: Sprague-Dawley rats were chronically treated with olanzapine while being offered diets including standard chow, a high fat (60% fat) diet, and a high fat/high carbohydrate (42% fat; 42.7% carbohydrate) diet. Body weight, food intake, visceral fat and locomotor activity were measured. Results: Our findings related to weight gain are in line with other reports indicating that while olanzapine-induced weight gain can be observed, it does not mirror what is observed in humans on two levels: (i) it is not of the same magnitude, and (ii) it is more gender specific i.e., females greater than males. Conclusions: These data confirm that chronic treatment with olanzapine has varying effects on weight gain, food intake, visceral fat and locomotor activity.