This study investigated the relationship between preferred coping strategies, and major stressors for nondepressed, and depressed chronic pain patients. The subjects for this study were 67 chronic pain patients who are participating in a pain/spinal rehabilitation program. The information collected from the individuals or their records included: (1) basic demographic information, (2) level of activity, (3) level of perceived pain, (4) medication usage, (5) therapist rating of level of stabilization, (6) scores on three inventories including the Coping Strategies Questionnaire, the Ways of Coping Checklist, and the Beck Depression Inventory. Analyses included an examination of the relationship between level of depression and (1) type of stressors, (2) coping strategies, and (3) level of perceived pain. Further analyses included multiple regression with outcome as defined by therapist ratings at the end of treatment, and patients' ratings at follow up as the criterion variables.

In spite of theoretical models representing a bidirectional pattern of influence between children and mothers (Sameroff & MacKenzie, 2003), few comprehensive longitudinal studies have examined how maternal psychological functioning and child behavior relate to each other over time. This study explored the transactional relationship between child problem behavior (i.e., internalizing and externalizing) and maternal depressive symptoms from toddlerhood to adolescence. The transactional dynamic was conceptualized in two ways—(a) parallel growth and (b) bidirectional effects—in terms of timing, direction, and the magnitude of effects, as well as how effects were moderated by gender and level of maternal depressive symptoms. Data were drawn from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,179). Using advanced statistical techniques in the structural equation modeling framework, such as multivariate latent growth curve models, latent class analyses, and fully autoregressive cross-lagged models, these findings demonstrate that in contrast to the traditional unidirectional maternal effects framework, the transactional dynamic more accurately represents the relationship between maternal and child functioning. Specifically, results indicated that the relationship between child internalizing behavior and maternal depressive symptoms was more strongly characterized as a parallel growth dynamic, whereas child externalizing behavior and maternal depressive symptoms more consistently exerted mutual influence. Bidirectional effects were not restricted to periods of heightened psychosocial stress, such as toddlerhood, adolescence, or transitions in school. Gender and level of maternal depressive symptoms moderated this bidirectional association. Maternal depressive symptoms had the largest effect on child internalizing behavior in middle childhood. Children’s externalizing behaviors in toddlerhood and early childhood had a strong effect on maternal depressive symptoms; the magnitude of this effect was greater than any other pathway from children to mothers or mothers to children. Findings suggest that children’s externalizing and internalizing behavior may serve as a potential risk factor for future increases in maternal depressive symptoms.

The first year postpartum is often a challenging time for romantic partners. During this time, couples tend to experience less relationship intimacy and sexual satisfaction, which may be further exacerbated by individual stressors and vulnerabilities. Little is known about whether a maternal history of adverse life events and mental health prior to the infant’s birth negatively interfere with postpartum relationship and sexual well-being. Accordingly, the current study examined whether maternal trauma history, prenatal posttraumatic stress, and prenatal depressed mood were risk factors for poor postpartum couple adjustment. It also investigated whether perceiving a partner as motivated to meet one’s interest and disinterest in sexual activity, referred to as sexual communal strength for having sex (SCS for having sex) and sexual communal strength not having sex (SCS for not having sex), were buffers to relationship deterioration among mothers with this history of adversity. One hundred and sixty women (N = 160) who had completed an earlier study during pregnancy participated in a subsequent online survey between six and twelve months postpartum. Using path analysis to investigate the prospective relationships between maternal trauma history, prenatal mental health difficulties, and postpartum relationship and sexual well-being, trauma history was found to significantly predict sexual satisfaction and desire. Specifically, childhood maltreatment predicted poorer sexual well-being following childbirth, whereas adult sexual victimization predicted improved sexual well-being. No other pathways in the model were significant. Additionally, contrary to predictions, sexual communal strength did not moderate associations between maternal prenatal adversity and postpartum relationship outcomes in the primary analyses. However, follow-up analyses including only mothers who reported some symptoms of PTSD revealed that SCS for having sex moderated the association between these symptoms and relationship satisfaction. Results from this research highlight that childhood maltreatment likely has enduring detrimental implications for women’s sexual well-being as they transition- either again or for the first time - to motherhood. Further implications and directions for future research in this area are discussed. / Graduate

Labor may perhaps be the most painful a woman might experience, although characterized by large inter-individual variability. The perceived pain during labor is the result of diverse factors, i.e. her previous pain experiences, the analgesia she receives and maybe also her genes. The overall aim of this thesis was to investigate biological and psychological mechanisms underlying inter-individual differences in labor pain related behaviors. The mechanisms that characterize endogenous pain relief during labor are not fully understood, though it is known to be partly explained by the effects of β-endorphin (BE). BE plasma levels were followed longitudinally in a cohort of pregnant women and were found to remain unchanged between early and late pregnancy, although with a nadir in the beginning of the third trimester. Furthermore, women with low levels of BE in plasma at the end of the third trimester, required second line labor analgesia to a significantly higher extent than women with normal levels. In a population-based sample of 814 pregnant women we investigated if inter-individual differences in labor pain related behavior was influenced by the pain-protective single nucleotide polymorphism (SNP) combination of guanosine triphosphate cyclohydrolase (GCH1) and the opioid receptor µ-1 gene (OPRM1) A118G SNP. We identified a possible association between the pain-protective SNP combination of GCH1 and use of second line analgesia. No association was found between the OPRM1 and use of analgesia or labor pain related behavior. The association between self-rated antenatal depressed mood and anxiety in relation to pain behaviors and self-reported pain during labor was investigated. We found that depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia.  In conclusion, although an increasing number of studies strongly suggest that genetic predisposition plays an important role in pain and pain-related mechanisms, GCH1 and OPRM1 has little to offer in terms of individual counseling on labor analgesia. To enable the future use of genetic variability for pre-labor testing and counseling, a number of different genes reflecting pain mediation pathways, involving biological and psychological mechanisms, need to be analyzed in combination.

Source: Masters Abstracts International, Volume: 47-06, page: 3500. Adviser: Lu-Yu Hwang. Includes bibliographical references.

Transition to parenthood is a major life event that affects both fathers and mothers. Being a potentially stressful period, it can predispose vulnerable individuals to mental health problems. Compared with maternal studies, there is a dearth of longitudinal research on the psychological impact of transition to fatherhood, particularly with anxiety problems. There are emerging studies demonstrating the adverse consequences of paternal postpartum depression on infant outcomes. It is important to investigate paternal postpartum depression and anxiety and address their relationships with poor infant outcomes which will contribute to the recognition of the problems and the development of early intervention. The current study aimed to contribute to greater knowledge on risk factors of paternal postpartum mental health problems, and their adverse impact on infants, as well as understanding the possible mediating mechanisms underlying such a relationship. A total of 654 couples completed self-report questionnaires at third trimester of pregnancy using validated self-report psychological instruments to evaluate fathers' prenatal mental health. Among them, 255 couples were examined longitudinally at six week postpartum for depression and anxiety symptoms, and fathers were also assessed for marital satisfaction, self-esteem, social support, and postpartum attachment with infants. At six months postpartum, 121couples were again surveyed to assess their infants’ temperament and development. According to established cut-offs, 12.0% and 13.1% of fathers experienced significant postpartum depression and anxiety. No demographic risk factors were found for postpartum depression or anxiety. Multiple regression analyses indicated that low martial satisfaction, low self-esteem, fathers having prenatal anxiety and depression, partners having postpartum depression predicted fathers’ postpartum depression. Low marital satisfaction, low self-esteem, poor social support and fathers having prenatal anxiety were significant risk factors for fathers’ postpartum anxiety. Depressed and anxious fathers reported having less patience and tolerance, pleasure in interaction, and affection and pride with their infants. Paternal postpartum depression was related to reduced infants’ falling reactivity, and poor social and total development in infants; while postpartum anxiety was associated with heightened infants’ distress to limitations, reduced failing reactivity and greater sadness. Baron and Kenny’s criteria was used to investigate whether poor paternal attachment with infants mediated these relationships. Pleasure in interaction partially mediated the relationship between paternal postpartum depression and social as well as total development in infants, whereas affection and pride mediated between fathers' postpartum depression and infants' falling reactivity as well as social development. Affection and pride also served as a partial mediator between fathers' postpartum anxiety and infants’ failing reactivity. Findings revealed that paternal postpartum depression and anxiety are significant mental health problems. Low marital satisfaction, low self-esteem, poor social support, prenatal depression and anxiety, and partners' postpartum depression could contribute to these problems. Postpartum depression and anxiety could reduce fathers' attachment with infants, which adversely impacted infants' temperament and development. The current study also addressed that risk factors for paternal postpartum depression and anxiety were different, and they had distinctive environmental pathways affecting infant outcomes. This provides significant implications for designing timely and effective interventions to improve fathers' well-being and proper father-infant interaction. (499 / published_or_final_version / Psychiatry / Master / Master of Philosophy

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The focus of the research study is to explore chronically ill African American, Latino, and White patients' causal attributions of symptoms of depression and factors that predict depression care treatment preferences among these groups. Research has demonstrated that perception of illness impacts what treatments a person will deem appropriate for their mental health problems and from whom they will seek treatment. Research also indicates that certain ethnic groups are more likely to seek treatment for their symptoms of depression in the primary care setting. Yet, it is unclear how they actually perceive their symptoms and what best predicts the treatments that they are likely to consider acceptable. A convenient sample of 109 HIV+ adults, 79 diabetic adults, and 3 adults with both conditions were recruited for this study. Participants had to be receiving services for either HIV, diabetes, or both conditions in one of the three central Austin facilities and be a representative from one of three racial/ethnic groups: African Americans, Latino, and White. Differences were found across ethnicity with regard to causal beliefs and treatment preferences for the symptoms of depression both among the HIV and the diabetic subgroups. Latinos in both groups were more likely than Whites to prefer counseling or a single form of treatment over combined treatment methods. Diabetic Latinos were more likely to prefer counseling for symptoms of depression. HIV seropositive individuals who reported the least number of symptoms of physical illness were more likely to attribute their symptoms of depression to stressful life events, whereas those who reported the greatest number of symptoms of physical illness were more likely to attribute their symptoms of depression to their medical illness. Additionally among the HIV subgroup, individuals who reported high stress tended to predict the preferences for treatment provided by a psychiatrist/psychologist and Whites scored highest on this factor. Finally, differences in depression scores across race/ethnicity were also revealed. The utility of assessing a patient's understanding of symptoms of depression in order to determine how personal illness models impact treatment preferences and knowledge of patient's causal attributions can aid medical social workers and physicians in collaborative management of chronic illness and depression are discussed.

Cognitive-behavioral therapy (CBT) is used to treat children and adolescents with depression. Researchers determined that many individuals undergoing CBT and other therapies experienced sudden gains, meaning that they experienced a rapid and large improvement in their symptoms between sessions. The studies demonstrated that by the end of treatment, individuals who experienced sudden gains were significantly less depressed and had better long-term outcomes than individuals who did not experience sudden gains. Previous studies investigated sudden gains in individual therapy while the present study examined sudden gains in group treatment. In addition to replicating results of previous studies, the present study sought to examine the effect of sudden gains on depressive symptoms, family environment, cognitive triad, and negative life events at pre-treatment and at a one year follow-up using multivariate analysis of variance. Participants included 136 girls, aged 9 to 13, in two treatment conditions (CBT, CBT+ parent training (CBT+PT), and a Minimal Contact Control (MCC)). At pre-treatment, post-treatment, and at a one year follow-up, participants completed self-report measures of the family environment, cognitive triad, and negative life events. They also completed a semi-structured diagnostic interview designed to symptoms of depression. After beginning the study, participants’ depressive symptoms were monitored with a brief symptom interview and/or a self-report measure of depressive symptoms. Findings from the study provided further evidence that sudden gains occur during group CBT, and that the majority of sudden gains occur early in CBT. The number of sudden gains did not vary significantly by treatment condition, and similar to previous research, the presence of a parent intervention component did not appear to significantly change the relation between sudden gains and treatment outcome. One important finding was participants in the Minimal Contact Control group experienced sudden gains despite not being in treatment. Another important finding was that the participants who experienced sudden gains differed significantly from the participants who did not experience sudden gains on pre-treatment measures of family environment and the cognitive triad but no differences were found at post-treatment or at a one year follow-up. Implications of these results, limitations, and recommendations for future research are provided. / text

Disertaciją sudaro įvadas, trys darbo skyriai bei svarbiausios darbo išvados ir pasiūlymai. Darbas remiasi sektorinės sisteminės analizės logika, pagal kurią nagrinėjama depresinių šalies regionų darbo rinkos plėtros problema suprantama kaip visos ūkinės sistemos regioninis ir darbo rinkos problemų pjūvis. Nuo bendriausiųjų temos klausimų aptarimo pirmajame darbo skyriuje – sampratos, klasifikavimo sistemos, konkrečių kriterijų, regionų ir darbo rinkos bei socialinės apsaugos sistemų plėtojimo patirties apibendrinimo – antrajame disertacijos skyriuje pereinama prie nagrinėjamos problemos ypatumus atspindinčių elementų analizės: remiantis statistiniais matematiniais metodais, atmetimo principu atrenkami patikimai, operatyviai probleminę ir depresinę padėtį charakterizuojantys rodikliai. Preliminariai išskirti probleminiai šalies regionai tiriami siekiant identifikuoti veiksnius, turinčius didžiausią įtaką depresinių šalies regionų darbo rinkos raidai. Problemos kompleksinės analizės finalas – trečiajame darbo skyriuje. Čia pagrindžiami depresinių šalies regionų darbo rinkos plėtros sprendimai, kurių kompleksinio taikymo sinergetinis efektas užtikrintų geresnius depresinių šalies regionų, o tuo pačiu ir visos šalies, socialinės ekonominės raidos rezultatus. / The scientific work consists of introduction, three working sections, conclusive findings. This dissertation work is based on the logics of sectoral analysis in accordance with which the analysed problem of labour market development in depressed regions of the country is understood as a regional cross-section of the entire economic system and of labour market problems. Starting with a discussion of the most general issues of the topic in the first working section – concept, classification system, generalisation of particular criteria, experience in the development of regions, labour market and social security systems, the author comes to the analysis of elements reflecting the peculiarities of the problem at issue, i.e., based on statistic mathematical methods and elimination principle, indicators are selected for reliable and operative characterisation of problematic and depressed situations. Pre-identified problematic regions of the country are further analysed in order to identify factors that have the biggest influence on the labour market development in depressed regions of the country. The complex analysis of the problem is finalised in the third working section of the dissertation which contains justification of the solutions for the labour market development in the depressed regions. Synergy effects of complex application of such solutions would ensure better results of the socio-economic development in the depressed regions and, at the same time, in the whole country... [to full text]