Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 72-95).

While child and adolescent depressive disorders have been historically studied as a downward extension of adult depression, recent research has supported the existence of child and adolescent depression as a distinct disorder and has indicated important developmental differences in symptomatology (Birmaher, Ryan, Williamson, Brent, & Kaufman, 1996; Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993), as well as greater intensity and endurance of depressive disorders in childhood and adolescence than in adults (Jensen, Ryan, & Prien, 1992). Continued research with adolescence is particularly necessary because such symptomatology can manifest in self destructive or even life threatening behaviors. Symptoms such as depressed mood, irritability, and diminished interest in activities can lead to cognitive, familial, and social problems (Hammen & Rudolph, 1996). There is a particular need to investigate ways to identify individuals at risk for depression, and highlighting interactions between risk factors could make this possible. Childhood and adolescent investigations have under-examined the self-schema and its possible ability to moderate the effect of negative life events on depression. The current study investigated the role of life events as an element that, when combined with distorted and negative cognitions relating to the self, would increase the existence of depressive symptomatology in adolescents. Self-schemas, life events, and interactions of both variables were examined as predictors of the severity of depressive symptomatology in 9- to 14-year old girls in two public school districts in Central Texas. Participants completed a self-report measure of depression, a projective measure of the self-schema, a self-report measure of life events, and a diagnostic interview. As expected, a negative self-schema significantly predicted level of depressive symptomatology. However, the experience of adverse life events did not predict level of depressive symptomatology. Additionally, while analyses demonstrated that adverse life events and negative self-schema together predicted the severity of depressive symptoms to a statistically significant degree, the interaction of the two independent variables did not predict severity of depressive symptoms. Implications of the results, limitations, and recommendations for future research are provided. / text

This dissertation applies the life course framework to understanding gender differences in the connection between academic performance and mental health. The premise for this study is based on the paradox that girls perform better in school but get less of a boost to their sense of well being from their achievement relative to boys. The life course perspective focuses both on how different pathways, such as academics and mental health, intertwine and the need to study important transitions, such as the transition from adolescence to young adulthood. This research addresses this transition by considering the consequences of the gender paradox on college enrollment and persistence. The quantitative analyses utilize Waves I, II, and III of the National Longitudinal Study of Adolescent Health (Add Health). Results indicate that academic performance and depression were positively correlated for girls and negatively correlated for boys. Adolescent gender differences in depression are driven by the high achieving segment of the student population because girls tend to get less of a mental health boost from earning good grades across the board. This is especially pronounced in high school. The end result is a slight chipping away at the well-documented advantages girls have in postsecondary education. / text

Previous research demonstrates a marked increase in the occurrence of depression during adolescence, particularly for females. Research has found that this phenomenon is associated with the development of beliefs about the self, world, and future (known as the cognitive triad), which constitutes a potential cognitive vulnerability to depression. Research has also demonstrated that family characteristics, such as cohesion, communication, conflict, social/recreational activity, negative life events, and maternal depression are all related to depression and the development of a negative cognitive style. The purpose of the current study was to build upon previous literature on negative life events, family and cognitive correlates of depression in youth, and analyze specific cognitive-interpersonal pathways to depression for girls transitioning from childhood to adolescence. 194 girls ranging in age from 8 to 14 participated in the study, along with their mothers. Participants completed self-report measures of family environment, beliefs about the self, world, and future, and negative life events. Mothers completed a self-report measure of psychopathology. Participants also completed a diagnostic interview, which served as the primary measure of depressive symptoms. As found in similar studies and consistent with Beck’s theory of depression, daughter’s reports of cognitive triad predicted the severity of her depressive symptom severity. Moreover, the cognitive triad was found to be the mediating variable in the model; family variables affected daughter’s beliefs, which then affected depressive symptom severity. Specifically, girls who endorsed higher family conflict and lower social/recreational activity reported a more negative cognitive triad and subsequently higher levels of depression. Additionally, negative life events significantly affected cognitive triad and indirectly affected depressive symptoms via cognitive triad. Also, the interaction of negative life events and cognitive triad significantly affected depression. Further results indicated that the self subscale of the cognitive triad is a particularly important factor in this model of depression. Contrary to what was expected, mother’s reports of depressive symptoms did not predict daughter’s cognitive triad or depressive symptoms. Implications of these results, limitations, and recommendations for future research are provided. / text

published_or_final_version / Community Medicine / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers

Background: Dissemination of evidence-based mental health clinical practice guidelines had not been studied in Australia prior to the National General Practice Guideline Implementation Program. This naturalistic research reports ten national interventions designed to disseminate the NHMRC 1997 Clinical Practice Guideline Depression in Young People for GPs (GDIYP-GP) through 123 Divisions of General Practice. The guideline covered depression and suicide in young people aged 13 to 20 years. Aim: To evaluate a 'coordinated link agent' and 'enhanced packaged approach' for disseminating a national guideline by engaging 20 Divisions in using 5 dissemination models and to measure Divisions' capacities in performing unfunded local dissemination to GPs. Method: An Implementation Kit was the main national intervention, housing the guidelines and 5 models: Education by the Division; Education by an external provider; 3) Clinical Audit; 4) Segmented Formats and 5) Appraisal. Five studies are reported: 1) an organisational census on guideline-related practices in all topics; 2) a Case Study Database of 3 consecutive interviews of 51 participating Divisions; 3) a Guideline Appraisal study of 9 cohorts of doctors; 4) a Clinical Audit study of 54 doctors involving 1200 patients; and 5) a 'Segmented Formats' documentary analysis of Division communications on GDIYP-GP. Results: Prior dissemination by most Divisions was administrative mail outs rather than planned programs. In all, 70 instead of the pilot 20 organisations participated (57% of the sector) using 10,000 guidelines: 45 participated by 7 weeks and 71 by 35 weeks and the majority used multiple active strategies showing fidelity to the Kit. Education by the Division, Segmented Formats and Appraisal were the most adopted models. GDIYP-GP was acceptable and relevant to the majority of Divisions and to 9 samples of doctors. Conclusion: Divisions are one appropriate system through which evidence-based mental health guidelines can be disseminated to general practitioners. Uptake can be rapid using a flexible enhanced package approach with link-agent support. 3-6 months is needed for organisations to begin effective interventions. Divisions reorient their approach with guidance toward evidence-based dissemination but Division and practice barriers