Objective: The nature of interpersonal relationships, whether supportive or critical, may affect the association between health status and mental health outcomes. We examined the potential moderating effects of social support, as a buffer, and family criticism, as an exacerbating factor, on the association between illness burden, functional impairment and depressive symptoms. Methods: Our sample of 735 older adults, 65 years and older, was recruited from internal and family medicine primary care offices. Trained interviewers administered the Hamilton Rating Scale for Depression, Duke Social Support Inventory, and Family Emotional Involvement and Criticism Scale. Physician-rated assessments of health, including the Karnofsky Performance Status Scale and Cumulative Illness Rating Scale, were also completed. Results: Linear multivariable hierarchical regression results indicate that social interaction was a significant buffer, weakening the association between illness burden and depressive symptoms, whereas perceived social support buffered the relationship between functional impairment and depressive symptoms. Family criticism and instrumental social support were not significant moderators. Conclusions: Type of medical dysfunction, whether illness or impairment, may require different therapeutic and supportive approaches. Enhancement of perceived social support, for those who are impaired, and encouragement of social interactions, for those who are ill, may be important intervention targets for treatment of depressive symptoms in older adult primary care patients.

This study examined hope agency and pathway as potential mediators of the associations of religiosity and spirituality with depressive symptoms in an adult sample of 101 primary care adults. Results of conducting multiple mediation tests indicated that hope agency and pathway fully and significantly accounted for the associations of religiosity and spirituality with depressive symptoms. In contrast, an alternative mediation model involving religiosity and spirituality as potential mediators of the associations of hope agency and pathway with depressive symptoms failed to be supported. Overall, our findings offer support for the contention that hope agency and pathway play important roles in accounting for the associations of religiosity and spirituality with psychological adjustment in adults. Some implications of the present findings are discussed.

abstract: The transition out of high school is a major milestone for adolescents as they earn greater autonomy and responsibilities. An estimated 69.2% of adolescents enroll in higher education immediately following high school completion, including increasing numbers of Latino adolescents (National Center for Education Statistics, 2016). Integrative model (García Coll et al., 1996) suggests a need for research on promotive and protective contextual factors for ethnic minority children and adolescents. Guided by the model, the proposed research will explore a salient Latino cultural value, familism, and family communication as predictors of changes in depressive symptoms from high school to university among Latino adolescents (N = 209; 35.6% male; Mage=17.59, SD=.53). Furthermore, sleep, a key bioregulatory mechanism, was explored as a potential moderator of these processes (Dahl & El-Sheikh, 2007). On average, familism values were not associated with college depressive symptoms, but family communication was significantly negatively associated with college depressive symptoms. Neither sleep duration nor sleep problems significantly moderated the association between familism values and college depressive symptom. Patterns were similar for family communication. The interaction between sleep problems and familism-support values were significantly associated with college depressive symptoms. However, when simple slopes were probed, none were significant. / Dissertation/Thesis / Masters Thesis Psychology 2019

This study examines the impact of two types of trauma exposure, mistreatment by an adult as a child and exposure to stressful life events as an adolescent, and their impact on marijuana use as an adolescent and emerging adult and marijuana dependence as an adult. This study also investigates the mediating role of depressive symptoms on the relationship between trauma exposure and marijuana use and dependence. The AddHealth dataset, a nationally representative and longitudinal dataset, was used to assess these relationships. Results show that both types of trauma predict marijuana use and dependence. Results also show that there are indirect effects through depressive symptoms. These findings have implications on children and adolescents who are exposed to trauma, parents, teachers, and those working in the fields of mental health and therapy.

We examined the role of basic psychological needs as a mediator of the association between future orientation and depressive symptoms in a sample of 202 (159 female and 43 male) multiethnoracial adults. Multiple mediation analysis with 10,000 bootstraps was conducted to test for mediation. The association between future orientation and depressive symptoms was found to be accounted for by dimensions of basic psychological needs. Specifically, future orientation was negatively related to depressive symptoms through positive associations involving autonomy and competence, but not relatedness. The present findings are the first to not only point to the importance of examining future orientation in understanding depressive symptoms in multiethnoracial adults, but they are also the first to suggest possible mechanisms by which believing in a changeable future might foster stronger satisfaction of basic psychological needs, especially autonomy and competence, that might help multiethnoracials garner greater protection when encountering stressful situations in their lives.

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and depressive symptoms after traumatic injury on delayed ambulation (> 48 hours) following hospital admission. Specific Aim 1 was addressed by development of a conceptual model to describe the association between injury responses, immobility and skeletal muscle after trauma based on a comprehensive review of the state of the science. This model guided the research reported in Aims 2 and 3. The second specific aim was addressed with the conduct of an observational study in which we evaluated daily skeletal muscle strength with dynamometry and muscle thickness with ultrasound to evaluate the impact of trauma and immobility on skeletal muscle in patients after major trauma (n = 19). Participants with delayed ambulation after trauma (more than 48 hours immobility) demonstrated significantly less muscle strength compared with those who had early ambulation (bicep: delayed ambulation 12.9 ± 3.8, early ambulation 17.7 ± 4.7, p = 0.004; quadriceps: delayed ambulation 9.9 ± 3.1, early ambulation 17.1 ± 4.6, p = 0.001). Muscle thickness was unchanged over time in those with delayed ambulation; however, in those who ambulated early, muscle thickness significantly increased by 0.17 cm (p = 0.008) from baseline to day 5. The third specific aim was addressed with data collected during the same observational study of patients after trauma (n = 19). Participants provided measures of anxiety and depressive symptoms at baseline. Anxiety was not a predictor of delayed ambulation; however, depressive symptoms increased the likelihood of delayed ambulation by 67% (Odds Ratio [OR]: 1.67, 95% CI: 1.02 – 2.72, p = 0.041). Early ambulation was associated with significantly greater muscle strength and thickness as determined by dynamometry and muscle ultrasound, and depressive symptoms significantly increased the likelihood of delayed ambulation. Systematic evaluation of the association between trauma injury, immobility, skeletal muscle function and structure, and psychological state will provide an opportunity for the appropriate evaluation after injury and development of effective, tailored interventions to improve short- and long-term physiological and psychological recovery.

Poor metabolic control is a major health concern for children and adolescents with type 1 diabetes, particularly for African American youth. The aims of this study were to test the mediating relationship between two variables consistently related to metabolic control, depressive symptoms and adherence, as well as to attempt to explain racial disparities in metabolic control. The study sample consisted of 53 European American youth and 33 African American youth ages 5 to 20 (M = 13.59, SD = 3.49) with type 1 diabetes. Information on depressive symptoms, adherence, and HbA1c was collected during routine outpatient clinic visits. Significant associations were found between depressive symptoms and metabolic control, depressive symptoms and adherence, and adherence and metabolic control. When included together in a regression model, adherence mediated the relationship between depressive symptoms and metabolic control. This mediation pathway did not significantly differ between African American youth and European American youth; however, African American youth had significantly higher HbA1c levels. These findings indicate the importance of considering depressive symptoms during treatment for type 1 diabetes. This study also supports previous research findings of racial disparities in metabolic control among youth with type 1 diabetes. Future studies should further examine mechanisms by which these racial disparities emerge. / acase@tulane.edu

Toxoplasma gondii infects approximately one third of the population worldwide. There is strong evidence that a relationship between T. gondii titer and depressive symptoms exists. There is also evidence suggesting a protective effect of RhD positive blood factor on toxoplasma-induced behavioral and personality changes. This protective effect may influence the relationship between T. gondii and prenatal depressive symptoms. The purpose of this secondary data analysis was to examine the possible protective effect of RhD positive blood factor on prenatal depressive symptoms in 56 pregnant women with T. gondii infection. The cross-sectional design was utilized to answer the question “Does positive RhD blood factor provide a protective effect on prenatal depressive symptoms of patients infected with T. gondii when controlling for ethnicity, race, income, marital status, age and stress?” The conceptual model hypothesized that there was a relationship between socio-demographic variables (age, income, marital status, race, and ethnicity), stress, positive T. gondii titers, RhD positive blood factor, and prenatal depressive symptoms. Pearson correlations and multiple regression were utilized to explore the aims of this study demonstrated in the four statistical models. Significant relationship between stress and positive T.gondii seropositivity on prenatal depressive symptoms was identified. There was no significant relationship identified between RhD positive blood factor on the pregnant women infected with T. gondii which could be attributed to the small sample size.

For family caregivers, response to the death of the care recipient is marked by a high degree of variability. In recognition of this variability, a range of services and interventions is available to assist individuals in the adjustment to bereavement. The present dissertation, consisting of three related studies, was conducted to examine the utilization of bereavement services by family caregivers. The first study examined the role of psychological distress in the utilization of bereavement services by spousal caregivers in the Changing Lives of Older Couples (CLOC) study. The second study examined bereavement service utilization among dementia caregiver participants in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study. Both employed Andersen's Behavioral Model of Health Services Use. The third study examined bereavement service utilization, barriers, and preferences among bereaved spousal caregivers of patients of three hospices in Tampa Bay. Taken together, results of the current studies point to the importance of family physicians and members of the clergy in the provision of services to bereaved family caregivers and to the prominent role of bereavement outcomes (e.g., depressive symptoms, grief) as need factors in the utilization of bereavement services.

<p>Elderly committing suicide can be in a “preclinical phase” of dementia. Depressive symptoms may indicate a risk to develop a disease of dementia, for example Alzheimer’s Disease. Today almost 10% of the Swedish population older than 65 years suffer from a cognitive impairment diagnosed as dementia. Symptoms of dementia are associated with degenerative changes in the brain caused by a deposition of amyloid, leading among others things to a nerve cell death. A clinical diagnosis can be hard to set, and a definitive diagnose can only be set after a pathological examination, which only is possible after death. For this study we used Congo red staining of brains sections to find amyloid in autopsies from elderly people committing suicide. 35 cases (>60 year) were studied. Of the 35 cases 1/3 showed to be positive for amyloid deposition. This result in addition to other studies suggest that depressive symptoms is a “preclinical phase” of dementia, and therefore the suicide risk for this group must be consider to be elevated. However, more reliable prospective studies most be done to confirm this retrospective study.</p>