<p>Approximately 4.2 million Canadian adults suffer from a physical or psychological disability, of whom up to 30% suffer from depression. Those receiving disability benefits versus those not receiving benefits may be at greater risk of unsatisfactory outcomes because their circumstances or psychological status may interfere with successful implementation of standard therapies. This thesis addresses the effectiveness of therapies for depression in patients receiving disability benefits, using an individual patient data meta-analysis of all published randomized controlled trials evaluating Cognitive Behavioural Therapy and a secondary analysis of an administrative database from a large, private, Canadian insurer. Additionally, this thesis addresses an important methodological issue: assessing the impact of missing participant data for continuous outcomes in systematic reviews. Missing participant data may bias results of individual trials or systematic reviews of individual trials if participants with missing data have different expected outcomes from those with available data. No methods have been proposed for investigating the extent to which missing participant data for continuous outcomes might bias the results of systematic reviews, and this dissertation addresses that gap.</p> / Doctor of Philosophy (PhD)

Abstract The concept of waiting has received limited attention in the world of research. In modern society, waiting has become a commonplace event, especially in healthcare. Although the waiting experience can produce anxiety, healthcare environments can be easily manipulated in order to increase human comfort and reduce situational anxiety. One such way of accomplishing this is to introduce music to an environment. This paper will discuss the findings related to short wait periods, anxiety, and music within the literature, and the findings within this research study. This study found listener-selected music to be statistically effective in reducing anxiety for patients waiting in the exam room to be seen by a primary healthcare provider in an urgent care clinic.

Mental health disorder is the leading cause of disease burden in women worldwide. Pregnant women with mental disorder are especially at risk of having offspring with adverse outcomes. This study aimed to investigate risk factors of mental health disorder among Chinese pregnant women in the third trimester. A total of 462 pregnant women in their third trimester completed interviews at three hospitals in Shandong Province, China from July to December, 2010. The Symptom Checklist-90-R (SCL-90-R) was used to evaluate mental health disorder, and was defined as total score ≥160, or scores of any symptom dimensions ≥3, or total of positive symptoms ≥43. Multiple logistic regression was used to examine the risk factors of mental health disorder, and to adjust for covariates. The total score and scores of somatization, obsessive-compulsive, anxiety, and phobic anxiety were higher than corresponding national norm by SCL-90-R assessment (all p<0.05). Multiple logistic regression showed family income, relationship with parents-in-law, concerns about child's health, fear of delivery, and pregnancy complications were negatively associated with mental health disorder (all p<0.05). More specifically, relationship with parents-in-law, fear of delivery, preference on mode of delivery (Caesarean section), and body image concerns were positively associated with anxiety (all p<0.05); Fear of delivery was positively associated with depression (p=0.023). Family income, relationship with parents-in-law, concern about child's health, fear of delivery, and pregnancy complications were identified as potential risk factors of mental health disorder in this Chinese pregnant women population. Strategies to reduce mental health disorder are needed among Chinese pregnant women.

To examine the association between maternal depressive symptoms during early childhood of their offspring and later overweight in the children. Only children (n = 1,090) whose weights and heights were measured at least once for three time points (grades one, three and six) from the National Institute of Child Health and Human Development Study were included. Maternal depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or greater, were assessed using CES-D when the child was 1, 24, and 36 months. Childhood overweight was based on standardized height and weight measures taken during the interviews, and was defined according to appropriate CDC age- and sex-specific BMI percentiles. Generalized estimating equation was used to examine the impact of maternal depressive symptoms on the childhood overweight after adjusting for covariates. Compared to children of mothers without depression at any of the three time points, when children were one, 24 and 36 months of age, children of mothers with depression at all three time points were 1.695 times more likely to be overweight after adjusting for other child characteristics (95 % CI = 1.001–2.869). When further adjusted for maternal characteristics, children of mothers with depression at all three time points were 2.13 times more likely to be overweight (95 % CI = 1.05–4.31). Persistent maternal depressive symptoms may be associated with an increased risk of childhood overweight in their offspring. Children of mothers with depression may benefit from special attention in terms of obesity prevention.

Introduction: Depression is one of the most common mental disorders in the United States (U.S.). Annually, approximately 7% of adults and 3% of children were diagnosed with depression. The rates of depression are generally high among adults, however since past decade the depression among adolescents has been increasing progressively. According to the National Comorbidity Survey, about 11 % of adolescents annually reported to have a depressive disorder by age 18 years. Several studies have been conducted to understand depression in middle-aged and older-adults, while limited studies on adolescents. 2015 Appalachian Student Research Forum Page 65 The study aimed to estimate prevalence of depression among adolescents in the U.S. and identify key factors associated with it. Methods: Data (n=44,879) was obtained from the 2012 National Survey of Children’s Health (NSCH). In the data Depression is defined as a mental disorder, marked by loss of interest or pleasure, sadness, feeling of low self-worth along with disturbed sleep or appetite. Based on existing literature, several selected adolescent characteristics and disease outcomes were included as potential risk factors of depression including age, gender, race, asthma, diabetes, learning disability and exposure to adverse family experiences. Descriptive statistics were reported using frequencies and proportions along with 95% confidence intervals (CI). Multiple logistic regression model was performed to assess relationship of risk factors with depression in adolescents adjusting for other confounders. Results: Overall 6.4% of adolescents aged 10-17 years reported either prior symptom or current diagnosis of depression. Depression rates were 6.5% and 6.3% among male and female adolescents, 9.6%, 11.8% and 68.8% among non-Hispanic blacks, Hispanics and non-Hispanic whites, respectively. For every one year increase in age, the relative odds of depression increased by 19% (OR 1.19, 95% CI 1.17-1.21). Adolescents who reported physician diagnosis of asthma and diabetes were more likely to have depression (asthma - OR 2.22, 95%CI 2.05-2.42, diabetes- OR 3.23, 95%CI 2.45-4.25) than those who were not. In addition, those with learning disability were more likely to have depression (OR 5.56 95%CI 5.13 6.02) than those who were not. For increase in one adverse family experience, the risk of depression increased by 158.7% (OR 2.59 95% CI 2.46 2.72). Gender and race were not found to be not significantly associated with depression. Conclusion: The study illustrates that depression in adolescents is interplay between demographic characteristics, disease outcomes and personal/family experiences. Study findings help identify important etiological factors that must be considered during treatment and prognosis of depression among adolescents in the U.S.

Background: The psychosocial benefits of participating in physical activity (PA) are well known; less is known about the relationship between suicidal behaviors and PA among adolescents, especially among middle school-aged youth. This study seeks to fill that gap by assessing the cross-sectional relationship between these variables. Methods: A secondary analysis of the 2010 Tennessee Middle School Youth Risk Behavior Survey data was conducted among 65,182 middle school students. Items examined were PA, sports team engagement, physical education (PE) class, screen time, suicidal behaviors, drug/substance use, extreme weight control behaviors, weight status and weight misperceptions, and selected personal characteristics. Multiple logistic regression analysis was used to estimate the association between PA, sports team engagement, and PE class attendance on suicidal behaviors. Results: Sports team engagement was significantly associated with suicidal thoughts, plans, and attempts even after controlling for other important variables. There was no relationship, however, between total PA or PE class attendance in univariate or multivariate models, respectively. Conclusions: Findings suggest that sports team engagement is associated with reduced risk for suicidal thoughts, plans, and attempts, whereas, no relationships were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help clinicians screen for risk of suicidal behaviors.

Forty-five male and female family caregivers of institutionalized and noninstitutionalized Alzheimer’s Disease patients were assessed for depression, using the Beck Depression Inventory (BDI) and Geriatric Depression Scale (GDS). Internal consistency and concurrent validity for the BDI and GDS were acceptable, based on item-total correlation, coefficient alphas, and a Pearson’s Product-moment correlation. A stepwise multiple regression analysis was carried out to determine which variables predict depression in Alzheimer’s caregivers. Using the traditional cut-off score of 11 for each scale, it was found that 42% were depressed on the BDI, while 58% were depressed on the GDS; these rates were not significantly different. No difference in depression rate was found between male and female caregivers or between spouse and adult daughter caregivers. However, the depression rate for the caregiver sample was significantly higher than that reported for the general population of older adults. The regression analysis showed that only two variables were predictive of depression in this group of Alzheimer’s caregiver. The less frequently the caregiver spent time away from the patient, the less frequently the caregiver had help in caring for the patient, the more likely the caregiver was to be depressed. It is suggested that social support may be an important factor in the prevention and/or alleviation of depression in family caregivers of patients with Alzheimer’s Disease. Future research is suggested including validation of the BDI and GDS for Alzheimer’s caregivers, using a large representative sample.

The current study was designed to further examine the effects of verbal reward and punishment on task performance of schizophrenics. The relationship of need for approval of schizophrenics (as measured by the M-C SDS) to performance and to reward and punishment was also examined. Verbal reward and punishment along with need for approval served as independent variables. Task performance was the dependent variable. The following major questions were asked: Does verbal reward and punishment significantly influence performance of schizophrenics? How is the personality construct, need for approval, related to performance of tasks by schizophrenics? Is there a significant interaction between verbal reward and punishment and need for approval in schizophrenics?

The purpose of this study was to determine if prediction of premature termination of psychotherapy through the use of the Barrett-Lennard Inventory. The Study was conducted at health center and involved the clients could be attained Relationship a community mental of five therapists. The Relationship Inventory which assesses the relationship between client and therapist was mailed to clients who had terminated therapy against the advice of their therapists, and to clients who were still in therapy. The clients were asked to fill out the questionnaire anonymously, and send it back to the Center. Demographic data, such as age, sex, marital status, primary diagnosis, educational level, income, and number of individual sessions attended was collected from the client's records at the Center. The results of this study indicated that prediction of premature termination of psychotherapy was possible with these five therapists although the predictor variables were different for each therapist. Demographic variables appeared to be more predictive than the Relationship Inventory. The results point out the therapist differences in retaining clients and the potential usefulness of these results in the assignment of therapy cases and in the planning of inservice training.

Research suggests that the population of undergraduate college students may be especially prone to depression. While the prevalence of depression within the general population ranges from 3 to 9 percent (Boyd & Weissman, 1981), it has been shown that between 15 and 46 percent of undergraduate college students suffer the symptoms of mild to severe depression (Beck & Young, 1978; Oliver & Burkham, 1979). Although depression is prevalent among college students, there are no known instruments yielding indices of depression specific to the college population. In fact, depression measures frequently employed in college settings seldom recognize the unique features of depression among college students (e.g., academic anxiety, scholastic difficulties). The purpose of this study was to provide validity evidence for the Student Experience Inventory (SEI), which was specifically designed to assess depression among college students. Validation efforts consisted of: (a) cross validating the internal consistency results yielded by Kirkland and Redfield (1985) and (b) demonstrating the convergent and discriminant properties of the SEI. The SEI, Beck Depression Inventory (BDI), and Psychological Distress Inventory (PDI) were administered to 153 Introduction to Psychology students. Coefficient alpha for the SEI total scale was .90. Coefficient alphas for each of the seven hypothesized subscales ranged from .41 to .72. Stepwise multiple regression, using SEI scores as the criterion and BDI and PDI scores as the predictors, demonstrated that the best predictor model consisted only of the BDI total score. All Pearson product-moment correlation coefficients reflecting pairwise relationships between variables proved statistically significant (p<.01) and ranged from .23 to .61. The correlation of SEI and BDI scores yielded a coefficient of .61. A principle components factor analysis of SEI items produced eight factors, which cumulatively explained 62 percent of the total variance. The results of this study suggest that the SEI may prove a useful tool in the measurement of depression in college students. If the SEI is to be used to discriminate between depressed and nondepressed college students, future research should include investigation of the SEI's ability to detect change in differing populations.