Depression is a major public health problem. Decades of research have been conducted to create a classification system aligned with the complex phenomenological features of depression. The dominant classification system for depression is the latent paradigm, which conceptualizes observable symptoms of depression as effects of an underlying disorder. There is increasing evidence, however, that the latent model is inadequate to inform the prognosis and treatment of depression. Specifically, evidence is accumulating that symptoms of depression do not necessarily arise due to an underlying condition, but that symptoms occur as a network in which each one is causally related to a previous symptom. This dissertation critically evaluated the underlying assumptions of this “network paradigm,” one of the frameworks which had been proposed as an alternative to the traditional latent paradigm, as an appropriate model for studying depression. The first chapter systematically evaluated empirical depression network studies regarding whether the study design included an examination of the paradigm’s assumptions. In the second chapter, I investigated the relationships among depressive symptoms and determined whether causal relationships among depressive symptoms, a key assumption underlying this paradigm, could be a plausible explanation. The last chapter investigated a central controversy within the network literature regarding consistent findings and measurement error. The first chapter found that the majority of depression network studies published in the literature were not capable of providing empirical support of symptom causal relationships and often neglected to investigate the impact of measurement error. The second chapter estimated a significant relationship between two depressive symptoms - sadness and anhedonia, using an inverse probability treatment-weighted regression estimation approach in the context of longitudinal data. Causal relationships among symptoms, a key assumption underlying the network paradigm, may be a plausible explanation for the depressive symptom relationships. The third chapter found that statistical network models are not robust to measurement error through a series of simulation studies. Measurement error remained a general threat against the network paradigm, and existing network findings should be interpreted with caution. Overall, the network paradigm may be appropriate for study depression, but existing findings should be interpreted with caution. There is a need to explore the fundamental assumptions of paradigms prior to widespread application.

Serotonin 2A receptor (5-HT2aR) agonists and κ-opioid receptor (KOR) agonists have been demonstrated to be effective treatments for several central nervous system (CNS) disorders including depression, anxiety, addiction, and pain. In a recent clinical study, psilocybin (a classical hallucinogen) was shown to significantly decrease the symptoms of Major Depressive Disorder (MDD) and Treatment Resistance Depression (TRD) in humans for up to six weeks after a single dose. Several KOR agonists have been shown to be effective treatments of chronic pain without the physical dependence risks of µ-opioid receptor agonists. Also, due to KOR’s involvement in a biological anti-reward system, agonists for this receptor possess anti-addiction properties as demonstrated by their ability to decrease the self-administration of drugs of abuse in multiple different animal species. Despite the great therapeutic potential for both these classes of molecules, their hallucinogenic and disassociate effects have been a major roadblock in the approval new pharmaceuticals.This dissertation describes the synthesis and behavioral evaluation of known and novel 5-HT2aR and KOR agonists. In the first half, the synthesis of several molecules related to the structure of ibogaine are described and the novel “oxa-iboga” class is introduced. One of the molecules in this class, oxa-noribogaine, has been evaluated in a variety of in vivo mouse tests including tail-flick, open field, and forced swim test. The results demonstrate that oxa-noribogaine is a potent KOR agonist and analgesic but has a lower side-effect profile compared to other KOR agonists such as noribogaine, epi-oxa-noribogaine, and U50,488H. In the second half, two emerging classes of antidepressants, NMDAR antagonists and 5-HT2aR agonists, are described. Molecules from both these classes cause rapid acting antidepressant effects that can be induced after a single dose. This is a sharp contrast to traditional antidepressants such as SSRIs which require 4-6 weeks of consistent use before therapeutic effects are achieved. In our lab, a set of substituted phenethylamines which act as 5-HT2aR agonists were evaluated in vivo in the head twitch assay, forced swim test, sucrose preference test, and fear extinction assays. Their hallucinogenic and antidepressant-like effects are reported. One molecule, 4-CT, was designed and synthesized based on the structure of Ariadne, a 5-HT2aR agonist with low or no psychedelics effects. 4-CT produced a decreased number of head twitches compared to DOI (a hallucinogenic research control) and showed possible antidepressant-like effects in the forced swim test.

Disparities in mental health service use among People of Color (POC) adolescents with depression is a serious public health concern. Engaging and retaining POC adolescents in treatment is imperative to improving mental health outcomes. Parents/caregivers play a critical role in POC adolescent engagement in the therapeutic process, yet POC adolescents’ and parents’/caregivers’ preferences for parental participation engagement (PPE) in depression treatment are unknown. The goal of this dissertation was to investigate POC adolescents’ and parents’/caregivers’ preferences for PPE in adolescent depression treatment. A qualitative approach was used through individual semi-structured interviews with POC adolescents and parents/caregivers. A brief quantitative preferences questionnaire was also administered. Questionnaire data were analyzed via descriptive statistics. Qualitative data were analyzed via thematic analysis procedures. Results indicated that teen and parent/caregiver preferences for PPE included: (a) direct parental involvement, (b) indirect parental involvement, and/or (c) limited involvement. The quality of the teen-parent relationship and logistical factors informed teen and parent/caregiver preferences for PPE, with therapists having a key role in influencing these preferences and facilitating the initiation and continuation of PPE. Factors associated with the quality of the teen-parent relationship included: (a) parent mindsets and behaviors, (b) teen and parent perceptions of adolescent development, and (c) severity of teen symptoms. Themes related to the perceived outcomes of PPE included: (a) improved teen-parent communication, (b) improved parental support behaviors, (c) improved teen-parent connection and trust, (d) negative outcomes, and, (e) treatment retention. Based on these findings, implications for clinical practice and future research are discussed.

Perinatal depression (PND), depression that occurs during pregnancy or in the first year following delivery, is a common and debilitating mental health condition. In New York City, it is estimated that at least one in ten women suffer from PND. The clinicians who serve these women require training in acceptable, feasible, and effective treatments. Interpersonal psychotherapy (IPT) is a time-limited, evidence-based psychotherapy that has been found to be effective in the treatment of PND in community and primary care settings. The present study investigates the nuances of an IPT training program for licensed mental health providers who treat perinatal depression within integrated care settings in NYC. Using a qualitative-focused mixed-methods design, this study aims to systematically and comprehensively evaluate the acceptability, feasibility, sustainability, and preliminary effectiveness of the training program, and of the providers’ perceptions of IPT as a treatment for the patients they serve. To achieve these aims, five of the eight providers who participated in the training program were interviewed at two timepoints and quantitative data including demographics, use of IPT, satisfaction with training experience, and effectiveness of the training program were collected. Results indicate that providers viewed their training experience as acceptable and feasible and viewed IPT as an appropriate, relevant, and helpful treatment for their perinatal patients’ depression. Quantitative results provide preliminary support for the training model’s potential effectiveness, demonstrating that provider-trainees were able to obtain and retain knowledge of IPT and achieve certification as IPT practitioners. Overall, Patient Health Questionnaire (PHQ-9) scores show that patients who were treated by the study’s provider-trainees self-reported depression symptoms improved over the course of their IPT treatment. Recommendations for future directions and implications for future provider training programs are discussed.

The subjects were DUI probationers placed by the court system in the Virginia Alcohol Safety Action Program (VASAP). Due to their high risk level, the subjects were placed in treatment programs. An exercise program was incorporated in a VASAP treatment program to investigate the reduction in alcohol drinking frequency and quantity by implementing a weekly questionnaire as a repeated measure in an experimental vs. a control group design. Within these same groups, depression was measured through a pre-post design using the Beck Depression Inventory as a psychometric measure. The two arms of the study were evaluated by weekly ordinal data analyzed using a repeated measure ANOVA and a pre-post design using a 2x2 table with the appropriate ANOVA at a .05 level of significance. The results indicated no significant difference between the groups. There experimental group established a reduction in alcohol consumption and depression at a faster rate than the control group. / Master of Science

Text in Afrikaans / Aangesien depressie en angs hedendaags so 'n ingrypende invloed het op mense se lewens en hulle lewenskwaliteit, is daar 'n dringende behoefte aan 'n dinamiese, korttermyn en gerigte terapie om so gou as moontlik by die werklike onderliggende oorsake van die depressie en angs uit te kern. Hierdie studie het ten doel om die gebruik van hipnoterapie in die hantering van depressie en angs by adolessente en volwassenes te ondersoek. Tydens die studie word aangetoon dat die mediese hipnoanalise model 'n geskikte benadering is om as diagnostiese tegniek en terapeutiese intervensie, die oorsprong van depressie en angs aan te spreek. Emosionele probleme soos depressie en angs se oorsprong lê dikwels by foutiewe persepsies wat ontstaan tydens insidente in die kindertyd. Aangesien die persoon se breinprosesse in daardie stadium nag nie goed genoeg ontwikkel is om te besef dat die bedreiging verby is nie, word sulke persepsies nie verwyder nie. Elke persoon analiseer 'n nuwe stresvolle situasie of bedreiging vanuit sy persepsies en verwysingsraamwerk uit die verlede. Tydens 'n stresvolle insident is die depressie- en angslyer in die gewoonte om vanuit 'n depressiewe en angsvolle verwysingsraamwerk te dink en op te tree. Hierdie wyse van dink en optree is volgens sy onbewuste beter vir sy oorlewing van die stresvolle situasie, as wat denke en optrede vanuit 'n verwysingsraamwerk van die werklike onderliggende probleem sou wees. Die mediese hipnoanalise model is in staat om, tydens regressie, die ou foutiewe gedagtepatrone te verander deur die onderliggende gedagte, wat probleme veroorsaak, bloot te lê en te verwyder. Sodoende word die werklike onderliggende probleem blootgelê en verwyder. Die persoon word vry van foutiewe persepsies van die verlede en in staat om te dink en in die toekoms op te tree volgens die nuwe, akkurate persepsies. Deur hierdie meganismes, bewys mediese hipnoanalise homself as 'n geskikte terapeutiese ingreep om depressie en angs suksesvol aan te spreek. / In the light of the far-reaching effects that depression and anxiety have on the lives and the quality of people's lives, there is a need for a dynamic, short term and directed therapy in order to determine the real underlying causes of depression and anxiety as soon as possible. This study aims to examine the use of hypnotherapy in the treatment of depression and anxiety with adolescents and adults. During the course of this study, it is shown that the medical hypnoanalysis model is well suited as a diagnostic technique and therapeutic intervention for treating the origins of depression and anxiety. The origin of emotional problems like depression and anxiety, often lies in the faulty perceptions that have been formulated during childhood incidents. Since the brain processes are not yet as developed as they will become in adult life, the conscious mind does not realize that the threat ceased to exist, and can therefore not remove such perceptions. Each person analyses new stressful situations from the perspective of his own perceptions and the frame of reference of the past. A person suffering from depression and anxiety is in the habit of generating depressive and anxious ways of thinking and acting when confronted with a new stressful situation. The subconscious mind considers these ways of thinking and acting as the best way of surviving the stressful situation, better than ways of thinking and acting from the frame of reference of the underlying problem. The medical hypnoanalysis model can detect and remove the real underlying problem by regressing the person to the time of the incident, thus correcting the old patterns of thinking and acting. The person is freed from past false perceptions, and can think and act according to his new, corrected perceptions. Through use of these mechanisms, medical hypnoanalysis has shown itself to be well suited to the treatment of depression and anxiety. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)

Text in Afrikaans / Aangesien depressie en angs hedendaags so 'n ingrypende invloed het op mense se lewens en hulle lewenskwaliteit, is daar 'n dringende behoefte aan 'n dinamiese, korttermyn en gerigte terapie om so gou as moontlik by die werklike onderliggende oorsake van die depressie en angs uit te kern. Hierdie studie het ten doel om die gebruik van hipnoterapie in die hantering van depressie en angs by adolessente en volwassenes te ondersoek. Tydens die studie word aangetoon dat die mediese hipnoanalise model 'n geskikte benadering is om as diagnostiese tegniek en terapeutiese intervensie, die oorsprong van depressie en angs aan te spreek. Emosionele probleme soos depressie en angs se oorsprong lê dikwels by foutiewe persepsies wat ontstaan tydens insidente in die kindertyd. Aangesien die persoon se breinprosesse in daardie stadium nag nie goed genoeg ontwikkel is om te besef dat die bedreiging verby is nie, word sulke persepsies nie verwyder nie. Elke persoon analiseer 'n nuwe stresvolle situasie of bedreiging vanuit sy persepsies en verwysingsraamwerk uit die verlede. Tydens 'n stresvolle insident is die depressie- en angslyer in die gewoonte om vanuit 'n depressiewe en angsvolle verwysingsraamwerk te dink en op te tree. Hierdie wyse van dink en optree is volgens sy onbewuste beter vir sy oorlewing van die stresvolle situasie, as wat denke en optrede vanuit 'n verwysingsraamwerk van die werklike onderliggende probleem sou wees. Die mediese hipnoanalise model is in staat om, tydens regressie, die ou foutiewe gedagtepatrone te verander deur die onderliggende gedagte, wat probleme veroorsaak, bloot te lê en te verwyder. Sodoende word die werklike onderliggende probleem blootgelê en verwyder. Die persoon word vry van foutiewe persepsies van die verlede en in staat om te dink en in die toekoms op te tree volgens die nuwe, akkurate persepsies. Deur hierdie meganismes, bewys mediese hipnoanalise homself as 'n geskikte terapeutiese ingreep om depressie en angs suksesvol aan te spreek. / In the light of the far-reaching effects that depression and anxiety have on the lives and the quality of people's lives, there is a need for a dynamic, short term and directed therapy in order to determine the real underlying causes of depression and anxiety as soon as possible. This study aims to examine the use of hypnotherapy in the treatment of depression and anxiety with adolescents and adults. During the course of this study, it is shown that the medical hypnoanalysis model is well suited as a diagnostic technique and therapeutic intervention for treating the origins of depression and anxiety. The origin of emotional problems like depression and anxiety, often lies in the faulty perceptions that have been formulated during childhood incidents. Since the brain processes are not yet as developed as they will become in adult life, the conscious mind does not realize that the threat ceased to exist, and can therefore not remove such perceptions. Each person analyses new stressful situations from the perspective of his own perceptions and the frame of reference of the past. A person suffering from depression and anxiety is in the habit of generating depressive and anxious ways of thinking and acting when confronted with a new stressful situation. The subconscious mind considers these ways of thinking and acting as the best way of surviving the stressful situation, better than ways of thinking and acting from the frame of reference of the underlying problem. The medical hypnoanalysis model can detect and remove the real underlying problem by regressing the person to the time of the incident, thus correcting the old patterns of thinking and acting. The person is freed from past false perceptions, and can think and act according to his new, corrected perceptions. Through use of these mechanisms, medical hypnoanalysis has shown itself to be well suited to the treatment of depression and anxiety. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)

Utilizing an analogue research design conducted via the Internet, this study assessed athletic trainers' abilities to recognize, diagnose, and intervene with a hypothetical athlete experiencing depression, and examined the impact of their gender, athlete gender, and athlete's presenting problem on their decisions. Athletic trainers' perceived competency in using psychosocial interventions with athletes, history of referring athletes to psychology professionals, and training backgrounds in psychology also were examined. Participants (270 male and 370 female certified athletic trainers) were randomly assigned to one of six conditions (Athlete Gender X Presenting Problem). After reading the appropriate vignette, they completed questions related to the athlete's psychological symptoms and diagnosis, referral recommendations, and use of psychosocial interventions if working with the athlete. The vignettes were identical except for the athlete's gender and problem. Overall, athletic trainers accurately identified the athlete's depressive symptoms/diagnosis and need for psychological referral. They rated the athlete significantly higher in Depressive Symptoms than in Anger/Agitation Symptoms and Compulsive Behavioral Symptoms, and as more likely to be experiencing a depressive disorder compared to an adjustment disorder, anxiety disorder, sleep disorder, or substance abuse disorder. Female athletic trainers provided significantly higher ratings of Depressive Symptoms than males and the injured athlete was rated significantly higher in Anger/Agitation than the performance problem athlete. Diagnosis ratings were not influenced by athlete gender, athletic trainer gender, or type of problem. Athletic trainers were most likely to refer the athlete to a psychology professional compared to an allied health professional, treating the athlete themselves, or doing nothing. Presenting problem significantly impacted referral recommendations. If treating the athlete themselves, athletic trainers were significantly more likely to use supportive interventions than cognitive-behavioral techniques; they felt significantly more competent in providing supportive interventions. Competency in both interventions was significantly enhanced if athletic trainers completed psychology coursework. Findings suggest that athletic trainers are able to accurately identify and intervene with athletes experiencing psychological problems.

The diploma thesis deals with the theme of mental therapy, which it analyzes and examines with the result of the design of a specific architectural object - Center of Mental Health.

This dissertation research aims to develop systemic methods to analyze mental disorder and social media use data in young adults in a dynamic way. The first part of the dissertation is a comprehensive review on modeling methods of longitudinal data. The second part describes the methods that we used to identify symptom clusters that can characterize treatment trajectories and to predict responses of anti-depressants for depression patients. Manhattan distance and bottom-up hierarchical clustering methods were used to identify the symptom clusters. Penalized logistic regressions were conducted to identify top baseline predictors of treatment outcomes. The third part presents of Tweedie distribution application with generalized linear models and growth mixed models for analyzing association between social media use patterns and mental health status. The fourth part is future work and research directions.