The population of older adults in the United States is steadily rising. The Centers for Disease Control and Prevention (CDC) recently released a call to reduce mental distress in older adults. Research shows that mental distress is associated with depressive symptoms, which are significantly related to many chronic medical conditions, functional impairment, suicide, and all-cause mortality. Depression is a major public health concern. There is an interest in gerontology research on the buffering role of engagement against depressive symptoms such as volunteering, social activities, and religion. Certain religious beliefs and behaviors contribute to maintaining or improving mental health and research suggests that religiosity may act as a buffer against depressive symptoms. As the population of older adults exponentially increases, there is a need for theory guided research that examines the relationship between religiosity and depressive symptoms and mediators as possible mechanisms. This study addresses two important gaps in the literature on depressive symptoms within the religious gerontology field: the relationships of a wider range of religious variables with depressive symptoms, and examining health behaviors and social support as mediators. Data were collected from the University of South Florida (USF) Health in The Villages study, a population-based study of older adults residing in an active living community in southwest central Florida. Binary logistic regression analyses were conducted that examined multiple measures of religiosity (organizational religiosity, subjective religiosity, and subjective spirituality) and covariates as predictors of depressive symptoms as defined by the Patient Health Questionaire-2 (PHQ-2). The PHQ-2 is a validated 2-item screener tool for measuring depressive symptoms. A series of mediation analyses were conducted to test for possible mediation of religiosity and depressive symptoms. Proposed mediators included in the mediation analyses were: health behaviors (tobacco use, alcohol use, vegetable/fruit consumption, dietary habits, and medication adherence) and social support (emotional support and availability of a caretaker). Organizational religiosity was significantly associated with depressive symptoms. However, subjective religiosity and subjective spirituality were not significantly associated with depressive symptoms. Health behaviors and social support did not mediate the relationship of organizational religiosity and depressive symptoms. Findings suggest that increased religious/church service attendance is associated with fewer depressive symptoms. Social support and health behaviors did not mediate the relationship between religious/church service attendance and depressive symptoms. Future research studies should explore other theory-guided constructs as possible mediators of religiosity and depressive symptoms. Additionally, contrasting findings between the relationship of depressive symptoms and subjective measures of religiosity versus organizational religiosity, suggests the continued use of multidimensional measures of religiosity within research. Future research should examine specific aspects of religious service attendance and in relation to depressive symptoms. Furthermore, 41% of participants who attended a religious/church service weekly or more reported depressive symptoms, thus based on their choice to regularly engage in religious activities, they are likely to be receptive to participating in faith-based approaches to address depressive symptoms. Therefore, for communities and individuals who are open to faith-based approaches, findings support the use of spiritually modified depression therapies at the individual level. Also, behavioral health prevention initiatives are recommended at the organizational level such as hosting depression screenings at faith-based health fairs. As the population of older adults continues to rise public health and behavioral health professionals should explore opportunities for collaboration with faith-based communities.

The year 2012 was a year of great controversy surrounding autism in France. Thus it is an ideal time for an investigation of the treatment of and attitudes about autism in France, specifically in comparison with the United States. This investigation encompass several specific categories, and the Freudian psychoanalytic method against the behavior modification method, the French education system and the identification of autism, "Maternal Madness" - the connection between sexism and autism, the philosophy of humanity and the history of medical experimentation and psychiatry in France. This paper questions how is it that all these categories influence the opinions and and treatment of autism in France and what importance these attitudes have in French society.

Abstract Fatigue is one of the most bothersome symptoms reported by patients diagnosed with cancer, and research indicates that the majority of patients receiving chemotherapy report symptoms of fatigue. Fatigue can have an effect on quality of life; therefore, it is essential that healthcare providers gain a better understanding and recognition of fatigue. Fatigue can also be a symptom of depression. Depression is another prominent symptom reported by patients diagnosed with cancer. Unfortunately, there are similarities between the symptoms of depression and fatigue making it difficult for health care providers to distinguish between the two. This study utilizes the subscale of the Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Scale-Short Form to further investigate the relationship between cancer-related fatigue and depression. The convenience sample consisted of 30 chemotherapy patients being treated at an outpatient infusion center in a comprehensive cancer center in southwest Florida. All participants were between the ages of 26 and 74, and had been receiving chemotherapy for a minimum of three weeks; none had been diagnosed with chronic fatigue syndrome, or were currently being treated with radiation. The participants in the study self-rated their fatigue on a Likert-type scale of 0-10. The mean score on the self-rated fatigue scale was 4.03 (SD= 2.76). This study supports prior studies in which chemotherapy patients report mild to severe levels of fatigue. The mean score on the depression subscale of the Hospital Anxiety and Depression subscale was 4.53 (SD=4.2). A statistically significant correlation was noted between cancer-related fatigue and depression, utilizing the Hospital Anxiety and Depression subscale score and Multidimensional Fatigue Inventory-Short Form total scores (r=.676, p=.000). This study provides evidence that tools such as the Hospital Anxiety and Depression Scale and the Multidimensional Fatigue Inventory-Short Form can aid researchers and providers in distinguishing between fatigue and depression. Using these instruments in future research and practice may help avoid the overlap in symptoms of fatigue and depression. These study results support findings from previous studies indicating a moderate correlation between cancer-related fatigue and depression. This study addresses the correlation between cancer-related fatigue and depression in chemotherapy patients which may improve nursing assessment of fatigue and depression in this population. Findings suggest the need for ongoing research focusing on cancer-related fatigue and depression as well as appropriate pharmacological and non-pharmacological interventions to improve the quality of life of this patient population.

Older offenders (offenders 50 years and older) are a distinct groups within the U.S. correctional system. Studies 1 and 2 were intended to investigate mental health and stressors among jailed older offenders. Study 1 examined the prevalence rates of mental health disorders and explored the relationship between mental health disorders and stressors. Participants 50 years and older (N=330) from the 2002 wave of the Survey of Inmates in Local Jails (SILJ) were studied via descriptive analysis, factor analysis, and a logistic regression to determine which variables were related to the probability of having a mental health problem. 65.8% of participants had at least one mental health disorder, with high rates of substance abuse reported. Individuals who were between 50-59 years of age (compared with those over 60) and individuals who were unmarried had a significantly increased likelihood of being in the group with mental health problems. Caucasians and participants with fewer instances of childhood abuse were significantly less likely to be in the group with mental health problems. Study 2 compared stressors over the life course between late life first time offenders (offenders whose first arrest occurred at age 50 or older; hereafter LLFTO) and habitual older offenders, who had one or more arrests. This study descriptively and comparatively analyzed individuals who were age 50 or older at arrest and reported their age of first arrest from the 1996 and 2002 waves of SILJ, with a final sample of 62 LLFTOs and 357 older offenders with previous arrests. LLFTOs were significantly older, more likely to be married, and more likely to be female. Over the life course, LLFTOs were more likely to have lived with their father or other relative as children, were less likely to have used alcohol or had friends with a history of delinquency as adolescents, and were less likely to have been homeless as adults. This dissertation research shows that older offenders have a variety of needs during their incarceration that may persist upon release. Addressing mental health disorders, and stressors across the life span, is needed to promote successful aging.

Research in the area of self-injurious behaviors and the family context is still emerging. The majority of research available is quantitative in nature. The limited qualitative research available in this area has been conducted outside of the United States. A collective case study was conducted with four parents with an adolescent that had been admitted to an inpatient psychiatric residential facility with a presenting problem of self-injurious behavior. The purpose of this study was to gain an in-depth, qualitative understanding of the parent perspective and comprehension of adolescent self-injurious behavior including the parents' ideas on how the parent-child relationship or other family relationships may have influenced the self-injury. With-in case and cross-case analyses were utilized from the collected data including field notes, interview scripts, member checking sessions, and medical record reviews. Themes identified using an inductive content analysis were discussed based on each primary interview question. Clinical implications included the importance of providing parental education, encouraging parent participation in therapy, treating self-injurious behavior from a trauma-informed perspective, and others were considered. Limitations of the present study, directions for the use of the present research, as well as implications for future research were reported.

Although collaboration between school psychologists and community-based mental health professionals is essential in the provision of comprehensive and effective mental health services for youth with intensive mental health needs, youth may not receive the full benefit of these coordinated efforts, as collaboration may not occur as often as it should. This study investigated the frequency of communication and collaboration between school- and community-based professionals, the purposes and methods of communication, and the benefits and barriers to collaboration. Survey data from 80 members of the Florida Association of School Psychologists were collected and analyzed. Forty-three percent of school psychologists reported communicating and collaborating with community-based mental health professionals between one and four times a year. Findings indicated that school psychologists prefer to communicate through phone calls, written reports, and face-to-face discussion; they also perceive these methods of communication to be most effective. Barriers to collaboration included limited accessibility of community professionals and lack of time to collaborate. A significant relationship was found in communication frequency and number of professional development hours received related to mental health. Implications of these findings are discussed in relation to developing strategies for practitioners and trainers of school psychologists aimed at optimizing the mental health of youth.

Internalizing disorders, specifically depression and anxiety, affect up to 18% and 33% of youth, respectively (Costello, Egger, & Angold, 2005b). Schools have become a major provider of mental health services to children, primarily in attempts to overcome barriers to receiving community services (Farmer, Burns, Philip, Angold, & Costello, 2003). As such, it is important that schools have effective mechanisms in place to accurately identify students who may be in need of such services. The current study examined the accuracy of one such method, educator nominations (including from both teachers and school-based mental health professionals) in identifying students who self-report elevated levels of anxiety and/or depression. Participants were 238 fourth and fifth grade students within a large, urban school district in a southeastern state; 26 classroom teachers of these youth; and 7 mental health professionals who served the two schools that the student participants attended. Regarding sensitivity, teachers identified 40.74% and 50% of students who repeatedly reported clinically elevated levels of anxiety and depression, respectively. Teachers falsely identified as symptomatic 17.54% and 16.2% of students with typical levels of anxiety and depression, respectively. As a team, school-based mental health professionals identified 66.67% of students with elevated anxiety symptoms, and 45.45% of children who self-reported depressive symptoms. The team misidentified 31% and 35% of students as depressed and anxious, respectively. Individual school-based mental health professionals were less accurate (as compared to ix the team as a whole) in identifying students who self-reported symptoms of depression. Taken together, findings suggest educators can accurately identify approximately half to two-thirds of youth who experience clinical levels of anxiety and children, but substantial misidentification rates underscore the need for further follow-up assessment of students identified during educational nomination procedures. Implications for practice, contributions to the literature, and future directions for research are discussed.

Examinations of stress in relation to adolescent mental health have not often utilized a comprehensive definition of psychological functioning. Recent literature has found support for the importance of examining optimal psychological functioning as the presence of high life satisfaction in addition to low psychopathology (Antamarian, Huebner, Hills, & Valois, 2011; Suldo & Shaffer, 2008). Most research on stress has focused on either major stressful events or chronic environmental stressors; further research is needed on the psychological model of stress, which conceptualizes stress as involving both environmental events and one's cognitive appraisals of the stressor. The current longitudinal study determined how multiple types of stress (accumulation of stressful life events, chronic stressors in social relationships, global perceived stress level) are associated with mental health (i.e., psychopathology and life satisfaction) over a one year period. Additionally, this study explored whether perceptions of social support from various sources (i.e., parents, classmates, teachers) act as a protective factor in the relationship between stress and later mental health outcomes. Data collection for Time 1 occurred in the Fall 2010, and was part of a larger on-going research project involving 500 students from grade 9 - 11. Time 2 data collection occurred during the Fall of 2011 and included 425 of those students, now in grades 10-12. Analyses included multiple regression to examine both the overall contribution of stress on mental health outcomes (life satisfaction, internalizing psychopathology, externalizing psychopathology) as well as the unique contributions of various types of stress. Additional regression analyses explored whether social support from various sources acts as a buffer for students that experience stress from later increases in psychopathology or declines in life satisfaction. Results revealed that the combination of Time 1 mental health variables and all forms of initial stress accounted for the most amount of variance (45%) in Time 2 internalizing problems and the least amount of variance in Time 2 externalizing problems (13%). In all cases, the largest predictor of Time 2 mental health was initial levels of mental health. The only stressor that appeared as a unique predictor of Time 2 mental health was stress in the student-teacher relationship, which accounted for a significant amount of variance in Time 2 externalizing problems. Further regression analyses found that parent and peer support were critical in predicting later mental health (i.e., exerted main effects). These analyses identified trends in the data in which parent and teacher support acted as buffers in the relationships between some forms of stress and later mental health. Implications for school psychologists and future directions for research are discussed.

ABSTRACT Purpose of the study. Through secondary data analysis of results from the School Mental Health Services Integration Survey (SMHSIS), this study describes indicators of school mental health integration preparedness, including role identification, willingness to engage in tasks associated with mental health services integration and implementation facilitators. The study also investigated the utility of a modified version of the Evidence-Based Practice Attitude Scale (EBPAS) for use with school staff. Study rationale. With as many as 20% of children meeting criteria for mental disorders that cause impairment, the gaps in mental health services delivery to this special needs population are evident and persistently problematic. Less than a third receive the services they need due to structural as well as attitudinal barriers to accessing services. Trends toward delivering services where children are located are noted and schools have emerged as de facto provider of mental health services to children. Yet, schools are not traditionally arranged or organized toward mental health services delivery, and though school-based mental health innovations are emerging there is no agreed upon unifying framework for integration of mental health services into school settings. Whereas school-based mental health is connecting to the evidence-base more often, evidence-based practices remain under-utilized. The present study examines school mental health services integration readiness in a large urban school district in central Florida. Methods. The SMHSIS was conducted by email and participants included seven group of professional staff, including principals and assistant principals, teachers, guidance counselors, social workers, psychologists, school resource officers, and school health staff. Data analysis involved exploratory factor analysis (EFA) of survey sections, in an effort to uncover indicators of readiness for school mental health integration preparedness in three domains, role identification, willingness, and implementation facilitators. One-way analysis of variance (ANOVA) and post hoc tests were conducted to examine differences in perspectives on these domains, by professional group. Finally, a multiple regression model was used to examine the relationship between 6 predictor variables and a single continuous dependent variable, mean scores on the EBPAS. Results. EFA resulted in the identification of 6 variables in the domains of role identification, willingness, and implementation facilitators. Analysis of variance demonstrated significant differences by professional group in perspectives on these variables. In the role identification domain, social workers, school psychologists, and guidance counselors endorsed adoption of a provider role, and school principals and assistance principals as a group adopted a facilitator role. Social workers and psychologists were uniquely high and emerged as leaders in endorsing willingness to engage in tasks associated with mental health services delivery. However, it was noted that no group endorsed a non-willing, or non-participant role. Implementations facilitators were identified in the areas of overall organizational structure, individual support, and shared professional responsibility. Finally, a summary of the regression showed that indicates that 29.0% of the variance in EBPAS scores was explained by the 6 predictor variables. The Willingness variable made the strongest unique contribution to predicting EBPAS outcomes. One other variable, Shared Professional Responsibility also made a significant unique contribution to the variance in the dependent variable, and none of the remaining four variables approached statistical significance. Conclusions and implications. Taken together, these outcomes form the basis for a better understanding the current environment for integration of mental health services delivery in a large urban school district, and indicators for readiness to adopt evidence-based practices. Survey outcomes provide useful information to school administrators and EBP developers on characteristics that can facilitate services integration, and call attention to training and policy needs. More broadly, outcomes potentially contribute to the development of a formalized framework for mental health services delivery in schools. Finally, areas of divergence in beliefs about services delivery, as well as congruence in the attitudes of groups of professional staff have been examined. By engaging various levels and types of school staff simultaneously on a single survey, the survey design has the added value of addressing the need for more complex research methods in the investigation of mental health services in schools.

Caregivers of persons with dementia, who are often older adults, report sleep disturbance, high rates of depressive symptoms and may be at risk for impaired cognition. This dissertation examined sleep, depressive symptoms, and cognition in older adults and caregivers of persons with dementia. The aims of the review of literature were to understand, in community dwelling adults 60 years and older, the relationships among sleep parameters (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and general sleep complaints), and the domains of cognition (Executive Function, Attention, Episodic Memory, Working Memory, Processing Speed), and global cognition. Based on the findings, the research on the association of subjective sleep parameters and cognition is inconclusive and there is insufficient evidence to confirm or deny the existence of a relationship between objective sleep parameters and cognition. The methods section examined whether in adults 60 years and older, Radloff’s postulated 4-factor structure replicates across Afro-Caribbean Americans, African-Americans, Hispanic-Americans, and European-Americans and determine whether there is evidence for measurement invariance across the four ethnic groups in their responses to the Center for Epidemiological Depression Scale (CES-D) statements. Radloff’s postulated 4-factor model fit the data adequately and the results suggest that there is evidence for configural and partial metric invariance. The final section examined the relationships among subjective sleep parameters (Sleep Onset Latency, Wake After Sleep Onset, Total Sleep Time, Time in Bed, Sleep Efficiency, Sleep Quality), depressive symptoms, and, crystallized, fluid and total cognition in caregivers of persons with dementia with poor sleep. Based on the findings, depressive symptoms also did not mediate the ability of the sleep parameters to predict cognitive performance. With the knowledge that there are potential associations among sleep parameters, depressive symptoms and cognition in caregivers, healthcare providers should collect baseline assessments on sleep, depressive symptoms and cognition from caregivers and monitor them on an ongoing basis to identify changes and intervene in a timely manner. More research studies incorporating measures to capture sleep variability and similar cognitive measures, are needed to clarify the relationships both in older adults and caregivers of persons with dementia.