ABSTRACT Depression is one of the oldest known mental health conditions. It is acknowledged to be a global health problem that affects people from any culture or ethnic group. The prevalence of depression widely varied across countries and cultures. The cross-cultural relevance of the concept of depression, its screening or diagnosis, and cultural equivalence of items used to measure symptoms of depression has been area of research interest. Differences in prevalence rates in depression have been suggested as being due to research artifacts, such as use of instrument developed for one culture to another culture. With the current trend of globalization and increased rate of immigration, the need for measurement scales that can be used cross-culturally is becoming essential. Translation and adaptation of existing tools to different languages is time saving and cost effective than developing a new scale. The Center for Epidemiologic Studies Depression Scale [CES-D; (Radloff, 1977)] has been widely used as a screening tool for depressive symptoms in community and clinical settings. It has been widely accepted and translated to multiple languages and its measurement equivalence tested across groups. This study was designed as a mixed method study. The purpose of this study was three fold: (a) translate and adapt the CES-D scale into Tigrigna Language for use by Tigrigna speaking Eritrean immigrants in the United States using the forward backward translation and cognitive interview techniques (b) test the psychometric properties of the Tigrigna version CES-D scale using confirmatory factor analysis under the framework of structural equation modeling and (c) test measurement equivalence of the scale by comparing data collected from 253 Eritrean immigrants using the Tigrigna version CES-D scale with a secondary data collected from 1918 non Eritrean US citizens using the English version CES-D scale in a separate study. The baseline four factor CES-D scale model originally suggested for the general population fitted the data from both samples. The fit indices for the Tigrigna sample were (χ2 = 299.87, df = 164, RMSEA = .06, SRMR = .06, GFI = .89, and CFI = .98) and for the English sample (χ2 = 1496.81, df = 164, RMSEA = .07, SRMR = .04, GFI = .92, and CFI = .98). The Multi-group confirmatory factor analysis showed reasonably adequate fit (χ2 (328) = 1796.68, RMSEA= .07, SRMR = .06, GFI = .89, CFI = .98). Fourteen of the 20 CES-D items were invariant across the two samples suggesting partial metric invariance. Partial full factor invariance was also supported. In conclusion, the findings of this study provide adequate evidence in support of the applicability of the four factor CES-D scale for measuring depressive symptoms in Tigrigna speaking Eritrean immigrants/refugees in the United States.

Abstract Presently there are few studies that describe the current experiences of women warriors relative to issues such as sexual hostility, sexual harassment, and other uncommon experiences during their military careers. Very little is known about how being a woman in a male-dominated military may affect women warriors' choices between making the military a career or returning to civilian life. With better understanding of women warriors' military experiences, mental health professionals, educators, and other human services professionals may have a better understanding of the issues that may affect women in the military. To date there are limited studies that have examined the effects of military experiences on the psychological and emotional well-being of women warriors. Whether its effects are positive, negative, contextual, or permanent is not yet known. This study supports the earlier research regarding the needs and unknown needs of women programs and the training of counselors and helping professionals. With the United States Military being one of the largest special populations, and women warriors making up 15% of that population, it is imperative that appropriate training becomes available for counselors, educators, and other helping professionals.

School-Wide Positive Behavior Interventions and Support (SWPBIS) is an evidence- based application of Applied Behavior Analysis (ABA) to address and prevent problem behaviors from occurring, promote pro-social behaviors, and create a positive learning environment for all students. There are many secondary interventions that have been utilized within the framework of SWPBIS that have high success rates. However, the research conducted on the use of Check-In/Check-Out (CICO), a secondary intervention, has focused its attention more on its effectiveness in public elementary schools. There is a lack of research evaluating the effectiveness of CICO in alternative school settings. This study provides an extension to the literature by examining the effects of the CICO program with school-aged children residing in a mental health treatment facility. Using a concurrent multiple baseline across participants design, students were exposed to a CICO intervention strategy in which problem behaviors were targeted for reduction and academic engagement was targeted for acquisition. All three students showed substantial decreases in problem behavior and increases in academic engagement when the CICO intervention was in place.

For patients afflicted with symptoms of anxiety and insomnia, benzodiazepines are generally a safe and effective short-term pharmacological treatment option. Although considered safer than other sedative-hypnotic medications, substantial concern exists regarding the addictive nature and abuse potential of benzodiazepines along with potentially inappropriate prescribing and utilization in clinically vulnerable populations. These medication misadventures can have a significant impact on public health. Examples of medication misadventures as they pertain to benzodiazepines include the prescribing and use in clinically vulnerable populations for whom they are contraindicated or their efficacy has not been evaluated, the development of tolerance or addiction, abuse of the medication, and the manifestation of negative health outcomes including cognitive impairment, withdrawal symptoms upon discontinuation, or the reoccurrence of a preexisting substance use disorder. In order to better understand medication misadventures associated with benzodiazepines retrospective analyses using populations extracted from large health claims databases are employed. To understand how benzodiazepine use may lead to adverse events causing patient harm, the risk of exacerbations in benzodiazepine users diagnosed with chronic obstructive pulmonary disease was estimated. The inherent risk of benzodiazepine addiction and abuse was estimated in an HIV-infected population, a population with a high prevalence of substance use disorders. This risk was estimated by first determining whether HIV-infected individuals are more likely to have any benzodiazepine use compared to their uninfected counterparts, and secondly, by examining the association between HIV-infection and potentially problematic benzodiazepine use. Finally, in an effort to mitigate unexpected and undesirable consequences to public health associated with the prescription drug abuse epidemic in the US, states have implemented prescription drug monitoring programs (PDMPs) to track the prescribing and dispensing of controlled substance medications. The effect of these programs on benzodiazepine dispensing is evaluated on a state and national level. Findings will provide healthcare professionals a better understanding regarding the risk of medication misadventures involving benzodiazepines when evaluating their appropriateness in patients with anxiety, depression, and insomnia. Additionally, policymakers will understand the implications of PDMPs on the dispensing of benzodiazepines as they become a more widely used tool to combat prescription drug abuse and diversion.

Problem behaviors in the school setting have become more frequent as well as challenging for teachers and faculty to decrease while attempting to help their students attain their academic goals. Within the last decade, school-wide positive behavior support (SWPBS) has become more widespread as an evidence-based practice within the school system. SWPBS uses a multi-tiered support structure in order to affect behavior change across an entire school population. Several common secondary interventions have been utilized with high success rates. However, the research conducted thus far using the Check-In/Check-Out (CICO) program, a secondary intervention, has shown a lesser degree of success in behavior change with those students whose problem behavior is maintained by negative reinforcement or escape from aversive tasks. The current study examined the effects of the CICO program, adapted to address negative reinforcement contingencies. Using a multiple baseline across participants design, students in this study were exposed to a modified CICO intervention strategy in which problem behaviors, specifically related to the escape function as determined by a routine analysis, were targeted for reduction while academic engagement were targeted for acquisition. Results provided reductions in problem behaviors and an overall increase in academic engagement across participants with teacher implementers indicating the modified CICO program as feasible and acceptable. Implications for future research are discussed.

Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6595. Adviser: Arch I. Carson. Includes bibliographical references.

Hepatitis C virus (HCV) infection affects between 150,000 to 300,000 human immunodeficiency (HIV) positive adults in the US (Alter et al., 1999; Sherman, Rouster, Chung, & Rajicic, 2002). The majority of co-infected adults (50%-90%) have acquired HCV through substance abuse (Centers for Disease Control [CDC], 1998; CDC, 2006b). A patient's decision to begin HCV treatment is not straightforward. HCV evaluation and treatment involves a significant amount of time, energy, effort, and compliance on the part of the patient. There is limited information on how adults with HCV mono-infection make decisions about HCV evaluation and treatment (Fraenkel, McGraw, Wongcharatraee, & Garcia-Tsao, 2005). Even less is known about how adults with HIV/HCV co-infection with a history of substance abuse make treatment decisions. The purpose of this study was to describe substance abuse experiences and to explore how these related to patient decision-making about HCV treatment in HIV/HCV co-infected adults. Qualitative descriptive design and secondary data analysis were used to study these phenomena. Data were managed by using NVivo software and analyzed by secondary data analysis and qualitative content analysis. Five major themes with sub-themes emerged during the data analysis. They were: (1) The Evolution of Substance Abuse (with sub-themes: substance abuse initiation, escalation, polysubstance abuse, normalcy: a family of addicts, the enemy within, and transmission and disclosure), (2) Revolving Door: Going Back Out (with sub-themes: specific events as a trigger, emotions as a trigger, alcohol as a trigger, and destructive relationships as a trigger), and (3) Reconstructing Life (with sub-themes: defining moments in substance abuse addiction and maintaining sobriety), (4) HCV Infection Treatment Issues (with sub-themes: HCV treatment: not a priority, fear, and misinformation, and desire to use stimulated during HCV treatment), and (5) Get Clean and Try It. The participants spoke about how their substance abuse evolved from inception to sobriety, and for some it remained a problem. Relapse and recovery were fragile in nature especially in these adults with HIV/HCV co-infection. The decision-making process is influenced by substance abuse experiences, however more research is needed to uncover specific factors influencing these decisions.

The study sought to gain an in-depth understanding of the knowledge and skills regarding rehabilitation of mental health care users of nurses who work at a psychiatric rehabilitation centre, in order to design a continuing professional development plan for registered and enrolled nurses. The researcher used a qualitative, exploratory descriptive design to explore the knowledge and skills of nurses who practise in a psychiatric rehabilitation centre dealing with the rehabilitation of mental health care users. Four themes emerged from the data that were collected from four focus groups: knowledge of the rehabilitation process; the need for continuing professional development; nursing skills required for the implementation of psychiatric rehabilitation and means of communication within psychiatric rehabilitation. The researcher devised a continuing professional development plan, including topics on the management of the mentally ill, the problems associated with mental illness and rehabilitation appropriate to the mental illness. / Health Studies / M. A. (Health Studies)

This project presents dance as treatment for Orthorexia Nervosa, an eating disorder defined as an unhealthy obsession with healthy eating. Eating disorders disconnect body, mind, and spirit of an individual, and dance therapeutically connects these aspects. The specific effects of orthorexia on the body, mind, and spirit are analyzed; supported by evidence from research sources such as literature of books and scholarly journals, videos, an interview with board-certified dance/movement therapist Rachel Gonick-Mefferd, and a series of interviews with Dr. Thomas Doyle, in which he supplied a case study exemplifying dance as treatment for orthorexia. Conclusively, eating disorders and specifically orthorexia affect one’s entire being — physical, mental, emotional, social, spiritual health — and interfere with one’s entire life and daily functioning. Dance, as a holistic therapeutic approach, is effective in addressing and remedying every single one of these elements, healing one’s whole self. Therefore, it is suggested that dance may be an effective treatment for orthorexia.

DNA methylation is necessary for learning, memory consolidation and has been implicated in a number of neuropsychiatric disorders. Obtaining high quality and comprehensive data for the three common forms of methylation in brain is challenging for methylome-wide association studies (MWAS). To address this we optimized a panel of enrichment methods for screening the brain methylome. Results show that these enrichment techniques approach the coverage and fidelity of the current gold standard bisulfite based techniques. Our MBD-based method can also be used with low amounts of genomic material from limited human biomaterials. Psychiatric disorders have high prevalence and are often chronic making them a leading contributor to disability. Major depressive disorder (MDD) has a lifetime prevalence of ~15% and high recurrence leading to substantial morbidity and costs to society. The underlying biological processes that contribute to MDD are poorly understood. Noting the importance of DNA methylation in neurobiology, we conducted the largest MWAS in human post-mortem brain uncover novel candidate genes and biomarkers associated with MDD. The top result of this MDD MWAS was within the gene ANKS1B. This gene has been implicated in many past genetic studies of psychiatric disorders and has experimental support as a regulator of neurotransmission. Targeted epigenetic editing technologies allow for precise modification of DNA methylation in living cells. However, an appropriate model system is critical to properly interpreting such experiments. An accelerated protocol for differentiating Ntera2 cells into human neurons was developed for this purpose. Ntera2-derived neurons express key neuronal markers and are well suited to use in epigenetic editing experiments. Concurrently, the generation of the reagents necessary for recapitulating the aberrant methylation at ANKS1B linked to MDD was undertaken. Using a modified CRISPR/Cas9 approach demethylating enzyme was directed to target sites to attempt perform editing of DNA methylation. Results indicate that significant but biologically irrelevant changes to methylation at ANSK1B were achieved. The novelty of the technology employed presented challenges to the success of the current work. However, the field of epigenetic editing is advancing rapidly and will remain an attractive method for functional characterization of future MWAS findings and basic neuroscience research.