Background: Major depression is one of the most prevalent, disabling, and costly illnesses worldwide. Despite a 400% increase in antidepressant medication use since 1988, fewer than half of treated depression patients experience a clinically meaningful reduction in symptoms and uncertainty exists regarding how to successfully obtain symptom remission. Identifying homogenous subgroups based on clinically observable characteristics could improve the ability to efficiently predict who will benefit from which treatments. Methods: Latent class analysis and latent transition analysis (LTA) were applied to data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study to explore how to efficiently identify subgroups comprised of the multiple dimensions of depression and examine changes in subgroup membership during treatment. The specific aims of this dissertation were to: 1) evaluate latent depression subgroups for men and women prior to antidepressant treatment; 2) examine transitions in these subgroups over 12 weeks of citalopram treatment; and 3) examine differences in functional impairment between women’s depression subgroups throughout treatment. Results: Four subgroups of depression were identified for men and women throughout this work. Men’s subgroups were distinguished by depression severity and psychomotor agitation and retardation. Severity, appetite changes, insomnia, and psychomotor disturbances characterized women’s subgroups. Psychiatric comorbidities, especially anxiety disorders, were related to increased odds of membership in baseline moderate and severe depression subgroups for men and women. After 12 weeks of citalopram treatment, depression severity and psychomotor agitation were related to men’s chances of improving. Severity and appetite changes were related to women’s likelihood of improving during treatment. When functional impairment was incorporated in LTA models for women, baseline functional impairment levels were related to both depression subgroups at baseline and chances of moving to a different depression subgroup after treatment. Conclusion: Depression severity, psychomotor disturbances, appetite changes, and insomnia distinguished depression subgroups in STAR*D. Gender, functional impairment, comorbid psychiatric disorders, and likelihood of transitioning to subgroups characterized by symptom improvement differed between these subgroups. The results of this work highlight how relying solely on summary symptom rating scale scores during treatment obscures changes in depression that might be informative for improving treatment response.

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.

Barriers to Colorectal Cancer Screening in People Obtaining Care From Community Mental Health Agencies by Kelly Gardiner MSN, Wayne State University, 1997 BSN, Wayne State University, 1988 Dissertation Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University August 2016 Despite being highly treatable with early intervention and preventative screenings, the overall mortality rate of colorectal cancer is substantially higher in participants with a preexisting mental disorder. Variables affecting the likelihood of completing screening for those with mental illnesses were unknown in people who obtain services from a Community Mental Health agency. Using the Health Belief Model, the proposed study investigated the effects of access to transportation, referral to screening, physical ability to complete the colonoscopy prep, type of procedure, awareness of the purpose of screening, anxiety, embarrassment, gender, race, and age to determine which affect completion of colorectal cancer screening. Significant relationships existed between embarrassment, fear of pain, fear of cancer, anxiety, physical ability to do testing, awareness of screening at age 50, FOBT vs Scope procedures, age of first screening, being told to get screening, knowing someone who had screening, and completion of colorectal cancer screening. In the binary logistic model Anxiety was negatively correlated and being told to get screening was positively correlated to completion of colorectal cancer screening and those choosing Scope were more likely to complete than those choosing FOBT. The results of this study may effect positive social change by providing healthcare providers with an increased understanding of variables that influence colorectal cancer screening completion among persons with a diagnosed mental illness, resulting in a changing agenda for effective mental and physical health care in this population.

This qualitative multiple-case study sought to provide an in-depth understanding of how children living in broken families-due to the wrongful conviction of parent(s)-developed psychosocial issues. The theoretical frameworks applied to this study were the social learning theory, the social control theory, the role-modeling theory, and the general theory of crime. A purposeful sample of 13 adults who were children at the time of their parents’ wrongful incarceration were drawn for phone and in-person interviews. The data were transcribed and analyzed to code, sort, and organize; to analyze connections in the information, and to compare and contrast cases. The multiple-case study data were analyzed using 1st and 2nd cycle coding. Among the 10 themes identified in this study were these 5: family structure and activities, behavioral issues associated with the wrongful conviction of their parents, wrongful conviction effects on education, mental health impacts of a parental wrongful conviction on left-behind children and bullying in school and at home. This implications for positive social change are that the findings raise awareness of the psychosocial issues experienced by children whose parent(s) were wrongfully imprisoned for government officials, community leaders, policymakers, and justice reform advocates who can use them to implement programs to provide psychosocial assistance to all children of incarcerated parents.

Past research has revealed that African American/Black boys are referred for special education evaluation at disproportionately higher rates than boys of other racial/ethnic groups. This correlational study used survey methodology to examine whether student and teacher demographic variables predicted how likely a teacher would refer boy students for special education evaluation. The following questions guided this research: 1) To what degree does student race/ethnicity, teacher gender, teacher race/ethnicity, and teacher attitude toward inclusion predict how likely a teacher would refer boys' to special education after controlling for teacher's years of experience in general and special education? 2) What are the differences in teacher ratings regarding the severity of classroom behaviors based on the students' race/ethnicity? Cultural theory and social exclusion theory were used to guide this research. Data were collected through the researcher developed Teacher Rating Form from 110 teachers. Results from a multiple linear regression revealed that years of teaching experience, race of teacher, race the student, and teacher attitude toward inclusion were statistically significant predictors of teacher referral to special education. However, the effect size was small. Results from the ANOVA procedure revealed no statistically significant differences in teacher ratings for severity of described classroom behaviors based on the students' race/ethnicity. Findings form this study could be used to promote social change by increasing teacher awareness of how certain teacher demographics affect teacher referral of boys to special education. Findings can be used to advocate for training and seminars that could promote cultural understanding among teachers that may lead to and reduce the number of referrals.

Alternative school settings are success prospects for students at risk of school failure. However, research on the daily experiences of the special educators in alternate school settings tasked with educating the at-risk population, is limited. The purpose of this phenomenological study was (a) to recognize the perceptions of special educators concerning their preparation to advance the success of SEN students who are at risk of school failure; (b) to determine how to improve special educator preparation programs in alternative school settings. Deci and Ryan's self-determination theory, focused on student success provided the study's framework. Twelve semistructured interviews were conducted to examine special educators' perceptions on preparation and practice for student success. Data were analyzed through block coding, code comparison and thematic searches. The study's results included accounts of special educators' perceptions and challenges related to preparation and practice for student success in alternate school settings. Emergent themes included applying classroom structure and technology, as well as individualized student instruction. Participants cited a need for rich teacher/student relationships to advance student success. Included are inferences regarding the development of teacher/student relationships. Also included are suggestions for educational leaders to consider while preparing preparatory methods for special educators who teach within the alternative school setting such as administrator knowledge of what special educators require to teach in the alternate classroom. This study may lead to social change by providing information on special educator preparation coursework meant to develop student success for the alternative school student population.

Fans of college sports embrace the idea of athletes playing sport and, in turn, receiving tuition scholarships that provide them an opportunity to trade athletic talent for a free education. A contradictory body of research using internal colonization theory posits that the trade of education for playing sports is not a fair exchange but is fraught with exploitation that continues to perpetuate subjugation. An accepted narrative in athletic competition is that the recruiting pipeline draws athletes from impoverished inner-city areas engaging young athletes who experience difficulties keeping up scholastically becoming academically resistant as they focus on their sport at the expense of their academics. Biopsychosocial and developmental neuroscience research recognizes outside social factors as variables that affect the development of the brain, thus influencing basic mechanical operations of specific brain structures. This dissertation breaks new ground by utilization of the 10-question Adverse Childhood Experiences (ACE) Inventory to explore a possible relationship between ACE scores and Academic Resistance (AR), ACE scores and Locus of Control, and ACE scores and Identity Foreclosure. Using the T-test to determine a relationship between 194 participants’ ACE scores and AR, the findings showed the probability of Type I error of 5%, to be that the AR of student athletes with an ACE score >=2, n=94, to be significantly higher than the AR of student athletes with an ACE

Similar to other immigrant populations in the United States, Haitians have a migratory history of escaping from political turmoil, natural disasters, and extreme poverty (Zephir, 2004). However, Haitian Americans remain one of the underserved populations in the United States. Marginalized yet resilient, Haitian families in the U.S. continue to display strength in the face of adversity. Second-generation Haitian-American college graduates are the evidence of such strengths. There is very little research focused on second-generation Haitian-American college graduates’ perspective on the possible familial influences pertaining to education. Using an Interpretative Phenomenological Analysis (IPA) design and Bowen’s Family Systems Theory as a theoretical framework, this study explored the lived experiences of seven selected selfidentified second-generation Haitian-American college graduates. The study was driven by three questions: 1. How do second-generation Haitian-American college graduates describe their cultural views on education? 2. How do these cultural views on education inform or influence Haitian families living in South Florida? 3. What are the lived experiences of second-generation Haitian-American college graduates regarding their family of origin’s influences on them as it pertains to education? Six themes emerged as a result: Multigenerational Method of Transmission, Reminiscent Educational Dialogue, Education as Economic Protection, Expected Educational Momentum, Future Multigenerational Method of Transmission, and Broadening the Educational View. It is the hope of the researcher that this study will expand marriage and family therapists’ understanding of the possible cultural/familial concerns, as well as, possible strengths and resources when working with Haitian families.

Sleep is an essential part of life, and obtaining quality sleep is important for various areas of functioning. Behaviors to promote sleep include physical activity, managing stress, reducing anxiety symptoms, maintaining a consistent sleep schedule, and obtaining bright light exposure. Many of these behaviors overlap with benefits observed from pet ownership (PO). The present study aimed to examine the relation between PO and sleep as well as moderators and mediators of this relation. Four research questions were examined: 1) Is PO significantly related to sleep? 2) Does gender moderate the relation between PO and sleep? 3) Do sleep-promoting behaviors (i.e., physical activity, perceived stress, anxiety symptoms, bright light exposure, sleep-wake variability) mediate the relation between PO and sleep? 4) Do the mediating effects of the sleep-promoting behaviors on the relation between PO and sleep depend on the regularity of walking? Participants (N = 1,250; 80.8% White; 50.5% men) residing in the United States reported on their sleep, physical activity, perceived stress, anxiety symptoms, and light exposure. Participants were 25.5% non-pet owners (NPO), 24.1% cat-only owners (CO), 25.7% dog-only owners (DO), and 24.7% owned dogs and cats (DCO). Data analyses included ANCOVA, Moderation, Parallel Mediation, and Conditional Process Modeling. Key findings included that PO was significantly related to sleep, with NPO sleeping worse than PO (CO/DO/DCO combined) and DCO reporting the best sleep of all four PO groups. The relation between PO and sleep did not significantly differ for men and women. The relation was significantly mediated by anxiety symptoms, perceived stress, light exposure, and sleep-wake variability depending on the groups compared and scoring methods used. Anxiety symptoms and perceived stress were the most robust mediators of the relation between PO and sleep. Walking regularity did not change the mediating effects between PO and sleep. This study is one of the first to examine daytime mechanisms of the relation between PO and sleep. The findings provide a foundation for future research examining how the integration of PO and sleep-promoting behaviors can improve adherence to sleep health recommendations, thus improving owners’ sleep.

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these hazards. The educational intervention had a strong positive effect on resilience scores (effect size of r=72%; p < 0.05). Eighty-six percent of the participants believed that the intervention increased their capabilities for self-care, especially in sleep, spending time outside, hydration, nutrition, and physical stretching exercises but not in journaling. Eighty-one percent stated that they would be likely to seek professional help if needed. Although this study must be repeated in other samples before it be implemented with full confidence, the standardized, high intensity, short duration, resilience training session can be recommended to nursing programs just prior to graduation and to hospitals for nurse orientation programs.