Evidence supporting a range of 6-14 years between mental illness symptom recognition and psychological help seeking has spurred a substantial interest in help seeking barriers. The present study suggests that mind and body dualism, the perceiving of the mind as an entity distinct from the body, is one such barrier to help seeking. Despite the fact that beliefs in mind-body dualism or its opposite, that of physicalism, are evident in virtually all human cultures and religions, surprisingly little is known about the psychological and behavioral implications of holding such beliefs. An exception to this disparity is a study that demonstrated a connection between dualism and decreased engagement in healthy behaviors, such as exercise and eating habits (Forstmann et al., 2012). The aim of the present study was to expand on these findings by investigating the effects of mind-body beliefs and gender on attitudes towards professional psychological help and holistic or alternative medicines. In accordance with my hypothesis, a MANOVA indicated a main effect of gender, such that women felt more positively than men about seeking professional help for their own mental health problems as well as about the general value of therapy for others. A secondary analysis indicated that participants who self-identified as Jewish felt significantly more positive about psychotherapeutic treatment compared to Christian, Hindu, and Buddhist religious groups. Future research should continue to examine the links between mind-body ideologies, religion, culture, and help seeking through a large-scale correlational analysis utilizing naturally occurring mind-body beliefs.

Parental death can have a negative impact on children’s lives with changes in economic resources, and lead to change in residence, loss of contact with friends and neighbors, change in caretakers, and loss of time with the surviving parent. Research on the effects of a grandparent’s death on children is limited. Death of a sibling signifies the loss of a role model, friend, confidante, and playmate. The purpose of this correlational study was to identify: 1) differences in the spiritual coping strategies used by children across age groups, gender, race/ethnicity, participation in religious rituals and practices, and the relationship of the deceased to the child (parent, grandparent or sibling), and 2) the relationship between children’s use of spiritual coping strategies and grief, personal growth, anxiety, and depression after the death, with and without controls for child’s age, gender, race/ethnicity, participation in religious rituals and practices, and relationship of the deceased to the child. A sample of 97 children, 8 to 18 years old and 64% Hispanic completed the Spiritual Coping Strategies Scale, Hogan Inventory of Bereavement, Spence Children’s Anxiety Scale, and Child Depression Inventory, and their parents completed a demographic form. Children who participated in religious rituals after the death used less religious coping strategies than children who did not participate. When child’s age, gender, race/ethnicity, participation in religious rituals and practices, and relationship of the deceased were controlled, greater use of spiritual coping, but not religious coping, and greater grief were significantly related to greater personal growth and greater anxiety. Younger children and Black children had significantly greater anxiety. Only grief was significantly related to depression. Children who experienced the death of a parent, grandparent, or sibling had similar outcomes. The results of this pioneer study will add knowledge to the state of the science regarding the effects of children’s spiritual coping after parent, grandparent, or sibling death on their grief, personal growth, and mental health which is a subject area were very little is known.

AIDS-related stigma and mental health professionals.

Background: Alzheimer’s disease (AD) is a type of Dementia and a neurodegenerative disease that is characterized by the gradual degrading of both memory and cognitive functions. According to the World Health Organization (WHO), the prevalence of AD is increasing globally. Currently, AD is the sixth leading cause of mortality in the United States. As the ageing population increases in the United States, it is possible that AD will move up the ladder in the top cause of mortality. Although the prevalence of AD in most urban parts of developed nations such as the United States is widely known, little is known about the prevalence and early diagnosis of the disease among the rural populations. According to a study by the Centers for Disease Control and Prevention (CDC), on deaths from AD between 1999 and 2014, most mortality are concentrated in the rural counties of the Appalachian region of the United States, where the mortality rate has increased by an alarming 75%. Our study focuses on the Northeast Tennessee region, which is a prominent part of the Appalachian region. We examine the prevalence of Alzheimer’s disease in the Northeast Tennessee region compared to other parts of the state of Tennessee. We sought to understand whether there is a likely association between the disease and the rural counties in the Northeast Tennessee region. Methods: We performed a cross-sectional study that computes and compares between the Prevalence Odds Ratio (POR) of the 2013 to 2015 Centers for Medicare and Medicaid Services Public Use Files data on rural versus urban counties in the Northeast Tennessee region followed by the Northeast Tennessee counties versus other counties in Tennessee. In addition, we collected primary data from 44 experts and professionals working in AD-related fields within the Northeast Tennessee region using an online survey that captures the perceived observation of the experts and professionals about the increasing prevalence of AD over the last five years. Results: Findings show that the rural counties within the Northeast Tennessee region had 18.3% (POR: 1.183, C.I: 1.113-1.258), 4.7% (POR: 1.047, C.I: 0.982-1.117), and 19% (POR: 1.190, C.I: 1.121-1.264) increased odds of prevalence of AD compared to the urban counties within the region in 2013, 2014, and 2015, respectively. Similarly, the Northeast Tennessee region as a whole, had increased odds of 22.7% (POR: 1.227, C.I: 1.203-1.250), 22.5% (POR: 1.225, C.I: 1.202-1.249), and 21.2% (POR: 1.212, C.I: 1.189-1.235) of AD compared to all other counties in Tennessee during the same periods. Conclusions: Statistical analysis and findings from experts and professionals working with patients with AD in the Northeast Tennessee region show that there are more cases of AD in the Northeast Tennessee region compared to the last five years. We suggest early screening strategies for possible decrease in the morbidity and mortality rates in Northeast Tennessee region.

Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice–involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-of-home placements. Implications and future directions are discussed.

Background Youth and young adults represent a critical time for early detection and intervention of serious mental health conditions (SMHCs); however, of all age groups, health care use is lowest in young adults. Continued access to health services such as outpatient primary care and specialized mental health care, especially during the transition from pediatric to adult care, is important to improving outcomes in those with serious mental health conditions. Methods Stakeholder engagement and a mixed-method design were used. Quantitative Aims 1 and 2 used the IBM MarketScanCommercial Database. Qualitative Aim 3 used semi-structured interviews with a purposive sample of pediatricians and child/adolescent psychiatrists. Stakeholders were engaged throughout all Aims to ensure relevance of goals, real-world interpretation of results, and dissemination of key findings. Aim 1 described patterns of outpatient (e.g., primary, reproductive, mental health care) and acute (e.g., emergency room use, inpatient hospitalization) health care use by age, and serious mental health condition for youth and young adults. Aim 2 used logistic models with generalized estimating equations to identify factors associated with mental health follow-up after hospitalization and emergency room use for a serious mental health condition. Aim 3 explored pediatrician and child/adolescent psychiatrist perspectives on coordinated care for youth and young adults with serious mental health conditions, particularly as they transition to adult care. Main Results The prevalence of outpatient mental health care and primary care decreased with age, with a larger drop in primary care utilization. While 74.0-78.4% of those aged 12-17 years used both outpatient mental health care and primary care, 53.1-59.7% of those aged 18-27 years did. Differences were observed by mental health condition; those with schizophrenia and other psychotic disorders had the lowest rates of outpatient primary care use and the highest rates of acute care use. Of those hospitalized, 42.7% received follow-up within 7 days and 64.7% within 30 days. Of those with emergency room use not resulting in a hospitalization, 28.6% received follow-up within 7 days and 46.4% within 30 days. Having established mental health care strongly predicted follow-up, and more so than having established primary care. Providers described poor communication systems, no organized process for the transition from pediatric to adult care, a lack of time and reimbursement, and inadequate connection to community supports as key barriers to continuous, coordinated care for youth with serious mental health conditions. Conclusion Findings provide foundational knowledge to inform efforts to provide a comprehensive continuum of care for people with serious mental health conditions, potentially through increased access to primary care and specialized mental health care via enhanced care coordination of providers.

Bipolar disorders (BD) are characterized by symptoms of grandiosity, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increased goal-directed activities, psychomotor agitation, and excessive involvement in pleasurable activities. Those with a bipolar disorder have a high degree of psychiatric comorbidity including substance use disorders, and they also experience increased mortality. Despite the widespread recognition of BD as an important psychiatric condition, available population-based estimates for BD prevalence differs across data sources. Cannabis is one of the most widely-used illicit substances. Evidence supports it as a risk factor for psychotic symptoms and disorders. Because populations with psychotic disorders and populations with bipolar disorder share genetic characteristics, cannabis may increase risk for bipolar disorders through the same pathways as it does with psychotic disorders. Limited and conflicting evidence regarding the association of cannabis use and bipolar disorder is currently available. This dissertation investigates cannabis use as a risk factor for incident manic symptoms and bipolar disorders in a large nationally representative longitudinal cohort. The first aim of this dissertation is to evaluate the implications for manic, hypomanic and major depressive episode prevalence estimates arising from the different approaches to assessing DSM-IV criterion between two national surveys. Differences in the assessment of impairment strongly influence manic or hypomanic classification within the NESARC. Compared to multiple imputation estimates (19.7% [95% CI: 19.3-20.1]) which treat depressed mood and anhedonia as separate symptoms, symptom assessment in the NESARC substantially underestimates major depressive episode prevalence (16.9% [95% CI: 16.1-17.6]). The second research objective examined self-reported cannabis use as a risk factor for incident manic symptoms, bipolar spectrum disorders (including manic and hypomanic episodes) and SCID-based recalibrated BD I and II. Cannabis use risk was assessed in the population as a whole and in sub-populations defined by age, substance abuse/dependence status, and family history. Among those reporting no lifetime major depressive or manic symptoms at baseline, self-reported past-year cannabis use was associated with increased odds of an incident week of extremely elevated or irritable mood accompanied by at least two manic episode criterion B symptoms (adj. OR 1.69, 95% CI: 1.08-2.65, p=.02) over the three year follow-up period. Among adults (ages 26 to 45) >=1 reported use(s) of cannabis per week was associated with incident manic or hypomanic episodes (adjusted OR 2.52, 95% CI: 1.32-4.80, p=.006). Among those endorsing no major depressive symptoms, substance abuse/dependence, or anti-social traits in their first degree relatives, past year cannabis use is associated with increased risk for incident bipolar spectrum disorders (adjusted OR 2.27, 95% CI: 1.01-5.10, p=.05) and CIDI recalibrated BD I and II (adjusted OR 5.49, 95% CI: 1.38-21.9, p=.02). Past year cannabis use risk for DSM-IV manic or hypomanic episodes among those aged 26 to 45 is concentrated in those with a baseline history of a substance use disorder (adj. OR 2.00, 95% CI: 1.10-3.66, p=.02) as compared to those with no such history (adj. OR 1.87, 95% CI: 0.49-7.21, p=.36). The third research objective of this dissertation was a sensitivity analysis using externally-predicted categorized exposures and continuous cannabis use propensities. The sensitivity analysis found evidence of exposure misclassification. Exposures defined by external propensity scores had improved cross-sectional association with bipolar spectrum disorders compared to reported use when both were compared to an external standard. No significant risk estimates were found for categorized predicted cannabis use among groups that were previously found to have significant risk from reported exposure. However, among adults 18 to 45 years of age with no manic or major depressive symptoms at baseline, past year cannabis use propensity (as a log transformed continuous measure) was associated with incident manic or hypomanic episodes (adj. OR 1.49, 95% CI: 1.10-2.03, p=.01). Elevated risk for high cannabis use propensity (>=1 use/week in the past year) was also found in this same group (adj. OR 1.33, 95% CI: 1.03-1.72, p=.03). Among those with no reported history of depression, substance abuse/dependence, or anti-social traits among their first-degree relatives, propensity for past year cannabis use (adj. OR 1.61, 95% CI: 1.11-2.32, p=.01) and propensity for >=1 use/week of cannabis in the past year (adj. OR 1.38, 95% CI: 1.03-1.85, p=.03) were associated with incident manic or hypomanic episodes. Among those without a substance use history at baseline, propensity for past year cannabis use (adj. OR 1.63, 95% CI: 1.33-1.55, p=1 use/week of cannabis in the past year (adj. OR 1.54, 95% CI: 1.26-1.88, p The findings of the first aim support the conclusion that the AUDADIS substantially under-estimated lifetime major depressive episode prevalence compared to an imputed estimate that treated anhedonia and depressed mood as separate and concurrent MDE symptoms. The operationalization of impairment for manic disorders in both the AUDADIS and CIDI strongly influences case identification, with the CIDI having suppressed manic and hypomanic prevalence estimates. Evidence was found supporting the conclusion that self-reported cannabis use is a significant risk factor for incident bipolar spectrum outcomes within subpopulations in a nationally representative cohort. A sensitivity analysis finds evidence that supports the conclusion that increasing cannabis use propensity is associated with increased risk of bipolar spectrum outcomes within population subgroups, with the greatest increased risk among those with the lowest innate risk. Under-reporting of illicit substance use is a major limitation in this dissertation; further study is needed with improved exposure measures.

The development of emergency department medical interventions and the implementation of fast-transport trauma systems has decreased the rate of death resulting from traumatic brain injury (TBI). Without corresponding methods for long-term treatment and recovery, the prevalence of people disabled by TBI has increased, creating a growing public health problem. Investigations generated by physicians, rehabilitation programs, and social scientists, which attempt to associate standard measures of injury severity with outcome, leave unexplained variance in long-term functional status for persons with TBI. The purpose of this investigation was to use persons with brain injury and their family members, to guide an analysis of the factors that foster successful recovery from brain injury. Three studies were conducted. In Study #1, the method for observation generated by Kurt Goldstein (1934) was adopted to conduct 20 case studies of persons who sustained brain injury. The Schema of the EsEx Couple (Maynard. 1992) was used to orient the investigation. The EsEx Couple Schema proposes that events in human life must be understood by considering the whole system of Person (Essence) in the Environment (Exchange), and the transactions that flow in a recursive loop from Person to Environment and back. Kurt Goldstein's Laws of Organismic Life (1934), a model consistent with that of the EsEx Couple, was used to evaluate the data. Strong patterns associated family and social networks, autonomy, and perceived self-determination with higher levels of recovery, and were used to generate a Model for Recovery. In Study #2. the Motivational Analysis of Self-Systems Processes (Connell & Wellborn, 1991) was combined with results from Study #1 to generate a Development Model, and to build a survey which was administered to 248 persons with brain injury. Results (1) confirmed the model, indicating factors that contribute to recovery were hypothesized measures of Social Context, Perception, and Engagement; and (2) established a valid instrument, generated by persons with brain injury and their families, for measuring functional status. In Study #3. results of the survey research were used to return to the case studies to consider where individual lives differ from expected patterns, and why. Deviations from expected patterns were explored to identify how individual differences operate to affect outcome. Recommendations for clinical practice include (1) directing interventions toward family as well as patient, as a method of enhancing the Social Context for the patient, and (2) using careful evaluation of each patient's idiosyncrasies to consider individual interventions.

The purpose of the current study was to compare the results yielded from descriptive analyses of physical activity to those of functional analyses with the same preschool children. Descriptive analyses were conducted during repeated, 30-min naturally occurring outdoor times on an outdoor playground in a local daycare. Five minute functional analysis sessions were conducted on an outdoor playground within a multi-element experimental design. The Observational System for Recording Physical Activity in Children (McIver, Brown, Pfeiffer, Dowda, & Pate, 2009) was used to define the conditions and various levels of physical activity within both the descriptive and functional analyses. Overall, results for all participants suggested high correspondence between outcomes from the functional and descriptive analyses with respect to the context related to the highest level of MVPA, but correspondence varied across other contexts. Implications of the results and suggestions for future research are offered.

The United States generated 251 million tons of municipal solid waste in 2012, half of which ended up in landfills; paper and paperboard make up the largest portion. Although the effects of antecedent and consequent manipulations on recycling are fairly well understood, with few exceptions (e.g., Trudel & Argo, 2013), the effect of stimulus characteristics on recycling has not been evaluated. Using a between subjects experimental group design, Trudel and Argo (2013) found size, and for cans, condition, affected recycling, such that more participants recycled large pieces of paper and large undented aluminum cans and fewer participants recycled small pieces of paper and small dented and undented aluminum cans. However, Trudel and Argo’s (2013) data provide little information regarding how context or group sessions affect recycling or whether the condition of paper might differentially affect recycling, as it did with cans. The present study used individual sessions, controlled for contextual variables (i.e., participant viewed all sizes of paper), and examined the effect of both size and condition of paper (i.e., crumpled or smooth) on recycling. Participants ( N = 60) were told this was a study about memory. They were instructed to complete a set of sorting tasks twice (for a total of two trials) with four different pieces of paper (standard-size smooth, standard-size crumpled, half-size, eighth-size), and, after each sorting task, to dispose of a piece until all four pieces were disposed. Results indicated neither size nor condition affected recycling; nearly all participants (90%) recycled all the paper. Factors other than paper size or condition (e.g., participant reactivity, geographic differences, exposure to all types of paper) may explain why results of the current study differed from previous research.