Somatic complaints of children in primary care settings often go unexplained despite attempts to determine a cause. Recent research has linked violence exposure to stress symptomatology and associated somatic problems. Unknown, however, is whether specific physical symptom complaints can be attributed, at least in part, to violence exposure. Urban African-American 6- and 7-year-old children (N = 268), residing with their biological mothers, recruited before birth, and without prenatal exposure to hard illicit drugs participated. Children and mothers were evaluated in our hospital-based research laboratory, with teacher data collected by mail. Community violence exposure (Things I Have Seen and Heard), stress symptomatology (Levonn), and somatic complaints (teacher-and self-report items) were assessed. Additional data collected included prenatal alcohol exposure, socioeconomic status, domestic violence, maternal age, stress, somatic complaints and psychopathology, and child depression, abuse, and gender. Community violence witnessing and victimization were associated with stress symptoms (r= .26 and .25, respectively, p < .001); violence victimization was related to decreased appetite (r = .16, p < .01), difficulty sleeping (r = .21, p < .001), and stomachache complaints (r = .13, p < .05); witnessed violence was associated with difficulty sleeping (r = .13, p < .05) and headaches (r = .12, p < .05). All associations remained significant after control for confounding. Community violence exposure accounted for 10% of the variance in child stress symptoms, and children who had experienced community violence victimization had a 28% increased risk of appetite problems, a 94% increased risk of sleeping problems, a 57% increased risk of headaches, and a 174% increased risk of stomachaches. Results provide yet another possibility for clinicians to explore when treating these physical symptoms in children.

Co-rumination is a nuanced emotion socialization process that occurs with parents and friends during adolescence. Although co-ruminating builds closeness with others, it corresponds to increased internalizing symptoms, particularly for adolescent girls. The present study explored how specific features of co-rumination vary by relational context (parents, friends) and adolescent gender. These features were also examined in relation to adolescent internalizing symptoms, with adolescent gender as a potential moderator. Thirty adolescents (13–18 years old; 60% female, 40% male) participated in separate discourse tasks with their parent and their same-gender close friend. Co-rumination was observed during these conversations, and adolescents reported their internalizing symptoms. Features of co-rumination varied by relational context and adolescent gender, with unique links to adolescent internalizing symptoms. This study extends prior research by providing a fine-grained analysis of how co-rumination corresponds to internalizing symptoms across two relational contexts.

Maternal depression is a robust risk factor for heightened internalizing symptoms in offspring. Studies also suggest that maternal depression is associated with greater maternal emotion regulation (ER) difficulties. However, emotion regulation has been conceptualized as a multidimensional construct, and few studies have identified specific components of ER related to maternal depression and the role these components may play in the relationship between maternal depression and child internalizing symptoms. Mothers (n = 73) of young children (ages 4–9; 42 females), recruited from both clinical and community settings, reported their depression symptoms and emotion regulation difficulties. Children’s internalizing symptoms were assessed using both parental report and a semi-structured clinical interview. Regression analyses revealed that maternal depression symptoms were positively related to maternal ER, specifically, limited access to emotion regulation strategies and non-acceptance of emotional responses. Structural equation models revealed that the relation between maternal depression and child internalizing problems was mediated only through mother’s limited access to emotion regulation strategies. Our findings offer new insight for targeting mothers’ limited access to emotion strategies as a novel early intervention method to help break the intergenerational transmission of internalizing symptoms from mother to child.

Objective: Proper assessment and early identification of depressive symptoms are essential to initiate treatment and minimize the risk for poor outcomes in youth with epilepsy (YWE). The current study examined the predictive utility of the Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-E-Y) and the Neuro-QOL Depression Short Form (Neuro-QOL SF) in explaining variance in overall depressive symptoms and specific symptom clusters on the gold standard Children's Depression Inventory-2 (CDI-2). Methods: Cross-sectional study examining 99 YWE (female 68, mean age 14.7 years) during a routine epilepsy visit, who completed self-report measures of depressive symptoms, including the NDDI-E-Y, CDI-2, and the Neuro-QOL SF. Caregivers completed a measure of seizure severity. All sociodemographic and medical information was evaluated through electronic medical record review. Results: After accounting for seizure and demographic variables, the NDDI-E-Y accounted for 45% of the variance in the CDI-2 Total score and the CDI-2 Ineffectiveness subscale. Furthermore, the NDDI-E-Y predicted CDI-2 Total scores and subscales similarly, with the exception of explaining significantly more variance in the CDI-2 Ineffectiveness subscale compared to the Negative Mood subscale. The NDDI-E-Y explained greater variance compared to Neuro-QOL SF across the Total (48% vs. 37%) and all CDI-2 subscale scores; however, the NDDI-E-Y emerged as a stronger predictor of only CDI-2 Ineffectiveness. Both the NDDI-E-Y and Neuro-QOL SF accounted for the lowest amount of variance in CDI-2 Negative Mood. Sensitivity was poor for the Neuro-QOL SF in predicting high versus low CDI-2 scores. Significance: The NDDI-E-Y has strong psychometrics and can be easily integrated into routine epilepsy care for quick, brief screening of depressive symptoms in YWE.

The purpose of this study was to compare depressive symptoms reported by boys who were either pre- or postpubescent and who were legally designated delinquent or had no legal histories. A self-report puberty scale and a semi-structured interview (the Child Assessment Schedule-CAS) were administered to 48 boys. Results were analyzed using analysis of variance (ANOVA). Significance levels between groups were examined with Duncan's range test. No significant differences were found between pre- and postpubescent boys for reporting depressive symptoms, but delinquent youths were found to report significantly more depressive symptoms than nondelinquent youths. The implications of these results are discussed in relation to the measures used and recommendations for future research.

Over the past two decades, a great deal of research has been devoted to the understanding of internalizing disorders in children. Internalizing disorders encompass a wide variety of problems, including depression, anxiety, social withdrawal, and somatic complaints. It has been suggested that the existence of internalizing disorders in children has negative effects upon their self-esteem, academic achievement, physical health, and future adjustment. However, because internalizing disorders are, in great measure, subjective perceptions of internal distress, they are often not readily or reliably identified by external observers. As a result, several researchers have stressed the importance of eliciting the child 's perspective through self-report assessment. While there are several excellent self-report measures of internalizing constructs, none of these instruments is designed to measure the comprehensive domain of internalizing disorders in children below the age of 11 even though it has been established that children as young as 8 are able to give reliable self-reports. This apparent dearth of broad-based instruments for middle- to late-elementary school children creates problems for the assessment of internalizing problems because the various internalizing syndromes often coexist with one another, therefore limiting the utility of a single-syndrome instrument. The newly developed Internalizing Symptoms Scale for Children (ISSC) is a 48- item self-report instrument designed to measure the broad range of internalizing problems in children. This investigation was conducted to establish whether the ISSC is a reliable measure of internalizing symptoms in 8- to 12-year-old children over 2-, 4-, and 12-week intervals. Overall, the findings provide strong support for the ISSC as a reliable measure of internalizing symptoms in elementary-age children over short- to medium-length time intervals.

The need for a self-report instrument that assesses internalizing problems in children ages 8 through 12 is evidenced in the lack of such an instrument, and in the prevalence of internalizing problems in children. A new self-report instrument, the Internalizing Symptoms Scale for Children (ISSC), has been proposed and developed to fit this need. The present study evaluated the criterion-related validity, clinical cutoff points, and discriminating power of the ISSC. Two groups of child subjects, clinic-referred and general-school-population, were recruited and administered the ISSC, and a parent of each subject completed the Child Behavior Checklist (CBCL). Each case within the clinic-referred group was then classified as an Internalizer or non-Internalizer based on the CBCL Internalizing T-score. The CBCL was identified as the criterion because of empirical methods used in creating the factor structure, extensive clinical use, psychometric properties, cross-informant design, and large research representation. Results of the evaluations indicated the ISSC to have moderate, yet adequate evidence of criterion-related validity, an optimum clinical cutoff point of 70 (raw score), and strong discriminating power. These results give support for the clinical use of the ISSC as a screening instrument, and for potential use in diagnosis and treatment planning.

Indiana University-Purdue University Indianapolis (IUPUI) / In accord with the cognitive model of poor functioning in schizophrenia, defeatist performance beliefs, or overgeneralized negative beliefs about one’s ability to perform tasks, have been linked to poor functional outcomes, cognitive impairment, and negative symptoms in schizophrenia and are a suggested therapeutic target in Cognitive Therapy for Schizophrenia. However, there is a paucity of research investigating these beliefs in schizotypy, or those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had three aims: to examine whether defeatist performance beliefs 1) are elevated in schizotypy compared to non-schizotypy, 2) are associated with functioning-related outcomes (i.e., quality of life, working memory, negative schizotypy traits), and 3) mediate the relationships between working memory and both negative schizotypy traits and quality of life. Schizotypy (n = 43) and non-schizotypy (n = 45) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Results revealed that the schizotypy group reported significantly more defeatist performance beliefs than the non-schizotypy group. Within the schizotypy group, defeatist performance beliefs were significantly positively associated with negative schizotypy traits and significantly inversely associated with quality of life. No associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Further, defeatist performance beliefs did not mediate the relationships between working memory and either quality of life or negative schizotypy traits. Findings are generally consistent with the cognitive model of poor functioning in schizophrenia and suggest that defeatist performance beliefs may be an important therapeutic target in early intervention services.

Indiana University-Purdue University Indianapolis (IUPUI) / Cognitive changes associated with cancer and its treatment have been well documented. However, the majority of research on cognitive symptoms in cancer has been conducted with early-stage breast cancer patients or survivors in remission. Little is known about cognitive symptoms in patients with late-stage or metastatic cancers. To address this gap in the literature, this study examines cognitive and related symptoms among metastatic breast cancer patients enrolled in a parent study of perceptions of symptom importance and interference. Eighty metastatic breast cancer patients were recruited from the Indiana University Simon Cancer Center to participate in this cross-sectional telephone interview study. The interview consisted of self-report measures, including measures of symptom severity, distress, and the importance of seeing improvement in specific symptoms post-treatment. I hypothesized that cognitive complaints would cluster with fatigue, sleep disturbance, depressive symptoms, anxiety, and pain. This hypothesis was tested using cluster analysis and was partially supported. Cognitive complaints were found to cluster with fatigue, sleep disturbance, depressive symptoms, and anxiety, but not pain. In addition, the extent to which ratings of symptom importance for cognitive symptoms differed from those of other symptoms (i.e., pain, fatigue, sleep problems, depressive symptoms, anxiety, nausea, lymphedema, hot flashes, and neuropathy) was explored using ANOVA and Tukey’s HSD tests. Cognitive complaints were rated as significantly more important than anxiety, depressive symptoms, neuropathy, swelling, nausea, and hot flashes. Importance ratings for cognitive complaints, pain, fatigue, and sleep problems were not significantly different. Developing patient-centered treatment approaches that take into account symptom clustering and patients’ treatment priorities may increase treatment adherence and optimize healthcare quality.

Indiana University-Purdue University Indianapolis (IUPUI) / Post-craniotomy brain tumor patients often experience pain in the post-surgical period which can negatively affect recovery and surgical outcomes. Research with this population has focused on pharmacological treatments of post-craniotomy pain and measurement of pain intensity. Little is known about how these patients experience the quality of their pain and how this pain is managed. The purpose of this dissertation was to provide an in-depth description of the experience of post-craniotomy pain during the post-surgical period. The information gained about how post-craniotomy patients experience pain and pain management will contribute the development of effective, tailored interventions to enhance patient satisfaction and outcomes. This dissertation project was composed of two components. The first component was an integrative review of literature examining the evidence of pain and associated symptoms in adult (aged 21 and older), post-craniotomy brain tumor patients. The review examined studies from the past fourteen years that focused on the incidence and treatment of postcraniotomy pain. It revealed that the majority of post-craniotomy patients experience moderate to severe pain after surgery. This pain is associated with nausea, vomiting, changes in blood pressure, and increased length of hospital stay. The second component was a qualitative descriptive study of a sample of 28 adult (aged 21 and older) post-craniotomy patients hospitalized on an inpatient neurosurgical stepdown unit at a Midwestern urban teaching hospital. During semi-structured interviews, participants described their experiences of post-craniotomy pain and of their experiences of postcraniotomy pain management. Data generated from the qualitative descriptive study were analyzed and resulted in two qualitatively derived products. The first was a description of participants’ experiences of the quality of their post-craniotomy pain during the post-surgical period. The six types of pain quality described were pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. The second was a description of how post-craniotomy patients experience the management of their pain during the post-surgical period. The four groups of types of pain management experiences described were pain-as-non-salient, routine pain management; pain-as-non-salient, complex pain management; pain-as-salient, routine pain management; and pain-as-salient, complex pain management.