Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood psychological disorders with prevalence estimates ranging from 3%-7% (APA, 2000) and one of the most thoroughly studied child neurocognitive disorders. Children with ADHD have consistently shown executive functioning and processing speed deficits on a variety of measures (Berlin, Bohlin, Nyberg, & Janols, 2004; Geurts, Verté, Oosterlaan, Roeyers & Sergeant, 2004; Nigg, 1999; Nigg, Blaskey, Huang-Pollock & Rappley, 2002). The research on executive functioning deficits in other childhood disorders has been comparatively lacking. There is some research that suggests that internalizing disorders, such as anxiety and depression, can also have a detrimental effect on certain executive functioning domains (Airaksinen, Larsson, & Forsell, 2005; Christopher, & MacDonald, 2005; Emerson, Mollet, & Harrison, 2005). It is unclear how these internalizing symptoms will impact executive functioning, processing speed and fine motor control in children with ADHD. The purpose of this study is to determine whether the presence of internalizing symptoms impacts the ability of children with ADHD to perform executive functioning, processing speed, and fine motor control tasks. In order to assess this, the predictive ability of gender, ADHD subtype, parent ratings of anxiety, and parent ratings of depression were examined for processing speed, working memory, response inhibition, vigilance and fine motor control tasks. Gender was found to predict differences in working memory, response inhibition and fine motor control. ADHD subtype was found to predict differences in response inhibition. Parent ratings of anxiety were found to interact with ADHD subtype to predict some aspects of vigilance. Parent ratings of anxiety and of depression were found to predict differences in other aspects of vigilance looking across gender and subtype. Finally, teacher ratings of anxiety were found to predict differences in working memory. / text

The purpose of this research was to examine the proportion of clients diagnosed with a depressive disorder who also exhibit one or more comorbid disorders. In addition, this study examined multiple aspects of age and gender associated with comorbid disorders in an attempt to better inform treatment and diagnosis of depressive disorders and associated disorders and to answer two questions: 1) What is the proportion of clients diagnosed with a depressive disorder who also exhibit one or more comorbid disorders; and 2) Are there significant differences in number of comorbid disorders among developmental stages and gender. The current study helps to shed light on the understanding of comorbid disorders related to childhood and adolescent depression. Previously, no other study had investigated the changes in comorbidity that take place across childhood development.The present study used an archival data set obtained from the Dean-Woodcock Neurological Battery. Participants included patients that had been referred for psychological and neuropsychological evaluation and treatment at a large outpatient Midwestern neurology practice. For the purpose of the present study, participants were selected from the data set for analysis if he or she were diagnosed with a depressive disorder and were than nineteen-years of age. The sample included 136 males and 74 females (n=210). The ages of the participants ranged from 4 year-old to 18 years-old. Results of an ordinal regression revealed that males were significantly more likely to have a greater number of comorbid diagnoses than females. Additionally, participants appeared to exhibit a greater number of comorbid disorders as the age of the participant increased. / Department of Educational Psychology

There has been a significant increase in the use of amphetamine type stimulants (ATS) in Australia over the last decade, and according to the National Drug Strategy Household Survey (2004) results, amphetamine is the second most commonly reported illicit substance used by Australians after cannabis. It has been widely documented that illicit drug users, and in particular ATS users, experience high levels of psychiatric comorbidity and particularly high levels of depression. Depression is one of the leading diseases in the modern world and causes significant burden to those who suffer from it. The main aim of this study is to determine the levels of depression among a sample of regular amphetamine users and investigate the subjective experience of life quality among those with comorbid depression and those without. This study was a separate component of a randomised controlled trial for regular amphetamine users in Queensland and New South Wales (Baker, Lee, Claire, Lewin, Grant et al, 2003). Participants were required to be 18 years and over and regular users of amphetamines as defined by use of amphetamines on at least four occasions in the previous month. A total of 2 14 participants were recruited from a range of sources into the study. Levels of depression (measured by the BDI-11), quality of life (WHOQoL BREF), dependence status (SDS) and drug use patterns (OTI) were all examined. High levels of depression were found among the same with 84.6% of the sample reporting clinically significant depression with a large proportion of this group falling into the moderate to severe spectrum (7 1 %). Results identified several areas of major risk for poor quality of life for amphetamine users, including dependence, frequency of use and route of administration, and showed how these risks areas can be compounded by level of depression to create significantly decreased quality of life. No amphetamine withdrawal scales were administered in the assessment protocol for this study. It is possible that some of the reported symptoms of depression could be related in part to an amphetamine withdrawal syndrome. Further study of the natural history of withdrawal and the prevalence of related metal health symptoms is warranted. This sample was a treatment seeking, dependent group of amphetamine users. The results confirm the high rates of mental health comorbidity among regular amphetamine users and highlights the added burden of disease that this group suffers. The results have implications for treatment services, which need to manage both comorbidity and individual aspects that contribute to an improved quality of life. Further analyses examining treatment outcomes for this group would be useful.

Thesis (Ph. D.)--University of Oregon, 2004. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 118-124). Also available for download via the World Wide Web; free to University of Oregon users.

Type 2 diabetes is a highly prevalent disease which could affect roughly 552 million people globally by the year 2030. In addition to a range of medical complications, individuals with diabetes experience higher rates of mental illness (e.g., depression and anxiety) than the general population. A growing body of evidence suggests that depression may exert important influences at key stages of the diabetes experience, including: diabetes onset, diabetes management, and mortality. A smaller body of research has explored the influence of anxiety on diabetes outcomes, and anxiety is demonstrated to elicit similar effects on the dysregulation of endocrinological or behavioural process as depression. This is of concern given that depression and anxiety co-occur in the majority of primary care cases, and individuals experiencing both disorders tend to have poorer prognoses than either alone. This thesis sought to study the independent and concurrent contributions of depression and anxiety to key diabetes outcomes in a population-based sample of Norwegian adults, through a series of four studies. The first study uses meta-analysis to demonstrate that both depression and anxiety are associated with a moderate increased risk of diabetes onset, and that these effects may only be significant in men. The second study illustrates that the fraction of incident diabetes cases attributable to metabolic and behavioural factors at the population level increases in the presence of depression and anxiety, especially in men. The third study demonstrates that depression and anxiety are differentially associated with some diabetes management outcomes (i.e., glycemic control, c-reactive protein levels, and diet adherence), with variations by patient sex. And the final study provides evidence that long-term mortality risk is lowest in diabetic individuals experiencing anxiety, higher in those with concurrent depression-anxiety, and highest for depression, with variation by sex. Overall, this body of work suggests that both depression and anxiety may result in poorer diabetes outcomes in men across all key stages, while symptoms of anxiety may provide protection against diabetes onset and risk of mortality in women with Type 2 diabetes. Future research should aim to differentiate and control for co-occurring depression and anxiety when examining diabetes outcomes, and report sex-specific estimates as a standard approach.

In North America, the last two decades saw continued increases in population multimorbidity across all age groups. This trend, which is expected to endure in the coming years, has been attributed in large part to population aging and unhealthy lifestyle choices. While the societal consequences of multimorbidity have focused primarily on the burden it imposes on the sustainability of health systems and the need to implement innovative ways to deliver care, latent costs, such as possible increases in motor-vehicle accidents (MVAs) have received relatively little attention. The principal objective of this thesis was to investigate the relationship between multimorbidity and MVAs. To complement current knowledge on the topic, we conducted observational studies based on information recorded in electronic health records (EHR). The hypothesis that increasing levels of multimorbidity would translate into increasing risk of MVA was tested in both a general population of health care recipients and in persons with epilepsy, a subgroup of individuals predisposed to comorbidities and MVAs. To gain a better understanding of morbidity ascertainment in EHR data, preliminary validation studies were performed to evaluate the performance of Elixhauser comorbidity measures for predicting hospital mortality in our data source. A systematic review of risk factors contributing to the onset and progression of epilepsy was also performed in hopes of identifying elements that would help improve the methodological design of the principal thesis study limited to persons with epilepsy. Study results confirmed the excellent performance of the Elixhauser comorbidity measures for predicting hospital mortality in the Cerner Health Facts data repository. In the general health care recipient population, a positive exposure-outcome relationship was observed between multimorbidity and MVA risk. This relationship was consistent in adults across the lifespan and more pronounced in women than in men. In persons with epilepsy, the observed exposure-outcome relationship between multimorbidity and MVAs did not reach statistical significance. However, comorbid depression was identified as a risk factor for MVAs. Given increasing rates of multimorbidity in the general population, the findings of this thesis strongly support the need for replication and better characterization of the disease combinations that drive increases in MVA risk. Future work on this topic should also include estimates of MVA risk attributable to multimorbidity; this would inform and gauge the relevance of novel driving policies targeting individuals diagnosed with specific health conditions.

Despite numerous studies documenting the high prevalence of social anxiety in children and adolescents with High Functioning Autism Spectrum Disorder (HFASD), there has been little empirical investigation into methods for the assessment of social anxiety in this population. The purpose of this study was to create an empirically derived screening instrument to measure subjective feelings of social anxiety in adolescents and adults with HFASD. Based on a thorough review of the literature in this area, items from all measures (k = 15) used to assess social anxiety in adolescents and adults with HFASD were compiled. After collapsing similar items into one composite item, a pool of 86 items were included in an electronic survey that was sent to experts (n = 99) in the field of anxiety disorders in ASD. Experts ranked the degree to which each item was indicative of social anxiety in HFASD. Based on expert responses, 30 items were selected as the most representative for assessing social anxiety in the target population. In the second phase of the study, experts were asked to rate the final pool of items comprised of the 30 derived from phase I and 10 additional items developed from expert feedback and coding of taped diagnostic interviews with adolescents with HFASD and social anxiety. A final screening measure was derived comprised of 31 items. Future directions and use of the newly formed measure are discussed. / Master of Science

Objective: The objective of this study was to compare the use of different comorbidity measures to predict future healthcare utilization and expenditures for diabetic patients. Methods: This was a retrospective study that included 8,704 diabetic patients enrolled continuously for three years in the Department of Defense TRICARE program. Administrative claims data were used to calculate six comorbidity measures: number of distinct medications, index-year healthcare expenditures, two versions of the Charlson Comorbidity Index (CCI), and two versions of the Chronic Disease Score (CDS). Linear regression models were used to estimate three health outcomes for one- and two-year post-index periods: healthcare expenditures (COST), number of hospitalizations (HOS), and number of emergency department visits (ED). Logistic regression models were used to estimate binary outcomes (above or below the 90th percentile of COST; [greater than or equal to] 1 HOS or none; [greater than or equal to] 1 ED or none). Comparisons were based on adjusted R², areas under the receiver-operator-curve (c statistics), and the Hosmer-Lemeshow goodness-of-fit tests. Results: The study population had a mean age of 51.0 years (SD = 10.5), and 46.3 percent were male. After adjusting for age and sex, the updated CCI was the best predictor of one-year and two-year HOS (adjusted R² = 8.1%, 9.3%), the number of distinct medications was superior in predicting one-year and two-year ED (adjusted R² = 9.9%, 12.4%), and the index-year healthcare expenditures explained the most variance in one-year and two-year COST (adjusted R² = 35.6%, 31.6%). In logistic regressions, the number of distinct medications was the best predictor of one-year and two-year risks of emergency department use (c = 0.653, 0.654), but the index-year healthcare expenditures performed the best in predicting one-year and two-year risks of hospitalizations (c = 0.684, 0.676) and high-expenditure cases (c = 0.810, 0.823). The updated CCI consistently outperformed the original CCI in predicting the outcomes of interest. Conclusions: In a diabetic population under age 65, the number of distinct medications and baseline healthcare expenditures appeared to have superior or similar powers compared to the CCI or CDS for the prediction of future healthcare utilization and expenditures. The updated CCI was a better predictor than the original CCI in this population. / text

Class of 2010 Abstract / OBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.

No description available.