Matching Items (10)
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- All Subjects: Stress
- Creators: Lemery-Chalfant, Kathryn
- Creators: Thrall, Charlotte
Description
Low-income Mexican American women face significant risk for poor health during the postpartum period. Chronic stressors are theorized to negatively impact mental and physical health outcomes. However, physiological factors associated with increased self-regulatory capacity, such as resting heart rate variability, may buffer the impact of stress. In a sample of 322 low-income Mexican American women (mother age 18-42; 84% Spanish-speaking; modal family income $10,000-$15,000), the interactive influence of resting heart rate variability and three chronic prenatal stressors (daily hassles, negative life events, economic stress) on maternal cortisol output, depressive symptoms, and self-rated health at 12 weeks postpartum was assessed. The hypothesized interactive effects between resting heart rate variability and the chronic prenatal stressors on the health outcomes were not supported by the data. However, results showed that a higher number of prenatal daily hassles was associated with increased postpartum depressive symptoms, and a higher number of prenatal negative life events was associated with lower postpartum cortisol output. These results suggest that elevated chronic stress during the prenatal period may increase risk for poor health during the postpartum period.
ContributorsJewell, Shannon Linda (Author) / Luecken, Linda J. (Thesis advisor) / Lemery-Chalfant, Kathryn (Committee member) / Perez, Marisol (Committee member) / Arizona State University (Publisher)
Created2015
Description
The purpose of our study was to evaluate whether viewing videos of dogs had an effect on the stress response of college students. While there is strong support in the literature for demonstrating the beneficial effect of human-canine interactions on human stress indicators, there is very little to no literature on whether or not this phenomenon translates across a digital medium. We hypothesized that when exposed to a video of golden retriever puppies after a stress-inducing task, an individual would experience an increase in blood pressure recovery rate and a decline in perceived stress. In order to study this, we put together several surveys to test our participants' perceived stress, and we measured blood pressure several times in order to obtain a physiological measure of stress. Additionally, in order to produce a guaranteed stress response in our participants, we gave them 2 minutes to prepare a 4 minute video-recorded speech that they were not made aware of prior to entering the testing facility. After the speech task, the experimental group quietly viewed a pleasant 4 minute video containing imagery of dogs, while the control group sat silently for the same duration of time. During this time, the control group was asked to mentally review their performance and to focus intently on the feelings they experienced while giving their speech. Through these measures we found a significant recovery rate in systolic blood pressure and a trending difference between groups for the decline in negative affect. The data demonstrated that the experimental group had blood pressure levels that were significantly closer to their baseline levels when compared to the control group, whose blood pressure did not decline at the same rate. Additionally, the experimental group experienced a higher level of change in negative affect when asked to self-report their level of stress before the speech task and after the conditional recovery period. Interestingly, these findings can be applied to recent literature suggesting that systolic blood pressure is the most important factor of cardiac health to consider when assessing an individual for risk of heart disease or cardiac arrest. While the sample size of this study was small, the significant reduction in systolic blood pressure within the experimental group could indicate the possible efficacy of utilizing digital media containing imagery of canines as a form of therapy for systolically-hypertensive individuals as a means of managing their condition.
ContributorsDiModugno, Maria (Co-author) / Barbera, Joseph (Co-author) / Luecken, Linda (Thesis director) / Lemery-Chalfant, Kathryn (Committee member) / Department of Psychology (Contributor) / School of Life Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2017-05
Description
Research has shown that environmental stressors that occur during childhood and early adolescence are associated with multiple deficits in physiological and psychological functioning later in life. The hypothalamic-pituitary-adrenal (HPA) axis has been proposed as a potential biological mechanism through which these phenotypic alterations occur as studies have shown a link between early life adversity and altered diurnal cortisol patterns (Goldman-Mellor, Hamer, & Steptoe, 2012; Gunnar & Quevedo, 2008). Given research has shown that diurnal cortisol levels are influenced by genetic factors (Veen et al., 2011), but that a majority of differences across subjects can be attributed to the environment (Schreiber et al., 2006), phenotypic associations were explored between the quality of the home environment and children's diurnal cortisol patterns. The first aim of this study was to determine the level of genetic and environmental contributions to different parameters of diurnal cortisol rhythm. The second aim of this study was to examine whether the quality of the home environment, particularly indicators involving parenting and the physical environment, was associated with these same diurnal cortisol measures. A diverse sample of 320 twin children were assessed at 8 years using gold standard home environment interviews and a measure of diurnal cortisol rhythm across three days with three samples taken from each twin every day. Twin intraclass correlations indicated high levels of heritability for the morning to afternoon diurnal cortisol slope as well as the afternoon to evening slope, while measures of cortisol in the afternoon, evening, and across the day showed low levels of heritability, which suggested that differences in the environment were a more influential factor. Multilevel regression analyses showed that the overall quality of the home environment was found to be significantly negatively associated with cortisol levels at bedtime and negatively associated across the morning to afternoon slope at a trend level. The physical environment and emotional climate of the home were not significantly associated with any indicators of the diurnal cortisol pattern. A unique seasonality effect was noted as cortisol measurements taken from participants during the summer were significantly increased when compared to participants throughout the rest of the year. Overall, these findings showed a unique association between the quality of the home environment and diurnal cortisol levels at bedtime and perhaps the change in cortisol levels across the morning to afternoon, as well as a possible seasonal covariate which may affect diurnal cortisol measurements and one which often goes overlooked in cortisol research.
ContributorsSmith, Trevor James (Author) / Doane, Leah (Thesis director) / Lemery-Chalfant, Kathryn (Committee member) / School of Molecular Sciences (Contributor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
Declaration of Conflicts: This project has no conflicts of interest to declare.
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
ContributorsPatel, Dimple (Author) / Thrall, Charlotte (Thesis advisor) / Glover, Johannah-Uriri (Thesis advisor)
Created2018-05-02
Description
Chronic pain is among the most prevalent health issues experienced by older adults and negatively impacts daily functioning and psychosocial well-being through mechanisms that include energy depletion, pain interference, and pain-related changes in negative affect. The capacities to be aware of and regulate negative emotions play a critical role in the successful management of chronic pain. One dimension of negative emotion awareness, termed negative emotion differentiation (NED), is the ability to discriminate between negative affective experiences and recognize them as discrete categories. The ability to identify and distinguish between the various emotions that accompany pain flares and other stressors may enhance the precision of the individual’s regulatory efforts. In doing so, NED may be one possible resilience resource that can facilitate adaptive functioning in the context of chronic pain by buffering the effects of chronic pain flares on daily interpersonal stress. However, this has not yet been investigated. The current study aimed to examine the moderating effect of trait NED on the relationship between daily pain and same-day stress in 259 patients diagnosed with osteoarthritis (OA) or fibromyalgia syndrome (FMS). Individuals completed daily diaries each evening for 30 days reporting on average daily pain, negative emotions, interpersonal stress, and depressive symptoms. It was hypothesized that higher levels of NED would buffer the effects of daily pain on same-day stress. In exploratory analyses, it was evaluated whether the buffering effects were larger for individuals with FMS versus OA. Results of multilevel models revealed that, as expected, higher levels of trait NED predicted lower levels of same-day negative interpersonal events and perceived interpersonal stress. Trait NED also moderated the relationship between pain-related increases in same-day perceived interpersonal stress. Additionally, findings indicated that NED was similarly important for those with FMS and OA. Taken together, the current findings suggest that NED is an important resilience trait that can attenuate chronic pain-related increases in daily experiences of interpersonal stress.
ContributorsOlah, Meryl (Author) / Davis, Mary C (Thesis advisor) / Lemery-Chalfant, Kathryn (Committee member) / Infurna, Frank (Committee member) / Arizona State University (Publisher)
Created2022
Description
Primary health care clinics are essential first defenders determined to confront the upsurge in health-related leading causes of death in the United States. Unfortunately, the underserved or uninsured community continues to struggle to access these vital health care services. Consequently, this vulnerable population seeks venues such as community services events to obtain these unmet primary care services. Community services events effectively disseminate health-related material and provide access to vital medical services. Currently, community services strive to bridge the gap between underserved individuals and primary care clinics by providing participants referrals for low-fee or free clinics to establish ongoing care. A lack of data exists on whether these events sufficiently impact the participants to motivate them to follow-up with a health care clinic. A critical appraisal of evidence showed that follow-up adherence rates are remarkably improved by directly referring participants to a primary clinic during a community services event. This paper explores the effect on health outcomes and health disparities when establishing connections between community services participants and ongoing healthcare services.
ContributorsNavarrete, Elizabeth (Author) / Thrall, Charlotte (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-22
Description
Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).
The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.
A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.
ContributorsParamo, Cinthia Arredondo (Author) / Thrall, Charlotte (Thesis advisor)
Created2020-05-04
Description
Psychological stress plays a vital role in skin disease. The worsening and reoccurrence of signs and symptoms of a wide array of skin diseases have been linked by various studies to stress. Together, stress and skin disease synergistically inhibit occupational, social, and emotional functioning resulting in diminished quality of life (Dixon, Witcraft, & Perry, 2019). Heightened levels of stress may contribute to an assortment of immediate and future adverse outcomes. These outcomes include triggering a skin outbreak, impairing function, behavioral avoidance, intense negative emotions such as shame and embarrassment, and emotional distress such as depression and anxiety (Dixon et al., 2019).
The purpose of this paper is to discuss the relationship of stress, anxiety, and depression to the specific chronic skin diseases of acne vulgaris, psoriasis, vitiligo, rosacea, and atopic dermatitis. It will also discuss how a psychotherapeutic intervention called mindfulness-based stress reduction (MBSR) may decrease anxiety and depression in individuals affected by chronic skin diseases. This paper will also highlight the impact of MBSR on treatment adherence to dermatological prescription medications. A pilot program conducted in a dermatology clinic evaluates the effectiveness of an online mindfulness-based stress reduction intervention to decrease patient anxiety and depression.
Results indicate clinical significance in that participants noted reduced anxiety and depression symptoms and scores, enjoyed MBSR and would continue MBSR. The potential benefits of this pilot program may include decreased patient anxiety and depression, increased patient satisfaction, increased treatment adherence, improved patient satisfaction of intervention, and improved patient outcomes.
ContributorsHuebsch, Kylee M. (Author) / Thrall, Charlotte (Thesis advisor)
Created2020-04-25
Description
Chronic pain is common among children and can lead to future physical disability and health problems. The Biopsychosocial model of child pain suggests that biological, psychological, and social factors predict pain risk, but most research has focused on biological and psychological factors impacting child pain, and less on social factors. One social factor is family stress, including parent mental and physical health problems, and parenting and marital stress. The impact of stress, however, may vary depending on the presence of positive family resources, including marital empathy, parental warmth, and interpersonal support. Thus, the current longitudinal study examined links between family stress and increases in child pain during middle childhood and tested whether positive resources acted as a buffer to protect the development of child pain and if low social status acted as an extra stressor to make pain worse. Participants were part of the Arizona Twin Project, an ongoing longitudinal project of twins. At twin age 9, primary caregivers (PCs) reported on different stress, social status, and positive resources measures, and PCs and twins reported on twin bodily pain. At twin age 11, PCs and twins again reported on twin chronic bodily pain. Neither greater family stress nor parent physical health problems predicted increases in child pain over two years, controlling for twin pain at age 9. In tests of moderation, a single significant interaction emerged in a direction opposite of prediction: the relation between family stress and child pain was moderated by social status, such that average and high levels of social status exacerbated the relation between family stress, and child pain at age 11. Although the interaction needs to be replicated, findings suggest that high social status may act as a risk factor for poor child physical health and pain when family stress is high. Future research should further explore whether and how family stress and social status, as well as peer stress and resources, alone and in combination predict health as children age into adolescence.
ContributorsRusy, Isabella (Author) / Davis, Mary (Thesis director) / Corbin, William (Committee member) / Lemery-Chalfant, Kathryn (Committee member) / Barrett, The Honors College (Contributor) / Department of Psychology (Contributor) / School of Criminology and Criminal Justice (Contributor)
Created2023-12
Description
Approximately 20% of youth experience mental health problems (Vasileva et al., 2021), and dimensions of early childhood temperament, specifically negative affectivity and effortful control, predict later mental health (Rothbart, 2007). Examining temperament using person-centered methods, particularly in stressful contexts, may improve our understanding of vulnerability to adolescent emotional problems. The current study examined whether specific patterns, or types, of infant temperament longitudinally predicted adolescent anxiety and depression symptoms and whether family relationship stress moderated this association. We hypothesized that infants with a Negative Dysregulated temperament would experience higher anxiety and depression symptoms in later childhood compared to those with a Typical Expressive temperament, and that family relationship stress would exacerbate this link. In an ongoing-longitudinal study of families with twins (N=563, 51% female, 29.8% Hispanic/Latinx, 58.4% White; Lemery-Chalfant et al., 2019), primary caregivers (PCs) reported on infant temperament at 12 months (IBQ; Gartstein & Rothbart, 2003, α=.74-.90). In a prior study (Murillo et al., 2023), latent profile analysis yielded three infant temperament types: Negative Dysregulated, Positive Well-Regulated, and Typical Expressive. PCs reported on partner strain (PSS; Schuster, Kessler, & Asseltine, 1990, α=.87) and family conflict (FCS; Porter & O’Leary, 1980, α=.80) at age 8 and a composite of these two measures represented Family Relationship Stress (r = .689). Confirmatory factor analysis was used to form Depression and Anxiety outcome composites based on PC (4 reports), secondary caregiver (2 reports), teacher (2 reports), and self-report (3 reports) measures of depression and anxiety symptoms collected from ages 8-11 (HBQ, Armstrong & Goldstein, 2003; BPI, Measelle et al., 1998, all α’s > .80). We randomly selected one twin from each pair and conducted regression analyses, and then used the second twin for an internal replication. Family relationship stress had a significant main effect on both anxiety and depressive symptoms. The Negative Dysregulated temperament type did not predict anxiety and depression at ages 8-11, however, it interacted with family relationship stress to predict anxiety and depression in 1 of 2 samples. When family relationship stress was low, the Negative Dysregulated type was significantly associated with higher anxiety and depression outcomes compared to the Typical Expressive type, and high family relationship stress was significantly associated with lower depression outcomes. Elucidating these longitudinal relations is important for informing early intervention and reducing the burden of adolescent psychopathology.
ContributorsSingh, Ajuni (Author) / Lemery-Chalfant, Kathryn (Thesis director) / Corbin, William (Committee member) / Davis, Mary (Committee member) / Barrett, The Honors College (Contributor) / Department of Psychology (Contributor) / Sanford School of Social and Family Dynamics (Contributor)
Created2023-12