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- Creators: School of Social and Behavioral Sciences
The relevance of depression in the clinical realm is well known, as it is one of the most common mental disorders in the United States. Clinical depression is the leading cause of disease for women worldwide. The sex difference in depression and anxiety has guided the research of not just recent studies but older studies as well, supporting the theory that gonadal hormones are associated with the mechanisms of emotional cognition. The scientific literature points towards a clear correlative relationship between gonadal hormones, especially estrogens, and emotion regulation. This thesis investigates the neural pathways that have been indicated to regulate mood and anxiety. Currently, the research points to the hypothalamic-pituitary-adrenal axis, which regulates the stress response through its ultimate secretion of cortisol through the adrenal cortex, and its modulated response when exposed to higher levels of estrogen. Another mechanism that has been investigated is the interaction of estrogen and the serotonergic system, which is noteworthy because the serotonergic system is known for its importance in mood regulation. However, it is important to note that the research seeking to determine the neurobiological underpinnings of estrogen and the serotonergic system is not expansive. Future research should focus on determining the direct relationship between cortisol hypersecretion and estrogens, the specific neurobiological effects of serotonergic receptor subtypes on the antidepressant actions of estrogens, and the simultaneous effects of the stress and serotonergic systems on depressive symptoms.
A recent analysis has predicted that close to a million Americans will have died from contracting COVID-19 (Sullivan, 2021, para. 1). Unsurprisingly, the most vulnerable people, like those who have been incarcerated, have been hit the hardest (Brennan Center for Justice, 2020, para. 1). The ongoing COVID-19 pandemic has created additional stress affecting inmates both physically and mentally. Therefore, the maintenance of good mental health among inmates should be a concern. However, the nature of the correctional environment limits the therapeutic options available to health care professionals. Among the challenges mental health professionals face in ensuring quality care are a poor rapport between the care provider and client, having a client living in an environment where distressing factors are omnipresent, and a lack of resources (Gussak, 2015, p. 2). All of these issues are exacerbated when the client requiring mental health care is in the correctional system. Depression and anxiety are some of the most common disorders affecting the prison population. However, in the correctional system, therapies that have been found effective among a general population have been shown to not benefit 30% to 60% of clients (Abbing, Baars, Van Haastrecht, & Ponstein, 2019, p. 1). Effectively treating depression is of great concern because, as Gussak (2007) found, depression can lead to self-harming behaviors and suicide when left untreated (p. 2). Additionally, addressing and treating anxiety is of particular importance today as COVID-19 has been a significant source of distress; explicitly, one incarcerated journalist reported witnessing entire units of inmates experiencing high levels of anxiety and panic attacks (Popperl et al., 2020, para. 5). Thus, a critical review of the available literature can reveal the particular effectiveness of art therapy in treating depression and anxiety in prison populations. The impacts of implementing more effective therapies in the correctional system are a reduction in recidivism and successful reintegration into society. Consequently, this literature review will suggest a potential application of art therapy for improving the mental health of those incarcerated in the correctional system with the intent of engendering positive social impact.
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
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.
In the last 10 years there has been an increase in the number of mental health disorders in the United States. As these individuals with abnormal behavior start to become the norm, psychological research will need to adapt. The present work seeks to explore how to solve this problem by introducing abnormal behavior into social psychology. This can be done by measuring how depression and anxiety are related to aggression. The results from this study show that depression, anxiety, and aggression are all significantly correlated with each other and that only depression was a significant predictor for aggression. Although there are some limitations to this study, the results still suggest that the field of social psychology may need to start looking at how abnormal behavior can affect peoples’ behaviors.