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- All Subjects: Prevention
- Creators: Knight, George
Description
Anxiety and depression are among the most prevalent disorders in youth, with prevalence rates ranging from 15% to 25% for anxiety and 5% to 14% for depression. Anxiety and depressive disorders cause significant impairment, fail to spontaneously remit, and have been prospectively linked to problematic substance use and legal problems in adulthood. These disorders often share a high-degree of comorbidity in both clinical and community samples, with anxiety disorders typically preceding the onset of depression. Given the nature and consequences of anxiety and depressive disorders, a plethora of treatment and preventative interventions have been developed and tested with data showing significant pre to post to follow-up reductions in anxiety and depressive symptoms. However, little is known about the mediators by which these interventions achieve their effects. To address this gap in the literature, the present thesis study combined meta-analytic methods and path analysis to evaluate the effects of youth anxiety and depression interventions on outcomes and four theory-driven mediators using data from 55 randomized controlled trials (N = 11,413). The mediators included: (1) information-processing biases, (2) coping strategies, (3) social competence, and (4) physiological hyperarousal. Meta-analytic results showed that treatment and preventative interventions reliably produced moderate effect sizes on outcomes and three of the four mediators (information-processing biases, coping strategies, social competence). Most importantly, findings from the path analysis showed that changes in information-processing biases and coping strategies consistently mediated changes in outcomes for anxiety and depression at both levels of intervention, whereas gains in social competence and reductions in physiological hyperarousal did not emerge as significant mediators. Knowledge of the mediators underlying intervention effects is important because they can refine testable models of treatment and prevention efforts and identify which anxiety and depression components need to be packaged or strengthened to maximize intervention effects. Allocating additional resources to significant mediators has the potential to reduce costs associated with adopting and implementing evidence-based interventions and improve dissemination and sustainability in real-world settings, thus setting the stage to be more readily integrated into clinical and non-clinical settings on a large scale.
ContributorsStoll, Ryan (Author) / Pina, Armando A (Thesis advisor) / MacKinnon, David (Committee member) / Knight, George (Committee member) / Arizona State University (Publisher)
Created2015
Description
Women are now living longer than ever before, yet the age of spontaneous menopause has remained stable. This results in an increasing realization of the need for an effective treatment of cognitive and physiological menopausal and post-menopausal symptoms. The most common estrogen component of hormone therapy, conjugated equine estrogens (CEE; Premarin) contains many estrogens that are not endogenous to the human body, and that may or may not be detrimental to cognition (Campbell and Whitehead, 1977; Engler-Chiurazzi et al., 2011; Acosta et al., 2010). We propose the use of a novel treatment option in the form of a naturally-circulating (bioidentical) estrogen called estriol. Due to estriol’s observed positive effects on synaptic functioning and neuroprotective effects in the hippocampus (Ziehn et al., 2012; Goodman et al., 1996), a brain structure important for spatial learning and memory, estriol is promising as a hormone therapy option that may attenuate menopausal- and age- related memory decline. In the current study, we administered one of the three bioidentical estrogens (17β-Estradiol, 4.0 µg/day; Estrone, 8.0 µg/day; Estriol, 8.0 µg/day) or the vehicle polyethylene glycol by subcutaneous osmotic pump to ovariectomized Fisher-344 rats. We compared these groups to each other using a battery of spatial learning tasks, including the water radial-arm maze (WRAM), Morris water maze (MM), and delayed-match-to-sample maze (DMS). We found that all estrogens impaired performance on the WRAM compared to vehicle, while 17β-estradiol administration improved overnight forgetting performance for the MM. The estriol group showed no cognitive enhancements relative to vehicle; however, there were several factors indicating that both our estriol and estradiol doses were too high, so future studies should investigate whether lower doses of estriol may be beneficial to cognition.
ContributorsStonebarger, Gail Ashley (Author) / Bimonte-Nelson, Heather (Thesis director) / Knight, George (Committee member) / Engler-Chiurrazzi, Elizabeth (Committee member) / Barrett, The Honors College (Contributor) / Department of Psychology (Contributor)
Created2015-05