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Adolescent Depression: Integrating Behavioral Healthcare in a Pediatric Primary Care Setting

Description

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to result in suicide, the second leading cause of death in adolescents. Referring all patients with a positive depression screen to…

Introduction: Despite depression affecting one of every ten adolescents, primary care providers struggle to detect depression in affected individuals. Unmanaged early onset adolescent mood disorders have an increased potential to result in suicide, the second leading cause of death in adolescents. Referring all patients with a positive depression screen to a mental health specialist creates treatment delay and burdens already limited community resources.

Objective: The objective of this primary care practice transformation was to improve pediatric primary care provider confidence and behavior to support and deliver evidence-based behavioral healthcare for adolescents with mild to moderate depression.

Methods: An evidence-based adolescent depression education program was delivered to pediatric primary care providers in a small community setting. The program’s components included measures to identify and manage mild to moderate depression. Outcome measures included: 1. Provider knowledge, beliefs, and confidence measured pre- and post-intervention; and 2. Electronic health record documentation of provider adherence to guideline recommendations one, two, and three months post-intervention.

Results: Four providers participated in the intervention. The mean total score for the provider beliefs and knowledge from a 5-point Likert scale demonstrated a positive increase after the intervention (14.75 vs. 23.25, p = .068). The mean total provider confidence score achieved near significance as well (12.25 vs. 21.75, p = .066). Resultant behavior change in the providers did not reach statistical significance when the electronic health records of all adolescent well visits over a three-month period were assessed. Screening for depression at adolescent well visits
Adolescent Depression 3 increased from 0% to 84-90% post-intervention. Setting treatment goals upon detection of depression increased from 0% to 41% (p = .089). Providers appropriately administered active support 67% of the time when a patient was identified with mild depressive symptomology post-intervention. Providers complied with guideline recommendations with identified cases of moderate and severe depression (n = 2).

Conclusions: Pediatric primary care providers demonstrated some positive behavioral changes towards integrating behavioral healthcare into their practice after an educational session on the guidelines for adolescent depression.

ContributorsHuftalin, Tori (Author) / Jacobson, Diana (Thesis advisor)

Created2017-04-04

Novel Approaches to Modeling Depression in Female and Male Rats: Highlighting the Significance of Age and Sex Hormones

Description

Research demonstrates that chronic stress produces a depressive-like profile in rodents, affecting several domains including, cognition, depressive-like behavior, and anxiety-like behavior. However, chronic stress leads to these outcomes in a sex-dependent manner, as young adult female rodents fail to exhibit impaired cognition and increased depressive and anxiety-like behavior following chronic…

Research demonstrates that chronic stress produces a depressive-like profile in rodents, affecting several domains including, cognition, depressive-like behavior, and anxiety-like behavior. However, chronic stress leads to these outcomes in a sex-dependent manner, as young adult female rodents fail to exhibit impaired cognition and increased depressive and anxiety-like behavior following chronic stress. The primary goal of this dissertation was to reveal novel elements contributing to female susceptibility to stress-induced depressive-like presentations and possible factors that may counteract such outcomes. In chapter 2, novel stress paradigms were investigated to determine whether more robust stressors would lead to spatial memory deficits and elevated anxiety in young adult female and male rats. Results demonstrated that chronic stress impaired spatial memory in males, while the robust stressors failed to impair spatial memory in females. Chapter 3 revealed that both females and males in chapter 2 showed BLA dendritic hypertrophy days following the stressor without hippocampal alterations, with the latter likely due to the passage of time allowing for restructuring. Consequently, chapters 4 through 6 were conducted to investigate whether females would show chronic stress effects at middle-age in ovariectomized (OVX) females because menopause is a period of high vulnerability to cognitive and depressive-like effects. Chapter 4 investigated whether the stress hormone, corticosterone, would impair spatial working memory and increase the depressive-like profile of OVX, middle-aged female rats, which was confirmed using the radial arm water maze (RAWM), sucrose preference (SP), forced swim test (FST), and elevated plus maze (EPM). Chapter 5 investigated if estradiol (E2) may prevent the negative valence outcomes induced by OVX in middle-aged female rats. However, E2 showed antidepressant properties during FST, but failed to do so in other behavioral tasks. Chapter 6 further explored E2’s role in mitigating corticosterone-induced effects on cognition and mood in middle-aged female and male rats, with more pronounced antidepressant effects in females. Notably, this chapter unveiled a novel correlation between spatial memory and anxiety-like behavior in corticosterone-treated female rats. Collectively, these studies delineate a corticosterone-based model of depression in female rodents and introduce a novel approach for analyzing variables across multiple behavioral domains.

ContributorsPeay, Dylan (Author) / Conrad, Cheryl D (Thesis advisor) / Bimonte-Nelson, Heather (Committee member) / Verpeut, Jessica (Committee member) / Huynh, Thu (Committee member) / Arizona State University (Publisher)

Created2023

Infant Temperament Types and Late Childhood Internalizing Psychopathology: Moderation by Family Relationship Stress

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…

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

Self-compassion Versus Reappraisal Following Social Rejection: An Application of the Situated Action Cycle

Description

Identifying transtheoretical mechanisms of self-compassion is important for understanding its use as a treatment approach for depression and anxiety. This study examined the effectiveness of self-compassion and detached reappraisal on mechanisms involved in the processing of rejection, namely attention, appraisals, and affect. Rejection is a common experience that can increase…

Identifying transtheoretical mechanisms of self-compassion is important for understanding its use as a treatment approach for depression and anxiety. This study examined the effectiveness of self-compassion and detached reappraisal on mechanisms involved in the processing of rejection, namely attention, appraisals, and affect. Rejection is a common experience that can increase individuals risk for poor mental health outcomes, especially among those with rejection sensitivity. Outcomes are framed within the Situated Action Cycle, which offers an integrated approach to examining mechanisms of cognitive, affective, and behavioral processing. Online participants who reported at least moderate levels of rejection sensitivity were recruited to participate in the study. Study 1 documented that recalling an experience of rejection led to rejection-related emotions as opposed to conflict-related emotions, as expected. Additionally, a brief self-compassion writing induction produced expected increases in state self-compassion and positive affect, but also unexpected increases in state reappraisal. A brief detached reappraisal induction led to unexpected decreases in state reappraisal, particularly for those with marginalized identities. Study 2, which included a neutral control condition, found that brief self-compassion training increased negative attention bias and controllability appraisals and decreased positive affect. Detached reappraisal led to greater reductions in positive affect compared to both self-compassion and control conditions. Further, detached reappraisal led to increases in negative affect compared to the self-compassion condition. Changes observed from pre- to post-intervention in attentional, cognitive, and affective measures were not sustained following a Cyberball rejection manipulation administered one day later. Results from the study reveal nonsuperior effects of either intervention and possible mechanisms of self-compassion interventions for individuals with rejection sensitivity. Self-compassion may be a useful strategy to help individuals with rejection sensitivity attend to the negative emotions experienced during rejection with greater equanimity but may lead to reductions in positive affect. Further work is needed to determine whether the potential benefits of continued self-compassion training outweigh the mixed effects of brief self-compassion training and whether such benefits are superior to other evidence-based approaches.

ContributorsMistretta, Erin G (Author) / Davis, Mary C (Thesis advisor) / Shiota, Michelle N (Committee member) / Luecken, Linda L (Committee member) / Blais, Rebecca K (Committee member) / Arizona State University (Publisher)

Created2023

The Effect of Perceived Stress on the Sleep Quality of Dementia Caregivers

Description

This narrative literature review explores how perceived stress affects sleep quality in dementia caregivers by examining various factors. Ten studies from 2013 to 2022 across four continents were analyzed, focusing on caregiver stress levels, sleep quality, caregiver burden, and depression. Higher stress levels were linked to poorer sleep quality, alongside…

This narrative literature review explores how perceived stress affects sleep quality in dementia caregivers by examining various factors. Ten studies from 2013 to 2022 across four continents were analyzed, focusing on caregiver stress levels, sleep quality, caregiver burden, and depression. Higher stress levels were linked to poorer sleep quality, alongside factors like emotional distress and disrupted sleep patterns. The findings highlight the importance of targeted interventions to reduce stress and improve sleep quality among dementia caregivers, suggesting the need for longitudinal and empirical studies with standardized measures for a better understanding.

ContributorsBadhwar, Karan (Author) / Giasson, Hannah (Thesis director) / Koffer, Rachel (Committee member) / Barrett, The Honors College (Contributor) / School of International Letters and Cultures (Contributor) / School of Life Sciences (Contributor) / Department of Psychology (Contributor)

Created2024-05