• Depressive symptoms, depletion or developmental change? Multidimensionality in the Geriatric Depression Scale according to contemporary interpretations of the disengagement theory of aging

      Adams, Kathryn Betts; Saltz, Constance Corley (2000)
      Lewinsohn et al. (1991) have noted that some symptoms of depression, such as lack of social interest and greater self-involvement, mirror normal attributes of older adults according to Disengagement Theory (Cumming & Henry, 1961), the early developmental theory of aging which stated that there is a mutual social and affective withdrawal between the older adult and his social environment. Socio-Emotional Selectivity Theory (Carstensen, 1992) and gerotranscendence (Tornstam, 1997) both also describe the narrowing of the older person's social world and decreasing investment in activities and social relationships. The Geriatric Depression Scale (GDS; Brink et al., 1982), a 30-item self-report scale, was developed specifically to screen older individuals for depressive symptoms. Six GDS items, comprising a "Withdrawal/Apathy/[Lack of] Vigor" (WAV) dimension appear to be descriptive of disengagement and may lead to over-identification depression in older adults. The GDS, demographic and health measures, and an index of changes in activity and interest level developed for this study were mailed to 990 members of a large Health Maintenance Organization 65 years of age or older. Respondents returned 327 completed surveys and 163 "Decline" postcards after one mailing. Key findings include that GDS WAV contributed disproportionately to identification of depression. Endorsement rates for the items in WAV were among the scale's highest, whereas those of the 14-item Dysphoria factor were among the lowest, suggesting that WAV items are less likely to be "pathological." WAV's correlation with age was significant; Dysphoria's was not. In a multiple regression on the 28-item disengagement score WAV was the strongest predictor after controlling for age, health and Dysphoria. Approximately one third of the full sample and 60% of those aged 75 and over were identified as having at least moderate disengagement without depression. Disengagement is akin to "depletion of normal aging" and relates to changes in physical health and functioning. Since the six WAV items appear congruent with disengagement or Socio-Emotional Selectivity, particularly in later old age, interpretation of the GDS in clinical or research settings may be improved by considering subscale scores, weighting the items, or figuring in age and health status of the respondent.
    • The effect of negative self-referential mood and depression upon creative processes related to change in psychotherapy

      Blundo, Robert George; Altstein, Howard (1992)
      The present study uses the creative processing of information as a means of understanding the cognitive processes involved in therapeutic change during a depressive episode. The focus was on the consequences of cognitive content and moods on the enhancement or inhibition of the creative processing of information. It was hypothesized that the negative self-referential cognitive content associated with depression would inhibit the processing of information creatively. The first Study looked at the effect of induced negative and positive self-referential content and mood, negative and positive content and mood related to viewing the circumstances of others, and the effect of high and low arousal. Female student volunteers (105) were randomly assigned to one of these seven inductions and then completed the Remote Associates Test. The findings did not show a significant difference between these conditions. A Pearson correlation demonstrated a marginal relationship between subjects who reported their moods as negative and lower creative performance. To determine if naturally occurring negative self-referential thoughts would inhibit creativity, a second group of subjects were assigned to either the dysphoric or nondysphoric group based on their initial Beck Depression Inventory scores. To determine if this hypothesized inhibiting negative content could be reversed, one half of both the dysphoric and nondysphoric subjects were assigned to a positive self-referential induction prior to completing the creative task. A third group of subjects who had scored dysphoric during the initial screening were found to have scored nondysphoric when they completed the creativity task. No significant differences were found between the three groups. Contrasts demonstrated that those subjects in the third group undergoing affect-repair and who had received the positive induction performed significantly better than group members who had not received the positive induction. This suggests that interventions that enhance or help initiate affect-repair could benefit depressed individuals. Limitations suggest that the concept of creativity may be too general a description of more specific cognitive processes that are biasing in their effect. Change might best be considered the process of overcoming these biases. Future research might consider how this takes place.
    • Factors Associated with Changes in Parental Depressive Symptoms: A Longitudinal Multilevel Analysis of Parents at High Risk for Child Maltreatment

      Lim Brodowski, Melissa; Harrington, Donna (2012)
      Depression interferes with a parent's ability to adequately care for a child, which can lead to adverse consequences such as child maltreatment (National Research Council & Institute of Medicine, 2009). Given this complex relationship, it is critical to understand factors associated with how depressive symptoms change over time. Home visiting programs are strategies for addressing child maltreatment and parental depression (Paxson & Haskins, 2009). The primary purpose of this study was to assess factors predicting changes in depressive symptoms for a sample of parents at high risk for child maltreatment participating in a home visiting and neglect prevention program. This dissertation used secondary data to explore (1) individual, (2) relationship, and (3) service delivery factors associated with changes in depressive symptoms over time for a diverse sample of 569 parents enrolled in the same program implemented across 7 sites and 18 different program types. Factors predicting the likelihood of child maltreatment reports or substantiations after program participation were also examined. Two- and three-level multi-level growth models were used to address three of the research questions. Across all the models, there was a significant decrease in depressive symptoms over time. The two-level models indicated that Black parents had lower levels of depressive symptoms, whereas Hispanic parents had higher levels. Parents with less than 12 years of education were more likely to have lower levels of depressive symptoms. Higher levels of parental stress and a greater need for social support were associated with higher levels of depressive symptoms in all models. Significant factors found in the three-level models included parent's history of abuse or trauma and assigned program duration; however findings are exploratory given the small sample size (n=18) at this level. Logistic regression was used to predict the likelihood of child maltreatment after program completion. Prior child maltreatment reports and increased need for social support were associated with a greater likelihood of subsequent reports or substantiations. Other parent demographic factors, level of depressive symptoms, and parental stress were not significant. Findings can be used to prioritize areas for depression screening, comprehensive assessments, worker training, and support needed for this vulnerable population.
    • Relationship Between Caregiver Social Support, Depressive Symptoms, and Child Asthma Outcomes in Low-Income, Urban, African American Families

      Margolis, Rachel; Bellin, Melissa H; Dababnah, Sarah (2020)
      Caregiver depressive symptoms are prevalent and put low-income, urban, African American children with asthma at risk for poor asthma medication adherence and control. Caregiver social support may improve medication adherence and asthma control directly or buffer against the negative effects of caregiver depressive symptoms. In Paper 1, I systematically reviewed the literature and identified nine studies examining the relationship between caregiver social support and child asthma outcomes. Most studies measured informal social support using self-report instruments and evaluated clinical indicators of asthma morbidity in ethnically diverse school-age children. Studies were limited by referral and recall bias. A pattern of significant results suggested that more caregiver social support is associated with better child asthma outcomes; however, due to the variety in asthma outcomes and the heterogeneity in their measurement, further research is needed to draw more definitive conclusions. In Paper 2, I examined the factor structure of the five-item Medication Adherence Report Scale (MARS), in a sample of caregivers of low-income, urban, African American children with uncontrolled asthma. Confirmatory factor analysis indicated that a five-item one-factor model marginally fit the data. The MARS demonstrated acceptable internal reliability. MARS was associated with caregiver-reported inhaled steroid adherence, but not with Asthma Medication Ratio, asthma control, or caregiver perception of asthma control in the regression model. These results suggest it may be more productive for clinicians to engage in consistent, non-judgmental communication with families about asthma medication rather than using the MARS. In Paper 3, I used generalized estimating equations and ordered logistic regression to investigate the longitudinal relationships among caregiver social support and depressive symptoms and two asthma outcomes: (a) medication adherence and (b) asthma control in the above sample. The analyses revealed that caregiver social support did not have an effect on either outcome, nor did it moderate the relationship with depressive symptoms in either model. Medication adherence and asthma control improved over time. Caregiver depressive symptoms predicted decreased medication adherence. Severe and moderate baseline asthma, very low income, and season (fall) were predictors of poorer asthma control. Clinicians should target depressive symptoms as a modifiable factor associated with child asthma outcomes.
    • The tripartite model of anxiety and depression: Role of the factors of anxiety sensitivity in anxiety and depression

      Dia, David A.; Harrington, Donna (2006)
      Anxiety disorders are a common and can cause significant impairment in an adolescent's life (Last et al., 1997). Psychosocial treatments, particularly cognitive behavioral therapy, are effective in treating anxiety disorders, but there are many adolescents who have participated in empirically-based psychosocial treatment approaches who are still not improving (Bernstein & Kinlan, 1997; In-Albon & Schneider, 2004). The tripartite model of anxiety and depression was developed to try to account for the high comorbidity between anxiety and depression. The models states that there is a common component to anxiety and depression, which is negative affectivity, and unique components to anxiety, physiological arousal, and depression, low positive affectivity or anhendonia. The purpose of this dissertation study was to increase the knowledge base on the phenomenology of anxiety disorders. The objectives were to: (1) examine gender and ethnic differences in positive and negative affectivity and depressive and anxiety symptomology; and (2) to clarify the relationship between anxiety and the components of anxiety sensitivity within the tripartite model of anxiety and depression. This study consisted of mailed survey to a simple random sample of 315 adolescents between the ages of 12 and 18 who were in treatment for an anxiety and/or depressive disorder. A total of 187 completed surveys were returned for a 61.1% response rate. Adolescents filled out the Positive and Negative Affectivity Scale, Childhood Anxiety Sensitivity Index, and the Revised Child Anxiety and Depression Scale. There was not a statistically significant difference found between the ethnic subgroups (i.e., Hispanic/Latino or any ethnic subgroup) and the Caucasian subgroup on positive and negative affectivity and anxiety and depression. There was also no statistically significant difference found between males and females on negative and positive affectivity and anxiety and depression. A modified tripartite model of anxiety and depression fit the data the best with negative affectivity being related to anxiety and depression, low positive affectivity being related to depression, and physiological arousal being related to anxiety, and anxiety being related to depression. Another modified tripartite model, which examined the specific components of anxiety sensitivity related to specific anxiety disorders, did not fit the data as well as the earlier model. This study did find difference between ethnic subgroups and Caucasian adolescents or between males and females, which suggests there are more similarities than difference between these various subgroups. Additionally, the modified tripartite model supported the role of negative affectivity being related to anxiety and depression and there are unique components, physiological arousal and anhendonia, related to anxiety and depression. This study uniquely found that anxiety was related to depression, suggesting a mixed anxiety and depressive state.