Digital Commons Network^™

Evaluating The Association Between Depressive Symptoms And Glycemic Control Among Residents Of Rural Appalachia, Brittany L. Smalls, Adebola Adegboyega, Ellen Combs, Eli W. Travis, Felipe De La Barra, Lovoria B. Williams, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Type 2 diabetes mellitus (T2DM) is associated with a range of co-morbid physical and psychological conditions, including depression. Yet there is a dearth of evidence regarding the prevalence of depression among those in Appalachia living with T2DM; this gap persists despite the higher regional prevalence of T2DM and challenging social determinants of health.

Purpose: This study aimed to provide greater detail about the relationships between T2DM and depressive symptoms in adults living in Appalachia Kentucky.

Methods: The present study was a cross-sectional analysis of baseline data derived from an ongoing study of Appalachia Kentucky adults living with T2DM. Outcome …

The Association Of Persistent Symptoms Of Depression And Anxiety With Recurrent Acute Coronary Syndrome Events: A Prospective Observational Study, Abdullah S. Alhurani, Ayman M. Hamdan-Mansour, Muayyad M. Ahmad, Gabrielle Mckee, Sharon O’Donnell, Frances O’Brien, Mary Mooney, Zyad T. Saleh, Debra K. Moser

Nursing Faculty Publications

The purpose of this study was to examine the role of persistent symptoms of depression and anxiety in a second acute coronary syndrome (ACS) event. Data presented in this study were from an RCT study. A follow-up for 24 months after baseline to detect a second ACS event among 1162 patients from five hospitals. Hierarchal Cox regression analyses were used. The results showed that persistent depression only (HR 2.27; 95% CI: 1.35–3.81; p = 0.002), and comorbid persistent depression and anxiety (HR 2.03; 95% CI: 1.03–3.98; p = 0.040) were the significant predictors of a second ACS event. Secondary education …

Decreasing Anxiety, Depression, And Suicidal Ideation Through The Implementation Of Education And Screening At Chandler Medical Center, Ashley Gillstrap

DNP Projects

PURPOSE: To provide education on high suicide rates within the healthcare community, screen providers for suicide risk factors, and disseminate mental health resources at the University of Kentucky Chandler Medical Center (UKCMC). The goal of this intervention is to increase awareness and provide resources to providers to essentially decrease these suicide rates.

METHODS: A randomized controlled trial was used with a non-equivalent group pretest-posttest survey design to examine the effect of an education module about suicide risk factors. Along with a rating of how COVID-19 affected mental health, a Patient Health Questionnaire 9 (PHQ-9) was implemented, and mental health resources …

Promotion Of Early Recognition Of Depression To Improve Health Related Quality Of Life In Pediatric Oncology Patients, Jennifer Blankenship

DNP Projects

Background: Depression and anxiety are serious complications of cancer and deemed a challenging diagnosis due to the symptoms of depression mimicking common side effects of chemotherapy and radiation. Signs/symptoms frequently are underrecognized thus appropriate treatment is delayed, compromising the health-related quality of life (HRQOL) for pediatric oncology patients.

Purpose: Analyze existing physician and Advanced Practice Provider (APP) clinical practice regarding depression, via a pre- and post-survey and educational PowerPoint on the use of the Center for Epidemiological Studies Depression Scale for Children (CES-DC) to promote early recognition of depression.

Methods: A prospective, single-arm, study was completed in the Kentucky Children’s …

Social Media Use And Mental Health: An Educational Intervention To Reduce Depression And Anxiety In Adolescents, Natalie Catlett

DNP Projects

Background: Most adolescents spend a great deal of their time using various social media platforms. However, excessive and maladaptive social media use is correlated with worsening symptoms of depression and anxiety among adolescents.

Objective: This project aimed to determine whether an educational intervention could help decrease overall time spent using social media and improve mood and mental health outcomes among adolescents with depression or anxiety disorders.

Methods: This was a quasi-experiment with a pretest and posttest design. An educational intervention about the relationship between social media use and symptoms of depression and anxiety among adolescents and strategies to minimize risk …

Mental Health In The Courtroom: How Victim Mental Illness Impacts Juror Decision-Making In A Rape Case, Mary M. Levi

Theses and Dissertations--Psychology

The influence of mental illness on jury decision-making has rarely been investigated, and even fewer studies have examined how jurors perceive a victim with mental illness. The present study investigated the effect of victim mental illness on jury decision-making in a rape trial using a 3 (victim mental health status: schizophrenia, depression, no illness) x 2 (participant gender: female, male) between-subjects design. I hypothesized that mock jurors would render fewer guilty verdicts in the schizophrenia condition compared to the depression condition, and render fewer guilty verdicts in the schizophrenia and depression conditions compared to the control. I also hypothesized that …

The Outcomes Of Cope, A Cognitive Behavioral Therapy Program, In Patients Awaiting Lvad Implantation, Aaron G. Harris

DNP Projects

PURPOSE: The purpose of the Doctor of Nursing Practice (DNP) project was to pilot Creating Opportunities for Personal Empowerment (COPE), an evidence based cognitive behavioral therapy (CBT) intervention, with patients diagnosed with advanced heart failure who are awaiting Left Ventricular Assist Device (LVAD) implantation or those who have had one recently implanted before they are discharged home. METHODS: A cross-sectional study design was used for this Pilot project. Patients were identified for potential participation by LVAD coordinators and represent a convenience sample. The patients were screened for anxiety and depression using the GAD-7 and PHQ-9 screening tools. If patients scored …

Adhd-Internalizing Disorder Co-Occurrence In Childhood And Adolescence: Comparing Network And Latent Variable Conceptualizations, Patrick Kenneth Goh

Theses and Dissertations--Psychology

Co-occurrence of attention-deficit/hyperactivity disorder (ADHD) with depression or anxiety (i.e., internalizing disorders) is a major route to poor outcomes, with temperament traits presenting as potential shared risk markers that underlie these disorders’ development and characterization. Prior work investigating the nature of ADHD-internalizing disorder co-occurrence using structural equation modeling has provided support for both temperament-based common cause (i.e., effortful control and negative affect as liabilities for multiple disorders) and direct causation (i.e., ADHD directly contributing to risk for internalizing disorders) effects separately. Using a network approach, the current study represented the first attempt to integrate these effects into one model while …

Socioemotional Selectivity And Psychological Health In Amyotrophic Lateral Sclerosis Patients And Caregivers: A Longitudinal, Dyadic Analysis, Suzanne C. Segerstrom, Edward J. Kasarskis, David W. Fardo, Philip M. Westgate

Psychology Faculty Publications

Objective: Socioemotional selectivity theory predicts that as the end of life approaches, goals and resources that provide immediate, hedonic reward become more important than those that provide delayed rewards. This study tested whether these goal domains differentially affected psychological health in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a life-limiting disease.

Design: ALS patients (N = 102) being treated in three multidisciplinary clinics and their spouses (N = 100) reported their loneliness, financial worry and psychological health every 3 months for up to 18 months.

Main …

Evaluating Depression Management In Primary Care, Danica Amos

DNP Projects

Background: Within primary care patients identified with depression often do not receive appropriate care (43%). Guidelines recommend combining pharmacotherapy and psychotherapy when possible and establishing follow up with patients to improve their response to treatment According to the APA, only 10% of patients receive combination therapy.

Purpose: The purpose of this study was to evaluate depression management practices in a primary care clinic, describe providers’ attitudes and skills related to depression treatment, and work with the healthcare team to identify strategies to improve depression management within the clinic.

Methods: A single site, descriptive study utilized a retrospective chart review of …

An Evaluation Of Depression In Adolescents With Type 1 Diabetes Mellitus, Elleanor Gray

DNP Projects

Depression can significantly affect how adolescents with T1DM self-manage their disease. The combination of depression and diabetes is closely linked to reduction in self-care behaviors, poor treatment adherence, and sub-optimal metabolic control.

PURPOSE: The purpose of this study was to evaluate current screening for depression in adolescents with T1DM and determine the need for additional support or services to improve the quality of routine, follow-up diabetes care.

METHODS: A cross-sectional, retrospective review of electronic medical records was used to evaluate current practice of depression screening for adolescents with T1DM (11-21years) bring followed at a local pediatric diabetes center between April …

Evaluation Of Depression Screening By Providers For Adult Patients With Type 2 Diabetes In Primary Care, Kristy M. Bryant

DNP Projects

BACKGROUND: Depression in adults with type 2 diabetes can lead to non-adherence to self-management behaviors and treatment recommendations, and ultimately worse health outcomes. Currently, only 50% of adult patients with type 2 diabetes treated in the primary care setting are screened for depression. Without screening for depression, a diagnosis of depression and subsequent treatment is likely to be missed and the patient is more likely to experience worse health outcomes and worse quality of life.

PURPOSE: The purpose of this study was to evaluate impact of provider education on improving screening rates for depression in adult patients with type 2 …

Evidence-Based Music Therapy Treatment To Elevate Mood During Acute Stroke Care, Jessica L. Rushing

Theses and Dissertations--Rehabilitation Sciences

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The …

Race-Based Discrimination, Occupational Stress, And Depression In Black Registered Nurses, Arica A. Brandford

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine depression, experiences of work-related racism, and occupational stress among black nurses. Nursing is a highly stressful and demanding profession that can negatively affect health. Underscoring this is the high rate of depression experienced by nurses. In fact, nurses experience depression at a rate twice that of individuals in other occupations. Examining depression in nurses can provide insights that can inform measures addressing the psychological health of this group. This may be particularly important in black nurses who, in addition to the already high occupational stress associated with nursing, may experience additional stress …

Examining Symptom Trajectories That Predict Worse Outcomes In Post-Cabg Patients, Ming-Fen Tsai, Shiow-Luan Tsay, Debra K. Moser, Tsuey-Yuan Huang, Feng-Chun Tsai

Nursing Faculty Publications

Background: Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians’ abilities to support symptom recovery.

Aims: To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively.

Methods: A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and …

Evaluating The Relationship Between Phq9 And Global Pain Scale (Gps) Scores In Opioid Dependent Adults: A Retrospective Correlational Study, Lori Nolan

DNP Projects

Background: Depression, chronic pain and opioid dependence are conditions commonly encountered in primary care settings. These comorbidities create treatment challenges while negatively influencing outcomes of care. The Patient Health Questionnaire (PHQ9) and Global Pain Scale (GPS) are valid screening tools used to score depression and pain symptoms. The purpose of this study was to determine the relationship between the PHQ9 and Global Pain Scale (GPS) scores in opioid dependent adults with chronic pain to determine whether both tools are necessary.

Methods: This was a descriptive study using a retrospective correlational research design. Data was obtained from the electronic medical records …

Diabetes-Related Distress Screening: A Survey Of Primary Care Providers' Knowledge, Attitudes, And Practices In Treating Patients With Difficulty Meeting Glycemic Goals., Michele Patrice Paxton

DNP Projects

A patient with diabetes is two to three times more likely to be depressed than the general population. Furthermore, the combination of diabetes and depression is associated with increased morbidity and mortality. However, research has shown that treatment for depression does not correlate with lower HbA1c levels or a decrease in morbidity and mortality. Recently, a body of evidence has shown that increased HbA1c levels and depression are associated with the emotional burden of managing diabetes. The emotional burden is caused by the constant behavioral and mental demands of managing the disease and the worry and fear of the impending …

Appraisal Of Depression Among Individuals With T2dm Not On Insulin Therapy, Beverly Woods

DNP Projects

Abstract

BACKGROUND: Type 2 diabetes (T2DM) is a complicated disease process that affects more than 15 percent of adults in the state of Kentucky, with a national average of 9.4%. Individuals with diabetes are at increased risk for micro and macro neurovascular complications. Depression is a common co-morbidity and potentially affects their ability to manager this complex disease.

PURPOSE: The purpose of this study was to examine the prevalence of depression in a group of patients with T2DM, not on insulin therapy. Further, relationships between depression and blood glucose monitoring, Hgb A1c, other co-morbidities, number of medications taken, and demographics …

Transactions Between Thinness Expectancies And Depression In The Prediction Of Adolescent Weight Restricting Behaviors, Anna Marie L. Ortiz

Theses and Dissertations--Psychology

Both the transdiagnostic risk associated with depression and the eating disorder-specific risk associated with expectancies for reinforcement from thinness have been identified as risk factors for the development of weight restricting behaviors. The purpose of this study was to examine if these risk factors transact to further predict risk in youth. Depression, thinness expectancies, and weight restriction were assessed in 1,907 adolescents three times during the transitional period between middle school and high school. We compared three different possible transactional processes. Mediation tests demonstrated that depression in 8th grade predicted an increase in the number of weight restricting behaviors endorsed …

Reducing Depression And Suicide Ideation Among College Students, Andrew Ritzel

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Suicide rates have been on the rise for the past 30 years; 42,773 Americans dying every year by suicide. Suicide is the tenth leading cause of death among all ages, but the second leading cause of death among Americans ages 15-24. College students traditionally fall within this age group, and are especially at risk for suicide due to stressful life conditions. The University of Kentucky, located centrally within Kentucky in the city of Lexington, is an ideal location for a suicide prevention intervention. Students demonstrated an increased rate of depression compared to the national population (15.13% of students surveyed reported …

Psychosocial Functioning And The Cortisol Awakening Response: Meta-Analysis, P-Curve Analysis, And Evaluation Of The Evidential Value In Existing Studies, Ian Andres Boggero, Camelia E. Hostinar, Eric A. Haak, Michael L. M. Murphy, Suzanne C. Segerstrom

Psychology Faculty Publications

Cortisol levels rise immediately after awakening and peak approximately 30-45 minutes thereafter. Psychosocial functioning influences this cortisol awakening response (CAR), but there is considerable heterogeneity in the literature. The current study used p-curve and metaanalysis on 709 findings from 212 studies to test the evidential value and estimate effect sizes of four sets of findings: those associating worse psychosocial functioning with higher or lower cortisol increase relative to the waking period (CARi) and to the output of the waking period (AUCw). All four sets of findings demonstrated evidential value. Psychosocial predictors explained 1%-3.6% of variance in CARi and AUCw …

Substance Use Disorders, Violence, Mental Health, And Hiv: Differentiating A Syndemic Factor By Gender And Sexuality, Kiyomi Tsuyuki, Eileen V. Pitpitan, Maria A. Levi-Minzi, Lianne A. Urada, Steven P. Kurtz, Jamila K. Stockman, Hilary L. Surratt

Center for Health Services Research Faculty Publications

This paper measures syndemic substance use disorder, violence, and mental health and compares the syndemic among HIV-infected heterosexual men, heterosexual women, and men who have sex with men (MSM). Data were from a sample of high needs substance-using, HIV-infected people in South Florida between 2010 and 2012 (n = 481). We used confirmatory factor analysis to measure a syndemic latent variable and applied measurement invariance models to identify group differences in the data structure of syndemic co-morbidities among heterosexual men, heterosexual women, and MSM. We found that variables used to measure the syndemic fit each sub-group, supporting that substance use …

The Impact Of A Civic Service Program On Biopsychosocial Outcomes Of Post 9/11 U.S. Military Veterans, Monica M. Matthieu, Karen A. Lawrence, Emma Robertson-Blackmore

Social Work Faculty Publications

Volunteering as a health promotion intervention, improves physical health, mental health, and social outcomes particularly in older adults, yet limited research exists for veterans. We conducted a preliminary study to explore whether volunteering impacts a variety of biopsychosocial outcomes, including symptoms of post-traumatic stress disorder (PTSD) and depression, among returning military veterans from Iraq and Afghanistan. A survey enrolling a prospective cohort of United States (U.S.) veterans who served in the military after 11 September 2001 and who participated in a national civic service program was conducted. A total of 346 veterans completed standardized health, mental health, and psychosocial self-report …

Mental Health Treatment Seeking Patterns And Preferences Of Appalachian Women With Depression, Claire Snell-Rood, Emily Hauenstein, Carl G. Leukefeld, Frances Feltner, Amber Marcum, Nancy E. Schoenberg

Behavioral Science Faculty Publications

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia—a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants’ perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. …

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

Evaluation Of Depression Screening Practices In Comorbid Patients In The Primary Care Setting, Kristyn L. Clark

DNP Projects

SPECIFIC AIMS: To evaluate the current rates of depression screening using the PHQ-2/9 in patients with comorbid conditions at a single, urban primary care office; to explore barriers to depression screening among providers.

METHODS: A retrospective chart review was completed on a sample of 188 patients seen between January and June 2017. Patients were equally divided among four comorbid diagnoses- COPD, obesity, hypertension, and type 2 diabetes. A provider interview was conducted to identify depression screening barriers and typical treatments regimens.

RESULTS: A total of 70.2% of patients had a documented depression screening. Of 67 patients diagnosed with depression, 11.9% …

Internalizing And Externalizing Dysfunction: An Integrative Model Of Adolescent Drinking, Leila Guller

Theses and Dissertations--Psychology

Separate externalizing and internalizing pathways to problem drinking have been described. However, internalizing and externalizing are substantially correlated, thus, there is good reason to believe that these two forms of dysfunction behaviors do not operate independently.

We tested an integrative developmental model of transactions among internalizing symptomatology, externalizing personality, and psychosocial learning in the prediction of both drinking problems and future internalizing symptoms. To do so, we studied a large sample (n = 1910, 49.9% female) of children over a critical developmental period, from the spring of 5th (last year elementary school) grade through the spring of 9th grade (first …

Extended Family Relationships: How They Impact The Mental Health Of Young Adults, Kayla Jansen

Theses and Dissertations--Family Sciences

This study bridges the gap in literature about the impact of extended family relationships on young adult depression and self-esteem. A sample of 304 undergraduate students between the ages of 18 and 21 at the University of Kentucky was recruited to complete an online survey about their immediate and extended family relationships and their mental health. The largest predictor of self-esteem and depression in early young adults is perceived social support from the family of origin, which is also moderately correlated with perceived support from extended family members. This indicates that extended family support collaborates with family of origin support …

What Can Parents Do? Examining The Role Of Parental Support On The Negative Relationship Between Racial Discrimination, Depression, And Drug Use Among African American Youth, Tamika C. B. Zapolski, Sycarah Fisher, Wei-Wen Hsu, Jessica Barnes

Educational, School, and Counseling Psychology Faculty Publications

African American youth who experience racial discrimination are at heightened risk to use drugs as a coping response to distress. Based on the buffer-stress hypothesis, we proposed that parental support would attenuate this effect. Participants were 1,521 African American youth between 4th and 12th grade. As hypothesized, a mediation pathway was observed among racial discrimination, depression symptoms, and drug use. This effect was observed for both genders, although the pathway was partially mediated for males. In addition, as hypothesized, parental support buffered the negative effect of depression symptomatology on drug use as a consequence of discrimination. Our findings highlight the …

Molecular Analyses Of Circadian Gene Variants Reveal Sex-Dependent Links Between Depression And Clocks, S-Q Shi, M. J. White, H. M. Borsetti, Julie S. Pendergast, A. Hida, C. M. Ciarleglio, P. A. De Verteuil, A. G. Cadar, C. Cala, D. G. Mcmahon, R. C. Shelton, S. M. Williams, C. H. Johnson

Biology Faculty Publications

An extensive literature links circadian irregularities and/or sleep abnormalities to mood disorders. Despite the strong genetic component underlying many mood disorders, however, previous genetic associations between circadian clock gene variants and major depressive disorder (MDD) have been weak. We applied a combined molecular/functional and genetic association approach to circadian gene polymorphisms in sex-stratified populations of control subjects and case subjects suffering from MDD. This approach identified significant sex-dependent associations of common variants of the circadian clock genes hClock, hPer3 and hNpas2 with major depression and demonstrated functional effects of these polymorphisms on the expression or activity of the hCLOCK …