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Social and Behavioral Sciences Commons™
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Articles 1 - 30 of 78
Full-Text Articles in Social and Behavioral Sciences
Perceived Anxiety Disorder Stigma: A Predictive Analysis, Shawn Nabors, Richard J. Cicchetti, Gary Michael Szirony, Craig R. Blum, Sri Banerjee
Perceived Anxiety Disorder Stigma: A Predictive Analysis, Shawn Nabors, Richard J. Cicchetti, Gary Michael Szirony, Craig R. Blum, Sri Banerjee
Journal of Social, Behavioral, and Health Sciences
Anxiety remains one of the most commonly diagnosed mental health disorders. Systemic barriers to mental health treatment persist. Research on anxiety is robust, although research on perceived anxiety disorder stigma is limited. The purpose of this quantitative analysis was to determine whether factors including age, gender, level of education, and presence of a diagnosable anxiety disorder condition would predict perceived anxiety stigma in a population of adults from the Midwestern region of the United States who were in treatment for anxiety. Based on Goffman’s framework, we used the Generalized Anxiety Stigma Scale (GASS) to determine the presence and level of …
Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego
Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego
Adultspan Journal
The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …
General Psychology 2e, Will Stutterheim
General Psychology 2e, Will Stutterheim
All Open Educational Resources
General Psychology 2e offers an insightful exploration into the complexities of the field of psychology and all that it has to offer. This book provides a thorough introduction to the foundational principles of psychology, covering essential theories, research findings, and applications that illustrate the intricate workings of the mind.
The text begins with a historical overview of psychology, tracing its evolution from philosophical roots to its establishment as a scientific discipline. It then delves into essential topics regarding stress and mental health disorders and concludes with therapy and treatment approaches. It then covers research in psychology, biopsychology, consciousness, and perception. …
Trends In Substance Use And Mental Health Among Adolescents In Georgia, 2002-2022, Saumya S. Palipudi, Bangaru Talli Palipudi, Murty Komanduri
Trends In Substance Use And Mental Health Among Adolescents In Georgia, 2002-2022, Saumya S. Palipudi, Bangaru Talli Palipudi, Murty Komanduri
Georgia Public Health Association Annual Meeting and Conference
Background: While substance use and absence of mental health disorders among youth in the United States (US) have declined over the past two decades, post COVID-19 pandemic, these conditions have increased significantly with notable disparities, and witnessed a crisis in public health. In 2022, 24.7% or 6.1 million adolescents aged 12 to 17 in the US had either Major Depressive Episodes (MDE) or Substance Use Disorder (SUD) and 3.7 percent had both in the prior year2. Increased stress, lack of peer connections, parental abuse, and poor mental health conditions were attributed to this increase in substance use3-7 …
Unveiling The Therapeutic Garden Experience For People With Schizophrenia At A Rehabilitation In North Texas, Jeevita Sai Paspuneti
Unveiling The Therapeutic Garden Experience For People With Schizophrenia At A Rehabilitation In North Texas, Jeevita Sai Paspuneti
Landscape Architecture Masters & Design Theses
Therapeutic gardens have numerous benefits, including pain reduction, improved attention, stress reduction, and medical reduction (Urban et al.,2018). Green spaces have been shown to improve the physical, mental, social, and emotional health and well-being of those staying in healthcare facilities (Urban et al.; Greening,2022). Since the 1980s, research studies have discussed the therapeutic benefits of landscape design at healthcare facilities and the importance of sustainable practices in high-performance landscape design. Many successful and expensive landscape projects have been designed and constructed on hospital sites using healing gardens or sustainable strategies (Kaplan et al. S., 1989). However, researchers suggest additional empirical …
The Unequal Distribution Of Social Risk For Black Men Across The Life-Span. A Novel Framework., Waleed Y. Sami
The Unequal Distribution Of Social Risk For Black Men Across The Life-Span. A Novel Framework., Waleed Y. Sami
Adultspan Journal
This conceptual overview offers a comprehensive overview of systemic pathways that negatively impact the mental health of Black Men throughout their lives. Our argument highlights the importance for counselors and mental health professionals to utilize a thorough social risk assessment that considers these pathways in order to effectively address the mental health needs of Black Men while fostering positive working relationships. This overview strongly advocates for the use of context and structural determinants when evaluating mental health symptoms. Without an appropriate understanding of social risk and determinants, counselors may inadvertently perpetuate disparities by decontextualizing symptomology, and reproducing racist discourse.
On-Campus Mental Health Service Use Among College Students With Autism: A Case Study Applying The Andersen Behavioral Model Of Health Services Use, Estella C. Lilyquist
On-Campus Mental Health Service Use Among College Students With Autism: A Case Study Applying The Andersen Behavioral Model Of Health Services Use, Estella C. Lilyquist
Electronic Theses and Dissertations
The unique set of impairments and limitations presented by students with autism spectrum disorder (ASD) make the accessing of campus-based nonacademic resources more difficult and complicated than their typically developed peers. Each year, the rate of students entering college with disabilities continues to grow, but their mental well-being is relatively poor. The purpose of this qualitative case study was to apply the conceptual framework of the Andersen behavioral model of health services use (ABMHSU) to the experiences of college students with ASD to understand and predict their utilization of campus-provided mental health resources. The participants were seven college students with …
The Last Of Us In Therapy: How Mind-Controlling Fungi And Gut Bacteria Affect Your Mental Health, Anastasia Lyon
The Last Of Us In Therapy: How Mind-Controlling Fungi And Gut Bacteria Affect Your Mental Health, Anastasia Lyon
Journal of Pharmacology & Nutritional Sciences
The "psilocybiome" represents the mutually beneficial relationship between ourselves, our bacteria, and psychedelic drugs. This short review briefly discusses the benefits and limitations surrounding the potential for psychedelic therapy to synergize with gut bacteria to help regulate and maintain proper balance in the immune system, diet, and stress levels. Psychedelic therapy is a novel treatment strategy that has the potential to improve patient mental health, and, by identifying the types of gut bacteria present in patients, it can aid in personalizing medicine by determining how well their "psilocybiome" may respond.
Social Media And Wellbeing, Aditya Adsule
Social Media And Wellbeing, Aditya Adsule
Honors College Theses
This psychology thesis paper investigates the existing body of scientific literature surrounding the effects of social media on the wellbeing of adolescents and adults ages 18-29. The current body of scientific literature supports the overall finding that social media has a negative impact not only on mental health, but on physical health. There are also key findings showing the impact of social media on other facets of life such as sleep patterns, social interactions, and physical activity. Current intervention therapies need to be revisited and the DSM categorization of social media addiction needs to be investigated further.
An Exploration Of The Social And Economic Factors That Influence The Mental Health Of Lgbtq College Students, Alexandria Mh Fossum
An Exploration Of The Social And Economic Factors That Influence The Mental Health Of Lgbtq College Students, Alexandria Mh Fossum
Senior Theses
LGBTQ individuals face a much higher prevalence of psychiatric disorders and mental health issues than their heterosexual, cisgender counterparts. The added academic pressures of college introduce a unique set of challenges that LGBTQ students face. This thesis includes a review of academic literature and data examining the intersections between social isolation, institutional discrimination, and financial insecurity and the effects they have on the mental health outcomes of LGBTQ college students. The paper is accompanied by a documentary consisting of a set of interviews of LGBTQ college students, giving a more personal insight into the multitude of factors that affect their …
Sustaining Breaths For Restorative Rest: A Preliminary Evaluation Of Sleep, Mental Health, And Cognitive Function Following Hypoglossal Nerve Stimulation For Obstructive Sleep Apnea, Elliottnell Perez
Theses and Dissertations
Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that produces repetitive obstruction or collapse of the upper airway. Positive airway pressure (PAP) therapy is the gold standard treatment for OSA. Hypoglossal nerve stimulation (HNS) is considered an alternative treatment for patients who are unable to tolerate PAP therapy. The purpose of the study was to examine sleep, mental health, and cognitive health outcomes before and after HNS to determine its viability as an alternative treatment.
Methods: The study utilized a single-group, pretest-posttest design. Objective and subjective sleep was measured using actigraphy, sleep diary, and questionnaires. Objective and subjective …
The Perceptions, Barriers, And Facilitators To Seeking Mental Health Help In College Student-Athletes (Pbas-Mh And Pfas-Mh): A Mixed-Methods Pilot Study, Margaret Hunt
West Chester University Master’s Theses
Through the COVID-19 pandemic, 1 in 10 NCAA student-athletes reported feeling so depressed it has been difficult to function (NCAA, 2020). Despite this, student-athletes are significantly less likely to seek mental-health help than their non-athlete peers. The present study sought to develop and validate the Perceptions of Barriers to Seeking Mental Health Help in Student-Athletes (PBaS-MH) and the Perceptions of Facilitators to Seeking Mental Health Help in Student-Athletes (PFaS-MH) surveys in college student-athletes, as well as determine predominant barriers and facilitators they experience with seeking mental health help. A convergence mixed-methods research design was conducted to triangulate results. The surveys …
The Relationship Between Urban Green Space Perception And Use Within The Adolescent Population: A Focused Ethnography, Rachel Lyons
The Relationship Between Urban Green Space Perception And Use Within The Adolescent Population: A Focused Ethnography, Rachel Lyons
Electronic Theses and Dissertations
Introduction: Greenspace is beneficial for improving adolescent mental health, yet we still do not understand the connection between the built environment and subjective mental wellbeing. We also lack understanding of how this population uses greenspace and how they feel when in it. Purpose: The purpose of this qualitative study was threefold: to understand why adolescents use greenspace, to identify how they use greenspace, and to explore how they feel when they are in greenspace. Methods: participated in a focused ethnography that utilized auto photography for photo elicitation. Braun and Clark's (2006), six phases of thematic analysis were used to guide …
Lifestyle Choices Related To Food Consumption And Their Relationship To Depression, Steven L. Jennings Jr.
Lifestyle Choices Related To Food Consumption And Their Relationship To Depression, Steven L. Jennings Jr.
Dissertations
Dieting, or the act of restricting oneself to small amounts or particular kinds of foods on the basis of health, spirituality, lifestyle, and moral decisions, is a practice that dates to 1066 A.D. However, with social media being as influential as it is, one might believe dieting is a new obsession or at least an obsession to which popular culture is returning. Despite this, it is only in recent years that researchers have begun to focus on the health benefits of such behaviors. The present study was designed to take this focus a step further by exploring the potential risks …
Family Structure And Maternal Depressive Symptoms: A Cross-National Comparison Of Australia, The United Kingdom, And The United States, Kirsten Rasmussen, Elizabeth K. Sigler, Sadie A. Slighting, Jonathan A. Jarvis, Mikaela J. Dufur, Shana Pribesh
Family Structure And Maternal Depressive Symptoms: A Cross-National Comparison Of Australia, The United Kingdom, And The United States, Kirsten Rasmussen, Elizabeth K. Sigler, Sadie A. Slighting, Jonathan A. Jarvis, Mikaela J. Dufur, Shana Pribesh
Educational Leadership & Workforce Development Faculty Publications
The purpose of this study is to understand the relationship between family structure and maternal depressive symptoms (MDS) in Australia, the United Kingdom, and the United States. Family structures that involve transitions across life's course, such as divorce, can alter access to resources and introduce new stressors into family systems. Using the stress process model, we examine the links between family structure, stress, resources, and MDS. Using nationally representative data from Australia, the United Kingdom, and the United States and cross-sectional models for each country, we find that family structure may influence MDS differently in the UK than it does …
Comparison Of Schedules, Stress, Sleep Problems, Fatigue, Mental Health And Well-Being Of Low Cost And Network Carrier Pilots, Marion Venus
Comparison Of Schedules, Stress, Sleep Problems, Fatigue, Mental Health And Well-Being Of Low Cost And Network Carrier Pilots, Marion Venus
International Journal of Aviation, Aeronautics, and Aerospace
Objective
This research investigates and compares working-conditions, duty rosters, stress, sleep problems, fatigue levels, mental health, and well-being of pilots working for network (NWCs), and low-cost carriers (LCCs). This study extends previous research by investigating working conditions, pilots’ actual rosters, fatigue and mental health of two groups of pilots flying for LCC or NWC.
Method
A comprehensive cross-sectional online survey was completed by N=338 pilots (185 NWC, 153 LCC pilots). All pilots reported their roster data of the last 2 months during peak flight season, psychosocial and work-related stress (e.g., high job insecurity, less total flight-experience, lower income, more time …
Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji
Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji
Theses & Dissertations
Refugee mothers are at an increased risk of suffering from stress and mental health conditions during the first year after giving birth to a child. The objective of this study is to enhance the early identification of treatable mental health conditions among perinatal women living within humanitarian settings. The central hypothesis is that a culturally specific approach can be helpful for the long-term success of mental health efforts. In this study, we use qualitative interview methods to understand the cultural paradigms and predisposing factors for perinatal depression related to being a Syrian refugee in Lebanon during the COVID-19 pandemic. In …
Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos
Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos
Electronic Theses, Projects, and Dissertations
In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.
This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …
Exploring The Covid-19 Experience Of Young Adult Latinos In Rural California: Insights Into Mental Health & The Immigrant Health Paradox, Vivianna Plancarte
Exploring The Covid-19 Experience Of Young Adult Latinos In Rural California: Insights Into Mental Health & The Immigrant Health Paradox, Vivianna Plancarte
Pomona Senior Theses
This study expands the COVID-19 and Latino Immigrants in Rural California (CLIMA) Study at UC Merced by exploring how the mental health of young adult Latinos in rural CA has been affected by the COVID-19 pandemic and comparing the experiences of US-born Latinos to those of Latino immigrants to investigate an Immigrant Health Paradox. A convergent mixed methods design was first employed whereby qualitative and quantitative data was collected concurrently, and then merged. Then, the data collected from young adult Latinos was compared to that from Latino immigrants collected by CLIMA Study to explore the Immigrant Health Paradox in the …
Historical Trauma Response Scores As A Function Of Unresolved Grief And Substance Use Disorder In American Indian Populations, Andrew R. Saunders
Historical Trauma Response Scores As A Function Of Unresolved Grief And Substance Use Disorder In American Indian Populations, Andrew R. Saunders
Undergraduate Research Symposium
Abstract
Researchers are interested in the outcomes of interventions, specifically, measuring historical trauma (HT) among American Indian/Alaska Native communities and the long-term distress and substance abuse as a result of historical trauma response (HTR). Previous literature has implicated limitations in the clinical conceptualization of the relationship between intergenerational transfer of HTR and substance abuse. The aim of the current study is to examine treatment efficacy of 50 homosexual, American Indian males randomized to a culturally-adapted juxtaposition of (1) Group Interpersonal Psychotherapy (IPT), (2) Cognitive Processing Therapy (CPT), and (3) Historical Trauma and Unresolved Grief Intervention (HTUG), or (4) waitlisted on …
Exploration Of Physician Attitudes About Self-Care And Personal Mental Health: Possible Barriers To Physician Well Being, Candich Farrar
Exploration Of Physician Attitudes About Self-Care And Personal Mental Health: Possible Barriers To Physician Well Being, Candich Farrar
Dissertations
The present study was designed to examine physicians’ mental health, attitudes, and behaviors toward self-care and the utilization of mental health services. As the medical field can be very demanding and exhausting, it is believed that many physicians suffer from mental illnesses such as anxiety and depression. However, it was theorized that many physicians do not engage in adequate self-care regimes or seek support and suppress their symptoms, which may further exacerbate their illnesses. A thorough literature review was performed to explore the following: possible barriers to physicians seeking mental health services to address high rates of mental illnesses, physicians …
Mental Health Challenges Among Ethnic Minorities College Students, Fiorella G. Valles, Ruben Gonzalez
Mental Health Challenges Among Ethnic Minorities College Students, Fiorella G. Valles, Ruben Gonzalez
Electronic Theses, Projects, and Dissertations
This research study explored the challenges of mental health-seeking services of college students of color in the San Bernardino area. College students of different ethnicities have unique needs and challenges that contrast with the general student population. Previous research stated that students of color deal with a greater number of unmet mental health needs and indicates a connection between mental health and attaining a college degree (Arria et al., 2013). To increase the utilization of mental health amongst students of color, this study aimed to identify the influencing factors that prevented students from help-seeking. The research design of this research …
Promoting Resilience In Self-Management (Prism): Adverse Childhood Experiences And Impacts On Emotion Regulation, Kasey Ann Macedo
Promoting Resilience In Self-Management (Prism): Adverse Childhood Experiences And Impacts On Emotion Regulation, Kasey Ann Macedo
Honors Scholar Theses
PRISM (Promoting Resilience in Self-Management) is a mindfulness-based intervention that aims to strengthen emotion regulation skills among individuals by employing cognitive behavioral therapy components. The purpose of the current study is to identify the relationship between adverse childhood experiences (ACEs) and depression, as well as to examine the changes in emotion regulation strategies of participants by comparing pre and post test data. The participants were voluntarily recruited from the Cornerstone Foundation, a homeless shelter, food pantry, and community center in Vernon, CT. The 13 participants completed PRISM through four weeks of two-hour workshop sessions in a small-group format. Results indicate …
Recognizing The Need For Mental Health Reform In The Texas Department Of Criminal Justice, Kara Mchorse
Recognizing The Need For Mental Health Reform In The Texas Department Of Criminal Justice, Kara Mchorse
St. Mary's Law Journal
The ways in which mental health care and the criminal justice system interact are in desperate need of reform in Texas. The rate of mental illness in Texas is higher than the current state of mental health care can provide for. While state hospitals were once the primary care facilities of those with mental illness, the Texas Department of Criminal Justice (TDCJ) has taken on that role in the last few decades; and when the criminal justice system becomes entangled with mental health care, it often leads to “unmitigated disaster.” If Texas continues to allow the TDCJ to act as …
Mental Health Service Use In The Kingdom Of Saudi Arabia, Abdulaziz S. Alangari
Mental Health Service Use In The Kingdom Of Saudi Arabia, Abdulaziz S. Alangari
Graduate Theses, Dissertations, and Problem Reports
Objectives: The goal of this project was to increase knowledge concerning the current prevalence, needs and barriers to mental health service use in the Kingdom of Saudi Arabia (KSA). It’s purpose was to gather data that would help to inform future policy decisions aimed at optimizing the use and availability of these services in the KSA. There were three specific aims: 1) Examine the barriers to initiation and continuation of mental health treatment in people with a disorder diagnosed during the previous 12-months. 2) Explore the prevalence and predictors of mental health treatment dropout. 3) Examine the prevalence and patterns …
As A Pediatrician, I Don’T Know The Second, Third, Or Fourth Thing To Do: A Qualitative Study Of Pediatric Residents’ Training And Experiences In Behavioral Health, Rachel Petts Phd, Jeffrey D. Shahidullah Phd, Paul W. Kettlewell Phd, Kathryn A. Dehart Md, Kris Rooney Md, Ilene G. Ladd Ms, Tyler Bogaczyk Bs, Sharon L. Larson Phd
As A Pediatrician, I Don’T Know The Second, Third, Or Fourth Thing To Do: A Qualitative Study Of Pediatric Residents’ Training And Experiences In Behavioral Health, Rachel Petts Phd, Jeffrey D. Shahidullah Phd, Paul W. Kettlewell Phd, Kathryn A. Dehart Md, Kris Rooney Md, Ilene G. Ladd Ms, Tyler Bogaczyk Bs, Sharon L. Larson Phd
International Journal of Health Sciences Education
Despite a mandated 1-month rotation in developmental-behavioral pediatrics (DBP), pediatric residents report inadequate training in behavioral health care. As a first step in much needed curriculum development in this area, this study sought to assess learner experiences regarding the management of behavioral health problems during residency. Four focus groups were conducted for residents in years 1-3 of training in 2 residency programs in a northeastern state. Transcripts were analyzed and coded by researchers through qualitative classical content analysis. The exploratory analysis revealed 9 key themes: time requirements, rapport building, resources and referrals for behavioral health, psychiatric medications, diagnosis vs. treatment, …
Depression, Anxiety, Post-Traumatic Stress Disorder And A History Of Pervasive Gender-Based Violence Among Women Asylum Seekers Who Have Undergone Female Genital Mutilation/Cutting: A Retrospective Case Review, Hazel Lever, Deborah Ottenheimer, Jimmitti Teysir, Elizabeth Singer, Holly G. Atkinson
Depression, Anxiety, Post-Traumatic Stress Disorder And A History Of Pervasive Gender-Based Violence Among Women Asylum Seekers Who Have Undergone Female Genital Mutilation/Cutting: A Retrospective Case Review, Hazel Lever, Deborah Ottenheimer, Jimmitti Teysir, Elizabeth Singer, Holly G. Atkinson
Publications and Research
We sought to evaluate the frequency of anxiety, depression, PTSD, and any experiences of violence in women who had undergone Female Genital Mutilation/Cutting (FGM/C) and were seeking asylum in the United States. We undertook a retrospective qualitative descriptive study of FGM/C cases seen in an asylum clinic over a 2-year period. Standardized questionnaires provided quantitative scores for anxiety, depression and PTSD. Clients’ personal and physician medical affidavits were analyzed for experiences of violence. Of the 13 cases, anxiety and depression were exhibited by 92 and 100% of women, while all seven women screened for PTSD had symptoms. Qualitative analysis revealed …
An Examination Of The Impact Traumatic Events Has On Psychosocial Impairment In Eating Disorder Patients, Jennifer Parker Hackett
An Examination Of The Impact Traumatic Events Has On Psychosocial Impairment In Eating Disorder Patients, Jennifer Parker Hackett
Electronic Theses, Projects, and Dissertations
Research suggests that trauma has an impact on eating disorders. While prior research has demonstrated that the trauma from abuse has a significant impact on eating disorders, research has failed to explore other types of trauma. In addition, previous studies have stopped short of examining the impact trauma has on functioning among individuals with an eating disorder. This study aimed to address that gap in the literature. The purpose of this study is to examine whether traumatic life events impact psychosocial functioning among individuals living with an eating disorder. Furthermore, this study aimed to identify which traumas are shown to …
Differences In Mental Health Education Across Baby Boomers, Generation X, And Millennials, Ashlyn M. Avera
Differences In Mental Health Education Across Baby Boomers, Generation X, And Millennials, Ashlyn M. Avera
Honors College Theses
There is no denying that mental illness has gained a strong prevalence in the United States. According to the National Alliance on Mental Illness, approximately one in five adults in the United States experiences a mental illness in any given year. Although mental health stigmas have played a role in the past, it does not mean they must continue to play the same role in the future. Research is now looking toward ways to decrease mental health stigma through increasing mental health knowledge. This study examines the starting point for which a society becomes literate in mental health. Using a …
Research Brief: "Impact Of Military Trauma Exposures On Post-Traumatic Stress And Depression In Female Veterans", Institute For Veterans And Military Families At Syracuse University
Research Brief: "Impact Of Military Trauma Exposures On Post-Traumatic Stress And Depression In Female Veterans", Institute For Veterans And Military Families At Syracuse University
Institute for Veterans and Military Families
This brief is about the relation between combat stressors, depression, and PTSD among female veterans. In policy and practice, health providers should refer female veterans to services if they have experienced military sexual trauma; the DoD and VA should conduct analysis on the experiences of service and veteran women, and how they can best support service women who experienced military sexual trauma. Suggestions for future research include using an expanded sample and more sampling strategies, as well as use clinical interviews to collect data.