Psychiatry and Psychology Commons^™

The Importance Of Shared Language In Rural Behavioral Health Interventions: An Exploratory Linguistic Analysis, Michele Staton, Jennifer Cramer, Robert Walker, Claire Snell-Rood, Athena Kheibari

Behavioral Science Faculty Publications

A focus on the use of shared language to enhance congruence in interventionist-client dialogue is missing from traditional research on evidence-based practices and rural behavioral health. This study incorporates qualitative interactional sociolinguistics, which includes discourse analysis (typically written or audio recordings of face-to-face encounters with 11 clients and a study interventionist), to describe those speech patterns in a broad sense (dialect), as well as more specific use of communicative strategies to increase parity in the interaction between a rural interventionist delivering an evidence-based practice in the context of a research study with rural women opioid users in a non-therapeutic context. …

Staying Out: Reentry Protective Factors Among Rural Women Offenders, Michele Staton, Megan F. Dickson, Martha Tillson, J. Matthew Webster, Carl G. Leukefeld

Behavioral Science Faculty Publications

The current study examines protective factors for women who transition from county jails to rural Appalachian communities, areas with limited health and behavioral health services. The study included drug-using women recruited from three jails in rural Appalachia and followed-up at 12-months post-release. Analyses focused on differences between women who remained in the community and those who returned to custody, as well as a multivariate model to determine protective factors for reentry success. At the bivariate level, staying out of jail was associated with being older, having a job, not using drugs, stable housing, receiving health treatment, and having prosocial peers. …

Beyond The Employment Dichotomy: An Examination Of Recidivism And Days Remaining In The Community By Post-Release Employment Status, Amanda Marie Bunting, Michele Staton, Erin Winston, Kevin Pangburn

Behavioral Science Faculty Publications

Criminological research has tended to consider employment in a dichotomy of employed versus unemployed. The current research examines a sample of individuals 1-year post-release to assess the extent to which four distinct employment categories (full-time, part-time, disabled, and unemployed) are associated with reincarceration and days remaining in the community. Findings indicate disabled individuals remain in the community longer and at a higher proportion compared with other employment categories. Furthermore, unique protective and risk factors are found to be associated with each employment category while some risk factors (e.g., homelessness) highlight the importance of addressing reentry barriers regardless as to employment …

Decoding Attentional State To Faces And Scenes Using Eeg Brainwaves, Reza Abiri, Soheil Borhani, Yang Jiang, Xiaopeng Zhao

Behavioral Science Faculty Publications

Attention is the ability to facilitate processing perceptually salient information while blocking the irrelevant information to an ongoing task. For example, visual attention is a complex phenomenon of searching for a target while filtering out competing stimuli. In the present study, we developed a new Brain-Computer Interface (BCI) platform to decode brainwave patterns during sustained attention in a participant. Scalp electroencephalography (EEG) signals using a wireless headset were collected in real time during a visual attention task. In our experimental protocol, we primed participants to discriminate a sequence of composite images. Each image was a fair superimposition of a scene …

Lung Cancer Screening In A Community Setting: Characteristics, Motivations, And Attitudes Of Individuals Being Screened, Margaret M. Byrne, Sarah E. Lillie, Jamie L. Studts

Behavioral Science Faculty Publications

We describe the characteristics of individuals being screened in community settings including factors influencing screening decisions and the level of information sought prior to screening. Individuals from two community-based radiology clinics (N = 27) were surveyed after screening. Screening efficacy and salience were the most important factors in screening decisions, whereas healthcare provider recommendations were rated not important. Half of participants reported no or little conversation about screening with their primary care provider, and 61.5 percent had not sought any information on screening. Individuals being screened in a community setting are unlikely to have sufficient information for an informed …

Pharmacy Staff Perspectives On Alcohol And Medication Interaction Prevention Among Older Rural Adults, Faika Zanjani, Hannah Allen, Rachel Vickers Smith, Demetra Antimisiaris, Nancy E. Schoenberg, Catherine A. Martin, Richard Clayton

Behavioral Science Faculty Publications

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. …

A Stress Management App Intervention For Cancer Survivors: Design, Development, And Usability Testing, Elin Børøsund, Jelena Mirkovic, Matthew M. Clark, Shawna L. Ehlers, Michael A. Andrykowski, Anne Bergland, Marianne Westeng, Lise Solberg Nes

Behavioral Science Faculty Publications

Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions.

Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative …

Using Mhealth To Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2care): Protocol For A Randomized Controlled Trial, Jennifer M. Reingle Gonzalez, Michael S. Businelle, Darla Kendzor, Michele Staton, Carol S. North, Michael Swartz

Behavioral Science Faculty Publications

Background: There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). …

Perceived Importance Of Substance Use Prevention In Juvenile Justice: A Multi-Level Analysis, Jessica M. Sales, Gail Wasserman, Katherine S. Elkington, Wayne Lehman, Sheena Gardner, Larkin Mcreynolds, Tisha Wiley, Hannah K. Knudsen

Behavioral Science Faculty Publications

Background: Youth under juvenile justice (JJ) supervision are at high-risk of adverse outcomes from substance use, making prevention important. Few studies have examined prevention-related attitudes of JJ employees, yet such attitudes may be important for implementing prevention programs. Attitudes toward prevention may reflect individual characteristics and organizational contexts.

Methods: Mixed effects regression was used to analyze data from 492 employees in 36 sites participating in the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) cooperative agreement. JJ employees' perceived importance of substance use prevention was measured. Staff-level variables included attitudes, job type, and demographic characteristics. Site-level …

Test Of A Workforce Development Intervention To Expand Opioid Use Disorder Treatment Pharmacotherapy Prescribers: Protocol For A Cluster Randomized Trial, Todd Molfenter, Hannah K. Knudsen, Randy Brown, Nora Jacobson, Julie Horst, Mark Van Etten, Jee-Seon Kim, Eric Haram, Elizabeth Collier, Sanford Starr, Alexander Toy, Lynn Madden

Behavioral Science Faculty Publications

Background: Overdoses due to non-medical use of prescription opioids and other opiates have become the leading cause of accidental deaths in the USA. Buprenorphine and extended-release naltrexone are key evidence-based pharmacotherapies available to addiction treatment providers to address opioid use disorder (OUD) and prevent overdose deaths. Treatment organizations’ efforts to provide these pharmacotherapies have, however, been stymied by limited success in recruiting providers (physicians, nurse practitioners, and physician assistants) to prescribe these medications. Historically, the addiction treatment field has not attracted physicians, and many barriers to implementing OUD pharmacotherapy exist, ranging from lack of confidence in treating OUD patients to …

Low Arousal Positive Emotional Stimuli Attenuate Aberrant Working Memory Processing In Persons With Mild Cognitive Impairment, Lucas S. Broster, Shonna L. Jenkins, Sarah D. Holmes, Gregory A. Jicha, Yang Jiang

Behavioral Science Faculty Publications

Emotional enhancement effects on memory have been reported to mitigate the pathophysiology of Alzheimer’s disease (AD). However, relative to their manifestation in persons without pathologic aging, these effects may be reduced in magnitude or even deleterious, especially in tasks that more closely model ecologic memory performance. Based upon a synthesis of such reports, we hypothesized that in persons with AD low arousal positive stimuli would evoke relatively intact emotional enhancement effects, but that high arousal negative stimuli would evoke disordered emotional enhancement effects. To assess this, participants with and without mild cognitive impairment (MCI) presumed to be due to AD …

Partner Relationships And Injection Sharing Practices Among Rural Appalachian Women, Michele Staton, Justin C. Strickland, Martha Tillson, Carl Leukefeld, J. Matthew Webster, Carrie B. Oser

Behavioral Science Faculty Publications

Background—The role of relationships in initiating and maintaining women’s risk behaviors has been established. However, understanding factors that may underlie partner relationships and women’s risky drug use, particularly in rural contexts, is limited. This study is the first to examine the association between injecting partners and women’s risky injection practices as a function of relationship power perception.

Methods—Female participants were recruited from three rural jails in the Appalachian region. Women were randomly selected, provided informed consent, and screened for study eligibility criteria. This cross-sectional analysis focuses on women who inject drugs (WWID) during the year before entering jail …

Sources Of Medical Student Stress, Krishna Subhash Vyas, Terry D. Stratton, Neelkamal S. Soares

Behavioral Science Faculty Publications

Background: Key elements in the clinical practice of prevention, health and wellness are best cultivated in medical professionals during undergraduate medical training. This study explores students' self-assessed stress relative to gender, academic expectations, and level of medical training to guide development of targeted wellness interventions. Methods: In early 2012, undergraduate (M1-M4) students in four Southeastern U.S. allopathic medical schools were surveyed about health-related attitudes and behaviors. Results: A total of 575 students returned completed questionnaires. Students in the preclinical years (M1-M2), especially females, reported significantly higher stress levels. Academic expectations and satisfaction were also significantly implicated. Discussion: These findings highlight …

N-Acetylcysteine Reduces Cocaine-Cue Attentional Bias And Differentially Alters Cocaine Self-Administration Based On Dosing Order, B. Levi Bolin, Joseph L. Alcorn Iii, Joshua A. Lile, Craig R. Rush, Abner O. Rayapati, Lon R. Hays, William W. Stoops

Behavioral Science Faculty Publications

Background—Disrupted glutamate homeostasis is thought to contribute to cocaine-use disorder, in particular, by enhancing the incentive salience of cocaine stimuli. n-Acetylcysteine might be useful in cocaine-use disorder by normalizing glutamate function. In prior studies, n-acetylcysteine blocked the reinstatement of cocaine seeking in laboratory animals and reduced the salience of cocaine stimuli and delayed relapse in humans.

Methods—The present study determined the ability of maintenance on n-acetylcysteine (0 or 2400 mg/day, counterbalanced) to reduce the incentive salience of cocaine stimuli, as measured by an attentional bias task, and attenuate intranasal cocaine self-administration (0, 30, and 60 mg). Fourteen individuals …

Healthcare Contact And Treatment Uptake Following Hepatitis C Virus Screening And Counseling Among Rural Appalachian People Who Use Drugs, Dustin B. Stephens, April M. Young, Jennifer R. Havens

Behavioral Science Faculty Publications

Background—Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings.

Methods—503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and …

A Mixed Methods Study Of Hiv-Related Services In Buprenorphine Treatment, Hannah K. Knudsen, Jennifer Cook, Michelle R. Lofwall, Sharon L. Walsh, Jamie L. Studts, Jennifer R. Havens

Behavioral Science Faculty Publications

Background: Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers’ medical specialty and across practice settings.

Methods: Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients …

Impulsive Personality Dimensions Are Associated With Altered Behavioral Performance And Neural Responses In The Monetary Incentive Delay Task, Ruolei Gu, Yang Jiang, Seth Kiser, Chelsea L. Black, Lucas S. Broster, Yue-Jia Luo, Thomas H. Kelly

Behavioral Science Faculty Publications

Individual differences in dimensions of impulsivity personality including disinhibition and sensation seeking modulate approach responses to reinforcing stimuli, such as drugs and money. The current study examined the effects of monetary incentive on both behavioral performance and electrophysiological activity among individuals varying in disinhibition and sensation seeking. The monetary incentive delay (MID) task was completed under electroencephalogram (EEG) recording. Behavioral data showed that higher disinhibition and sensation-seeking were associated with lower performance accuracy. Event-related potential (ERP) data showed that high reinforcement cues elicited a larger late positive component (LPC) than other conditions among high disinhibition participants, indicating its strong emotional …

A Randomized Placebo-Controlled Trial Of N-Acetylcysteine For Cannabis Use Disorder In Adults, Kevin M. Gray, Susan C. Sonne, Erin A. Mcclure, Udi E. Ghitza, Abigail G. Matthews, Aimee L. Mcrae-Clark, Kathleen M. Carroll, Jennifer S. Potter, Katharina Wiest, Larissa J. Mooney, Albert Hasson, Sharon L. Walsh, Michelle R. Lofwall, Shanna Babalonis, Robert W. Lindblad, Steven Sparenborg, Aimee Wahle, Jacqueline S. King, Nathaniel L. Baker, Rachel L. Tomko, Louise F. Haynes, Ryan G. Vandrey, Frances R. Levin

Behavioral Science Faculty Publications

Background—Cannabis use disorder (CUD) is a prevalent and impairing condition, and established psychosocial treatments convey limited efficacy. In light of recent findings supporting the efficacy of N-acetylcysteine (NAC) for CUD in adolescents, the objective of this trial was to evaluate its efficacy in adults.

Methods—In a 12-week double-blind randomized placebo-controlled trial, treatment-seeking adults ages 18–50 with CUD (N=302), enrolled across six National Drug Abuse Treatment Clinical Trials Network-affiliated clinical sites, were randomized in a 1:1 ratio to a 12-week course of NAC 1200 mg (n=153) or placebo (n=149) twice daily. All …

Neurophysiological Capacity In A Working Memory Task Differentiates Dependent From Nondependent Heavy Drinkers And Controls, Michael J. Wesley, Joshua A. Lile, Mark T. Fillmore, Linda J. Porrino

Behavioral Science Faculty Publications

Background—Determining the brain-behavior profiles that differentiate heavy drinkers who are and are not alcohol dependent will inform treatment efforts. Working memory is linked to substance use disorders and can serve as a representation of the demand placed on the neurophysiology associated with cognitive control.

Methods—Behavior and brain activity (via fMRI) were recorded during an N-Back working memory task in controls (CTRL), nondependent heavy drinkers (A-ND) and dependent heavy drinkers (A-D). Typical and novel step-wise analyses examined profiles of working memory load and increasing task demand, respectively.

Results—Performance was significantly decreased in A-D during high working memory load …

Compulsive Buying And Quality Of Life: An Estimate Of The Monetary Cost Of Compulsive Buying Among Adults In Early Midlife, Chenshu Zhang, Judith S. Brook, Carl G. Leukefeld, Mario De La Rosa, David W. Brook

Behavioral Science Faculty Publications

The aims of this study were to examine the associations between compulsive buying and quality of life and to estimate the monetary cost of compulsive buying for a cohort of men and women at mean age 43. Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. Linear regression analyses showed that compulsive buying was significantly associated with …

A Pilot Investigation Of Acute Inhibitory Control Training In Cocaine Users, Joseph L. Alcorn, Erika Pike, William W. Stoops, Joshua A. Lile, Craig R. Rush

Behavioral Science Faculty Publications

Background—Disrupted response inhibition and presence of drug-cue attentional bias in cocaine-using individuals have predicted poor treatment outcomes. Inhibitory control training could help improve treatment outcomes by strengthening cognitive control. This pilot study assessed the effects of acute inhibitory control training to drug- and non-drug-related cues on response inhibition performance and cocaine-cue attentional bias in cocaine-using individuals.

Methods—Participants who met criteria for a cocaine-use disorder underwent five sessions of inhibitory control training to either non-drug-related cues (i.e., rectangles) or cocaine cues (n=10/condition) in a single day. Response inhibition and attentional bias were assessed prior to and following training using …

Functional Human Grin2b Promoter Polymorphism And Variation Of Mental Processing Speed In Older Adults, Yang Jiang, Ming Kuan Lin, Gregory A. Jicha, Xiuhua Ding, Sabrina L. Mcilwrath, David W. Fardo, Lucas S. Broster, Frederick A. Schmitt, Richard J. Kryscio, Robert H. Lipsky

Behavioral Science Faculty Publications

We investigated the role of a single nucleotide polymorphism rs3764030 (G > A) within the human GRIN2B promoter in mental processing speed in healthy, cognitively intact, older adults. In vitro DNA-binding and reporter gene assays of different allele combinations in transfected cells showed that the A allele was a gain-of-function variant associated with increasing GRIN2B mRNA levels. We tested the hypothesis that individuals with A allele will have better memory performance (i.e. faster reaction times) in older age. Twenty-eight older adults (ages 65-86) from a well-characterized longitudinal cohort were recruited and performed a modified delayed match-to-sample task. The rs3764030 polymorphism was …

Lack Of Preventive Health Behaviors In The Early Forties: The Role Of Earlier Trajectories Of Cigarette Smoking From Adolescence To Adulthood, Chenshu Zhang, Judith S. Brook, Carl G. Leukefeld, Mario De La Rosa, David W. Brook

Behavioral Science Faculty Publications

Objective: To study the degree to which individuals in different trajectories of cigarette smoking from adolescence to the early forties are similar or different in terms of lack of preventive health behaviors (e.g., underuse of preventive health services, unhealthy eating habits) in early midlife. Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from adolescence to early midlife (mean age = 43 years, standard deviation [SD] = 2.8) at seven time points. Using growth mixture modeling, we statistically identified the number of smoking trajectories. …

Psychosocial Factors Related To The Intergenerational Transmission Of Externalizing Behaviors In Early Midlife, Chenshu Zhang, Judith S. Brook, Neo K. Morojele, Mario De La Rosa, Carl G. Leukefeld, David W. Brook

Behavioral Science Faculty Publications

Background: To study the intergenerational transmission of externalizing behaviors. Methods: Participants came from a community-based random sample of residents in two upstate New York counties (N = 548). Data were collected from mothers at mean age 40 and from their children from adolescence (mean age = 14, SD = 2.8) to early midlife (mean age = 43, SD = 2.8) at seven time points. Structural equation modeling (SEM) was used to study the psychosocial factors as related to externalizing behaviors in early midlife. Results: First, maternal externalizing behaviors were indirectly associated with the offspring's externalizing behaviors …

Buprenorphine Physician Supply: Relationship With State-Level Prescription Opioid Mortality, Hannah K. Knudsen, Jennifer R. Havens, Michelle R. Lofwall, Jamie L. Studts, Sharon L. Walsh

Behavioral Science Faculty Publications

Background: Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation’s prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states.

Methods: The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June 2013 to January 2016. States were divided into two groups: those with rates of …

Psychological And Behavioral Impact Of Participation In Ovarian Cancer Screening, Michael A. Andrykowski

Behavioral Science Faculty Publications

Evaluation of costs and benefits associated with cancer screening should include consideration of any psychological and behavioral impact associated with screening participation. Research examining the psychological and behavioral impact of screening asymptomatic women for ovarian cancer (OC) was considered. Research has focused upon potential negative psychological (e.g., distress) and behavioral (e.g., reduced future screening participation) impact of false positive (FP) OC test results. Results suggest FP OC screening results are associated with greater short-term OC-specific distress. While distress dissipates over time it may remain elevated relative to pre-screening levels for several weeks or months even after clinical follow-up has ruled …

Oral Cannabidiol Does Not Produce A Signal For Abuse Liability In Frequent Marijuana Smokers, Shanna Babalonis, Margaret Haney, Robert J. Malcolm, Michelle R. Lofwall, Victoria R. Votaw, Steven Sparenborg, Sharon L. Walsh

Behavioral Science Faculty Publications

Background—Cannabidiol (CBD) is a naturally occurring constituent of the marijuana plant. In the past few years, there has been great interest in the therapeutic effects of isolated CBD and it is currently being explored for numerous disease conditions (e.g., pain, epilepsy, cancer, various drug dependencies). However, CBD remains a Schedule I drug on the U.S. Controlled Substances Act (CSA). Despite its status, there are no well-controlled data available regarding its abuse liability.

Methods—Healthy, frequent marijuana users (n=31) were enrolled in this within subject, randomized, placebo-controlled, double-blind, multisite study that administered oral cannabidiol (0, 200, 400, 800 …

Trait Anxiety And Economic Risk Avoidance Are Not Necessarily Associated: Evidence From The Framing Effect, Ruolei Gu, Runguo Wu, Lucas S. Broster, Yang Jiang, Rui Xu, Qiwei Yang, Pengfei Xu, Yue-Jia Luo

Behavioral Science Faculty Publications

According to previous literature, trait anxiety is related to the tendency to choose safety options during risk decision-making, that is, risk avoidance. In our opinion, anxious people’s risk preference might actually reflect their hypersensitivity to emotional information. To examine this hypothesis, a decision-making task that could elicit the framing effect was employed. The framing effect indicates that risk preference could be modulated by emotional messages contained in the description (i.e., frame) of options. The behavioral results have showed the classic framing effect. In addition, individual level of trait anxiety was positively correlated with the framing effect size. However, trait anxiety …

A Cognitive Electrophysiological Signature Differentiates Amnestic Mild Cognitive Impairment From Normal Aging, Juan Li, Lucas S. Broster, Gregory A. Jicha, Nancy B. Munro, Frederick A. Schmitt, Erin L. Abner, Richard J. Kryscio, Charles D. Smith, Yang Jiang

Behavioral Science Faculty Publications

Background: Noninvasive and effective biomarkers for early detection of amnestic mild cognitive impairment (aMCI) before measurable changes in behavioral performance remain scarce. Cognitive event-related potentials (ERPs) measure synchronized synaptic neural activity associated with a cognitive event. Loss of synapses is a hallmark of the neuropathology of early Alzheimer’s disease (AD). In the present study, we tested the hypothesis that ERP responses during working memory retrieval discriminate aMCI from cognitively normal controls (NC) matched in age and education.

Methods: Eighteen NC, 17 subjects with aMCI, and 13 subjects with AD performed a delayed match-to-sample task specially designed not only to be …

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. …