Browsing by Author "Shell, Aubrey L."

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Associations between affective factors and high-frequency heart rate variability in primary care patients with depression
    (Elsevier, 2022-10) Shell, Aubrey L.; Gonzenbach , Virgilio; Sawhney , Manisha; Crawford, Christopher A.; Stewart, Jesse C.; Psychology, School of Science
    Objective Depression is a risk factor for cardiovascular disease (CVD), and subgroups of people with depression may be at particularly elevated CVD risk. Lower high-frequency heart rate variability (HF HRV), which reflects diminished parasympathetic activation, is a candidate mechanism underlying the depression-CVD relationship and predicts cardiovascular events. Few studies have examined whether certain depression subgroups – such as those with co-occurring affective factors – exhibit lower HF HRV. The present study sought to assess associations between co-occurring affective factors and HF HRV in people with depression. Methods Utilizing baseline data from the 216 primary care patients with depression in the eIMPACT trial, we examined cross-sectional associations of depression's co-occurring affective factors (i.e., anxiety symptoms, hostility/anger, and trait positive affect) with HF HRV. HF HRV estimates were derived by spectral analysis from electrocardiographic data obtained during a supine rest period. Results Individual regression models adjusted for demographics and depressive symptoms revealed that anxiety symptoms (standardized regression coefficient β = −0.24, p = .002) were negatively associated with HF HRV; however, hostility/anger (β = 0.02, p = .78) and trait positive affect (β = −0.05, p = .49) were not. In a model further adjusted for hypercholesterolemia, hypertension, diabetes, body mass index, current smoking, CVD prevention medication use, and antidepressant medication use, anxiety symptoms remained negatively associated with HF HRV (β = −0.19, p = .02). Conclusion Our findings suggest that, in adults with depression, those with comorbid anxiety symptoms have lower HF HRV than those without. Co-occurring anxiety may indicate a depression subgroup at elevated CVD risk on account of diminished parasympathetic activation.
  • Thumbnail Image
    Item
    Associations of somatic depressive symptoms with food attentional bias and eating behaviors
    (Elsevier, 2021-12) Shell, Aubrey L.; Jackson, Rachel A.; Patel, Jay S.; Hirsh, Adam T.; Cyders, Melissa A.; Stewart, Jesse C.; Psychology, School of Science
    Recent evidence suggests that atypical major depressive disorder (MDD) – whose key features include the reversed somatic symptoms of hyperphagia (increased appetite) and hypersomnia (increased sleep) – is a stronger predictor of future obesity than other MDD subtypes. The mechanisms underlying this relationship are unclear. The present study sought to elucidate whether the individual symptoms of hyperphagia, hypersomnia, poor appetite, and disturbed sleep have differential relationships with food attentional bias, emotional eating, external eating, and restrained eating. This cross-sectional laboratory study involved 103 young adults without obesity (mean age = 20 years, 79% female, 26% non-White, mean BMI = 23.4 kg/m2). We measured total depressive symptom severity and individual symptoms of hyperphagia, poor appetite, and disturbed sleep using the Hopkins Symptom Checklist-20 (SCL-20) and added an item to assess hypersomnia; food attentional bias using a Food Stroop task; and self-reported eating behaviors using the Dutch Eating Behavior Questionnaire. Hyperphagia was positively associated with emotional eating but negatively associated with food attentional bias. Hypersomnia was negatively associated with emotional eating. Poor appetite was negatively associated with emotional eating. Disturbed sleep was positively associated with food attentional bias and emotional eating. An aggregate of the remaining 15 depressive symptoms (SCL-15) was positively associated with emotional and restrained eating. Our findings highlight the importance of examining the direction of somatic depressive symptoms, and they set the stage for future research to identify subgroups of people with depression at greatest risk for obesity (e.g., those with hyperphagia and/or disturbed sleep) and the mechanisms responsible for this elevated risk (e.g., emotional eating).
  • Thumbnail Image
    Item
    Depressive Symptom Severity as a Predictor of Attendance in the HOME Behavioral Weight Loss Trial
    (Elsevier, 2020-04) Shell, Aubrey L.; Hsueh, Loretta; Vrany, Elizabeth A.; Clark, Daniel O.; Keith, NiCole R.; Xu, Huiping; Stewart, Jesse C.; Psychology, School of Science
    Objective We examined whether total depressive symptoms and symptom clusters predicted behavioral weight loss attendance among economically disadvantaged adults in a randomized controlled trial. Methods 150 adults with obesity were randomized to 12 months of in-person, video conference, or enhanced usual care weight loss groups. We categorized percent session attendance in the intervention arms into three levels: no attendance, poorer attendance, and better attendance. Results Higher baseline Patient Health Questionnaire-8 (PHQ-8) score was associated with a greater odds of being in the poorer versus better attendance group (OR = 1.94, 95% CI: 1.02–3.69, p = .04). A similar relationship between PHQ-8 score and odds of being in the no attendance versus better attendance group was observed but was not statistically significant (OR = 1.63, 95% CI: 0.94–2.81, p = .08). Both cognitive/affective and somatic clusters contributed to the depressive symptoms-attendance relationships. Conclusion Greater depressive symptoms at the start of a behavioral weight loss program may predict poorer subsequent session attendance. Screening for and addressing depression may improve intervention uptake.
  • Thumbnail Image
    Item
    Depressive Symptoms and Eating Behaviors: Do Atypical Symptoms Drive Associations with Food Attentional Bias, Emotional Eating, and External Eating?
    (2019-05) Shell, Aubrey L.; Stewart, Jesse C.; Hirsh, Adam T.; Cyders, Melissa A.; Guare, John C.
    Depression is an emerging risk factor for obesity; however, it is unclear whether certain depressive symptoms drive this relationship. Recent evidence suggests that atypical major depressive disorder (MDD) – whose key features include the reversed somatic-vegetative symptoms of hyperphagia (increased appetite) and hypersomnia (increased sleep) – is a stronger predictor of future obesity than other MDD subtypes. The present study sought to examine food attentional bias (increased attention to food cues), emotional eating (eating in response to negative emotions), and external eating (eating in response to external food cues) as candidate mechanisms of the depression-to-obesity relationship. This cross-sectional laboratory study hypothesized that total depressive symptom severity, hyperphagia severity, and hypersomnia severity would all be positively associated with measures of food attentional bias, emotional eating, and external eating. Data were collected from a sample of 95 undergraduate students. Depressive symptom severity was measured using the Hopkins Symptom Checklist (SCL-20); two measures of food attentional bias were obtained from eye tracking with high calorie food images: direction bias and duration bias; and emotional eating and external eating were assessed using the Dutch Eating Behavior Questionnaire. Simultaneous regression models (adjusted for age, sex, race/ethnicity, body mass index, and subjective hunger) revealed total depressive symptom severity and hypersomnia severity were not associated with measures of food attentional bias, while hyperphagia severity was negatively associated with direction bias but not associated with duration bias for high and low calorie food images. Findings related to emotional and external eating are consistent with previous literature: total depressive symptom severity and hyperphagia severity were positively associated with both emotional eating and external eating, and the pattern of results suggests that hyperphagia may be driving relationships between depressive symptoms and these eating behaviors. Hypersomnia severity was not associated with emotional eating and external eating, suggesting this symptom does not play an important role in the relationships between depressive symptoms and these eating behaviors. Future studies should examine prospective associations of hyperphagia severity with food attentional bias, emotional eating, and external eating in larger, more representative samples.
  • Thumbnail Image
    Item
    Effect of Modernized Collaborative Care for Depression on Depressive Symptoms and Cardiovascular Disease Risk Biomarkers: eIMPACT Randomized Controlled Trial
    (Elsevier, 2023) Stewart, Jesse C.; Patel, Jay S.; Polanka, Brittanny M.; Gao, Sujuan; Nurnberger, John I., Jr.; MacDonald, Krysha L.; Gupta, Samir K.; Considine, Robert V.; Kovacs, Richard J.; Vrany, Elizabeth A.; Berntson, Jessica; Hsueh, Loretta; Shell, Aubrey L.; Rollman, Bruce L.; Callahan, Christopher M.; Psychology, School of Science
    Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, Mage = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges' g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results - 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI: 1.93-7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers - i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges' gs = -0.23 to 0.02, ps ≥ 0.09). Our modernized collaborative care intervention - which harnessed technology to maximize access and minimize resources - produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches.
  • Thumbnail Image
    Item
    The Lasting Effects of Growing up in a Military-Connected Home: A Qualitative Study of College-Aged American Military Kids
    (Taylor & Francis, 2019) Zurlinden, Taylor E.; Firmin, Michael W.; Shell, Aubrey L.; Grammer, Hannah W.; Psychology, School of Science
    Being reared as a military kid is a unique experience shared by millions of children all over the world. This study seeks to understand the experiences shared by military kids and how those experiences change their perspectives, behaviours, and relationships. In the present phenomenological study, we conducted 21 in-depth, semi-structured qualitative interviews of college students who were reared as United States military kids (MKs). Using criterion sampling, the participants all met specific criteria, including experiencing deployment of their military parent as well as a minimum of 10 years of parental service during the MK’s lifetime. Interviews were tape-recorded, transcribed, and coded for analysis. Researchers reviewed the transcriptions to find common themes and meta-themes present in a majority of the interviews. Common themes centred around relationships with family, changes during childhood, and military presence in everyday life. Particular findings reported in the present article include demonstrated respect, military pride, military community commonality, anticipation of change, childhood instability, family dynamics, military terminology, adaptability, and an overall positive experience. These common themes are relevant for all involved in the care of military kids and their families, as they underline the unique perspective that MKs have about their childhood and their future.
  • Thumbnail Image
    Item
    Negative Urgency and Central Adiposity in a Community Sample: Moderated Mediation by Depressive Symptoms and Eating Behaviors
    (Elsevier, 2021) Shell, Aubrey L.; Oglesby, Larissa T.; Um, Miji; Stewart, Jesse C.; Cyders, Melissa A.; Psychology, School of Science
    Negative urgency – acting rashly in response to negative emotions – is a risk factor for central adiposity. We examine whether the relationship between negative urgency and waist-to-height ratio (WHtR) is mediated by eating behaviors (emotional eating, external eating, and cognitive restraint) and moderated by depressive symptom severity, factors that could be targeted to reduce risk associated with negative urgency. Using baseline data from the Nathan Kline Institute-Rockland Sample (N = 872; mean age = 42.4 years, SD = 15.3; 65% female; 27% non-White; mean body mass index = 27.9 kg/m2, SD = 5.9), we conducted a series of mediation and moderated mediation analyses controlling for age, sex, race, and socioeconomic status. Overall, there was a positive association between negative urgency and WHtR. Emotional eating (ab = 0.02, SE = 0.003, 95% CI [0.02, 0.03]) and uncontrolled eating (ab = 0.008, SE = 0.002, 95% CI [0.004, 0.01]) were partial mediators of the relationship between negative urgency and WHtR, while cognitive restraint was not. In a parallel mediation model, emotional eating remained significant, while uncontrolled eating did not. Depressive symptom severity moderated the indirect effect of negative urgency on WHtR through emotional eating (bint = −0.08, p < .001) but not the direct effect of negative urgency on WHtR. Our results indicate that emotional eating is a viable potential mechanism explaining the relationship between negative urgency and WHtR, and the indirect effect of negative urgency on WHtR through emotional eating becomes stronger as depressive symptom severity decreases.