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Item Depression and Cancer-Related Fatigue: A Cross-Lagged Panel Analysis of Causal Effects(2012-07-03) Brown, Linda F.; Bigatti, Silvia M.; Kroenke, Kurt; Rand, Kevin L.; Stewart, Jesse C.Fatigue is one of the most common and debilitating symptoms reported by cancer patients, yet it is infrequently diagnosed or treated. Relatively little is understood about its etiology in the cancer context. Recently, as researchers have begun to focus attention on cancer-related fatigue (CRF), depression has emerged as its strongest correlate. Few longitudinal studies have been done, however, to determine whether causal influences between the two symptoms exist. The aim of the current study was to determine whether depression has a causal influence on CRF and whether reciprocal effects exist. The study used a single-group cohort design of longitudinal data from a randomized controlled trial (N = 405) of an intervention for pain and depression in a heterogeneous sample of cancer patients. To be eligible, participants met criteria for clinically significant pain or depression. A hypothesis that depression would influence change in fatigue after 3 months was tested using latent variable cross-lagged panel analysis, a structural equation modeling technique. A second hypothesis was that fatigue would also influence change in depression over time but at a lesser magnitude. Depression and fatigue were strongly correlated in the sample (i.e., baseline correlation of latent variables was 0.72). Although the model showed good fit to the data, χ2 (66, N = 329) = 88.16, p = 0.04, SRMR = 0.030, RMSEA = 0.032, and CFI = 1, neither cross-lagged structural path was significant. The findings suggest that depression had no causal influence on changes in fatigue in this sample, and fatigue did not influence change in depression. The clinical implication is that depression treatment may not be helpful as a treatment for CRF and therefore interventions specifically targeting fatigue may be needed. Future research should include additional waves of data and larger sample sizes.Item Depression treatment and diabetes risk: a 9-year follow-up study of the impact trial(2015) Khambaty, Tasneem; Stewart, Jesse C.; Hirsh, Adam T.; Mosher, Catherine E.; Callahan, Christopher M.Objectives: To examine the effect of a collaborative care program for late-life depression on risk of diabetes among depressed, older adults. Method: We conducted a 9-year follow-up study of 160 older, primary care patients with a depressive disorder but without diabetes enrolled at the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. Results: Surprisingly, the rate of incident diabetes in the collaborative care group (22/80 = 27.5%) was twice the rate observed in the usual care group (11/80 = 13.7%). Cox proportional hazards models adjusted for randomization status (HR = 1.94, p = .076), demographic factors (HR = 1.94, p = .075), and additionally for diabetes risk factors (HR = 1.73, p = .157) indicated that the risk of incident diabetes did not differ between the collaborative care and usual care groups, with collaborative care patients remaining at a nonsignificant increased risk. Conclusions: Our novel findings suggest that depression may not be a casual risk factor for diabetes and that depression treatment may be insufficient to reduce the excess diabetes risk of depressed, older adults.Item An Empirical Test of the Dimensionality of Self-Control(2013-08-23) Tunze, Chloe Ann; Rand, Kevin L.; Cyders, Melissa A.; Rexroth, Daniel F.; Stewart, Jesse C.; Ashburn-Nardo, Leslie; Hazer, JohnMinimal attention has been devoted to examining the dimensionality of self-control. The present study tested a multidimensional model of self-control in which dimensions were based on the nature of the behavior required (i.e., persistence, initiation, cessation, or prevention). A total of 336 undergraduates completed measures of self-control and psychological well-being. Seventy-four of these participants completed behavioral self-control tasks representing the proposed subtypes. Participants’ GPAs were obtained from the Registrar. Stop self-control was inversely related to previously-validated measures of persistence (β = -.61, p = .010) and prevention (β = -.56, p = .040) self-control and demonstrated differential predictive ability of persistence and prevention compared to the other proposed subtypes. Initiation self-control was inversely related to life satisfaction (β = -.35, p = .012) and demonstrated differential predictive ability of life satisfaction compared to stop self-control. These results were interpreted with caution due to inadequate power and questionable validity of several of the behavioral self-control tasks. Both handgrip persistence (r = -.25, p = .033) and blinking prevention (r = -.29, p = .023) were associated with depression. These pairwise correlations were not significantly different from each other, suggesting that no conceptual distinction should be made between persistence and prevention self-control. Confirmatory factor analyses of self-report data revealed that items clustered based on domain rather than on type of behavior required for self-control exertion. Thus, the structure of self-control remains unclear. Limitations of the present study and implications for future research are discussed.Item Is depression a stronger risk factor for cardiovascular disease among individuals with a history of adverse childhood experiences?(2014-07-31) Case, Stephanie M.; Stewart, Jesse C.; Cyders, Melissa A.; Hirsh, Adam; Grahame, Nicholas J.Epidemiologic studies suggest that depression is an independent risk factor for cardiovascular disease (CVD). Although several possible mediators of this association have been proposed, few studies have examined the role of moderators. Accordingly, I examined adverse childhood experiences (ACE) as a potential moderator of the depression-CVD association, given that individuals with a history of ACE show a greater inflammatory response to depression, and inflammation plays a role in the development of CVD. Data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. Participants were 29,282 adults (58% female, 42% non–white) aged 18–97 years, free of CVD diagnoses at baseline. Lifetime depressive disorder (LDD) was assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule–IV (AUDADIS–IV), and adverse childhood experiences (abuse, neglect, and household dysfunction), and CVD were assessed during separate interviews. The primary outcome was incident CVD (n = 1,255), defined as nonfatal arteriosclerosis, angina pectoris, myocardial infarction, and/or stroke reported during the Wave 2 interviews. All analyses were adjusted for demographic and traditional CVD risk factors. Logistic regression models revealed that both LDD (OR = 1.44, 95% CI: 1.28–1.62, p < .001) and any ACE (OR = 1.25, 95% CI: 1.16–1.35, p < .001) were independent predictors of incident CVD. Interactions between LDD x any ACE (p = .024), LDD x neglect (p = .003), and LDD x household dysfunction (p < .001), but not LDD x abuse (p = 0.16), were detected. Analyses stratified by the ACE variables revealed that LDD was a predictor of incident CVD among adults with a history of (1) any ACE (OR = 1.51, 95% CI: 1.32–1.73, p < .001), but not among those without a history (OR = 1.15, 95% CI: 0.87–1.50, p = .332); (2) neglect (OR = 1.59, 95% CI: 1.36–1.87, p < .001) and among those without a history (OR = 1.25, 95% CI: 1.07–1.62, p = .005); (3) household dysfunction (OR = 1.73, 95% CI: 1.46–2.04, p < .001), but not among those without a history (OR = 1.18, 95% CI: 0.96–1.43, p = .11). Overall, the present findings suggest that depression may be a stronger risk factor for CVD among adults with a history of ACE, especially neglect and household dysfunction, than among adults who did not have these experiences.Item Is Periodontal Disease a Partial Mediator of the Association Between Depressive Symptoms And Cardiovascular Disease?(2012-08-28) Khambaty, Tasneem; Stewart, Jesse C.; Cyders, Melissa A.; Salyers, Michelle P.Epidemiological studies suggest that depression may be an independent risk factor for cardiovascular disease (CVD). Although several possible mediators of this association have been proposed, the precise mechanisms are yet unknown. Accordingly, we examined periodontal disease as a novel mediator of the depression-CVD association, given its separate links with both depression and CVD. Data from the National Health and Nutrition Examination Survey (NHANES) I and its Epidemiologic Follow-up Study (NHEFS) were analyzed. Participants were 3,346 individuals aged 25-74 years free of CVD at baseline (53% female, 16% non-white). Depression was assessed by the, depressed mood subscale of the General Well-Being Schedule Based on the Russell Periodontal Index, periodontal disease (43%) was defined as the presence of four or more periodontal pockets identified by a licensed dentist during an examination. The primary outcome was incident CVD (n=727, 22%), defined as nonfatal or fatal coronary artery disease or cerebrovascular disease, identified during the follow-up period by interviews and death certificate records. All analyses were adjusted for demographic and cardiovascular risk factors. Logistic regression analyses revealed no association between the GWBS depressed mood score and periodontal disease (OR=1.05, 95% CI: 0.96-1.14, p=.24). Cox proportional hazard models revealed that both periodontal disease (HR=1.24, 95% CI: 1.06-1.46, p=.009) and depressed mood (HR=1.08, 95% CI: 1.01-1.17, p=.03) were significant predictors of incident CVD. However, Sobel analyses found that periodontal disease was not a partial mediator of the depressed mood-incident CVD association (t=1.01, p=.31). Overall, these mediation results suggest that (a) both periodontal disease and depressed mood are independent predictors of incident CVD and that (b) the effect of depressive symptoms on incident CVD is not mediated by periodontal disease.Item The processes of disease management in African American adolescents with depression(2016-05-05) Al-Khattab, Halima Abdur-Rahman; Draucker, Claire Burke; Oruche, Ukamaka; Perkins, Danielle; Pescosolido, BerniceDepression in African American (AA) adolescents is a prevalent mental health problem, can result in serious concurrent and long-term effects, and is associated with health disparities due to underutilization of mental health services. Initiatives to reduce disparities among depressed AA adolescents require a greater understanding of the experience of depression from their own point of view. The purpose of this dissertation was to generate a comprehensive theoretical framework that describes how AA adolescents experience depression throughout adolescence. The information gained about how AA adolescents understand and manage depressive symptoms, and in some cases seek and use mental health services will contribute to initiatives to reduce behavioral health disparities. This dissertation project was composed of two components. The first component was an integrative review of studies that explored associations between adolescent coping responses and depression. The integrative review summarized and integrated research from the past ten years that examined coping techniques of depressed adolescents. It revealed that the use of active coping strategies plays an important role in recovery from depression. The second component was a grounded theory study which included a sample of 22 community-based AA young adults (ages 18-21) and 5 clinic-based AA adolescents (ages 13-17). During semi-structured interviews, participants described their experiences with depression as adolescents. In addition, a timeline was constructed that included major events related to the unfolding of depression, including treatment seeking, which occurred during adolescence. Data generated from the grounded theory study were analyzed and resulted in two qualitatively derived products. The first is a typology titled Being With Others that depicts interaction patterns of depressed AA adolescents with people in their lives. The five categories in the typology are keeping others at bay, striking out at others, seeking help from others, joining in with others, and having others reach out. The second product is a theoretical framework titled Weathering through the Storm that describes how depression in AA adolescents unfolds over time. The five phases of the framework are labeled enduring stormy weather, braving the storm alone, struggling with the storm, finding shelter in the storm, and moving out of the storm.Item Veterans and non-veterans with schizophrenia : a grounded theory comparison of perceptions of self, illness, and treatment(2014-07-31) Firmin, Ruth L.; Salyers, Michelle P.; McGrew, John H., 1953-; Boyd, Elizabeth; Lysaker, Paul H.; Grahame, Nicholas J.This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.