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Item Antidepressant Use and Depressive Symptoms in Intensive Care Unit Survivors(SHM, 2017) Wang, Sophia; Mosher, Chris; Gao, Sujuan; Kirk, Kayla; Lasiter, Sue; Khan, Sikandar; Kheir, You Na; Boustani, Malaz; Khan, Babar; Psychiatry, School of MedicineNearly 30% of intensive care unit (ICU) survivors have depressive symptoms 2-12 months after hospital discharge. We examined the prevalence of depressive symptoms and risk factors for depressive symptoms in 204 patients at their initial evaluation in the Critical Care Recovery Center (CCRC), an ICU survivor clinic based at Eskenazi Hospital in Indianapolis, Indiana. Thirty-two percent (N = 65) of patients had depressive symptoms on initial CCRC visit. For patients who are not on an antidepressant at their initial CCRC visit (N = 135), younger age and lower education level were associated with a higher likelihood of having depressive symptoms. For patients on an antidepressant at their initial CCRC visit (N = 69), younger age and being African American race were associated with a higher likelihood of having depressive symptoms. Future studies will need to confirm these findings and examine new approaches to increase access to depression treatment and test new antidepressant regimens for post-ICU depression.Item Factors associated with depressive symptoms in young long-term breast cancer survivors(Springer, 2016-08) Cohee, Andrea A.; Stump, Timothy; Adams, Rebecca N.; Johns, Shelley A.; Von Ah, Diane; Zoppi, Kathleen; Fife, Betsy; Monahan, Patrick O.; Cella, David; Champion, Victoria L.; Department of Nursing, IU School of NursingPurpose Long-term breast cancer survivors frequently report distress (i.e., depressive symptoms) that impacts their quality of life. Previous studies have found that negative social interactions (“social constraints”) from partners contribute to long-term, unresolved cycling of intrusive thoughts and cognitive avoidance, resulting in psychological distress. However, these relationships have not been tested in long-term breast cancer survivors. Furthermore, the effect of partners’ depressive symptoms on the survivors’ depressive symptoms has not been tested within the context of these relationships. Therefore, the purpose of this study was to test relationships between breast cancer survivors’ depressive symptoms and (1) social constraints, cognitive avoidance, and intrusive thoughts, and (2) partners’ depressive symptoms. Methods Data were from a cross-sectional descriptive study of breast cancer survivors (N = 222) 3–8 years post-diagnosis and their partners, who completed surveys assessing demographic characteristics, social constraints, intrusive thoughts, cognitive avoidance, and depressive symptoms. Structural equation modeling confirmatory path analyses were conducted to determine significant relationships between survivors’ depressive symptoms and all other variables. Results Our model fits the data well. Breast cancer survivors’ depressive symptoms were predicted by social constraints and intrusive thoughts. The relationship between survivors’ depressive symptoms and partners’ depressive symptoms was close but not significant. Conclusions As hypothesized, depressive symptoms were predicted by social constraints and intrusive thoughts. Further research is needed to understand the possible relationship between survivors’ long-term depressive symptoms and cognitive avoidance and partners’ depressive symptoms. Our findings highlight the negative impact of social constraints from partners on psychological outcomes in long-term breast cancer survivors.Item Factors Influencing the Impact of Depressive Symptoms on Physical Functional Capacity After Cardiac Rehabilitation(Wolters Kluwer, 2019-05) Wierenga, Kelly L.; Moore, Shirley M.; Liu, Jintao; Sattar, Abdus; School of NursingPurpose This study aims to determine (1) if depressive symptoms in the year following completion of cardiac rehabilitation impact physical functional capacity and (2) if exercise, perceived benefits and barriers, self-efficacy, and social support moderate this relationship. Design This longitudinal correlational secondary data analysis included 379 cardiovascular rehabilitation patients. Methods Participants completed measures of depression and potential moderating variables at baseline, 2 months, 6 months, and 12 months and 6-minute work test at baseline and 12 months and wore heart rate monitors to measure exercise for 12 months. Findings Poorer physical functional capacity was predicted by depressed mood score. This relationship was moderated by the percentage of time exercising in target heart rate zone and family support of exercise, but not by perceived benefits and barriers or self-efficacy for exercise. Conclusions Depressive symptoms negatively impact physical functional capacity, and this relationship is moderated by family support and the percentage of time exercising in target heart rate zone.Item Locus of Control and Depression as Mechanisms in the Relationship between Racial Discrimination and Substance Use(2020-12) Khazvand, Shirin; Zapolski, Tamika C.B.; Cyders, Melissa A.; Pietri, Evava S.Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of affect-based factors, few other mechanisms have been examined in the literature. One potential candidate is locus of control (LOC). LOC is a learning processes that involves the degree to which an individual attributes rewards as resulting from their own control (internal LOC) versus outside control (external LOC). There is evidence that exposure to stressors is associated with LOC, with a separate body of literature linking LOC with substance use. Thus, it is plausible that LOC may be a mechanism underlying the relationship between racial discrimination and substance use. Additionally, there is evidence that depression is related to LOC. Thus, the relationship between racial discrimination, locus of control, and substance use may also be serially mediated through depressive symptoms. The current study investigated these two pathways among 503 racial/ethnic minority adults aged 18-35 who completed an online questionnaire that included measures on racial discrimination related stress, locus of control, depressive symptoms, and substance use. Results indicated a significant indirect effect of racial discrimination related stress through external locus of control, specifically the chance orientation, on substance use. Moreover, for both domains of external locus of control (i.e., chance and powerful others) a significant serial indirect effect was found through depressive symptoms within the racial discrimination-substance use pathway among racial/ethnic minority adults. These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming for this populationItem The "long arm" of childhood health: linking childhood disability to late midlife mental health(2015-01) Latham, Kenzie; Department of Sociology, School of Liberal ArtsA growing body of research underscores the early origins of health in later life; however, relatively little is known about the relationship between childhood physical health and adult mental health. This research explores the relationship between childhood disability and depressive symptoms among a nationally representative sample of late midlife adults (N = 3,572). Using data from Waves 8-10 (2006-2010) of the Health and Retirement Study, a series of ordinary least squares regression models were created to assess the number of depressive symptoms. Childhood disability was significantly associated with higher levels of depressive symptoms; however, late midlife social and health factors accounted for differences between those with and without childhood disability. Late midlife physical health appeared to be a particularly salient mediator. Individuals who experience childhood disability may accumulate more physical impairment over the life course, thus experiencing worse mental health such as greater depressive symptoms in late midlife.Item Long-Term Fear of Recurrence in Young Breast Cancer Survivors and Partners(Wiley, 2017-01) Cohee, Andrea A.; Adams, Rebecca N.; Johns, Shelley A.; Von Ah, Diane; Zoppi, Kathleen; Fife, Betsy; Monahan, Patrick O.; Stump, Timothy; Cella, David; Champion, Victoria L.; Department of Nursing, IU School of NursingBackground Fear of a breast cancer recurrence is the most prevalent and disruptive source of distress for long-term survivors and their partners. However, few studies have focused on predictors of fear of recurrence. The aim of this study is to test the efficacy of the Social Cognitive Processing Theory (SCPT) in predicting fear of recurrence in long-term breast cancer survivors diagnosed at age 45 years or younger and their partners. Methods In a large cross-sectional study, breast cancer survivors (n = 222) 3–8 years from diagnosis and their partners completed a survey assessing demographic characteristics, fear of recurrence, social constraints, and cognitive processing (intrusive thoughts and cognitive avoidance). Mediation analyses were conducted for survivors and partners separately to determine if cognitive processing would mediate the relationship between social constraints and fear of recurrence. Results Cognitive processing mediated the relationship between social constraints and fear of recurrence both for survivors [F(3,213) = 47.541, R2 = 0.401, p < 0.001] and partners [F(3,215) = 27.917, R2 = 0.280, p < 0.001). Demographic variables were not significant predictors of fear of recurrence. Conclusions As predicted, cognitive processing mediated the relationship between social constraints and fear of recurrence. Results expand the utility of the SCPT in long-term survivors and their partners by supporting its use in intervention design.Item Preliminary Efficacy of a Stroke Caregiver Intervention Program for Reducing Depressive Symptoms(Office of the Vice Chancellor for Research, 2013-04-05) Bakas, Tamilyn; Austin, Joan K.; Buelow, Janice M.; Habermann, Barbara; Li, Yong; McLennon, Susan M.; Weaver, Michael T.; Williams, Linda S.Background and Purpose: Stroke caregivers who lack skills because of unmet needs are at increased risk for depressive symptoms; which can impede rehabilitation of the survivor and increase the survivor’s risk for costly, long-term institutionalization. The Telephone Assessment and Skill-Building Kit (TASK) is an 8-week follow-up program based on individualized assessment of caregiver needs. The purpose of this study was to explore preliminary efficacy of the TASK program for improving stroke caregiver depressive symptoms. Methods: A subgroup of 15 caregivers who screened positive for mild to severe depressive symptoms at baseline (PHQ-9 > 5) were randomized to the TASK program (n=8) or an attention control group (n=7). Data were analyzed using Univariate ANCOVA, controlling for baseline scores and number of minutes spent with the nurse for each timepoint (4, 8, and 12 weeks after baseline). Partial ƞ2 was used to estimate effect sizes (< .08 small, .09-.24 medium, >.25 large). Results: Although not statistically significant because of the small sample size, medium to large improvements based on effect sizes were found in depressive symptoms for the TASK group relative to the control group at 4 weeks [F(1,11) = 4.15, p=.07, ƞ2=.27], 8 weeks [F(1,11) = 1.66, p=.22, ƞ2=.13], and 12 weeks after baseline [F(1,11) = 1.47, p=.25, ƞ2 =.12]. Adjusted PHQ-9 means for the TASK group at 4, 8, and 12 weeks ranged from 4.9 to 5.9; adjusted PHQ-9 means for the control group at 4, 8, and 12 weeks ranged from 9.0 to 10.8. Conclusions: Caregivers in the TASK group reduced their depressive symptoms to the mild range, while caregivers in the control group maintained their scores primarily in the moderately depressed range. Further testing of the TASK program in a larger randomized controlled clinical trial is warranted and is currently underway.Item Relations of perceived injustice to psycho-spiritual outcomes in advanced lung and prostate cancer: Examining the role of acceptance and meaning making(Wiley, 2022-12) Secinti, Ekin; Wu, Wei; Krueger, Ellen F.; Hirsh, Adam T.; Torke, Alexia M.; Hanna, Nasser H.; Adra, Nabil; Durm, Gregory A.; Einhorn, Lawrence; Pili, Roberto; Jalal, Shadia I.; Mosher, Catherine E.; Psychology, School of ScienceObjective: Many advanced cancer patients struggle with anxiety, depressive symptoms, and anger toward God and illness-related stressors. Patients may perceive their illness as an injustice (i.e., appraise their illness as unfair, severe, and irreparable or blame others for their illness), which may be a risk factor for poor psychological and spiritual outcomes. This study examined relations between cancer-related perceived injustice and psycho-spiritual outcomes as well as potential mediators of these relationships. Methods: Advanced lung (n=102) and prostate (n=99) cancer patients completed a one-time survey. Using path analyses, we examined a parallel mediation model including the direct effects of perceived injustice on psycho-spiritual outcomes (i.e., anxiety, depressive symptoms, anger about cancer, anger towards God) and the indirect effects of perceived injustice on psycho-spiritual outcomes through two parallel mediators: meaning making and acceptance of cancer. We then explored whether these relations differed by cancer type. Results: Path analyses indicated that perceived injustice was directly and indirectly – through acceptance of cancer but not meaning making – associated with psycho-spiritual outcomes. Results did not differ between lung and prostate cancer patients. Conclusions: Advanced cancer patients with greater perceived injustice are at higher risk for poor psycho-spiritual outcomes. Acceptance of cancer, but not meaning making, explained relationships between cancer-related perceived injustice and psycho-spiritual outcomes. Findings support testing acceptance-based interventions to address perceived injustice in advanced cancer patients.Item The relationship between acceptance of cancer and distress: A meta-analytic review(Elsevier, 2019-07) Secinti, Ekin; Tometich, Danielle B.; Johns, Shelley A.; Mosher, Catherine E.; Medicine, School of MedicineAcceptance of cancer has long been recognized as playing a critical role in psychological adjustment to the illness, but its associations with distress outcomes have not been quantitatively reviewed. Informed by coping theory and third wave conceptualizations of acceptance, we first propose an integrated model of acceptance of cancer. Then we examine the strength of the relationships between acceptance of cancer and general and cancer-specific distress in cancer patients and potential moderators of these relationships. CINAHL, Embase, MEDLINE, PsycINFO, PsycARTICLES, and Web of Science databases were searched. Random-effects meta-analyses were conducted on 78 records (N = 15,448). Small-to-moderate, negative, and significant relationships were found between acceptance of cancer and general distress (r = −0.31; 95% CI: −0.36 to −0.26, k = 75); cancer-specific distress (r = −0.18; 95% CI: −0.21 to −0.14, k = 13); depressive symptoms (r = −0.25; 95% CI: −0.31 to −0.19, k = 41); and anxiety symptoms (r = −0.22; 95% CI: −0.30 to −0.15, k = 29). Age, marital status, and stage of cancer were identified as significant moderators. Findings suggest that acceptance of cancer may be important to target in interventions to reduce general and cancer-specific distress in cancer patients. Future research should focus on developing multifaceted measures of acceptance and identifying theory-based psychological and social processes that lead to greater acceptance.