DSpace Repository :: Browsing by Author "Dautovich, Natalie D."

Browsing by Author "Dautovich, Natalie D."

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Affective mediators of the association between pleasant events and global sleep quality in community-dwelling adults
(Springer, 2016) Tighe, Caitlan A.; Shoji, Kristy D.; Dautovich, Natalie D.; Lichstein, Kenneth L.; Scogin, Forrest; University of Alabama Tuscaloosa
This study explored the association of engagement in pleasant events and global sleep quality, as well as examined the intermediary roles of positive affect and depressive symptoms in this association. Data were derived from the Midlife in the United States-II study. The sample consisted of 1054 community-dwelling adults. Participants completed the Pittsburgh Sleep Quality Index and indicated the frequency and enjoyableness of experiences on a positive events scale. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Positive affect was measured using the Mood and Symptoms Questionnaire. Regression analyses indicated more frequent engagement in pleasant events was associated with better global sleep quality. Depressive symptoms, but not positive affect, partially mediated the association between pleasant events and global sleep quality. The findings suggest that behavioral engagement in pleasant events may be related to global sleep quality via depressive symptoms, but not positive affect. These findings highlight the potential for engagement in pleasant activities to influence both mood and sleep.
The association between chronotype and nonrestorative sleep
(University of Alabama Libraries, 2016) Tutek, Joshua; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ; Drake et al., 2014) is one of the first validated self-report instruments for investigating NRS severity, presenting new opportunities to explore what factors predict and perhaps contribute to unrefreshing sleep. The present study sought to determine whether inherent circadian preference for morning or evening activity, known as chronotype, predicted restorative sleep in 164 college undergraduates who completed daily RSQs over two weeks. Participants who endorsed greater orientation to evening activity on the morningness-eveningness questionnaire (Terman, Rifkin, Jacobs, & White, 2001) reported significantly less average restorative sleep across their full sampling period, and this association was maintained after accounting for demographic factors, number of sleep-relevant psychiatric and medical diagnoses, sleep diary parameters, self-reported status as an insomniac, and ratings of sleep quality. Furthermore, when analyses were conducted separately for weekday and weekend RSQ scores, eveningness significantly predicted NRS above extraneous variables only during the workweek, not during Saturday and Sunday. These findings have implications for the developing conceptualization of NRS, and continue the work of elucidating the interconnections between common sleep disturbances and the circadian system.
Barriers and facilitators to yoga practice in adults with chronic low back pain
(University of Alabama Libraries, 2015) Combs, Martha Anne; Thorn, Beverly E.; University of Alabama Tuscaloosa
Given the high prevalence of chronic low back pain in the United States and the potential beneficial effects that integrative yoga interventions may have on this condition, the current study sought to examine barriers and facilitators to trying yoga in a population of adults with chronic low back pain. Participants self-reporting chronic low back pain were recruited from community sites in a collegiate town in western Alabama. Primary analyses utilized hierarchical regression and traditional 4-step mediational analyses to examine the predictive influence of catastrophizing and fear of movement on yoga attitudes. Results indicate that fear of movement serves a mediating role between catastrophizing and yoga attitudes. Originally proposed analyses included measurement of "intent to try yoga" as a primary outcome of interest. However, relationships between predictor variables and the unstandardized intent measure were, in general, extremely weak and execution of analyses was not indicated. Measurement of intention is discussed in Appendix A. Participants also responded to items asking them about perceptions of potential barriers and facilitators to trying yoga. Responses were subjected to qualitative thematic analysis and several common themes emerged for both barriers and facilitators: physical issues, cognitive/affective issues, motivational issues, informational issues, practical issues, and social issues. Qualitative analyses are discussed in Appendix B. Identifying cognitive barriers to consideration of yoga as a potential beneficial treatment for chronic low back pain conditions has great importance for clinical treatment of pain, especially as health care focus in the U.S. shifts to be more preventative and emphasizing self-management.
Expert testimony and substance-themed mitigation in capital case sentencing
(University of Alabama Libraries, 2016) Boyle, Jessica Ann; Brodsky, Stanley L.; University of Alabama Tuscaloosa
The present study explored how jurors utilize biopsychosocial variables during the sentencing phase of a capital trial. According to literature, certain mitigating factors, like substance abuse, cause a "backfire effect." This means that contrary to the defense's intentions, jurors considered the information more aggravating than mitigating. Previous studies of biopsychosocial mitigation have neglected the impact of expert testimony on juror decision-making. Ideally, an expert imparts knowledge so jurors are more informed in their sentencing choice. However, such testimony may exacerbate the “backfire effect” by underscoring unfavorable qualities of the defendant. Hypotheses anticipated participants (mock jurors) exposed to expert testimony regarding a defendant’s substance abuse would be more likely to choose the death penalty. Further, it was anticipated this effect would be greater for mock jurors displaying problematic drinking patterns. Results revealed a significant main effect of expert testimony such that mock jurors exposed to testimony were significantly less likely to choose the death penalty, regardless of whether the defendant abused substances. Upon further investigation, the significant effect of expert testimony only held true for college student participants. These results highlight the importance of a two-step process of data analysis in juror decision-making studies using college student samples. Specifically, significant effects should be confirmed within a more venire-representative sample before drawing conclusions. Uncovered data also shed more light on the influence of expert testimony during capital cases, as well as the juror characteristics associated with different sentencing decisions for a defendant displaying mental health problems. In addition, data suggested substance-themed mitigation is not necessarily deleterious for the defense. Effective expert testimony may provide a buffer against the backfire effect, especially for jurors with higher levels of achieved education.
Factors predicting intraindividual cognitive variability in older adults with different degrees of cognitive integrity
(University of Alabama Libraries, 2016) Shoji, Kristy Douglas; Dautovich, Natalie D.; University of Alabama Tuscaloosa
Given the increasing number of older adults in the population, the fact that about 1 in 10 people over the age of 65 will develop mild cognitive impairment, and the substantial individual, familial, and financial burden associated with such disorders, the need for innovative research examining cognitive impairment in older adults is evident. The present study used a microlongitudinal design to assess cognition and contextual factors that may affect cognition for 14 consecutive days using a daily diary method in older adults with varying degrees of cognitive function. This study design enables investigation of concurrent associations between variables, as well as providing unique information not gleaned from the traditional focus on mean values of cognition. The present study had two broad aims: 1) to compare variability in cognition in older adults with varying degrees of cognitive impairment and 2) to investigate relationships between daily cognitive performance, variability in cognitive performance, and contextual factors that may influence daily cognitive performance and variability in older adults with varying degrees of cognitive impairment. Results suggest there was sufficient intraindividual variability in daily cognition to warrant investigation of within-person associations. Furthermore, the contextual factors of pain, stress, and sleep were predictive of cognitive performance, but with significance and directionality of these associations depending on level of measurement (baseline, daily, or mean values). Finally, associations between contextual factors and cognition were frequently conditional upon baseline cognitive status. The findings highlight the need for continued examination of these associations to expand our understanding of cognition in older adults and to discover potential targets for interventions to attenuate cognitive decline.
Geographic variations in alcohol consumption among racially/ethnically diverse older adults
(University of Alabama Libraries, 2015) Bryant, Ami; Kim, Giyeon; University of Alabama Tuscaloosa
This dissertation sought to examine the role of geographic location, geographic characteristics, and individual level race/ethnicity in alcohol consumption among older adults. Data were obtained from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) and the 2010 US Census. Participants aged 60 and older who were not missing data on any of the main study variables were included (n=185, 190). Data was analyzed for a total of 2,229 counties. Racial/ethnic groups examined included American Indian/Alaska Natives, Asians/Pacific Islanders, Blacks, Hispanics, and Whites. Multilevel modeling was used for main analyses in order to account for the nested structure of the data. Individuals at level 1 were nested within counties at level 2 which were nested within regions at level 3. Alcoholic drinks consumed per month was used as the dependent variable. Significant within and between county variance was found in average alcoholic drinks consumed per month. There were significant main effects of race/ethnicity, county percentage of older adults, county percentage of racial/ethnic minorities, and county median income on average alcoholic drinks consumed per month. Significant interactions were found for individual level race/ethnicity and each of the aforementioned county level variables. These results indicate that geographic location and characteristics are significantly related to the alcohol consumption of older adults. Additionally, results suggest that the role of geographic characteristics in the alcohol consumption of older adults varies by individual level race/ethnicity.
Immediate and lagged effects of daily stress and affect on caregivers' daily pain experience
(University of Alabama Libraries, 2016) Carden, Keisha Dawn; Allen, Rebecca S.; University of Alabama Tuscaloosa
Using secondary data analysis of DaSH (R01AG031758, S. Zarit, PI), we examined the effect of daily stress, affect, and adult day service (ADS) use on the daily subjective pain experience among caregivers of individuals with dementia (IWD). Participants were interviewed for 8 consecutive days. Caregivers utilized an ADS program on some days and provided care at home on other days. We hypothesized a significant relation between daily stress and daily pain would be moderated by time-varying positive affect (PA) and negative affect (NA) within and beyond ADS use. Participants were 173 family caregivers of IWDs using ADS more than 2 days per week. Participants with IWDs diagnosed with “mild cognitive impairment” were excluded. Daily telephone interviews assessed stress, affect, and pain. Multilevel models were used to examine the relation between daily stress and daily pain and moderating effects of other daily experiences within the context of ADS use. Multilevel models revealed a significant relation between care-related and non-care related stress and daily bodily pain. ADS use and affect did not predict daily pain. Lagged effects revealed a significant moderation for the relation between ADS use and positive affect and pain such that positive affect was higher and pain was lower following an ADS day. Findings suggest that further studies are warranted for understanding and controlling pain among caregivers. Addressing the physical health needs of caregivers through pain management interventions may improve the overall wellbeing of caregiving dyads.
Impact of physical-mental comorbidity on subjective well-being among racially/ethnically diverse elders
(University of Alabama Libraries, 2016) Wang, Sylvia Yanlian; Kim, Giyeon; University of Alabama Tuscaloosa
Background: Older adults are more likely to be burdened by multiple health conditions, and comorbid physical and mental health conditions adversely affect one’s overall well-being. However, little is known about physical-mental comorbidity as a determinant for subjective well-being among racially/ethnically diverse elders. Objectives: The current study examined racial/ethnic variations in the relationship between types and severity of comorbidity and subjective well-being among diverse elders (White, Black, Hispanic, and Asian). Methods: Data were drawn from the National Health and Aging Trends Study (NHATS) collected in 2011. The current study included 8064 participants who self-identified as White, Black, Hispanic, or Asian in our analyses. In order to examine comorbidity, participants were grouped using sixteen common physical health conditions and two mental disorders. Chi-square analyses were used to compare racially/ethnically diverse participants on demographic variables and types of comorbidity. Analyses of covariance (ANCOVAs) were used to assess the relationship between types and severity of comorbidity and subjective well-being among diverse elders. Results: Significant differences were found on background characteristics and types of comorbidity among racially/ethnically diverse elders. For main analysis results (ANCOVAs), Blacks and Hispanics reported higher subjective well-being than Whites after controlling for covariates. Participants with physical-mental comorbidity reported lower subjective well-being compared to healthy participants. As the severity of physical-mental comorbidity increased, subjective well-being decreased. Conclusion: The current study provided detailed descriptions and comprehensive knowledge of the relationship between physical-mental comorbidity and subjective well-being among diverse elders. Study limitations, clinical implications, and directions for future research are discussed.
Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study
(Oxford University Press, 2013) Kaufmann, Christopher N.; Canham, Sarah L.; Mojtabai, Ramin; Gum, Amber M.; Dautovich, Natalie D.; Kohn, Robert; Spira, Adam P.; Johns Hopkins University; Johns Hopkins Bloomberg School of Public Health; University of South Florida; University of Alabama Tuscaloosa; Brown University
Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults. We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics. Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio [AOR] 1.28, 95% confidence interval [CI] 1.151.43, p < .001), use of home health care services (AOR 1.29, 95% CI 1.091.52, p .004), and any health service use (AOR 1.28, 95% CI 1.151.41, p < .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR 1.71, 95% CI 1.501.96, p < .001), use of home health care services (AOR 1.64, 95% CI 1.322.04, p < .001), nursing home use (AOR 1.45, 95% CI 1.101.90, p .009), and any health service use (AOR 1.72, 95% CI 1.511.95, p < .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates. In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.
Insomnia and suicide risk
(University of Alabama Libraries, 2015) Woosley, Julie; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
A growing body of literature supports the notion that sleep disturbances, including insomnia, are related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The primary goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI). Additionally, analyses were conducted to determine which demographic, health, sleep, and daytime functioning variables best predict hopelessness. Finally, this research will address gaps in the literature by determining which types of insomnia best predict suicide risk (i.e., hopelessness and SI), and whether a complaint of insomnia, poor sleep (as defined by quantitative criteria), or the combination of these factors best predicts suicide risk. The present study used an existing data set consisting of self-report data from a community-dwelling epidemiological sample. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the Diagnostic and statistical manual of mental disorders (4th ed., text rev.) as well as quantitative criteria were used to identify participants with insomnia (n = 135). The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI (Percentile 95% CI [0.24, 0.71]). Additionally, stepwise logistic regression revealed that, of a large pool of candidate variables, depression, anxiety, mean sleep efficiency, and intra-individual variability in sleep quality ratings are the best predictors of hopelessness. Finally, stepwise logistic regression revealed that a complaint of insomnia is a better predictor of suicide risk than quantitatively-defined poor sleep or the combination of these factors. Recommendations for future research include determining whether cognitive behavioral therapy for insomnia decreases hopelessness, which could ultimately decrease suicide risk. Additionally, the present research suggests the need for clinicians to routinely screen clients who report insomnia for hopelessness and SI.
An investigation of the association between cognition and depression with sleep quality as a mediator among older adults
(University of Alabama Libraries, 2016) Condeelis, Kristen; Dautovich, Natalie D.; University of Alabama Tuscaloosa
Persons aged 65 and over account for an estimated 13% of the U.S. population, and, by 2030, they are predicted to account for almost 20% of the population. It is important to focus on the mental health of this segment of the population, because mental health issues frequently affect older adults. In addition, older adults commonly have co-morbid psychological disorders. In particular, older adults often experience issues with cognition, depression, and sleep, and the co- occurrence of these disorders results in greater negative outcomes for older adults. Therefore, this study investigated the relationship between depressive symptoms and cognitive performance with sleep quality as a mediating variable among older adults aged 65 and above. A secondary data analysis was performed using data from the Midlife in the United States Study II (MIDUS II). Specifically, wave two data from the Cognitive and Biomarkers Projects was analyzed using the Center for Epidemiologic Depression Scale, the Pittsburgh Sleep Quality Inventory, and the Brief Test of Adult Cognition by Telephone measures. Results suggest that being older and having more depressive symptoms was associated with worse cognitive performance, R2 = 0.12, F(4, 242) = 8.70, p < 0.001. Poorer sleep quality did not underlie the association between greater depressive symptomatology and worse cognitive performance, (Percentile 95% CI [.-.01, .01]; Sobel test of mediation: z-score = .41, p >.05). Future research is needed to further investigate the role of sleep in the association between depression and cognitive performance in older adults.
Links between Savoring, Rumination, and Sleep-Related Experiences across Adulthood: Implications for Older Adults
(Routledge, 2022) Tighe, Caitlan A.; Dautovich, Natalie D.; Hilgeman, Michelle M.; Allen, Rebecca S.; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Pittsburgh Healthcare System; Virginia Commonwealth University; University of Alabama Birmingham; University of Alabama Tuscaloosa
Objectives: Sleep problems are pervasive, particularly in older adults. Much work examines psychological factors that adversely affect sleep; fewer studies examine those with a positive effect. Savoring is a form of positive repetitive thought that is linked to several aspects of health but has been understudied in relation to sleep. We examined cross-sectional associations of both savoring and rumination with subjective sleep experiences, and assessed if these associations vary by age. Methods: Adults and older adults (N = 216) ranging from 20-80 years in age (M = 44.9 +/- 15.6 years) completed an online survey of validated measures of savoring, rumination, sleep disturbance, and sleep-related impairment. Results: Higher levels of savoring were significantly associated with lower levels of sleep-related impairment but not sleep disturbance in regression analyses. Higher levels of rumination were significantly associated with higher levels of sleep disturbance and sleep-related impairment. Associations of savoring and rumination with sleep-related experiences did not vary by age. Conclusions: Savoring and rumination are relevant to sleep-related experiences in adults ranging from younger to older. Further investigation of the potential positive impact of savoring on sleep-related experiences is needed.
Medication state at the time of the offense: medication noncompliance and criminal responsibility
(University of Alabama Libraries, 2014) Titcomb, Caroline Richards; Brodsky, Stanley L.; University of Alabama Tuscaloosa
Ethical and due process concerns arise when insanity standards lack a nuanced picture of how society views mental illness and its effects on the volitional nature of a defendant's actions. This project examined whether mock jurors consider meta-responsibility (MR) of mentally ill defendants, how they think about MR in relation to criminal responsibility, and if various degrees of MR differentially influence defendant responsibility and guilt. The MR benchmark manipulation was medication compliance (or noncompliance; MNC) for a NGRI defendant at three levels: medication compliant (MC/control), purposive MNC, and inadvertent MNC. The type of MNC was manipulated by establishing the defendant's insight into his illness as either High or Low. A second variable - the extent to which a forensic mental health expert explains issues relevant to the defendant's MR (i.e., MNC and insight into one's mental illness) - was also manipulated. Using a between-subjects jury deliberation paradigm and a mixed quantitative-qualitative methodology, results did not yield the hypothesized interactions between a NGRI defendant's MNC, insight, and testimony elaboration on MR and verdict. Results suggest that as ecological validity of the study parameters increased, effects found in prior research with more experimental control were unsupported. Findings were consistent with research suggesting jurors are unlikely to recognize the complexity of the relationship between a defendant's MNC and volitional, informed decision-making; thus, readily attributing MR to NGRI defendants at the cost of overlooking individual differences in case facts related to some of the key determinants of their verdicts such as MNC and insight into one's illness. Implications for future research, NGRI proceedings, and forensic mental health expert testimony are discussed.
Mental health policy outcomes: an examination of older adults' mental health service use, 2002-2012
(University of Alabama Libraries, 2018) Ford, Katy Lauren; Kim, Giyeon; Allen, Rebecca S.; University of Alabama Tuscaloosa
The underutilization of mental health services (MHS) by older adults – and especially by racial/ethnic minority elders – is a well-recognized problem. Though several national-level mental health policies have been enacted and implemented over the past decade, rates of underutilization remain high. Guided by the Socio-Ecological Theory of public health policy, we aimed to examine individual- and community-level factors that have fostered the most successful implementations of national mental health policies in recent years. This dissertation conducted a multilevel growth curve analysis in order to examine older adults’ MHS use using a large, nationally-representative panel survey (the Medical Expenditure Panel Survey – Household Component, or MEPS-HC). We considered MHS use in the MEPS-HC for the period of 2002-2012, during which members of MEPS Panels 6-17 provided responses. This analysis revealed that rates of older adults’ MHS use did not increase significantly over our examination period, regardless of race/ethnicity or rurality of location. Only insurance status was a significant predictor of change in MHS use rates over the years 2002-2012. Our findings highlighted several important issues for policy implementation and future research of MHS use and mental health policy, and we make suggestions for ensuring greater efficiency and efficacy of efforts to improve older adults’ MHS use in the coming decade.
Pain and emotional well-being as variability predictors and the role of mindfulness in community-dwelling older adults
(University of Alabama Libraries, 2016) Zakoscielna, Karolina Magdalena; Parmelee, Patricia A.; University of Alabama Tuscaloosa
This dissertation examines pain, emotional well-being, affect variability, pain variability and mindfulness in community-dwelling older adults diagnosed with osteoarthritis (OA) of the knee. Osteoarthritis is one of the most common chronic illnesses. Its sufferers experience a great deal of pain and a potentially substantial decline in emotional well-being. This data comes from an ongoing research project, Everyday Quality of Life in Osteoarthritis (EQUAL; R01 AG046155), which examines quality of life among African American (AA) and non-Hispanic White (NHW) older adults with a diagnosis of OA. Subjects aged 50 and older complete a comprehensive baseline assessment, as well as an experience sampling method (ESM) procedure. Baseline measures include Philadelphia Geriatric Center Pain Scale, Freiburg Mindfulness Inventory, Center for Epidemiological Studies Depression Scale, as well as the short form Spielberger State Anxiety Scale. Variability was examined via the ESM procedure which includes responses to mood and pain questions 4 times daily over 7 consecutive days. Structural equation modeling (SEM) was used to examine whether traditional summary measures of pain and overall well-being are predictors of within-day pain and affect variability. Second, the role of mindfulness as a moderator was examined. Path analyses indicated that baseline pain, negative affect, and number of pain locations predict positive affect variability; negative affect predicts negative affect variability; and negative affect predicts pain variability. Mindfulness moderated the effect of emotional well-being on pain variability, but did not moderate the remaining three hypothesized relationships. These results highlight the complex nature of pain and affect in older adults suffering from OA, and how variability and mindfulness may affect that relationship.
Perceived control and affect: the influence of regularity in the duration of time spent on daily activities
(University of Alabama Libraries, 2014) Tighe, Caitlan; Dautovich, Natalie D.; University of Alabama Tuscaloosa
Low perceived control is associated with adverse physical and mental health outcomes. As such, the main objective of the present study was to examine the relationship between perceived control, and its component parts, personal mastery and perceived constraints, with affect in community-dwelling adults. Additionally, the potential buffering effect of a third variable, regularity of the duration of time spent on daily activities, was examined. The sample for the current study was derived from the Midlife in the United States longitudinal follow-up study, MIDUS-II. Findings corroborated the relationship between a general sense of perceived control and positive and negative affect. Further, daily regularity was found to moderate the relationships of perceived control and both positive and negative affect, as well as perceived constraints and positive and negative affect. In each case, the findings suggest that individuals who scored lower on perceived control or higher on perceived constraints measures were more likely to have positive affective outcomes when they demonstrated greater regularity in daily activities. Implications of the findings are discussed.
Perceived stigma, illness invalidation, sleep difficulties, and psychological distress in emerging adults in college with persistent pain
(University of Alabama Libraries, 2015) Kapoor, Shweta; Thorn, Beverly E.; University of Alabama Tuscaloosa
Persistent pain is traditionally associated with middle-aged to older adults and most of the pain literature is focused on this age group. However, recent research indicates a high prevalence of pain in children and adolescents as well. These studies have indicated significant differences in the variables affecting pain experience of children and adolescents as compared to older adults. One of the least studied groups of individuals with pain is emerging adults, individuals between the ages of 18-29 years. The limited number of epidemiological surveys focused on this age group has suggested a surprisingly high prevalence of pain in this age group. A lack of understanding and acknowledgement of pain experience in emerging adults may lead to problems of inadequate pain relief and delay in treatment, potentially worsening long-term health outcomes. Preliminary analyses of a qualitative study of college students with chronic or recurrent pain (Kapoor, Thorn, & Eyer, forthcoming) suggest a perception of stigmatization because of their pain as well as perceived invalidation of their pain experience. These factors seemed to be additionally influenced by college students' perception of experiencing persistent pain as an off-time life event. The current study aimed to examine pain experience of college students with chronic or recurrent pain and compare them to peers who do not experience pain on a regular basis. It was hypothesized that participants with pain, apart from endorsing higher depressive symptomatology, would report lower satisfaction with life as well as lower physical quality of health. In addition, the association of sociocultural contextual factors such as perceived pain-related stigma and illness invalidation with pain-related variables and psychological variables was analyzed. The results revealed that greater perceived invalidation of pain was associated with a higher perceived pain-related stigma, lower satisfaction with life, heightened pain perception and catastrophizing, impaired quality of life, as well as greater self-reported depression. Finally, sleep difficulties of the participants with pain as compared to their same age peers were investigated. The results indicated that those with pain reported poorer quality as well as quantity of sleep. Furthermore, for participants with pain, higher self-reported depression was associated with a lower quality of sleep. Clinical implications are discussed.
Power and autonomy in the nursing home
(University of Alabama Libraries, 2014) Jacobs, Mary Lindsey; Snow, Andrea Lynn; University of Alabama Tuscaloosa
As with all organizations, nursing homes have an internal hierarchy that guides decision-making practices and policies. Nursing assistants (NAs) are positioned at the bottom of the hierarchy. They are generally the last nursing home employees to be solicited for input regarding practices and the last to learn about mandated policies created by upper level management. Consequently, they have the most limited amount of power compared to other staff. The one group of people that is impacted by all levels of the hierarchy and generally positioned at the bottom of all power relations in long-term care is nursing home residents. Residents' daily life is directly influenced by nursing policies and practices, staff shortages, staff's ability to provide timely care, and staff's opinions about what type of care residents should receive. This dissertation is a compilation of three publishable manuscripts that describe the balance of power and hierarchy within the nursing home. Data were collected through observations and interviews with NAs in long-term care settings at one Veterans Affairs Medical Center (VAMC). All data were analyzed using grounded theory. Nursing homes are slowly shifting from a paternalistic medical model to a biopsychosocial model of care that promotes quality of life and autonomy. Unfortunately, the current conceptualizations of autonomy are not appropriate for long-term care settings. Without a cohesive framework for autonomy in long-term care, nursing home staff are apt to continue their approach to daily care consistent with a paternalistic, medical model of care. Therefore, the aim of the first paper is to present an applied conceptual framework for "everyday autonomy" in the nursing home. Additionally, a decisional framework is presented to assist NAs in determining what degree of resident autonomy to support. Within the framework of everyday autonomy, NAs are challenged to explore ways to support resident autonomy. The purpose of the second paper is to describe how NAs can support resident autonomy in long-term care. Through observations and interviews with NAs, ten autonomy-supportive approaches were identified. Suggestions for future research are presented. Several barriers to successful recruitment emerged during this study. The purposes of the final paper presented in this dissertation are to describe my recruitment process in detail, present challenges to recruitment, and reflect on the strengths and weaknesses of my recruitment strategies. Additionally, I summarize the characteristics of NAs in relation to power and hypothesize links between these characteristics and barriers to recruitment of the NA population. Finally, I propose possible strategies for effective recruitment of NAs for research in long-term care settings.
The role of pain catastrophizing, body mass index, and sex in exercise rates among participants in an organizational wellness program
(University of Alabama Libraries, 2016) Cunningham, Julie; Thorn, Beverly E.; University of Alabama Tuscaloosa
Maladaptive cognitions that emerge in response to exercise-related pain detract from sports participation among athletes, yet these same cognitive patterns have not been widely studied among individuals engaging in non-competitive physical activity. The present study examined pain catastrophizing - a cognitive construct that is characterized as a `negative mental set' that may be adopted in the face of pain stimuli--among participants engaged in an organizational wellness program. The primary aim was to determine if either dispositional or situational pain catastrophizing predict exercise rates among these participants. Additionally, this investigation examined exercise rates and pain catastrophizing among two groups that have historically had lower rates of physical activity: individuals with obesity and women. Participants were 373 faculty and staff members at the University of Alabama who were participating in Crimson Couch to 5K, a program that trains individuals to run or walk a 5K event at the end of 9 weeks. Participants completed measures at the beginning, middle, and end of the program, which assessed pain catastrophizing, biometric information, aerobic exercise rates, and a range of health-related variables. Neither dispositional nor situational pain catastrophizing predicted exercise rates at the conclusion of the program. There were no differences in exercise rates or pain catastrophizing between men and women. However, BMI predicted a small percentage of the variance for baseline exercise rates as well as dispositional and situational catastrophizing. Future research will encompass the development of a new measure to assess a broader and more applicable range of negative cognitions that emerge in response to exercise-related pain.
Six-Month Utilization of Psychotherapy by Older Adults with Depressive Symptoms
(Springer, 2014) Gum, Amber M.; Hirsch, Anne; Dautovich, Natalie D.; Ferrante, Stephen; Schonfeld, Lawrence; University of South Florida; University of Alabama Tuscaloosa; Florida Atlantic University
We explored psychotherapy utilization patterns for community-dwelling older adults with depressive symptoms identified during a statewide initiative designed for identifying risk of substance misuse. Individuals screening negative for substance misuse, but positive for depressive symptoms, agreed to participate in monthly interviews conducted over 6 months (n = 144). Results showed that 39 (27 %) received psychotherapy, of which nearly two-thirds reported four or fewer visits. Mental health counselors were the most frequently reported service providers (50-62.5 %). Location of service varied considerably. This study documents low rates of psychotherapy use and few visits. Current efforts to increase psychotherapy access are discussed.

Browsing by Author "Dautovich, Natalie D."

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