DSpace Repository :: Browsing by Author "Scogin, Forrest Ray"

Browsing by Author "Scogin, Forrest Ray"

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Body mass index and its associations with pain, depressive symptoms, and disability in knee osteoarthritis
(University of Alabama Libraries, 2017) Pierpaoli, Christina Marie; Parmelee, Patricia A.; University of Alabama Tuscaloosa
Obesity is a risk factor for osteoarthritis (OA) and both are steadily increasing among older adults. Nevertheless, empirical examinations of the associations of body mass index (BMI) with depressive symptomatology, pain, and disability in OA remain limited. Few studies have described and differentiated functional disability in necessary tasks (basic and instrumental activities of daily living; ADL/IADLs) from discretionary, leisure activities among symptomatic normal, overweight, and obese adults. Therefore, here, associations of BMI with pain, depressive symptoms, and measures of disability among older adults with knee osteoarthritis were examined. A key focus was how BMI influences the form functional disability takes in terms of limiting necessary vs. discretionary activities. Data were collected from a sample of community-dwelling older adults with physician-confirmed knee osteoarthritis (N =353). BMI predicted significant variance in psychological and functional impairment in osteoarthritis, including pain, depressive symptoms, and three functional outcomes measures (specifically, ADL/IADL disability, discretionary activity, and activity limitation). Effects of BMI depended on level and were differentially mediated through pain. For adults with low BMI, engagement in more discretionary activities was associated with fewer depressive symptoms. This research confirms the association of BMI with disability related osteoarthritis, identifying it as a rich intervention target in a comprehensive treatment of OA to interrupt its cycle of excessive weight gain, pain, depressive symptoms, and disability particularly among older adults.
Brief depression literacy intervention with palliative cancer outpatients
(University of Alabama Libraries, 2016) Azuero, Casey Balentine; Allen, Rebecca S.; University of Alabama Tuscaloosa
Cancer patients are at risk for depression due to the nature of their disease. Previous investigations indicate patients meeting screening criteria for depression may be underdiagnosed or undertreated for their symptoms. For cancer patients, psychological distress may exacerbate pain, increase desire for hastened death, and increase disability. A randomized controlled trial (RCT) design was employed to determine feasibility and efficacy of a one-time, in-person psychoeducation and depression literacy intervention by comparing it to a treatment as usual (TAU) control group. Outpatient palliative care patients were eligible with PHQ-9 score ≥5, cancer diagnosis, absence of SMI or cognitive impairment, 19 years or older, able to speak and understand English, and available to be reached and communicate by telephone. Baseline and one month follow-up telephone assessments used vignettes and questionnaires to assess depression literacy, psychological distress, and disability. Forty-three patients enrolled, majority white (65%) females (75%) with mean age of 48 years (SD= 11.08). Three intervention participants dropped out before completing the intervention visit and follow-up interview; therefore, 40 participants were included in analysis. Group differences were controlled using propensity score. Intervention participants demonstrated clinically relevant change in depression literacy including: symptom identification (OR=2.0, 95%CI=0.296-13.511), likelihood to seek MH care with counselors (OR=4.059, 95%CI=0.388-42.491), psychiatrists (OR=4.2, 95%CI=0.397-44.4), and social workers (OR=4.2, 95%CI=0.397-44.401), and improved perceptions toward employees (OR=2.556, 95%CI=0.214-30.469) and parents (OR=15.333, 95%CI=1.711-137.404) with severe depression. Decreased somatic complaints (M=-1.7, SE=1.68, d=-0.378) and more stable level of disability were also found (M=-3.0, SE=3.36, d=-0.319). Although results are promising, future studies with more participants, improved outcome measurement, and diversity in the sample are warranted to improve the understanding of the magnitude of change in depression literacy between groups, and improve the generalizability of findings. Integration of the intervention across time, within the clinical setting may increase uptake and completion of the intervention. Also, long term follow-up would allow researchers to track the effect of the intervention on help-seeking behaviors.
Chronicity among older psychiatric inpatients
(University of Alabama Libraries, 2018) Williams, Jordan Chase; Parmelee, Patricia A.; University of Alabama Tuscaloosa
The goal of this dissertation is to examine factors that could relate to length of stay (LOS), latency to readmission, and number of admissions. Length of stay is generally defined as the amount of time an individual stays in the facility; latency to readmission is the amount of time between the last discharge and the most recent admission for each individual. I examined several factors that related to these outcomes, including number of falls, number of assaults, medical diagnoses, psychological diagnoses, frequency of PRN medication, emergency department visits and seclusion/restraints. Structural equation modeling was used to create statistical models incorporating these variables. Several models were proposed using each variable (LOS, admits, and latency) as outcome variables. Based on these models, integrated models were proposed and analyzed. Results based on these models were discussed and future research projects were proposed.
Competence through cognition: cognitive remediation and restoration of trial competence
(University of Alabama Libraries, 2015) Wilson, Jennifer Kelly; Brodsky, Stanley L.; University of Alabama Tuscaloosa
A new and promising avenue for research into competency restoration treatment is cognitive remediation, which is an empirically-supported set of treatment techniques designed to facilitate cognitive skills development (Medalia, Revheim, & Herlands, 2009). Working with 33 male patients from an inpatient forensic hospital, this randomized control trial was a pilot study to explore the effectiveness of cognitive remediation to improve competence to stand trial. Compared to a control group receiving standard hospital treatment, the treatment group received a supplement of five weeks of cognitive remediation using the NEAR model (Neuropsychological Educational Approach to Cognitive Remediation; Medalia, Revheim, & Herlands, 2009). The researcher compared pre- and post-treatment data for changes in verbal memory, problem-solving, and competence to stand trial, as measured by the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). Results indicated that cognitive remediation significantly improved the Reasoning ability measured by the MacCAT-CA. Changes on the two other factors of the MacCAT-CA were not significant. No significant changes were found on measures of verbal memory or problem solving. Patients who benefitted most from cognitive remediation were those exhibiting greater need for treatment. Successful treatment participants tended to be more mentally ill, have diagnoses of schizophrenia or another psychosis, and exhibited poor performance on a pre-test measure of competence to stand trial. This pilot investigation provided initial support for the use of cognitive remediation to improve competence to stand trial in individuals with severe mental illness and impaired legal reasoning.
Developmental differences in repeated visual search as modulated by signal to noise ratio
(University of Alabama Libraries, 2015) Yang, Yingying; Merrill, Edward C.; University of Alabama Tuscaloosa
This dissertation was designed to study developmental differences in the way simultaneous and sequential signal to noise ratios impact contextual cueing effects. Contextual cueing refers to a form of implicit associative learning of the target location and its context. Over repeated exposures, participants typically respond faster to repeated displays than to new displays that are not repeated. Researchers have assumed that this reflected the learning of associations between the location of the target and the locations of the distracters in the repeated displays. Couperus et al. (2011) found that 10 year olds were able to show intact contextual cueing when the ratio between the predictive distracters and the unpredictive distracters within each display was 75:25, but not when the ratio was 50:50. In contrast, adults showed significant contextual cueing effects when the ratio was 50:50. Hence, it seems that children and adults are differentially sensitive to noise (irrelevant distracters) in the displays. The current study incorporated two forms of signal to noise ratio (S/N): simultaneous S/N, defined as the ratio of predictive and unpredictive distracters within each display; and sequential S/N, defined as the ratio of repeated and new displays within each block. It was predicted that low S/N might be more detrimental to the learning of contextual cueing effects for children than it was for adults. Three age groups participated in the study: 6-8 year old children, 10-12 year old children and college students. In the simultaneous condition, 20 participants in each group were included in the final analysis. The results suggested that all three groups demonstrated significant and comparable contextual cueing effects across three S/N ratio conditions. In addition, the analysis of search efficiency suggested that all three groups demonstrated guided search. This was indicated by faster search slopes to the repeated displays than to the new displays as a function of set size. Therefore, no developmental difference was found in the simultaneous condition. In the sequential condition, 22 participants in each group were included in the final analysis. The results suggested that adults demonstrated significant contextual cueing effects across all three ratio conditions. Older children demonstrated significant contextual cueing effects in the high and medium conditions but only marginally significant learning in the low condition. By contrast, younger children only demonstrated significant learning in the high and medium conditions, but they did not show significant contextual learning in the low S/N condition. There was a significant developmental difference in the sequential condition. Explicit memory tests conducted after the experiment suggested no conscious awareness about the repetition for any age group in any condition. First, the results suggested that adults have an intact ability to extract repeated information from the information stream, as long as it is at least 33% predictive. Contextual cueing is hence a relatively robust form of implicit learning. The developmental difference found in the sequential but not in the simultaneous condition suggested that the presentation mode of irrelevant information impacted the acquisition of contextual cueing in children. It is likely that children's intact learning in the simultaneous condition reflected their relatively mature selective attention mechanisms. They were able to selectively attend to the predictive information when the unpredictive information was presented on the same scene. The developmental difference observed in the sequential condition might be due to children's immature working memory, especially as it applies to younger children. The practical and methodological implications of this dissertation were also discussed.
Does race moderate social support and psychological distress among rural older adults?
(University of Alabama Libraries, 2013) Hyams, Adriana; Crowther, Martha R.; Scogin, Forrest Ray; University of Alabama Tuscaloosa
Psychological distress (PD) among older adults is prevalent but undertreated, especially in minorities. Most of what is known about late-life PD in African Americans comes from studies comparing them to Caucasians, but results are contradictory, with some concluding that African Americans have more symptoms, and others demonstrating that differences disappear when sociodemographic factors are controlled. One consistent finding among all older adults is that greater social support is associated with decreased PD. African American cultural values of collectivism may act as a buffer for PD, potentially making race an important moderator of the relationship between social support and PD. Participants were aged 60 and older (N=100) and part of the Project to Enhance Aged Rural Living (PEARL). Multiple regression analyses controlling for health, income, education, and gender were conducted to determine whether race moderates the relationship between different types of social support and PD. Results showed that race moderated satisfaction with social support and PD, but Caucasians benefitted from increases in satisfaction more than African Americans. Emotional support, quality of social support, and physical health were significant negative predictors of PD. Being male also significantly predicted PD. More research including religion is needed to understand racial differences in social support and PD. Interventions for African Americans experiencing PD may be best designed by targeting males; focusing on improving emotional support, quality social support, and satisfaction with social support; and promoting physical health, perhaps by enlisting the church as middle-man.
Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility
(University of Alabama Libraries, 2014) DiNapoli, Elizabeth Ann; Scogin, Forrest Ray; University of Alabama Tuscaloosa
The study examined the effect of an individualized social activities intervention (ISAI) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. This randomized control trial consisted of 52 older adults (65 years of age or older). A 2 (group condition) x 2 (time of measurement) design was used to compare the control (treatment-as-usual) and intervention (treatment-as-usual plus ISAI) conditions at pre- and post-treatment. ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days. Intent-to-treat analyses indicated a significant Time x Group Condition interaction on quality of life, with this effect remaining when only completer data were included. There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia. Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric inpatients.
The effects of unconscious thought and domain familiarity on younger and older adults' decision making
(University of Alabama Libraries, 2014) Wayde, Ernest N.; Black, Sheila R.; University of Alabama Tuscaloosa
The current study examined age differences in decision making as a function of familiarity and time for deliberation. The primary goal was to determine circumstances under which older adults could make optimal purchasing decisions using intuitive thought processes. The participants made purchasing decisions regarding cell phone and houses. There were three phases involved in the process. In the acquisition phase, younger and older adult participants were presented with information related to purchasing decisions. Younger and older adults were given a limited amount of time to review the materials related to the purchasing decision. During the deliberation phase, participants were randomly assigned to a conscious condition in which they had a predetermined amount of time to deliberate or a distracted condition in which their working memory resources were taxed for the same amount of time. In the decision phase, participants were then asked to immediately choose which of the two options provided the best value for money. Results indicated that overall older adults made better quality decisions than younger adults. Older adult participants also made accurate decisions using the intuitive process of thinking. These results might be explained by the fact that the older adult participants were a unique group of older adults, given their overall cognitive abilities and level of education. Additionally, older adult participants might have been able to use intuition effectively in this study because of their extensive experience with purchasing products. Interestingly, older adults performed better than younger adults although younger adults had better episodic memory with respect to specific features associated with the products in the purchasing decision.
Efficacy of an audio-based cognitive behavioral therapy for older adults with depression
(University of Alabama Libraries, 2010) Shah, Avani; Scogin, Forrest Ray; University of Alabama Tuscaloosa
The purpose of this study was to develop and assess the efficacy of an audio-based cognitive behavioral therapy (ACBT) intervention for older adults with depressive symptoms. The process of developing this program included: 1) adaptation of a client and therapist manual developed for older adult caregivers (Dick, Gallagher-Thompson, Coon, Powers, & Thompson, 1996); 2) review of the ACBT program by older adults and cognitive behavioral therapists for acceptability; and 3) program revision. The revised program consists of 8 compact discs (CDs) and a workbook on the following topics: 1) introduction to CBT; 2) identifying and changing unhelpful thoughts; 3) addressing feelings; 4) relaxation; 5) engaging in pleasant events; 6) assertiveness; and 7) problem-solving. The next phase of this study entailed testing the efficacy of the ACBT program. Eligible participants (N = 34) were recruited from mainly medical settings and rural communities (e.g. above age 54 with a score greater than 9 on the Geriatric Depression Scale; GDS). Participants were randomly assigned to an immediate treatment group or a minimal contact delayed treatment group. The delayed treatment group waited four weeks to begin treatment while the immediate treatment group received a brief training session and 4 weeks to complete the ACBT program. Both groups received brief weekly contact calls to monitor mood. Outcome analyses assessed change in depression with the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1967) and GDS. Intent-to-treat carry forward analyses revealed significant differences on only the HRSD by group and time. Analyses assessing change on the Somatization subscale of the Brief Symptom Inventory (Derogatis & Spencer, 1983) and GDS by group and time were not significant.
Evaluation of a brief behavioral activation therapy for depression (BATD) group protocol in an inpatientgeriatric psychiatry facility
(University of Alabama Libraries, 2010) Norton, Misti Johnson; Crowther, Martha R.; University of Alabama Tuscaloosa
The present study examined the effect of a modified Brief Behavioral Activation Therapy for Depression (BATD: Lejuez, Hopko, & Hopko) intervention added to hospital treatment as usual on depressive symptoms (measured by the Geriatric Depression Scale) and global psychopathology (measured by the Brief Symptom Inventory) at a state-run inpatient geriatric psychiatry facility. A control group received hospital treatment as usual only. The intervention was conducted in a group therapy format. Assessments were conducted at baseline, midpoint, and post-intervention. Although results revealed that the intervention did not have a significant effect on depressive symptoms or global psychopathology over and above the effects of hospital treatment as usual, this study was limited by various logistical barriers to implementing the intervention. Treatment implementation data revealed that patient attendance at groups, patient understanding of intervention materials, and patient enactment of treatment concepts in their daily lives were below expectation. Future studies should focus on increasing patient receipt and enactment of the intervention to ensure fair tests of behavioral activation interventions in this setting.
An examination of the effect of a commercially available cognitive training program on speed-of-processing
(University of Alabama Libraries, 2014) Presnell, Andrew Harrison; Scogin, Forrest Ray; University of Alabama Tuscaloosa
This study examined the effect of a commercially available cognitive training product, Brain Age, on the objective and subjective cognitive abilities of 40 older adults. Of particular interest was the effect on speed-of-processing, as this type of training was implied by the game design. A 2 (time of measurement) x 2 (group) design was used to compare a weekly-contact control to a group playing the game three times a week for 30 minutes at a time over a four week period. The game play intervention showed significant improvement over the controls and within participants on a Stroop Color-Word test, a skill directly trained in the game. No other significant effects were found on objective or subjective cognitive measures, though some trends in the data suggest the possibility of small effects on some measures. Within the game play group, frequency and time spent playing did not significantly affect scores. These findings suggest that the effect of commercial products is largely isolated to skills trained and expectations about the benefits of these products should be modest.
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.
Hearing aids and quality of life among older adults
(University of Alabama Libraries, 2016) Hyams, Adriana; Scogin, Forrest Ray; University of Alabama Tuscaloosa
Eighty percent of older adults have hearing loss. Hearing loss is associated with quality of life (i.e., social support, mental health, general health, and physical functioning), but it is unclear if using hearing aids is positively correlated with quality of life. The current study tested three groups, those with: normal hearing, hearing loss with hearing aids, and hearing loss without hearing aids. Hearing thresholds were established with pure-tone audiometry. Total sample size was 100 participants aged 60 and older. It was hypothesized those with normal hearing would have significantly better quality of life than those with hearing aids, who would have significantly better quality of life than those with hearing loss but without hearing aids. Data were analyzed with MANCOVAs and ANOVAs. Differences in quality of life among the three groups approached significance despite platykurtic data that brought power sharply down. After Winsorization, there was a significant difference among the groups; the group without aids had significantly poorer quality of life than the group with normal hearing, which did not significantly differ from the group with hearing aids. MANCOVA significance was largely due to the significant general health variable. These results were found when 54% of the group with aids wore them for less than eight hours a day, and the group without aids only had mild hearing loss. Further, disease-specific measures suggested decreased handicap for the group with aids. These results call for future investigations of people with at least moderate hearing loss and people who wear aids more consistently.
The impact of an educational intervention on attitudes and beliefs of law students about "what works" in juvenile rehabilitation
(University of Alabama Libraries, 2012) Perelman, Abigayl Meirav; Clements, Carl B.; Lochman, John E.; University of Alabama Tuscaloosa
Opinions about "what works" in juvenile justice are often based on poorly informed beliefs and attitudes rather than on scientific evidence. Disseminating credible information remains a challenge. Studies have identified programs that effectively address juvenile offenders while exposing "get tough" alternatives as ineffective. It is important to communicate these findings to future legal policy professionals, many of whom will come from the ranks of today's law students. Previous findings by this author suggest that belief barriers may impact openness to empirical evidence. The current study addressed two questions: Can brief, on-line educational modules change participant knowledge and beliefs about "what works"? How will attitudes influence receptivity to new information? The 161 nationally recruited law students who completed this study were randomly assigned to one of two experimental groups (Module One: "benefits of empirically-supported programs [ESP]" or Module Two: "weaknesses of unsupported programs") or a control group (Module Three: general information about juvenile crime). Prior to receiving an educational module, participants completed surveys regarding demographics, baseline justice related attitudes, and beliefs about program effectiveness. After completing the modules, participants rated program effectiveness again. Results at pre-test demonstrated that individuals were readily categorized as having either a treatment-focused "supportive" belief system or a punitive "get tough" belief system. The "supportive" group tended to rate ESP as highly effective while the "get tough" participants tended to rate unsupported programs as highly effective, while also emphasizing the lack of effectiveness for ESP. Although baseline attitudes were significant predictors of pre-test program ratings, at post-test, it was clear that exposure to Module One not only produced the expected result (i.e., raising the ESP effectiveness ratings), but also had a notable carryover and corrective influence on subsequent ratings of unsupported programs. Module Two also produced expected results (i.e., lowering the post-test ratings of unsupported program effectiveness). Following exposure to educational modules based on empirical evidence, it appeared that pre-existing attitudes no longer played a significant role in assigning program effectiveness ratings. Module One had a particularly robust effect on post-test ratings; these were in line with the research literature on "what works" in juvenile intervention.
The impact of posttraumatic growth, transformational leadership, and self-efficacy on psychological symptoms among combat veterans
(University of Alabama Libraries, 2017) LaRocca, Michael Andrew; Scogin, Forrest Ray; University of Alabama Tuscaloosa
Previous research has established self-efficacy and posttraumatic growth as essential to post-deployment adjustment among veterans, and perceived transformational leadership is well known for its positive effects on follower outcomes across contexts. However, little is known regarding how transformational leadership may relate to self-efficacy and posttraumatic growth in fostering psychological wellbeing among combat veterans. The purpose of this dissertation was to examine the role of posttraumatic growth and transformational leadership in predicting PTSD and depression symptoms among combat veterans, as well as how post-deployment coping self-efficacy may mediate these relations. Regression analysis revealed post-deployment coping self-efficacy and perceived transformational leadership as predictors of fewer psychological symptoms. In addition, mediation modeling using bootstrapping resampling revealed that post-deployment coping self-efficacy mediated the relation between transformational leadership and both PTSD and depression. These findings may aid in the prediction of PTSD and depression symptoms among veterans, which may then influence pre-deployment leadership training among military personnel as well as clinical treatment protocols for veterans.
Judicial decision making in atkins cases: examining the influence of psychological reports and judicial attitudes
(University of Alabama Libraries, 2015) Hedge, Krystal; Salekin, Karen L.; University of Alabama Tuscaloosa
The impact of psychological assessment report style (i.e., deficit- versus strength-based reports), report content (e.g., claimant educational background, details of the instant offense, prison behavior), and judicial attitudes toward intellectual disability (ID) were assessed with regard to judicial decision-making in a mock Atkins case. A between-groups study (i.e., strength- and deficit-based report groups) was conducted through the use of a mixed-mode design. Participants included 122 judges serving in either federal or state courts. Results supported the hypothesis that the style in which a psychological assessment report is written is influential in final case outcome. Specifically, the strength-based report group was significantly more likely to find against ID than the deficit-based group, and the deficit-based group was more likely to find in favor of ID than the strength-based group. Contrary to the hypotheses, judicial attitudes toward ID did not predict the extent to which participants weighed certain report content in their final decision (i.e., relevant evidence against ID, not relevant to the decision, relevant evidence in favor of ID). However, the results showed that the extent to which participants weighed the claimant’s index offense to be evidence in support of ID was a significant predictor of final case outcome; when the index offense was viewed as evidence against ID, participants were more likely to find against ID. Personal experience with the ID population was not a significant predictor of final case outcome, but as knowledge of the diagnostic criteria increased, participants were more likely to find in favor of ID. The perceived credibility of the psychologist who authored the mock report did not predict participant agreement with the report’s final conclusion regarding ID. Overall, the results of this study indicated that the general style in which psychological assessment reports were written influenced judicial decision-making in a mock Atkins case. In addition, the results of this study revealed that attitudes toward and experience with ID were less influential in judicial decision-making than initially believed. Knowledge of ID was revealed to be a significant predictor of final case outcome. The limitations of this study and suggested directions for future research 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.
Mindfulness-based cognitive therapy for the treatment of chronic headache pain
(University of Alabama Libraries, 2013) Day, Melissa Anne; Thorn, Beverly E.; University of Alabama Tuscaloosa
This study reports the findings of a randomized controlled trial (RCT) investigating the feasibility, tolerability, acceptability and initial estimates of efficacy of mindfulness-based cognitive therapy (MBCT) compared to a delayed treatment (DT) control for chronic headache pain. It was hypothesized that MBCT would be a viable treatment approach and that compared to DT, would elicit significant improvement in primary headache pain-related outcomes and secondary cognitive-related outcomes. Mixed design ANOVAs were conducted on the sample of eligible participants who did not commence treatment (N=4), the intent-to-treat sample (ITT; N=36), and on the completer sample (N=24). Results indicated that overall, MBCT represents a feasible, tolerable and acceptable treatment option for headache pain; statistical indicators for these outcomes are reported. ITT analyses showed that compared to DT, MBCT participants reported significant improvement in pain interference, self-efficacy, and activity engagement, whereas the DT group did not. Results of the completer analyses produced a similar pattern of findings; additionally, MBCT completers reported significantly improved pain intensity and pain catastrophizing whereas DT completers did not. The clinical significance of the findings is reported. Some preliminary support was found for the proposed MBCT for pain conceptual model; however, many of the hypothesized mediational pathways were precluded from analysis. This is the first study to empirically examine a MBCT approach for the treatment of chronic headache pain. Results provide a research base for future RCTs comparing MBCT to attention control, and future comparative effectiveness studies of MBCT and cognitive-behavioral therapy.
Modified core mindfulness skills training in an adolescent female correctional sample
(University of Alabama Libraries, 2010) Wakeman, Emily E.; Salekin, Karen L.; University of Alabama Tuscaloosa
Dialectical Behavior Therapy's Core Mindfulness skills have the potential to help incarcerated adolescents reduce diverse symptoms of psychopathology. Due to the current lack of research on the independent effect of the Core Mindfulness skills, two studies were performed to examine the effectiveness of a modified Core Mindfulness skills training program in reducing symptoms of depression, anxiety, anger, and suicidal ideation in a sample of incarcerated adolescent females ("students"). In Study 1, eight students completed five self-report measures at three time points. The first two assessments were conducted prior to the treatment, and the third assessment was collected upon completion of the treatment. A series of analyses of variance (ANOVAs) revealed no significant changes in the outcome variables, although there was a slight trend of decreasing scores in the hypothesized direction. In Study 2, 38 students completed two self-report measures prior to and upon completion of the modified Core Mindfulness skills training program, and they provided feedback about the treatment. Additionally, staff members provided behavioral ratings, and group leaders and co-leaders provided feedback about the overarching modified DBT program. Multivariate analyses of variance (MANOVAs), ANOVAs, and Friedman tests revealed significant reductions in student-reported levels of depression, anxiety, and suicidal ideation. There were no significant changes in staff ratings of student behavior. Limitations and contributions of the study are discussed, as well as barriers to successful implementation of treatment research in a correctional facility. Recommendations to improve treatment implementation in secure settings, and suggestions for future research are offered.
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.

Browsing by Author "Scogin, Forrest Ray"

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