UT Southwestern School of Health Professions
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Browsing UT Southwestern School of Health Professions by Author "Chiu, Chung-Yi"
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Item Bandura's Social Cognitive Concepts and Physical Activity of People with Multiple Sclerosis: A Hierarchical Regression Analysis(2013-12-30) Gaylord, Kathryn Lee; Chiu, Chung-Yi; Froehlich-Grobe, Katherine; Rose, LindseyBACKGROUND: Social Cognitive Theory (SCT), developed by Alfred Bandura, is a theory often employed for health promotion. This theory focuses on a set of determinants, examining how each operates, and translating information about the determinants into health practices. The combination and interaction of the primary determinants of SCT (perceived self-efficacy, outcome expectations, goals, and perceived facilitators and barriers) not only determine, but also influence the health behaviors individuals engage in. Through the use of this theory, determinants to change and adoption of a new behavior can be assessed, and individual treatment plans may be developed to effectively focus on the most influential targets for behavioral change. Multiple Sclerosis, a chronic and debilitating health problem estimated to affect hundreds of thousands of individuals in the United States, often leads to individual suffering and an overall decreased quality of life. Currently, there is no cure for MS, so symptom management and a decrease in debility remain a critical area of focus for health professionals working with MS patients. While there is no cure for this disorder, physical activity has been shown to alleviate multiple symptoms of MS such as mobility impairment, fatigue, pain, and depression, which then improves the quality of one’s life. Furthermore, there is strong empirical evidence to support the use of SCT as an efficacious treatment approach for employing health promotion practices. The purpose of this study is to extend previous findings by examining how various SCT concepts relate to physical health, mental health, stage of change for exercise, and action planning and coping planning for exercise. Additionally, the present study examines how disability affects self-efficacy thereby impacting physical activity. SUBJECTS: A total of 214 individuals (185 females [86%] and 29 males [14%] with self-reported MS recruited from the National Multiple Sclerosis Society and a neurology clinic of a university teaching hospital in the Midwest participated in the current study. The average age among participants was 46.97 years (SD = 9.92). Around 36% of participants were retired due to MS, and approximately 72% of participants reported being treated for secondary health problems (e.g., overweight, high blood pressure, and diabetes). METHOD: Participant demographic data were gathered from self-reports and include age, gender, ethnicity, marital status, years since onset of MS, secondary health issues, education level, vocational status, occupation, area of residence, current and past rehabilitation services received, source of income, total income, access to physical exercise in community, and changes in health practice since onset of MS. SCT concepts were assessed using the following measures: Action Self-Efficacy Scale-Physical Exercise (ASES-PE), Outcome Expectancy Scale-Physical Exercise (OES-PE), Health/Safety Risk Perceptions Scale (HRPS), Health/Safety Expected Benefits Scale (HEBS), Barriers to Health Promoting Activities for Disabled Persons Scale (BHADP), the Action Planning and Coping planning Scale-Physical Exercise (APCPS-PE), the Physical Activity Stages of Change Instrument (PASC). Participant disability and health were assessed using the following measures: Minimal Record of Disability (MRD) and the MOS Short form Health Survey (SF-12v2). The present study used a hierarchical regression analysis to examine associations between various domains and a set of social cognitive concepts (self-efficacy, knowledge of health and risk benefits, and outcome expectancy). RESULTS: There were several significant findings when examining the four domains of action planning and coping planning, stage of change, physical health, and mental health. Results indicated action planning and coping planning was predicted by action self-efficacy (R2 = 45%, ß = .45, p < .001), outcome expectancy (R2 = 45%, ß = .20, p < .01), risk perception (R2 = 45%, ß = .14, p < .05), and perceived barriers (R2 = 16%, ß = -.14, p < .05). Results indicated that stage of change was predicted by action planning and coping planning (R2 = 28%, ß = .26, p < .01). When “physical health” was the outcome variable, it was predicted by age (R2 = 8%, ß = -.20, p < .01), severity of disability (R2 = 14%, ß = -.28, p < .01), action self-efficacy (R2 = 22%, ß = -.16, p < .05), and outcome expectancy (R2 = 22%, ß = .27, p < .01). Lastly, when “mental health” was the outcome variable, it was predicted by age (R2 = 6%, ß = .18, p < .05), perceived barriers (R2 = 11%, ß = -.23, p < .01), outcome expectancy (R2 = 18%, ß = -.25, p < .01), and action self-efficacy (R2 = 18%, ß = .22, p < .05). DISCUSSION: The research findings support the applicability of Bandura’s Social Cognitive Theory as a model for exercise or physical activity for people with MS. This study found unique relationships between physical health and action self-efficacy, and mental health and outcome expectancy (with both relationships having a negative correlation). The current study includes a unique subset of the MS population who are well-educated, affluent, and report greater access to services and who expressed the negative correlate between action self-efficacy and physical health. The aforementioned factors are supposed to support physical health. However, the current group has high action self-efficacy to exercise, and given that they likely have good knowledge about exercise benefits to MS and good environmental support to engage in exercise, their motivation has likely surpassed, and is greater than, their experienced physical health, such as suffering pain and fatigue, which decreases physical health. Furthermore, it may be that the participants in the current study have good knowledge about how physical activity benefits their MS symptoms and progress management; consequently, they have high intention to push themselves to engage in exercise even though they may have experienced pain and fatigue, both of which have affected physical health significantly. Additionally, considering that high outcome expectations of a behavior may lead to stress and anxiety, such stress may decrease mental health, particularly if the positive effects of an activity (such as exercise) are not experienced as soon as and as much as expected. Examining the social cognitive, physical health, and mental health domains provides a well-rounded and empirical basis for employing health promotion efforts in clinical work with persons with MS. Rehabilitation professionals may help persons with MS implement physical activity through the use of SCT, which may improve their mobility impairment, pain, fatigue, and depression. The present study’s findings enable clinicians and rehabilitation professionals to better create and customize treatment to best meet individual patients’ needs and improve their overall quality of life.Item Comparing Distribution-Based and Anchor-Based Minimal Clinically Important Difference Values for Temporomandibular Disorder(2011-10-03) Ingram, Megan Elizabeth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-YiThe current study is a continuation of studies by Gatchel and colleagues. Data were collected from 101 patients at several community dental clinics. Based on the patients' initial evaluations, they were randomly assigned to one of three treatment groups: Low Risk/Non-intervention Group; High Risk/Biobehavioral Group; or High Risk/Self-Care Group. This study attempted to better understand and objectively quantify meaningful symptom relief by determining the minimal clinically important difference (MCID) for temporomandibular joint disorder (TMD). Despite limitations and controversy with determining the most appropriate method, this information will play an important role in determining treatment effectiveness for not only TMD, but for other pain conditions as well. The most commonly referenced methods for determining meaningful change are the distribution- and anchor-based approaches. Distribution-based minimal detectable change (MDC) values were calculated using the formula 95% CI=1.96 x Square Root(2) x SEM, while the anchor-based approach minimal clinically important change (MCID) values were calculated using a Receiver Operating Curve (ROC). Both mean particle size and broadness of distribution served as two separate functional anchors, and normal range and .5 SD as two separate cutoff methods. Despite some variability, the MCID values were relatively consistent with the MDC values regardless of method, anchor, or cutoff for both the Physical Component Scale (PCS) and Mental Component Scale (MCS) of the SF-36. The Characteristic Pain Inventory and Graded Chronic Pain Scale showed a narrow range of variation within the MCID values; however, the MCID values calculated were significantly higher than the MDC values reported for the same measures. Findings indicated that the PCS component of the SF-36 provided stronger evidence of clinically meaningful change. The PCS resulted in asymptotic values closer to .1 (at the 90% confidence interval) with areas under the curve that better fit the model compared to the other subjective measures (considered fair at .701 when using the normal range and .740 when using .5SD for the Biobehavioral Group). Additionally, broadness of distribution resulted in more clinically meaningful changes as a result of better metric values when comparing the biobehavioral versus the self-care groups.Item Effect of Physical Activity on Community Participation among Breast Cancer Patients(2015-08-31) Dean, Victoria Nicole; Casenave, Gerald W.; Chiu, Chung-Yi; Rose, LindseyBACKGROUND: Breast cancer patients who engage in physical activity are shown to have a reduction in difficulties during daily living as a result of treatment side effects; however, it is unknown if participation in physical activity will reduce the limitations experienced by these individuals while participating in community activities. SUBJECTS: Female breast cancer patients, with a mean age of 51.81(SD = 7.88, range 30-64), diagnosed with stage 1 (n = 16, 21.3%), stage II (n = 37, 49.3%), stage III (n = 15, 20.0%) cancer who have completed chemotherapy (n = 63, 84.0%), are undergoing chemotherapy (n = 9, 12.0%), or have not yet started chemotherapy (n = 1, 1.3%). The majority of the participants were individuals were employed full time (n = 39, 52.0%), employed part time (n = 13, 17.3%). The majority of these women were married (n = 49) or divorced (n = 11). These women were college graduates (n = 30) or finished some graduate school (n = 20). These participants were European American (n = 34, 45.3%) and African American (n = 13, 17.3%). The BMI of these participants had a mean of 27.28 with a range from 16.30 to 44.81(SD = 5.35). Some of these individuals (n = 53) reported co-occuring medical conditions such as high cholesterol, high blood pressure, diabetes, and being overweight. METHOD: We recruited female breast cancer patients between the age of 18-66, with stage I, II, or III cancer, who are starting, in the process of, or have completed chemotherapy. Participants who met the inclusion criteria were selected to participate. Research assistants invited these patients to volunteer the survey study. For the current study purpose, we analyzed the association between the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Disability Assessment Scale version 2.0 (WHODAS 2.0), using the Pearson product-moment correlation at the level of statistical significance at .05. The survey packages were sent to the participants through the United States Postal Service. Once the surveys were returned by mail the participants received a $10 gift card for compensation. RESULTS: A significant negative association was observed between limitations in participation in society (r = -.31, p =.004, medium effect size) and walking. Significant negative associations were also discovered between the limitations in life activities and vigorous activity (r = -.24, p = .023, small to medium effect size), along with walking (r = -.23, p = 0.25, small to medium effect size). Lastly, a significant negative association was seen between the limitations in communication and understanding and walking (r = -.20, p = .046, small to medium effect size). DISCUSSION: Engaging in physical activity decreases the limitations in understanding and communication, life activities, and participation in society an individual encounters. Vigorous activity is not required to experience reductions in community limitations. Simply engaging in light physical activity, like walking, produces results.Item The Effectiveness of Biopsychosocial Interventions at the Dallas Spinal Rehabilitation Center: Applying the NIDRR Logic Model(2013-09-10) Siles, Melisa Garcia; Chiu, Chung-Yi; Wolf, Tina; Casenave, Gerald W.BACKGROUND: The National Institute on Disability and Rehabilitation Research has developed a program evaluation framework, the NIDRR logic model describing and assessing the relationship between planning, implementing, and evaluating outcomes in rehabilitation service environments, such as the Dallas Spinal Rehabilitation Center. Standard primary care facilities have treated chronic pain with narcotic medications; however, controversies surrounding the lack of long-term efficacy, risk of addiction, and the physical and psychological side effects of these medications continue to be heavily debated. There is strong evidence to support a biopsychosocial treatment approach for chronic pain which reduces narcotic dependence and restores daily functioning. The purpose of this study is to assess the effectiveness of the comprehensive interdisciplinary pain rehabilitation (IPR) program at the DSRC based on the NIDRR logic model. SUBJECTS: A total of 226 patients (131 males [58%] and 95 females [42%]) with chronic pain were admitted to the IPR program at the DSRC between January 2010 and December 2012. Among the 226 patients, 150 patients required medication tapering at admission. The average age of patients was 47 years old (SD= 9.74). The DSRC assigned patients to one of two groups after assessing the severity of their chronic pain curbing their ADL limitations, their social functioning, and their individualized treatment goals; 60 patients were in the chronic pain program, and 166 patients were in the functional restoration program. Patients attended between 80 hours to 160 hours of treatment that included medication management, physical therapy, cognitive-behavioral therapy with psychoeducation and biofeedback, and vocational counseling. METHOD: The current study is a descriptive design. All patients completed self-report measures assessing their current level of pain, functioning, depression, anxiety, and fear-avoidance beliefs at pre- and post-treatment. A dependent paired-samples t-test was used to assess the significance of treatment effect. RESULTS: Overall, significant improvements were seen among patients in the areas of independent functioning, depression, anxiety, fear-avoidance beliefs, medication tapering, and return to work status. Physical demand level, assessing independent functioning, improved significantly, t(225)=27.79, p=.000, among all patients. Results indicated significant improvements in depression scores, t(225)=13.38, p= .000, and anxiety scores, t(225)= 12.94, p= .000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(225)= 13.68, p= .000, as did those beliefs pertaining to work, t(223)= 15.33, p= .000. Additionally, 93% of patients successfully returned to work after completion of the program, and 96% of patients who required tapering at admission successfully tapered or discontinued their medication use. Improvements were also found within each treatment group. Physical demand level in the chronic pain program improved significantly, t(59)=12.19, p.000. Results indicated significant improvements in depression scores, t(59)= 5.79, p= .000, as well as anxiety scores, t(59)= 5.83, p=.000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(59)= 7.16, p= .000, as did those beliefs pertaining to work, t(59)=8.77, p= .000. Forty-four (73%) patients in the chronic pain program successfully returned to work. Of the 45 patients that required medication tapering at admission, 101 (96%) tapered or discontinued their medications. DISCUSSION: The NIDRR logic model has provided an excellent framework to assess treatment effectiveness in rehabilitation centers. Findings suggest that a biopsychosocial approach for chronic pain (e.g., the IPR program) is effective and efficient in diminishing overall distress and corroborating more biopsychosocial long-term effects than a short term quick fix of narcotic medications.Item The Effectiveness of Electroconvulsive Therapy for Major Depressive Disorder According to Patient Self-Report(2013-08-28) Metoyer, Melissa C.; Chiu, Chung-Yi; McClintock, Shawn Michael; Brewer-Mixon, KarenBACKGROUND: Major depressive disorder (MDD) is a common, typically recurrent, often chronic, and disabling disorder affecting approximately 14 million adults in the United States (US) each year. Electroconvulsive therapy (ECT) is a neurostimulation therapeutic intervention that is highly effective and most often used to treat certain psychiatric conditions, in particular MDD. Despite the proven effectiveness of using ECT to treat MDD there have been no other studies that have addressed methods of assessing the severity of depressive symptoms using patient self report instrument. SUBJECTS: Ninety-four participants, comprised of 58 (61.7%) females and 36 (38.3%) males who ranged from 20 to 85 years of age (M=51.76, SD=15.19) participated in this study. All subjects had a diagnosis of MDD and were treated with ECT over an average of 11 sessions on an inpatient or outpatient basis at the UT Southwestern Medical Center Zale Lipshy University Hospital (ZLUH, Dallas, TX). METHOD: The 16-item self-report version of the Quick Inventory of Depressive Symptomatology (QIDS-SR16) measure was used to determine the effectiveness of ECT in treating MDD. Data was acquired at baseline and after the end of the acute ECT treatment course. Paired t-tests were applied to determine if there were significant depression improvements and effect size (r) was calculated to determine the effect size between pre- and post- treatment scores on the Quick Inventory of Depressive Symptomatology-Self Report₁₆ total score and each domain score. RESULTS: The overall baseline average total score of QIDS-SR₁₆ (M=18, SD=4.34) for the study sample was in the severe range. After completion of the acute ECT course, the QIDS-SR₁₆ total score on average significantly decreased to the mild range (M=7.18, SD=4.74). The overall total QIDS-SR₁₆ score had a large effect size (E.S.) (E.S. (r) =.91; t = 20.98, df = 93, p =. 000). Consistent with this, the domain scores also had a large effect size. The E.S. (r)-scores from greatest to the least for the domain scores are mood (E.S. (r) =.88; t = 17.58, df = 93, p =.000), suicide (E.S. (r) =.83; t = 9.19, df = 93, p =.000), fatigue (E.S. (r) =.78; t = 12.13, df = 93, p=.000), self-outlook (E.S. (r) =.75; t = 11.07, df = 93, p =.000), concentration (E.S. (r) =.72; t = 10.03, df = 93, p =.000), sleep (E.S. (r) =.68; t = 8.96, df = 93, p =.000), loss of interest (E.S. (r) =.68; t = 14.58, df = 93, p = .000), psychomotor(E.S. (r) =.65; t = 8.35, df = 93, p = .000), and appetite change (E.S. (r) =.62; t = 7.74, df = 93, p = .000). Data revealed few differences between electrode configuration placements. The sad mood and suicide domains resulted in a greater decline in symptom ratings than the remaining seven domains over the course of an acute ECT treatment. DISCUSSION: The findings of the study are consistent with prior research suggesting that ECT is an effective treatment for MDD. Specifically, depressive symptoms as rated by self report showed a significant decrease from baseline to completion of the acute ECT course. The data from the QIDS-SR16 revealed an overall marked improvement in total depression severity, and in specific depressive domains including mood, suicidal ideation, energy, self-outlook and concentration/decision making. IMPLICATIONS: The research has some limitations. the present study only recruited patients from one hospital, which may limit the generalizability of the findings. This was a naturalistic study based on a clinical database. There could have been possible comorbidities (both medical and neuropsychiatric) that could have affected outcome. The switch of electrode placement was non-systematic and based on physician judgment and not based on the study’s criteria.Item Efficacy of an Early Biopsychosocial Intervention for Patients with Acute Temporomandibular Disorder-Related Pain: a Six- to Ten-Year Follow Up Study(2011-12-09) Fraley, Sarah Elizabeth; Gatchel, Robert J.; Stowell, Anna W.; Chiu, Chung-YiA long-term follow up study was conducted to further evaluate the efficacy of an early biopsychosocial intervention for patients with acute high risk (HR) temporomandibular disorder (TMD). Subjects from Gatchel and colleagues’ one-year outcome study (Gatchel, Stowell, Wildenstein, Riggs, & Ellis, 2006), and two- to six-year follow up study (Gatchel, Potter, Hinds, & Ingram, 2011) were contacted to assess pain and psychosocial measures six to ten years post intake. An early intervention (EI) group had received cognitive behavioral skills training and biofeedback, while a nonintervention (NI) group had received no intervention. EI group subjects demonstrated significant improvement as well as maintenance of gains in several psychosocial domains, including coping skills and reduction in depression scores relative to NI group subjects. EI group subjects also showed a decreasing trend in jaw pain-related healthcare visits relative to NI group subjects, providing further evidence for reduced costs associated with early interventions. The present study supports the findings of the earlier one-year outcome study and two- to six-year follow up study, indicating that an early biopsychosocial intervention is beneficial for patients with acute TMD. In utilizing this approach to treat patients in the acute stage of TMD, these patients are less likely to develop chronic TMD, and to be impacted long-term by the physical, emotional, and financial aspects of TMD.Item The Exploratory Study of Consumers' Experience of Using Food Pantries and Their Self-Sufficiency and Quality of Life(2013-09-10) Sims, Candice M.; Chiu, Chung-Yi; Brewer-Mixon, Karen; McClintock, Shawn MichaelBACKGROUND: Food insecurity and consumers' chronic dependence on social welfare designed for emergency use has raised concern for food banks and food pantry directors who are interested in consumers' experience of using food pantries and their self-sufficiency during the period of relying on food pantries. In addition to knowing the demographic and socioeconomic status of consumers, there is still a need to understand consumers' satisfaction with food pantry services, experience of using a food pantry, self-sufficiency, motivation, and quality of life. These subjects were addressed in the present study. SUBJECTS: From 12 randomly selected food pantries in the greater Dallas area that are serviced by the North Texas Food Bank, 151consumers were surveyed, which included 112 females and 39 males. There were 51 Caucasians, 70 African Americans, 28 Hispanics and 2 other races/ethnicities. The average age of consumers surveyed was 44.45 (Range= 20-65, SD = 20.65). Additionally, a total of 28 surveys were completed by food pantry directors. The total sample included 17 female and 11 male directors. The average age of directors surveyed was 55.65 (Range= 27-69, SD= 12.82). Only 1 director (3.6%) reported being of Hispanic/Latino or Spanish origin. Twenty-three directors (82.1%) were Caucasian, three (10.7%) were African American, and one (3.6%) reported being American Indian or Alaska Native. METHODS: A descriptive research design was used. SPSS 19.0 was used to analyze the data. The following scales were used: Consumer Demographic Questionnaire, Food Pantry Services Questionnaire, Service Satisfaction Questionnaire, Food Pantry Use Reason Questionnaire, Service Perception and Emotion Questionnaire, Dependence Questionnaire, Stages of Change in Employment, Work Intention Scale, Life Crisis Solution Questionnaire, Kessler Psychological Distress Scale, and the SF-12. RESULTS: Around 40% (n=58) of consumers had a high school diploma and less than 11th grade education. Forty-seven consumers (31.1%) were currently unemployed and 40 (26.5%) unable to work. Thirty-nine consumers' income came from SSI (25.8%) and 23 consumers' (15.2%) income came from SSDI. Eighty-seven consumers' (57.6%) annual household income was under $11,999. Overall, consumers were satisfied with food pantry services and felt appreciated and relieved when receiving services and food. There was no significant difference of service satisfaction evaluation between directors and consumers. Their motivation of returning to work and being self-sufficient was moderate. Consumers' quality of life was significantly lower than the general population. However, there was a very significant difference in the way consumers and directors rated food pantry use reason importance (t(53.85)= -9.65, p = .000), with consumers' overall ratings being significantly lower than directors. DISCUSSION: Studies have shown that demographic factors such as household income, race, gender, marital status, employment and accessibility of social welfare are mediating factors for food insecurity and poverty. All of these factors contribute to increased reliance on food pantry services. The responses from consumers regarding their dependence on food pantries has supported the fact that consumers need assistance in finding good paying jobs, education in learning to budget, and classes where job skills can be learned. Additionally, in order to best serve food pantry consumers and to meet the ultimate goal of encouraging self-sufficiency, food pantry directors must understand their consumers' quality of life and the factors that contribute to it. IMPLICATIONS: The ability of the food bank's top-down approach to promote self-sufficiency has been questioned. Developing community initiatives that promote self-sufficiency through community development brings accountability and pride back into the community. At the center of this facilitation is the much-needed strong leadership of the directors, serving as life coaches to consumers.Item The Impact of Specialized Family Camps on Quality of Life and Hope in Families Who Are Coping with Pediatric Cancer(2012-08-15) Cook, Ellen Claire; Wetherington, Crista E.; Germann, Julie; Chiu, Chung-Yi; Leavey, PatrickBACKGROUND: Over the past several decades, specialized summer camps for children with cancer have been shown to have various positive results in those who attend. Family camps have become increasingly popular over the past few years, but the efficacy of family camps for specialized populations has not been well established through research. In addition, few studies have addressed the benefits of the camp experience over time, especially in regard to its impact on quality of life. The aim of this study was to learn whether or not the family camp experience increases the quality of life of families with a child with cancer, and whether or not these changes are maintained after the camp experience ends. In addition, this study examined the impact of camp on levels of hope, and analyzed how hope and social support contribute to the quality of life of those who attend camp. SUBJECTS: A total of 66 families participated in this study. Participants include parents, cancer patients or survivors, and siblings. Thirty-nine families who attended a specialized weekend camp participated in the study, and a control sample of 27 families who did not attend camp was recruited as well. METHOD: Questionnaire data was collected at three time points: pre-camp, post-camp, and a three-month follow up. Measures included a demographic questionnaire, age appropriate versions of the PedsQLTM 4.0 Generic Core Scales, the PedsQLTM 2.0 PedsQLTM 2.0 Family Impact Module, the Hope Scale (Adult and Child versions), the Young Children’s Hope Scale, and a brief follow-up questionnaire. RESULTS: Quality of life did not significantly increase in the camp group in the overall family unit. However, quality of life was shown to be significantly higher in the camp group than the control group at the beginning and end of camp. Siblings demonstrated a significant increase in quality of life when examined separately from the family unit. No significant changes in hope or differences in hope between groups were observed. DISCUSSION: Though this study did not demonstrate the efficacy of family camp as predicted, it did show that individual family members are impacted by camp in different ways. Camp has been show to benefit siblings in particular, which is indicated by improvement in quality of life, hope, and social support in this population. This study also shows that different results may be found using different measures of the same variables.Item Influences on Mental Health Service Utilization for Vietnamese Young Adults(2012-08-15) Phan, Hang Tu; Stewart, Sunita M.; Lee, Simon Craddock; Chiu, Chung-YiBACKGROUND: Vietnamese-Americans underutilize mental health services. Several factors have been proposed to influence rates of service utilization within this population, including cultural identification and families' acceptance of such services. Most measures of cultural identification are lengthy and burdensome. Furthermore, studies examining the link between parental attitudes towards mental health services and their children's attitudes have only included children who were under the age of 18 - therefore unable to legally seek their own services. This study was designed to address these gaps by developing and testing brief scales of identification with Vietnamese and American culture, and obtaining information about the influence of parents' attitudes on older adolescents and young adults in this cultural group where a strong family orientation persists through the lifespan. A third aim of the study was to examine the role of the participants' acceptance of mental health services both as a predictor for utilization of such services, and as a mediator between other predictors and utilization. SUBJECTS: The participants in the study included a total of 87 Vietnamese-American young adults between the ages of 18 to 30 years old. Participants were recruited from the Texas Exes Asian Alumni Network (TEAAN) in Austin, Texas and from the Mother of Perpetual Faith Catholic Church's youth group. Recruitment also occurred through a method called the "snowball effect," where those involved in the study were asked to help recruit additional participants. METHOD: Surveys were completed on-line. Participants reported their mental health service utilization in the past 12 months. They also were administered measures of potential predictors: cultural identification scales, the participants' distress level, perceived stigma towards mental health services, perceived parental acceptance of mental health services, and their own (personal) acceptance of mental health services. RESULTS: The psychometric properties of the brief cultural identification scales were examined; the scales have good validity, but slightly low reliability. None of the proposed factors were found to be significant predictors of formal mental health service utilization, but items assessing distress level were found to correlate with service utilization at a trend level. The only factor found to predict personal acceptance was perceived parental acceptance of these services. Because personal acceptance was not found to be a predictor of mental health service use, it could not serve as a mediating variable between the other factors and service utilization. DISCUSSION: Before the originally developed cultural identity scales can be used for research, further development of the scales will be necessary. A limitation of this study is that there were very few participants who reported formal mental health service utilization, reducing the power to determine prediction to this variable. In this sample, only distress was found to be even a marginal predictor of mental health service use, suggesting that the low rates of mental health service utilization found in these Vietnamese young adults may in fact be due to actual low levels of psychological distress. The fact that parental acceptance significantly predicted personal acceptance of mental health services among participants supports the idea that parental attitudes towards mental health services may have been adopted by their children, even after they were independent enough to seek their own services. Future research and clinical implications are discussed.Item Maternal Depressive Symptoms and Its Relationship to Outcomes of Adolescents with Type 1 Diabetes in a Diverse Sample of Caucasian and Latino Youth(2012-05-18) Godbey, Elida Isabel; Wiebe, Deborah J.; Chiu, Chung-Yi; Reed, GabrielaPURPOSE/BACKGROUND: Maternal depression can have deleterious effects on adolescents' psychosocial adjustment and management of type1 diabetes. These associations have been primarily studied among Caucasian middle-income families. Ethnic minority status and economic disadvantage may alter the experience of maternal depressive symptoms and their association with adolescent diabetes management. The purpose of this study was to determine if mothers' depressive symptoms are similarly associated with adolescent diabetes outcomes in Caucasian and Latino/a youth, and whether associations occur independent of socioeconomic factors. METHODS: Participants were Caucasian and Latina mothers and their adolescents with type I diabetes (N=118 dyads; 48% Latino; 54% female; 10 to 15 years old; illness duration > 1 year; 25% on insulin pump). Mothers completed surveys assessing depressive symptoms, household income and parental education. Adolescents reported treatment adherence and depressive symptoms. Metabolic control was determined from HbA1c from medical records. Socio-demographic information was collected through a combination of maternal report and census tract data. RESULTS: Although Latino participants had lower socioeconomic status (SES) than Caucasian participants, there were no ethnic group differences in terms of parental marital status, adolescent age, adolescent gender, illness duration, or insulin pump status. Latina mothers reported significantly more depressive symptoms than Caucasian mothers t (112) = 2.48, p = .015, and these differences were independent of lower SES among Latina mothers. Hierarchical regression analyses revealed maternal reports of depressive symptoms were associated with higher adolescent depression t(108) = 1.98, p = .05, but this association was moderated by both a two-way interaction with adolescent age, t(105) = 2.13, p = .036, and a three-way interaction with age and ethnicity, t(104) = -2.05, p = .043. Among older Latino adolescents, maternal depressive symptoms were positively associated with adolescent report of depression; this association was not found among older Caucasian participants or among younger participants. There were no significant associations between maternal depressive symptoms and adolescent adherence. All associations remained independent of SES indicators, which were generally unrelated to adolescent outcomes. CONCLUSION: Maternal depressive symptoms may undermine the psychosocial adjustment of adolescents with diabetes, but appears to have complex associations with diabetes management across ethnic groups. The finding that Latino youth did not experience heightened depression despite the risks of their mother's elevated depressive symptoms and lower SES is potentially quite important. If replicable, further research should explore potential protective factors that may be contributing to adolescent diabetes outcomes in Latino families.Item The Prevalence of Temporomandibular Disorder in African Americans(2011-12-09) Doyle, Nicole J.; Gatchel, Robert J.; Chiu, Chung-Yi; Haggard, RobbieThis pilot study collected a convenience sample of adult residents of the Dallas, Texas metropolitan area to estimate the prevalence of temporomandibular disorder (TMD) in African Americans. Additionally, the study also collected the same data on Caucasians for comparisons against the African American numbers on all measures. At the conception of this study, there existed no prior studies focusing primarily on prevalence of TMD in African Americans. The study administered a survey of acute jaw pain symptoms to a convenience sample of 274 participants 18 years and older, 129 African Americans, 116 Caucasians and 29 of other races. The survey assessed TMD symptoms using 19 questions derived from the Research Diagnostic Criteria for TMD. The overall prevalence of TMD for total sample of 274 was 22.3%, with a higher prevalence of TMD in women (25.3%) than in men (16%). The prevalence of TMD among African Americans was 22% with a higher prevalence among females (24.4%) than males (15.6%). Among Caucasians, the prevalence of TMD was 22.5%, with a higher prevalence among females (23.7%) than males (20%). Caucasians reported greater rates of tinnitus, low back pain (p<.05), clenching and grinding (p<.1), while African Americans reported greater rates of teeth problems (p<.1). For all-participants, African American and Caucasian samples, discriminant analysis showed the ability of the symptoms listed on the survey to classify correctly the participants as having TMD or as not having TMD approached 100%. Among the top predictors of TMD for African Americans were earache and sounds around ears, while among top predictors for Caucasians were a diagnosis of TMD and joint locking. Distinct symptom clusters found within the overall sample as well as a 2-symptom cluster within both African American and Caucasian samples, yielded highly significant differences. In treatment seeking for TMD symptoms, both African Americans and Caucasians with private insurance types sought treatment at the same rates (60%). TMD rates for this sample were notably higher than found in other national studies (about 4-8%). However, where definitions of and measurement instruments for TMD differ among prevalence studies, it appears that prevalence rates tend to differ.Item A Proposed Battery Used to Monitor Treatment Outcomes in Individuals with Multiple Sclerosis: A Case Study(2013-05-17) Riggs, Amanda Lynn; Gatchel, Robert J.; Chiu, Chung-Yi; Haggard, RobbieBACKGROUND: Multiple Sclerosis (MS) is a chronic disease of the central nervous system. As of now, there is no cure for MS, but different forms of treatment have been studied to ameliorate both physical and psychosocial symptoms. Numerous measures have been used within the MS population to monitor symptoms before, during, and after treatment. The aim of this present study was to ensure the usefulness of a battery of outcome measures that will assess MS-related symptoms before and after standard treatment. Another aim of the study was to assess treatment outcomes and determine the current success of each individualized treatment plan. SUBJECTS: All participants had a confirmed diagnosis of MS, were able to read and write in English, were 18 years of age and older, and able to walk, even briefly, with or without an assistive device. Participants were recruited through The University of Texas Southwestern Medical Center, Multiple Sclerosis Clinic. METHOD: Ten qualified MS patients were given a Six-minute walk test, two cognitive tests, and nine psychosocial measures as a baseline assessment. After six to eight weeks of Standard care, all participants were asked to return in order to complete all the measures again. It was hypothesized that the proposed battery of measures would prove to be useful in monitoring treatment outcomes in patients with MS. It was also hypothesized that individualized treatment would prove to be beneficial to each participant over the course of the study. RESULTS: This study did not provide any evidence that the individualized treatment was beneficial. Moreover, it did not provide any evidence that this particular battery was sensitive enough to truly monitor treatment outcomes. There was only one significant difference found between initial and follow-up assessment. The sum of ranks for the BORG was 0.00 (Z = -2.00, p = .046, r = -0.89) when comparing breathlessness scores. This indicates that individuals that returned for follow-up assessment experienced less breathlessness at follow-up assessment before and after the Six-minute Walk Test than before and after the Six-minute Walk test upon initial assessment. DISCUSSION: The period between assessments may not have been long enough to identify any changes in treatment or treatment outcomes. Due to the unpredictable nature of MS, it may be important for providers to assess individuals using a comprehensive, biopsychosocial battery on a case-by-case basis rather than a generalized pre-established time frame.Item Psychometric Properties and Clinical Utility of the Texas Functional Living Scale Short Form in Individuals with Schizophrenia(2013-09-10) Rogers, Kathryn Rayne; Casenave, Gerald W.; Hester, Andrea; Chiu, Chung-YiBACKGROUND: Schizophrenia is a chronic mental disorder presenting with psychotic and cognitive symptoms that lead to impairments in independent living and psychosocial functioning. Individuals with schizophrenia demonstrate cognitive deficits in areas of attention, executive functioning, memory, and language. Additionally, schizophrenia has been associated with impairments in activities of daily living (ADLs) such as toileting and the ability to feed one’s self and instrumental activities of daily living (IADLs) such as taking medication, financial management, communication, and transportation. METHODS: Twenty-six participants diagnosed with schizophrenia or schizoaffective disorders were recruited from the University of Texas Southwestern Medical Center’s Division of Translational Neuroscience of Schizophrenia’s IRB approved Database Registry for Psychotic Disorders and completed a neuropsychological test battery which included the Texas Functional Living Scale (TFLS) and University of California San Diego (UCSD) Performance-based Skills Assessment (UPSA). IBM SPSS Statistics (SPSS v. 19.0) was used to perform Pearson correlation coefficients and multiple regression analyses to identify which subscale(s) of the TFLS had the highest predictive ability for examining IADLs to create a possible short form and to identify which subscales of the TFLS long form have the strongest correlation to neurocognitive measures used in the study. The present pilot study used the Type I error rate at .10; a 90% confidence interval. RESULTS: Results of the analysis indicated that the Time and Money Calculation subscales of the TFLS long form significantly correlated with more neurocognitive measures than the UPSA. Specifically, these two subscales had a higher number of moderate to strong correlations with the neurocognitive measures compared to the UPSA. Results also indicated the TFLS short form to have a stronger correlation with the UPSA (r =.59, p < .003) compared to baseline correlations of the TFLS long form and the UPSA (r = .34, p < .112), which suggests that the Time and Money Calculations subscales of the TFLS can be used as a valid short form of the TFLS in the assessment of IADLS in schizophrenia. DISCUSSION: Overall, the short form of the TFLS appears to be a valuable addition to standard neuropsychological assessment batteries given its numerous correlations with neurocognitive measures. Results also suggest that the TFLS short form is a stronger measure for detecting IADL impairments compared to its original long form and the UPSA.Item Relationship Between Exercise and Cognitive Functioning in Breast Cancer Survivors Following Chemotherapy(2013-05-17) Antony, Merlyn; Kendall, Jeffrey; Cullum, C. Munro; Chiu, Chung-YiBACKGROUND: A growing body of research suggests that individuals who undergo chemotherapy for treatment of cancer experience adverse changes in cognitive functioning as a side effect of treatment. While there is not yet a known remedy for such effects, exercise has shown to improve cognitive functioning in individuals within other clinical populations. Therefore, the purpose of this current study is to examine whether any relationships exist between self-reported post-chemotherapy exercise and cognitive functioning. SUBJECTS: The sample consisted of sixty female breast cancer survivors between the ages of 38-71. All participants had been diagnosed with stage I, II, or III breast cancer and had completed chemotherapy between three months to two years prior to their study visit. METHOD: Participants completed a self-report measure of post-chemotherapy exercise behavior and were administered a battery of neurocognitive tests to measure cognitive functioning. Subjects were categorized into one of three exercise groups based on their total exercise score (LSI): sedentary (LSI < 14), moderately active (LSI = 14-23), or active (LSI > 24). Mean scores on cognitive tests between exercise groups were compared to determine whether significant differences existed between groups both before and after controlling for IQ. Additionally, a hierarchical multiple regression was performed to determine how much of the variance in cognitive test scores could be explained by the following predictors: age, education, IQ, anxiety, depression, and exercise. RESULTS: Only three test scores (CVLT, Digit Span Backward, and Digit Symbol Coding) showed significant differences between exercise groups. Before controlling for IQ, CVLT (F=7.40, p=.001) and Digit Span Backward (F=3.01, p=.057) displayed significant differences between groups. After controlling for IQ, CVLT (F=4.19, p=.012), Digit Span Backward (F=5.98, p=.004), and Coding (F=3.05, p=.055) displayed significant differences. Predictors explained a small portion of the variance in cognitive test scores. DISCUSSION: Only three out of seven cognitive test scores demonstrated differences between exercise groups. Even among those tests that showed differences, higher levels of exercise were not consistently associated with better performance. In some cases, a moderate level of exercise seemed to have an optimal effect with regard to cognitive performance, suggesting the possibility of a dosing effect of exercise. Overall these findings suggest that a possible relationship may exist, but additional research is warrantedItem Resilience Profile Among People with Spinal Cord Injury: A Cluster Analysis(2013-12-30) White, Brian Dale; Chiu, Chung-Yi; Driver, Simon; Casenave, Gerald W.BACKGROUND: Resilience is considered as an important coping attribute for people adjusting from trauma and loss such as spinal cord injury. Resilience has been found that it has moderate to high correlations with multiple psychosocial characters such as coping strategies, spiritual belief, and life satisfaction as well as mental health. However it is unclear if resilience could have developmental phases when people have adjusted to their trauma and distress over time, or if there are different types of resilience based on a person’s psychosocial characters. Therefore the present study aimed to explore if there are some phases of resilience among people with spinal cord injury (SCI). SUBJECTS: The 93 inpatients with SCI who were undergoing rehabilitation at Baylor Institute of Rehabilitation, Dallas, TX, 58 males (62.4%) and 35 females (37.6%), 77 Caucasians (82.8%) and other races (17.2%; i.e., African American, Hispanic), with mean age of the sample was 44.2 years (SD = 16.2), and the mean months since onset was 16.14 months (SD = 62.12). METHODS: Patients completed the Connor-Davidson Resilience Scale, Personal Health Questionnaire- 9, Satisfaction with Life Scale, Intrinsic Spirituality Scale at any time point since being hospitalized to discharge. Using SPSS 19.0, a hierarchical cluster analysis was performed to preliminarily explore optimal patterns of resilience based on the psychosocial evaluations. Further a two-step cluster was used as a post hoc test of cluster quality and predictor importance. ANOVA and chi-squared test were used to identify any differences of the above psychosocial components of resilience and related demographic characters between the identified patterns of resilience. RESULTS: A hierarchical cluster analysis found three clusters with appropriate differentiable dendrogram distance labeled Spontaneous Resilience (SR; n=28, 35.9%), Evolving Resilience (ER; n=28, 35.9%) and Rebounding Resilience (RR; n=22, 28.2%). Further using a two-step cluster analysis as a post hoc testing, the silhouette measure of cohesion and separation indicated that the cluster quality was fair (0.40). The predictor importance for the cluster formation showed spirituality had an importance of 1.00, the most important predictor, with depression and SWL each showing a predictor importance score of 0.46. The ANOVA found significant differences between groups on resilience, F(2,75) = 7.98, p < .001; depression, F(2, 75) = 23.86, p < .000; SWL, F(2,75) = 23.66, p < .000; and spirituality, F(2, 75) = 71.62, p < .000. Chi square test found no significant associations between the two resilience patterns of gender (X2(2, N = 78) = 1.997, p = 0.368), and marital status (X2( 8, N = 78) = 8.287, p = 0.406). Race results were significant (X2(4, N = 78) = 9.559, p = 0.049), but race was unable to be used due to the majority of participants being Caucasians. DISCUSSION: The current study suggested that there are three resilience patterns recognized in this sample of people with SCI. The hierarchical cluster analysis clustered participants into three clusters: Spontaneous Resilience (SR), Evolving Resilience (ER) and Rebounding Resilience (RR), three of which reflect the levels of resilience change over time and differences in depression, SWL and spirituality. Rehabilitation professionals could apply the present findings on understanding the status of patients’ resilience and design according adjustment psycho-educational therapy for growing patients’ optimal resilience.Item Self-Management of Physical Activity in African Americans and Hispanics with Multiple Sclerosis: Mixed Methods(2013-05-17) Griffith, Desiree Nicole; Chiu, Chung-Yi; Rose, Lindsey; Frierson, GeoritaBACKGROUND: People with multiple sclerosis (MS) are prone to inactivity due to mobility impairments, which too often leads to obesity and other secondary conditions (e.g. depression, diabetes). Minorities with MS have health disparities when compared to Caucasians with MS, but the current health behavior theories were developed and validated mainly among the Caucasian population. There is a paucity of research considering multicultural perspectives for minorities with MS. The present study used the Health Action Process Approach (HAPA) as a theoretically driven framework to study how people with MS, specifically African Americans (AF) and Hispanics, self-manage their physical activity (PA). SUBJECTS: Eighteen AF (4 males, 14 females) with MS were recruited, ages 27-61 years old (M = 44.72, SD = 8.89). Three Hispanics (3 females) with MS were recruited, ages 27-54 years old (M = 38.33, SD = 14.01). They were all diagnosed with MS on average about 8 years prior (M = 7.83, SD = 5.58) and the majority of the participants (n = 18, 86%) lived in the Dallas-Forth Worth area. METHODS: Recruiting flyers were posted in the Multiple Sclerosis Clinic at UT Southwestern Medical Center, neurology clinics, churches in the community, and the National Multiple Sclerosis Society website. This study used a mixed methods research design. Qualitative data, used to gather minorities’ perspectives of their self-promotion of PA, was collected via focus groups and phone interviews; this data was transcribed verbatim and coded. For quantitative data, each participant filled out several HAPA surveys to assess severity of symptoms, self-efficacy, coping and planning, and PA engagement. RESULTS: An independent samples t-test was conducted to examine whether there was a significant difference between AF and Caucasians in self-evaluation of HAPA constructs, using an archived data of 170 Caucasians with MS as a norm for following comparisons. All measured HAPA constructs for PA were not significantly different between AF and Caucasians with MS. Interestingly, AF with MS had stronger intention to eat healthily (when comparing 18 Caucasians and 18 AF, t = -3.29, df = 34, p = 0.002; when comparing a norm database of 170 Caucasians and 18 AF, t = -2.31, df = 186, p = 0.02). However, Caucasians with MS had higher recovery self-efficacy for nutrition than the counterpart (comparing 170 Caucasians and 18 AF, t = 2.63, df = 186, p = 0.009). Qualitative analyses of transcriptions from six focus groups produced significant themes of self-motivated regulation of health promotion for minorities with MS. Significantly, modified item content on some HAPA-based measures is required to make the model more conducive to AF. For example, the study found that PA has been redefined for minorities with MS, self-efficacy is based on successful daily functional PA, it is not necessary to make a PA schedule because the course of MS is unpredictable, and self-defined PA goals vary according to daily MS course. DISCUSSION: Although many HAPA constructs were shared amongst AF, Hispanics, and Caucasians, this study discovered many new themes that were related to how minorities with MS approach PA. AF with MS redefined exercise as being any body movement costing physical energy. For AF, the fear of losing life roles and daily functioning was motivation to persevere and do any PA given the opportunity. In contrast to many studies on AF, this study showed AF with MS do not need social support from family or friends to do PA because they view it as self-responsibility and they have learned to be independent. For Hispanics, it appeared as though collective family thoughts regarding exercise were more influential on the intention to engage in PA. AF and Hispanics with MS agreed healthy eating habits had equal importance to PA for people with relatively severe MS status. Being AF commonly led to late treatment of MS among the focus group participants.Item State Vocational Rehabilitation Services and Employment for Individuals with Cardiac and Other Types of Circulatory System Conditions(2015-12-03) Camacho, Juan Jose; Casenave, Gerald W.; Chiu, Chung-Yi; Rose, LindseyBACKGROUND: Obtaining and maintain employment can be a significant challenge for individuals with disabilities, including cardiac and other conditions of the circulatory system. Although federal vocational rehabilitation laws allow for each state to provide various services, it is not well understood which services make a difference in employment rates, or how receipt of cash and medical benefits affect the rate of employment as well. SUBJECTS: Data points regarding 4,475 state vocational rehabilitation consumers were extracted from an archival database controlled by US Department of Education containing demographic covariates, specific vocational rehabilitation services used, and final employment outcome. METHOD: A hierarchical logistic regression analysis was utilized using vocational rehabilitation services as predictors to predicting employment for consumers with a cardiac and/or circulatory system disability. RESULTS: A total of 2,616 out of 4,475 cardiac consumers (58.5%) were competitively employed after receiving vocational rehabilitation services. Logistic regression analysis results indicated that cash benefits (OR = 0.34; 95% CI: 0.3-0.4) were negatively associated with employment, whereas on-the-job supports (OR = 4.25; 95% CI: 3.51-5.16), diagnosis and treatment (OR = 1.69; 95% CI: 1.45-1.96), on-the-job training (OR = 1.91; 95% CI: 1.2-3.04), job placement assistance (OR = 1.7; 95% CI: 1.43-2.03), and maintenance (OR = 1.95; 95% CI: 1.58-2.39), and the other services category (OR = 1.3; 95% CI: 1.1-1.54) were significant predictors of positive employment outcomes. DISCUSSION: Vocational services offered by state vocational agencies have been found to positively benefit individuals with a cardiac or other circulatory condition disability by assisting with obtaining or maintaining employment.Item Two Efficacy Studies for Acute TMJ Related Headaches and Chronic Headaches(2011-10-03) Hinds, Christopher Worth; Gatchel, Robert J.; Haggard, Robbie; Chiu, Chung-YiThis project focused on two efficacy studies. The aim of the first study conducted by Dr. Robert Gatchel at University of Texas at Arlington was to evaluate the efficacy of the Biobehavioral, Self-care, and Non-Intervention treatment groups on the presence and distress of the headache symptom related to acute temporomandibular joint disorder. The study consists of a cohort of 283 patients with acute TMD. Participants are being referred to UT Southwestern Medical Center in Dallas, Texas through the community dental clinics in the Dallas/Ft. Worth area. Questionnaires were administered to patients before and after treatment. At the time of data collection 283 participants were enrolled in the study. 238 participants (84%) of 283 met eligibility requirements and were placed in one of the three treatment groups.91 participants endorsed having regular headaches that are either new or different from headaches you had prior to the onset of your illness. A Pearson Chi-Square (χ2) found a significant difference in the presence of headaches before treatment (χ2 = 11.082, p =.004). No significant difference was found in the presence of headaches after treatment (χ2 = .335, p =.846). Non-Parametric analysis found a significant difference of improvement (.021) in the Biobehavioral group post-treatment. A significant difference of improvement (.023) was also found in the Self-care group post-treatment. Non- Parametric analysis found a significant improvement of distress of headache in each treatment group. This study shows a significant prevalence of 38% headaches related to TMD. It also shows that Biobehavioral and Self-care treatments significantly reduce headache presence. The study also finds a psychological effect of “attending the project” in decreasing levels of distress relating to headaches. The second study aimed to measure the effectiveness of a dental technique pioneered by Dr. Neeley DDS. Patients were referred through his private dental clinic in Dallas, TX. Qualitative analysis was used through a case study of 6 patients of an original 12. The data from the second study indicated that this treatment is very efficacious. All 6 participants showed a reduction in headache symptoms and all reported satisfaction with their treatment over a year later.Item University of Texas Southwestern Medical Center Group Therapy Outcomes: Social Skills Training for Adults with Mental Illness(2012-12-06) Russo, Amanda; Chiu, Chung-Yi; Casenave, Gerald W.; Rose, LindseyBACKGROUND: Group therapy is an effective method of treating people with various mental illnesses. Social skills training is often used in a group therapy setting to improve the social functioning of people with mental illness, many of whom have social skills deficits. Currently, there is very little literature on how social skills training reduces symptomology, most of which is limited to children or adolescents and people with autism spectrum disorders. The current study looks to determine what, if any, effect social skills training has on alleviating depression and anxiety symptoms in a mixed mental illness sample. SUBJECTS: 23 subjects were recruited from the University Rehabilitative Services to take part in the study. There were 11 males and 12 females divided into two treatment groups named Connections (CG) and Personal and Social Adjustment Treatment (PSATG). METHOD: A one-way paired samples t-test was used to determine improvement between pre and post BDI-II and BAI scores. RESULTS: BDI-II scores were significantly lowered, indicating improvement in depression symptoms. BAI scores were not statistically significant. DISCUSSION: Social skills training does alleviate depression symptoms in an adult mixed mental illness sample. Future studies need to focus on improving anxiety symptoms as well.