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(PDD - informant) Bramston et al. (mild ID  self report)FZ"I["I,} <zStressEvents perceived by the individual as a threat to his or her well-being (Lazarus & Folkman, 1984) Long term worries (financial, ongoing illness) Daily hassles (traffic jams, rude people) Major life events (death of a loved one, move) Jb@S={Research questionsCan individuals with ID and their caregivers reliably report stress? How do well do self-report and caregiver perspectives correspond? Is subjective stress related to depression?>|Method70 caregiver/self-reports of stress and depression Lifestress Inventory (Bramston) Birleson Depression Scale (Birleson) Inventory of Negative Social Interactions (Lakey & Drew) Informant questionnaires returned within 8 weeks of interviewsZb3  -H?}0 Most common stressors Self report CaregiverPDeath/illness of loved one 82% Heard people you know arguing 76% People think you can t do things properly 73% People think you can t do things when you can 72% Z   Able to have or find a job 88% Difficult situation, didn t know what to do 85% Been in crowded places 84% Heard people arguing 81%Z @~Findings Stress ratings were internally reliable (.80 / .77) and corresponded to ratings on related measures (r=.62 and r=.58) Caregiver and self-reports had some correspondence (r=.41) Stress correlated with depression according to self-report & caregivers (r=.46 and r=.31)"ZZ A ImplicationsMinor hassles and major stressors both very common Caregivers not always be aware of magnitude of impact of stressful events >> may not help to resolve Greater attention needed to provide strategies to cope with stress to improve overall health +lInterpersonal Variables,Interpersonal Model of Depression derived from the Theory of Human Relatedness* Ecological theory developed in psychiatric nursing Basic human need to have relationships Disruption in relatedness associated with depression *(Hagerty, Lynch-Sauer, Patusky, & Bouwsema, 1993; Hagerty & Williams, 1999)P3x'5xN!/"Z"4"" N " P,mMethodsSecondary data analysis Data from "Exercise adherence among adults with Down syndrome" project * Rasch item analysis Canonical correlation *Heller & Rimmer, 1999dIn*n"" ",b0-nSample100 adults with Down syndrome Over 30 Mild to moderate ID Clients of community agencies 50% female, 35% African-American and 7% Hispanic 69 informants 13 parents 6 other relatives 27 residential staff 19 day program staff 4 other staff |ZnZZ^ZZ"n""^".o/p LonelinessImportant in Interpersonal Model of Depression Associated with depression in general population May reflect lives of individuals with ID Limited social support networks* *(Krauss, Seltzer, & Goodman, 1992). !(!""" " $ "  "  " 0q!Lack of friends- social isolation|More difficult item than general statement of loneliness Endorsement of lack of friends may be indicative of higher levels of loneliness and depression Individuals with higher depression scores (>6) T=2.25 more likely to endorse Hardest item to endorse on loneliness measure is  not feeling part of group of friends D+"x1rDepressed MoodCardinal symptom of major depression and dysthymic disorder Reflected in questions regarding sadness and denial of happiness Denial of happiness Second most difficult item May be better indicator of depressed mood than sadness for this population. `=VnkZ=A k ) 2s Self-hate (Clinical indicator major depression* Only individuals with high CDI-S scores (> 6) Previous research Negative self-concept associated with depression Global self-worth associated absence of depression** ( *Abbeyet al., 1990;** Benson & Ivins, 1992; Glick, Bybee & Zigler, 1997) giMZZZN   i" M" " P 3tSocial withdrawal(Clinical indicator major depression* Social withdrawal/ not liking being with groups of people most difficult item Linked to self hatred** (*Abbey et al., 1990; ** Kaufman, 1996).F+ +"4uCanonical correlation(Association Depression with social support, loneliness, life satisfaction First canonical variate pair explains 23.4% of variance in relationship between variables B n  ZD5v Conclusions Depression has personal and social effects Interpersonal constructs can be assessed in individuals with Down syndrome Depression, loneliness, social support, and life satisfaction by self-report are associated in the direction expected .""&gCognitive Variables(HAttributions Hopelessness Automatic Thoughts Self-Esteem Cognitive Triad7w!Hopelessness Theory of Depression""(8x`Cognitive theory of depression  Cognitive Triad11( OMethods(122 participants screened for various psychopathology Screened adults with MR for: Receptive verbal ability 4-choice response sets Resulted in n=73 Matched Depressed with Control (n=12) Gender, Age (within 2 years), Level of intellectual functioning T1&@HKT1&@WResults(QResults(`Results((i Implications Cognitive variables Can be measured* Correlated with depressed mood Differ between depressed and control Caution regarding hopelessness Need to evaluate cognitive theories and therapy *Among adults MR, adequate receptive vocabulary and using self-report instrumentsLu0Tu0T)h Conclusions%Stressors and environmental variables impact development of depression, and indicate need for coping skills Interpersonal variables are good indicators of clinical depression Cognitive variables continue to need evaluation with regard to development of depression. 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B    t  `b ?? T  6nsH t 0޽h ? 3f3fy___PPT10Y+D=' = @B +} a @$(  @r @ S nA%;   r @ S ptBP4  H @ 0޽h ? 3f3f___PPT10i.:@C-+D=' = @B +$  <$(  <r < S A%;   r < S B?4  H < 0޽h ? 3f3f80___PPT10.:Ќ! }u`H (  H H < %; #Acknowledgments> H 0  Preparation of this presentation was supported in part by: U.S. Department of Education, Office of Special Education and Rehabilitative Services, National Institute on Disability and Rehabilitation Research (#H133B980046) Royal Center on Health Maintenance (National Institute on Aging #AG15890-12) Ohio Department of Mental Health (#03.1184) Ohio State University Alumni Grant for Graduate Research and Scholarship  <gH H 0޽h ? f̙0 UM(  ^  S    G  c $ j @   u All groups showed means in the expected directions. Clinically depressed group shows greater depressed mood and automatic thoughts, and more negative attributional styles. Also show less self-esteem and more negative cognitive triad. While MANOVA was significant, individual group differences revealed that HSC was not significantly different between groups (4.7 vs 3.8) (tvmH  0޽h ? ̙330 |t (  ^  S    n  c $0M @T  <4___PPT9 vResults indicate that adults with MR in the study could report well on the instruments used. Only one instrument was developed for MR, and three others had been piloted by others in MR without reporting psychometrics. Retest reliability for 4 instruments was obtained, all were good to excellent. Alpha, a measure of internal consistency, high for 4 instruments. It was low for the CASQ. However, this is only slightly lower than the internal consistencies found by the developers and subsequent assessments with children. The internal consistency for the HSC was lower than the child original and lower than that reported in MR.,H  0޽h ? ̙3330 P((  ^  S      c $ @    H  0޽h ? ̙33O0 1) (   X   C    )   S ( @   The focus then becomes on whether or not we can measure constructs associated with the theories, in order to ultimately use or modify the theory in relation to therapy with adults with MR. The research that addressed cognitive variables comes from a larger study conducted on depressed mood and cognitions in adults with MR. Participants were screened by their residential provider for various forms of psychopathology. At interview, participants screened again for adequate receptive vocabulary (as defined by a receptive verbal equivalent to a 5 year old) and the ability to answer 4-choice response questions accurately. Of 122 individuals screened, 73 participated in interviews as part of the larger study. All instruments were read to participants and they were given response cards to assist in choice responses. 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".--tq,p-- 3f@"Verdana@ QwZw0- .!2 VAnna J Esbensen,    . . 2 V%Yona. .2 VLunsky. .2 ] & Sarah H    . .2 )Ailey .@"Verdana@ _QwZw0- .2  Philadelpha. . 2 ", PA . .2  June 3, 2004   .--"System 0-&TNPP &՜.+,0  $ , On-screen Show"University of California - IrvineoAcD   'ArialVerdana WingdingsTimes New Roman Courier New Bold StripesMicrosoft Graph Chart4Promoting Health through Understanding Depression Symptoms of DepressionOutline of PresentationOutline of PresentationEnvironmental Variables StressResearch questionsMethod1 Most common stressors Self report Caregiver Findings ImplicationsInterpersonal VariablesMethodsSamplePowerPoint Presentation Loneliness"Lack of friends- social isolationDepressed Mood Self-hateSocial withdrawalCanonical correlation Conclusions Cognitive Variables"Hopelessness Theory of Depression1Cognitive theory of depression Cognitive TriadMethodsResultsResultsResults Implications ConclusionsPowerPoint Presentation  Fonts UsedDesign TemplateEmbedded OLE Servers Slide Titles _Smariamaria  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)PicturesCurrent UserSummaryInformation(&PowerPoint Document(ASDocumentSummaryInformation8