Elizabeth P. Flint

Social Support and Locus of Control as Predictors of Adherence to Antidepressant Medication in an Elderly Population

OBJECTIVE The authors examined whether social support and locus of control (LOC), either individually or jointly, would be associated with subsequent self-reported medication adherence and treatment barriers in a sample of depressed elderly patients. METHODS A group of 85 elderly patients with major depression was enrolled in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University and treated with a standardized algorithm. During the course of the study, participants completed measures of social support and internal locus of control (LOC). A little more than 1 year later, they completed general measures of medication adherence and treatment barriers. RESULTS Increasing subjective and instrumental social support and non-family interaction were associated with greater adherence among patients high in internal LOC but not among patients low in internal LOC. Less instrumental social support was associated with more treatment barriers among patients low in internal LOC but not among patients high in internal LOC. CONCLUSION The relationship between social support and antidepressant medication adherence is moderated by beliefs about control over ones illness.

Social support and depression as risk factors for loss of physical function in late life

Abstract Poor physical function status in elders is a robust predictor of not only medical service use and institutionalization but also mortality. We assessed whether depressive symptoms and low social support would predict deficits in three domains of physical function among 3,240 community-dwelling older adults in the Piedmont of North Carolina over one year. Between 7-23% of the sample declined in functional ability, depending on the domain tested. Depressive symptoms and receipt of instrumental support predicted declines in all domains of physical function. Giving instrumental support and subjective social support protected elders against declines, and subjective social support buffered the detrimental effect of depression on risk of physical decline. This study suggests that significant risk of functional impairment could be reduced among elderly persons if coincidental depressive symptoms could be alleviated and/or deficits in their social environment remedied.

Psychosocial and physical correlates of chronic depression

This study used a case-control design to address differences in psychosocial, physical and clinical profiles between subjects who presented with a chronic index episode of major depression and those who presented with a non-chronic index episode. Subjects were adult patients participating in the Duke University Mental Health Clinical Research Center (MHCRC) for the Study of Depression in Later Life. Cases (N = 88) who reported duration of depressive symptoms lasting > or = 24 months at enrollment were compared to controls (N = 354) who reported symptoms lasting 1-12 months. The groups were compared with respect to selected demographic and clinical variables, physical function deficits, medical comorbidity, social support constructs and number of recent stressful life events. Social support and physical health were more relevant to chronicity of major depressive illness than were severity of illness or family history. Older age (> 60 years) intensified the deleterious effect of recent negative life events and reduced the deleterious effect of functional impairment on chronic major depression. These findings require special emphasis where treatment for chronic major depression is divorced from considerations of the social environment and functional capacity.

Trends in Carbon Content of Vegetation in South and Southeast Asia Associated with Changes in Land Use

The land-use data set of Richards and Flint described in Chapter 2 was used to derive a set of estimates of the total carbon content of live vegetation in 13 South and Southeast Asia nations in 1880, 1920, 1950, and 1980. A bookkeeping model was developed to produce estimates of the magnitude of the live-phytomass carbon pool for 93 discrete geographic units for those same dates. These data were then aggregated at the national and supranational levels to allow estimation of net changes in carbon stock of vegetation with time for those regions by simple subtraction.

Allelic differences in the serotonin transporter-linked polymorphic region in geriatric depression.

Previous studies have examined the role of genetic variations in the serotonin transporter-linked polymorphic region (5HTTLPR) in affective disorders. The authors studied 182 older depressed subjects and 107 elderly control subjects and obtained DNA for genotyping at the 5HTTLPR. There were no significant differences in allele frequencies generally or for number of short alleles for the group as a whole, but interesting gender effects emerged. Among men, 23% of depressed men had two short alleles, compared with only 5% of control subjects. Among women, 67% of depressed women with more than one episode had at least one short allele, compared with 41% of single-episode female patients. Also, 74% of women with a positive family history of psychiatric illness in any female relative had at least one short allele, whereas 53% had at least one short allele who did not have such a family history. Our results add to the literature linking this gene to affective illness. The negative association of allele frequency and depression may be related to the relatively small sample size. The findings raise the possibility that this genetic locus may exert differential effects based on gender, increasing risk in men, and increasing risk of recurrence in women.

Effect of virtual reality on time perception in patients receiving chemotherapy

PurposeVirtual reality (VR) during chemotherapy has resulted in an elapsed time compression effect, validating the attention diversion capabilities of VR. Using the framework of the pacemaker–accumulator cognitive model of time perception, this study explored the influence of age, gender, state anxiety, fatigue, and cancer diagnosis in predicting the difference between actual time elapsed during receipt of intravenous chemotherapy while immersed in a VR environment versus patient’s retrospective estimates of time elapsed during this treatment.Materials and methodsThis secondary analysis from three studies yielded a pooled sample of N = 137 participants with breast, lung, or colon cancer. Each study employed a crossover design requiring two matched intravenous chemotherapy treatments, with participants randomly assigned to receive VR during one treatment. Regressions modeled the effect of demographic variables, diagnosis, and Piper Fatigue Scale and State Anxiety Inventory scores on the difference between actual and estimated time elapsed during chemotherapy with VR.ResultsIn a forward regression model, three predictors (diagnosis, gender, and anxiety) explained a significant portion of the variability for altered time perception (F=5.06, p = 0.0008). Diagnosis was the strongest predictor; individuals with breast and colon cancer perceived time passed more quickly.ConclusionsVR is a noninvasive intervention that can make chemotherapy treatments more tolerable. Women with breast cancer are more likely and lung cancer patients less likely to experience altered time perception during VR (a possible indicator of effectiveness for this distraction intervention). Understanding factors that predict responses to interventions can help clinicians tailor coping strategies to meet each patient’s needs.

A century of land-use change in South and Southeast Asia

Compilation of published reports on land use in South and Southeast Asia betwen 1880 and 1980 produced time-series land-use data in a uniform format for the countries of India, Bangladesh, Sri Lanka, Myanmar, Thailand, Cambodia, Laos, Vietnam, Malaysia, Singapore, Brunei, Indonesia, and the Philippines. To make use of this data, we developed a procedure to systematically document changes in land use and vegetative cover. The objective of this compilation and analysis is to produce data that can be used to test geographically referenced models of carbon dynamics and other greenhouse gas emissions so global climatic modeling can be improved.

Long-term transformations in the Sundarbans wetlands forests of Bengal.

The landscape of the Sundarbans today is a product of two countervailing forces: conversion of wetland forests to cropland vs. sequestration of the forests in reserves to be managed for long-term sustained yield of wood products. For two centures, land-hungry peasants strove to transform the native tidal forest vegetation into an agroecosystem dominated by paddy rice and fish culture. During the colonial period, their reclamation efforts were encouraged by landlords and speculators, who were themselves encouraged by increasingly favorable state policies (land grants, tax incentives, cadastral surveys, and eventually colonization projects and subsidized irrigation) designed by revenue officials to maximize the rate of transformation of wetland forest to taxable agricultural land.In the late nineteenth century, as the rate of agricultural conversion increased, the colonial Forest Department succcessfully sought to preserve large areas of the remaining Sundarbans tidal forest by giving them legal status as Reserved or Protected Forests. These forests were intensively managed to provide a sustainable supply of timber and firewood for the increasing population of southern Bengal. Institutionalization of conflicting policies by the Revenue and Forest Departments reflected the escalating needs for both food and forest products as the colony grew. Today, supplies of some economically valuable trees have been depleted, and some mammals are locally extinct (although the Bengal tiger remains), but government policy in both Bangladesh and India now favors use of the Sundarbans as forest rather than its transformation to agricultural land. Further expansion of cropland to meet the grain demands of the burgeoning Bengali population in both nations has largely taken place outside the boundaries of the Sundarbans. Overexploitation of these forests for wood products remains a possibility, but large-scale clearing for rice paddies is unlikely under present policies.

Application of a Partnership Model for Transformative and Sustainable International Development

There are differences of intent and impact between short-term and long-term engagement of U.S. academic institutions with communities of need in developing nations. Global health programs that produce long-term transformative change rather than transient relief are more likely to be sustainable and in ethical harmony with expressed needs of a region or community. This article explores characteristics of successful ethical partnerships in global health and the challenges that threaten them, introducing a consensus community engagement model as a framework for building relationships, evolving an understanding of needs, and collaboratively developing solutions and responses to priority health needs in underserved regions of the world. The community engagement model is applied to a case study of an initiative by a U.S. school of nursing to establish long-term relationships with the nursing community in the Caribbean region with the goal of promoting transformative change through collaborative development of programs and services addressing health care needs of the regions growing elderly population and the increasing prevalence of noncommunicable chronic diseases. Progress of this ongoing long-term relationship is analyzed in the context of the organizational, philosophical, ethical, and resource commitments embodied in this approach to initiation of transformative and sustainable improvements in public health.

Suicidal behaviors in depressed men with a family history of suicide: Effects of psychosocial factors and age

Effects of impaired social support and stressful life events on non-lethal suicidal behaviors were examined in a clinical sample of high-risk patients: depressed adult men with a family history of suicide or attempted suicide. All subjects (N = 79) were participants in the Mental Health Clinical Research Center (MHCRC) for the Study of Depression in Later Life (Duke University, USA). Outcome measures were self-reported one-year histories of three suicide-related ideation symptoms and attempted suicide. One-year prevalences for these outcomes were: death ideation, 58%; death wish, 48%; suicidal ideation, 57%; and attempted suicide, 11%. In adjusted models, none of the four measures of social support (network size, frequency of social interaction, receipt of instrumental support, and subjective social support) increased the odds of any outcome. Thus, in this high-risk group, impaired social support did not appear to increase the odds of one-year history of any form of suicide-related ideation or of attempte...