Lisa M. Hooper

Depression, patient characteristics, and attachment style: correlates and mediators of medication treatment adherence in a racially diverse primary care sample

BACKGROUND The depth and breadth of problems related to depressive symptomatology and optimal treatment outcomes, including medication treatment adherence, have long been documented in the literature. Missing are clear explanations as to what factors and patient characteristics may account for lack of medication treatment adherence. OBJECTIVES The two objectives of the current study were to examine the predictive strength of depression, patient characteristics, and patient attachment style regarding medication treatment adherence and to consider the extent to which attachment styles mediate the relation between depression and medication treatment adherence. METHOD Participants in the present study were 237 racially diverse American primary care patients with a diagnosis of hypertension who were participants in a clinical trial. Depression, patient characteristics, attachment style, and medication treatment adherence were assessed. RESULTS Partly consistent with our four hypotheses, the following results were found: (a) Black American, younger, never married, and poorer patients had lower medication treatment adherence (b) depression was significantly associated with lower self-reported medication adherence; (c) insecure-dismissing attachment style was related to lower medication adherence; and (d) insecure-dismissing attachment style mediates the relation between depression and medication treatment adherence by exacerbating the negative association. CONCLUSION Physicians and other primary care providers should consider how depressive symptomatology, patient characteristics, and attachment style may inform the treatment plans they put forward and the extent to which patients may adhere to those treatment plans.

Does Biology Matter in Parent–Child Relationships? Examining Parental Warmth Among Adolescents From Low-Income Families

Family structure has long been a consideration in research focused on adolescent outcomes. The current study uses data derived from the Mobile Youth Survey to examine how parental warmth differs over time for male and female adolescents reporting biological parents and other parental figures (e.g., grandparents, aunts, and siblings). Using estimation of random and fixed growth effects, significant differences were noted for parental type and for adolescent gender. Paternal warmth trajectories decreased across time for biological fathers, while maternal warmth remained stable for biological mothers. Conversely, maternal and paternal warmth trajectories increased from ages 11 to 18 for other parental figures. Implications for adolescent–parent relations are discussed, with an emphasis on family structure and the contributions of other parental figures on adolescent outcomes in Black American families.

Depressive Symptoms, Assessment, and Treatment in Latino/a Adolescents: A Brief Review

Latino/a individuals comprise the largest and fastest growing United States ethnic minority group of youth. Latino/a adolescents are a high priority, vulnerable population at risk for death and serious injury. More specifically, Latino/a adolescents are at high risk for being diagnosed with depression and thus experiencing depressive symptoms, including suicide ideations, attempts, and completions. The current article summarizes the scant research regarding the expression of depressive symptoms and depression care in Latino/a adolescents. In the current article we describe select literature focused on Latino/a adolescents and the following areas of mental health research: (a) prevalence rates of depression; (b) the intersection of gender and depressive symptoms; (c) the intersection of age and depressive symptoms; and (d) depression care (i.e., assessment and treatment) for Latino/a adolescents.

The Longitudinal Impact of Distal, Non-Familial Relationships on Parental Monitoring: Implications for Delinquent Behavior:

An extensive body of work shows that parental monitoring reduces the likelihood of risky behaviors among youth, yet little attention has been given to the factors compelling parents to engage in monitoring behaviors. The current study examines the association between non-familial, adolescent relationships (i.e., school connectedness, community connectedness, and peer relationships) and parental monitoring. The data used come from the Mobile Youth Survey (MYS), and from 2006 and 2011, resulting in a longitudinal sample of 3,287 adolescents. Longitudinal growth modeling reveals strong associations between non-familial relationships and parental monitoring, along with gendered effects across time. Implications for parental monitoring and delinquency in a low-income, Black American sample are discussed.

Associations Among Depressive Symptoms, Wellness, Patient Involvement, Provider Cultural Competency, and Treatment Nonadherence: A Pilot Study Among Community Patients Seen at a University Medical Center

Treatment nonadherence is a pernicious problem associated with increasing rates of chronic diseases, escalating healthcare costs, and rising mortality in some patients. Although researchers have suggested numerous factors related to treatment nonadherence, several understudied aspects warrant attention, such as primary-care settings, provider cultural competence, and patient involvement. Adding to the research base, the present pilot study examined 88 primarily Black American and White American community patients from a large university medical center in the southern part of the United States. The study explored two research questions: (a) To what extent are there associations among depressive symptoms, wellness, patient involvement, cultural competency, and treatment nonadherence in a racially diverse community patient population? And (b) to what extent do the study exploratory variables and background characteristics predict treatment nonadherence, both separately and jointly? Depressive symptoms, the patient’s perception of a provider’s cultural competence, and marital/partnered status were found to be statistically significantly associated with treatment nonadherence, but not entirely in the directions expected.

The interrelationships among pain interference, depressive symptoms, loneliness, and employment status: a moderated mediation study

Objective: To explore the mediating effect of loneliness on the relationship between pain interference and depressive symptoms and to determine whether this mechanism is contingent on employment status. Design: Cross-sectional study. Subjects: A total of 876 adult caregivers of adolescents living in extremely impoverished conditions. Analysis: Mediation and moderated mediation analyses using standard path-analytic approaches. Results: The mean age of the sample was 39.0 (SD = 12.8) years and 80.7% (n = 707) identified as female. Almost half (48.9%, n = 425) of the participants did not report any pain, while 32.5% (n = 285) reported non-disabling pain, and 19.0% (n = 166) reported disabling pain. The mean depressive symptoms score was 16.20 (SD = 10.6), and the mean loneliness score was 40.09 (SD = 10.5). Loneliness mediated the effect of both non-disabling and disabling pain on depressive symptoms. However, the indirect effect of pain interference on depressive symptoms through loneliness was more pronounced among participants reporting disabling pain (coefficient, 2.11; Boot 95% confidence interval (CI) (1.25–3.01)) than non-disabling pain (coefficient, 0.99; Boot 95% CI (0.25–1.76)). Moderated mediation results showed that the indirect effect of pain interference on depressive symptoms, via loneliness varied in magnitude as a function of employment status among participants reporting disabling pain but not those reporting non-disabling pain. Conclusion: Loneliness provides an important link in the relationship between depressive symptoms and pain interference. Furthermore, employment status is an important factor to consider, especially among individuals reporting disabling pain with comorbid depressive symptoms.

Age of Alcohol Initiation Matters Examining Gender Differences in the Recency and Frequency of Alcohol Use Across Adolescence Using a Sample of Impoverished Minority Adolescents

While previous research has shown alcohol use to increase developmentally throughout adolescence, the age of alcohol initiation has rarely been incorporated into developmental trajectories. Simultaneous estimation of the effects of early alcohol initiation was made in relation to the recency and frequency of alcohol use utilizing a sample of 1,209 low-income, minority adolescents initiating alcohol between 12 and 18. Significant effects of both age of alcohol initiation and gender were found. Initial alcohol use was higher the later the adolescent initiated alcohol use. Following initiation, trajectories of the recency and frequency of alcohol use for female adolescents increased more rapidly the earlier they initiate alcohol use, while trajectories for male adolescents increased independent of their year of initiation. Modeling age of initiation using piecewise growth models provided more informative results regarding early alcohol initiation effects as compared to traditional longitudinal model.

Say it Loud: The Obama Effect and Racial/Ethnic Identification of Adolescents

The current study examined how self-reported racial/ethnic identification of adolescents living in poverty may be related to significant societal events and seminal public figures. Data from a multiple cohort longitudinal study, conducted in Mobile, Alabama between 1998 and 2011, were used to examine the impact of Barack Obamas nomination and presidency on racial/ethnic identification. The results show that significantly more adolescents changed their self-reported racial/ethnic identification from White or Mixed-Race to Black or Mixed Race after the election than before. These results suggest that a distant public figure can serve as a role model with observable effects for adolescents.