Measuring depression and anxiety in autistic college students: A psychometric evaluation of the PHQ-9 and GAD-7.

LAY ABSTRACT: Anxiety, depression, and suicidality are major concerns among college students, though less is known about these constructs in autistic college students. Given the rising number of autistic individuals entering college, adequate screening and diagnosis of mental health difficulties is necessary to provide care to this population. For example, despite widespread usage of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), it is unknown if the two instruments accurately measure depression and anxiety the same way between non-autistic and autistic individuals. Thus, the current study was the first to examine how these instruments measure depression and anxiety symptoms in autistic versus non-autistic college students. Utilizing tests of construct measurement in a sample of autistic (n = 477) and non-autistic (n = 429) university students aged 18-29, results showed that while the GAD-7 and PHQ-9 appear to be accurately capturing anxiety and depression in autistic college students, the PHQ-9 item assessing suicidality was found to be measuring different things. This indicates that autistic college students are not interpreting this question the way non-autistic students are, and thus, the measure is failing to capture suicidality in autistic people. Future investigators should continue to assess the appropriateness of using common screening measures, originally created by non-autistic people, in autistic populations.

Finding Benefit and Feeling Strain in Parenting a Child with Autism Spectrum Disorder.

Female caregivers of children with autism spectrum disorder (ASD) often report higher levels of psychological distress related to increased levels of caregiver strain, as well as frequency and severity of child problem behaviors (CPB). However, despite reported distress, caregivers have also reported benefits. A sample of n = 259 female caregivers of children with ASD completed online surveys assessing CPB, caregiver strain, psychological distress, and benefit finding. Results suggest that objective caregiver strain is a significant mediator between CPB and caregiver distress. Benefit finding, however, was not found to be a significant moderator. These findings inform theoretical applications and provide implications for future research in the development of interventions to enhance functioning in female caregivers.

Bouncing Back: Resilience as a Protective Factor for the Impact of Child Problem Behavior on Caregiver Depressive Cognitions Among Youth with Autism Spectrum Disorder.

Caregivers of children with autism spectrum disorder (ASD) often report higher rates of depression and the related negative thought patterns that may precede a clinical diagnosis. These negative thought patterns are referred to as depressive cognitions. Depressive cognitions are exacerbated by child problem behaviors (CPB) but may be impacted by parental resilience. The current study examines relations between CPB and depressive cognitions and the role of resilience as a moderator among caregivers of children with ASD (n = 287) and a sample of caregivers of children who are typically developing (n = 207). Significant positive associations were found between CPB and depressive cognitions for caregivers of children with ASD and who are typically developing. A moderation analysis revealed that, among the ASD sample, the model accounted for 33% of the variance in caregiver depressive cognitions (R2 = 0.33, SE = 35.52, p < 0.001). The interaction of child problem behaviors and caregiver resilience on caregiver depressive cognitions was statistically significant (B = - 0.016, SE = 0.007, p = 0.037), thus resilience was a significant moderator, for caregivers of children with ASD. Resilience serves as a protective factor in the relationship between child problem behavior and caregiver depressive cognitions for caregivers of children with ASD only. This finding highlights the importance of assessing and supporting resilience among caregivers of children with ASD. Interventions addressing child behavior would benefit from additional components to bolster caregiver resilience to enhance caregiver mental health and protect against depressive cognitions.

Resourcefulness revisited: Further psychometric evaluation of resourcefulness scale.

Resourcefulness, a collection of problem-solving, coping, self-control and emotion regulation skills, has been shown to moderate health outcomes in various caregiver populations. Caregivers of children with neurodevelopmental disorders, such as autism spectrum disorder (ASD), report higher levels of stress, anxiety and depressive symptoms with poorer health-related quality of life. The current study replicated and extended psychometric research on the Resourcefulness Scale (RS) among caregivers of children with ASD (n = 287) and a comparison group of caregivers of non-affected children (n = 207). Results suggest acceptable internal consistency and construct validity when using the RS among caregivers of children with and without ASD. The RS demonstrated poor temporal stability over an average of 4 weeks (r = 0.087, p = 0.434). Caregivers of children with ASD report higher levels of general, social, and personal resourcefulness than non-affected caregivers. Findings validate the use of the RS within caregiving populations with implications for clinical use and future research in the development of interventions to enhance caregiver QoL.

Comparative Effectiveness of Parent-Child Interaction Therapy for Children with and Without Autism Spectrum Disorder.

Youth with autism spectrum disorder (ASD) often display disruptive behavior and noncompliance. Disruptive behavior in youth with ASD may limit their participation in educational and therapeutic activities and impact family functioning. Several evidence-based interventions are available for typically developing children, such as Parent-Child Interaction Therapy (PCIT). The current study examined the comparative effectiveness of PCIT for youth with ASD and without ASD. Results indicate that PCIT significantly improves parent-reported disruptive behavior in children with ASD at levels comparable to children without ASD. Additionally, improvements in ASD-related symptoms were noted for youth with ASD. These findings support the use of PCIT for children with ASD and provide clinicians with an evidence-based tool to address disruptive behavior in a wide spectrum of presenting children.

Modification of slot-machine preferences through the use of a conditional discrimination paradigm.

The present experiment investigated the impact of contextually trained discriminations on gambling behavior. Nine recreational slot-machine players were initially exposed to concurrently available computerized slot machines that were each programmed on random-ratio schedules of reinforcement and differed only in color. All participants distributed responding equally across the two slot machines. A conditional discrimination procedure was then used to teach the contextual cues representing the arbitrary relations of "greater than" and "less than." Following contextual cue training, participants were reexposed to the concurrent slot-machine task. After training of the contextual cues, a higher proportion of responses were made to the slot machine that shared formal properties (i.e., color) with the contextual cue representing "greater than."

Cardiovascular Health of Filipinos in the United States: A Review of the Literature.

PURPOSE: Filipino Americans (FAs) are at high risk for cardiovascular disease. The purpose of this literature review is to enhance understanding of cardiovascular health among FAs. DESIGN: Databases searched: MEDLINE (via PubMed), Google Scholar, Journals@OVID, and EBSCO databases including CINAHL Complete. Health Source: Nursing/Academic Edition, Academic Search Complete, and Biological Abstracts 1969-Present. Key terms used: FAs and cardiovascular disease. Criteria for inclusion: peer-reviewed empirical articles published in English. FINDINGS/RESULTS: A total of 51 studies were identified and 27 were selected for the review based on relevance to nursing care for FAs. Three main themes emerged from the literature reviewed: risk factors and disease prevalence, health promotion, and health beliefs/practices. DISCUSSION/CONCLUSIONS: The literature review identified that FAs were at high risk for cardiovascular disease, hypertension, type 2 diabetes, and metabolic syndrome at lower BMI levels. IMPLICATIONS FOR PRACTICE: Health care providers should implement prevention strategies and interventions for the FA population to ensure the best outcomes.

Stress and worry: examining intolerance of uncertainty's moderating effect.

Intolerance of uncertainty (IU), or the way an individual perceives, interprets, and reacts to uncertainty in life, has been frequently investigated in relation to anxiety and worry. While a substantial body of research suggests that individual differences in IU foster stress and anxiety, IU's involvement as a potential moderator in the relation between stressful events and worry has only recently been investigated. Therefore, the present study examined the moderating effect of IU on the relation between daily hassles and worry as well as major life events and worry in a sample of 1092 young adults. Results revealed that IU showed a significant moderation effect in the relation between daily stress and worry. More specifically, when the two factors were examined individually only inhibitory IU served as a moderator between daily stress and worry. While major life events significantly predicted worry, no moderation effect was found for this relation. These findings highlight the need to better understand the mechanisms through which IU impacts worry and contributes to anxiety.

Linking cognitive avoidance and GAD symptoms: The mediating role of fear of emotion.

Although cognitive avoidance has been linked to generalized anxiety disorder (GAD), the mechanism that may account for this association has not been fully elucidated. The current study uses structural equation models to evaluate the relationship between cognitive avoidance and symptoms of GAD in a large unselected sample (n = 1220), and to examine whether subjective fear of emotion partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relations among fear of emotion, cognitive avoidance, and GAD symptoms is invariant for men and women. However, subsequent analysis revealed equivalence of meditational models where cognitive avoidance leads to GAD symptoms and vice versa. The implications of these findings for better understanding the etiology, maintenance, and treatment of GAD are discussed.

A taxometric investigation of the latent structure of worry: dimensionality and associations with depression, anxiety, and stress.

Worry has been described as a core feature of several disorders, particularly generalized anxiety disorder (GAD). The present study examined the latent structure of worry by applying 3 taxometric procedures (MAXEIG, MAMBAC, and L-Mode) to data collected from 2 large samples. Worry in the first sample (Study 1) of community participants (n=1,355) was operationalized by worry engagement, absence of worry, and the worry feature of trait anxiety. Worry in the second sample (Study 2) of undergraduate participants (n=1,171) was operationalized by the tendency to experience worry, intolerance of uncertainty, beliefs about worry, and symptoms of GAD. Results across both samples provided converging evidence that worry is best conceptualized as a dimensional construct, present to a greater or lesser extent in all individuals. Findings from Study 2 also indicated that the latent dimension of worry generally has an equal association with symptoms of depression, anxiety, and stress across the entire continuum. These findings are discussed in relation to the conceptualization and assessment of worry in GAD and related disorders.