Feasibility of Actigraphy for Evaluating Sleep and Daytime Physical Activity in Children with Autism Spectrum Disorder.

This research evaluated the feasibility of actigraphy to measure sleep and physical activity in children (ages 2-8 years) with autism spectrum disorder (ASD). We also explored associations between sleep and physical activity. Validated screening measures established eligibility. Questionnaires, diaries, and 5 days and 5 nights of actigraphy monitoring were used to collect data. Of the 32 children enrolled, 27 (84.4%) completed actigraphy monitoring. Based on the median steps per day, children with high physical activity had lower total sleep time and more disruptive behaviors than children with low physical activity. Findings support the feasibility of using actigraphy to measure sleep and physical activity in children with ASD. Larger studies are needed to evaluate interactions of physical activity on sleep in this population.

Preliminary Evidence for Effectiveness of Resourcefulness Training in Women Dementia Caregivers.

Nearly 10 million women in the U.S. are caregivers for an elder with dementia, which often produces overwhelming stress and adversely affects their health. Resourcefulness training (RT) may promote the caregiver's optimal health and continue in their caregiving role. This pilot trial of 138 women dementia caregivers examined the effectiveness of RT on perceived stress, depressive cognitions, and negative emotions over time. Caregivers were first randomized to RT or no RT and then further randomized into random versus choice conditions followed by assignment to the journal or recorder methods, thus creating eight groups. We examined differences on perceived stress, depressive cognitions, and negative emotions between groups: 1) RT versus no-RT, 2) choice versus random condition; and 3) journaling versus recording. Significant time by group interactions were found on stress (F=4.36, p<.05), depressive cognitions (F=10.93, p<.001), and negative emotions (F=20.48, p<.001) in the RT versus no RT group. No differences were found between the random versus choice conditions or the journaling versus recording methods for practicing the RT skills. The results provide evidence for the effectiveness of RT for decreasing stress, depressive cognitions, and negative emotions in women caregivers of elders with dementia. The findings also suggest the need for further examination of the effects of allowing caregivers to choose a method for practicing RT in larger samples if caregivers of elders with dementia.

Personal beliefs, learned resourcefulness, and adaptive functioning in depressed adults.

Learned resourcefulness and personal beliefs are significant predictors of adaptive functioning. The mediating effect of personal beliefs on the relationship between learned resourcefulness and adaptive functioning was validated in adults with depression. The findings from this study may provide the basis for developing a useful nursing intervention constituting resourcefulness skills with positive personal beliefs to help patients with depression improve their ability to function well in their daily activities. ABSTRACT: Research has shown that patients with depression have difficulty with performing daily tasks and meeting their own personal care needs. According to Beck's cognitive theory of depression, such deficits in adaptive functioning are affected by disturbances in specific personal beliefs that reflect the process of regulating cognitions. Rosenbaum's learned resourcefulness theory proposed that adaptive functioning is influenced by learned resourcefulness, while learned resourcefulness is associated with the process regulating cognitions. This study aims to test the mediating effect of personal beliefs on the relationship between resourcefulness and adaptive functioning. The study involved a cross-sectional design. Participants consisted of 187 adults with depression in southern Taiwan. The data were collected through four instruments: Cognitive Triad Inventory, Self-Control Schedule, modified Community Living Skills Scale, and a demographic questionnaire. Both resourcefulness and personal beliefs were significant predictors of adaptive functioning, and personal beliefs mediated the effect of learned resourcefulness on the adaptive functioning of the adults with depression. The results validate the role played by personal beliefs in effecting learned resourcefulness and adaptive functioning among adults with depression and provide direction for designing nursing interventions that consider personal beliefs when teaching resourcefulness skills to adults with depression.

Effects of teaching resourcefulness skills to elders.

The objective of this study was to examine the effects of learned resourcefulness training (LRT) on health of elders in retirement communities (RCs). In a clinical trial, 46 elders in four randomly selected RCs received resourcefulness training and were compared to 43 elders in four RCs who participated in a focused reflection reminiscence (FRR) group. The two groups were similar at baseline. Repeated measures analysis of variance revealed no changes on anxiety or depression over time; however, both were significantly correlated with functional status (r's = 0.29 and 0.35, p's < 0.01), self-assessed health (r's = -0.18 and -0.26, p's < 0.05), and resourcefulness (r's = -0.24 and -0.21, p's < 0.05). Although main effects for group were not significant, interaction effects of group and time on self-assessed health and functional status were found. These findings suggest that although teaching resourcefulness to groups of elders in RCs may have beneficial effects on improving their perception of health and functioning over time, significant effects on mental health may not be apparent.

Social cognitive factors predicting the health of elders.

The social cognitive model of health is primarily concerned with influences on a person's decisions to perform health behaviors. In this study, the relationships among social cognitive factors reflecting enabling skills (learned resourcefulness), internal motivation for health (health self-determinism), and help responses (coping responses) and a measure of physical and psychosocial health were examined in 137 chronically ill elders. Gender, race, and number of chronic conditions were predictors of learned resourcefulness. Learned resourcefulness was associated with the use of informal help, whereas health self-determinism was related to self-help and formal help. None of the help responses were significant predictors of health. Model testing revealed that greater resourcefulness or skill in coping with stressful situations was the most important predictor of health. Strategies are recommended to help elders achieve optimal health.

Psychometric testing of the depressive cognition scale in women with type 2 diabetes.

Depression is prevalent in young and middle-aged diabetic women. Although cognitive depressive symptoms precede the development of depression, there is no screening instrument to measure these symptoms in diabetic patients. This study tested the psychometric properties of the Depressive Cognition Scale (DCS) in a convenience sample of 83 women with Type 2 diabetes. Alpha coefficient for the 8-item scale was .85, and the average inter-item correlation coefficient was .42. Construct validity was supported by correlations in the expected directions between the DCS and measures of learned resourcefulness, depressive symptoms, and health practices. Factor analysis presented a single dimension of 8 items. These findings suggest that the DSC will be useful in identifying patients with chronic conditions such as diabetes who are at risk for the development of clinical depression.

Resourcefulness and health practices of diabetic women.

More than one fourth of the millions of Americans with Type 2 diabetes experience depression, of which two thirds are women. Unless the individual is resourceful, coexisting diabetes and depression adversely affect one' health practices. The effects of diabetic and depressive symptoms on health practices and the mediating and moderating role of learned resourcefulness in this relationship were examined in 90 women with Type 2 diabetes. Regression analyses showed direct negative effects of diabetic and depressive symptoms on health practices. The effects of depressive, but not diabetic, symptoms were partially mediated by resourcefulness; no moderating effects were found. The results suggest the need to test interventions to minimize symptoms associated with diabetes, particularly depression. Teaching resourcefulness to Type 2 diabetic women may promote their positive health practices by minimizing their depression.

Sensation and Distress of Pain Scales: reliability, validity, and sensitivity.

Psychometric properties of the Sensation and Distress of Pain Visual Analogue Scales (VAS) are compared to dual numerical rating scales (NRS) with data from a randomized controlled trial of postoperative patients. On postoperative days 1 and 2, 15-minute test-retest reliability was .73 to .82 for the VAS and slightly lower for the NRS, r = .72 to .78, while convergent validity of the scales ranged from r = .90 to .92; construct validity of sensation and distress ranged from r = .72 to .85; and discriminant validity was lower, r = .65 to .78. Both instruments were significantly associated with pain reduction following treatment, p < .05 to .01. The VAS scores were significantly lower, p < .01 to .001, and more evenly distributed than NRS scores. It is recommended that the VAS be used in research to produce continuous scores that are more suited to parametric analysis.

Translation and validation of Caregiving Satisfaction Scale into Korean.

The purpose of this study was to establish the equivalence and to examine the psychometric properties of a Korean translation of the Caregiving Satisfaction Scale (CSS). A convenience sample of 44 bilingual Koreans was selected. The Cronbach's alpha for the English and Korean versions were .87 and .90, respectively. There was significant mean difference between items 3 and 12 of the English items and their Korean translations. Pearson's Correlations demonstrated that 13 of the 15 CSS items had significant correlations (r = .35-.75, p < .05) between two versions. The correlation between total scores of both versions was .86 (p < .001). Overall, none of the items would be regarded as having unacceptable numeric properties. According to the fine process for translation, back-translation, and bilingual field test, the Korean version of the CSS appears to have concrete construct validity and reliability for use in measuring caregiver satisfaction in the Korean population.

Spirituality, resourcefulness, and arthritis impact on health perception of elders with rheumatoid arthritis.

Arthritis is the leading chronic condition for older adults and the leading cause of disability in the United States. Providing holistic care to promote positive health perception and support healthy lifestyle decisions with these individuals is critical in attaining and maintaining quality of life. This study examined variables reflecting reactions to stress, lines of defense and resistance, and the basic core of humans in the context of the Neuman Systems Model in a convenience sample of 47 adults with a mean age of 70.4 years. The combined effects of the social, emotional, and physical impact of arthritis and additive or mediating effects of learned resourcefulness and spirituality on general health perception in older adults were investigated. Social, emotional, and physical impact together predicted health perception. The social impact of arthritis was a significant independent predictor for spirituality. Furthermore, spirituality and health perception were significantly correlated.

Patterns of depressive symptoms in three groups of depressed adults.

This study examined patterns of depressive symptoms experienced by acutely depressed inpatients, previously hospitalized depressed outpatients, and depressed outpatients who had never been hospitalized for depression. The groups' symptom profiles were compared to determine whether the 21 major depressive symptoms measured by the Beck Depression Inventory were similar or different for the three groups. The groups differed significantly on five depressive symptoms that are classified as affective/cognitive symptoms (sadness, guilt, self-blame, indecisiveness, suicidal ideas) and one that is considered a somatic/vegetative symptom of depression (anorexia). Thus, commonly used diagnostic criteria may not reflect the full range or temporal patterning of symptoms experienced by depressed persons at varying levels of acuity or severity and in different treatment settings.

Mood and blood pressure responses in black female caregivers and noncaregivers.

BACKGROUND: Substantial interaction between mood and blood pressure, especially in the context of caregiving for a dependent elder, could increase the risk in the already at-risk population of black women for either higher blood pressure or the onset of hypertension. OBJECTIVES: To examine the relationship between mood symptoms and daytime ambulatory blood pressures during a 12-hour period in Black female caregivers and noncaregivers. METHOD: A prospective cohort design was employed to study black females 18 years of age or older identified by randomly selected elders as the provider or potential provider of 5 or more hours of care per week to the elder. Mood symptoms were measured on visual analogue scales by the subjects in a diary attached to a retractable clip key ring worn by the subject. Blood pressure responses were measured with automated portable blood pressure monitors every 30 minutes. Additional risk and treatment factors were considered for descriptive purposes. RESULTS: The two groups were equivalent on all hypertension risk and treatment factors except alcohol use (more noncaregivers consumed alcohol). Among caregivers, anger and mean diastolic blood pressure (DBP) were negatively related (parameter = -0.64, SE = .23, p = .01) and the negative relationship between anger and systolic blood pressure approached significance (parameter = -0.81, SE = 0.65, p = 0.10). Anxiety and sadness were not significant predictors. CONCLUSION: Among black caregivers, elevated anger was associated with significant decreases in DBP, while lowered anger was associated with significant increases in DBP. Whether lower anger scores reflect a low level of perceived anger or suppressed anger among black caregivers should be explored in future studies.

Life events and psychological well-being in women sentenced to prison.

There have been no systematic analyses of the factors that influence the development of psychological well-being in women sentenced to prison. This study identified relationships among life events, coping resources, and psychological well-being (indicated by the absence of anxiety and depression). A descriptive correlational design was used in a convenience sample of 62 incarcerated female offenders. The respondents were in their early 30s, single, unemployed, and receiving financial support from a variety of sources. They reported an average of 10 life events in the 12 months preceding incarceration and accumulated an average of 354 life change units. A positive correlation between the number of life events and depression was identified (r = .24, p < .05). The women in this study had high levels of depression as measured by the Center for Epidemiologic Studies Depression Scale (L. Radloff, 1977; M = 31) and anxiety as measured by the State-Trait Anxiety Inventory (C. D. Spielberger, 1983; M = 46). Nursing interventions to reduce psychological distress at the time of admission to a correctional facility may reduce feelings of loss, inadequacy, and powerlessness that the women might otherwise have to endure.

Developmental task achievement and learned resourcefulness in healthy older adults.

Although resourcefulness has been found to promote healthy functioning and is believed to be learned throughout life, studies have not examined relationships between developmental variables and resourcefulness. This study examined Erikson's eight developmental tasks as predictors of learned resourcefulness in 60 healthy elders. Hierarchical regression based on Erikson's theory revealed that 37% of the variance in learned resourcefulness was explained by trust, autonomy, initiative, industry, and identity whereas intimacy, generativity, and integrity were not significant. The results suggest that mastery of developmental tasks through adolescence play a key role in determining how resourceful healthy elders are in their daily activities.

The Children's Cognitive Triad Inventory: reliability, validity, and congruence with Beck's cognitive triad theory of depression.

Depression, once thought rare in children, is now more widely recognized and believed to arise from negative views of self, world, and future, according to Beck's cognitive theory of depression. The Cognitive Triad Inventory for children measures the three negative views, and although reported as psychometrically adequate, this study extended previous analyses with confirmatory factor analysis in a sample of 122 school-aged children. Internal consistency was .82 (total scale) but ranged from .54 to .76 for subscales reflecting the views of self, world, and future. Confirmatory factor analysis revealed factors reflecting three aspects of the self rather than the three negative views. The findings suggest that Beck's theory about the negative cognitive triad may be less suitable for children than adults.

Depressive cognitions and psychosocial functioning: a test of Beck's cognitive theory.

Depression, the most common mental disorder, is frequently treated with cognitive therapy based on Beck's theory, which suggests that depressive cognitions (negative views of self, world, and future) affect psychosocial functioning. This study tested Beck's theory in depressed inpatients, previously hospitalized and nonhospitalized outpatients, and undiagnosed adults. Multiple regression indicated that negative views of self, world, and future explained a substantial part of psychosocial functioning in all 4 groups. In the 3 depressed groups, views of self and world had a greater impact on psychosocial functioning than did the view of the future, suggesting that interventions to build self-esteem and enhance self-control may be most effective in improving psychosocial functioning of depressed adults.

Evaluation of a measure of learned resourcefulness for elders.

Learned resourcefulness is important in promoting independence and healthy, productive lifestyles among older adults, and therefore it is essential to have a measure of learned resourcefulness that is reliable and valid for this population. However, for elders published psychometric tests of Roseblaum's Self-Control Schedule (SCS), which is the measure of learned resourcefulness, are limited to internal consistency estimates. This study examined the ease of administration and psychometric properties of the SCS in three samples of healthy elders (age 65+). The findings yield promising evidence that the instrument is fairly easy for elders to understand when administered during face-to-face interviews. Evidence of reliability and validity is considerable, and the SCS shows acceptable internal consistency and construct validity. These findings support the potential usefulness of the measure of learned resourcefulness for adults.

Cardiovascular responses of African American female caregivers.

A sample of 18 African American female caregivers and 24 noncaregivers were recruited for the purpose of exploring the relationships among caregiver status, demands, resources, sociodemographics, and cardiovascular responses. The principle finding of the study were that there were no significant relationships between caregiver status, daily hassles, total chronic conditions, total antihypertensives, learned resourcefulness, age, income, education, pulse, systolic, and diastolic blood pressures. Longitudinal studies of African American female caregivers' and noncaregivers' cardiovascular responses are needed to determine whether caregiving is related to increased cardiovascular responses. Nursing interventions that support caregivers in managing care recipient deficits in instrumental activities of daily living and cognitive impairment are needed.

Teaching resourcefulness skills to older adults.

With rapidly increasing numbers of elders in the United States, there is a growing need for interventions to promote independence and productive, healthy lifestyles among the elderly. Highly resourceful persons have been found to function better in their daily activities than those who lack resourcefulness skills. These skills, including self-controlling techniques and problem-solving, are believed to be learned and therefore can be taught. This pilot study examined the effects of teaching resourcefulness skills to healthy elders on measures of learned resourcefulness, anxiety, depression, adaptive functioning, and life satisfaction using a quasi-experimental pre-test-post-test design. The intervention group consisted of 20 elders and the placebo group had 17 elders. Those elders who received the 6-week small group intervention that taught the skills constituting resourcefulness scored significantly higher on post-test measures of learned resourcefulness, adaptive functioning, and life satisfaction. Although significant negative correlations were found between resourcefulness scores and scores on measures of anxiety and depression, there were no significant differences in anxiety and depression between the intervention and placebo groups on the post-test measures. The findings suggest that learned resourcefulness training (LRT) is an important nursing intervention for promoting healthy, independent, and productive lifestyles among older adults.

The Depressive Cognition Scale: further psychometric evaluation.

Depressive cognitions often precede the development of affective and behavioral symptoms of depression. Cognitive factors have been shown to influence the development of depression in older adults and thus identification of depressive cognitions is important for prevention of clinical depression and early intervention. The Depressive Cognition Scale (DCS) assesses cognitions that may precipitate clinical depression, and it has been found to be internally consistent and to demonstrate construct validity with measures of psychosocial development. This psychometric investigation was designed to further examine the construct validity of the DCS through comparison with measures of hypothetically related constructs. An alpha of .78 indicated acceptable internal consistency. Construct validity was demonstrated by significant correlations with measures of depression, resourcefulness, adaptive functioning, and life satisfaction. The study, conducted with 160 healthy elders, provides additional support for the reliability and validity of the DCS and yields promising evidence of its usefulness with elderly persons.