The E¤ect of Rurality on Mental and Physical Health

Any time researchers choose to conduct a study on any aspect of rural health care, they are faced with a di¢ cult methodological choice regarding the oper- ational de?nition of rural to use in their study. While this seems to many who are not familiar with rural research to be a straightforward question (and often naive rural researchers expect to ?nd a single answer that is commonly agreed upon by experts in rural research), to date there is no single answer that is based on a consensus and supported by scienti?c evidence. Coburn, et al. (2007) states that ?there is no single, universally preferred de?nition of rural that serves all policy purposes.? One goal of this paper is to provide a method useful in informing the choice of rural de?nitions for a speci?c research study. This methods paper presents a systematic evaluation of the impact of the choice of rural de?nition on results. It was stimulated by the need to select a rural de?nition to use in related papers on the impact of community resources on mental and general health outcomes in other research by the authors. A na- tional dataset, the Community Tracking Survey, 2000-2001, includes individual level observations from household interviews. We merge it with county level data re?ecting community resources, and we use econometric methods to ana- lyze this multi-level data, accounting for individuals from the same family being included in the dataset. The e¤ect of using four di¤erent de?nitions of rural available for use in county level analysis is presented. A statistical analysis of the impact of the choice of a rural de?nition on outcomes and on the esti- mates and signi?cance of explanatory variables in the model is presented and is used to inform the selection of the de?nition to use in other research. Dif- ferences in results for mental health, physical health, and utilization of health care variables are evaluated. The choice of a rural definition is presented and justi?ed using the methodological analyses presented in this paper. Strengths and weaknesses of using county-level community characteristics as compared to data from larger geographic areas, such as Health Services Areas, or from smaller geographic areas, such as census tracts or zip codes, are discussed. Fi- nally, the need for a methods study to guide the use of multi-level geographic data to re?ect community characteristics within health care studies is proposed.rural, mental health, physical health, testing

Mental Health Treatment Seeking Patterns and Preferences of Appalachian Women with Depression

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia—a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants’ perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality—not merely access—limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women’s self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study’s findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation

Self-Perception of Language Abilities in Older Adults

Thesis (Ph.D.)--University of Rochester. School of Nursing. Dept. of Health Practice Research, 2016.Purpose: To examine awareness of language abilities in cognitively healthy older adults and those with cognitive decline. Methods: A conceptual model of Awareness of Language Abilities (ALA) was developed to contribute to the limited existing research and to provide a framework for the analyses for this study and for future research. A descriptive, longitudinal secondary data analysis using the Alzheimer’s Disease Neuroimaging Initiative dataset was conducted, incorporating a series of generalized estimating equations to model the relationship between language abilities and self-perception of language performance across cognitive subgroups. Results: Within-group results: All subgroups showed measureable declines in language abilities; however, none of the groups showed measurable decline in self-perception of language performance over time. Between-group results: There were significant between-group differences in language abilities and self-perception of language performance at baseline. Adults in the Alzheimer’s disease (AD) group declined the fastest. Interaction between objective language abilities and self-perception of language performance: Compared to healthy elders, those with mild cognitive impairment underestimated their language abilities; those with AD overestimated their language abilities. Individual characteristics related to self-perception of language abilities: Presence of depressive symptoms was negatively correlated with and was the only individual characteristic associated with self-perception of language performance. Results situated within ALA model: The ALA model partially explained awareness of language abilities, but is in need of revision and further research. Clinical and Research Implications: These findings have important implications for assisting older adults in optimizing safety, decision-making and quality of life. When language deficits are present and awareness is high, older adults may socially withdraw, thereby accelerating decline. They may benefit from interventions to promote meaningful linguistically-rich social interactions. When language deficits are significant and awareness is low, older adults may profit from interventions to support communication of important linguistic content. Further research, guided by the ALA model, is needed to further clinical and theoretical understanding of awareness of language abilities. Conclusions: Awareness of language abilities has the potential to moderate the effects of language deficits by providing an opportunity for compensation. If awareness is impaired as a function of cognitive decline, opportunities for compensation can be lost

Author's personal copy Feasibility, Acceptability, and Effects of Gentle Hatha Yoga for Women With Major Depression: Findings From a Randomized Controlled Mixed-Methods Study

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Major depressive disorder (MDD) is a common, debilitating chronic condition in the United States and worldwide. Particularly in women, depressive symptoms are often accompanied by high levels of stress and ruminations, or repetitive self-critical negative thinking. There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women, such as ruminations. To begin to address this need, we conducted a randomized, controlled, mixed-methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD. After controlling for baseline stress, there was a decrease in depression over time in both the yoga group and the attention-control group, with the yoga group having a unique trend in decreased ruminations. Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga. The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination. © 2013 Elsevier Inc. All rights reserved. One of the most common and debilitating health conditions in the United States and worldwide is major depression, considered in this paper to include major depressive disorder (MDD) and dysthymia Depression is a complex disorder that can be difficult to treat successfully. Many women with depression express frustration about the usual care, citing reasons such as inadequate symptom management, unacceptable side effects, and inadequate methods for coping Although depression is characterized by a depressed mood, many women experience a variety of psychological, cognitive, and physical symptoms beyond the depressed mood (APA, 2000). For example, up to half of all women with a diagnosis of depression may experience "anxious depression," typified by excessive rumination

The effects of rurality on mental and physical health

The effects of rurality on physical and mental health are examined in analyses of a national dataset, the Community Tracking Survey, 2000-2001, that includes individual level observations from household interviews. We merge it with county level data reflecting community resources and use econometric methods to analyze this multi-level data. The statistical analysis of the impact of the choice of definition on outcomes and on the estimates and significance of explanatory variables in the model is presented using modern econometric methods, and differences in results for mental health and physical health are evaluated. © 2010 Springer Science+Business Media, LLC