1. Learned Resourcefulness, Cognitive Processes, and Adaptive Functioning in Depressed Adults 憂鬱症成人之內在習得資源、認知過程及適應功能 賴倩瑜 Chien-Yu Lai PhD, RN 高雄醫學大學護理學系助理教授 Funded by Alpha Mu Chapter, Sigma Theta Tau International

2. Background and Significance  Approximately 19 million American adults suffer from depressive illness in a given 1-year period.  The onset of depression in the general population often begins between the ages of 27 and 35 years.  Depression has been the leading cause of years lived with a disability among all ages in the U.S. and worldwide in the year of 2000.  The research budget for funding for studies of Major Depression has increased 89% from 1999 to 2003.

3.  Depressed people frequently experience the limitations in daily activities and increased psychosocial dysfunction in social and occupational functioning.  The significance of this secondary analysis lies in the determination of the utility of a combined theoretical model of cognitive theory, social interest theory, and learned resourcefulness theory for depressed persons.

4. To explore the relationship between cognitive processes (including personal beliefs and social interest) and adaptive functioning in depressed adults. To examine mediating and moderating effects of learned resourcefulness on the relationship between cognitive processes and adaptive functioning in depressed adults. To compare the three groups of depressed adults (inpatients, outpatients with and without prior psychiatric hospitalization) on the variables related to personal beliefs, social interest, learned resourcefulness, and adaptive functioning. Purposes

5. Cognitive triad-- depressed persons view themselves, their world, and their future in a negative fashion. The negative views of self, world, and future are responsible for the onset, development, and maintenance of depression. Cognitive processes that focus on positive personal beliefs are critical for depressed people. Theoretical Framework Cognitive Theory of Depression (Beck, 1979)

6.  Social interest is a cognitive process which is the criterion of mental health.  The value of social interest is based on the human capacity to transcend the limits of self and to identify with the needs and concerns of others.  Social interest may influence a person's attention, perception, thoughts about others, and motivation of overt behaviors such as cooperation and contributing to others.  Higher social interest may facilitate to cope with stress, to prevent depression, and to attain mental health. Social Interest Theory (Adler, 1964)

7.  Learned resourcefulness--- a set of coping skills that are used to control the undesirable effects of certain thoughts and disturbing internal processes that may interfere with the performance of daily activities.  Learned resourcefulness functions as a mediating and/or moderating factor on the relationship between cognitive processes and daily functioning.  Situational factors have contextual influences on an individual’s cognitive processes, self- control behaviors, and further influence the target behavior of optimal health. Theory of Learned Resourcefulness (Rosenbaum, 1990)

8. Cognitive processes : Personal beliefs--- an individual’s view of self, the world, and the future. Social interest--- a process of positive cognition and innate social responsiveness to others in order to cope with life tasks. Adaptive functioning : the ability to perform daily activities in a psychologically stable and socially appropriate manner that reflects mental health. Learned resourcefulness : a mediator and a moderator on the relationship between cognitive processes and adaptive functioning. Major Study Variables

9. Theoretical Model Learned Resourcefulness Cognitive Processes Personal Beliefs Social Interest Adaptive Functioning Situational Factors

10. Research Design  Secondary data analysis  Two parent studies were cross-sectional and comparative designs with convenience sampling (Zauszniewski, 1994a, 1995a).  Both original studies were descriptive, predictive, and correlational studies that described the effects or relationships among phenomena at one point in time.

11. The Parent Studies: The first study--- “Health-seeking resources and adaptive functioning in depressed and non-depressed adults” (Zauszniewski, 1992; 1994a) The second study--- “The health-seeking resources in depressed outpatients” (Zauszniewski, 1995a)

12. The Current Study : Three groups of depressed adults from the two studies-- (1) 63 depressed inpatients, (2) 63 outpatients with prior psychiatric hospitalization, (3) 63 outpatients without prior psychiatric hospitalization. Three groups of depressed adults from the two studies-- (1) 63 depressed inpatients, (2) 63 outpatients with prior psychiatric hospitalization, (3) 63 outpatients without prior psychiatric hospitalization. Adults between ages of 21 and 65 years old. Adults between ages of 21 and 65 years old. Subjects met DSM-III-R diagnostic criteria for major depression, bipolar disorder (depressed phase), or dysthymia when treatment was initiated. Subjects met DSM-III-R diagnostic criteria for major depression, bipolar disorder (depressed phase), or dysthymia when treatment was initiated.

13.  The inpatients were recruited from the psychiatric units of three large psychiatric hospital settings.  The outpatients were drawn from outpatient clinics, community mental health centers, and private practices with the same community in northeast Ohio.  Available subjects were entered in the study until the desired sample size was reached. Sampling

14. Instruments Personal beliefs Personal beliefs Social interest Social interest Learned resourcefulness Learned resourcefulness Adaptive functioning Adaptive functioning Severity of depression Severity of depression The Cognitive Triad Inventory (CTI; Beckham, Leber, Watkins, Boyer, & Cook, 1986) The Cognitive Triad Inventory (CTI; Beckham, Leber, Watkins, Boyer, & Cook, 1986) The Social Interest Scale (SIS; Crandall, 1991) The Social Interest Scale (SIS; Crandall, 1991) The Self-Control Schedule (SCS; Rosenbaum, 1980) The Self-Control Schedule (SCS; Rosenbaum, 1980) The Community Living Skills Scale (modified) (CLSS; Smith & Ford, 1990; Zauszniewski, 1992) The Community Living Skills Scale (modified) (CLSS; Smith & Ford, 1990; Zauszniewski, 1992) The Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) The Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961)

15. Demographic Characteristics Age Age Gender Gender Race Race Educational level Educational level Annual income Annual income Marital status Marital status Family history of depression Family history of depression

16. Results for Preliminary Analyses Sample Description

18. Description of the Study Variables

19. Prediction of Situational factors on the Study Variables (N=189) Study variables Personal Beliefs Social Interest Learned Resourcefulness Adaptive Functioning Age   Educational level   Annual income   Severity of depression   Gender (male/female) ♀ > ♂ Race (Caucasian/Black) Marital status (Yes/No) Yes > No Family history (Yes/No) No > Yes

20. Results & Discussion Research Question 1 Research Question 1 Are personal beliefs (PB) and social interest (SI) predictors of adaptive functioning in depressed adults?

21. Research Question 2 What is the relationship between personal beliefs (PB), social interest (SI), and learned resourcefulness (LR) in depressed adults? Research Question 3 What is the relationship between learned resourcefulness (LR) and adaptive functioning (AF) in depressed adults?

22. Research Question 4 Does learned resourcefulness mediate the relationship between cognitive processes (personal beliefs, social interest) and adaptive functioning in three groups of depressed adults?

23. Research Question 5 Does learned resourcefulness moderate the relationship between cognitive processes (personal beliefs, social interest) and adaptive functioning in three groups of depressed adults?

24. Limitations Selection, operationalization, and measurement of the study variables Selection, operationalization, and measurement of the study variables The selection of the instruments The selection of the instruments The cross-sectional design of the parent studies The cross-sectional design of the parent studies The generalizability of study results across populations is limited The generalizability of study results across populations is limited

25. Implications Nursing Theory Development Future Nursing Research Clinical Nursing Practice Advanced Nursing Education Mental Health Policy

26. Recommendations Use larger samples of depressed adults or the sample of persons within high risk for depression Conduct an intervention study to test the applicability and effectiveness of resourcefulness skills Conduct a longitudinal study to examine the correlations among changes in severity of depression during the progress of depressive illness over time Consider other physiological factors Conduct a qualitative study

27. The End