Melbourne School of Psychological Sciences - Theses
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ItemAssessing the relationship between executive function, coping, stress, depression, anxiety and quality of life in multiple sclerosis( 2014)Background: Compared to healthy controls, people with multiple sclerosis (PwMS) use fewer adaptive and more maladaptive coping strategies when managing stressors and they experience higher rates of depression, anxiety and adjustment disorders. In addition, PwMS experience a high prevalence of cognitive impairment, including executive dysfunction, which has been linked to depression and anxiety. Aims: The current study examined the relationship between executive function, coping strategy use and psychosocial adjustment outcomes including stress, depression, anxiety and quality of life (QoL) in PwMS. The research assessed i) the ability of coping strategies and executive function to predict maladaptive and adaptive adjustment outcomes, and ii) the relationship between executive function and coping and whether there is a moderating and mediating relationship of different coping strategies between executive function and psychosocial adjustment in PwMS. Methods: Participants (N=107) with relapsing remitting or secondary progressive multiple sclerosis were administered tasks of executive function and completed self-report measures of stress, depression, anxiety, QoL and coping. Results: Consistent with expectations, stress, depression, anxiety and QoL were predicted by adaptive and maladaptive coping styles. Similarly, coping strategies, total coping and an adaptive coping index were predicted by tasks of executive function. Lower scores on tasks of executive function best predicted higher use of maladaptive strategies, but also adaptive strategies, while higher scores were limited in their ability to predict adaptive coping strategies. Tasks of executive function that most often predicted coping strategies included tasks of working memory, cognitive flexibility, information processing and attention. However, contrary to expectations, there was limited support for a relationship between tasks of executive function and psychosocial adjustment outcomes. An indirect relationship was found between executive function performance and adjustment through individual maladaptive coping strategies and adaptive coping strategies, as well as for an index of adaptive coping. Higher executive function performance was related to better adjustment via lower venting and behavioral disengagement, as well as higher scores on the adaptive coping index, whereas lower executive function performance was related to better adjustment via higher growth and acceptance. In general, better executive function and psychosocial adjustment was associated with minimal use of adaptive coping strategies, or greater use of maladaptive coping strategies. Conclusion: Executive function and psychosocial adjustment is mediated and moderated by coping strategies used by PwMS. Well-preserved executive function provides relative protection from poorer adjustment in the presence of high maladaptive or low adaptive coping. PwMS who perform poorly on tasks of executive function benefit from using less cognitively demanding coping strategies to enhance adjustment outcomes and this area that would benefit from further research to underpin effective intervention strategies. Findings from this study will assist with development of patient resources and patient management aimed at enhancing adaptive psychosocial adjustment in PwMS.
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ItemNeural correlates of attention in the context of prematurity( 2014)This study aimed to examine attention outcomes in a high-risk very preterm (VPT; <30 weeks’ gestational age) and/or very low birth weight (VLBW; <1250 g) children at 7 years, and to assess whether brain abnormality measured by neonatal magnetic resonance imaging (MRI) can predict later adverse outcome within this domain. It also aimed to investigate whether the attention difficulties observed at 7 years were associated with abnormalities in the key white matter pathways associated with attention. A cohort of 198/224 VPT/VLBW children and 70/77 term controls were examined. Neonatal MRI scans performed at term-equivalent age were assessed for white matter, cortical grey matter, deep grey matter, and cerebellar abnormalities. Standardised neuropsychological tests of attention and MRI scans were conducted at 7 years. Diffusion tractography analyses were performed on the key white matter tracts associated with attention (the superior longitudinal fasciculi, the cingulum bundles, and the reticular activating system). At 7 years of age, the VPT/VLBW group performed significantly worse than term controls on all attention outcomes. Associations between higher neonatal brain abnormality scores and adverse attention performances at 7 years were found in the VPT group; in particular, white matter and deep grey matter abnormalities were reasonable predictors of long-term attention outcomes. Findings at 7 years also revealed altered microstructural organisation and reduced tract volume within the proposed attention tracts in the VPT children compared with the term controls and also that, such alterations were related to the adverse attention outcomes in VPT children. Attention is a significant area of concern in VPT/VLBW children. This is the first study to show that neonatal brain pathology may be used to predict, in conjunction with other known risk factors, which children may be at risk of later adverse attention outcomes. This study also highlights the importance of white matter tract integrity for the development of attention abilities in VPT children.