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.
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ItemMemory functioning during the menopausal transition: subjective experience and objective performance( 2013)Whilst many women complain of forgetfulness during the menopausal transition, few studies have provided a detailed examination of women’s beliefs about memory at this stage of their lives. Furthermore, prior studies have not included assessment of prospective or incidental memory, memory domains that may relate to the type of memory lapses that women describe. Therefore, this study aimed to examine women’s subjective perceptions of memory as well as their objective memory performance across the menopausal transition, including measures that have not been examined in previous studies. An additional aim was to explore relationships between subjective perceptions of memory and objective memory performance, menopausal symptoms and psychological factors during the perimenopausal stage. An improved understanding of the determinants of memory self-efficacy would allow for a more informed response to women’s concerns about memory, and potential enhancement of women’s well-being during this time of transition. One hundred and thirty women, aged 40 to 60, were recruited from outpatient menopause and gynaecological clinics at the Royal Women’s Hospital, Melbourne. Women were divided into pre- (n = 36), peri- (n = 54) and postmenopausal (n = 40) groups according to the STRAW+10 criteria based on menstrual patterns. All women completed self-report measures of physical menopause symptoms, symptoms of depression and anxiety, sleep quality and attitude towards menopause. Scales examining various aspects of memory were also administered, measuring reported frequency of common memory mistakes, sense of control over memory, use of memory strategies, memory contentment, knowledge and motivation to perform well on memory tasks. The women also completed a comprehensive neuropsychological evaluation of memory, assessing verbal learning and memory, attention and working memory, information processing speed, executive function, semantic, incidental and prospective memory. The results indicated that perimenopausal women felt less content with their memory and reported more frequent forgetfulness, despite performing at a similar level to their pre- and postmenopausal peers on a challenging and comprehensive neuropsychological assessment. This sense of dissatisfaction with memory was accompanied by a more negative attitude towards menopause, when compared to women who had experienced the transition to menopause, but the level of anxiety, depressive and sleep symptoms was similar across pre-, peri- and postmenopausal groups. Perimenopausal women who expressed a stronger sense of control over their memory function, and had lower expectations of their memory reported feeling more content with their memory. At the time of transition to menopause, perceptions of more frequent forgetting were associated with attentional capacity, and memory contentment was related to attitude towards menopause. Subjective memory in perimenopausal women was also associated with anxiety, depressive, vasomotor and sleep problems. The findings do not indicate a significant impact of the menopausal transition on memory function. Nevertheless, this does not diminish the potential adverse impact of perimenopausal women’s negative appraisals of memory on their quality of life. Modification of factors that have been shown to be related to perceived forgetfulness and memory contentment could improve memory self-efficacy at midlife and beyond.
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ItemAdjustment in life after traumatic brain injury: the impact of cognition, employment, and perceived sense of purpose in life( 2013)Traumatic brain injury (TBI) affects the most wide-ranging domains of survivors’ lives, markedly reducing emotional health and quality of life. The primary objective of this study was to explore the widely proclaimed therapeutic effect of employment on psychological wellbeing (PWB) and quality of life (QoL) relative to perceived sense of purpose in life (PIL). An additional aim was to examine the influence of factors involving cognitive function, injury severity, age at time of injury, gender, and preinjury education, on survivors’ work ability and return to work (RTW). A mixed methods design was used for an in-depth and comprehensive understanding about adjustment in life post-TBI. Method: Participants (N=40; 10-18 months post-TBI) were grouped according to age: 18-39 years (younger group), 40-55 years (older group) and injury severity (Glasgow Coma Scale scores): mild TBI (n=25), moderate-severe TBI (n=15). Quantitative Component: Neuropsychological testing and questionnaire surveys were performed to evaluate participants’ cognitive function, levels of perceived work gainfulness, PIL, PWB, and QoL. Data was analysed using bivariate and multivariate analyses of variance, aided by SPSS computer software. Qualitative Component: 12 participants (6 from each severity group) were randomly selected for digitally recorded semi-structured interviews, predominantly concerning the impact of work and life meaningfulness on adjustment process. Interviews were analysed using grounded theory methodology, aided by NVivo 10 computer package. Results and Discussion: PIL, in comparison to employment, cognitive function, and injury severity, made the strongest unique contribution in explaining PWB and QoL (p < 0.001). Employment potential was largely affected by memory and injury severity, with increased memory deficits (p < 0.01) and injury severity (p < 0.05) respectively associated with deteriorated employment potential. Main Conclusion: Having a strong sense of life as purposeful, notwithstanding employment, cognitive function, and injury severity, encourages survivors to focus on their lives and important life goals and to ultimately, achieve a promising life with healthy wellbeing.
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ItemThe neuroendocrine system following preterm birth and its effects on cognitive and brain development at age 7( 2012)Preterm birth is associated with a well-defined pattern of neurodevelopmental impairments which include a range of cognitive deficits, as well as structural brain abnormalities. Further, preterm infants are known to have a transiently altered neuroendocrine system during the first weeks of postnatal life. Although recent studies have focused on characterising long-term neurobehavioural deficits, few have examined potential mechanisms that may, at least partly, explain these poorer outcomes. This study aimed to address this shortcoming by focusing on the postnatal neuroendocrine system and its association with neurodevelopmental outcomes at age 7 in a group of children born very preterm. Postnatal concentrations of three hormones, free thyroxine, cortisol, and growth hormone, were examined using both direct hypothesis testing and exploratory hypothesis-generating approaches. Three direct hypotheses were proposed following review of the literature. Firstly, it was hypothesised that lower postnatal free thyroxine concentrations would be associated with poorer performances on measures of intellect, attention, and visuoperceptual abilities, as well as reductions in grey and white matter volumes at age 7 in children born very preterm. Secondly, it was hypothesised that higher postnatal cortisol concentrations would be associated with poorer performances on tasks of new learning and memory and volumetric reductions in the hippocampi at age 7 in children born very preterm. The final hypothesis predicted that elevated postnatal growth hormone concentrations would be related to deficits in attention and executive functioning and reductions in the prefrontal brain volumes at age 7 in children born very preterm. The current study investigated 83 children born very preterm (gestational age <30 weeks and/or birth weight <1250g), born between June 2002 and December 2003 in Melbourne, Victoria. During the neonatal period, hormone analysis was conducted over eight time points during the first 42 days of life (cord, Day 1, Day 4, Day 7, Day 14, Day 21, Day 28, and Day 42) to characterise the hormone profiles associated with preterm birth. At age 7, the children participated in a cognitive assessment and an MRI scan. A broad neuropsychological battery that assessed six domains of cognition, namely intellect, language, visuoperceptual reasoning, memory, attention and executive functioning, and processing speed, was used to characterise the cognitive profiles of this group of children. MRI imaging analysis was conducted using Freesurfer (v 5.1.0) to obtain cortical and subcortical brain volumes. The results did not confirm the direct hypotheses, although some interesting and novel findings arose. Firstly, elevated free thyroxine concentrations were related to poorer processing speed performances. A similar relationship was observed with elevated cortisol concentrations and decrements in processing speed. Lastly, elevated cortisol concentrations were related to volumetric reductions in subcortical regions, particularly the basal ganglia. Possible explanations for these findings were reviewed, though more research is required to confirm these relationships. Using a critical illness theory of endocrinology, it was concluded that the hormone profile exhibited by this cohort of children born very preterm during the early postnatal period, namely low concentrations of free thyroxine, and elevated concentrations of cortisol and growth hormone, reflected a transient reaction to acute critical illness. Moreover, given the adaptive nature of this acute illness phase, it was concluded that this postnatal hormone profile did not explain the diffuse nature of the neurodevelopmental impairments common to the preterm population.