PRISM :: Browsing by Author "Campbell, Tavis"

Browsing by Author "Campbell, Tavis"

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Open Access
A Pilot Trial of Light Therapy on Fatigue, Mood, Sleep Quality, and Quality of Life in Individuals with Post-Treatment Cancer-Related Fatigue
(2013-09-23) Johnson, Jillian; Campbell, Tavis
Cancer-related fatigue (CRF) is a common and distressing symptom reported by individuals with cancer, with 33% of patients continuing to experience fatigue for months or years following treatment. Despite its prevalence, CRF remains relatively undertreated and poorly understood. Light therapy is an effective treatment for a variety of fatigue disorders. This study evaluated the impact of a one-month light therapy treatment on fatigue, mood, sleep quality, and quality of life (QOL) in post-treatment cancer survivors with CRF. Eight participants were randomized to either bright white light (BWL) or dim red light (DRL) and completed baseline and post-treatment measures. Participants in both the BWL and DRL treatments groups showed reductions in fatigue, and improvements in sleep quality and QOL. Given the small sample size and the time of year the study was conducted, the results should be interpreted with caution.
Open Access
A Scoping Review of Self-Report Measures Used to Assess Individual and Contextual Determinants of COVID-19 Vaccination in General Population Samples
(2023-08-24) Moran, Chelsea Véronique; Campbell, Tavis; Ronksley, Paul; McDonough, Meghan; Boucher, Jean-Christophe; Kennedy, Eric
Introduction: Understanding vaccine refusal is crucial for enhancing COVID-19 vaccination rates. There has been a surge in survey-based research using self-report measures to identify predictors of COVID-19 vaccination uptake. The validity of research findings greatly depends on the use of appropriate and rigorous measurement practices. This dissertation aims to describe constructs and evaluate measurement practices in peer-reviewed studies on determinants of COVID-19 uptake in general population samples. Methods: A scoping review adhering to PRISMA-ScR guidelines was conducted (Study 1, Chapter 2). This review focused on construct definition and theoretical representation, based on the Capability, Opportunity, Motivation, Behavior (COM-B) model, and examined the characteristics of self-report measures. A secondary analysis of data from this scoping review, supplemented by a targeted search strategy, identified validated self-report measures and critically appraised the quality of their measurement properties using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance (Study 2, Chapter 3). Results: The comprehensive literature search identified 157 unique studies which reported on 425 constructs. Constructs representing the motivation dimension of the COM-B model were prominent, while capability and opportunity factors were often neglected. Frequently assessed constructs included positive and negative attitudes, intentions, beliefs, willingness, and hesitancy. The results revealed conceptual overlap in construct definitions and inconsistent use of construct labels. Most self-report measures were developed by study authors, used in only one study retrieved, and lacked reporting of psychometric properties. Study 2 identified ten validated self-report measures assessing COVID-19 vaccine attitudes, beliefs, hesitancy, and anxiety, with generally inadequate quality of psychometric evidence examined and limited reporting of methods used to ascertain content validity. Although the Vaccination Concerns in COVID-19 Scale (VaCCS) demonstrated the highest quality evidence for measurement properties, none of the measures retrieved in Study 2 could be recommended without further research to further quantify their measurement properties. Conclusion: This dissertation offers guidance on construct definition and measure selection for future research on COVID-19 vaccination determinants. Further research is needed to standardize construct definitions, confirm the measurement properties of existing measures, and develop measures to assess social and environmental factors. Recommendations for improving measurement practices are discussed.
Open Access
Advancing Gestation Does Not Attenuate Biobehavioural Coherence Between Psychological Distress and Cortisol
(Biological Psychology, 2013-04) Giesbrecht, Gerald; Campbell, Tavis; Letourneau, Nicole; Kaplan, Bonnie; APrON Study Team
Background: Despite little evidence to suggest that HPA axis responses to psychological provocation are attenuated during pregnancy, it is widely held that dampening of the HPA axis response to psychological distress serves a protective function for the mother and fetus. The current study was designed to assess changes in biobehavioral coherence between psychological distress and cortisol over the course of pregnancy. Methods: Ambulatory assessment of ecologically relevant psychological distress and salivary cortisol were repeated in all three trimesters for 82 pregnant women. Samples were collected 5 times per day over the course of 2 days in each trimester. Results: Psychological distress and cortisol were positively associated, β = .024, p < .01, indicating that increases in psychological distress were associated with increases in cortisol. Gestational age did not moderate this association, β = .0009, p = .13, suggesting that negative psychological experiences remain potent stimuli for the HPA axis during pregnancy. Conclusion: Biobehavioral coherence between ecologically relevant experiences of psychological distress and cortisol is not attenuated with advancing gestation.
Open Access
Affective Experience in Ecologically Relevant Contexts is Dynamic, and Not Progressively Attenuated During Pregnancy
(Archives of Women's Mental Health, 2012-08) Giesbrecht, Gerald; Letourneau, Nicole; Campbell, Tavis; Kaplan, Bonnie; APrON Study Team
Pregnancy is thought to diminish a woman’s appraisals of and affective responses to stressors. To examine this assumption, we used an electronic diary and an ecological momentary assessment strategy to record women’s (n=85) experiences of positive and negative affect five times each day over two days within each trimester of pregnancy. Women also completed the Edinburgh Postnatal Depression Scale each trimester. Multi-level modeling indicated non-linear patterns for both positive and negative affect that differed by level of depressive symptoms. The findings suggest that changes in psychological experience over the course of pregnancy are dynamic and not progressively attenuated.
Open Access
An investigation of the benefits of stress management within a cardiac rehabilitation population
(2009) Stevenson, Andrea; Campbell, Tavis
Research on whether stress management can improve clinical outcomes for patients in cardiac rehabilitation (CR) has yielded equivocal findings. The present investigation retrospectively examined the incremental impact of exercise and stress management (n = 188), relative to exercise only (n = 1,389), on mental and physical health outcomes at 12-weeks in a CR population. Secondary analyses described the association between the change in CR patients' symptoms of depression or anxiety between baseline and 12-weeks and mental and physical health outcomes at one-year. Participation in stress management was uniquely associated with greater reductions in waist circumference and systolic blood pressure for patients with clinical elevations on these measures. Patients with improved depression and anxiety severity had higher mental quality of life scores and patients whose anxiety severity remained unchanged had higher functional capacity at one-year. These findings suggest that stress management may offer additional benefits over and above exercise in CR.
Open Access
Autonomic Specificity Associated with Participation in the Mindfulness And Tai chi for Cancer Health (MATCH) Study
(2017) Toivonen, Kirsti; Campbell, Tavis; Carlson, Linda; Tomfohr-Madsen, Lianne; Culos-Reed, Nicole
Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ) are two therapies used by cancer survivors to help alleviate side effects of cancer and its treatment, but have never been directly compared in this population. The present study assessed the autonomic specificity (indexed by blood pressure, heart rate variability, and baroreflex sensitivity) associated with participating in MBCR or TCQ among cancer survivors. Secondary analyses examined associations between changes in distress, quality of life, sleep, and pain and changes in autonomic functioning. Results suggest participation in MBCR, but not TCQ, may be associated with a degree of change in baroreflex sensitivity and blood pressure. Further, increased low-frequency heart rate variability was associated with a pattern of improvements (e.g., decreased fatigue, depression, and mood disturbance). Results may lead to a better understanding of mechanisms involved in symptom improvement as well as a better rationale for selection of complementary therapies.
Open Access
Bridging the Gap - Exploring the Role of Cortisol on The Effects of Prenatal Depression on Child Neurocognition
(2022-08-19) Cattani, Danielle; Giesbrecht, Gerald; Lebel, Catherine; Campbell, Tavis
Prenatal depression is a potentially debilitating experience that can affect both birthing parent and child. The current study investigates the role of cortisol, a hormone well-known for its involvement in the stress response, in the association between prenatal depression and child neurocognitive outcomes. Specifically, we assessed child executive function and cortical thickness in the right frontal and prefrontal cortices. Pregnant participants completed the Edinburgh Postnatal Depression Scale (EPDS) to assess prenatal depression, and we examined prenatal cortisol using salivary cortisol samples. Children completed six executive function tasks spanning the three domains of executive functioning and underwent magnetic resonance imaging to assess their cortical thickness. Our results indicate that prenatal depression during pregnancy, particularly early pregnancy, has the potential to adversely impact mental flexibility in children ages 3 – 4 years. Furthermore, an elevated prenatal cortisol awakening response (CAR) was related to timing-specific and region-specific cortical thinning in the right frontal cortex of children ages 3 – 7 years. Lastly, increased CAR in the third trimester was associated with better mental flexibility outcomes. Prenatal cortisol did not mediate the relationship between prenatal depression and child cortical thickness or executive function outcomes in our sample. Future research directions are discussed. Our study emphasizes the importance of caring for prenatal mental health in improving outcomes for child neurocognition.
Open Access
The Buffering Effect of Social Support on Hypothalamic-Pituitary-Adrenal Axis Function During Pregnancy
(Psychosomatic Medicine, 2013) Giesbrecht, Gerald; Poole, Julia; Letourneau, Nicole; Campbell, Tavis; Kaplan, Bonnie; APrON Study Team
Objective: Recent studies suggest that effective social support during pregnancy may buffer adverse effects of maternal psychological distress on fetal development. The mechanisms whereby social support confers this protective advantage, however, remain to be clarified. The aim of this study was to assess whether individual differences in social support alter the co-variation of psychological distress and cortisol during pregnancy. Methods: Eighty two pregnant women’s psychological distress and cortisol were prospectively assessed in all three trimesters using an ecological momentary assessment strategy. Appraisal of partner social support was assessed in each trimester via the Social Support Effectiveness questionnaire. Results: In multilevel analysis, ambulatory assessments of psychological distress during pregnancy were associated with elevated cortisol levels, unstandardized β = .023, p < .001. Consistent with the stress buffering hypothesis, social support moderated the association between psychological distress and cortisol, unstandardized β = -.001, p = .039, such that the co-variation of psychological distress and cortisol increased with decreases in effective social support. The effect of social support for women with the most effective social support was a 50.4% reduction in the mean effect of distress on cortisol and a 2.3 fold increase in this effect for women with the least effective social support scores. Conclusions: Pregnant women receiving inadequate social support secrete higher levels of cortisol in response to psychological distress as compared to women receiving effective social support. Social support during pregnancy may be beneficial because it decreases biological sensitivity to psychological distress, potentially shielding the fetus from the harmful effects of stress-related increases in cortisol.
Embargo
Design and Feasibility of a Behavioural Weight Loss Treatment for Patients with Atrial Fibrillation and Obesity referred to Cardiac Rehabilitation
(2024-09-17) Williamson, Tamara Marie; Campbell, Tavis; Rouleau, Codie; Wilton, Stephen; Tomfohr-Madsen, Lianne; Alberga, Angela; McDonough, Megan
Background: Moderate weight loss (i.e., ≥10%) reduces symptom burden and disease progression among patients with atrial fibrillation (AF) and co-morbid obesity (BMI ≥ 30 kg/m2). Cardiac rehabilitation (CR) improves AF risk factors (e.g., hypertension, cardiorespiratory fitness, lipids) and thus represents an ideal multidisciplinary setting for AF management. Yet, few CR programs include targeted behavioural weight loss treatment (BWLT) for patients with cooccurring obesity. Evidence-based approaches to integrating BWLT into CR are needed to encourage sustainable weight loss in this patient group. Purpose: The purpose of this dissertation was to adapt and establish the acceptability of a Small Change BWLT that could be integrated into an existing CR program for patients with AF and obesity prior to efficacy testing in a randomized clinical trial (RCT). Methods: Chapter 2 was a qualitative descriptive exploration of patients’ preferences, barriers, and enablers to participating in a Small Change BWLT in CR. Chapter 3 was a pre-post feasibility study to adapt the BWLT to patients with AF and obesity, and establish the acceptability of the modified program. Chapter 4 was a protocol for an RCT comparing the efficacy of the BWLT + CR in terms of 12-month weight loss relative to the traditional CR program. Results: Barriers and enablers identified in Chapter 2 were used to adapt the BWLT program and included changes to patient education materials and discussion of AF risk factors. In Chapter 3, patients reported strong liking of the adapted program, however weight loss at 6 months was not clinically or statistically significant. The BWLT was further refined using the findings from Chapter 3 to inform the protocol in Chapter 4, which is currently recruiting patients (NCT05230823). Conclusion: While the benefits of a Small Changes BWLT + CR for weight loss among patients with AF and obesity relative to CR-only remain to be seen, the results of this dissertation provide important acceptability and feasibility evidence suggesting that program uptake, adherence, and completion may be favourable in the RCT. Future directions including the potential addition of adjunct pharmacotherapy to BWLT and additional therapeutic BWLT components (e.g., values-based behaviour change, self-compassion) are discussed.
Open Access
Developmental Origins of Infant Emotion Regulation: Mediating and Moderating Effects of Infant Temperament and Maternal Sensitivity
(2015-09-23) Thomas, Jenna; Campbell, Tavis; Giesbrecht, Gerald
The current study examined perinatal factors that impact infant emotion regulation (ER) development. Prenatal depression, generalized anxiety, pregnancy-specific anxiety (PSA), and diurnal cortisol levels were assessed in 256 pregnant women in early and late pregnancy. Infant temperamental negativity was assessed at 3 months, and observational measures of infant ER during frustration and maternal sensitivity were assessed at 6 months. Results revealed that PSA had a positive direct effect on infant ER, which potentially indicated emotional over-regulation in these infants. PSA also had a negative indirect effect on infant ER through increased temperamental negativity, which was dependent on levels of maternal sensitivity. Specifically, infants with high negativity demonstrated emotional under-regulation, but only when their mother displayed low levels of sensitivity. The study identified two pathways by which PSA may result in long-term changes in infant emotional development. Implications for future research and intervention planning are discussed.
Open Access
Effects of Online Mindfulness-Based Cancer Recovery on Cognitive Function in Cancer Survivors Undergoing Chemotherapy
(2022-09) Flynn, Michelle Jacqueline; Campbell, Tavis; Carlson, Linda; Hodgins, David; von Ranson, Kristin
Introduction: Cancer survivors commonly report deterioration in cognitive function during and for several years following cancer treatment, adversely affecting their quality of life. Cognitive changes in cancer survivors likely occur due a complex interaction of disease-related, treatment-related, and psychological factors. One promising intervention for alleviating disruptions in cognitive function in cancer survivors is Mindfulness-Based Cancer Recovery (MBCR). Methods: A systematic review examined the effects of mindfulness-based interventions (MBIs) on cognitive function in cancer survivors. An observational study included 38 breast and colorectal cancer survivors to investigate predictors of self-reported and objectively-assessed cognitive function before chemotherapy treatment. Finally, an intervention study including 38 breast and colorectal cancer survivors investigated the effects of participating in an online MBCR group during (immediate group) or after (waitlist group) chemotherapy treatment in self-reported and objectively-assessed cognitive function. Results: Results of the systematic review indicated significant effects on self-reported cognitive function, favouring MBIs over inactive controls (e.g., waitlist, usual care) and active controls (e.g., metacognition training, walking groups). Mixed results were reported for objectively-assessed cognitive function. Results of the observational study indicated that mood disturbance was a significant predictor of self-reported cognitive function. Objectively-assessed cognitive function was not significantly correlated with other unwanted side effects. Results of the intervention study indicated an average worsening of self-reported cognitive function from pre- to post-MBCR/post-waiting regardless of group assignment. Small to large within-person and between-group effects were observed across timepoints for objectively-assessed cognitive function. Differences in objectively-assessed cognitive function across time were not statistically significant. Conclusion: Future research is warranted to further investigate the role of MBIs in improving both self-reported and objectively-assessed cognitive function in cancer survivors undergoing treatment. In particular, there is a need for studies adequately powered to detect cognitive changes between groups over time, using a range of cognitive assessment methods, with diverse samples.
Open Access
Healthcare Utilization Among Young Adult Survivors of Childhood Cancer in Canada: The Role of Patient-Level Factors
(2024-09-20) Drummond, Rachelle Marie; Schulte, Fiona; Campbell, Tavis; Reynolds, Kathleen; Ronksley, Paul
Background: Survivors of childhood cancer (SCC) face substantive risks for developing late effects (LE) from their cancer treatments due to disruptions in crucial periods of physical and social development while undergoing cancer treatment (Tonorezos et al., 2022; Baker & Syrjala, 2018). The inappropriate use of healthcare services, whether underutilization or overutilization, may jeopardize the effective risk-based prevention and management of LE among SCC. In addition, inappropriate healthcare utilization (HCU) may contribute to unsustainability and inefficiency in the healthcare system, creating challenges for supporting the growing population of survivors in Canada. Despite existing knowledge that young adult (YA) SCC are at a heightened high risk for the development of LE and life-long complications from their treatments, limited research exists that describes HCU among this population. The two aims of this study were to 1) identify and explore the associations of survivor’s demographics (i.e., sex, gender, age, race, geographic location, SES), knowledge of cancer history and risks, and psychological factors (i.e., anxiety, depression) and perceived vulnerability with healthcare utilization; and 2) examine the relationships among demographic, clinical, and psychological patient-level factors with HCU among YA SCC. Methods: Canadian YA SCC (n=123; 31% male; mean age=28.19yrs, mean time post treatment= 16.56yrs) diagnosed <18 years of age; and >5 years from diagnosis and/or >2 years from treatment completed the Self-Report Survey of Cancer Knowledge (Kunin-Batson et al., 2016), and the Self-Report Survey of Core Health Beliefs (Tercyak et al., 2004), to assess knowledge of cancer history and risks and perceived vulnerability, respectively. Survivors completed the Patient-Reported Outcomes Measurement Information System (PROMIS) SF v1.0 Anxiety 8a and the PROMIS SF v1.0 Depression 8a to assess levels of anxiety and depression respectively. To assess HCU, survivors reported the number of times that they saw a doctor within the last 2 years, in relation to their cancer diagnosis. A bivariate logistic regression model examined associations between YA SCC’s demographics, knowledge of cancer history, and psychological factors with HCU. Results: Survivors reported a wide range of HCU rates over the past 2 years (median= 3-4 visits). The number of reported visits ranged from 0-20+ visits. Despite 45.5% of reported health problems being attributed to mental health, psychiatrists and psychologists/counselors were the third and fourth least utilized types of providers, respectively. A logistic regression model was conducted to assess the associations between HCU and patient-related factors. The model was significant X2(8) =23.68, p=0.003, and accounted for 29.3% of variance in healthcare utilization among YA SCC (NagelKerke R2= 0.293). Anxiety was the only independent variable that contributed significantly to the model (p<0.001), and higher anxiety scores were associated with increased odds of HCU. Conclusion: Anxiety levels were a significant predictor of HCU rates within this population, whereby higher anxiety scores were associated with higher HCU rates. Based on the findings of this study, behavioral interventions could be beneficial in reducing anxiety among YA SCC and promoting appropriate risk based HCU that support the long-term well-being of survivors, and the sustainability of the healthcare system.
Open Access
How does mindfulness-based stress reduction (mbsr) improve psychological functioning in cancer patients?
(2012) Labelle, Laura Elizabeth; Campbell, Tavis; Carlson, Linda
OBJECTIVE: This longitudinal waitlist controlled study examined mediators of MBSR in cancer patients. First, the study explored the timing of MBSR-related change and whether earlier changes in putative mediators were associated with later changes in outcome variables. Next, a mediation model was tested based on the theory that increased mindfulness through MBSR leads to enhanced emotion regulation (indexed by rumination, worry, and experiential avoidance), which in tum leads to improved psychological functioning. The study also assessed whether increased mindfulness mediated the effects of MBSR on spirituality and posttraumatic growth. METHODS: Patients were recruited from the MBSR program waitlist and were either registered for immediate participation (n=135), or were waiting for the next program (n=76). Participants completed questionnaires pre-, mid- and post-MBSR or waiting period (i.e., 0, 4 and 8 weeks). Hierarchical linear modeling (HLM) and piecewise HLM were employed to assess changes over time as a function of condition (MBSR vs. waitlist). Cross-lagged correlations and linear regression analyses explored temporal associations among changes in mediator and outcome variables. Mediation models were tested using linear regression and bootstrapping analyses. RESULTS: Compared to the waitlist group, MBSR participants showed significant changes in expected directions on all putatjve mediator and outcome variables. In the MBSR condition, present-focused nonjudgmental attention/awareness, worry, rumination and spirituality changed during the first and second halves of the program relative to the control group; all other variables changed only during the second half in the program. Early increases in the "non judging" mindfulness facet were associated with later decreases in worry, and early increases in the "describing" facet were associated with later increases in posttraumatic growth. However, more temporal associations emerged in the direction opposite of the proposed model. Mindfulness mediated the effect of MBSR on emotion regulation, which in tum mediated the effect of mindfulness on psychological functioning. Mindfulness also mediated the effect ofMBSR on "positive" outcomes. CONCLUSIONS: Increased mindfulness and enhanced emotion regulation are related to beneficial outcomes of MBSR in cancer patients. Findings suggest bi-directional effects of mediator and outcome variables, and illustrate the need for a more detailed analysis of MB SR-related change. Determining the precise timing of change in mindfulness and its sequelae will permit stronger conclusions regarding mechanisms ofMBSR.
Open Access
Insomnia Symptoms, Affective Response to Exercise, and Exercise Adherence among Patients Enrolled in Cardiac Rehabilitation
(2013-09-04) Rouleau, Codie; Campbell, Tavis
Insomnia symptoms (e.g., difficulty initiating or maintaining sleep) are common in cardiac patients and contribute to impaired mood, concentration, and motivation. The purpose of this study was to assess whether insomnia symptoms relate to unpleasant affect during exercise and poor exercise adherence. The Insomnia Severity Index was administered to 349 patients in 12 week exercise-based cardiac rehabilitation. Affect was measured in 57 patients with the Physical Activity Affect Scale, 5 minutes before and 15 minutes after onset of moderate intensity exercise. Exercise adherence (attendance, ∆ functional capacity, weekly exercise duration, dropout) was ascertained by chart review. Greater insomnia severity was associated with shorter weekly exercise duration but not with other adherence measures. Affective improvement during exercise was associated with greater insomnia severity, but not with adherence. Insomnia symptoms do not appear to interfere with objectively measured exercise adherence, and exercise might support affect regulation in cardiac patients with insomnia.
Open Access
Insomnia Treatment Preferences of Expectant Couples
(2016) Sedov, Ivan; Tomfohr-Madsen, Lianne; Campbell, Tavis; von Ranson, Kristin; Este, David
Client treatment preferences are recognized as a key factor in delivery of evidence based practice. The current study investigated pregnant couples’ treatment preferences for insomnia; the modalities assessed included pharmacotherapy and cognitive behavioral therapy for insomnia (CBT-I). Method: Expectant couples completed an online questionnaire asking them to read expert validated treatment descriptions of pharmacotherapy and CBT-I; they then indicated their preference and perceptions of each approach. Results: Pregnant women indicated that if they were experiencing insomnia they would prefer CBT-I to pharmacotherapy (p < .001). Women rated CBT-I as more credible and indicated stronger positive reactions to it than pharmacotherapy (p < .001). Expectant fathers indicated that they would prefer CBT-I to pharmacotherapy for both their own (p < .001) and the mother’s insomnia (p < .001). Conclusion: The current findings suggest that expectant mothers and father prefer CBT-I to pharmacotherapy as a treatment for insomnia.
Open Access
An Intervention to Enhance Mental and Physical Health of Nursing Students
(2022-09) Ciezar Andersen, Sylwia; King-Shier, Kathryn; White, Deborah; Campbell, Tavis
Nursing students exhibit some of the highest symptoms of depression, anxiety, and stress relative to students in other health-related disciplines and to their counterparts outside of university. Up to 50% of nursing students are sedentary, compromising their physical health and exacerbating risk for musculoskeletal injury. Yoga has been associated with improved mental and physical health in a variety of populations. With the ORBIT Model as a guide to implementation, the first manuscript in this thesis consists of a systematic review exploring existing evidence of the effectiveness of yoga interventions for healthcare professionals and students (design phase, Phase I). This evidence was then used to plan and optimize protocol details for Phases IIa and IIb. The process of undertaking a web-based yoga intervention was explored in a proof-of-concept study (Phase II a). After protocol refinement, a pilot study was conducted (Phase II b), and is described in the second manuscript. All 68 participants who completed the pilot study exhibited a significant decrease in symptoms of depression, anxiety, stress, and improved self-compassion and core endurance scores. While significant mental and physical health benefits following yoga intervention were demonstrated in this sample, 44% attrition rates were encountered during the course of the pilot study. Thus, retention challenges were explored and recommendations for further refinement and protocol optimization were the focus of the third manuscript.
Open Access
Investigating relationships between psychological distress and hypertensive disorders of pregnancy
(2021-12) Shay, Matthew; Tomfohr-Madsen, Lianne; Campbell, Tavis; Giesbrecht, Gerald; Dumanski, Sandra; Ditto, Blaine
Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of pregnancy-related death worldwide. Psychological distress has been implicated in the development and progression of hypertensive disorders in non-pregnant populations; however, while pregnancy is a time of increased physical and emotional stress for many people, our understanding of the role of psychological health and development of HDP is limited. This dissertation expands the literature investigating the relationship between psychosocial factors and HDP through three distinct projects. Methods: The first manuscript was a meta-analysis that systematically reviewed and analyzed all current research investigating the relationship between depression and anxiety experienced during pregnancy and associations with HDP. The second manuscript applied artificial intelligence-driven machine learning methods to create a predictive model of HDP that included biologic, demographic, and psychosocial characteristics. The third manuscript was an analysis of blood pressure trajectories over the course of pregnancy using a functional data analysis approach, with an exploratory investigation of baseline factors that could differentiate between them. Data for the second and third manuscripts was obtained through the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Results: The meta-analysis literature search identified 6291 citations, and ultimately 44 studies were included that captured data from 61.2 million pregnancies. Depression and/or anxiety were associated with increased risk of HDP (RR=1.39; 95% CI, 1.25-1.54). The second analysis included 1108 participants, with 75 (6.8%) identified as having HDP at delivery. The model predicting HDP generated an average accuracy of 65% using exclusively biologic, demographic, physical and psychosocial characteristics. The highest ranked predictors were body mass index (BMI), nulliparity, weekly physical activity, stressful life events during pregnancy, and age. The third analysis of blood pressure trajectories during pregnancy detected three dominant patterns of blood pressure variation: late pregnancy (64.8% in SBP and 63.4% in DBP variance), early pregnancy (13.21% in SBP and 13.43% in DBP variance), and mid-pregnancy (8.51% in SBP and 8.63% in DBP variance). HDP were associated with a trajectory of increased blood pressure in late pregnancy. Conclusion: Understanding possible psychological contributions to hypertensive risk during pregnancy is critical given the high prevalence of these conditions and both the immediate and longstanding impact on maternal and fetal health. These investigations furthered the understanding of the relationship between psychological health and cardiovascular health during pregnancy.
Open Access
Light Therapy for Post-Treatment Cancer-Related Fatigue: An Investigation of Impact on Psychological Outcomes and Biological Mechanisms
(2016) Johnson, Jillian; Campbell, Tavis; Carlson, Linda; Caird, Jeff; Millet, Guillaume; Palesh, Oxana
OBJECTIVE: To investigate the impact of a one-month light therapy intervention on symptoms of fatigue, psychological outcomes, and diurnal cortisol rhythms in cancer survivors with clinical fatigue. METHODS: Adult cancer survivors who met diagnostic criteria for cancer-related fatigue were eligible and randomized to receive either bright white light (BWL) or an active comparator (dim red light; DRL). Participants used the device for 30 minutes upon waking for 4 weeks. Baseline and post-intervention assessments of fatigue, mood disturbance, depression, sleep quality, and quality of life were obtained. Participants also provided four saliva samples per day over a period of 3 days both before and after the intervention. Linear mixed-model (LMM) analysis with random slopes and intercepts were conducted on the primary outcome of fatigue, and generalized estimating equations were employed to investigate the secondary psychological outcomes. Cortisol slopes, total cortisol output (area under the curve), and cortisol output at four sampling times were examined for time, group, and interaction effects using LMM analyses. RESULTS: Eighty-one participants were randomized to either BWL (n=42) or DRL (n=39). The light therapy intervention was acceptable as evidenced by high adherence rates and low dropout (2.5%). Overall, participants in the BWL condition displayed greater improvements in symptoms of fatigue than those in the DRL condition (d=.30). Both groups showed improvements on symptoms of mood disturbance, depression, sleep quality, and quality of life over time. A subsample of participants (n=77) were included in the cortisol analyses. Cortisol slope and total cortisol output were unchanged after the intervention, but an increase in output was observed in both groups at the post-intervention noon sample, as well as decreased output at the post-intervention 5pm sample in the BWL condition. CONCLUSION: Early morning exposure to bright white light resulted in improvements in symptoms of fatigue in cancer survivors with clinical fatigue. These findings, along with those of previous research of light therapy in cancer patients and survivors, support the use of light therapy for cancer-related symptoms. Furthermore, light therapy has the potential to impact the diurnal release of cortisol, though further research into the associations with symptoms of fatigue are required.
Open Access
Maternal cortisol during pregnancy is related to infant cardiac vagal control
(Psychoneuroendocrinology, 2015-04) Rash, Joshua; Campbell, Tavis; Letourneau, Nicole; Giesbrecht, Gerald
Background: Prenatal exposure to maternal psychological distress and glucocorticoids result in neurobiological adaptations within the fetus that increase risk for developing exaggerated emotional, behavioral, and stress responses to novelty and challenges in childhood. The current study investigated the influence of maternal depressed mood and cortisol during pregnancy on infant cardiac vagal control (CVC) to standardized laboratory challenge tasks. Methods: The sample comprised 194 women and their infants. Maternal reports of depressed mood and salivary cortisol were assessed at 14 and 32 weeks gestational age. Linear regression was used to examine associations between maternal measures during early and late pregnancy, and infant CVC indexed via respiratory sinus arrhythmia (RSA) at rest and in response to laboratory tasks designed to elicit frustration when infants were 6 months of age. It was hypothesized that maternal depressed mood and cortisol would be associated with lower basal RSA and smaller decreases in RSA from baseline to challenge. Results: A significant decrease in infant RSA from baseline to frustration tasks indicated that laboratory tasks elicited a reliable decrease in RSA from baseline to frustration among infants which is characterized by reduction in vagal efferent activity on the heart in response to challenge. Higher maternal cortisol, but not depressed mood, was associated with lower basal RSA and greater decrease in RSA from baseline to frustration. Associations between maternal cortisol and infant basal RSA were observed for both early and late pregnancy whereas the associations between prenatal cortisol and decrease in RSA from baseline to frustration were observed for early, but not late, pregnancy. Conclusions: Maternal cortisol during pregnancy was associated with infant CVC at 6-months of age. Such influences may have enduring impacts on the child and important implications for the development of physical and mental health outcomes.
Open Access
Mindfulness-Based Cognitive Therapy for Treatment of Psychological Distress in Pregnancy: Is there an Effect on Maternal Autonomic Response to Acute Stress?
(2017) Shay, Matthew Shawn; Tomfohr-Madsen, Lianne; Campbell, Tavis; Carlson, Linda; Nerenberg, Kara
Pregnancy is a time of increased physical and emotional stress for many women. Examination of cardiovascular response to acute stress can provide a non-invasive way of assessing autonomic nervous system function. Previous research suggests that the experience of heightened stress response in pregnancy is a risk factor for poor maternal and child health. Treatment of psychological distress with mindfulness-based cognitive therapy (MBCT) in non-pregnant populations can positively impact cardiovascular reactivity to stress. The current randomized controlled trial investigated MBCT for treatment of prenatal distress and examined whether MBCT was associated with changes in the physiological stress response. Women between 12-28 weeks gestation were recruited for participation in an 8-week MBCT intervention (N = 29) or assigned to treatment-as-usual (N = 32). Cardiovascular responses to a laboratory-based Stroop task and mental arithmetic stressors were measured by respiratory sinus arrhythmia (RSA), heart rate, and systolic and diastolic blood pressure) and assessed at pre-treatment, posttreatment, and three-months postpartum. MBCT participants experienced higher RSA at posttreatment for Stroop, mental arithmetic, and during the respective recovery periods, as well as greater RSA reactivity to both stressors at three-months follow-up. No changes in blood pressure or blood pressure reactivity were found. MBCT appeared to increase vagal activity posttreatment and vagal response to acute stress at three-months follow-up. Treatment of maternal distress with mindfulness-based interventions may have physiological health benefits.