Browsing by Author "Tomfohr-Madsen, Lianne"
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- ItemOpen AccessAdvancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: protocol study(BMJ, 2017-07-01) Yeates, Keith O.; Beauchamp, Miriam; Craig, William; Doan, Quynh; Zemek, Roger; Bjornson, Bruce H.; Gravel, Jocelyn; Mikrogianakis, Angelo; Goodyear, Bradley; Abdeen, Nishard; Beaulieu, Christian; Dehaes, Mathieu; Deschenes, Sylvain; Harris, Ashley D.; Lebel, Catherine; Lamont, Ryan; Williamson, Tyler; Barlow, Karen M.; Bernier, Francois; Brooks, Brian L.; Emery, Carolyn; Freedman, Stephen B.; Kowalski, Kristina; Mrklas, Kelly; Tomfohr-Madsen, Lianne; Schneider, Kathryn J.Introduction Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. Methods and analysis A-CAP is a prospective, longitudinal cohort study of children aged 8.00-16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. Ethics and dissemination The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals.
- ItemOpen AccessAdverse childhood experiences and HPA axis function in pregnant women(Elsevier, 2018-05-28) Thomas, Jenna C.; Magel, Chantelle; Tomfohr-Madsen, Lianne; Madigan, Sheri L.; Letourneau, Nicole Lyn; Campbell, Tavis S.; Giesbrecht, G. F.; APrON Study Team
- ItemOpen AccessAutonomic 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, NicoleMindfulness-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.
- ItemOpen AccessBody Perception and Body Dissatisfaction: A Longitudinal Examination of Body Image and Disordered Eating Symptoms(2023-07-24) Magel, Chantelle A.; von Ranson, Kristin; Tomfohr-Madsen, Lianne; Madigan, SheriIntroduction: Body size perception and attitudes towards the body (e.g., body dissatisfaction) are two distinct but interconnected components of body image. The relationship between body perceptions and disordered eating is poorly understood. The objective of this project was to examine body size perception and elucidate how it changes and relates to disordered eating behaviours and attitudes across development when compared to body dissatisfaction. Method: In three studies, we analyzed data from the Minnesota Twin Family Study (MTFS), a population-based, prospective study of 1,359 predominantly (95%) White, reared-together female twins ranging from age 10 to 33, in which participants completed assessments approximately every three to five years. Study 1 examined the psychometric properties of a scale used to measure body size perception (Body Rating Scales (BRS); Chapter 2); Study 2 investigated the developmental trajectories of body mass index (BMI) and BRS body size perception scores across the study period (Chapter 3); and Study 3 compared the degree to which BMI, BRS body size perception scores, and body dissatisfaction impacted disordered eating behaviours and attitudes over time (Chapter 4). Results: In Study 1, the psychometric properties of the BRS support its validity as a measure of body size perception in girls and women. In Study 2, participants generally selected increasingly large perceived actual body sizes and increasingly small ideal body sizes across time and development, resulting in widening discrepancies between actual and ideal body size ratings until approximately age 30. In Study 3, body perception variables (i.e., larger actual body size ratings, smaller ideal body size, and greater actual-ideal discrepancies) predicted subsequent elevated disordered eating behaviours and attitudes across time more strongly than did body dissatisfaction as measured by self-report questionnaire ratings. Conclusion: Our results suggest that the BRS is a psychometrically-sound tool that may be used to evaluate body perception quickly and easily. Further, this research advances understanding of how body perceptions and ideals change across development, and highlights their relationship with subsequent disordered eating.
- ItemOpen AccessBuilding Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants(2023-02-18) Xie, E. B.; Freeman, Makayla; Penner-Goeke, Lara; Reynolds, Kristin; Lebel, Catherine; Giesbrecht, Gerald F.; Rioux, Charlie; MacKinnon, Anna; Sauer-Zavala, Shannon; Roos, Leslie E.; Tomfohr-Madsen, LianneAbstract Background Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care. Methods To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6–17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys. Results The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen’s d = .93). Discussion This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants. Trial registration NCT04772677 . Registered on February 26 2021.
- ItemOpen AccessBuilding Emotional Awareness and Mental Health (BEAM): study protocol for a phase III randomized controlled trial of the BEAM app-based program for mothers of children 18–36 months(2022-09-05) Xie, E. B.; Simpson, Kaeley M.; Reynolds, Kristin A.; Giuliano, Ryan J.; Protudjer, Jennifer L. P.; Soderstrom, Melanie; Sauer-Zavala, Shannon; Giesbrecht, Gerald F.; Lebel, Catherine; Mackinnon, Anna L.; Rioux, Charlie; Penner-Goeke, Lara; Freeman, Makayla; Salisbury, Marlee R.; Tomfohr-Madsen, Lianne; Roos, Leslie E.Abstract Background The prevalence of maternal depression and anxiety has increased during the COVID-19 pandemic, and pregnant individuals are experiencing concerningly elevated levels of mental health symptoms worldwide. Many individuals may now be at heightened risk of postpartum mental health disorders. There are significant concerns that a cohort of children may be at-risk for impaired self-regulation and mental illness due to elevated exposure to perinatal mental illness. With both an increased prevalence of depression and limited availability of services due to the pandemic, there is an urgent need for accessible eHealth interventions for mothers of young children. The aims of this trial are to evaluate the efficacy of the Building Emotion Awareness and Mental Health (BEAM) app-based program for reducing maternal depression symptoms (primary outcome) and improve anxiety symptoms, parenting stress, family relationships, and mother and child functioning (secondary outcomes) compared to treatment as usual (TAU). Methods A two-arm randomized controlled trial (RCT) with repeated measures will be used to evaluate the efficacy of the BEAM intervention compared to TAU among a sample of 140 mothers with children aged 18 to 36 months, who self-report moderate-to-severe symptoms of depression and/or anxiety. Individuals will be recruited online, and those randomized to the treatment group will participate in 10 weeks of psychoeducation modules, an online social support forum, and weekly group teletherapy sessions. Assessments will occur at 18–36 months postpartum (pre-test, T1), immediately after the last week of the BEAM intervention (post-test, T2), and at 3 months after the intervention (follow-up, T3). Discussion eHealth interventions have the potential to address elevated maternal mental health symptoms, parenting stress, and child functioning concerns during and after the COVID-19 pandemic and to provide accessible programming to mothers who are in need of support. This RCT will build on an open pilot trial of the BEAM program and provide further evaluation of this evidence-based intervention. Findings will increase our understanding of depression in mothers with young children and reveal the potential for long-term improvements in maternal and child health and family well-being. Trial registration ClinicalTrials.gov NCT05306626 . Registered on April 1, 2022
- ItemOpen AccessCalming the Tide: Emotional Regulation in Young Adults with ADHD(2017) Nicholson, Andrew; Zwiers, Michael; Price, Anne; Tomfohr-Madsen, LianneThe present study examines how young adults diagnosed with ADHD experience and perceive emotional regulation. Six post-secondary students were interviewed using the Enhanced Critical Incident Technique to elicit rich, nuanced responses. Participants were asked to describe situations in which they experienced intense emotions, and to contextualize examples in the form of events or stories (what led up to the situation, what actually happened, and what was the outcome). Data analysis identified 205 critical incidents comprised of 109 helping incidents, 79 hindering incidents, and 17 wish list items. These incidents informed the development of the following 7 categories: (a) Appraise & Process, (b) Social Interaction, (c) Distancing, (d) Physical Response, (e) Emotional Engagement, (f) Taking Medication, and (g) Active Problem-Solving. Further contextual themes were identified using a secondary thematic analysis. Results are discussed in light of relevant literature, and implications for researchers, therapists, and young adults living with ADHD are highlighted.
- ItemOpen AccessCluster-specific associations between the gut microbiota and behavioral outcomes in preschool-aged children(2024-03-21) van de Wouw, Marcel; Wang, Yanan; Workentine, Matthew L.; Vaghef-Mehrabani, Elnaz; Barth, Delaney; Mercer, Emily M.; Dewey, Deborah; Arrieta, Marie-Claire; Reimer, Raylene A.; Tomfohr-Madsen, Lianne; Giesbrecht, Gerald F.Abstract Background The gut microbiota is recognized as a regulator of brain development and behavioral outcomes during childhood. Nonetheless, associations between the gut microbiota and behavior are often inconsistent among studies in humans, perhaps because many host-microbe relationships vary widely between individuals. This study aims to stratify children based on their gut microbiota composition (i.e., clusters) and to identify novel gut microbiome cluster-specific associations between the stool metabolomic pathways and child behavioral outcomes. Methods Stool samples were collected from a community sample of 248 typically developing children (3–5 years). The gut microbiota was analyzed using 16S sequencing while LC-MS/MS was used for untargeted metabolomics. Parent-reported behavioral outcomes (i.e., Adaptive Skills, Internalizing, Externalizing, Behavioral Symptoms, Developmental Social Disorders) were assessed using the Behavior Assessment System for Children (BASC-2). Children were grouped based on their gut microbiota composition using the Dirichlet multinomial method, after which differences in the metabolome and behavioral outcomes were investigated. Results Four different gut microbiota clusters were identified, where the cluster enriched in both Bacteroides and Bifidobacterium (Ba2) had the most distinct stool metabolome. The cluster characterized by high Bifidobacterium abundance (Bif), as well as cluster Ba2, were associated with lower Adaptive Skill scores and its subcomponent Social Skills. Cluster Ba2 also had significantly lower stool histidine to urocanate turnover, which in turn was associated with lower Social Skill scores in a cluster-dependent manner. Finally, cluster Ba2 had increased levels of compounds involved in Galactose metabolism (i.e., stachyose, raffinose, alpha-D-glucose), where alpha-D-glucose was associated with the Adaptive Skill subcomponent Daily Living scores (i.e., ability to perform basic everyday tasks) in a cluster-dependent manner. Conclusions These data show novel associations between the gut microbiota, its metabolites, and behavioral outcomes in typically developing preschool-aged children. Our results support the concept that cluster-based groupings could be used to develop more personalized interventions to support child behavioral outcomes. Video Abstract
- ItemOpen AccessCorrection: Building Emotional Awareness and Mental Health (BEAM): study protocol for a phase III randomized controlled trial of the BEAM app-based program for mothers of children 18–36 months(2022-09-30) Xie, E. B.; Simpson, Kaeley M.; Reynolds, Kristin A.; Giuliano, Ryan J.; Protudjer, Jennifer L. P.; Soderstrom, Melanie; Sauer-Zavala, Shannon; Giesbrecht, Gerald F.; Lebel, Catherine; Mackinnon, Anna L.; Rioux, Charlie; Penner-Goeke, Lara; Freeman, Makayla; Salisbury, Marlee R.; Tomfohr-Madsen, Lianne; Roos, Leslie E.
- ItemOpen AccessDesign and Evaluation of a Brief Motivational Intervention to Promote Enrolment in Outpatient Cardiac Rehabilitation: A Mixed-Methods Feasibility Study(2017) Rouleau, Codie R; Campbell, Tavis S.; King-Shier, Kathryn M; Tomfohr-Madsen, Lianne; von Ranson, Kristin M; Russell-Mayhew, Michelle K; Oh, Paul IObjective: Patients who are referred to exercise-based cardiac rehabilitation (CR) following an acute coronary syndrome (ACS) event stand to benefit from a range of positive CR-related outcomes, including reduced morbidity and mortality. Yet, only 19-34% of eligible patients participate in CR in the United States and Canada. Motivational interviewing could be useful for encouraging CR enrolment, but empirical support does not exist. Research that examines patients’ decision-making about CR enrolment is needed to inform effective motivational intervention in this context. Methods: A two-part study was conducted to design and evaluate a brief motivational intervention to enhance intention to attend a 12-week CR program. Part 1 involved a qualitative examination of decision-making about CR enrolment using semi-structured interviews with ACS patients following CR referral but prior to enrolment (n = 14). A brief motivational intervention was subsequently designed to target obstacles to CR identified by patients in Part 1. Part 2 involved a two-group randomized controlled trial to examine preliminary efficacy and mechanisms of the intervention, using a usual care control group (n = 96). The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, CR barriers, self-efficacy, illness perception, social support, CR enrolment/adherence, and intervention acceptability. Results: Thematic analysis of qualitative data in Part 1 suggested the intervention should aim to bolster anticipated benefits of CR; assist patients in overcoming concerns about exercise, transportation, finances, and scheduling; and address contextual variables such as emotional distress and knowledge gaps. Randomization to the motivational intervention was associated with greater intention to attend CR (p = .001), greater perceived necessity of CR (p = .036), lower exercise concerns (p = .011), and higher CR adherence (p = .008), compared to usual care. Conclusions: Results provide preliminary evidence for the efficacy of a brief motivational intervention to enhance intention to attend CR. Implementing strategies that enhance the perceived necessity of CR and reduce exercise concerns may help improve adherence to CR following an ACS event. This body of work will help optimize efforts to promote participation in an under-utilized, cost-effective program that significantly improves ACS outcomes.
- ItemOpen AccessEarly Life Circadian Rhythm Disruptions Alters Brain and Behavior in Adulthood(2021-08-25) Ameen, Rafal Wafer; Antle, Michael; Dyck, Richard; Tomfohr-Madsen, LianneChildren typically sleep much more than adults, and sleep in infancy and childhood is thought to play an important role in brain and cognitive development. However, the problem with examining poor sleep in toddlers is that sleep quality is often confounded with other factors such as socioeconomic status, quality of housing, and fragmented family structure. Therefore, the aim of this study is to investigate sleep and circadian rhythm disruptions during postnatal period on behavior in adulthood using an animal model (C57B/6 mice) where it is possible to disentangle these various confounding factors. In particular, the current study is examining the consequences of early life circadian disruption on executive functioning and circadian rhythmicity in adulthood. In the first phase of the study, sleep/wake rhythms were impaired with disrupting light-dark cycle imposed the day of birth until weaning. At around 3 months of age, animals were evaluated on executive functioning (i.e., series of behavioral tests to assess anxiety level, spatial memory, and working memory), circadian rhythmicity, and neural complexity in key brain areas. Results suggest that early life circadian disruptions impair executive functioning, and neural complexity in key areas of the brain later in life. Circadian rhythms in adulthood do not appear to be affected by early life circadian disruption. In humans, sleep disruptions in early life is often confounded with other detrimental factors like environment or socioeconomic status. Here we provide evidence that early life sleep disruption, independent of such confounding factors, is sufficient to affect brain development and impair cognitive functions.
- ItemOpen AccessEvaluation of the Associations between Prenatal Cannabis Use and Infant Developmental Outcomes at 12 Months of Age(2023-08-29) Watts, Dana; Tomfohr-Madsen, Lianne; Chaput, Kathleen; Hill, Matthew; Lebel, CatherineDespite warnings from governing health bodies advising against using cannabis products during preconception, pregnancy, and breastfeeding, cannabis continues to be commonly consumed by pregnant individuals. Past research has found associations between children exposed to cannabis prenatally and adverse childhood development outcomes; however, some of these studies fail to control for important confounding variables, and many are becoming outdated. Using data from the Pregnancy During the Pandemic cohort, the current project evaluated prenatal cannabis use and its association with increased risk of developmental delay across five domains: communication, gross motor, fine motor, problem-solving, and personal social skills. In addition, the association between prenatal cannabis use, birth weight, and instances of preterm birth is explored, and sociodemographic differences between cannabis users and non-users are described. Using multiple linear regression analysis, no significant associations were found between prenatal cannabis use and greater risk of infant development delay in any domain (ps > .05). Prenatal cannabis use was not associated with greater instances of preterm birth or lower birth weight. Cannabis users and non-users significantly differed on all measured sociodemographic variables.
- ItemEmbargoFear of Cancer Recurrence Experienced by Pediatric Survivors of Childhood Cancer(2024-03-14) Russell, Karleen Brooke; Tomfohr-Madsen, Lianne; Schulte, Fiona; von Ranson, Kristin; Guilcher, Greg; McDonough, Meghan; Galica, JacquelineIntroduction: Fear of cancer recurrence (FCR) is a common and sometimes debilitating concern among survivors of cancer. While much is known about FCR experienced by adults, research exploring FCR experienced by children and adolescents has only begun to emerge. Importantly, given the dynamic development of cognitive and social factors throughout childhood, pediatric survivors may experience FCR differently than adults. Method: A scoping review was undertaken to evaluate the existing literature on pediatric FCR. Additionally, given the absence of available tools to measure pediatric FCR, the psychometric properties of an adult FCR measure, the Cancer Worry Scale, was evaluated in a pediatric sample. Results: The scoping review identified 19 studies that met inclusion criteria. FCR was explored as a primary aim in only six. The prevalence of FCR in identified samples ranged from 43% to 90%. FCR was positively associated with somatic symptoms and negatively associated with quality of life and emotional functioning. Evaluation of the Cancer Worry Scale demonstrated acceptable psychometric properties for use with youth but pointed towards the utility of developing a new FCR measure intended specifically for use with youth. Conclusion: FCR is a prevalent and important concern for this population. Additional research is needed to better characterize and understand pediatric FCR.
- ItemOpen AccessInsomnia Treatment Preferences of Expectant Couples(2016) Sedov, Ivan; Tomfohr-Madsen, Lianne; Campbell, Tavis; von Ranson, Kristin; Este, DavidClient 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.
- ItemOpen AccessInvestigating relationships between psychological distress and hypertensive disorders of pregnancy(2021-12) Shay, Matthew; Tomfohr-Madsen, Lianne; Campbell, Tavis; Giesbrecht, Gerald; Dumanski, Sandra; Ditto, BlaineBackground: 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.
- ItemOpen AccessMindfulness-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, KaraPregnancy 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.
- ItemOpen AccessA Multi-Method Investigation of Factors Associated with Adherence to/Persistence with Adjuvant Endocrine Therapy in Breast Cancer Survivors to Inform Intervention Development(2021-08-31) Toivonen, Kirsti Ilona; Campbell, Tavis; Carlson, Linda; Tomfohr-Madsen, LianneIntroduction: Adjuvant endocrine therapy (AET) reduces risk of hormone receptor-positive breast cancer recurrence; however, adherence to AET is sub-optimal and prior attempts to improve this have been unsuccessful. This work aimed to better understand factors associated with AET use to inform the development of a behavioural intervention for AET adherence. Methods: A systematic review examined which potentially modifiable factors were most consistently associated with AET adherence. An observational study recruited 133 women to assess potentially modifiable factors associated with self-reported adherence at baseline and objectively measured adherence over 12 months. Finally, a qualitative study interviewed 47 individuals (women who persisted with, women who discontinued, and healthcare providers who manage AET) about factors supporting AET use. Thematic analysis was used to describe the data. Results: Results of the systematic review indicated that self-efficacy and positive decisional balance were most consistently associated with AET adherence. Results of the observational study indicated that side effect severity, then self-efficacy, and finally medication/healthcare-related barriers explained the most unique variance in self-reported adherence at baseline. Only medication/healthcare-related barriers explained unique variance in objectively measured adherence over 12 months. The qualitative study indicated that women who persisted with AET were prepared for side effects, and had effective management strategies, strong rationale for AET use, supportive HCPs, and available resources. Women who discontinued described feeling overwhelmed by side effects, information needs, drawbacks of AET, experiences with HCPs, and contextual factors as relevant to their discontinuation. HCPs described health system- and patient-related barriers, side effect management, and patient provider-interactions as relevant to supporting AET use. General Conclusion: Considering salient factors associated with AET use across the studies (e.g., self-efficacy, side effects) and potential utility of using theory to guide intervention development, social cognitive theory (SCT) was considered as a theoretical framework from which to conceptualize multiple influences on AET use. SCT could also guide selection of potential intervention components and guide understanding of potential mechanisms of change. Considerations for next steps in a phasic and iterative approach to developing an intervention to improve AET adherence are discussed.
- ItemOpen AccessNeighbourhood Socioeconomic Disparity in Exposure to Preterm Birth Risk During the Pandemic: Secondary Analysis of Pregnancy During the Pandemic Cohort(2023-09-17) Jung, Won Kyu; Tomfohr-Madsen, Lianne; Giesbrecht, Gerald; Chaput, KathleenBackground: Preterm birth (PTB) is defined as a live birth before 37 weeks of gestation and remains a major public health concern, affecting an estimated 15 million births annually with a global prevalence of 11%. Socioeconomic disparities play a crucial role in PTB rates, with both individual- and neighborhood-level factors contributing. Stress response pathway has been identified as a key mechanism in the relationship between neighborhood socioeconomic status (nSES) and PTB risk. As such, the new challenges added due to the COVID-19 pandemic, such as disruption to the support networks and increased psychosocial distress for pregnant individuals, were expected to increase PTB rates. However, studies found lack of change or even decrease in the incidence during this period. It is suggested that such counter intuitive findings are due to lack of consideration for the differential exposure to the pandemic-related hardships based on nSES. Therefore, the primary aim of the present study is to test whether a measure of objective pandemic hardship and psychological distress mediate the relationship between nSES and PTB. Methods: Present study is a secondary analysis of the data collected from a prospective longitudinal cohort study, Pregnancy during the Pandemic (PdP). Two serial mediation path models with a measure of baseline objective pandemic hardship and psychological distress included as mediators between nSES and PTB/gestational age (GA) were tested. Results: In both models, the main indirect pathway of interest from nSES to pandemic objective hardship, psychological distress, then PTB/GA was non-significant with minimal effect. Secondary indirect pathway of interest from pandemic objective hardship to psychological distress then PTB/GA was significant in both models while controlling for months into the pandemic at birth and baseline sociodemographic characteristics. Discussion: The present paper is the first to test a comprehensive model of the role of nSES on PTB risk with an explicit measure of pandemic objective hardship and psychological distress included as mediators. While the main indirect serial mediation pathway was non-significant, partial support for the proposed mechanism was observed where increase in pandemic-related hardship elevated psychological distress, which then heightened the risk of PTB risk and shortened gestational age at birth.
- ItemOpen AccessNeural Correlates of Adolescent Mindfulness, Working Memory, and Internalizing Symptoms(2020-08) Stein, Jade Aurelie; Kopala-Sibley, Daniel C.; MacMaster, Frank P.; Bray, Signe L.; Tomfohr-Madsen, LianneThe central aim of this thesis was to investigate behavioural and neural associations between dispositional mindfulness, working memory, and internalizing symptoms in adolescents. One hundred and thirty-one adolescents, aged 11-18 (M = 13.76, SD = 1.65), who had a parent with a history of mood or anxiety disorders completed measures of dispositional mindfulness, internalizing symptoms, and working memory, including a functional Magnetic Resonance Imaging (fMRI) N-Back task. Hierarchal regressions and correlation analyses were performed. The blood oxygen level dependent (BOLD) signal was contrasted between 2-back versus 0-back conditions and a small volume correction was computed in the dorsolateral and ventrolateral prefrontal cortex (dlPFC, vlPFC) and the anterior cingulate cortex (ACC). Controlling for neuroticism, sex, and mindfulness experience, higher adolescent dispositional mindfulness, including higher self-acceptance and the interaction between attention and awareness and nonreactivity, related to fewer internalizing symptoms. Endorsement of attention and awareness was associated with better 2-back efficiency, except when controlling for mindfulness experience. Internalizing symptoms related to slower reaction time, controlling for sex. Significantly less BOLD signal in the right vlPFC was observed in adolescents with higher attention and awareness scores when controlling for mindfulness experience. Self-acceptance and nonreactive observing (attention and awareness x nonreactivity) may be unique components of mindfulness that have implications for adolescent internalizing symptoms. Adolescents with higher attention and awareness may require less cognitive effort when performing working memory tasks. Learning to be mindful on a daily basis may be beneficial for adolescent cognition and emotional well-being.
- ItemOpen AccessPersistent Effects of Paediatric Mild Traumatic Brain Injury: The Role of Resilience(2016) Laliberté, Christianne; Yeates, Keith; Brooks, Brian; Tomfohr-Madsen, Lianne; Goghari, VinaObjective. This study examined the relationship of multiple mild traumatic brain injuries (mTBIs) and psychological resilience to persistent post-concussion symptoms (PCS). Methods. Participants (N = 65), ages 8-18 years, who sustained multiple mTBIs (n = 24), a single mTBI (n = 22), or an orthopaedic injury (OI; n = 19) were recruited from a children’s hospital in Calgary, Alberta. Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC) and PCS were measured using the Post-Concussion Symptom Inventory (PCSI). Results. The multiple mTBI group and low psychological resilience were significant predictors of PCS. Conclusions. Sustaining multiple mTBIs may increase a child’s risk of persistent PCS; however, high psychological resilience may serve as a protective factor, regardless of the number of injuries a child sustains. Results of this study provide support for interventions aimed at increasing psychological resilience in order to improve outcomes for children suffering from persistent PCS after mTBI.