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Open Access Publications from the University of California

Scholarly Works (17 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2025)

Background: Major Depressive Disorder (MDD) affects approximately 300 million people worldwide. Despite available treatments, many patients do not achieve full recovery with traditional antidepressants, and others lack access to evidence-based care. Esketamine, a glutamatergic agent approved for treatment-resistant depression, and mindfulness meditation represent promising approaches for depression care that may improve neuroplasticity. The neuroplasticity theory of depression posits that reduced neural plasticity contributes to MDD development, with both esketamine and mindfulness potentially addressing this deficit.

Objectives: This quality improvement project aimed to implement and evaluate the feasibility and efficacy of adding mindfulness meditation to esketamine treatments for patients with MDD, with the goal of improving depression outcomes.

Methods: A quasi-experimental pilot was conducted at an outpatient psychiatric clinic with 19 participants (10 in mindfulness plus esketamine group, 9 in usual care esketamine-only group). Outcome measures included changes in depressive symptoms using the Patient Health Questionnaire-8 (PHQ-8), mindfulness domains of self-compassion and acting mindfully using Five Facet Mindfulness Questionnaire-Short Form (FFMQ-SF) subscales, and Hope, Agency, and Opportunity (HAO) scores. The intervention consisted of structured mindfulness meditations during esketamine treatments. Data were analyzed using t-tests, regression modeling, and Pearson’s r correlations.

Results: Patients receiving the mindfulness adjunct had significantly greater PHQ-8 score reductions (4.70 points) compared to the usual care group (1.00 point; p = .014), with a large effect size (Cohen’s d = 1.27). Within the mindfulness group, self-compassion scores significantly increased (p < .01) and were strongly correlated with PHQ-8 score improvements (r = -0.71, p = .032). Both groups showed excellent treatment adherence. All mindfulness group participants reported satisfaction with the intervention.

Conclusion: Adding mindfulness meditations to esketamine treatments provided clinically meaningful improvements in depressive symptoms compared to esketamine alone. The strong correlation between increased self-compassion and depression symptom reduction highlights a potential mechanism for this effect. This feasible, well-received intervention offers a promising approach to enhance outcomes for patients with MDD undergoing esketamine treatment. Future research should examine optimal timing, duration, and long-term benefits of this integrative approach.

    Cover page: Mindfulness Meditation as an Adjunct to Esketamine Treatment for Major Depressive Disorder
    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2024)

    BackgroundEmergence delirium is an adverse reaction when awakening from anesthesia, defined as an abnormal mental state of restlessness, confusion, and possible combativeness. Emergence delirium occurs in approximately 5% of the general population, but it is more common and problematic in patients with a history of Post-Traumatic Stress Disorder (PTSD). Emergence delirium can lead to significant patient and staff injury and adverse patient outcomes, but many perioperative nurses lack training in best practices for the management of emergence delirium. Objectives To educate perioperative nurses on the identification and management of emergence delirium among patients with post-traumatic stress disorder (PTSD). Methods Perioperative nurses at three healthcare institutions were invited to participate in a 60-minute education intervention, including a simulation, to introduce evidence-based practices when caring for patients diagnosed with PTSD who experience emergence delirium. Participants completed a knowledge assessment and a self-reported confidence measure collected via Qualtrics electronic survey before and after the educational intervention and six weeks post-intervention. Bivariate tests were used to assess pre/post change in learning outcomes, and repeated measures ANOVA was used to examine retention of learning over time. Results Perioperative nurse participants (n= 36) at three hospitals participated in the intervention. Participants were predominantly women (81.8%) whose ages ranged from 18 to 64 years. Perioperative nurses most commonly worked in peri-anesthesia settings. Nurses who participated in the intervention demonstrated a pre/posttest increase in knowledge levels from 65.2% to 89.1% (p<.001) and confidence levels from 6.07 to 8.09 on a 10-point scale (p<.001), respectively. Knowledge and confidence gains were sustained at a six-week follow-up. Conclusion A brief educational intervention can raise nurses' awareness of the serious complication of emergence delirium and high-risk populations and increase their knowledge and confidence levels when caring for this patient population. KEY WORDS: Posttraumatic Stress Disorder, PTSD, Emergence Delirium, Evidence-Based Practices, Perioperative Nurses, Education

      Cover page: Evidence-Based Practices for Managing Emergence Delirium in Patients Diagnosed with PTSD: Pilot Evaluation of a Nursing Education &amp; Simulation Program
      • Thesis
      • Peer Reviewed
      UCLA Electronic Theses and Dissertations (2025)

      Background: Depression is the leading cause of disability worldwide, disproportionately affecting women during the perinatal period. Despite evidence supporting Interpersonal Psychotherapy (IPT) as an effective treatment for perinatal depression, access to IPT remains limited in routine care.

      Objectives: This project aimed to implement a nurse-led, virtual group IPT intervention for perinatal women with depressive and anxiety symptoms, compare it to individual IPT, and evaluate changes in mood symptoms, perceived social support, and patient satisfaction.

      Methods: Conducted at the UCLA Health Maternal Outpatient Mental Health Services Clinic, this quality improvement project recruited 18 perinatal women experiencing depression or anxiety. Participants chose to engage in either virtual group or individual IPT sessions over nine weeks, with optional in-person final sessions for the group. Outcome measures included the Beck Depression Inventory-II, GAD-7, and Duke-UNC Functional Social Support Questionnaire, analyzed using paired and independent t-tests, as well as correlation analyses.

      Results: Both group and individual IPT participants experienced significant reductions in depressive and anxiety symptoms post-intervention. Depression scores decreased by an average of 10.2 points, and anxiety scores by 5.9 points across the total sample. Although individual IPT participants showed slightly higher gains in perceived social support, differences between group and individual formats were not statistically significant. Qualitative feedback indicated high satisfaction with the IPT intervention, highlighting improvements in emotional support and interpersonal relationships.

      Conclusion: Nurse-led IPT, delivered virtually in group or individual formats, is feasible, acceptable, and effective in improving mood and anxiety symptoms among perinatal women. These findings support integrating nurse-led IPT into perinatal care to address mood disorders and enhance social support, with future efforts focusing on tailoring IPT to the specific interpersonal challenges of the perinatal period and scaling up access through hybrid care models

        Cover page: Nurse-led Interpersonal Psychotherapy (IPT) For Perinatal Women with Mood and Anxiety Symptoms
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2020)
        BACKGROUND:Older adults complete suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. METHODS:This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were [1] total number of gun laws to assess for impact of overall firearm legislation at the state level, and [2] GVRO laws. RESULTS:The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults ages 55-64 and > 65 years-old (p < 0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. CONCLUSION:Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.
          Cover page: The impact of gun violence restraining order laws in the U.S. and firearm suicide among older adults: a longitudinal state-level analysis, 2012–2016
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2022)

          Introduction

          This study aimed to compare phone, email, or text message recruitment strategies for engaging parents of autistic children in an online survey.

          Method

          In this randomized study, a sample of 1,624 parents of autistic children spectrum disorder (autism) from an integrated health system in Southern California were sent an initial mailed letter and email simultaneously for baseline survey outreach. Then, participants were randomly assigned to one of three follow-up recruitment groups: phone, email, or text message. We compared the efficacy of recruitment strategies in multivariate models.

          Results

          All three follow-up methods were equally effective for eliciting a survey response. Parents of girls were less likely to respond to survey outreach attempts than parents of boys.

          Discussion

          Multiple modalities of survey recruitment, including digital and mobile approaches, effectively recruit parents of children in research.
            Cover page: Randomized Study of Survey Recruitment Strategies for Parents of Autistic ChildrenCreative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2024)
            To investigate the relationship of predisposing, enabling, need, and immigration-related factors to tele-mental health services utilization among California adults, we conducted a secondary analysis of two waves of the California Health Interview Survey (CHIS) collected between 2015 and 2018 (N = 78,345). A series of logistic regression models were conducted to examine correlates and predictors to tele-mental health services use. Approximately 1.3% reported the use of tele-mental health services. Overall, health insurance status, severe psychological distress, perceived need for mental health services, and identifying as Asian, remained strong predictors for tele-mental health service use. When accounting for all factors, we found that being a non-citizen was associated with lower odds of tele-mental health service use (AOR = 0.47, CI = 0.26, 0.87, p < 0.05). These findings suggest that citizenship, resources to access, and perceived need for mental health care collectively are the most significant factors driving the use of tele-mental health services. There is a need to address inequitable access to tele-mental health services among immigrants who do not qualify for healthcare coverage due to citizenship status.
              Creative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2021)

              Background

              The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet, how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies.

              Methods

              We analyzed the network of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010-2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state's firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms.

              Results

              Over the 8-year period, states had an average of 26 (Standard Deviation [SD] 25.2) firearm laws. On average, a state was the source of 100 or more crime-related firearms for 2.2 (SD 2.7) states and was the destination of 100 or more crime-related firearms for 2.2 (SD 3.4) states. Greater number of firearm laws was associated with states being the source of 100 or more firearms to fewer states (Incidence Rate Ratio [IRR] 0.58 per SD, p < 0.001) and being the destination of 100 or more firearms from more states (IRR1.73 per SD, p < 0.001).

              Conclusions

              Restrictive state-level firearm policies are associated with less movement of firearms to other states, but with more movement of firearms from outside states. The effectiveness of state-level firearm-restricting laws is complicated by a network of interstate firearm movement.
                Cover page: Firearm laws and the network of firearm movement among US statesCreative Commons 'BY' version 4.0 license
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2022)

                Background

                Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes.

                Purpose

                The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder.

                Methods

                This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite.

                Results

                There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period.

                Conclusions

                In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.
                  Cover page: Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autismCreative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2019)
                  The purpose of this exploratory subanalysis was to compare the effects of two depression quality improvement approaches on clinical outcomes and service utilization for individuals with comorbid depression/anxiety. This study used data from Community Partners in Care (CPIC), a cluster-randomized comparative effectiveness trial (N = 1,018; depression = 360; comorbid depression/anxiety = 658). Each intervention arm received the same quality improvement materials, plus either technical support (Resources for Services, RS) or support for collaborative implementation planning (Community Engagement and Planning, CEP). For the comorbid depression/anxiety subgroup, the collaborative planning arm was superior at improving mental health-related quality of life and mental wellness, as well as decreasing behavioral hospitalizations and homelessness risk at 6 months. The effects were not significant at 12 months. A collaborative planning process versus technical support for depression quality improvement can have short-term effects on mental wellness and social determinants of health among those with comorbid depression/anxiety.
                    Cover page: A Comparative Effectiveness Trial of Depression Collaborative Care: Subanalysis of Comorbid Anxiety
                    • Article
                    • Peer Reviewed
                    UCLA Previously Published Works (2022)

                    Objective

                    The purpose of this study was to investigate whether service losses during the coronavirus disease 2019 (COVID-19) pandemic were associated with worsened parent mental health or child behavioral health among families of children with autism spectrum disorder and to identify factors associated with favorable parent appraisals of habilitative teletherapy (applied behavior analysis; speech, occupational, physical therapy) for their child.

                    Method

                    This web-based survey study was conducted from May to July 2021 with parents whose children were receiving habilitative therapy for autism from an integrated health system. A total of 322 parents responded to the survey (20% response rate). The outcome variables were pandemic-related parent mental health, pandemic-related child behavioral health, and appraisal of habilitative teletherapy. Predictors were COVID-19-related services changes in health care or child care, COVID-19 history (COVID-19 stress, testing positive for COVID-19), and child autism factors (autistic behaviors, caregiving strain).

                    Results

                    Loss of regular child care was associated with higher odds of worsened parent mental health (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.5-4.8); higher levels of caregiving strain were associated with worsened child behavioral health (OR = 2.3, 95% CI = 1.4-3.8). Higher levels of COVID-19 stress were associated with more favorable appraisals of telehealth (β = 0.4, p < 0.01), whereas higher caregiving strain scores were associated with less favorable appraisals of telehealth (β = -0.2, p < 0.01).

                    Conclusion

                    During COVID-19, caregiving factors were associated with worsened parent mental health and worsened child behavioral health, and telehealth is not preferred by all families. Policy interventions to support caregivers, such as affordable, high-quality child care and paid family leave, are a high priority.
                      Cover page: Habilitative Teletherapy for Children with Autism Spectrum Disorder: A Survey of Parents
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