Date on Master's Thesis/Doctoral Dissertation

8-2018

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Meeks, Suzanne

Committee Co-Chair (if applicable)

Wright, Jesse

Committee Member

Wright, Jesse

Committee Member

Lewine, Richard

Committee Member

Mast, Benjamin

Committee Member

DeCaro, Daniel

Author's Keywords

depression; clinical decisions; screening; barriers; older adults; primary care

Abstract

Purpose of the Study: The purpose of this study is examine the influence of barriers on clinicians’ decisions to screen for depression in older adults or to refer to other health professionals. A second purpose is to explore how well the Theory of Planned Behavior is supported as a framework for understanding the likelihood of screening for depression and how the variables within the theory interact with barriers to affect clinician behavior. A final purpose is to explore characteristics of depression screening or referral of older adults by several clinical disciplines. Design and Methods: This study featured a cross-sectional survey design with experimental manipulation of vignettes. A 4-way mixed ANOVA explored the effects of clinical discipline (between subjects) and time pressure, patient difficulty, and level of symptoms (within subjects) on likelihood of screening and likelihood of referral. The Theory of Planned Behavior factors attitudes, norms, and perceived behavioral control were used as potential covariates. Clinical graduate students were recruited locally and nationally to take an online survey that presented participants with 8 vignettes which fully crossed the within-subjects factors. Vignettes were presented to each participant in a random order; respondents rated their likelihood of five clinical decisions, two of which were the dependent variables of interest. Results: 229 graduate students in medicine (n = 83), psychology (n = 51), nursing (n = 49), and social work (n = 46) completed a clinical decision-making survey. For likelihood of screening, there were significant main effects of time pressure and level of symptoms, but no main effects of patient difficulty or clinical discipline. There was a significant 3-way interaction between discipline, patient difficulty, and symptom level that was driven by social work graduate students’ greater likelihood of screening for depression when there were more symptoms present, a difference that was less prominent if the patient was being difficult than for non-difficult patients. There was also a 2-way interaction between patient difficulty and level of symptoms. Time pressure, patient difficulty, and level of symptoms all had an effect on likelihood of referral to another health professional. The clinical disciplines differed in their ratings of attitudes, norms, and perceived behavioral control of screening for depression. Implications: The study holds implications for identifying and addressing gaps in education and training on depression and how to screen for it, as well as how to minimize the effects of potential barriers. Several interventions could be implemented addressing goals and self-efficacy of screening, time management, behavior management skills, and more effective ways of screening. The TPB serves as a good framework for understanding the likelihood of screening, with attitudes and norms being the strongest contributors across all disciplines.

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