A Longitudinal Study of Depressive Symptoms, Neuropsychological Functioning, and Medical Responsibility in Youth With Spina Bifida: Examining Direct and Mediating Pathways
A Longitudinal Study of Depressive Symptoms, Neuropsychological Functioning, and Medical Responsibility in Youth With Spina Bifida: Examining Direct and Mediating Pathways
复制标题
DOI：
10.1093/jpepsy/jsy007
复制
发表时间：
2018-09-01
影响因子：
3.6
通讯作者：
Holmbeck, Grayson N.
中科院分区：
文献类型：
--
作者：
Stern, Alexa;Driscoll, Colleen F. Bechtel;Holmbeck, Grayson N.
目的考虑到脊柱裂（SB）青少年认知功能障碍和抑郁症状发生的风险增加，本研究旨在探讨抑郁症状和神经心理功能障碍与该人群医疗自主性的两种途径：（1）抑郁症状作为由注意力/执行功能介导的医疗自主性的预测因子（认知疤痕模型），（2）注意力/执行功能作为抑郁症状介导的医疗自主性的预测因子（认知脆弱性模型）。方法参与者被招募作为一个更大的纵向研究的一部分，包括114名青年SB（M年龄= 10.96在时间1），他们的父母，和教师。神经心理学结构包括注意力、工作记忆和计划/组织能力，这些能力通过问卷和基于绩效的数据进行测量。抑郁症状和医疗责任通过多个受访者的问卷调查进行了评估。结果自举中介分析显示，教师报告的抑郁症状显著介导了神经心理功能（即，注意力和工作记忆）和医疗责任（所有P < .05）;神经心理功能障碍并没有介导抑郁症状和医疗责任之间的关系。结论神经认知功能障碍可能阻碍SB青年患者医疗自主性发展的一种方式是增加抑郁症状的风险。
Objective Given the increased risk for cognitive deficits and development of depressive symptoms in youth with spina bifida (SB), this study aimed to examine two pathways through which depressive symptoms and neuropsychological dysfunction may be associated with medical autonomy in this population: (1) depressive symptoms as predictors of medical autonomy as mediated by attention/executive functioning (the cognitive scarring model), and (2) attention/executive functioning as predictors of medical autonomy as mediated by depressive symptoms (the cognitive vulnerability model). Methods Participants were recruited as part of a larger, longitudinal study, and included 114 youth with SB (M age = 10.96 at Time 1), their parents, and teachers. Neuropsychological constructs included attention, working memory, and planning/organizing abilities, which were measured with questionnaire and performance-based data. Depressive symptoms and medical responsibility were assessed via questionnaires from multiple respondents. Results Bootstrapped mediation analyses revealed that teacher-reported depressive symptoms significantly mediated the relations between neuropsychological functioning (i.e., attention and working memory) and medical responsibility (all p's < .05); neuropsychological dysfunction did not mediate the relationship between depressive symptoms and medical responsibility. Conclusions One way in which neurocognitive dysfunction may hinder the development of medical autonomy in youth with SB is through an increased risk for depressive symptoms.