Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Public Health Services

Committee Chair/Advisor

Dr. Lu Shi

Committee Member

Dr. Heidi Zinzow

Committee Member

Dr. Moonseong Heo

Committee Member

Dr. Sara Wagner Robb


Prevention efforts in the public health field operate at various levels, including primary prevention among those without a disease of interest, secondary prevention among persons at high risk or showing early signs of the disease, and tertiary prevention among persons with the disease. The three essays presented in this dissertation are centered around the theme of prevention, and taken together, have implications for prevention at the primary, secondary, and tertiary levels. Specifically, the essays focus on the prevention of depressive disorders and the prevention of behavioral and mental health correlates for depression in the context of various populations (general adult, aging, and sedentary) in the United States (US). Depression is one of the most common mental health disorders that affects the quality of life of individuals and is associated with increased mortality risk and increased healthcare utilization. Therefore, the first essay focuses on estimating the economic burden of depressive disorders in terms of incremental all-cause healthcare expenditures in the general adult population in the US. The purpose of the study is to support evidence-based decision making about whether channeling more resources for the screening and treatment of depression is an investment in terms of reducing the burden of managing overall health which is reflected in all-cause healthcare expenditures. This purpose relates to the goal of prevention at the secondary and tertiary levels. The second essay focuses on assessing the value of complementary health practices such as meditation and breathing exercises on changes in depression outcomes at two-year follow-up in an aging population. If found to be effective, these practices could be promoted to help improve access to prevention measures while at the same time help reduce the burden of depression on the healthcare system by facilitating self-management of symptoms. A variety of meditation-based therapy options are available for the prevention and treatment of mental and behavioral disorders. But there is a need for more research to help understand the effectiveness of the available options for the targeted outcomes. Therefore, the third essay presents findings from a pilot trial that examines the efficacy of a specific type of meditation intervention among sedentary individuals for improving physical activity and sleep quality which are correlated with depression. Overall, the value of this research is in quantifying the extent of the burden that having depressive disorders, especially when unrecognized, can add to the healthcare system and providing direction for intervention efforts to help those in need of treatment for depressive disorders. Also, this research contributes to the evidence base about sustainable options for the prevention of depressive disorders and behavioral risk factors for depression.

Author ORCID Identifier




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