Date of Conferral

8-12-2026

Date of Award

August 2026

Degree

Ph.D.

School

Psychology

Advisor

Benita Stiles-Smith

Abstract

Treatment-resistant depression (TRD) affects approximately 30% of individuals with major depressive disorder who do not respond to conventional antidepressant therapies. TRD symptoms severely impact a patient’s quality of life (QoL) and impose a considerable burden on healthcare systems. The purpose of this quantitative study was to evaluate the impact of esketamine in decreasing depressive symptoms and improving QoL factors in patients diagnosed with TRD. The research aimed to determine whether there were statistically significant improvements in depressive symptoms, as measured by the Patient Health Questionnaire-9, and changes in QoL, as measured by the Quality of Life in Depression Scale, over the course of 8 weeks of esketamine treatment. Grounded in the Rasch measurement theory and the biopsychosocial model, this study employed a quasi-experimental within-subjects repeated-measures design to examine patterns of change at baseline, Week 4, and Week 8, with the theoretical frameworks guiding a focus on patient-centered care and meaningful change from the individual’s perspective. The final sample consisted of eight participants who completed all required assessment time points. Parametric analyses were conducted using repeated-measures analysis of variance with Bonferroni-adjusted pairwise comparisons, and nonparametric analyses were used to support interpretation of findings. Results indicated that depressive symptoms decreased and QoL increased across the esketamine treatment period. Implications for positive social change include reduction of healthcare resources and reduction in social and economic burdens, promoting better outcomes for individuals with TRD.

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