The research contained in this thesis was concerned with the parental care afforded to children and the effect of that parenting on the child's self-concept in relation to the aetiology of major depressive disorder (MDD). It was based upon psychoanalytic and cognitive theories of depression, which implicate negative relationships with significant others in childhood as of aetiological importance in MDD. Both schools also argue that this link is mediated by negative self-beliefs which a child develops as a consequence of such relationships. An attempt was made to identify, firstly, which aspects of parenting style are associated with such depression and, secondly, whether low self-esteem acts as a vulnerability factor for MDD. A measure of 'self-concept' was also created to test whether the way in which an individual thinks about themselves occupies a distinct role in the aetiology of MDD. A measure of neuroticism was taken in order to examine the role that this personality characteristic plays in relation to parenting and self-esteem. The main finding was that lack of maternal care was indirectly associated with MDD via 'selfconcept' and self-esteem, with the former preceding the latter in a hypothesised temporal order. A further indirect link was found between high levels of paternal overprotection and depression; this link being mediated, firstly, by self-esteem and, secondly, by neuroticism. It is suggested that there may be two separate routes to MDD and that these routes may be based upon 'sociotropic' and 'autonomy' schemas. The main suggestion, however, is that low levels of maternal care lead to the development of a sociotropic depressogenic schema and that this schema represents a vulnerability to depression. It is suggested that this schema will only lead to depression, however, if an individual experiences a schema relevant negative life-event which lowers self-esteem and sets up a cyclical process culminating in major depressive disorder.

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published_or_final_version / Public Administration / Master / Master of Social Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

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The TC program, designed to decrease preventable readmissions and support patients who have chronic illnesses including HF, at BUMCP has had a low referral rate. This low referral rate results in the program being unable to make an impact to decrease readmission rates in the HF population and increase quality of life among this patient population. The purpose of this project was to identify current barriers to referral and develop interventions directed at the identified barriers. An online survey was sent to a hospitalist group employed at BUMCP. Results revealed perceived barriers include decreased accessibility, limited number of accepted patient diagnoses, and lack of involvement in launch of TC. Recommended interventions include increased accessibility through 24 hours day, seven days week availability, abolishment of current accepted patient diagnoses, and implementation of Lewin's Change Theory to increase buy-in from physicians.

<p> Under the provision of the United States Department of Health and Human Services, the patient centered medical home is a model of primary care transformation that seeks to meet the variety of healthcare needs of patients and to improve patient and staff experiences, outcomes, safety, and system efficiency. Serving the medically underserved and primary care clinic shortage area of Long Beach, California, the Physically Active Centered Medical Home (PAC MH) will be a safe haven for healthy and physically active individuals who are required to avail of health insurance coverage as mandated by the Patient Protection and Accountable Care Act of 2010 (PPACA). PAC MH will offer comprehensive and integrated services that will keep its members healthy and away from the burden of repeated clinical visits. PAC MH understands that medical coverage is the least of the priorities for healthy adults. Hence, PAC MH&rsquo;s payment system is made simple. The value-based care provided at PAC MH will reward the healthcare team for achieving and exceeding the pre-established benchmarks for quality care.</p>

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