Thesis (M.Med.(Psychiatry))--University of the Witwatersrand, Faculty of Health Sciences, 2014. / The Luthando Neuropsychiatric HIV clinic was set up at Chris Hani Baragwanath Academic Hospital as an anti-retroviral roll out centre, specifically designed to provide anti-retroviral therapy to HIV positive patients with a psychiatric illness. Adherence to HIV treatment is essential for virological suppression, and non-adherence is a key factor in treatment failure. Research has suggested that psychiatric illness may negatively influence adherence to ART. Importantly, negative perceptions with regards to adherence may affect the decision to initiate ART in psychiatric patients. Attendance at clinic appointments is the first step in adherence, and has been found to be one of the most important predictors of medication adherence. Attendance at first clinic appointment is easily measurable in a limited resource setting, such as South Africa. The aim of this study was to examine the rate of attendance at the first clinic appointment post discharge from psychiatric hospitalization in HIV positive psychiatric patients initiated on ART as in-patients, and to determine which factors, if any may be related to clinic attendance. This study was a retrospective record review, conducted at Chris Hani Baragwanath Academic Hospital, at the Luthando clinic. Patients that were initiated on ART as psychiatric in-patients, 18 years to 65 years of age from 1st July 2009 to 31st December 2010 and then discharged for follow up as out-patients at Luthando clinic were included in the sample. The primary outcome was attendance at the clinic post discharge from hospital. Socioeconomic and clinical data were also recorded and analysed, comparing attendant and non-attendant P a g e | vi groups. The rate of attendance was 79.59%. There were a number of similarities between the attendant and non-attendant patients in terms of demographic and clinical data. The only significant difference between the attendant and non-attendant groups was disclosure of HIV status, and significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p = .01). Further research needs to quantify the significance of in-patient vs. out-patient initiation of ART, as well as to investigate the impact of a psychiatric diagnosis on attendance at ART clinics. Non-disclosure of HIV status needs to be further investigated and addressed in HIV treatment facilities in order to improve attendance.

Thesis advisor: Callista L. Roy / Purpose: The purpose of this research was to address the gap in the literature related to frail older adults' experience of participating in clinical trials. Background: Frail older adults are generally underrepresented in the population of research volunteers from which evidence-based guidelines are derived. To improve care for frail older adults, research must be expanded to specifically target this population. Most of the users of healthcare today are greater than 65 years old, use more health care services than any other age cohort and suffer from coexisting illnesses for which they take several prescribed medications. Since the number of elders is increasing within the general population, it is important to reach a more thorough understanding of frail older adults' experience. Acquiring a better understanding of their experience will give the investigator more insight into barriers of recruitment, retention, and factors affecting elders' decision to participate in research. Method: Using a qualitative descriptive approach involving semi-structured interviews, a cohort of participants age 65 and older was asked about their experience of participating in research studies. Data analysis used an interpretive paradigm involving the methods of Miles, Huberman, and Saldana (2014). Results: Participants identified the main factors influencing their decision to participate as the opinions and encouragement of family members with the strongest influence being a recommendation from their doctor. Participants were varied in the emotions evoked by their participation in the study procedures. The majority of participants stressed how important it was to them to receive feedback in the form of results of studies in which they had participated. The majority of participants stated that receiving feedback or research results was the exception. Conclusions: Data generated from this study related to the experience of frail elder participation in clinical trials will be useful in designing future clinical trials to be more inclusive of this patient population. Keywords: frail elders, research participation, clinical trials, chronic illness, qualitative, multmorbidity / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A Thesis submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements of the Degree of Doctor of Philosophy. Johannesburg, 2015 / Sensemaking is the process through which people construct meaning around issues or events that are novel, ambiguous, confusing, or in some regard run contrary to expectations. Drawing on key insights from the work of Karl Weick on sensemaking, the aim of this study was to explore how staff members and volunteers at a non-profit human service organisation make sense of and enact the idea of quality in their environments. The study employed an interpretive approach and took the form of a single-case holistic case study. Using thematic analysis, several themes emerged from the data, which suggest that in order to deconstruct the idea of quality, as it exists in the minds and behaviours of organisational members, it is critical to obtain insight into the social and context driven processes that influence sensemaking. The findings also suggest that existing models and approaches to quality in the literature are incomplete in terms of their lack of a sensemaking focus. Practical recommendations are made for human services organisation administrators and managers to improve and monitor quality in their respective environments. The study concludes with a discussion of limitations as well as possible avenues for future research in light of the findings

Aims: This study aims to explore the experience of osteoarthritis (OA) in older adults, drawing on concepts from the literature on chronic illness including social-cognition models (e.g. Self-Regulatory Model) and cognitive concepts (e.g. self-schema). Design and Participants: A qualitative research design and Phenomenological Interpretative Analysis Methodology were used. Sixteen participants were interviewed. Ten were recruited from an orthopaedic surgical waiting list source and six from a GP source: age ranged from 67 to 79 years, and history of osteoarthritis ranged from one to 35 years. Measures: A semi-structured interview schedule was designed and piloted, based on the research literature. Results: Analysis identified the following themes: Demands of OA (pain, impact on activity, and impact on mood); Perceptions ofOA (onset/deterioration, cause, label, seriousness, prognosis); Strategies to manage OA (use of health services, changes in behaviour, psychological strategies, appraisal of strategies); Perception of Self (compared to past/future/others) and Contextual factors (age, co-morbidity, waiting list). Links between themes were reciprocal, and a tentative model ofOA is presented. Implications: A comprehensive model of the experience of chronic illness could provide a framework to guide interventions for direct clinical interventions (e.g. adjustment to chronic illness, pain management, identification of psychological comorbidity) and indirect interventions (e.g. consultancy with other health professionals).

The methodologies of systems design, rooted in engineering and in cognitivist conceptions of human action, have been stretched to the limit by the complexity of uses to which information and communication technologies are being turned. Within segments of the broader design community there has been a `turn to the social' - a perception that there is a need now for richer stories about the everyday practices systems designers build tools to support. This thesis is presented as a contribution to the corpus of `richer stories' about the what, how, why, when and where of information gathering. The thesis presents findings from an ethnographic study of newsroom information gathering at a UK daily newspaper. Adopting an analytical perspective based upon cultural-historical activity theory (CHAT), it describes and analyses journalistic information gathering on two mutually constitutive levels; that of activity and that of artefact mediation. Its starting point is that neither information gathering, nor the artefacts of information gathering, can be understood without consideration of the social, cultural and historical contexts within which they are situated. Ethnographic data is drawn upon to argue that journalistic information gathering can only be understood within the particular context of the `story lifecycle'. Stories are the principal object of journalistic enterprise, and the thesis examines in detail how everyday working practices are oriented towards this lifecycle. Based on an analysis of the artefacts of newsroom information gathering, and of the discourses of information systems designers, it is also argued that the discourses of systems designers over-emphasise the importance of the category `information'. In particular it is argued that sources are how journalists orient themselves in the vast, heterogeneous information spaces they simultaneously inhabit and populate. The background to these discussions is the often controversial relationship between ethnography, theory and systems design. This relationship is examined and it is argued that the CHAT perspective provides design ethnographers with an opportunity to move from ethnographic intuition to design insight. It is also argued that at a more pragmatic level, CHAT helps the fieldworker navigate the apparently never-ending mass of `potentially interesting material' any field experience throws up.

Background and aims: Pain management programmes provide effective interventions for people with chronic pain, but effects are modest, and not all participants benefit. The current study aims to investigate the role of acceptance and cognitive representations i.e. beliefs about pain, in engagement, and outcome, of this kind of intervention. Design and participants: A quantitative design was used to investigate whether acceptance and cognitive representations of pain predict engagement and outcome of intervention, whether acceptance and cognitive representations change during intervention, and the relationship of acceptance with five dimensions of belief. Participants were 116 patients referred for assessment to a pain management programme. Measures Questionnaire measures of acceptance of pain, and cognitive representations of pain were used as predictor variables. Measures of distress, self-efficacy and physical function were used as outcome measures. Pain severity and waiting time were also measured as potentially confounding variables. Results: Measures of acceptance and cognitive representations of pain did not predict who would complete the intervention. Increases in acceptance, and decreases in perceived consequences of pain, and pain identity, occurred during the intervention. Lower acceptance was related to more serious perceived consequences and greater pain identity, but not with beliefs about cause or expected duration of pain, or beliefs in control and cure. Implications: Interventions aiming to increase acceptance by changing beliefs about perceived consequences of pain and pain identity may be useful. Further research is needed to explore the nature of acceptance, and the role of different dimensions of belief in affecting functioning, in chronic pain populations.

Digitized by Kansas Correctional Industries

This dissertation traces the evolution of ideas and experiences of mental illness (seishinbyō) in Japan around the turn of the twentieth century, showing how it changed from a diagnostic category of biomedical disease into a dynamic but stigmatized pathology of the self in which the mental and emotional core of a person – who he or she was, essentially – was thought to have malfunctioned. In the course of this transformation, seishinbyō had multiple manifestations, its meanings shifting across time and in different social contexts. It originated in Japanese psychiatric discourse of the 1870s as an allegedly universal category of disease, but was soon modified to account for such existing phenomena as fox-spirit possession. In the family, one of the main sites for the management and treatment of madness in modern Japan, mental illness was associated less with medical etiology and more with violent and socially unacceptable behavior, as seen in cases of home confinement. As the concept of mental illness spread in popular culture and legal discourse, it evolved into a broader cultural idiom about the pathology of the self during a time of rapid social and cultural change. From the gendering of hysteria as the feminine counterpart to male neurasthenia in the media to the menstrual psychosis defense invoked to absolve female defendants of criminal responsibility, gender played an especially prominent role in this evolution. By the 1930s, the idea that the self was the source of its own distress had taken root, shifting attention away from external and social factors, whether fox possession or the stresses of modernity, to inner causes of suffering. The driving forces behind this conceptual change were the social structures and relations of family, gender, and the urban-rural divide. In the context of these three overlapping social sites, changing ideas and practices concerning the mentally ill produced broader transformations in the understanding of the relationship between self and society, including conceptions of mind and body, gendered norms of thought and behavior, and the boundary between the inner self and social forces during a time of modernizing change.

Paper one is a systematic literature review of qualitative studies examining psychosis in women using a metasynthesis approach. The review involved three stages: a systematic search of qualitative studies reporting the experiences of women with psychosis, critical appraisal of these studies, and the metasynthesis. Thirteen studies met the inclusion criteria, yielding data from 220 women in total. The synthesis of the studies demonstrated three overarching themes: (a) women's beliefs about their illness, (b) perceived consequences of illness, and (c) strategies to cope with illness. Important barriers to strategy use were identified and recommendations made for addressing them. In the second paper grounded theory methodology was used to explore recovery in women who had experienced psychosis following childbirth. Semi-structured interviews were conducted with 12 participants and data were analysed using grounded theory methodology. A theory of four superordinate themes was developed from the data, including: (a) the process of recovery; (b) evolving an understanding; (c) strategies for recovery; and (d) sociocultual context. It was concluded that women experienced a complex process of recovery which was ongoing. The role of other people, including professionals in the recovery process was central. Recommendations were made for professionals to assess women's position in terms of their recovery in order to offer timely, appropriate interventions. The final paper is a critical reflection of the work reported in the previous two papers. I reflected upon how my previous experiences influenced my decision to undertake this research and other aspects of the research process. I explored the rationale for my choice of research methodology and discussed the debates which exist around the use of these methods. Finally, my personal reflections upon the entire research process are included.

The proliferation of social media-based research on mental health offers exciting possibilities to complement traditional methods in mental health care. As ascertained by psychology experts, the online platform should get priority over offline as it offers considerably reliable diagnosis than granted in person. Early detection does not only alleviate the effects of depression on the patient but also benefits the whole community. In this thesis, we explore computational methods in tackling some of the research challenges in depression analysis and make four contributions to the body of knowledge. First, we develop a binary classification model for classifying depression-indicative text from social media. We propose three feature engineering strategies and assess the effectiveness of supervised model to enhance the classification performance in predicting posts indicate depression. To tackle the short and sparse social media data, we particularly integrate the coherent sentiment-topic extracted from the topic model. Additionally, we propose strategies to investigate the effectiveness of affective lexicon in the task of depression classification. Second, we propose a computational method for analysing potential causes of depression from text. With this study, we demonstrate the ability to employ the topic model to discover the potential factors that might lead to depression. We show the most prominent causes and how it evolved over time. Furthermore, we highlight some differences in causes triggered between two different groups, i.e. high-risk of depression and low-risk. Hence, this study significantly expands the ability to discover the potential factors that trigger depression, making it possible to increase the efficiency of depression treatment. Third, we develop a computational method for monitoring the psychotherapy outcome from the individual psychotherapy counselling. Third, we develop a computational method for monitoring the psychotherapy outcome from the individual psychotherapy counselling. By doing this, we show the possibilities of utilising the topic model to track the treatment progress of each patient by assessing the sentiment and topic discussed throughout the course of psychotherapy treatment. Fourth, we propose an unsupervised method called split over-training for identifying user's intention expressed in social media text. We develop a binary classification model for classifying intentions in texts. With this study, we want to show the possibility of applying the intention analysis in mental health domain. Overall, we demonstrate how computational analysis can be fully utilised to benefit clinical settings in mental health analysis. We suggest that more future work could be further explored to complement the traditional settings in mental health care.