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Introduction: There is a growing literature base focusing on the correlates and predictors of psychological distress following stroke. However, there is still limited understanding regarding the physical, cognitive and psychosocial variables that may increase an individual’s vulnerability to experiencing post stroke psychological distress. This thesis had two aims: 1) to review the evidence relating to functional impairment and depression post stroke, in order to identify any differences in this relationship at different stages of recovery, or over time, and 2) to explore whether perceived social support and perceived control moderate the relationship between cognitive impairment and psychological distress following stroke. Methods: A systematic review of the literature was conducted to investigate any potential differences in the relationship between functional impairment and depression post stroke. Quality criteria were applied to the included studies and the results were discussed in relation to these. A cross-sectional study was conducted to address the second aim of this portfolio. Participants completed three self-report questionnaires and a clinician administered measure. Statistical analysis was utilised to explore the relationships between cognitive impairment, perceived social support, perceived control and psychological distress following stroke. Results: The results of the systematic review were inconclusive. It was not possible to identify any definitive differences in the relationship between functional impairment and depression post stroke, at different time points or with regard to change over time. With regard to the cross-sectional study, none of the independent variables (cognitive impairment, perceived social support and perceived control) were found to be significantly related to psychological distress following stroke. Conclusions: The results of the systematic review highlight the need for methodologically robust, longitudinal studies to investigate differences in the relationship between functional impairment and depression during different stages of recovery and potential change over time in this relationship. Further research into the cognitive and psychosocial correlates and predictors of psychological distress are required in order to identify, and provide timely intervention to, those that are most likely to experience psychological distress following stroke.

The causes and consequences of police stress has received considerable research interest. Reversal theory postulates some individuals may inherently require higher (Le. paratelic) arousal levels, compared with those seeking lower (Le. telic) arousal levels. This present study investigated: (i) psychological problems experienced between British police officers, special (voluntary) police and civilian support staff; (ii) telic and paratelic dominance; (iii) use of humour; (iv) dimensions of police humour; and (v) predictors of police psychological problems, telic dominance and humour use. A mixed, cross-sectional survey design was employed. Questionnaires were sent to all police officers, support staff and specials (N = 373) within one division of a provincial police service. Participants completed the following measures: (i) Coping Humour Scale (CHS); (ii) Multi-dimensional Sense of Humour Scale (MSHS); (iii) Telic Dominance Scale (TDS); and (v) Employee Assistance Program Inventory (EAPI). Questionnaires were returned from 191 participants (51% response rate). For overall CHS and MSHS scores, no significant differences between groups were found; although police gender differences were significant. MSHS police dimensions deviated from previous samples. Overall TDS scores were significantly higher for specials. For all three groups, EAPI subscale scores were normative, but with significantly higher substance use reported by police. Police EAPI scores were generally significantly higher, indicative of greater psychological difficulties. Predictors of police psychological problems, TDS, CHS and MSHS scores are reported. These results suggest that police may have a paratelic dominance, in which humour provides a valuable and adaptive mechanism for pOlice stress. Clinical implications are discussed in light of these results.

Chronic conditions negatively impact well-being, and the negative impact of a chronic condition can extend beyond the diagnosed person to his or her spouse. This association may be further influenced by gender, as gender can shape how individuals experience their own chronic conditions-- including what conditions they develop-- and how they react to the conditions and distress of their spouses. In my dissertation, I examine how one spouse’s chronic conditions are related to the other spouse's psychological distress over time. I address this using quantitative analysis of the Health and Retirement Study and qualitative analysis of in-depth interviews. In my quantitative analysis, I find that the association between one spouse’s chronic conditions and the other spouse’s distress differs by gender, number of conditions, whether one or both spouses have chronic conditions, and type of condition. Regarding number of conditions, a husband’s number of chronic conditions increases his wife’s distress more so than a wife’s number of chronic conditions increases her husband’s. These associations are mitigated by the chronically ill spouse’s own distress and functional limitations. Additionally, this gender difference is more pronounced if both spouses have chronic conditions compared to if only one has chronic conditions. Regarding type of condition, lung disease and stroke are the most negatively impactful for spouses’ distress, whereas high blood pressure, cancer, and arthritis are not related to spouses’ distress. All conditions, except for stroke, relate to husbands’ and wives’ distress similarly, but a husband's stroke increases a wife's distress initially whereas the wife's stroke increases the husband's distress over time. In my qualitative analysis, I find that when women are chronically ill, they continue to emotionally care for their husbands, which likely protects their husbands from psychological distress but exacerbates women’s own distress. My results point to the importance of promoting the psychological well-being of both spouses during periods of chronic conditions. This is especially critical for spouses of people with more than one condition, chronically ill women whose husbands are also chronically ill, and spouses of people experiencing stroke and lung disease. / text

Background: Wheezing is one of the most common respiratory illnesses in children worldwide. Severe wheeze can result in significant morbidity, caregiver burden and increased health care costs. In addition, early childhood wheeze may be associated with reduced lung function, diminished airway responsiveness, increased risk of asthma in late childhood and subsequent respiratory disease including asthma in adulthood. This is particularly true in those experiencing recurrent wheeze episodes, which in the presence of viral respiratory tract infections, are believed to lead to asthma diagnosis. Thus, it is imperative to understand the risk factors for early childhood wheeze to reduce the increasing burden of respiratory illness. Recent research has seen a shift to maternal psychosocial risk factors and the impact these have on child respiratory health outcomes, such as wheeze. Various studies, largely conducted in High Income Countries (HIC), have found associations between antenatal or postnatal psychosocial risk factors, such as depression, psychological distress, and Intimate Partner Violence (IPV), and child wheeze and/or asthma diagnosis in early stages of life. However, these studies predominantly considered those in low-income urban regions that were predisposed to respiratory illnesses, including wheeze and asthma. Utilising the techniques and knowledge gained from previous studies, this research considers the relationship between antenatal or postnatal maternal psychosocial exposures and the onset and recurrence of child wheeze in a South African setting. In the study population used for this research, the reported prevalence of antenatal psychological distress and depression was 23% and 20%, respectively, while 34% of the women were exposed to antenatal IPV. Often those suffering from poor mental health in these contexts are not recognised and therefore remain untreated. In addition, service provision in these settings is also generally poor. The combination of low levels of social and psychiatric support, with unique political and socio-economic risk factors, may result in more persistent and severe forms of psychosocial exposure in Low Middle Income Countries (LMIC). Given the high prevalence of psychosocial risk factors, as well as the high prevalence of child wheeze, South Africa provides an excellent platform to investigate the association between maternal antenatal or postnatal psychosocial exposure and the development and recurrence of child wheeze in an LMIC context. Methods: The data used for this research was provided by the Drakenstein Child Health Study (DCHS), a prospective birth cohort study conducted in the Drakenstein region, a peri-urban region outside of Paarl in the Western Cape of South Africa. Pregnant women over 18 years old, between 20-28 weeks' gestation, living in the region were enrolled in a parent study, in order to investigate the epidemiology and aetiology of respiratory illnesses in children. The parent study considered various risk factors, including psychosocial risk factors such as maternal depression, psychological distress and IPV, which were measured antenatally and postnatally by validated questionnaires. In the context of this research, wheeze was considered to be present if it was identified during any routine study follow-up visit, as well as at an unscheduled lower respiratory tract infection (LRTI) episode visit during the first two years of life. Recurrent wheeze was defined as experiencing two or more episodes of wheeze in a 12-month period. Logistic regression was used to investigate the relationship between antenatal and postnatal psychosocial risk factors and child wheeze. Results: From the results, postnatal psychological distress and IPV were associated with experiencing at least one episode of child wheeze (adjusted OR = 2.10, 95% CI: 1.16-3.79 and 1.60, 95% CI: 1.11-2.29 respectively) and recurrent wheeze (adjusted OR = 2.33, 95% CI: 1.09- 4.95 and 2.22, 95% CI: 1.35-3.63 respectively), within the first two years of life. No associations were found between antenatal psychosocial risk factors and child wheeze. Of clinical covariates explored, maternal smoking and household smoke exposure, birth weight, gestational age, sex and population group were associated with the presence of wheeze. All of these clinical covariates, as well as alcohol consumption were associated with recurrent child wheeze. Conclusion: Maternal postnatal psychological distress and postnatal IPV had the strongest impact on predicting wheeze outcomes. These findings suggest that screening and treatment programs which address maternal postnatal psychosocial risk factors may lessen the burden of childhood wheeze in LMIC settings.

There are substantial data exploring the link between religiosity and health, yet there is no consensus regarding the appropriate measurement tool for assessing religiosity in health psychology settings. The purpose of this study was to identify a set of items that could serve as a reliable and valid proxy measure of religiosity. Participants included 251 (M=19.02; range = 17-25) young adults who completed self-report measures of religiosity (Intrinsic-Extrinsic/Revised, Quest Scale, Faith Maturity Scale), psychological distress (SCL-90-R), and personality (NEOPI-R). Individual item pools for religiosity were developed by identifying significant correlations between each of the religiosity measures and the SCL-90-R items. Exploratory factor analyses and item-level analyses were conducted and convergent and discriminant validity were examined for each proposed measure. A group of items were identified that were associated with previously validated measures of religiosity. These religiosity measures were also associated with the personality domains of Openness to Experience and Agreeableness but were not associated with Neuroticism. There was insufficient evidence, however, to conclude that the proposed measures could serve as true proxy measures of religiosity as they were more strongly associated with Neuroticism than the religiosity measures from which they were derived. The results of this study underscore the importance of the religiosity construct to health-related outcomes, yet much work remains to delineate the optimal means of measuring the construct and the specific pathways by which religiosity may exert its influence on both mental and physical health.

Most acculturation research has been focused on the direct relationship between acculturation and mental health (Yoon, Langrehr, & Ong, 2011; Salanta & Lauderdaleb, 2003; Koneru, Weisman de Mamania, Flynn, & Betancourt, 2007). However, less is known about the mechanisms for this relationship. Social-cultural resources such as friend and neighbor support may have a beneficial impact on mental health, and acculturative stress such as the level of family conflict and perceived racial discrimination would be expected to be risk factors (Kawachi & Berkman, 2001; Wolff & Agree, 2004; Gong et al., 2003; Kerr-Correa, Igami, Hiroce, & Tucchi, 2007). The present study investigated the mediating roles of acculturative stress and social-psychological resources in the relationship between acculturation and psychological distress among first generation Asian Americans. Data were from 1528 Asian Americans who participated in the National Latino and Asian Americans Study (NLAAS), a nationally representative study of the Asian immigrant population in the U.S. Using structural equation modeling with latent variables, direct and indirect influences on Asian immigrant psychological distress were examined. The findings indicate that higher acculturation was not directly associated with psychological distress for Asian immigrants, but there was an indirect pathway from higher acculturation to poorer mental health through acculturative stress. Asian immigrants with higher levels of acculturation experienced more acculturative stress, which contributed to more psychological distress symptoms. However, this finding was moderated by gender, holding only for women. On the other hand, while a higher level of acculturation was also associated with more perceived social resources, the expected protective effect of these resources was not present. The findings show the complex relationship between acculturation and psychological distress during the acculturative process of Asian immigrants. / text

<p>Arbetslöshet innefattar fler faktorer än brist på arbete och ekonomiska begränsningar. Tidigare studier uppvisar samband mellan arbetslöshet och stressrelaterade sjukdomar och som arbetslös kan upplevelse av kategorisering medverka till känsla av att förlora sin identitet. I denna kvalitativa intervjustudie bestående av sex stycken arbetslösa, kvinnliga deltagare diskuteras olika coping strategiers betydelse för hur situationen som arbetslös hanteras. Datamaterialet har bearbetats induktivt genom meningskoncentrering. Studien visar att stöd från omgivningen samt självförtroende är avgörande faktorer som medverkar till adaptiv, problemfokuserad coping. Det sociala stödet anses betydelsefullt även vid känslomässigt fokuserad coping samt reducerar oro och depressivitet. Studien bidrar till förståelse för hur viktig yttre coping upplevs av individen, samt självförtroendets betydelse.</p>

Active Surveillance (AS) for the clinical management of prostate cancer (PC) is a treatment option for men with low-risk PC. Screening procedures have led to the overdetection of PCs that would have never caused problems. Active treatment (e.g., surgery or radiation) for these non-aggressive tumors may not be necessary given the slow-growing nature of PC. AS provides a way to monitor the disease and delay treatment-related compromises on quality of life until clinically indicated (e.g., rising PSA level). However, the intensive monitoring in AS may be a stressful experience and lead to greater anxiety, an emotional state that has been associated with undergoing active treatment despite physician recommendation for AS. The current study aimed to identify psychosocial correlates of anxiety in men undergoing AS. Using Mishel’s Reconceptualized Uncertainty in Illness Model as a framework, the proposed study aimed to examine the relationships between perceived stress management skills, PC psychosocial concerns, and anxiety/arousal. Hierarchical multiple regression analyses were conducted on a sample of 71 men undergoing AS, who were on average 65.40 years old (SD=7.85) and ethnically diverse (52% non-Hispanic White; 31% Hispanic; 17% African American). Results indicated that greater PSMS were significantly associated with less IES-R anxiety (β=-.28, p<.04). PSMS were not significantly associated with PC concerns (β=-.02, p>.05), but greater PC concerns were significantly associated with greater IES-R anxiety (β=.61, p<.01) and PSA anxiety (β=.42, p<.01). These associations held after controlling for relevant covariates. The results suggest a possible role for stress management skills as perceived ability to manage stress was related to less anxiety in the AS experience. Future studies should examine the relationship among these factors in longitudinal designs and whether greater stress is associated with unnecessary active treatment in low-risk PC.

Arbetslöshet innefattar fler faktorer än brist på arbete och ekonomiska begränsningar. Tidigare studier uppvisar samband mellan arbetslöshet och stressrelaterade sjukdomar och som arbetslös kan upplevelse av kategorisering medverka till känsla av att förlora sin identitet. I denna kvalitativa intervjustudie bestående av sex stycken arbetslösa, kvinnliga deltagare diskuteras olika coping strategiers betydelse för hur situationen som arbetslös hanteras. Datamaterialet har bearbetats induktivt genom meningskoncentrering. Studien visar att stöd från omgivningen samt självförtroende är avgörande faktorer som medverkar till adaptiv, problemfokuserad coping. Det sociala stödet anses betydelsefullt även vid känslomässigt fokuserad coping samt reducerar oro och depressivitet. Studien bidrar till förståelse för hur viktig yttre coping upplevs av individen, samt självförtroendets betydelse.