This programme of research involved the development of a new health psychology concept: health baseline comparisons (HBCs). This is defined as the comparative baselines used to assess subjective health status. The following broad research questions were tested: Which HBCs are adopted by individuals with cancer?; What are the implications of different HBCs for quality of life (QoL) and other types of well-being?; How stable are HBCs throughout a course of treatment? A mixed-methodology approach was adopted to address the research questions. Five studies were conducted, all but the initial pilot study involving a clinical sample of people with cancer. A questionnaire to measure the use of different HBCs was developed and pilot tested, before being used to examine HBCs in people with breast and prostate cancer. On further refining the HBC construct, the questionnaire was re-validated and used to explore HBCs in women undergoing chemotherapy for breast cancer. The extent to which HBCs predicted QoL and psychological well-being was also examined in these studies. The stability of HBCs was sought from the same women two-months post-chemotherapy, focusing on associations with QoL and emotional well-being. The cross-sectional and longitudinal findings obtained in the first four studies were supplemented by a series of semi-structured interviews with a purposive sample of women from the longitudinal study. Interview transcripts were analysed via interpretative phenomenological analysis. Five categories of health baselines emerged from this programme of research: social; social comparison; biological; illness-specific; and turning to others. Some evidence was found that HBCs can change over time or be affected by illness and its treatment. Some HBCs, particularly social comparison and illness-specific baselines, were found to be significant predictors of QoL and psychological well-being, but the variance accounted for in these outcomes was generally small. Although the HBC questionnaire had acceptable internal consistency and reflected the experiences of people during cancer treatment and in the survivorship period, evidence was also found that the type and pattern of HBCs are subject to individual differences. This indicates that assessment of the construct also requires a qualitative and personalised component. The implications of the findings for the development of interventions are discussed and ideas for future research explored.

No description available.

No description available.

In human societies, cooperation between strangers flourishes despite the risk of being exploited. Correct evaluation of others‟ cooperative intentions aids in selecting partners for profitable interactions. Assessment of intentions can be made by (a) considering individuals‟ reputations gained through observed interactions with others and third-party information (gossip) or (b) interpreting immediate cues such as facial expressions and body language. I empirically investigated the role reputations play in human economic decisions. More specifically, I addressed research questions such as (1) how and why people manage cooperative reputations, (2) what role reputations play in partner choice, (3) whether reputations can stabilize cooperation in groups, (4) whether people have a memory bias for specific reputations and (5) whether the ability to assess trustworthiness in faces relates to mind reading skills known as Theory of Mind (ToM). Student participants were recruited for five experiments, all involving the use of economic games to a greater or lesser extent. Depending on the study, participants either played social dilemma games in groups under various experimental conditions or performed individual tasks e.g. recalled information previously presented in different contexts or assessed photographed faces with regard to their cooperativeness and completed ToM tasks. The results provide evidence for the existence of reputation-based partner choice („competitive altruism‟). Participants strategically invested in reputations and reaped benefits from such investments in the form of profitable interactions with the most desired partners. By varying endowments I demonstrated that resource inequalities affect the way people invest in reputation with low-resource individuals behaving in a relatively more generous way than their high-resource counterparts. Moreover, I showed that cooperation in social dilemmas can be stabilized by introducing reputational incentives in the form of partner choice. My results also suggest that people have a memory bias for information about uncooperative acts which is independent of the cooperativeness of the environment they are exposed to. I found no relationship between the ability to identify cooperative intentions in faces and ToM skills. In summary, by unravelling the mechanisms behind reputational cooperation my thesis sheds light on the reasons for extensive cooperation among strangers observed in humans.

There is increasing consensus that to understand developmental disorders we must apply developmental theoretical models and methodologies. To develop a fully specified developmental model of a developmental disorder we must understand both the nature of the innate causal processing deficits of the disorder and also how these deficits in early processing mechanisms then change the developmental process. This study aimed to examine the second of these issues with respect to Specific Language Impairment (SLI) and so describe the altered trajectory of development in this group of children. Explanatory models which propose hypothetical trajectories of development from impaired processing mechanisms in the infant to the patterns of linguistic impairments typically found in SLI are beginning to be developed. To date however there is very little empirical research which maps these trajectories. This study sought to contribute to that necessary empirical data and so to our understanding of the development of SLI. In addition it aimed to consider whether the application of a developmental methodology and perspective adds to our understanding of this disorder. A series of longitudinal case studies of children with SLI were completed. The participants were seen for four blocks of comprehensive assessment of language processing, language knowledge and "language relevant" processing over a 15 month time period. Cross sectional data from 38 typically developing (TD) children was also collected for comparison purposes. The data presented represents a part of this larger study and focuses on the development of the lexicon in SLI. Lexical and phonological processing and their interaction with phonological working memory capacity are thought to be crucial to the ontogeny of SLI. A series of tasks were developed to create a window into the nature of the developing lexicon. Data is presented from a novel non-word repetition task which manipulated the phonological characteristics of the stimuli and from a fast-mapping task where both phonological and lexical variables were manipulated. The influence of these factors on performance and changes in their influence across development were examined. Analysis of the trajectory of development of the two measures in TD children showed evidence of increasing abstraction of sub-lexical/phonological knowledge from lexical knowledge across development. In addition the developmental trajectory of fast mapping abilities demonstrated a significant and radical shift in processing bias across the age range. This result suggests that functional reorganisation in the developing lexicon, and hence the speech processing mechanism, may be taking place and which may occur as a result of increasing sub-lexical/phonological abstraction. The developmental trajectories of the children with SLI suggest that this group of children develop a different lexical processing architecture from typically developing children which does not reach the levels of efficiency of TD children's speech processing mechanisms. There is tentative support for a deficit in schema abstraction across the lexicon and an absence of functional reorganisation. The possibility that these results represent entrenchment within a self-organising network, and the possible relationship to issues of timing and critical periods is discussed. In addition it appears that compensatory strategies for this inefficient speech processing architecture may result in impaired semantic learning and so may have effects on the wider trajectory of atypical language development in SLI. Applying a developmental emergent perspective to SLI and so considering trajectories of development rather than static group comparisons can begin to uncover the nature of change within an interactive system and the nature of interdependence of processing mechanisms across development. Such an approach holds promise for revealing the nature of SLI and providing a more ecologically valid explanation of this complex disorder. The implications of developmental emergent conceptualisations of language impairment for research methodologies, diagnosis and therapy are discussed.

The aim of this thesis was to investigate key themes of emerging adulthood in young adults with motor co-ordination difficulties from both a parental and personal perspective using a mixed method approach. A number of studies over the past twenty years have considered longer term outcomes in children with Developmental Co-ordination Disorder (DCD) (Losse et al., 1991, Cantell et al., 1994, Cousins and Smyth,2003) but few have considered the social experiences of these young people and the views of their parents as they move into further and higher education. This study has focused particularly on the 16-25 year age group, a time of emerging adulthood and continuing developmental change (Arnett, 2000), which differs from the key previous study in adults by Cousins (2003), which centred around an older age group. Emerging adults in further and higher education with motor difficulties completed questionnaires alongside a cohort of parents of these individuals. A subset from each group were also interviewed. A retrospective analysis of case notes of those seen in childhood from a clinical setting was also undertaken, in order to consider changes from childhood. Students were matched with a cohort of students without any reported difficulties. Social behaviour including driving, drinking, and leisure pursuits were compared with typically developing students. An additional comparison was made with students who considered themselves to be 'clumsy' but had a diagnosis of Dyslexia, in order to compare current support in Further and Higher Education. This study has highlighted the persistent, pervasive and variable nature of DeD with over 50% of students reporting some level of impairment in an area of their life. These difficulties included learning to drive a car, difficulties with planning and organising themselves and their property, and continuing motor difficulties especially with handwriting and everyday tasks. Differences in social behaviour were also noted compared with control students. This study provides evidence that even in this resilient group who had reached further and higher education, DCD does not disappear for all once they reach adulthood.

International epidemiological studies note that gay men are 4 times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics, misrepresent the rate of suicides amongst homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls, report increased rates of mental health problems and subsequent suicide among the homosexual population. Whilst current healthcare policy in England is concerned with suicides among young people, the importance of research findings relating to gay people and their mental health needs are often not acknowledged. Additionally, addressing the problem through a public health agenda, the juxtaposition of trying to reduce the rate of suicide among young gay men in a social climate of heterosexism often compounds the negative mental health consequences for this group of people. This thesis explores possible psychosocial experiences that might have contributed to the suicidality of four gay men. A qualitative approach, using single case studies, was used to gain an in-depth understanding of the individual's experience. This methodology was psychoanalytically informed, and used free association narrative interviewing as a means of data collection. Initial data analysis involved interpretation of the Gestalt of each of the case studies. Subsequent analysis explored the shared experiences that are to be found in each of the individual narratives. Thematically, these are described as 'knowing and not knowing', 'the centrality of the father-son relationship' 'the loneliness of 'outsiderness', 'leading a double life' and 'crime and punishment'. The exploration of the significance of the life, experiences these themes illustrated revealed why some gay men might not only experience long term mental health problems but also engage in suicidality. Individually and collectively the analyses provide important insights for health professionals becoming more attuned to specific aspects of a gay man's story and thus, as a consequence, providing sensitive mental health care, at a primary, secondary and tertiary level, to those who have a gay sexual orientation.

Epidermolysis Bullosa (EB) is the term used to describe a number of genetically determined disorders characterised by excessive susceptibility of the skin and mucosae to separate from the underlying tissue following mechanical trauma. EB is a rare, life-long and non-curable condition. At its clinically mildest, the blistering occurs on the hands and/or feet and makes holding things and walking extremely painful. In clinically more severe forms, all the body is affected and the wounds heal slowly, giving rise to scarring, an altered physical appearance and significant disability. Despite the potentially severe and restrictive nature of EB, there has been scarcely any published research on its psychosocial impact. However, anecdotal evidence has suggested that those affected can face considerable challenges in their daily lives. This research was undertaken to address the deficit of empirical evidence concerning the ways and extent to which living and working with EB can affect individuals' social, emotional and psychological wellbeing and to identify unmet support needs. Given the exploratory nature of the thesis, a qualitatively-driven mixed method design was employed. A total of four studies were undertaken. The first two studies used an inductive approach. They produced wide-ranging, multi-level data about the many ways in which EB can impact on the daily lives of affected adults and also informed the subsequent quantitative study. The third study used a deductive approach. It examined the role of specific psychosocial variables that had been implicated in the qualitative data in relation to the psychological wellbeing of adults with EB. The fourth study employed mixed methods to explore the impact of working in the field on specialist EB professionals, as understanding their perceptions and experiences is an important aspect of effective care provision. In the final stage of the research, the support needs of adults with EB and EB specialist professionals were identified. Initial recommendations have been made for ways of meeting these needs based on findings from the four studies evaluated in the context of the existing chronic conditions and skin conditions literature.

No description available.

Body size is very much linked to the gendered issue of beauty, as well as, nowadays, to irresponsibility both in terms of a person's physical health and a nation's financial health. As such both men and women are targets in the current 'war on obesity', which is driven by a variety of agencies as well as the media. My research is a critical psychological investigation into the embodied experience of being 'large' or 'fat' in contemporary Western cultures and the present atmosphere of neo-liberal 'healthism'. I conducted 21 interviews with 18 women and 3 men, as well as two focus groups, one with 2 men and one with 6 women, discussing the topic areas of the language used to describe 'large' individuals, the media, appearance, healthy lifestyles and health generally, as well as responsibility and gender. I am taking a feminist post-structuralist perspective, using Foucauldian discourse analysis. Focusing on the themes 'in/visibility', 'clothing', 'health & responsibility' and 'gender', I explore the multiple gendered discourses that converge on 'fat' women and men, and how 'large' individuals are positioned within these discourses. I explore how 'fat women' and 'fat men' are discursively constituted, how they manage their subjectivities and subject positions within the politics of 'obesity', as well as the gendered constructions of embodied 'fat', health and wellbeing, and the power relations and conditions of possibilities produced in discourses of body size. The subject positions constructed and accepted by my participants were dynamic and multiple, at times contradictory and never monolithic. This was in contrast to their positioning within narratives of discrimination, marginalisation and moral and health judgements, which reflected the socially constructed metonymy of the 'fat' body as abject on a number of levels. With this thesis I expand on the research on being 'large' in relation to the discursive regulatory processes at play, the gendered power-relations constituted within them and how these impact on the embodied experiences of 'fat' women and men. I am illustrating post-structuralist discourse analysis as a useful and important method for the exploration of embodied experiences.