Background: Interventions for young children with autism are increasingly delivered through parents. This thesis investigated baseline and process variables associating with quality of parent-therapist alliance in a parent-mediated intervention for autism, including variables relating to parents' causal beliefs and perspectives. Participants: 77 parents and 6 therapists from a RCT of a parent-mediated intervention for autism (PACT). Method: A sequential exploratory mixed methods approach, with an intermediary instrument development phase. Baseline variables, investigated for the full sample of 77 cases, comprised demographic variables, parental dichotomous causal belief variables, and a therapist average fidelity variable. Thematic analysis of intervention session transcripts informed the development of the Parental Perspectives Coding Scheme (PPCS), a video-based scheme for rating the quality of parent 'Expression' and therapist 'Integration' of parental perspectives during intervention. 5 overarching themes were initially identified, these were collapsed into three items for the PPCS; Interpretation of the Child (IOC), Parent Actions and Strategies (PAS) and Parental Self Disclosures (PSD). Item inter-rater reliabilities were satisfactory to good. Parent-therapist dialogue, for a sub-sample of 20 cases, was coded using the PPCS to create process variables for the Expression and Integration of parental perspectives. Initial analyses identified baseline and process variables with significant univariate associations with alliance; these were included in separate multivariate models of parent-rated alliance and therapist-rated alliance. Results: Parent-rated and therapist-rated alliance did not correlate. PPCS Expression and Integration scores were higher in the high parent-rated alliance group but the difference was non-significant. Parents who cited MMR as a possible cause of their child's autism rated the alliance significantly lower than those who did not. Parents with no post-16 qualifications rated the alliance significantly higher than those with higher qualifications. Each factor contributed independently to a multiple regression model, together explaining 18.3% of variance in parent-rated alliance. Therapist-rated alliance significantly correlated positively with therapist fidelity and with PPCS variables for parent Expression and therapist Integration; together these explained 58.8% of variance in therapist-rated alliance. Conclusions: Therapists should be aware that parents may rate the alliance differently from themselves and that different factors associate with their ratings. Parents' causal beliefs and level of education may influence their ratings of alliance in specific interventions.

Existing research and anecdotal accounts have consistently reported that Jewish people are positively inclined to seek treatment for mental health problems, including making use of psychiatric services and psychotherapy. However, much of this data has been based on samples of American Jewry and there appear to be no existing studies in the UK which have quantitatively investigated whether there are similar help seeking preferences for mental health problems amongst British Jewry. The present study investigated Jewish people’s attitudes and intentions to seek professional help for mental health problems and their experiences of seeking professional help in the UK. Using the theoretical framework of the Theory of Reasoned Action (Fishbein and Ajzen, 1975; Ajzen & Fishbein, 1980) the study also aimed to determine the strongest predictors of intentions and attempts to seek professional help, according to people’s attitudes, perceived social pressure, beliefs about the causes of mental illness and level of religiosity. The study included 126 Jewish people who were predominantly recruited from synagogues and community centres across the UK. Results indicated that a high percentage of this sample would be willing to see a mental health professional if they experienced a mental health problem. According to multiple regression analysis, attitudes towards seeking professional help and stress-related causal beliefs most strongly predicted intention to seek professional help. Despite the sample being non-clinically recruited, 63% of participants reported that they had experienced a mental health problem and the majority of these individuals had sought professional help in the past. Path analysis revealed that actual attempts to seek professional help were directly influenced by intention to seek professional help, perceived social pressure and supernatural causal beliefs. Given the high prevalence of mental health problems and use of professional mental health services amongst this sample, clinical considerations highlighted the need for preventative mental health strategies and culturally sensitive mental health services for Jewish people. Limitations of the study include the use of an opportunity sample which was unable to recruit members of the Ultra-Orthodox Jewish community.

To provide empirical basis for mental health interventions in the deprived sub-Saharan African region, this study explored the perspectives of the Igbo people of south-eastern Nigeria on four dimensions of mental illness: causal beliefs, attitudes towards sufferers, preferred treatment pathways and perceived barriers to accessing formal psychiatric care. Mixed sampling methods were used to select participants who completed quantitative questionnaires. The number of participants varied between 200 and 706 in the exploratory studies but remained constant (n = 1127) in the confirmatory studies. The study found mixed endorsements of the supernatural, biological and psychosocial causal explanations with supernatural causations being significantly more endorsed. The study also found mixed treatment preferences with formal psychiatric care being significantly more preferred to the spiritual pathway which was in turn significantly more preferred to the traditional pathway. Significant negative attitudes and desire for social distance from persons with mental illness were observed across groups. Barriers to accessing mental healthcare were also significantly perceived with ideological barriers being significantly more perceived than instrumental barriers. Systematic associations were found between causal beliefs and treatment preferences: supernatural causal belief predicted preference for the spiritual and traditional treatment pathways while psychosocial causal belief predicted preference for both formal psychiatric care and the traditional treatment pathway. Mixed causal attributions and treatment preferences reflect holistic view of health and healing and calls for the evolution of complementary model of care that would incorporate people's spiritual and cultural needs. The prospect is supported in psychosocial causal beliefs being associated with preference for the traditional treatment pathway. Significant negative attitude is a contradiction in the traditionally communitarian and predominantly Christian culture, and is deserving of intervention in the context where the solidarity of the social network should compensate for the inadequate mental healthcare. Significantly more ideological than instrumental barriers have crucial policy implication; improved conceptualizations of mental illness should precede improvement of facilities and services or else these could be underused. Demographic correlates of causal beliefs, negative attitudes, pathway preferences and barriers to accessing formal mental healthcare care were determined for targeted interventions.

Made available in DSpace on 2016-04-28T20:38:42Z (GMT). No. of bitstreams: 1 Fabiana Rocha Biagigo.pdf: 934226 bytes, checksum: 77ae4574316234df5b706b4d1f22e764 (MD5) Previous issue date: 2013-05-24 / The overarching objective of this study is to investigate 197 women in treatment stage diagnosed with either breast or gynecologic cancer in regard to their beliefs about the causes of their very own diseases. Specifically, the present study aims to establish correlations of these subjects reported causal beliefs with selected sociodemografic and clinical variables. All subjects found themselves under treatment at a public hospital located in São Paulo, where the data was collected. The tools adopted specifically for data collection were a sociodemografic and clinical questionnaire as well as the Causes subscale from Illness Perception Questionnaire Revised (IPQ-R). A quantitative method was implemented and Analytical Psychology used for theoretical reference. Subjects reported several factors as causes for their cancer and attributed an important role to stress and emotional factors. The predominant causes mentioned were: stress or worry (77,2%), worries or family problems (77,2%), emotional state (69,5%), poor medical care administered in the past (54,3%), changes in the body defense system (52,3%) and fate or bad luck (45,3%). The sociodemografic and clinical variables (age, educational level, household income, type of cancer, tobacco addiction, changes in healthcare behavior, religion, family or own history of cancer and psychological treatment) influenced the causal beliefs reported by the subjects. Marital status was not observed as having influence over causal attribution. Low educational level on top of lack of information as well as low family income presented great influence in causal beliefs in regard to these subjects. Educational campaigns are crucial initiatives to the studied subjects, especially those targeting causes and factors that if acted upon might mitigate risk of cancer / Este estudo tem como objetivo geral investigar as crenças de 197 mulheres diagnosticadas com câncer de mama ou ginecológico, em fase de tratamento, a respeito das causas de sua própria doença. O objetivo específico é de correlacionar as crenças causais relatadas pelas participantes com as variáveis sociodemográficas e clínicas. Todas as participantes encontravam-se em tratamento em um hospital público da cidade de São Paulo. Os instrumentos utilizados na coleta de dados foram: questionário clínico e sociodemográfico e a subescala de Causas do Illness Perception Questionnaire Revised (IPQ-R). O método utilizado foi quantitativo e o referencial teórico foi o da Psicologia Analítica. As participantes citaram diversos fatores como causa de sua doença e atribuíram papel importante para o estresse e os fatores emocionais. Entre as causas mais mencionadas estiveram: estresse ou preocupação (77,2%), preocupações ou problemas familiares (77,2%), estado emocional (69,5%), pouca assistência médica no passado (54,3%), alteração das defesas do organismo (52,3) e destino ou má sorte (45,3%). As variáveis sociodemográficas e clínicas (idade, nível de escolaridade, renda familiar, tipo de câncer, tabagismo, mudanças nos cuidados com a saúde, religião, histórico anterior da doença, histórico familiar e realização de acompanhamento psicológico), influenciaram as crenças causais relatadas pelas participantes. A condição marital das pacientes não teve influência significativa sobre as atribuições causais. O baixo nível de escolaridade, somado à falta de informação, e a baixa renda familiar foram variáveis que apresentaram grande influência sobre as crenças causais das participantes da amostra. Campanhas educativas, que tenham como foco as causas do câncer e os fatores de risco que podem ser modificados a fim de reduzir o risco da doença, são de grande importância para a amostra estudada