The present study examined a social marketing approach to a health promotion program in stress management education that combined various aspects of large scale mass-market campaigns and individually tailored interventions. The study was conducted in two major phases using two groups from the main population of retired university faculty members. The intervention was a series of stress management seminars which was presented in each phase. Program evaluation took place at several intervals throughout the study. The first phase of the study served to assess the retirees' needs and to develop the program content and delivery style by using the target population's administrative committee. This committee became the focus group. The presentation of the stress management seminars to the focus group was specifically tailored to the group through frequent interactions and participation by the group members. On evaluation, the program was shown to be effective on a number of dimensions, but it was also labor intensive. A second phase was conducted on a larger sample from the target population of retirees. The sample was found to be equivalent to the focus group on demographic variables, stress levels, and stress management practices. This phase utilized the same program content that was developed in the first phase, but further examined program delivery. Two styles of program delivery were compared. The first was a didactic, lecture-style frequently used in large scale educational campaigns; the second was an interactive, discussion style, used more frequently in individual interventions. Overall, the program participants from both phases improved in their abilities to identify their stress symptoms, stress management strategies that they felt they would use, and increased their levels of perceived control over their stress. Factor analysis was one method used to evaluate program effectiveness and to replicate the factor structure of coping strategies from another study. The utility of factor analysis as an assessment procedure was developed and supported. No major significant differences between delivery styles were found. Thus, indirect tailoring of the program for the target population through the representative focus group was as effective as directly tailoring the program with the target population. Both the interactive and didactic approaches can be integrated into a single educational program to obtain an optimal combination of cost-effectiveness and informativeness. Once the program content was developed through the intensive process of tailoring in the first phase, the more efficient didactic delivery style could be used equally successfully with a matched population. Clinically, the study served as a cost-effective prototype of a stress-management education program for the mass-market. / Ph. D.

The purpose of this research was to examine specific coping methods used by the elderly as they adjust to the environment of a long-term care facility, and to examine the correlations between these coping methods and levels of depressive symptomatology.

The purpose of this study was twofold: to test the Competence Model for Normal Aging and to generate valid and reliable indices of mental health outcomes in elderly clients. A correlational descriptive design accommodated the psychometric assessment of the instruments with a causal modeling methodology. The relationship between competence and self-esteem was the primary focus. Theoretical model testing was used to test the causal relationships between competence and three estimates of cognition: causal attributions, self-efficacy, and value. Associated demographic variables, age, and gender, were included in the model. Well elders (n = 137) living independently in Tucson participated in the study by completing 9 instruments within a 40-minute testing period. The mean age of the group was 73 (sd = 7.9). A quarter of the sample was at least 80 years old. All participants were caucasian, with more than twice the number of females than males. Most participants were married or widowed. The instruments met validity and reliability criteria in varying degrees. Hypothesis 1 was supported in both the separate success and failure models and the total sample theoretical model. Self-efficacy (β = .48) and value (β = .27) predicted competence (R² = .42). The social subscale of competence was strongly predicted by the same variables (β = .53, β = .26; R² = .39). The same predictors were evident in the total sample theoretical model (β = .52; β = .25; R² = .38). Hypothesis 2 was partially supported. Self-efficacy predicted total competence (β = .49; R² = .30) and the social dimension of competence (β = .59; R² = .32). Hypothesis 2 was minimally supported in the total sample theoretical model by self-efficacy (β = .29) predicting the social component of competence (R² = .44). Hypothesis 3 was most strongly supported. Competence predicted self-esteem under multiple conditions (βs averaged .43). The associated demographic and gender variables made minimal contributions to the model, except under failure conditions. Not being married and being a male negatively impacted upon competence (β = -.21; β = -.39; R² = .31). Both theoretical and empirical model results have similar explained variances. The theoretical model provided key information regarding the process of self-esteem, and the empirical model provided a guide for clinicians to measure mental health outcomes.

Social support has been shown to lessen the negative effects of life stress on psychological and physical health. The stress buffering model and the main effects model of social support were compared using two samples of women over the age of 50 who were either married or recently widowed. These two groups represent low and high uncontrollable major life stress respectively. Other life stress events were also taken into account. Measures assessed current level of life stress, perceived social support, satisfaction with social support, and psychological symptomatology. Results using overall psychological health as the dependent variable support the main effects model.

O desencadeamento do Lúpus Eritematoso Sistêmico (LES) está relacionado às situações estressantes e traumáticas da vida dos pacientes, o que sugere o fator psicológico como deflagrador da doença. A Nefrite Lúpica (NL) pode ser a primeira manifestação do LES e constitui fator de maior morbidade e mortalidade, por levar à insuficiência renal, com necessidade de hemodiálise, e colocar o sujeito diante de mudanças da rotina de vida, da autoimagem, o que faz da própria doença um evento traumático para o paciente. Dentro desse contexto, os objetivos desta pesquisa foram: (i) verificar a existência de eventos de vida associados ao deflagramento do LES nos relatos dos pacientes com NL e a forma como esses pacientes compreendem o seu adoecimento; e (ii) analisar correlações entre eventos de vida, estado de atividade do LES e perfil socioeconômico. Para a pesquisa empírica, adotou-se uma abordagem quali-quantitativa, por meio da aplicação dos seguintes instrumentos: entrevista semiestruturada (psicológica), entrevista para eventos de vida recentes (psiquiátrica) e instrumental de classificação socioeconômica. A amostra foi composta por 43 sujeitos internados no Serviço de Nefrologia do Hospital das Clínicas de São Paulo, sendo 22 pacientes do grupo caso, com NL e 21 pacientes do grupo controle, com doença glomerular primária. Os dados clínicos e laboratoriais foram coletados por meio do SLEDAI e por consulta ao prontuário. Os principais resultados obtidos demonstram que a ocorrência de eventos de vida não apresentou correlação à atividade do LES. Evidencia-se uma associação entre eventos de vida negativos e o deflagramento da doença nos dois grupos estudados, o que demonstra que eventos negativos também antecedem e podem estar associados ao início de outras patologias. Quanto à maneira como os pacientes com NL compreendem o seu adoecimento, observou-se que eles compreendem parcialmente sua doença, atribuindo um significado negativo e associam uma situação emocional ao início do adoecimento. São pacientes que percebem os problemas de suas vidas e possuem necessidade de lidar com o adoecimento implicando-se ao tratamento. Há sofrimento quanto ao adoecimento pelas mudanças e limitações que a doença impõe, principalmente em relação à autoestima, por isto, sofrem emocionalmente e possuem necessidade de serem escutados e amparados. Portanto, conclui-se que os eventos de vida negativos e/ou traumáticos estão relacionados ao deflagramento do LES tanto de forma objetiva como um acontecimento que envolve mudanças no ambiente social externo, sem considerar a subjetividade do sujeito quanto de forma subjetiva como um evento de vida singular, relatado pelos próprios pacientes como um evento traumático. Essas evidências sugerem que os pacientes com NL possuem fatores psicológicos particulares que atuam tanto no curso da doença, quanto em seu deflagramento / The onset of Systemic Lupus Erythematosus (SLE) is related to stressful and traumatic situations in patient lives, which suggests the psychological factor to trigger the disease. The Lupus Nephritis (LN) may be the first manifestation of SLE and is a major factor of morbidity and mortality, because it leads to kidney failure, requiring hemodialysis. Furthermore, the LN changes the routine of life and selfimage of patients, which makes the disease itself a traumatic event. Within this context, this study aims to: (i) verify the existence of life events associated with the outbreak of SLE, and how these patients understand their illness, and (ii) evaluate correlations between life events, status of SLE activity and socioeconomic profile. For the empirical research, we used a qualitative and quantitative approach, applying the following instruments: a semi-structured psychological interview; a psychiatric interview for recent life events and an instrumental for socioeconomic status. The sample was consisted of 43 subjects admitted to the Nephrology Department, at Hospital das Clinicas in Sao Paulo: 22 patients formed the case group, with LN and 21 formed the control group, with primary glomerular disease. The clinical and laboratory data were collected using the SLEDAI. The main results show that the occurrence of life events had no correlation with SLE activity. There was an association between negative life events and the outbreak of the disease in both groups, showing that negative events also precede and may be associated with the onset of other pathologies. Regarding the manner LN patients understand their illness, we see that they partially understand their disease, giving a negative meaning and associating an emotional situation at the beginning of illness. These are patients who perceive problems in their lives and need to deal with the disease giving importance to the treatment. The illness process causes suffering due to the changes and limitations the disease imposes, especially related to self-esteem, therefore, patients suffer emotionally and demand to be heard and supported. Thus, we conclude that the negative life events and/or trauma are related to the triggering of SLE both in an objective way as an event that involves changes in the external social environment, without taking into account the subjectivity of the subject as in a subjective singular life event, reported by the patient as a traumatic event. Based on this analysis, we suggest that patients with LN have particular psychological factors that operate both in the course of the disease, and in its triggering

A sociedade contemporânea alcançou muitas conquistas com a ciência e a tecnologia, porém o número de pessoas com doença mental aumenta a cada ano. A depressão é o tema deste estudo, pois trata-se de uma doença incapacitante que traz prejuízos à pessoa, à família e à sociedade por afetar milhões de pessoas em todo o mundo. O objetivo do trabalho foi compreender e descrever a experiência da pessoa com depressão. A coleta de dados foi realizada em um Centro de Atenção Psicossocial (CAPS) da cidade de São Paulo, por meio de entrevistas utilizando-se como referencial metodológico a História Oral de Vida. Participaram do estudo seis colaboradoras. Os dados foram analisados, de acordo com a análise de conteúdo e para a interpretação foram usados os princípios teóricos das Ciências Humanas e Sociais. A depressão é uma doença vivenciada historicamente e, por isso, os resultados foram divididos em três categorias, compreendendo a experiência vivida dentro da história de vida, com passado, presente e futuro, quando vislumbrada pelas colaboradoras. O passado é narrado como sofrido, doloroso e pesado, fatos marcantes são trazidos à tona e sinalizados pelas colaboradoras em conjunto, como se unindo, aglutinando e acumulando, como uma pesada carga a ser carregada. No presente, a depressão toma todo o espaço e engloba a vida de uma forma que ela se torna apenas pano de fundo. O viver com os sintomas, as tentativas de suicídio, a busca pela etiologia e o tratamento realizado fazem parte dessa categoria. A probabilidade de um futuro possível é vislumbrada por algumas colaboradoras, que já conseguem enxergar uma tênue luz no fim desse túnel escuro da depressão. Este estudo possibilitou compreender que as pessoas têm vida, projeto e necessidades diferentes e que o projeto terapêutico e o cuidado desempenhado pelo enfermeiro devem ser dirigidos para atender à sua singularidade no mundo. / Contemporary society has achieved a great deal with science and technology; nevertheless the number of people suffering from mental illnesses increases every year. Depression is the subject of this work, for it is an incapacitating illness, damaging its sufferers, their families and the whole society, as it affects millions of people worldwide. The present study aims at understanding and describing the depressed person’s experience. Data collection was carried out at a Centro de Atenção Psicossocial (CAPS, or in English, Center of Psychosocial Attention) located in São Paulo county, by means of interviews using the Oral Life History methodological framework. Six collaborators took part in the study. Data were analyzed according to content analysis and interpretation was undertaken using theoretical principles from Human and Social Sciences. Depression is a historically experienced illness and, thus, results were divided into three categories comprehending the lived experience with a past, a present and a future within life history, as seen by collaborators. The past is recounted as distressful, painful and heavy – remarkable events are brought to light and perceived by the collaborators as a whole, as if they came together, gathered and accumulated as a heavy burden to be carried by the sufferer. During the present phase, depression takes over and encompasses life to a certain extent that life becomes merely background. This category also includes living with symptoms, suicides attempts and search for etiology and treatment. The probability of a possible future is seen by some collaborators who can glimpse a dim light at the end of the somber tunnel of depression. This work made it possible to understand that people have different lives, projects and needs and that the therapeutic project and the care provided by the nurse must be directed to attend to their uniqueness in the world.

Thesis (D. Min.)--Westminster Theological Seminary, Philadelphia, 2002. / Includes abstract. Includes vita. Includes bibliographical references (leaves 155-160).

Thesis (M.A.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 163-169). / ix, 169 leaves, bound 29 cm

Thesis (Ph. D.)--University of Virginia, 2007. / Includes bibliographical references. Also available online through Digital Dissertations.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.