Emotional distresses are common in Hong Kong adult population. Previous studies of positive psychology interventions which utilized a strength-based approach suggested its potentials for alleviation of depressive symptoms. However, existing strength assessments shown limits for offering prompt and useful feedback for the planning of positive psychology interventions. Therefore, the Chinese Psychological Resources Questionnaire (CPRQ) was developed as a quick and valid measure of strengths for the purpose. Psychometric properties of CPRQ were examined among 149 service users from 7 wellness centres of a local nongovernment organization. A series of exploratory factor analyses were conducted and resulted in a 12-item questionnaire with a 3-factor model: (1) Cautiousness (α=.79), (2) Interpersonal Strength (α=.71), and (3) Vitality (α=.81). This echoed the same 3-factor model presented by Duan et al. (2012). Concurrent validity was indicated by significant positive correlations with measurements of hope and gratitude and negative correlations with measurements of depression. The results were discussed in terms of implication for applying CPRQ and limitations of the present study. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This paper investigates whether the potential for rent extraction due to shareholders' strategic actions is reflected ex ante in stock and bond prices based on a joint study of stock and bond markets. I document that higher default probabilities are associated with higher yield spreads and bond returns but not with higher stock returns. Shareholder advantage has no significant effect on distress risk premia in stock or bond returns for firms with bonds outstanding. I also find that the negative relationship between distress risk and stock returns is more evident for firms with high trading cost and arbitrage risk. My findings suggest that the stock market, but not the bond market, misprices distress risk.

Thesis (doctoral)--Universität Erlangen.

Köln, Rechtswiss. Diss. v. 4. Okt. 1937.

Background: Canada relies heavily on family and friend caregivers to care for its increasing older population. However, many caregivers experience distress, which can jeopardize their ability to continue care provision and the health of their care-recipients. Objectives: This thesis research has three objectives: 1) Provide an overview of the burden and trajectories of caregiver distress in Ontario, and to compare differences in the experience of distress between caregivers of men and women; 2) Determine the association between caregiver distress and care-recipients' location of death; 3) Develop and test a comprehensive model of the relationships between caregiving factors, caregiver and care-recipient profiles, and caregiver distress. Methods: The main data source for objectives 1 and 2 is the Resident Assessment Instrument for Home Care, linked to multiple health administrative datasets at ICES. For objective 1, older (50+) community-dwelling adults in Ontario and their caregivers were examined. Descriptive analyses were performed to identify baseline and one-year change in caregivers' distress status, stratified by year of baseline assessment and care-recipients' level of care needs. Logistic regression was performed to identify the associations between care-recipients’ gender on caregiver distress. For objective 2, a retrospective cohort study of adult decedents in Ontario was conducted. Their caregivers' distress status within one-year of death was described, and logistic regression was performed to determine the association between caregiver distress and the odds of dying in non-palliative acute care. The data source for objective 3 is the General Social Survey-Caregiving & Care-receiving (cycle 26) conducted by Statistics Canada. The study population included respondents who have provided unpaid care within one year of survey. Exploratory factor analysis and structural equation modelling were performed to test a theoretical model of caregiver distress and its contributing factors and covariates. Results: From 2008 to 2015, there was a steady increase in prevalent, incident, and sustained caregiver distress. The increase was especially prominent among caregivers of individuals with lower care needs. Caregivers of older men were more likely to be distressed than caregivers of older women, largely because older men have greater health and functional impairments and required more care. Individuals cared for by distressed (vs. non-distressed) caregivers spent more time in non-palliative acute care in their last month of life and were more likely to die in non-palliative acute care. Receipt of home care and palliative home care greatly reduced the odds of dying in non-palliative acute care. Exploratory factor analysis established a well-fit model that represented caregiver distress and its five contributing factors: caregiving burden, disruptions of family and social life, caregiving history, caregiving network and support, and positive emotional experiences. Subsequent structural equation modelling found that disruptions of family and social life and positive emotional experiences had the largest associations with caregiver distress. Implications: Supporting older Canadians and their caregivers is a policy priority. This thesis research highlighted a rising trend of caregiver distress, identified risk and protective factors of distress, and determined the effect of caregiver distress on care-recipients' place of death. These findings can inform policy decisions and facilitate health systems planning. The risk factors found in this research can also be integrated into clinical assessments to identify caregivers at high risk of distress to provide them with timely and appropriate support. Enabling caregivers to provide quality care without being distressed is crucial for reducing cost incurred by the negative impacts of caregiving, ultimately reducing the overall healthcare cost of the aging population.

Individuals with diabetes face many multifaceted issues when integrating their plan of care into their daily lives, which can become burdensome and lead to inadequate diabetes control. Due to the persistent demands of diabetes management, screening for psychosocial factors that can impact control, such as depression, anxiety, and diabetes-related distress (DRD) should occur routinely (American Diabetes Association [ADA], 2017). DRD is distinctly different from depression in that the focus is on the burden experienced due to the rigorous treatment regimen associated with diabetes. DRD focuses on the self-management demands, complications, comorbidities, and lack of perceived social support (ADA, 2019). DRD can affect treatment compliance and lead to negative health outcomes, including more frequent hospitalizations and higher healthcare costs. Therefore, early screening and detection of psychosocial factors influencing management is essential to prevent health complications and deterioration. The purpose of this practice improvement project was to implement DRD screening in a rural North Dakota clinic. Rural providers were educated on DRD and the use of an evidenced-based screening tool called the Problems Areas in Diabetes (PAID) scale. This self-report scale allows providers to make appropriate referrals to diabetes educators, dieticians, and mental health professionals, which may result in individualized treatment plans and improved outcomes. The project implementation was comprised of an educational session focused on DRD that included a pre- and post-test, as well as return skill demonstration where attendees were asked to score a mock patient’s PAID scale. Following the educational session, the PAID scale was implemented at diabetic appointments for a three-month period. Positive PAID scale results were monitored to determine if the positive screenings resulted in a referral or additional resources. Twenty-four scales were completed by patients during the project, resulting in 30 referrals for additional support. Additionally, an increase in healthcare provider knowledge related to DRD evaluation and management was identified. The provision of DRD education and implementation of the PAID scale in this rural primary care clinic enabled patients within the community to receive evidence-based, individualized care, which may potentially reduce complications, as well as improve diabetes control and overall patient health.

Psychosocial research is increasingly focused on attachment, specifically on the potential mechanisms associating attachment with psychological functioning (Cassidy & Shaver, 2016). In past decades, attachment research has sought to better understand the development of individual psychological distress as well as relationship distress, given its major impacts on the overall well-being of individuals. It is worth noting that researchers have identified specific intrapersonal and interpersonal factors that are important variables to consider in the link between attachment and both individual distress and relationship dissatisfaction (Ensel & Lin, 1991; Hobfoll, 2002). However, little attention has been paid to investigating these mechanisms using a dyadic approach in order to gain a better understanding of reciprocal impacts within couple relationships. Since dyadic research methods have not been commonly utilized for understanding distress within an attachment framework, this has limited our understanding of the effect partners have on one another. Consequentially, the importance of dyadic effects has possibly been minimized in research. The present thesis, composed of two main studies, aims to verify if self-esteem and dyadic trust help explain the link between insecure romantic attachment (attachment anxiety and attachment avoidance) and individual and relationship distress using actor-partner interdependence mediation model analyses. The studies presented in the present thesis were approved by the University of Ottawa’s Research Ethics Board. The first study was comprised of two separate studies, both of which aimed to assess a conceptual model examining whether low self-esteem mediates the relationship between insecure romantic attachment and high psychological distress using two independent samples within unique periods in adulthood: a young adult student sample and a sample of couples in later adulthood who are parents. The first sample consisted of 485 Canadian university students (414 females; M age= 19.83 years) who were all in a couple relationship for at least 6 months at the time of participation. Bootstrapping procedures were utilized to assess indirect effects, and results supported our hypothesized model. As such, low self-esteem mediated the relationship between insecure romantic attachment and high psychological distress for both men and women. The second sample consisted of 35 couples in later adulthood who are parents (70 individuals, M age = 41.04 years). An actor-partner interdependence meditational model was tested to assess actor, partner, and indirect effects. Results showed that low male self-esteem partially mediated the relationship between male attachment anxiety and high male psychological distress. Similarly, low female self-esteem partially mediated the relationship between female attachment anxiety and high female psychological distress. Interestingly, high female self-esteem partially mediated the relationship between female attachment avoidance and low female psychological distress. Unexpectedly, low self-esteem in women fully mediated the relationship between female attachment anxiety and low male psychological distress. In the same vein, high self-esteem in women partially mediated the relationship between female attachment avoidance and high male psychological distress. The second study investigated whether low dyadic trust mediates the relationship between insecure romantic attachment and low relationship satisfaction in a third independent community sample of heterosexual couples engaged in a relationship for at least 12 months. The sample consisted of 199 Canadian couples ranging from young to later adulthood (398 individuals, M age = 31.02 years). An actor-partner meditational model was used to test hypothesized relations. Results revealed that lower dyadic trust partially explained the relationship between both male and female attachment avoidance and male attachment anxiety with lower relationship satisfaction. Findings from these studies have major implications for both clinical applications as well as future research directions. Specifically, gaining a better understanding of the role of romantic partners in the overall well-being of individuals can confirm as well as guide couple therapy conceptualizations and techniques. Uncovering existing dyadic patterns can also help support romantic relationship theories and shape future research avenues.

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