published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (DPhil (Psychology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Major Depressive Disorder is a prevalent psychiatric illness that poses critical risk factors to families. Risk factors associated with depression are widely researched, but limited South African and international research exists with regard to family resilience factors and intervention programmes associated with these high-risk families. The aim of the present study was to address these limitations by (a) identifying and describing the qualities of resilience in families in which a parent had been living with Major Depressive Disorder, (b) developing a family intervention programme for parents to strengthen and enhance a quality of resilience and, finally, following the intervention programme, (c) to evaluate the impact of the intervention programme on the identified resilience quality. The research was divided into two phases in order to address the above-mentioned, namely the descriptive phase (Phase 1) and the intervention phase (Phase 2). The results of the descriptive phase revealed various statistically significant correlations between the independent variables and the dependent variable, namely family adaptation, as measured by The Family Attachment Changeability Index 8 (FACI8) (McCubbin et al., 1996). The strongest statistically significant correlation was found between family problem solving and communication, and family adaptation. This steered the development of the intervention programme, aiming it at enhancing family problem solving and communication as a family resilience quality. An experimental design was used to evaluate the impact of the intervention programme. Analysis 1 revealed a trend (not statistical significant on a 5% level), suggesting that negative communication decreased over a three-month period after the intervention programme. Analysis 2 supported this trend on a 5% level. The qualitative post-test data reveal that the participants perceived the intervention programme in a very positive light, namely as a beneficial and educational experience. Furthermore, the three-month follow-up assessment showed that the majority (81%) of the participants indicated that the intervention programme impacted positively on their family’s communication. / AFRIKAANSE OPSOMMING: Major Depressiewe Steuring is ‘n bekende psigiatriese siekte wat gesinne met kritiese risikofaktore uitdaag. Hierdie risikofaktore is wyd nagevors, maar beperkte Suid-Afrikaanse en internasionale navorsing bestaan met betrekking tot gesinsveerkragtigheidsfaktore en gepaste intervensieprogramme wat met hierdie hoë risiko gesinne geassosieer word. Die doel van die huidige studie was om hierdie beperkings aan te spreek, deur (a) veerkragtigheidsfaktore te identifiseer en te beskryf in gesinne waar ‘n ouer met Major Depressiewe Versteuring leef, (b) om ‘n gesinsintervensieprogram vir ouers te ontwikkel wat ‘n spesifieke veerkragtigheidsfaktor kan versterk en ontwikkel, en (c) om die impak van die intervensieprogram op die geïdentifiseerde veerkragtigheidsfaktor te evalueer. Die navorsing is in twee fases verdeel, naamlik die beskrywende fase (Fase 1) en die intervensie fase (Fase 2) om bogenoemde aan te spreek. Die resultate van die beskrywende fase het verskeie statisties beduidend korrelasies getoon tussen die onafhanklike veranderlikes en afhanklike veranderlike, naamlik familie aanpasbaarheid, wat deur The Family Attachment Changeability Index 8 (FACI8) gemeet is (McCubbin et al., 1996). Die sterkste statisties beduidende korrelasie was tussen gesin probleemoplossing en kommunikasie en gesin aanpasbaarheid. Hierdie verhouding het die ontwikkeling van die intervensieprogram bepaal wat ten doel gehad het om gesin probleemoplossing en kommunikasie as ‘n gesinsveerkragtiheidskwaliteit te ontwikkel. ‘n Eksperimentele ontwerp is gebruik om die impak van die intervensieprogram te evalueer. Analise 1 het ‘n tendens (nie statisties beduidend op ‘n 5 % vlak) uitgelig wat daarop dui dat negatiewe kommunikasie verminder het oor ‘n periode van drie maande na die intervensieprogram. Analise 2 het hierdie tendens ondersteun op ‘n 5% vlak. Die kwalitatiewe na-toets data het aangedui dat die deelnemers die intervensieprogram in ‘n baie positiewe lig ervaar het en as voordelig en opvoedkundig beskou het. Die drie-maande opvolgassessering het ook aangedui dat die meerderheid (81%) van die deelnemers gevind het dat die intervensieprogram ‘n positiewe impak op hulle gesinskommunikasie gehad het.

Zhang, Dexing = 階梯式治預防焦慮癥和抑鬱癥的效果和可性的研究 / 張德杏. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 181-205). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendixes includes Chinese. / Zhang, Dexing = Jie ti shi zhi yu fang jiao lü zheng he yi yu zheng de xiao guo he ke xing de yan jiu / Zhang Dexing.

Increasing prevalence and severity of undergraduate psychopathology, combined with heightened burden on college campus counseling centers and the potential for sustained distress and self-harm, has necessitated comprehensive, vertically integrated on-campus mental health services. Initiatives include preventive interventions that: 1) foster resilience and adaptive coping, 2) ameliorate sub-threshold symptoms of pathology as secondary prevention, and 3) foster well-being and meaningful student experiences for greater fulfillment and thriving. A growing body of supportive data has led to some expansion of mental health and wellness services on college campuses, including the use of spiritually integrated mind-body practices to promote well-being. While college campuses’ wellness initiatives show promise, structured spiritual-mind-body (SMB) interventions have yet to be formally tested in either open or controlled clinical trials. The primary aim of this open-trial pilot study was to evaluate the feasibility and acceptability of an eight-session SMB-integrated wellness intervention, Awakened Awareness for Adolescents (AA-A), adapted specifically for late adolescent (ages 18 - 25) college students from Awakened Awareness for adults (AA) to support spiritual development and individuation. A secondary aim was to obtain preliminary data on changes in undergraduate students’ mental health and spiritual well-being across the AA-A intervention. Participants consisted of 77 non-clinically-referred undergraduates aged 18 - 24, who attended an average of M = 5.75 (SD = 1.42) out of the eight sessions. Measures included common psychopathology symptoms, spiritual well-being, psychological, and psychosocial variables using validated self-report assessments. Additionally, we explored the effect of spiritual well-being variables’ change scores as predictors of post-AA-A psychopathology symptom scores, controlling for pretest symptom scores. Differential effects between participants with high and low baseline depression symptoms were examined on outcome measures. Preliminary findings support the feasibility and acceptability of the AA-A intervention for college student’s mental health and spiritual well-being. Results include significant reductions in depression, anxiety, post-traumatic stress (PTS) symptoms, and significant improvements in numerous spiritual well-being, psychological, and psychosocial variables. Further, a recovery process from high rates of PTS symptomatology and spiritual decline may be initiated by SMB interventions that foster enhanced spiritual perception and build awareness of personal and relational spirituality.

xiv, 105 p. ill. (some col.) / Depression during adolescence is highly prevalent with as many as 20% experiencing a major depressive episode by the age of 18. Adolescent depression causes significant impairment across life areas including school functioning, such as poor academic performance and decreased academic achievement. Despite the existence of many evidence-based treatment options, merely 25% of depressed adolescents receive treatment. For this reason, it is essential that easily accessible preventive interventions for adolescent depression be developed and made available. Computerized interventions could broaden the reach of prevention efforts and preliminary results indicate that they have the potential to successfully prevent adolescent depression. The Coping with Depression course is an empirically validated cognitive-behavioral depression treatment and prevention program that is well-suited for computerized delivery. This dissertation reports on the development and evaluation of a web-based interactive multimedia version of the adolescent Coping with Depression course with students experiencing subclinical levels of depression. The Blues Blaster program includes the following six modules, with five mini-sessions in each: (a) defining depression, (b) mood monitoring, (c) increasing fun activities, (d) increasing positive thinking, (e) recognizing negative thinking, and (f) decreasing negative thinking. Key concepts are presented and reinforced in a variety of engaging ways within each session, including video, animation, comic strips, graphics, interactive exercises, and games. The Blues Blaster program was evaluated in a randomized controlled trial with 161 adolescents who were randomly assigned to either the Blues Blaster or informationonly control conditions. Participants were assessed at baseline, post-treatment (six weeks after baseline), and six-month follow-up. Results demonstrated greater improvement for the Blues Blaster condition in depression levels, negative thoughts, behavioral activation, knowledge, self-efficacy, and school functioning compared to the information-only control condition. These findings suggest that this targeted prevention program is appropriate for use with middle school students to decrease depression levels and therefore the risk that they will develop major depression in the future. / Committee in charge: Christopher Murray， Chairperson； Deanne Unruh， Member； Jeffrey Sprague， Member； John R. Seeley， Member； Sara Hodges， Outside Member

Introduction. HIV positive men who have sex with men (HIVMSM), facing severe stigma and many stressors, have high prevalence of mental health problems, such as depression. However, there is a lack of mental health promotion and treatment services targeting HIVMSM in China. The Three Good Things (TGT) exercise is one of the commonly used positive psychology interventions; its benefits in reducing depression have been scientifically proven in many disease groups. Yet, TGT has not been applied among HIVMSM. In addition, social support has shown to be protective of depression. The emergence of electronic social media allows for integration of social networking and TGT exercise among HIVMSM. / Objectives. This study aimed to evaluate the efficacy of a one-month online intervention combining TGT with social networking (TGT-SN) versus a control of dissemination of information in reducing depressive symptoms among HIVMSM in Chengdu, China. / Methods. A randomized controlled trial design was applied. A total of 205 HIVMSM were recruited and randomly assigned to the TGT-SN (N=100) or control group (N=105) by four well-trained peer fieldworkers. Self-administered surveys were given to all participants at baseline, at the end of the 1-month intervention (T1), and at the 3-month (T2) and 6-month (T3) post-intervention follow-ups. The intervention was delivered via “QQ”, the most widely used Chinese social networking service. Participants in TGT-SN group were divided into four “QQ” groups, each the size of 20-30 persons. Participants in TGT-SN were asked to post three things they experienced that they feel grateful about daily onto the QQ platform and share them with members of their group. They were also asked to read others’ messages and give positive and encouraging feedbacks to those messages. Members of the control group received information about mental health promotion from research assistants via QQ once a week during the one-month intervention period. The primary mental health outcome was probable case of mild to severe depression measured by Center for Epidemiologic Studies Depression Scale (CES-D). Secondary psychological outcomes include depressive symptoms, anxiety, positive and negative affect, life satisfaction, subjective happiness, gratitude level, and perceived social support. Generalized Estimating Equation models were fit. Structural equation modeling was applied for mediation analysis. / Results. Among all participants, the prevalence of probable mild, moderate, and severe depression were, respectively, 14.6%, 9.3%, and 35.6% at baseline. All baseline background characteristics and outcome measures were balanced (statistically non-significant) between the two groups. Based on data obtained at T1, T2 and T3 that were analyzed by GEE model, there was a significant main effect of TGT-SN on reducing depression (B=-2.35, 95% CI=-4.53, -0.16, p=0.035), indicating significantly lower depression score in the intervention group as compared with that of control group. Nonetheless, such significant effect became non-significant (B=-1.67, 95% CI=-3.79, 0.46, p=0.124) when controlled for baseline depression score. Significant differences were also found between the TGT-SN and the control group in anxiety symptoms (B=-1.14, 95% CI=-2.06, -0.22, p=0.016) and negative affect (B=-2.08, 95% CI=-3.62, -0.55, p=0.008). The effect of TGT-SN on reducing depression was most evident at T3. Structural equation modeling indicated that gratitude and negative affect fully mediated the effect of TGT-SN in reduction of depression and anxiety (mediation effect=-0.17, 95% CI=-0.30, -0.04, p<0.05) at T3. / Conclusions. TGT-SN is a feasible, acceptable, sustainable, and scalable intervention to improve mental health among HIVMSM. It is warranted to increase awareness and policy support for mental health services for people living with HIV (PLWH). Mental health services should be integrated into the HIV/AIDS care system as a key component. Future translational studies are needed to further investigate the efficacy and effectiveness of the intervention in other groups of PLWH and in other cultures and countries. / 研究背景：艾滋病在男男性接觸（men who have sex with men, MSM）人群中的感染率正在以前所未有的速度在我國蔓延。艾滋病陽性的男男性接觸（HIV positive men who have sex with men, HIVMSM）人群面臨極大的壓力，心理疾病（例如抑鬱症）的患病率很高。但是，目前我國對HIVMSM人群的心理健康服務比較缺乏。“三件好事情”是最被廣泛使用的能有效降低抑鬱症的積極心理學干預。這項練習要求參與者每天寫下三件令他們感到高興或者感激的事情。“三件好事情”這兩練習還沒有在HIVMSM 人群中應用。此外，社會支持對抑鬱症有保護作用。電子社交網絡是一種潛在的有效的平台，可以將調查對象（HIVMSM）的“好事情”相互傳遞，加強“三件好事情”的效果。 / 研究目的：本研究的目的是在中國成都市使用隨機對照研究評估積極心理學結合社會網絡干預對減少HIVMSM人群抑鬱症的效果。 / 研究方法：本研究採用隨機對照試驗。四名同伴調查員共招募205位HIVMSM，其中100人被隨機分配到“三件好事情結合電子社交網絡組（TGT-SN）”，105人被分配到對照組。所有參與本研究的調查對象將在隨機分組之前完成基線調查（T0），並在一個月的干預結束時（T1）、干預結束后三個月（T2）、十二個月（T3）時完成隨訪調查。 / TGT-SN干預通過騰訊QQ實施。騰訊QQ是在中國最被普遍使用的社交網絡。TGT-SN組的調查對象將被分配到4個QQ組，每組20-30人。TGT-SN干預要求調查對象在一個月的干預期，每天需要完成以下三個任務：i）每天回想當天發生的三件或以上令自己開心、感激的事情，并將這三件好事情發佈到各自的QQ群留言板；ii）每天閱讀本QQ群其他組員發佈的三件好事情；iii）每天對組員發佈的三件好事情進行正面的積極的評論。被隨機分配到對照組的調查對象在一個月的干預期內，每週收到一條有關心理健康促進的信息。 / 本研究的主要結果為抑鬱症狀，採用美國國立衛生研究院流行病學研究中心抑鬱量表。次級結果包括焦慮症狀、正性和負性情緒、生活滿意度、主觀幸福感、感恩心理、以及社會支持。分析採用廣義估計方程模型（GEE）。中介效應分析採用結構方程模型。 / 研究結果：所有調查對象中，59.5%有輕度到重度抑鬱症（CESD≥16）。TGT-SN和對照組基線所有的背景變量及結果變量均無顯著性差異。基於對T1、T2和T3數據的GEE模型分析，相比于對照組，TGT-SN對降低抑鬱症有顯著主效應（B=-2.35, 95% CI=-4.53, -0.16; p=0.035）。但是此顯著主效應在控制基線抑鬱症狀后變為不顯著（B=-1.67, 95% CI=-3.79, 0.46, p=0.124）。相比于對照組，TGT-SN對降低焦慮症狀（B=-1.29, 95% CI=-2.22, -0.36; p=0.007）和負性情緒（B=-2.24, 95% CI=-3.73, -0.74; p=0.003）也有顯著效果。TGT-SN對降低抑鬱症的效果在T3最為顯著。結構方程模型表明，負性情緒和感恩心理對TGT-SN干預降低T3時抑鬱症和焦慮症的效果中發揮完全中介效應（中介效應=-0.17, 95%置信區間=-0.30, -0.04; p<0.05）。 / 研究結論：TGT-SN能有效減少HIVMSM人群的心理健康問題（例如抑鬱症和焦慮症），並且是可行的和被HIVMSM所接受的干預措施。TGT-SN練習的實施成本較低並且不需要心理學專家的參與，因此可以在資源有限的國家和地區（例如中國）推廣實施。未來需要更多的研究來評估TGT-SN干預在其他艾滋病病毒感染者人群中以及其它國家的效力和效果。" / Li, Jinghua. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 136-149). / Abstracts also in Chinese; some appendixes in Chinese. / Title from PDF title page (viewed on 06, October, 2016). / Li, Jinghua. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.