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

published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

本研究是一項關於北京中年抑鬱症患者主觀經驗的敘事分析。研究的目的在於探尋患者對於自身患病歷程的主觀詮釋，他們的服務需求以及對於中國大陸精神衛生社會工作進行反思。研究的參與對象為目的性抽樣所得到的來自北京的一個抑鬱癥自助團體的八名中年抑鬱癥患者。 / 患者回顧了他們不同階段的經歷：發病期、住院期以及康復期。然後他們對於這些經歷做了詮釋。基於不同領域的社會服務需求，對於醫院、社區、大眾傳媒以及政府，他們都給出了寶貴的意見。 / 研究發現，既有的理論觀點對於關著對自身經歷的詮釋有著重要的影響，尤其是生物醫學模型。認知觀點和性別觀點也可以在患者們的敘事中找到蹤跡。精神科醫生在患者的整個經歷中都處於重要的地位，他們的觀點和行為對患者也產生了重要的影響。 / 患者還受到社會和歷史因素的影響。他們的詮釋會受到社會觀念和文化價值的影響，比如命運、面子、孝順以及性別角色等等。而歷史事件諸如文化大革命以及天安門事件也會對他們的人生經歷以及他們的主觀詮釋造成影響。而中國目前的社會情境也是另一項重要的影響因素。 / 從他們的故事中，我們可以看到，最重要的主題就是他們在患病過程中認知模式的轉變，包括對待抑鬱癥本身，所接受的服務以及自身的看法。在他們的敘述中，另外兩個主題也是非常值得注意的，那就是和抑鬱症有關的“喪失以及醫院裡非人道的治療方式。 / 他們的故事為我們對於北京中年抑鬱症患者經歷的理解提供了非常豐富詳實的材料。這些發現對於知識理論的發展、政策的制定以及針對抑鬱症患者的臨床社會工作實踐都有著很大的啟示。整個社會以及不同領域的精神衛生專業人士都應該攜起手來幫助他們，共同去創造一個更加包容和諧的社會。 / This research was a narrative analysis of the subjective experiences of the depressed middle-aged adults in Beijing, China. The purposes of the research were to explore the clients’ subjective interpretation of their lived experience of depression, their service needs and reflect on the improvement of mental health social work in Mainland China. A purposive sample of eight depressed clients from a self-help group in a mental health hospital in Beijing participated in this study. / The clients talked about their experiences at different stages: the onset, in the hospital and the rehabilitation, and interpreted their experiences. They also gave some advice to the hospital, the community, the mass media and the government based on their social service needs. / The theoretical perspectives influenced the clients’ interpretations of their experiences, especially the biomedical model. The cognitive perspective and the gender perspective could also be found in the client’s narratives. The psychiatrists were very important in the whole process of the clients’ experiences. Their perspectives and behaviors also influenced the clients. / It is found that the clients were also influenced by social and historical factors. Their interpretations were affected by social beliefs and cultural values such as fate, face, filial piety and gender roles. The historical events such as Cultural Revolution and June.4th Movement also affected their experiences and interpretations. The current social context in China was another important factor affecting them. / From their stories, we could see that the main theme was change of their cognitive styles, including view of depression, service and themselves. Another two themes were highlighted in their narratives as well: the linkage of their losses with depression and the dehumanized treatment in the hospital. / Their stories have provided comprehensive materials for an in-depth understanding of depressed middle-aged adults in Beijing. Based on the findings, recommendations are made to knowledge development, policymakers and clinical social workers in helping the depressed clients. It is necessary for our society and mental health professionals in different areas to work together to help them and build an inclusive society. / 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. / Shi, Song. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 228-245). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts and appendixes also in Chinese. / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Rationale of the study --- p.1 / Chapter 1.2 --- Background of the study --- p.2 / Chapter 1.3 --- Research Questions --- p.3 / Chapter 1.4 --- Purposes and significance of the research --- p.4 / Chapter Chapter 2 --- Literature Review --- p.7 / Chapter 2.1 --- Adult depression --- p.7 / Chapter 2.1.1 --- Definition of adults’ depression --- p.7 / Chapter 2.1.2 --- Different perspectives on “depression“ --- p.9 / Chapter 2.1.3 --- Social factors associated with adult depression --- p.24 / Chapter 2.1.4 --- Cultural influences in Chinese society --- p.32 / Chapter 2.2 --- Treatment of depressed adults --- p.36 / Chapter 2.2.1 --- Psychotherapy --- p.36 / Chapter 2.2.2 --- Medication --- p.38 / Chapter 2.3 --- Research on subjective experiences of people with mental disorders --- p.39 / Chapter 2.4 --- Research on depression in Mainland China --- p.48 / Chapter 2.5 --- The roles of social work in mental health services --- p.51 / Chapter Chapter 3 --- Research Methodology --- p.58 / Chapter 3.1 --- Paradigmatic Considerations --- p.58 / Chapter 3.1.1 --- Social constructionism --- p.58 / Chapter 3.1.2 --- Social construction and mental illness --- p.61 / Chapter 3.1.3 --- Theoretical Framework --- p.63 / Chapter 3.2 --- Research Design --- p.70 / Chapter 3.2.1 --- Qualitative research strategy --- p.70 / Chapter 3.2.2 --- Sampling strategies --- p.75 / Chapter 3.2.3 --- Data collection procedures --- p.84 / Chapter 3.2.4 --- Data analysis procedures --- p.86 / Chapter 3.2.5 --- Strategies for validating findings --- p.88 / Chapter 3.3 --- Ethical issues --- p.91 / Chapter Chapter 4 --- Research findings --- p.93 / Chapter 4.1 --- The experiences of the participants --- p.93 / Chapter 4.1.1 --- The experience during the onset of depression --- p.94 / Chapter 4.1.2 --- The experience in hospital --- p.118 / Chapter 4.1.3 --- The experience in the rehabilitation period --- p.131 / Chapter 4.2 --- The interpretation of their experiences --- p.142 / Chapter 4.2.1 --- The interpretation of the process of suffering from depression --- p.143 / Chapter 4.2.2 --- The interpretation of the process of recovery --- p.148 / Chapter 4.3 --- Advice on their needs --- p.154 / Chapter 4.3.1 --- The hospital --- p.154 / Chapter 4.3.2 --- The community --- p.159 / Chapter 4.3.3 --- Mass media --- p.161 / Chapter 4.3.4 --- The government --- p.164 / Chapter 4.4 --- Summary --- p.170 / Chapter Chapter 5 --- Discussion and Recommendation --- p.171 / Chapter 5.1 --- Characteristics of the participants in this study --- p.171 / Chapter 5.2 --- Social and historical factors affecting the clients’ interpretation of suffering from depression --- p.173 / Chapter 5.2.1 --- Social beliefs and cultural values --- p.174 / Chapter 5.2.2 --- Social context --- p.183 / Chapter 5.2.3 --- Historical events --- p.184 / Chapter 5.3 --- Themes --- p.186 / Chapter 5.3.1 --- Change of Cognitive Style --- p.187 / Chapter 5.3.2 --- The linkage of loss with depression --- p.190 / Chapter 5.3.3 --- The dehumanized treatment of hospitalization --- p.193 / Chapter 5.3.4 --- The interrelationships among the themes --- p.195 / Chapter 5.4 --- Revisiting the proposed conceptual framework --- p.197 / Chapter 5.5 --- Significance and recommendations --- p.200 / Chapter 5.5.1 --- Significance and recommendations --- p.201 / Chapter 5.5.2 --- Limitations --- p.214 / Chapter Appendix A: --- Possible Probes for interview (English Version & Chinese Version) --- p.218 / Chapter Appendix B: --- Oral Consent form (English Version & Chinese version) --- p.225 / References --- p.228

Clinical depression has been prevalent in international health statistics but people are often found to be reluctant to seek help when they encounter depression. This thesis built and evaluated a mental health promotion campaign to encourage help-seeking through first forming a behavioral model to conceptualize the interplays of various factors in shaping one’s help-seeking intention and behavior for depression in Hong Kong. The thesis began with in-depth illness narrative qualitative interviews with 18 participants through purposive sampling from the general public of Hong Kong. Through the interview results and close reference to the theory of planned behavior (TPB), a behavioral model was drafted highlighting impacts of view on depression, help-seeking and other factors had on individual’s help-seeking intention and behavior. Followed by that, 70 quantitative questionnaires completed by members of the general public were then done through snowball sampling to validate the model. 16 items were then retained in the model that uses attitude towards help-seeking, subjective norm and perceived behavioral control to explain individual’s help-seeking intention and behavior. At the same time, the interviews and questionnaires found that participants seem to have a limited view of treatment options and have diverse views of the symptoms of depression, both of which profoundly affect their motivation to seek help. The role of family and friends and a holistic approach to mental health education were found to be particularly important for encouraging help-seeking behavior in future campaigns concerning depression. The content for this mental health promotion campaign was then designed into 4-weeks of email campaign material according to the factors mentioned in the model to encourage help-seeking for depression built and validated in the previous stages. The participant recruitment for the media campaign was done through the social media Facebook through two paid advertisements. A total of 5,405 clicks were gained through the Facebook advertisements and these Facebook users were then directed to a Survey Monkey email registration site to the campaign. 383 people registered their emails in the site with 199 of them completed the pre-test and joined the 4-week campaign. The 199 participants were randomly divided in two groups with one receiving the campaign material and another group receiving information from tradition leaflet issued by the Hospital Authority in Hong Kong. Pre-test and post-test were done before and after the campaign to measure the difference in help-seeking intention after reading the two sets of material respectively. As a result, 116 participants completed the campaign and the post-test. With a post-test only design, no significant change has been found in primary outcomes including attitude, subjective norm and perceived behavioral control, but significant change has been found in secondary outcome, which participants were found to have better mental health literacy after the campaign. This thesis has shown the practicality and effectiveness of using online media and theory-guided material for mental health promotion campaigns. It is important for future studies to take advantage of the popularity of online media and conduct primitive and evaluative research on these campaigns. / published_or_final_version / Journalism and Media Studies Centre / Master / Master of Philosophy

背景 / 「因壓力事件而引發的反覆思索」 (stress-reactive rumination) 是指個人在經歷負性生活事件後不斷在腦海中重覆思索該事件及與該事件相連的負面個人想法。在科學文獻中，這現象初步驗證為其中一項導致情緒低落的認知誘因。 / 研究目的 / 本研究旨在透過模擬「因壓力事件而引發的反覆思索」，增加對此現象在影响情緒方面的理解。 / 研究方法 / 研究對象是三百三十三名沒有抑鬱病病徵的大學生。他們首先寫下一段他們感到情緒低落的個人失敗經歷，並揀選相關的負面思想，然後他們被隨機分成六個實驗組：第一、第二及第三組為「反覆思索實驗組」，第四、第五組為「思想轉移組」，第六組為「文獻對照組」。第一組要求研究對象在五分鐘內不斷投入地反覆誦讀該段個人經歷及相關的負面思想，以達到模擬此現象的效果。第二組要求研究對象除了反覆誦讀上述材料外，還要反問自己「為甚麼心情會弄到如此田地、再這樣持續下去的話對自己的影响」。第三組要求研究對象投入地反覆誦讀與該段個人經歷不相關的負面思想。第四組透過要求研究對象誦讀寫有實物的字咭，以達致思想轉移的效果。第五組要求研究對象誦讀不構成意義、由個別中文單字拼湊而成的中文字串，以達致思想轉移的效果。第六組參照文獻中「因覺察本身低落情緒」而引發的另一類反覆思索，研究對象誦讀相關的提引，例如留意身體在低落情緒時的狀況，及思索低落情緒的成因、意義及影響。 / 研究結果 / 「反覆思索實驗組」的情緒顯著地較實驗前低落，並更焦慮情緒失控，這三組間並沒有明顯的區別。「實物思想轉移組」的情緒顯著地較實驗前改善，並減少對情緒失控的焦慮。在「字串思想轉移組」中，女性研究對象的情緒顯著地較實驗前改善，並減少對情緒失控的焦慮，而男性研究對象的情緒較實驗前並沒有顯著變化，但他們較實驗前更焦慮情緒失控。「文獻對照組」的情緒較實驗前並沒有顯著變化，但此組的男女研究對象較實驗前更焦慮情緒失控。 / 討論 / 此項研究初步確立用實驗形式去檢視「因壓力事件而引發的反覆思索」對低落情緒直接影響的可行性，並為相關論理提供有力的驗證。本文亦探討不同形式的「反覆思索」與抑鬱情緒之間的關係，及在臨牀治療上的應用。 / Background / Stress-reactive rumination (SRR) refers to the tendency to ruminate on negative inferences following stressful events. Previous studies indicated that SRR, in interaction with negative cognitive style, predicted the prospective onset, number and duration of major depressive episodes. Yet, it is under-researched and there is no experimental studies demonstrating its causative role in depressed mood. / Objectives / The current study aims at simulating SRR among a non-clinical sample of undergraduates and assessing its immediate effect on the genesis of depressed feelings. / Method / An experimental paradigm was adopted in which SRR was operationalized in accordance with existing conceptualizations of depression. An initial sample of 544 university students were recruited, and the final analyses included 333 of them who met various inclusion criteria. Each participant was asked to write a sad personal experience of failure and to select thought cards associated with such experience. They were then randomly assigned into one of the six experimental conditions for five minutes. In the SRR Condition, participants ruminated about their sad experience and the associated thoughts by reading them aloud repeatedly. In the Double Rumination Condition, apart from what was required in SRR Condition, participants were asked to read aloud and think about two additional questions that capture the essence of depressive rumination. In the SRR with Unrelated Thoughts Conditions, participants ruminated on thought cards not associated with their respective experience. In the Distraction with Objects Condition, participants focused their attention on common objects. In the Distraction with Chinese Characters Salad Condition, participants read aloud chunks of Chinese characters that formed no cohesive meaning. In the Depressive Rumination Condition, participants were asked to read aloud statements depicting depressive rumination like the symptoms of depression, the causes and the meaning of depression. / Results / As predicted, participants undergoing any one of the SRR conditions reported further mood decline while those in Distraction with Objects Condition reported uplifted mood. A gender difference was found in that after undergoing the Distraction with Chinese Characters Salad Condition, female participants reported uplifted mood and less anxiety about loss of emotional control while the male participants reported more anxiety. / Discussion / Unlike previous studies who measure SRR with a self-administered questionnaire, the current study serves to be the first attempt to operationalize stress-reactive rumination in a laboratory setting and put such construct under an experimental paradigm. Findings lend support to the cognitive attentional syndrome as postulated in Wells' S-REF model and metacognitive theory for emotional disorders, and address some inadequacies of existing conceptualization of depression (e.g., Beck's theories of depression). The adoption of an experimental paradigm provides supplementary evidence for the causal role of SRR in the genesis of depressed feelings. Implications for further research and intervention are discussed. / 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. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chong, Heung Chuen. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 190-202). / 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. / Chapter Chapter 1: --- Introduction --- p.1 / Stressful Life Events as Risk Factors for Depression --- p.8 / Negative Cognitive Style as Cognitive Vulnerability for Depression --- p.9 / Self-regulatory Executive Function Model (S-REF) and Metacognitive Theory --- p.13 / Stress Reactive Rumination --- p.24 / Other Related Constructs: Depressive Rumination --- p.29 / Other Related Constructs: Metacognitive Beliefs on Rumination --- p.32 / Current Study --- p.35 / Chapter Chapter 2: --- Method --- p.43 / Design --- p.43 / Participants --- p.47 / Measures --- p.51 / Procedures --- p.59 / Chapter Chapter 3: --- Results --- p.67 / Gender Difference --- p.67 / Analysis of Experimental Effect on Mood State for Male Subjects --- p.77 / Analysis of Experimental Effect on Mood State for Female Subjects --- p.93 / Analysis of Gender Difference on Anxiety over Loss of Emotional Control (AC) after Elicitation of Stressful Events --- p.112 / Analysis of Experimental Effect on Anxiety over Loss of Emotional Control (AC) for Male Subjects --- p.117 / Analysis of Experimental Effect on Anxiety over Loss of Emotional Control for Female Subjects --- p.127 / Restoration of Mood after Debriefing and Mood-uplifting Procedure --- p.137 / Exploratory Factor Analyses with the Scores from Three Mood Visual Analogue Scales (VASs) --- p.141 / Chapter Chapter 4: --- Discussion --- p.154 / Preliminary Evidence for Experimental Simulation of Stress-Reactive Rumination --- p.155 / Stress-Reactive Rumination as a Research Entity --- p.163 / Findings that Warrant Further Exploration --- p.168 / Limitations --- p.176 / Further Research Directions --- p.180 / Clinical Implications --- p.185 / Concluding Comments --- p.188 / References --- p.190 / Appendices --- p.203