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Depression and anxiety are prevalent in adults with diabetes and are associated with poorer adherence to diabetes self-care. The Common Sense Self-Regulation Model (CS-SRM) hypothesises that both illness cognitions and emotions determine adherence to health behaviours but little is known about the causal pathways through which poor emotional health impairs adherence. Using the CS-SRM as a theoretical framework this thesis aimed to identify the pathways that exist between diabetes cognitions and poor emotional health and explored their combined and independent effects on diabetes self-care. A systematic review with meta-analysis identified that all previous observational studies used cross-sectional designs to explore the relationships between diabetes cognitions and poor emotional health, excluding one. Randomised controlled trials showed that changes in diabetes cognitions were associated with changes in poor emotional health but these mechanisms of action were not confirmed by mediation analyses. Few observational studies have rigorously tested how diabetes cognitions and poor emotional health operate together to determine diabetes self-management behaviours. This thesis used a longitudinal design to test whether: i) diabetes cognitions and poor emotional health have a longitudinal bi-directional relationship and ii) diabetes cognitions and poor emotional health have a combined (mediated) and independent (direct) longitudinal effect on diabetes self-care. Outpatients with Type 2 diabetes (N=261) were recruited at baseline and completed self-report measures of poor emotional health (Well-being Questionnaire), cognitions (Revised Illness Perception Questionnaire; Beliefs about Medicines Questionnaire) and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) at baseline and six months follow-up. Hypothesised pathways were tested simultaneously using structural equation modelling. Participants who were more anxious at baseline perceived diabetes to be unpredictable and were apprehensive about their medications at follow-up. These effects were not observed for depression. Baseline diabetes cognitions did not predict change in poor emotional health at follow-up. Equally, neither baseline depression or anxiety predicted change in diabetes self-care behaviours at six months (directly or indirectly via diabetes cognitions). Baseline personal control beliefs remained independent of poor emotional health: greater personal control beliefs were associated with reduced adherence to diabetes self-care. A bi-directional relationship between diabetes cognitions and poor emotional health was absent in this sample. The main direction of effect was from anxiety only to diabetes cognitions. Depression and anxiety had no relationship with diabetes self-care. Whilst personal control remained independent of poor emotional health, mastery beliefs appear to be insufficient on their own to sustain adherence behaviours over time suggesting that interventions should also provide patients with action plans whilst managing outcome expectations. The unexpected findings for the relationship between poor emotional health, cognitions, and diabetes self-care may be because the sample did not include individuals with more severe depression or anxiety. This study needs to be replicated among people experiencing clinically significant levels of depression and anxiety in diabetes.

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Individuals who engage in excessive reassurance seeking (constantly seeking reassurance that one is needed and valued) have higher rates of internalizing disorders. However, little research has examined excessive reassurance seeking among adolescents, particularly in a non-clinical population. Furthermore, research has not examined how close relationships in adolescence, such as best friends and romantic partners, view an adolescent?s use of excessive reassurance seeking behavior. This is particularly interesting, as best friends and romantic partners may be the primary recipients of this behavior. The current study sought to (a) examine the association between excessive reassurance seeking and internalizing symptoms among adolescents, (b) examine the agreement between adolescents? and close peers? ratings of excessive reassurance seeking as well as potential moderators of concordance, and (c) examine the association between peer ratings of excessive reassurance seeking behavior and adolescents? internalizing symptoms, both concurrently and prospectively over time. Participants included 465 adolescents (61% girls), ages 15-20 years, 64.3% Hispanic, 19.1% White non-Hispanic, 6.3% Black and 10.3% other. Participants completed the Excessive Reassurance Seeking subscale of Depressive Interpersonal Relationships Inventory, the Youth Self Report (YSR) and the Network of Relationships Inventory ? Revised. Of this larger sample, a subsample of 44 adolescents (68% female), ages 15-18, 59.1% Hispanic, 31.8% White-non-Hispanic, 2.3% Black and 6.8% mixed ethnicity or other, was used to test hypotheses related to close peer?s assessment of excessive reassurance seeking behavior. Participants also completed the YSR two months later. Data were collected as part of a larger study of adolescent peer relationships during class periods at public high schools in an urban area of the Southeast US. Data were analyzed using hierarchical linear regression techniques, controlling for demographic variables and testing the unique contributions of study variables. Regarding the first study aim that sought to examine associations between excessive reassurance seeking and adolescents? internalizing symptoms, results indicated that excessive reassurance seeking was related to internalizing symptoms concurrently, but not prospectively. Age, gender and ethnicity were found to also be significant predictors of adolescents? internalizing symptoms concurrently, but only ethnic differences emerged prospectively. Regarding the second study aim, examining the concordance between self and peer reports of excessive reassurance seeking, the agreement between self and peer reports was significant. However, further analysis revealed this association was moderated by friendship quality and informant type. Specifically, relationships with high positive quality showed concordance, as opposed to those low in positive relationship quality. Furthermore, romantic partners showed concordance in reports, but not best friends. Regarding the third study aim that sought to examine whether both self and peer reports of excessive reassurance seeking were related to adolescents? internalizing symptoms, results indicated that both self and peer reports were uniquely related to internalizing symptoms concurrently; however this was not the case prospectively. These findings suggest that certain peer informants (romantic partners, high quality relationships) may be reliable indicators of adolescents? excessive reassurance seeking behavior. This has potential implications in the assessment of adolescent internalizing symptoms and interpersonal behaviors associated with these symptoms. However, as results did not emerge in the current study over time, future research is needed to examine the developmental pathways between excessive reassurance seeking and internalizing symptoms.

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Background: Depression and related phenotypes, such as anxiety and neuroticism are thought to have a common genetic background. The malfunction of the serotonergic system is likely to play an important role in the etiology of these phenotypes, with compelling evidence coming from animal and human studies. However, recent studies indicate that other factors should be investigated, such as environmental stress. Aim: To investigate the role of the serotonergic gene variants (HTR1A-7 and SLC6A4) in depression, anxiety and neuroticism, in interaction with each other and other factors, such as stressful events. Method: Two large independent Caucasian cohorts, haplotype tagging single nucleotide polymorphisms (htSNPs) and existing genome-wide genotype data were used. Phenotypes were assessed by detailed questionnaires about psychiatric phenotypes (depression, anxiety and neuroticism) as well as background information, such as physical health. Environmental stress factors were investigated in one cohort by self-reported life event (recent and childhood) questionnaires. Healthy participants from this cohort took part in a computerised task to measure the effect of a functional polymorphism in the HTR1A gene on threat-related emotional information processing. ResultsMy study confirmed the importance of stressful life events in depression and anxiety modulated via the 5-HT1A and 5-HT1B autoreceptor, but not via the SLC6A4. I found evidence for epistatic interaction between HTR2A and SLC6A4 genes and between different subunits of the HTR3 gene which may contribute towards the depressive phenotype. Finally, certain alleles of SNPs in other serotonergic receptors (5-HT4 and 5-HT6) were also associated with depression, anxiety and neuroticism however, this association was weak. On the other hand, my study did not provide evidence for the interaction between the serotonin transporter 5-HTTLPR polymorphism and stressful life events which is widely reported in the literature. Conclusion: This study provides further support for the serotonergic hypothesis of depression and confirms the role of the environment in the aetiology of depression. The results show evidence of possible epistatic interaction between the SLC6A4 and HTR2A genes. These results highlight the complex interactions between the members of the serotonergic pathway as well as the role of the environment on the individual.

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The overarching aim of this research was to understand factors implicated in the maintenance of rumination and worry, conceptualised as a transdiagnostic process of repetitive negative thought (RNT), through the use of cross-sectional, prospective, and experimental research designs. Rumination and worry have been repeatedly implicated in the development and maintenance of various forms of psychopathology, in particular, depression and anxiety disorders. Given the negative outcomes for mood and psychopathology, there is a need for a better understanding of vulnerability factors that maintain this unconstructive thinking. Based on a review of the literature, an integrative theoretical model was developed and tested using structural equation modelling. Using cross-sectional data, the model was tested in a large sample of adults (n = 506). Of the broad range of proximal and distal vulnerability factors examined, only neuroticism and beliefs about the function of repetitive thought remained significantly associated with RNT once current symptoms were statistically controlled. Emotional abuse and abstract processing were indirectly associated with RNT. Following on from this, a prospective study examined which of these vulnerability factors prospectively predicted change in RNT over six to eight weeks. Only neuroticism and the specific belief that repetitive thought aids instrumental understanding predicted change in RNT, after controlling for depression and anxiety symptoms. Next, two experimental studies were conducted to explore the causal relationship between RNT and the belief that RNT aids insight and understanding, by experimentally manipulating this appraisal and measuring the impact on state RNT. Whilst methodological issues with the first experimental study precluded clear conclusions being drawn about the nature of the relationship, the second experimental study demonstrated that participants manipulated to believe that RNT is helpful for increasing insight and understanding had greater levels of state RNT after exposure to a stressor, relative to participants manipulated to believe that RNT is unhelpful. Finally, in order to see whether rumination has any consequences that may potentially reinforce its further use, an experimental study was conducted to manipulate processing mode (abstract rumination versus concrete thinking) and examine the effect on a range of outcomes relating to insightfulness and avoidance. Whilst rumination did not lead to increased insight, it did afford more justification for avoidance, relative to concrete thinking. The clinical and theoretical implications of these findings are discussed with respect to existing theories of repetitive negative thought.

Background: In order to aid effective assessment and detection of psychological health, a clear understanding of the risk factors for disturbance is required. This study was undertaken to test the hypothesis that demographic factors, health factors, social factors, attitudes to ageing, number of life events in the last year and relocation status would each significantly account for, and contribute to, the variance in psychological health. Method: The study employed a cross-sectional design in which 1,080 individuals over the age of 55 were randomly drawn from the community health index (CHI) of a rural health board in Scotland and invited to participate in the study. One hundred and ninety-six respondents completed questionnaires assessing psychological health and a range of potential predictors. Results: Overall, negative attitudes to ageing were the most prominent predictors of poor psychological health. Psychosocial loss was the only variable found to be a predictor of all seven outcome variables, including anxiety and depression, physical, psychological, social, and environmental quality of life, and general psychological and social functioning. Other predictors included a higher number of life events, poor social support from friends, poor self-rated health and not having a spouse/partner. Conclusions: Attitudes to ageing appear to play a significant role in the psychological health of older adults. Promoting positive perceptions of ageing in society may potentially pay dividends in the prevention of emotional distress in later life. Psychological interventions, such as cognitive behaviour therapy (CBT), may be key to addressing negative attitudes to ageing at an individual level.