Depression is poorly recognised, under-assessed and under-treated in patients receiving palliative care for a life-limiting illness. There are barriers to assessment and diagnosis, and limited access to specialist clinicians who might assist in these complex assessments and who could provide options for treatment. The three studies presented, using different research methodologies, and using both qualitative and quantitative analysis, seek to clarify these issues and to provide some solutions. A questionnaire was sent to all Palliative Care Services (PCS) in Australia. Questions included what part specialist psychological clinicians played in multi-disciplinary team meetings and in the treatment or coordination of patient care. Very few PCS used a valid screening instrument for psychological distress and very few had regular support from a psychiatrist or psychologist. Many did not have access to social work support. There are two competing issues with regard to recognising and assessing depression in palliative populations. A rapid reliable screen that points to a likely problem would be useful, but also there is a need to understand something of the patient experience of depression. In the second study, the one- and two-item screening instruments widely used in palliative care are examined and limitations that have been found in other settings are confirmed. A new novel screening tool is developed from this data and tested empirically. This algorithm is short, has good psychometric properties and is validated for an Australian palliative care population. Depending on the response pattern it is possible to identify that a particular patient has significant symptoms of depression by asking between one and four questions. Professional carer and patient acceptability of the questions is high. The understanding of the experience and symptom profile of depression in Australian palliative care patients is addressed in the third study. Patients and family carers were recruited prospectively from palliative care and oncology ambulatory clinics of two teaching hospitals in an Australian capital city. The Geriatric Depression Scale (GDS) was administered to the patient and the Collateral Source version of this instrument was asked of the carer. A subset of this sample completed the measures twice. The results using this 30-item scale were then compared with all the known previously published short versions of this scale. Two short forms met as many psychometric criteria as the longer forms. None of the versions of the GDS showed sufficiently high correlations between carer-completed and patient-completed forms. The frequency of symptoms was also assessed. Patients more frequently reported fatigue and anhedonia than depressed affect. Despite many screening instruments being available for depression, their use is limited in Palliative Care Services. Although these studies have validated several options for Australian palliative care patients, the issues behind the low uptake rates for screening have not been resolved. The final chapter of this thesis constructs known and potential barriers into a logical structure and then offers some solutions to improve access to mental health professionals by considering service models and applying this theory to the problem of depression and its assessment in palliative care populations.

No description available.

Anxiety and depression are common mood disorders in cancer patients, regardless of mental state prior to diagnosis. A gap in the education of oncology nurses in an eastern Caribbean island was discovered regarding their ability to identify anxiety and depression symptoms and to help patients who suffered from these disorders. The purpose of this project was to improve oncology nurses' assessment skills by reviewing appropriate use of the Hospital Anxiety and Depression Scale (HADS) tool and familiarizing nurses with resources to help patients who score high on the HADS. The Levine conservation model was the theoretical framework for this project. The research question addressed whether a staff education module regarding the use of the HADS tool would improve staff knowledge about screening cancer patients for mood disorders in a clinic setting. This project involved a staff education module with a pretest/posttest assessment and evaluation of the responses and levels of improvement. A total of 10 oncology nurses with varying academic degrees and years of experience participated in the project. The pretest showed that many had inadequate knowledge of the HADS tool. Based on posteducation assessment scores, all participants understood how to use the tool to screen for mood disorders. The implication of this study for positive social change is that oncology nurses will be able to use a screening tool to identify undiagnosed anxiety and depression symptoms in cancer patients and provide patients with appropriate resources.

No / The factor structure of the Hospital Anxiety and Depression Scale (HADS) were investigated in 376 individuals with facial disfigurement. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. Competing one-factor, two-factor and three-factor models were evaluated to identify best model fit. The best model fit to the data was found to be consistently provided by three-factor models. However, further research into the factor structure of the HADS is suggested, particularly in terms of developing and scoring the instrument as a three-dimensional affective state screening tool.

Paternal postnatal depression has begun to receive attention during the last decade. Studies have shown that the consequences of paternal and maternal postnatal depression are equally serious. There are currently no validated instrument for screening of paternal postnatal depression. In this cross-sectional study a self-report questionnaire, the Edinburgh Gotland Depression Scale (EGDS) is validated against the clinical interview SCID-CV as gold standard, and is further developed. A convenience sample of Swedish fathers (N = 95) who had children in the past year, answered an online questionnaire and a subsample (n = 52) of them were later interviewed with the SCID-CV. The revised EGDS showed improved criterion-related validity, sensitivity and specificity. The scale has problems disciminating between mildly and non-depressed fathers. A cut-off score of ≥8 on the revised EGDS results in sensitivity of 91.7 per cent and specificity of 85.0 per cent. This study should be replicated and cross-validated to provide further evidence of validity. / Postnatal depression hos fäder har börjat uppmärksammas under det senaste decenniet. Studier har visat att konsekvenserna av postnatal depression hos fäder och mödrar är lika allvarliga. Det finns för närvarande inga validerade instrument för screening av postnatal depression hos fäder. I denna tvärsnittsstudie har självskattningsformuläret, Edinburgh Gotland Depression Scale (EGDS) valideras mot den kliniska intervjun SCID-CV som gold standard, och vidareutvecklas. Ett bekvämlighetsurval av svenska fäder (N = 95) som fått barn under det senaste året, besvarade en webbenkät och en undergrupp (n = 52) av dem blev senare intervjuade med SCID-CV. Det reviderade EGDS visade förbättrad kriteriumrelaterad validitet, sensitivitet och specificitet. Skalan har problem med att diskriminera mellan milt och icke-deprimerade pappor. En cut-off poäng ≥8 för den reviderade EGDS resulterar i sensitivitet på 91,7 procent och specificitet på 85,0 procent. Denna studie bör replikeras och korsvalideras för att ge ytterligare belägg för validiteten.

Bakgrund: Under graviditeten och efter förlossningen genomgår kvinnan en period som innebär en stor förändring i hennes liv och det är vanligt att uppleva ett brett spektrum av olika känslor. Den första tiden efter förlossningen kan symtom på allvarliga psykiska hälsoproblem utlösas, såsom en depression. Depression hos nyblivna mödrar, en så kallad postpartumdepression, har sedan 1990-talet ökat i intresse inom hälso- och sjukvården, inom omvårdnadsforskningen samt bland föräldrar.   Syfte: Syftet med denna studie var att belysa BVC-sköterskors upplevelser av att möta mödrar med symtom på postpartumdepression.   Metod: En induktiv ansats användes där datamaterialet analyserades med kvalitativ innehållsanalys. Datamaterialet utgjordes av intervjuer och åtta BVC-sköterskor intervjuades.   Resultat: Ur analysen av datamaterialet framkom fyra kategorier: etablera ett gott samarbete, ge råd och vägledning, att använda instrument som underlättar och kommunikativa hinder i arbetat samt tillhörande underkategorier.   Konklusion: För att kunna möta mödrar med symtom på postpartumdepression bör BVC-sköterskorna etablera ett bra samarbeta. Det första hembesöket var också betydelsefullt för att kunna etablera ett bra samarbete mellan BVC-sköterskorna och mödrarna. Att använda instrument såsom EPDS-formuläret, underlättade samtalet och var ett viktigt verktyg för BVC-sköterskorna. / Background:  During pregnancy and after childbirth the woman go through a period that represents a major change in her life and it´s common to experience a wide range of different emotions. The first time after birth, symptoms of serious mental health problems can be triggered, such as depression. Depression in new mothers, known as postpartum depression, has increased in interest since the 1990s in health care, nursing research and among parents.   Aim: The aim of the study was to illustrate Child health care nurses’ experiences of encounting mothers’ with symptoms of postpartum depression.   Method: Qualitative content analysis with inductive approach was used and data were collected through interviews. Eight Child health care nurses’, CHCN, were interviewed.   Results: Four categories emerged from the analysis: establish a good collaboration, provide advice and guidance, to use instruments that facilitate and communicative barriers at work and associated subcategorys.     Conclusion: In order to meet mothers with symptoms of postpartum depression CHCN need to establish a good collaboration. The first home visit was also important to establish a good collaboration between CHCN and mothers. The use of instruments such as EPDS, facilitate the conversation and was an important tool for the CHCN.

Background: Mental ill-health among adolescents is one of the most increasing public health problems in Sweden. Particularly girls suffer from mental and psychosomatic symptoms. The National Board of Health and Welfare recommend the DISA method as a preventive measure. Problem: Investigations has been done of the DISA method, but further investigations needs to be done. Aim: The aim of the study was partly to investigate how participants in DISA groups in two counties understand the method and its eventual effect and partly how their mood change, to contribute with knowledge to the development of the DISA method. Methods: A questionnaire and the self-report CES-D scale were collected from a population of 154 participants. A statistical analysis with Paired-Samples T Test carried out to examine if the difference between the sum of points of the group from the first and the last completing of the self-report CES-D scale was statistical guaranteed. Results: The participants were most satisfied with the group size and the rules. They were less satisfied with the mood diary and the homework. They wanted to talk less about negative thoughts and wanted it to be voluntary to participate in a DISA group. The participants got better insight and understanding of mental health and mental ill health. It is statistical significant that the average sum of points of the participants got lower the last time they completed the self-report CES-D scale compared to the first time. Conclusion: There are many indicators who points out that DISA is a well functioning depression preventive method.

Many eating disordered patients fail to respond to traditional cognitive behaviour therapy. As a result it has been suggested that further research needs to be completed to determine the cognitive processes and mechanisms that underpin these disorders. This research aims to empirically test Young’s Schema Mode concept (Young et al., 2003) within the eating disordered population and determine the relationship between schema modes and early maladaptive schemata, experience of invalidation of emotion during childhood and symptoms of anxiety and depression. In total 15 patients from an outpatient eating disorders service and 28 non patient controls completed the Schema Mode Inventory, The Young Schema Questionnaire, the Hospital Anxiety and Depression Scale, The Invalidating Childhood Environment Scale, and measures of eating disordered pathology. Non parametric analyses were completed to determine the differences between the two groups. The relationship between all measures was determined using correlation analyses. The eating disordered group were significantly more dysfunctional than the control group across all schema modes and early maladaptive schemata. Both groups did not display uniformity in their dysfunctional schema modes. The eating disordered group had raised scores in the detached self soother, the compliant surrender and the vulnerable child mode, whereas the control group had lower scores in the detached protector and the vulnerable child modes. The measure if eating pathology was not associated with the total score on any questionnaire measure. This research indicates that the schema mode concept may be a useful addition to the schema model of eating disorders.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2017-04-24T14:36:33Z No. of bitstreams: 1 Clarissa Martins.pdf: 1616707 bytes, checksum: 7d6ba6c5f2c247d0a5ccd351abde1ebe (MD5) / Made available in DSpace on 2017-04-24T14:36:33Z (GMT). No. of bitstreams: 1 Clarissa Martins.pdf: 1616707 bytes, checksum: 7d6ba6c5f2c247d0a5ccd351abde1ebe (MD5) Previous issue date: 2014-10-28 / This dissertation refers to an epidemiological study of screening scales for depression in pregnant adolescents. The main objective of the research was to adjust the cutoff scales for screening for depression, Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI), for pregnant teenagers. It is a cross-sectional, population-based study carried out with pregnant adolescents (10-19 years old), which consulted the service prenatal Unified Health System (SUS) of Pelotas. Was carried out from October 2009 to March 2011. The sample was composed based on the SIS-Prenatal program records along the municipal health department and the Basic Health Units, and specialized clinics in the urban area of Pelotas / RS. The women answered a questionnaire with socio demographic and obstetric data, besides the two scales for screening for depression during pregnancy. Also participated in a structured clinical interview Mini International Neuropsychiatric Interview 5.0 (MINI) for the clinical diagnosis of depression. Demographic, obstetric and psychiatric social variables were assessed according to the WHO questionnaire. The accuracy of the scales was calculated by their Area under the curve (AUC) of ROC, as well as their respective sensitivity, specificity and predictive values. The best cutoff (PC) found for this sample was ≥10 EPDS scale, with sensitivity 81.1% and specificity 82.7% and AUC of 0.899. BDI for the best cutoff point was ≥11, sensitivity 81.1%, sensitivity 76.8% and an AUC of 0.869. Since the difference between the two AUC were statistically significant (p = 0, 0215). Based on the results, it is concluded that the EPDS scale has become more predictive and sensitive in screening for depression in pregnant adolescents, with respect to BDI. / A presente dissertação refere-se a um estudo epidemiológico sobre escalas de rastreamento para depressão em gestantes adolescentes. O objetivo principal da pesquisa foi verificar os pontos de corte das escalas para rastreamento da depressão Edinburgh Postnatal Depression Scale (EPDS) e Beck Depression Inventory (BDI), em gestantes adolescentes. Trata-se de um estudo transversal, de base populacional, realizado com gestantes adolescentes (10 a 19 anos de idade), as quais consultaram o serviço de pré-natal do Sistema Único de Saúde (SUS) de Pelotas-RS. Desenvolvido no período de outubro de 2009 a março de 2011. A amostra foi composta com base nos registros do programa SIS-Pré-Natal, junto a secretaria municipal de saúde e nas Unidades Básicas de Saúde, além de ambulatórios especializados na zona urbana de Pelotas/RS. As gestantes responderam a um questionário com dados sócio demográfico e obstétricos, além das duas escalas para o rastreamento da depressão durante a gestação. Também participaram de uma entrevista clínica estruturada Mini Internacional Neuropsychiatric Interview 5.0 (MINI) para o diagnóstico clínico da depressão. As variáveis sócio demográficas, obstétricas e psiquiátricas foram avaliadas nos domínios do questionário da OMS. A precisão das escalas foi calculada através de suas Áreas sob a curva (AUC) de ROC, assim como suas respectivas sensibilidade, especificidade e valores preditivos. O melhor ponto de corte (PC) encontrado para esta amostra na escala EPDS foi ≥10, com sensibilidade 81,1% e especificidade 82,7% e AUC de 0,899. Para a escala BDI o melhor ponto de corte foi ≥11, sensibilidade 81,1%, sensibilidade 76,8% e uma AUC de 0,869. Sendo que a diferença entre as duas AUC mostraram-se estatisticamente significativas (p=0,0215). Com base nos resultados, conclui-se que a escala EPDS apresenta-se mais preditiva e sensível no rastreamento para depressão em gestantes adolescentes, quando contrastada com a escala BDI.

The purpose of this secondary data analysis was to assess for the relationships among sleep disturbances, depressive symptoms, inflammatory markers, and sexual trauma in female veterans. This may contribute to an understanding of the physical and mental health effects of sexual trauma in female veterans. Correlational analyses were conducted to evaluate the strength of these relationships. A reported history of sexual trauma was significantly correlated with longer sleep latencies, poorer sleep efficiency, shorter sleep durations, more daytime dysfunction, and poorer overall sleep quality in female veterans. A reported history of sexual trauma was also significantly correlated with depressive symptoms including anhedonia and a negative affect in female veterans. No significant correlations were noted between inflammatory markers and a reported history of sexual trauma in female veterans. Female veterans with a reported history of sexual trauma had more trouble falling and staying asleep, had more trouble functioning during daytime hours, and had total poorer sleep quality. These veterans also appeared depressed and they found normally pleasurable activities unenjoyable. Disturbed sleep and depressive symptoms may be risk factors in the development of chronic health diseases. By assessing and treating the sleep disturbances and depressive symptoms experienced by sexually traumatized female veterans, nurses may help to prevent the development of costly and deadly chronic diseases