A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: Mental health plays a central role in the well‐being of individuals. Understanding the factors that influence mental wellness is critical in order to develop effective policy that addresses the burden of mental illness in society. The objective of this study is to identify a possible relationship between healthcare access and the presence of mental distress in individuals. Methods: Logistic regression was performed using cross sectional data from a CDC developed nationwide behavioral health surveillance program (BRFSS, 2013‐4). Odds ratios were estimated using frequent mental distress as the outcome of interest while adjusting for confounding variables such as smoking, binge drinking, obesity, etc. Six models were estimated utilizing our hypothesized variables of interest. Results: The calculated adjusted odds ratios (AOR) and confidence intervals (CI) demonstrated a positive correlation between certain variables measuring access to healthcare and the reporting of frequent mental distress, agreeing with the hypothesis. Those variables were financial cost preventing access to medical care (AOR [2], CI [1.9‐2.1]) as well as a span of more than 2 years having elapsed since a routine medical checkup by a healthcare provider (AOR [1.1], CI [1.1‐ 1.2]). The opposite effect was demonstrated in individuals who had no insurance coverage (AOR [.8], CI [.7‐.9]), which was contrary to the hypothesis. Conclusion: After adjusting for confounding variables, a strong relationship exists between individuals who are not able to see a physician due to cost, and the presence of frequent mental distress. Frequent mental distress is also increased in individuals who have not had a routine medical checkup with a physician in the last 2 years.

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The causes and consequences of police stress has received considerable research interest. Reversal theory postulates some individuals may inherently require higher (Le. paratelic) arousal levels, compared with those seeking lower (Le. telic) arousal levels. This present study investigated: (i) psychological problems experienced between British police officers, special (voluntary) police and civilian support staff; (ii) telic and paratelic dominance; (iii) use of humour; (iv) dimensions of police humour; and (v) predictors of police psychological problems, telic dominance and humour use. A mixed, cross-sectional survey design was employed. Questionnaires were sent to all police officers, support staff and specials (N = 373) within one division of a provincial police service. Participants completed the following measures: (i) Coping Humour Scale (CHS); (ii) Multi-dimensional Sense of Humour Scale (MSHS); (iii) Telic Dominance Scale (TDS); and (v) Employee Assistance Program Inventory (EAPI). Questionnaires were returned from 191 participants (51% response rate). For overall CHS and MSHS scores, no significant differences between groups were found; although police gender differences were significant. MSHS police dimensions deviated from previous samples. Overall TDS scores were significantly higher for specials. For all three groups, EAPI subscale scores were normative, but with significantly higher substance use reported by police. Police EAPI scores were generally significantly higher, indicative of greater psychological difficulties. Predictors of police psychological problems, TDS, CHS and MSHS scores are reported. These results suggest that police may have a paratelic dominance, in which humour provides a valuable and adaptive mechanism for pOlice stress. Clinical implications are discussed in light of these results.

Thesis (M.D.)--Boston University School of Medicine