Student Veterans experience a range of health and mental health challenges that may impact their social and academic functioning as they transition from military to student life. Of those in need of treatment, some do not receive support for successful integration into collegiate life. Recognizing the barriers to care faced by this population, a brief, non-stigmatizing psychosocial support intervention was developed to address the mental health needs of Student Veterans experiencing psychological distress. The intervention, called IPC-3, was adapted to be sensitive and inclusive of Veteran culture, norms, and values. It was delivered by peer providers and offered on campuses instead of at medical treatment facilities. IPC-3 trained and provided clinical supervision for peers through the Department of Veterans Affairs, Veterans Integration to Academic Leadership program, to leverage and expand capacity through an existing, care-delivery pathway. This study examined specific Dissemination and Implementation (D&I) science outcomes for IPC-3, assessing the intervention’s readiness for transitioning from a research setting to routine, clinical practice, utilizing a mixed-methods research design. Specifically, the D&I outcome measures of Adoption, Acceptability, Appropriateness, Feasibility, Reach, and Sustainability were explored across three groups. Participants included the Student Veteran consumers who received the intervention, the Peer Mentor providers who delivered IPC-3, and the Site Supervisors who provided clinical case supervision. Attitudes regarding each construct were evaluated at the pre- and post-intervention timepoints via surveys and key informant interviews. Results were assessed to identify potential barriers that, if removed, may bridge the research-to-practice gap for IPC-3. As the first study to assess D&I outcomes for a psychosocial support intervention developed specifically for Student Veterans, findings offer insights for treatment developers and implementors serving Student Veterans experiencing psychological distress and suggest ways that IPC-3 may be implemented in routine-care settings.

This thesis is an investigation of social problem-solving skills, psychological distress, and supportive relationships among three distinct samples. The research groups comprise a) 25 depressed inpatients and a matched comparison group; b) 50 hospital admissions following an act of suicidal behaviour; and c) 5 sub-groups of incarcerated young offenders (inmates on Strict Suicidal Supervision, inmates on protection, victims of bullying, identified bullies, comparison group) with 25 inmates in each group. Data was collected by structured interviews, standardised psychometric measures of mood states (e.g. Hospital Anxiety and Depression Scale, Beck Hopelessness Scale), problem-solving ability (e.g. Means-Ends Problem-Solving Procedure) and supportive relationships (e.g. Significant Others Scale). Data were analysed by means of parametric statistical techniques (e.g. analyses of variance and multiple regression analyses). Eight cross-sectional studies are reported. Depressed patients demonstrated problem-solving difficulties, which were related to the level of psychological distress experienced. Clinically depressed patients were also found to differ from a comparison group in their autobiographical memory recall and concentration ability - both of which were related to their impoverished problem-solving ability. Deficits in problem-solving ability in the depressed patients were not an artefact of their verbal IQ. Regression analyses of the data relating to suicidal community inpatients illustrated that social support variables were the prime predictors of suicidal intent, depression and hopelessness. Social problem-solving variables also emerged as significant predictors of psychological distress, albeit to a lesser extent. Social support and problem-solving variables were also important moderator variables in the relationship between stress and suicidality. The studies conducted with young offenders illustrated a hierarchy of problem-solving deficits and psychological distress among the inmate groups. Problem-solving ability was not an artefact of verbal IQ. The value of using problem-solving interventions with vulnerable offenders is discussed. The importance of prison relationships in the experience of stress by inmates was also highlighted. Similarly, parental relationships were related to the levels of distress experienced while incarcerated. The results of each study are discussed in relation to the relevant literature, practical implications for clinical interventions with each group, and suggestions for future research. The findings of the thesis are discussed in relationship to transactional, stress-hopelessness-distress models of psychological illness and distress.

Submitted in fulfillment of the requirements for the Degree in Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Moral distress is a widely recorded phenomenon in the nursing profession. It can be described as a form of distress that occurs when one knows the ethically correct thing to do, but is prevented from acting on that perceived obligation. Moral distress impacts patients, nurses and the organization. If the nurse is unable to advocate for her or his patient and avoidance behaviour occurs, increased patient suffering result. Moral distress results in high staff turnover, decreased quality patient care and low patient satisfaction. Unrelieved moral distress jeopardizes nurse’s sense of self-worth and threatens their integrity. Aim of the study The aim of the study was to determine the impact of moral distress on the provision of nursing care amongst critical care nurses. Methodology A quantitative descriptive design was used to determine the intensity and frequency of moral distress amongst critical care nurses, to assess the impact of moral distress on the provision of nursing care to the patient as well as to evaluate the effectiveness of organisational strategies implemented to reduce moral distress. Critical care nurses from both private and public hospitals were selected to participate in the study. Data was collected by means of a survey using the moral distress scale which was revised to meet the objectives of the study. A non-probability purposive sampling technique was utilised to gather data from a sample size of 100 critical care nurses currently working in the critical care environment. Results The study indicates that the frequency and intensity of moral distress is related to specific clinical situations in the critical care environment. The study also specifies that moral distress continues to have a negative effect on the provision of nursing care. Critical care nurses feel that some strategies are effective whereas others are not at all effective. Impact of the research study This study reveals that there is a significant negative effect of moral distress on the provision of nursing care. Nurses experience challenges in the clinical environment that result in them experiencing moral distress. Nurses more attuned to the ethical dimensions of care may be more at risk for moral distress since these nurses see the moral dimensions of nursing being neglected. Nurses may find themselves distancing themselves from patient care, resulting in a perceived lack of care and concern for the patient. / M

The present study examined the relationship between coping and psychological and psychosomatic distress of 25 individuals who experienced the same severe, acute traumatic event: the violent shooting that killed 23 people and severely injured 20 more in Luby's Cafeteria in Killeen, Texas, on October 16, 1991. Distress was assessed by one-month pre-event and post-event scores on the SCL-90R, Psychosomatic Questionnaire, and by a Life Event Questionnaire score for the year before the incident. Coping was measured by a modified version of the Ways of Coping Scale (Folkman et al., 1986) and Response Style Questionnaire (Nolen-Hoeksema & Morrow, 1991). All post-event distress scores, except the Psychosomatic score, significantly increased over their corresponding pre-event scores regardless of gender. Although female distress scores were consistently higher than male scores, gender was predictive of post-event distress only for the SCL-90R Anxiety, Somatization, and Global Severity Index scales. The only pre-event score found to be predictive of post-event distress was the Psychosomatic scale. Regression analysis, with demographic and pre-event variables controlled, found a significant positive relationship between Escape/Avoidance coping and one-month post-event levels of Anxiety and Psychosomatic distress. Findings were discussed in the context of the process-oriented stress-illness model and were compared to current disaster and crime victimization literature. Implications for helping professionals, methodological issues, and implications for future research were explored.

Mutations in BRCA1 and BRCA2, the first two breast cancer susceptibility genes identified, carry as much as an 85% lifetime risk of developing breast, ovarian or other cancers. Genetic testing for mutations in these two genes has recently become commercially available. There have been varying amounts of psychological distress noted among women with a family history of breast cancer. Distress has been observed to impact psychological functioning, activities of daily living, and the practice of breast cancer surveillance behaviors. Within the genetic screening process, psychological distress has been shown to impact the decision to undergo genetic screening, the comprehension and retention of risk assessment information, as well as affecting the subject following the receipt of the genetic test results. Little work has been done to examine predictors of distress within at risk subjects. This study examines psychological distress among 52 community women presenting for BRCA1 and BRCA2 genetic mutation testing. Predictors of distress included family cancer history, education, age, Ashkenazi ethnicity, and Internality and Powerful Others Health Locus of Control. Vulnerable sub-groups of patients include younger women, women with higher levels of education and women of Ashkenazi ethnicity.

The emotional impact of serious illness in families is recognised. To enhance well-being in families living we must understand how distress is experienced within families; from this, evidenced-based systemic distress interventions can be derived. However, the success of systemic intervention programmes is reliant on whether families will seek help (or not) for distress. This PhD by publication explores emotional distress and help-seeking in families living with advanced cancer. Papers one and two used systematic review techniques. Paper one evidenced distress as a systemic construct and proposes the tiered model of distress to convey current understandings. Paper two offers the attaining normality model to convey why some people seek help for distress to achieve a new normality whereas some choose not to seek help to maintain normality. Together, these papers evidence gaps in systemic understandings of distress and help-seeking; from this an exploratory cross-sectional multiple case study of families was proposed. Papers three and four provided methodological underpinning to this research through the development of the DESCARTE model: The Design of Case Study Research in Healthcare (paper three) used in the case study design; paper four reflects on multi-perspective interviewing methods used. Distress and help-seeking are conceived as systemic relational phenomena, occurring within the family system and arising from relational interaction with healthcare. Distress is conveyed through four themes: interdependent distress, living in uncertainty, unnecessary distress and oscillatory distress; from this, possible systemic intervention designs are offered (paper five). Non-help-seeking for distress was the predominant response in families. The mutuality model of help-seeking is proposed to synthesise current understandings (paper six). Families describe how healthcare interactions cause unnecessary distress and shapes families’ help-seeking behaviours. Findings indicate significant gaps between the rhetoric of palliative care policy and families’ experience. To improve families’ wellbeing, relational care must be embedded in policy and practice.

Thesis (M. A. (Psychology)) -- University of Limpopo, 2018 / Upon entering the university environment, first year students encounter what could be described as a “foreign culture”, and have to reconcile conflicting transitional spaces of their home and university identities. This adjustive demand can lead to some considerable levels of psychological distress. This study examined the level of psychological health in first year students. It also evaluated whether factors such as monetary background, residential area, race and the availability of bursaries affect students’ transition into “university life”. First year students (N = 300; male = 135; female = 165) completed the General Health Questionnaire-12 at the University of Limpopo. A substantial percentage (that is, 30.33%) of the participants was found to have or is prone to psychological health problems. This finding is consistent with the results of previous studies which have found that some students may be susceptible to mental health problems predating their entry into university. There was no significant difference between the levels of psychological health between males and females and bursary users and those that are funded by their parents or guardians. There was also no significant difference between those that live in the rural areas and those from the cities. However, the figures between those that are poor and rich were strikingly noteworthy.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Appendices in English and Korean. Typescript. Vita. Includes bibliographical references (leaves 71-75). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Appendices in English and Korean. Typescript. Vita. Includes bibliographical references (leaves 71-75). Also available on the Internet.

patterns, severe personality patterns, depressive constructs, other clinical syndromes, severe clinical syndromes and dissociation following EMDR treatment. Thirty-two people, ranging from 23 to 65 years old, underwent the full EMDR protocol treatment for up to three traumas. The findings regarding clinical personality patterns revealed that EMDR is most effective in reducing the symptoms of dependent personality pattern because 76% of participants with clinically significant dependent personality pattern before EMDR treatment no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment; compared to 75% with masochistic personality pattern, 77% with negativistic personality pattern, 69% with avoidant personality pattern, 40% with depressive personality pattern and 29% with schizoid personality pattern. These gains were maintained on the MCMI-III at follow-up by 76% with dependent personality pattern, 64% with masochistic personality pattern, 46% with negativistic personality pattern, 38% with avoidant personality pattern, 30% with depressive personality pattern and 29% with schizoid personality pattern. The analysis of the severe personality patterns at the end of EMDR treatment revealed that the scores on the MCMI-III reduced from within one standard deviation above the mean (60-74) to below the mean (<60) for 84% of participants with borderline personality pattern, compared to 68% with paranoid personality pattern and 52% with schizotypal personality pattern. These gains were maintained on the MCMI-III at follow-up by 84% with borderline personality pattern, 68% with paranoid personality pattern and 48% with schizotypal personality pattern. The analysis of the depressive constructs revealed that EMDR is most effective in reducing symptoms of major depression as 86% of participants with clinically significant major depression before EMDR treatment no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment; compared to 73% with dysthymia and 40% with depressive personality pattern. These gains were maintained on the MCMI-III at followup by 86% with major depression, 58% with dysthymia, and 33% with depressive personality pattern. The findings regarding the other clinical syndromes revealed that 91% of participants with clinically significant post traumatic stress before EMDR treatment, no longer had a clinically significant score (>75) on the MCMI-III at the end of EMDR treatment, compared to 75% of participants with anxiety. These gains were maintained on the MCMI-III at followup by 91% of participants with post traumatic stress and 69% of participants with anxiety. The analysis of the severe clinical syndromes at the end of EMDR treatment revealed that the scores on the MCMI-III reduced from within one standard deviation above the mean (60-74) to below the mean (<60) for 78% of participants with delusional disorder, compared to 67% with thought disorder, 32% with bipolar (manic), 28% with alcohol dependence and 28% with drug dependence. These gains were maintained on the MCMI-III at follow-up by 67% of participants with delusional disorder, compared to 63% with thought disorder, 53% with bipolar (manic), 48% with alcohol dependence and 57% with drug dependence. The analysis of the effects of EMDR on dissociation revealed that there was a significant decrease in symptoms of dissociation on the DES at the end of EMDR treatment and these gains were maintained at the follow-up measurement at the end of the study. Whilst the findings of the present study cannot be generalised due to the small sample size, the findings do suggest that EMDR is successful in the treatment of a number of clinical conditions in addition to post traumatic stress; with further research being strongly indicated in order to further explicate the efficacy of EMDR across different psychiatric conditions. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.