The purpose of this dissertation was to evaluate the association of psychological distress with cardiac disease, events, and mortality. Specific aims were to: 1) to evaluate the association between hostility level and recurrence of acute coronary syndrome (ACS) and all-cause mortality in patients with coronary heart disease (CHD); 2) to evaluate the psychometric properties of the Brief Symptom Inventory (BSI) hostility and anxiety subscales in a group of incarcerated participants at high risk of cardiovascular disease; and 3) to evaluate the association of patient and caregiver psychological state with quality of life in both patient and caregiver, and postoperative complications after cardiac surgery. Specific aim one was addressed through a secondary analysis of data collected during the Patient Response to Myocardial Infarction following a Teaching Intervention Offered by Nurses trial to determine whether hostility was a predictor of ACS recurrence and mortality. Hostility was common after ACS and predicted all-cause mortality. Hostility did not predict recurrent ACS. Specific aim 2 was addressed in a secondary analysis of baseline data from a randomized controlled trial in male prisoners. Participants completed the BSI at baseline prior to the intervention. Internal consistency reliability was good for both subscales (Cronbach’s alpha - hostility 0.83, anxiety 0.81). Items from the two dimensions were analyzed together using exploratory factor analysis with varimax rotation. Two dimensions, anxiety and hostility, were identified. Construct validity was supported; those with high anxiety and hostility reported a greater number of days where their self-reported health was rated as fair or poor. Those prisoners with less perceived control had higher levels of anxiety and hostility. Specific aim 3 was addressed through a prospective, descriptive correlational study that measured patient and caregiver anxiety, hostility and depressive symptoms, at baseline to determine whether these predicted quality of life using a multilevel dyadic analysis; and to evaluate the association of baseline anxiety, hostility and depressive symptoms and quality of life with postoperative complications and mortality. Anxiety, hostility, and depressive symptoms were common in both cardiac patients and their caregiver. Psychological state influenced quality of life in both dyad members, but was not associated with complications.

This study sought to determine the therapeutic effectiveness of client-therapist dyads in a residential treatment center for emotionally disturbed adolescents. The theories of George Kelly's personal construct psychology were utilized in assessing the dyadic relationship. The four elements investigated were organizational similarity, understanding, organizational congruency and predominant selves. The sample consisted of 140 dyads comprised of 10 adolescent boys and girls and 14 therapeutic staff of a residential treatment center in the southwest United States. Responses to Kelly's Role Construct Repertory Test were compared to four relational factors—parental/respect, identity, problem-solving, and sexual/affection—and two rating scales of client-therapist preference and ratings of therapeutic effectiveness. Contrary to expectations, as content similarity among dyads composed of clients and staff increased, there was not an increase in functional aspects of the therapy relationship. Possible mitigating factors may have been level of client disturbance and/or methodological issues relating to how organizational similarity was determined. Dyadic understanding was not found to be related to perceptions of the therapy relationship. This may be a function of adolescent of adolescent clients' need for independence and resistance to adult understanding and control. Therapy dyads with a moderate level of lateral or vertical organizational congruence were not found to be curvilinearly related to functional aspects of the therapy relationship. However, a weak linear relationship regarding client perceptions of the therapy relationship was noted on four measures. Several methodological recommendations related to the instruments used to determine therapeutic effectiveness and the means of eliciting personal constructs on the REP test.

<p> There has been substantial growth in recent decades in the variety and popularity of roles for dogs assisting humans in professional therapeutic partnerships. Simultaneously, increasingly rigorous research has repeatedly demonstrated the effects of professional human-canine partnerships in remedying important issues of public health among several at-risk populations. Yet, despite these areas of growth, mechanisms of action and predictors of efficacy in the field of human-animal interaction (HAI) remain poorly understood, and the role of human diversity has been rarely discussed. Thus, the present dissertation examines potential mechanisms and diverse predictors in two distinct samples of professional human-canine partnerships, while building the impetus to explore diversity in the HAI field as a whole. For the first three studies (Chapters 2-4), the selected samples of professional human-canine partnerships include military veterans working with psychiatric service dogs to mediate their symptoms of PTSD and healthcare professionals in pediatric hospitals working with facility dogs to benefit their patients. Following the introduction in Chapter 1, the objective of Chapters 2-3 was to examine primary human outcomes in the selected professional canine partnerships. In a crosssectional study of N=198 military veterans with PTSD, Chapter 2 compared PTSD symptom severity between n=112 veterans with service dogs and n=86 veterans on the waitlist to receive service dogs in the future. Next, in a cross-sectional study of N=130 healthcare professionals in pediatric hospitals, Chapter 3 compared job-related well-being and mental health of n=65 professionals working with facility dogs to n=65 working without. Findings suggested benefits to the mental health and well-being of both military veterans with PTSD and pediatric healthcare professionals, which were significantly associated with their professional canine partnerships. Subsequently, the objective of Chapter 4 was to explore how variances within a specific professional canine partnership may suggest predictors and potential mechanisms for the observed human outcomes. Thus, in a longitudinal study of N=82 veterans with PTSD and their service dogs, Chapter 4 explored associations of veterans’ outcomes with veteran-service dog demographics and interactions. Results suggested components of the human-canine partnership which might explain observed human outcomes, including social connections, a calming influence, and strong humananimal bonds. </p>

<p>The attached document contains the dissertation of Clare Jensen, including descriptions of all procedures used in the associated research studies.</p>

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Matching clients and therapist based on demographic variables might enhance therapeutic outcomes. Even so, research in this field is still inconclusive and not much is known about same-gender client therapist dyads in the context of cognitive behavioral (CBT) and psychodynamic methods. For this purpose, we studied the therapy outcomes of N = 1.212 participants that had received therapy (3 months–6 years) in Germany. The results showed a trend for same-gender client therapist dyads in terms of symptom reduction and quality of life specific to psychodynamic approaches. The latter applied specifically to female client-therapist dyads. On the other hand, this trend was not fully evident for CBT-based therapies. In conclusion, despite the robust sample and observed trends, it is not clear whether matching same gender dyads is advantageous with regards to symptom reduction and quality of life. Regardless, these results are preliminary and further studies are needed in order to find out whether same gender client-therapist dyads enhance therapy outcomes or not.

Au Québec, près de 25 000 personnes, principalement des aînés, sont touchées par la maladie de Parkinson (MP), la majorité étant soignée par leur conjoint. Au stade modéré, la MP altère la santé et la qualité de vie de ces couples. Ce stade est propice à la mise en place d’interventions dyadiques, car les couples expérimentent des pertes croissantes, nécessitant plusieurs ajustements. Néanmoins, aucune étude n’avait encore examiné leurs besoins d’intervention lors de cette transition et peu d’interventions pour les soutenir ont fait l’objet d’études évaluatives. Avec comme cadre de référence la théorie de l’expérience de transition de Meleis et al. (2000) et l’approche systémique de Wright et Leahey (2009), cette étude visait à développer, mettre à l’essai et évaluer une intervention auprès de couples âgés vivant avec la MP au stade modéré. À cette fin, un devis qualitatif et une approche participative ont été privilégiés. L’élaboration et l’évaluation de l’intervention s’appuient sur le cadre méthodologique d’Intervention Mapping de Bartholomew et al. (2006) et sur les écrits de Miles et Huberman (2003). L’étude s’est déroulée dans une clinique ambulatoire spécialisée dans la MP. Dix couples et quatre intervenants ont collaboré à la conceptualisation de l’intervention. Trois nouveaux couples en ont fait l’expérimentation et l’évaluation. L’intervention dyadique compte sept rencontres de 90 minutes, aux deux semaines. Les principaux thèmes, les méthodes et les stratégies d’intervention sont basés sur les besoins et les objectifs des dyades ainsi que sur des théories et des écrits empiriques. L’intervention est orientée vers les préoccupations des dyades, la promotion de la santé, la résolution de problèmes, l’accès aux ressources, la communication et l’ajustement des rôles. Les résultats de l’étude ont montré la faisabilité, l’acceptabilité et l’utilité de l’intervention. Les principales améliorations notées par les dyades sont l’adoption de comportements de santé, la recherche de solutions ajustées aux situations rencontrées et profitables aux deux partenaires, la capacité de faire appel à des services et l’accroissement des sentiments de maîtrise, de soutien mutuel, de plaisir et d’espoir. Cette étude fournit des pistes aux infirmières, engagées dans différents champs de pratique, pour développer et évaluer des interventions dyadiques écologiquement et théoriquement fondées. / In Quebec, nearly 25 000 people are affected by Parkinson’s disease (PD). They are, for the most part, elders cared for by their spouse. At the moderate stage, PD alters the couples health and quality of life. This stage of the illness offers opportunities for dyadic interventions, as these couples experiment growing losses requiring numerous adjustments. Nevertheless, no study had yet explored their intervention needs during this transition and few interventions to support them have been the object of evaluative studies. Based on transition theory by Meleis and colleagues (2000) and on family systems approach by Wright and Leahey (2009), the purpose of this study was to develop, implement and evaluate a dyadic intervention oriented towards elderly couples living with PD at the moderate stage. To achieve this goal, a qualitative design and a participative approach were privileged. The Intervention Mapping framework by Bartholomew and colleagues (2006) and the analytic methods developed by Miles and Huberman (2003) were used to conceptualize and evaluate the intervention. The study took place in an ambulatory clinic specialized in PD. Ten couples and four health professionals collaborated to the intervention development. Three new couples tested and evaluated the intervention. The dyadic intervention consists of seven sessions of 90 minutes, held every second week. The themes of the sessions and the intervention methods and strategies are based on the couples needs and goals, as well as on specific theories and empirical findings. The intervention is oriented towards dyads concerns, health promotion, problem solving, access to resources, communication, and role adjustments. The study results showed the feasibility, the acceptability and the utility of the intervention. The main benefits observed by the dyads are the adoption of health behaviors, the finding of solutions adapted to various situations and favorable to both partners, the skills to get help and services, and the increased feelings of mastery, mutual support, pleasure and hope. This study can illuminate nurses involved in different domains of practice and interested in developing and evaluating dyadic interventions that are ecologically and theoretically based.

De nombreuses études empiriques ont démontré que la qualité des comportements maternels et paternels est importante pour le développement de l’enfant. Cependant, peu d’études ont investigué le degré de concordance des comportements de la mère et du père dans des couples intacts ainsi que les antécédents ou déterminants de cette concordance. Le présent mémoire contient un article empirique qui poursuit deux buts. Premièrement, l’article a examiné le niveau de concordance (similarité) entre la qualité des comportements des mères et des pères dans des couples intacts. Deuxièmement, l’article a investigué les antécédents familiaux de la concordance des comportements maternels et paternels: la satisfaction conjugale et le stress parental des mères et des pères. L’étude a été menée auprès de 44 familles intactes (mère-père-enfant). Les résultats indiquent que la concordance mère-père est modérée (r = .31). De plus, un degré significatif de concordance a été trouvé chez les couples dont les partenaires rapportent une satisfaction conjugale élevée ainsi qu’un faible niveau de stress parental, mais pas chez les couples moins bien ajustés. Les implications théoriques et empiriques sont discutées. / There is compelling evidence that the quality of both maternal and paternal parenting behaviour is important for child development. Yet, little is known of the degree of similarity between maternal and paternal parenting behaviour in intact couples, and about the antecedents or determinants of this parental concordance. The present master’s thesis includes an empirical article pursuing two aims. First, the article examined the concordance (similarity) between the quality of maternal and paternal behaviours with their toddler. Second, the article investigated the parental determinants of this concordance: marital satisfaction and parenting stress. The sample included 44 families (mother-father-toddler). Results indicated that the concordance between the quality of maternal and paternal behaviour was moderate (r = .31). Furthermore, significant mother-father concordance was found among more satisfied and less stressed parents, but not among less adjusted parents. The theoretical and empirical implications are discussed.