Increasingly patients are surviving admission to intensive care units (ICUs) with life-threatening, critical illness. This has led to a growing interest in longer-term patient outcomes, including their psychological health. This thesis consists of two discrete sections: 1) a systematic review of research that evaluated emotional outcomes between 3 and 12 months post-ICU discharge, and 2) a longitudinal cohort study of emotional sequelae among adults with Type 1 diabetes during and following admission for diabetic ketoacidosis (DKA). The systematic review identified seven studies that met inclusion criteria, and highlighted weaknesses in the existing literature. From the available evidence there appears to be elevated rates of clinically significant depression (11%), anxiety (15%) and post-traumatic stress disorder (PTSD) symptoms (23%) 3 months after discharge, and these remain high 9 months later (12%; 18%, and 27%, respectively). The prospective study of DKA admissions indicated substantial rates of clinically relevant depression (25%); anxiety (37.5%), and PTSD symptoms (37.5%) prior to discharge. However, 3 months later the rates of depression and PTSD had substantially attenuated (both 8.3%) although rates of anxiety (37.5%) remained higher than that found in the general population (7%) and the local Type 1 diabetes clinical community (11.9%). Those admitted with DKA had significantly poorer HbA1c compared to the overall Type 1 clinic population (10.9% vs. 8.9%; p < 0.0001), which indicates substantial difficulties in self managing their condition. It appears that psychological problems are elevated over time following ICU discharge. PTSD is notably high and enduring in general ICU survivors, whereas was observed to fall away in the DKA sample. Anxiety seems to be elevated and this persists over time following DKA; this is pertinent given the dearth of research on the role of anxiety in the efforts of people with type 1 diabetes to manage their condition. As far as the authors’ are aware, this is the first study tracking emotional outcomes post DKA discharge. There are clearly significant psychological issues that will likely impact on staff efforts to provide ward-based care aimed at improving post-discharge diabetes control, and on the future efforts of those admitted for DKA to self-manage a complex condition. A greater awareness of the psychological issues affecting people with type 1 diabetes who experience DKA is an important first step. More specifically, a better understanding among health professionals about the ways emotional distress can impact on self-management is needed, as well as a greater understanding of how best to communicate information and educational material in light of possible information processing deficits (which may be a result of emotional distress). Larger, multi-centre, higher quality studies are required in both general ICU settings and looking at specific disease complications (such as DKA). Psychological screening for ICU survivors and implementation of a care pathway to allow access to services post-ICU may be a useful development.

Children with incarcerated parents face a disproportionate number of risk factors for becoming incarcerated (Bilchik, Seymour & Kreisher, 2001; Jucovy, 2003; Martin, 2001). The purpose of this study was to empirically analyze the relationship between episodes of parental incarceration and psycho-social and educational outcomes. This study aimed to find earlier indicators of incarceration risk, in order to provide points for intervention. Concepts from the differential association and social learning theories (criminology), attachment theory (psychology and sociology) and Maslow's Hierarchy of Needs (motivational psychology, used often in the field of education) were used as a guide in order to create a unique conceptual framework that directs the statistical models selected in this study. The data for the proposed study were drawn from the National Data Archive on Child Abuse and Neglect, which is a project of the Family Development Center at Cornell University. Specifically, the dataset from the Longitudinal Study of Child Abuse and Neglect (LONGSCAN) was used. ANOVAs and correlations were used preliminarily to explore relationships among variables. The impact that episodes of parental incarceration have on psycho-social variables and educational outcome variables was tested using sequential OLS regression models. The major research question of this study was, "Do psycho-social variables or educational outcomes differ based on episodes of parental incarceration?" The results suggest the only educational outcome that differs based on episodes of parental incarceration is externalized behavior problems. This difference is present in the full sample, but not in the matched sample, implying that this relationship is only significant when compared to low risk subjects, and is not significant when compared to equally at-risk subjects. The secondary question in this research study was, "How does the relationship between attachment to parents and psycho-social variables (post-traumatic stress or self esteem) differ based on episodes of parental incarceration?" The results of this analysis showed that problems with attachment to parents did become a more significant predictor of post- traumatic stress and self esteem when frequency of parental incarceration was added to the regression model. After analysis of the results, two themes are discussed: sample selection and its implication for socio-context of at-risk students and age implication and the role of elapsed time. / Urban Education

Whether it is in private or professional lives, people are called to make decisions and they tend to seek expert advice. The old adage indicates that more heads are better than one. Receiving more information is often helpful to decisions. However, getting multiple conflicting expert advice might put decision makers in difficult situations. Little is known about their feelings, thinking, and behaviors under such conditions. This research aims to fill the gap and understand the abovementioned consequences of taking multiple conflicting expert advice when making professional (i.e., business or personnel-related) decisions. Using an interview-based qualitative approach, this research sheds light on contextual characteristics where conflicting expert advice may be more beneficial (or harmful), which contributes practical recommendations to improve professional decisions. In sum, this research seeks to verify whether the common wisdom of “more is better” holds up to empirical scrutiny, and suggests that it is “no pain, no gain”.