The purpose of this study was to examine direct and interactive relationships of stimuli and adaptive modes on help-seeking and quality of life. Stimuli were external (social network characteristics, social support need) and internal (age, symptom, symptom severity, satisfaction with social support). Adaptive modes were physiologic function, self-concept (enabling skill, mastery), role function (socioeconomic status, self-care), and interdependence (trust in health care provider, dyadic adjustment). The conceptual framework was based on Roy's Adaptation Model. Data were secondary analyzed using stepwise multiple regression to test the research hypothesis. The sample consisted of 102 married/cohabitating women with breast cancer. Thirteen instruments measured the variables. Factor analysis constructed indices for variables having multiple measures. Social support need had a direct effect on help-seeking. Number in the network interacted with education on help-seeking. Number of symptoms interacted with mastery on help-seeking. Self-care had a direct effect on quality of life. Satisfaction with social support, number of symptoms, and number in the network interacted with self-care on quality of life. Age interacted with self-care and trust in health care provider on quality of life. Severity of symptom interacted with mastery on quality of life. Social support need, the interaction between number in the network and education, and the interaction between number of symptoms and mastery significantly contributed to help-seeking. The interaction between satisfaction with social support and self-care significantly contributed to quality of life. Based on multiple interactive effects of stimuli and adaptive modes relative to help-seeking and quality of life rather than separate direct effects, Roy's Adaptation Model may better specify interactive relationships of stimuli and adaptive modes than simple direct relationships. To promote women's help-seeking, nurses should assess the number in women's social networks and women's level of education, be aware of women's level of social support need, recognize women's symptoms, and enhance women's sense of mastery. To promote women's quality of life, nurses should assist women toward improved perception of social support, which should increase their level of satisfaction with social support, and encourage performance of self-care activities.

Described since the beginning of medicine and considered to be the oldest mental illness, depression is understood as a mood, symptom, syndrome and mental disease. It affects a large number of individuals, mainly women during their productive period, in different cultural environments. World Health officials suggest that over 200 million individuals worldwide are affected by one of the forms of depression. Epidemiological and biological studies have revealed the close relationship between depression and several factors, including sex, age, social environment, personality, and genetics. They utilize a single causal model of illness, and neglect the role played by culture in the expression and experience of depressive disorders. As a mood variation, depression is a panhuman phenomenon, but not all cultures recognize depressive disorders as a categorized ailment. Indeed, some cultures (Buddhist) give positive values for depressive complaints and even encourage them; other cultures (Western), however, tolerate depressive symptoms only as acute phenomena. Cross-cultural researchers have discussed the importance of culture for modeling the experience and effects of depression. It is culture which gives positive or negative meaning to depressive phenomena. In this way, anthropologists have questioned the universality of depressive disorders and suggested that depression is a cultural, Western construction. In the second half of the twentieth century, research studies have described the high prevalence rates of depression across cultures. Probably because of emotional and socioeconomic pressures, modern industrialized life exposes individuals to a high risk of depression. Indeed, Western researchers have demonstrated that in each new generation, a greater number of individuals have experienced depression. Contrary to the belief of Brazilian health professionals, lower class African Brazilians are at an increased risk for depressive disorders. The research study for this dissertation was realized in public health services in greater Sao Paulo, Brazil. I interviewed 565 patients and included 105 in the study. All patients presented clinical depression and the majority of them were considered to be chronically impaired. Psychosocial factors such as: gender, age, socioeconomic background, race, migration, marital status, educational background and religious preference were positively associated with the occurrence of depression.

This study was designed to extend the research on ethical beliefs to child-oriented mental health practitioners. The purpose of the study was to identify the beliefs and practices of psychiatrists, psychologists, and social workers regarding confidentiality, competence, and multiple relationships, and to determine whether ethical beliefs vary by profession, gender, or other demographic and professional characteristics. A two-part questionnaire was mailed to 3000 child-oriented psychiatrists, psychologists, and social workers regarding their ethical beliefs in the areas of competence, confidentiality, and multiple relationships. A total of 1029 responses were obtained. Part One of the questionnaire addressed demographic and professional information, and Part Two contained 43 behavior description stems. Respondents were asked to indicate the degree to which they felt each behavior was ethical, using a Likert-like scale. Significant (p <.001) differences were obtained between the three professional groups in their beliefs regarding multiple relationships, competence, and the total ethical belief rating. Psychiatrists were the least conservative/most accepting in their ethical belief ratings, social workers were the most conservative/least accepting and psychologists tended to fall in the middle on each measure. In addition, female practitioners endorsed a significantly (p < .001) more conservative viewpoint than did male practitioners in multiple relationships, competence, and total ethical behavior ratings. Although respondents were most in agreement in their respective beliefs about confidentiality, a significant (p < .05) difference was found for gender, with females being more conservative/less accepting than males. In the area of multiple relationships, psychiatrists indicated a greater willingness to engage in relationships such as treating the child of a close friend, and entering into business or social relationships with current or former clients, than either social workers or psychologists. Additionally, respondents as a group were more likely to rate as acceptable breaking confidentiality when working with children than when working with adolescents (p <.001). This study points to the differences, as well as areas of general agreement, in the ethical beliefs of psychiatrists, psychologists, and social workers.

Two studies examined the electrophysiology of cognitive functioning in Alzheimer's disease. In the first study, fifteen AD patients and 26 elderly controls engaged in a lexical decision task with a list of words and non-words while event-related brain potentials were recorded. Embedded in the list were two repetition conditions: one where words were repeated at relatively long lags and one where words were repeated shortly after a brief masked presentation. Although elderly controls displayed behavioral and ERP repetition priming for words repeated at long lags, AD patients did not. In contrast, both controls and AD patients displayed an ERP repetition priming effect for the words repeated shortly after a brief masked presentation. Although the 2 ERP priming effects differ in elderly controls, the masked priming effect was also different between controls and AD patients. The results are used to critically assess the utility of an impaired/intact dichotomy when examining memory performance in brain damaged populations and are interpreted as lending support to dimensional models which postulate complex interactions between brain regions. In the second study utilizing the participants from the first study, eighteen AD patients and 22 elderly controls had their EEG recorded under four conditions: eyes open and closed resting baseline, and a verbal and spatial categorization task. EEG power was examined in 6 spectral bands revealing significant differences in the Theta band across all conditions and in the Alpha band during resting eyes closed and the categorization tasks. Alpha activity was examined utilizing instantaneous frequency analysis (IFA) in order to produce a measure of amplitude per unit time in the eyes open baseline and for the verbal and spatial cognitive tasks. The IFA analysis revealed that AD patients, relative to controls, failed to show an event-related decrease in alpha activity across the entire scalp during the performance of the 2 cognitive tasks. The failure of AD patients to display the expected alpha decrease in the left frontal region was significantly correlated with verbal task performance. These results are discussed with respect to disruptions in sustained and focused attentional mechanisms which appear to occur in AD.

The Positive and Negative Syndrome Scale (PANSS) has long been widely used to assess the extent and severity of psychiatric symptomatology in research studies with samples diagnosed with schizophrenia, particularly in pharmacological studies. Recently it was used in a federally funded multisite study with a mixed-diagnosis sample of persons with serious mental illness. Though numerous factor analytic studies of the PANSS (both exploratory and confirmatory) have been undertaken in samples with schizophrenia, its use in mixed-diagnosis samples characteristic of those encountered in research on psychiatric rehabilitation has not been much studied. This paper reports on a series of confirmatory factor analyses undertaken to explore the fit of various models found in the schizophrenia literature to data from the more heterogeneous multisite sample. Two of the models tested attained marginal fit to the data (using the conventional fit criteria of CFI > .90 and RMSEA), however, both failed to represent a broad range of symptoms because they incorporated only a few PANSS items. An alternative model was developed using all 30 PANSS items and tested using parceling to improve item fit. This 5 factor model demonstrated adequate fit to the data. These findings are discussed in light of the need for a model that fits a mixed-diagnosis sample.

Divorce among older women is a growing social phenomenon about which little is known. The qualitative case study method was employed to determine issues relevant to women experiencing late-life divorce in order to: provide a basis of knowledge about these women; to identify areas for further research; and, to yield information that would facilitate the development of mental health programs intended to serve this population. Using open-ended questions during tape recorded interviews, the perceptions of five women who divorced over the age of sixty were elicited. The areas of concern within the broad categories of physical and mental health, family and social relationships, and economic and legal issues were identified and then compared and contrasted to data gathered by previous researchers. Recommendations were made for future research and a model for a cooperative community mental health program was endorsed.

Ethnographic interviews with four adult children revealed four domains: "Quality of Life"; "Doing the Right Thing"; "Staying Strong"; and "Impact of Decision" they used to create meaning for their decision to withdraw life support from an ill parent. The domains were analyzed and eight cultural themes were discovered: The decision is much easier when the family know what the person would want; the decision should include family input; health care providers can be/are a source of support and information for the family; doing the right thing is important for the family; as death approaches, the family needs extra support from others, when death is imminent the family has difficulty "letting go" and "staying strong"; feelings of guilt; and the impact of life patterns associated with loss. The significance of this data can be used by nursing in assisting families faced with the decision to withdraw life support towards healthy grieving patterns.

Little is known about the importance of courage in serious mental illness. The purpose of this study was to discover whether courage was a significant variable in clients struggling with mental illness. The phenomelological approach and research method was used and the question was asked: What is the essential structure of the lived experience of courage in serious mental illness. Five seriously mentally ill adults participated in an open ended, recorded interview, recounting their experience of courage. Phenomenological analysis was used to derive 69 theme clusters and 13 categories. An essential structure of courage was drawn from the clusters and categories. The 13 categories fell so naturally into the stages of Joseph Campbell's Hero's Journey that the stages were incorporated into category headings. In this study courage played a significant role in the ability of the participants to live successfully with serious mental illness.

Research indicates that nearly half of all persons infected with HIV are substance abusers. Experts have called for chemical dependency treatment professionals to prepare to deal with infected clients in their programs. The purpose of this study was to develop a handbook to help addictions counselors prepare to work with clients diagnosed with HIV spectrum disease. The historical research method was used to develop the handbook. The outline for the handbook and the completed manuscript were each evaluated by a group of counselors working in the field of outpatient addictions treatment. The evaluations indicated that the handbook will be useful for substance abuse counselors. Changes suggested by the evaluators will be made prior to publication. Implications for further research and literature in this area were presented.

The mental and emotional well-being of mental health care professionals can be jeopardized by burnout, a syndrome similar to depression and other affective disorders in its symptomology and effects. A questionnaire designed to assess mental health and burnout was developed using various assessment tools from the mental health care community to obtain information about health habits, stressors, coping skills, personal history, and length of service. Forty-seven workers at a public mental health facility responded to the questionnaire. The results of this study suggest that approximately 20% of mental health care-givers are experiencing high degrees of burnout and mental disease. Neither personal history or long-term service appears to contribute to the burnout. Workers new to the field seem to be at greatest jeopardy. Control coping mechanisms were found to be more effective than escape coping mechanisms in combating stress and mental illness.