Background. Because there have been few studies examining resilience associated with postnatal (PN) depression, this study aimed at formulating and testing a theory-based model integrating both traditional resilience paradigms and non-traditional factors including existential beliefs about life, motherhood and religion. Method. Study hypotheses addressed prediction of PN depression, stress and resilience, and the confounding influence of negative affectivity (neuroticism). Study variables included PN depression (Edinburgh PN Depression Scale, EPDS), stress, neuroticism, self-esteem, mother's distress and ambivalence, purpose/meaning, religious belief, parity, age, marital and social status. They were assessed with standardized self-report instruments and, following a pilot, administered to a probability sample of women four months postpartum in a one-wave, community, postal survey. Because the overall response rate was so low (49%) only the Europeans were included in the study (N = 225; response-rate = 78%). Statistical hypothesis-testing included linear and logistical multivariate model-twilding techniques, and principal components analysis. Results. Sixteen percent scored in the major depression range (EPDS > 12), and 14% in the minor depression range. Depression was associated with stress, neuroticism, purpose/meaning, mother's distress and (marginally) religious belief, but not with self-esteem, mother's ambivalence, age, parity or social class. Although neuroticism was strongly associated with depression, and also overlapped with most psycho-social variables, nonetheless stress, purpose/meaning, and mother's distress maintained significant relationships with depression after neuroticism was statistically controlled. Stress was associated in part with the perception of losing one's freedom in the motherhood role (neuroticism controlled). When resilience was defined as high stress coupled with low depression, it was associated with low levels of neuroticism and mother's distress. When resilience was defined in terms of high levels of maternal satisfaction, it was associated with high purpose and low ambivalence. Principal components analyses revealed that (1) stress scores reflected two dimensions suggestive of distress and self-efficacy; and (2) depression, stress, neuroticism, self-esteem and purpose were markers for the same underlying component, whereas mother's distress and ambivalence were markers for another (unrelated) component. Conclusion. This study underlines the relevance of temperament, self-efficacy, self-transcendence, existential beliefs and motherhood-related cogniitions to the understanding of PN depression and stress. / Subscription resource available via Digital Dissertations only.

Background. Because there have been few studies examining resilience associated with postnatal (PN) depression, this study aimed at formulating and testing a theory-based model integrating both traditional resilience paradigms and non-traditional factors including existential beliefs about life, motherhood and religion. Method. Study hypotheses addressed prediction of PN depression, stress and resilience, and the confounding influence of negative affectivity (neuroticism). Study variables included PN depression (Edinburgh PN Depression Scale, EPDS), stress, neuroticism, self-esteem, mother's distress and ambivalence, purpose/meaning, religious belief, parity, age, marital and social status. They were assessed with standardized self-report instruments and, following a pilot, administered to a probability sample of women four months postpartum in a one-wave, community, postal survey. Because the overall response rate was so low (49%) only the Europeans were included in the study (N = 225; response-rate = 78%). Statistical hypothesis-testing included linear and logistical multivariate model-twilding techniques, and principal components analysis. Results. Sixteen percent scored in the major depression range (EPDS > 12), and 14% in the minor depression range. Depression was associated with stress, neuroticism, purpose/meaning, mother's distress and (marginally) religious belief, but not with self-esteem, mother's ambivalence, age, parity or social class. Although neuroticism was strongly associated with depression, and also overlapped with most psycho-social variables, nonetheless stress, purpose/meaning, and mother's distress maintained significant relationships with depression after neuroticism was statistically controlled. Stress was associated in part with the perception of losing one's freedom in the motherhood role (neuroticism controlled). When resilience was defined as high stress coupled with low depression, it was associated with low levels of neuroticism and mother's distress. When resilience was defined in terms of high levels of maternal satisfaction, it was associated with high purpose and low ambivalence. Principal components analyses revealed that (1) stress scores reflected two dimensions suggestive of distress and self-efficacy; and (2) depression, stress, neuroticism, self-esteem and purpose were markers for the same underlying component, whereas mother's distress and ambivalence were markers for another (unrelated) component. Conclusion. This study underlines the relevance of temperament, self-efficacy, self-transcendence, existential beliefs and motherhood-related cogniitions to the understanding of PN depression and stress. / Subscription resource available via Digital Dissertations only.

Master of Science / Department of Family Studies and Human Services / Anthony Jurich / Throughout this report, I focused on the effects that the loss of a parent has on an adolescent during the various stages of adolescent development. Drawing upon research already completed on divorce during adolescence, I speculated on the similarities and differences between losing a parent through divorce or death during the adolescent stages of development. Loss by any means is tragic and life altering. However, as I attempted to illustrate, it was even more defining when encountered during the period of adolescence.

Master of Science / Department of Family Studies and Human Services / Joyce Baptist / Theraplay is a technique used to replicate healthy parent-child interactions in order to build healthy attachments. Theraplay is a short-term therapeutic approach that is intimate, physical, personal and enjoyable. The goal of Theraplay is to improve attachments, self-esteem and trust in the relationship. The use of Theraplay has been shown to be beneficial for people of all ages including infants up to geriatric clients. This report offers an overview of Theraplay, provides clinical issues in which Theraplay can be implemented, describes the Theraplay process, and gives implications for further research. Because Theraplay is a highly specialized field, this report also gives information on how to become certified in Theraplay. This report was written for Masters' and Doctoral students in the mental health field that have an interest in working with clientele with attachment injuries.

Master of Science / Department of Family Studies and Human Services / Anthony Jurich / Adolescent pregnancy has been an ongoing concern in society for many years. This concern is even greater among the African American community. Girls who experience a pregnancy or childbirth during adolescence often experience difficulties in school and future careers, as well as financial and mental instability. This report will examine how the pregnancy and childbirth experiences of African American teens influence their younger female siblings.

Doctor of Philosophy / Department of Family Studies and Human Services / Rick J. Scheidt / Alzheimer's disease (AD) is a chronic illness that has the capacity to impact several domains of a person's life. The purpose of this qualitative study was to explore four particular domains of meaning of an AD diagnosis to gain a systemic understanding of couples' experiences when one spouse had recently been diagnosed with Alzheimer's disease. A social constructionist framework was used in conjunction with the biopsychosocial-spiritual model, to explore the biological, psychological, social, and spiritual factors which inform and possibly influence couples' experiences in relation to an AD diagnosis. The interview guide was constructed using the underlying biopsychosocial-spiritual framework for the purpose of exploring couples' experiences in a systemic manner. Four couples were interviewed in their homes, no more than two months following a formal diagnosis of AD. This particular time frame captured the raw experience couples went through when receiving an AD diagnosis. All interviews were recorded, transcribed, and analyzed according to a modified version of Moustakas' phenomenological method of analysis. A family medicine physician served as the co-interpreter throughout the entire analysis process. Results consisted of unique descriptions for each couple's case and a composite description of the cross-case analysis, highlighting similarities and differences among cases. The biopsychosocial-spiritual model was found to be a significant tool for elliciting a systemic understanding of each couple's experience, and recognizing unique aspects of couples' experiences. Analysis across cases revealed 14 common themes that emerged across the four (five biological, four psychological, four social and two spiritual) domains. Results revealed that of the 14 common emerging themes, five themes were shared by all cases: Recognizing a Problem, Experience of Diagnosis Process, Experience of Symptoms, Social Support, and Social Activities. The overall analysis illustrated many more similarities among biological experiences than any other domain of experience. One case, #3, displayed a particularly unique psychological experience, as well as a significant spiritual foundation. Overall, this study emphasized the importance of using a systemic framework, such as the biopsychosocial-spiritual model, to gain a rich, in-depth understanding of how different couples experience the diagnosis process of AD.

Doctor of Philosophy / Department of Family Studies and Human Services / Anthony Jurich / Ann Murray / Despite the intensified research efforts into the field of Infant Mental Health and Marriage and Family Therapy, a truly systemically designed program has not been developed. This formative evaluation study illuminates the design phase, its developmental process, and the professional staff member’s experience of this newly implemented “Options” program. I focused specifically on Crawford County Community Mental Health Center’s innovative systemic approach to issues related to infant mental health. In this body of work, I describe the process of creating this innovative approach, identified how the program originators made decisions about their approach and how the approach is being operationalized on a daily basis by interviewing the clinicians, who are providing the services and the administrators who created and oversee the program. I utilized a qualitative approach in the design, transcription categorization, and data analysis. This formative evaluation used the “flashback approach” to tell the story of the evaluation findings, this included an Executive Summary. This study’s exploration yielded a clearer understanding of the developmental process of the infant mental health program and its initial implementation. The results of this evaluation revealed that there are a number of core program components (three levels of focus: child and family, program, and community and catchment area) that were organized and clearly disseminated throughout the staff. The interviews revealed that the program has encountered problematic issues including; policy and procedural agreements and mandates, staff turnover, program ownership and funding limitations. It grew increasingly clear that the value of the program’s positive impact on families outweighed the perceived hassle of establishing and implementing the program. This evaluation produced a number of program recommendations for program perpetuation and potential improvements. The program recommendations addressed the challenges facing the “Options Program” are explained. The future research implications of this formative evaluation are enumerated.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.

This thesis is an analysis and evaluation of a case study in deinstitutionalisation of people with intellectual disabilities. The process has been viewed as an example of organisational change and the focus is on the relationship between formal and informal caregivers and the notion of care. Three key groups were included in the study, families of residents, the residents and staff. A qualitative approach was taken. The theoretical perspective that was developed attempted to account for links between social movements, organisations and individual experience in the arena of intellectual disability. This was based on the approach of New Institutionalism in organisational theory. The focus was primarily on the process--of change, and in caregiving. Three models of intellectual disability, which have informed policy and the recent changes to a preference for community care, have been identified and the links between these and the elements of organisations developed for providing care explored. The experience of families and residents within the hospital setting and then the community care setting has been examined in relation to the nature of the organisation. Outcomes for the three groups have been examined in terms of their needs and the extent to which these needs were met by the arrangements over a given time. It is concluded that community care has the potential to better meet the needs of those involved, than has hospital based care. A number of factors in the process of change and in the delivery of care have been identified as impacting on outcomes for those involved. Consideration is given to the practical implications of these findings. / Subscription resource available via Digital Dissertations only.