No description available.

No description available.

No description available.

No description available.

No description available.

This thesis uses observational study design methods to explore the relationship between depression and various outcomes following acute myocardial infarction (AMI). There are three main studies. First, the relationship between depression and mortality following AMI was measured. The main finding was that the factor determining the increased mortality rate in depressed patients is reduced cardiac functional status. The main implication was that efforts to address increased mortality in depressed patients with cardiovascular illnesses should focus on processes that impact cardiac functional status. Second, the impact of depression on service consumption following AMI was examined. Depressive symptoms were associated with a 24% (Adjusted RR:1.24; 95% CI:1.19-1.30, P<0.001), 9% (Adjusted RR:1.09; 95% CI:1.02-1.16, P=0.007) and 43% (Adjusted RR: 1.43; 95% CI:1.34-1.52, P<0.001) increase in total, cardiac, and non-cardiac hospitalization days post-AMI respectively, after adjusting for baseline patient and hospital characteristics. Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity. The disproportionately higher cardiac health service consumption among lower-risk AMI depressive patients may suggest that health seeking behaviors are mediated by psychosocial factors more so than by objective measures of cardiovascular risk or necessity. Third, methodological issues related to missing data were explored. A systematic review of three psychiatric journals revealed that a small minority of studies (5.8%) addressed the impact of missing data in a meaningful way. An example using real data demonstrated the potential bias introduced by missing data and different ways to address this bias. The paper concludes with recommendations for both reporting and analyzing studies with substantial amounts of missing data. Overall, the studies add to the literature exploring the relationship between depression and outcomes following acute myocardial infarction. Future studies measuring the relationship between depression and mortality will need to factor the mediating relationship between depression and cardiac functional status. The increased health service utilization associated with depression will need to be replicated in other illness models. Together, the studies add to the existing conceptual framework for measuring relationships between depression and outcomes in patients with cardiovascular illnesses.

A research report submitted to the Discipline of Psychology, Faculty of Humanities, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Masters in Clinical Psychology Johannesburg, South Africa December 2015 / Extensive literature emphasises that good quality maternal care is crucial for infants to develop secure attachments which positively shapes their future mental health. In a developing society such as South Africa where many mothers are raising children in contexts of multiple adversities, interventions which focus on improving the quality of maternal care are vital. Home visiting programmes are an effective way to support mother-baby dyads. In South Africa, it has been found that lay women from local communities trained to work as home visitors can make a significant difference to these mother-infant relationships. Ongoing supportive supervision has been found to be particularly important for lay home visitors. The evaluation and improvement of these intervention programmes is recommended. One aspect of programme evaluation is the investigation of the programme staff experiences. Currently, there is a dearth of research focusing on the experiences and supervision of lay community health care workers, internationally as well as in South Africa. The Ububele Mother Baby Home Visiting Project, run in the Alexandra Township in Johannesburg, is one such intervention and no evaluation of this intervention from the perspective of the staff has, as yet, been conducted. It was felt that research into the experiences of the home visitors and their supervisors would be beneficial in gaining clarity regarding which aspects of the project they perceive to have been effective and those that have been challenging, as well as to assist the team in developing their intervention further. The current research aimed to gain insight into these experiences and to gain an understanding of the main concerns. The form of data included 10 semi-structured in-depth interviews with the staff of the programme: the home visitors, the supervising psychologists and the director of the project. An interpretive thematic analysis was used to interpret the results. The findings indicated that the staff’s experience included a mixture of positive and challenging experiences. The staff all agreed on their passion for the project and their belief in the effectiveness of their work in improving the bonds between mothers and babies in the community. The challenges included working in a community faced with multiple adversities, as well working in a team divided by education level, race, culture and socioeconomic class. Suggestions for the Ububele Mother Baby Home Visiting Project team are also provided.

No description available.

No description available.

No description available.