<p> This dissertation explored several internal and external factors in relation to psychiatric readmissions. Internal factors are directly related to the individual i.e., demographic information, diagnosis, admission history and status. External factors are factors outside of the individuals control i.e., length of hospital stay and reimbursement processes. The goal of the study was to explore the impact of multiple factors in relation to the phenomenon of psychiatric readmissions. Dynamic Systems Theory (1994) was used as a theoretical foundation to understand the complexities associated with psychiatric readmissions. The study utilized state archival data provided by the Maryland Health Services Cost Review Commission; an agency charged with collecting statewide hospital data on hospital admissions. </p><p> A quasi experimental study was conducted using a logistic regression design to answer the research question: When taken together do age, sex, ethnicity, diagnosis, insurance type, admission status and length of stay predict psychiatric readmission? This researcher predicted that the null hypothesis will be rejected. The sample included a large state-wide data set of over 130,000 individuals who fell under the criteria of being over the age of 18 when readmitted for psychiatric care in Maryland in 2015. The research methodology includes a logistic regression research design, exploring multiple factors, simultaneously, that impact psychiatric readmissions. </p><p> The results of the study indicate that length of stay is the most important factor impacting psychiatric readmissions. The second most important factor associated with psychiatric readmission, is a psychiatric readmission within 30 days. Medicare and Medicaid were also found to be significant factors associated with psychiatric readmission. Additionally, affective disorders were found to be the primary diagnosis associated with psychiatric readmissions. Lastly, individuals at greatest risk for psychiatric readmissions are between the age of 18-39, are non-Hispanic, are enrolled in Medicare, most likely to be disabled, are diagnosed with an affective disorder and have had a previous psychiatric readmission.</p><p>

Until recently, there has been only limited interest in the role of the family in the treatment and rehabilitation of the mentally ill. Although it is generally conceded that the interest and support of the family, except in some unusual cases, is of considerable help in the patient's treatment, little attention has been devoted to the subject of visits to mental hospital patients by relatives and friends. As a consequence, little is known about the specific effects of such visits and the types of patients who receive visitors. The present study examines mental-hospital visiting in terms of the therapeutic value of visits for patients, with attention directed to how visits by relatives assist social workers in providing treatment services to patients, and what determines how frequently a patient is visited. The material required for this investigation was obtained by a questionnaire distributed to Social Workers in the psychiatric facilities at Essondale and Weyburn Saskatchewan. This information was supplemented by conducting personal interviews with a small sample of patients and another of visiting relatives in the Provincial Mental Hospital, Essondale. Reference has also been made to a previous study of mental hospital visiting conducted at Weyburn, Saskatchewan. Terms such as "disculturation" and "desocialization" have been used to describe the submissiveness, loss of interest and deterioration of personal habits which may result from prolonged institutional residence. The introductory chapter reviews these effects, points up the need for maintaining the patient's contact with the family to help counteract these unintended consequences, examines the social worker's investment in maintaining the support of the family, and demonstrates how the hospital has changed its attitude from one of limited acceptance of visiting relatives to a much greater realization of their potentialities. The core material compiled from the questionnaire interviews, and reference to other surveys is analyzed under three headings: (a) visits of questionable value, (b) positive contributions, and (c) social worker's utilization of visits (Chapter II). The determinants of visiting are assessed by reference to (a) the causes of infrequent visiting, (b) the characteristics of frequently and infrequently visited patients, and (c) other comparable surveys of visited and unvisited patients (Chapter III). The conclusions are that visits can make a positive contribution to the patient's treatment. However, there are some situations in which their value is questionable; for example, visits may not be indicated when the patient is acutely ill, not accustomed to living in hospital, the relatives are unable to accept mental illness, or there is a tenuous relationship between patient and relatives. More often, visits contribute to the patient's treatment by reassuring him that he has not been forgotten by loved ones; helping him to overcome feelings of being an anonymous member of a large community of patients; reassuring him about home and family matters. Visits indirectly benefit patients through the efforts of social workers to employ their contacts with relatives to obtain social information, determine family resources, plan for discharge, prepare for follow-up, communicate information, alleviate stresses in the family situation, discuss treatment, and help the relatives to accept the patient. The study also demonstrates that visiting frequency is dependent upon a variety of factors, such as, the distance relatives must travel, the misconceptions, fear or shame about mental illness, unwillingness to accept the patient's return home, feelings of anxiety and guilt connected with the patient and his illness, loss of interest in the patients, pain or embarrassment connected with visits, the hospital's visiting facilities and regulations, and the attention given to visitors by staff. Infrequently visited patients spend more time in hospital, have fewer previous admissions, are older, and have relatives further removed from hospital. In conclusion, a number of recommendations are made for improving a hospital's visiting program. / Arts, Faculty of / Social Work, School of / Graduate

This study outlines some historical backgrounds and present-day concepts regarding the mentally deficient, followed by a review of progress and experiences in Great Britain and the United States, in preparation for a description and discussion of services being offered mentally deficient persons in British Columbia. This subject is of particular concern to the field of social welfare since the mentally deficient represent a large group of persons who, along with their families are dependent upon the Social Services. The Social Worker's responsibilities for the mentally deficient begin with the period of intitial diagnosis and planning, continue through training, and are particularly evident through rehabilitation and the supervision in the community. In preparing the material the literature was reviewed and classified so that some similarities, differences, and gaps in the programs of Great Britain and the United States would be readily apparent, and could be applied comparatively to a similar description of services to the mentally deficient in British Columbia. The latter was obtained from available literature and reports, and especially from a series of interviews with persons from representative agencies who were concerned in some way with giving services to this group. The study presents, in outline, the advanced state of services to the mentally deficient in Great Britain and some parts of the United States. The description of British Columbia services shows many gaps, and the need for a comprehensive program which, if implemented, would enable the mentally deficient person to function at his maximum level, throughout his life. It is found that the Parents' Associations are becoming a strong force in the advancement of services to the mentally deficient, especially in the area of education and training. The increased interest on the part of the public can be expected to have a quickening effect on the formation of a new program, and those who are working in this area must be prepared to give leadership. The study presents a foundation of basic information about the mentally deficient in British Columbia upon which it is hoped, more specific research studies can be made toward providing better service to the mentally deficient. / Arts, Faculty of / Social Work, School of / Graduate

The present study is designed to gather evidence concerning two predictions made by Magda B. Arnold from her hypothesis as to the mechanism of hypnosis and suggestion. She believes this mechanism to be based upon ideo-motor action. As the individual imagines (or, more precisely, images) the actions, situations, and, emotions suggested, this process tends to bring them about. A suggestion is not acted upon until the subject begins to think about it and to imagine the situation described in the suggestion. The results of three distinct kinds of operation have been referred to as resulting from suggestion. The Arnold hypothesis applies only to the ideo-motor or 'prestige’ type, which is most typically represented by the Hull Sway Test. It is held that sway occurs in the Hull test only as the subject imagines himself falling. Because imagery is essential to effective suggestion in both the waking and the hypnotic states, the prediction is made that a direct appeal to the subject to imagine himself falling will result in scores more closely related to his ability to become hypnotized than will the standard "you are falling" instructions. The latter are believed to be effective only to the degree that imagery accidentally results from them. A second prediction is that only those who can imagine most vividly and well will be capable of attaining the deepest states of hypnosis. For the purposes of this experiment scores obtained on the Friedlander and Sarbin Scale of Hypnotic Depth are taken as a measure of the 'hypnotizability' of the subjects, in the same manner as Hull Sway Test scores are used to indicate their relative 'suggestibility'. “Goodness of imagery" is inferred from the scores of tests designed to be carried out in terms of the kinaesthetic and visual modes of imagery. Two groups of thirty students equated on sex, age, and sway in an initial sway test using Hull's standard "falling" instructions were subject to a second sway test. The second sway scores of the control group, which repeated the original test, correlated with the hypnosis scale scores to a degree significantly higher than did the first scores. The second sway scores of the experimental group, obtained from a test in which the instructions were to imagine falling as vividly as possible, showed a significantly smaller correlation than Hid the first ones. This is contrary to Arnold's first prediction and is evidence towards rejecting the derived hypothesis. Using the scores of all sixty students a significant though moderate correlation was found between imagery test scores and the results of the hypnosis scale. This is in accord with the second prediction, and is evidence towards accepting the derived hypothesis. The failure of a further analysis to show a significant relation to exist between scores of imagery and suggestibility suggests the interpretation that imagery scores represent a factor which is related to hypnotizability but independent of suggestibility. A more, adequate experimental control of motivation and the establishing of the reliability of the imagery tests used should precede the drawing of more definitive conclusions. / Arts, Faculty of / Philosophy, Department of / Graduate

There are 2 organizations in Vancouver, the Child Guidance Clinic and the Mental Hygiene Division of the Metropolitan Health Committee, which offer services to maladjusted children. No descriptive account of the work of these 2 clinics has been previously written, particularly from the viewpoint of the social worker. Accordingly, this study undertook a review of the clinic records of a particular group of patients, namely, children of elementary school age, to throw light on the problems and needs in this field. The criteria set for the selection of cases was threefold. (1) The examination took place within a 3 year period (1945 to 1947). (2) Patients were those between the ages of 6 and 12 years, with intelligence quotients of at least 80, who had lived with parents or relatives at least until the age of 5 years, or were still living with them. (3) The children were confined to those residing in Greater Vancouver. The number of cases which satisfied these criteria was 257. These cases were classified into 4 groups on the basis of "problems" or symptoms of maladjustment which led to clinical examination. The classifications adopted distinguished (1) socially unacceptable behaviour, (2) personality reactions, (3) habit disorders, (4) disabilities in specific school subjects. The proportion which this group of 257 cases bears to the total number of cases examined by the clinics is examined, and an attempt is made to demonstrate to what extent the clinical population is a cross-section of the general population, but gaps in information in the clinic records make this possible in part only. A further sample was selected (on a one-in-five basis) from each of the four classifications, in proportion to the number of cases examined by each clinic, as well as to the number of boys and girls in the total survey. More detailed information was obtained from the clinic records on the 52 cases which comprised this sample. An analysis of this material, with the use of case illustrations, throws light on the work of the clinics, and on the factors of disorganization existing within the family and the community which contributed to the maladjustment of the children. The clinical recommendations for the treatment of children are outlined, and so far as possible an evaluation of the outcome of treatment is made. There is evidence that emotionally disturbed patients might be better served by the clinics if more adequate community resources for mentally retarded children existed, thus reducing the number of clinical examinations of such children. More awareness on the part of parents of the availability of clinic services would undoubtedly lead to the earlier referral of many children requiring this kind of help. Improvement of the working relationships between the 2 clinics and between the Child Guidance Clinic and the schools would be beneficial. The enlargement of the Mental Hygiene Clinic staff to include social workers would result in a better integrated clinical service. A third psychiatrist on the Child Guidance Clinic staff would overcome some of the present lacks in clinic services. A treatment and observation centre for emotionally disturbed children is greatly needed in this community. In many instances, staff members of social and health agencies responsible for the preparation of social histories would benefit from brief clinical orientation and discussions with the members of the clinic team on the subject of history taking. The addition of a group worker to clinic teams would enhance the services to maladjusted children. / Arts, Faculty of / Social Work, School of / Graduate

The present study investigated the effects of success and failure performance feedback on subjects' (a) prediction of their performance on a future task, (b) estimation of parental and stranger predictions of their performance, (c) post-task evaluation, and (d) conformity behavior. High and Low Depressed psychiatric patients, selected on the basis of the Beck Depression Inventory (DI) (Beck, 1961, 1967), were given an experimentally induced success, failure, or neutral experience on a task of time estimation. They were then asked to predict their performance on a task of matching geometric figures. The conformity situation involved subjects' estimation of line lengths, after being given an erroneous hint as to the length of each line. The only measure significantly related to depression level was the magnitude of conformity responses, on which Low Depressed patients gave a greater number of inches of error in the hinted direction than High Depressed patients. There was no difference between these two groups on the frequency of conformity responses. It was suggested that the lack of hypothesized differences between High and Low Depressed subjects may have been due to ineffectiveness of the DI in differentiating between depression levels, or due to limitations of Beck's theory in predicting the behavior of depressed patients in a nonsocial experimental situation. The lack of differences between the three experimental groups was probably due to aspects of the experimental situation which decreased the effectiveness of the performance feedback. / Arts, Faculty of / Psychology, Department of / Graduate

While existing research suggests that caregivers contribute to the onset and maintenance of adolescent substance use, research also posits that caregivers are negatively affected by adolescent substance use. However, caregivers' experiences of adolescent substance use is the subject of little academic research, and it remains poorly understood. This study offers important empirical insights that address this significant gap in the literature. The purpose of this study is to understand how caregivers perceive and describe their experience with their adolescent's substance use. To gain a deeper understanding of the reciprocal relationship between caregivers and adolescent substance use issues, this study uses a phenomenological, qualitative research approach to examine caregivers' experiences of their adolescent's substance use issues. The guiding theoretical framework is family systems theory (FST; Bowen, 1974). Additionally, the study employed a Community-Based Participatory Research (CBPR) approach by actively involving community members, organizational representatives, and researchers in the research process (Israel, Schulz, Parker, & Becker, 1998). Data were collected through in-depth, qualitative interviews with 20 caregivers of adolescents with substance use issues. Data analyses resulted in 6 core themes: 1) Discovering and making meaning of the substance use, 2) A complex issue, 3) A systemic issue, 4) Process of treatment, 5) Parental efficacy, and 6) The silver lining. Results illustrate how parents discovered and made meaning of their adolescent's substance use. Findings explain how adolescent substance use is a complex and systemic issue, often disrupting the entire family system, leaving caregivers questioning their parental efficacy and negotiating the caregiver-child relationship. The results highlight the process of treatment, transformation, and the growth that took place at the individual and family level. Several implications for future research and clinical practice were identified. The study highlights the need to further examine the reciprocal relationship between caregivers and adolescent substance use. Results can also speak to how family-focused treatment of adolescent substance use may be adapted to meet the needs of this unique population. More specific suggestions for future research and for marriage and family therapists working with families experiencing adolescent substance use issues are provided. / A Dissertation submitted to the Department of Family and Child Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2015. / May 20, 2015. / Adolescent, Adolescent substance use, Caregivers, Parenting, Substance use / Includes bibliographical references. / Kendal Holtrop, Professor Co-Directing Dissertation; Lenore McWey, Professor Co-Directing Dissertation; Stephen Tripodi, University Representative; Ming Cui, Committee Member.

abstract: Despite the increasing number of Asian international students in the United States, American society remains discriminatory against the population. Asian international students are exposed to ethnic-racial discrimination against Asians, as well as language discrimination against non-native English speakers. The purpose of this study was to examine whether the two types of discrimination relate to Asian international students’ regard, which refers to their positive or negative evaluations about Asians in American society. It was hypothesized that language discrimination, a particularly relevant form of discrimination for non-native English-speaking immigrants, will be associated with public and private regard, after controlling for ethnic-racial discrimination and English proficiency. The present study tested two hypotheses by conducting hierarchical multiple regression with a sample of 195 self-identified Asian international students. The results supported the first hypothesis, which predicted higher levels of language discrimination would explain a significant amount of additional variance in negative public regard after controlling for ethnic-racial discrimination and English proficiency. The second hypothesis was not supported—language discrimination was not significantly associated with positive private regard after controlling for ethnic-racial discrimination and English proficiency. Limitations, implications, and future directions are discussed. / Dissertation/Thesis / Masters Thesis Counselor Education 2019

The National Guard is a unique, part-time subset of the U.S. military that has been increasingly deployed during recent conflicts, often has a different set of life circumstances compared to full-time Active Duty servicemembers, and is studied much less frequently than are Active Duty populations. Depression, one of the most common mental disorders among both civilian and military populations in the United States (US), is associated with a range of comorbid mental and physical health conditions. The associations between stressful life events throughout the civilian lifecourse—including during childhood—and adult-onset and persistent depression have been documented in some demographic groups, but have not yet been studied in a National Guard population. Stressful civilian life events may be particularly important in this population, due to frequent transitions between military and civilian employment and engagement among Guard members. We used data from the Ohio Army National Guard Mental Health Initiative to investigate the relationship between two domains of civilian life experiences from across the lifecourse and adult depression: (1) early-life adverse experiences, such as being mistreated during childhood, and (2) more recent stressful experiences outside of deployment, such as financial problems or divorce. First, we estimated the relationships between each of these two domains of exposure and the rates of incident depression across four years using Cox proportional hazards models. We found that male servicemembers who reported at least one out of four traumatic childhood events assessed had a 77% higher rate of incident depression during follow-up compared to those who reported no traumatic childhood events, after adjusting for race and age group (95% CI (confidence interval): 1.33, 2.49). When further adjusting for posttraumatic stress disorder (PTSD) in the time between childhood events and depression, this relationship only slightly attenuated (aHR (adjusted hazard ratio) = 1.71, 95% CI: 1.24, 2.35), suggesting that the relationship between traumatic childhood events and adult depression is not driven by PTSD. Furthermore, when stratified by income level, the association between traumatic childhood events and depression was stronger among men making $40,000 per year or less, with an adjusted hazard ratio of 2.06 (95% CI: 1.22, 3.49), compared to men making more than $40,000 per year (aHR = 1.63, 95% CI: 1.09, 2.45). We also found that men who reported at least one out of nine stressful events assessed in the prior year (a time-varying exposure updated over time) had twice the rate of incident of depression overall compared to men who reported no past-year stressful events (95% CI: 1.52, 2.72), adjusting for race, age group, and past-year PTSD. We observed imprecise associations between these exposures and incident depression among women that should be interpreted with caution due to the small sample size (aHR for one or more childhood events: 0.74, 95% CI: 0.35, 1.61 and aHR for past-year stressors: 1.07, 95% CI: 0.57, 2.01). Our second study departed from traditional epidemiologic null hypothesis testing methods, taking instead a prediction approach to studying incident depression. Supervised machine learning—including methods such as tree classification and random forests—have the flexibility to identify predictors that are not pre-specified, and can be used for hypothesis generation. Among both male and female soldiers, we found that reporting verbal abuse by a parent or guardian during childhood, being of mid-level rank status in the military, recently deploying to a non-conflict area, having been robbed, and having been mistreated were all important predictors of incident depression across five years of follow-up. PTSD and traumatic events in adulthood (including combat-related experiences) as well as having children appeared more important for prediction among men compared to women, while military characteristics (e.g., years of service) as well as hearing about traumatic events happening to others (e.g., learning that a family member was in a serious car accident) appeared more predictive of depression for women compared to men. We also identified subgroups of individuals with certain combinations of predictors who were at high risk of depression onset, such as men with both past-year PTSD and a casualty in their unit during their most recent deployment. Overall, prediction accuracies of our algorithms were moderate to good when cross-validated. Our third study returned the specific focus to our two main exposure domains of interest, childhood traumas and adult civilian stressors, but took a different approach for understanding depression as an outcome. While our first two studies assessed depression as a binary construct, our third study identified latent sub-groups of depression symptom patterns—or trajectories—across follow-up using latent class growth analysis, and estimated the associations between life stressors and membership into these different trajectory groups. For both men and women, a four-group depression model was identified, including a stable, symptom free group (showing essentially no depression symptoms at any point during follow-up) that included about 62% of the overall sample, an increasing depression symptom group including 13% of the sample, a decreasing depression symptom group with 16% of the sample, and a “chronic” depression symptom group representing 9% of the sample (staying essentially steady around 4-5 symptoms throughout follow-up). After controlling for sex, race, and age group, soldiers who reported one or more traumatic childhood events had 3.57 times the odds (95% CI: 2.53, 5.05) of belonging to the chronic depression symptom group compared to the symptom free group. Reporting childhood events was also associated with being in the decreasing and increasing depression symptom trajectory groups compared to the symptom free group (aOR (adjusted odds ratio): 2.33, 95% CI: 1.75, 3.11 for the decreasing symptom group and OR: 1.78, 95% CI: 1.29, 2.45 for the increasing symptom group). When controlling for sex, race, age group, and past-year PTSD, time-varying adult stressors had the largest effect on depression symptoms for the increasing depression symptom group compared to other groups, particularly in the last two years of follow-up (where there was an adjusted difference of 1.02 symptoms at each year, for stressors compared to no stressors). The decreasing depression symptom and symptom free groups saw a negligible difference in symptoms when comparing one or more stressors to no stressors, while about a half of a symptom difference was seen for the chronic depression symptom group, unchanging across the follow-up time. All three studies in this dissertation indicated the importance of considering stressful life events that occur outside of deployment when studying the mental health of National Guard servicemembers. These findings may be particularly relevant given the frequent switch between military and civilian engagement in the National Guard, and the relative neglect of this group within military research. Furthermore, our novel machine learning findings helped to bridge the gap between population-level and individual-level prediction of depression among National Guard members. Although replication studies are needed, the results of this dissertation may help inform potential intervention strategies for depression in order to reduce the overall disease burden of the U.S. Army National Guard.

This investigation was undertaken with a view in the first place to testing a claim of Pauline Davis as to the correlation, in manic-depressive psychosis, between certain psychological and electroencephalographic features, notably alpha frequency and irregular fast low voltage records which she termed "choppy". The scope of our undertaking is, however, wider in as much we shall be testing correlations with rhythms other than the alpha, and not only in respect of frequency but also amplitude and per cent time. Moreover the notion of "choppy" records will be subjected to critical analysis and replaced by a detailed characterization of irregular or disorganized records.