The purpose of this qualitative study was to explore school nurses’ (SN) perceptions of factors influencing their ability to identify, refer, and provide mental health services to students with early signs of mental, emotional, and behavioral (MEB) needs. The National Research Council and Institute of Medicine have urged a preventive public health approach to decrease adverse outcomes of unidentified and untreated MEB needs among children (O’Connell, 2009). Historically and theoretically based in public health, SN have daily contact with students and are in an optimal location for early identification, referral and provision of services, yet little empirical research describing their role is available. Five focus groups with 29 SN were conducted and four themes emerged through analysis of data: Frequent flyers : student visits to SN offices, the observations that alert SN to potential MEB needs; Digging to get the whole picture : the process SN frequently used to collect information necessary to confirm MEB needs; Road to referral : the resources used and barriers encountered within the referral process; and, Safety zone : the important role SN play in the provision of services to students with early signs of MEB needs. Within the provision of services was a collective subtheme across all five focus groups: What we need to better help our kids. In this category SN identified their educational limitations and learning needs, as well as potential strategies to improve provision of services for students with MEB needs. The findings of this study provide a lens into the complex and little explored are of early identification, referral and intervention processes used by SN to care for students with MEB needs. Understanding the role of the SN is a critical first step towards improving outcomes.

BACKGROUND: The correlates of legally significant outcomes that have been identified in people with mental disorders are of limited value in understanding the mechanisms by which these outcomes occur. AIMS: To describe the relationships between mental disorder, impaired psychosocial function, and three legally significant outcomes in a representative sample of the US population. METHODS: We used a population survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, sample size 36,309), to identify people who self-reported serious trouble with the police or the law over the past 12 months and two lifetime outcomes, being incarcerated and engaging in violence to others. DSM-5 categories were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Psychosocial function was assessed using social and role-emotional function scores of the 12-Item Short-Form Health Survey Version 2. RESULTS: Participants with mental disorder, but not people with no diagnosis, who reported serious trouble with the police or with the law during the previous 12 months reported significantly worse psychosocial function than those who did not report such trouble. The size of the statistical effect varied by diagnosis, moderate for some forms of mental illness and for alcohol abuse and nonsignificant for drug abuse and the personality disorders. Effect sizes were largest for diagnoses where legally significant outcomes were least common. CONCLUSIONS: The effect of impaired psychosocial function, for instance in disrupting family and social networks that would otherwise protect against these legally significant outcomes, warrants further investigation in studies with longitudinal designs.

<p><strong>Objectives: </strong>To examine associations between macrosomia, maternal body mass index (BMI) during pregnancy, and psychopathology in youth, and to determine if these are due to prenatal environmental exposures or confounding variables.</p> <p><strong>Methods: </strong>Study 1 reviewed studies examining associations between macrosomia and mental health. Data from the Ontario Child Health Study (OCHS) were then used to explore these links in youth (Study 2). A second review summarized studies assessing associations between maternal pregnancy BMI and psychopathology in offspring (Study 3). Data from the Western Australia Pregnancy Cohort were then used to quantify associations between maternal pre-pregnancy BMI and child behaviour at age 1 and 2 (Study 4), and from 5-17 years of age (Study 5).</p> <p><strong>Results: </strong>Seven of the 15 studies that had examined associations between macrosomia and psychopathology supported a link. In the OCHS, youth born macrosomic had elevated externalizing scores compared those born at appropriate birth weights. Eight of 12 studies suggested that links exist between elevated maternal BMI during pregnancy and psychopathology in offspring. Maternal pre-pregnancy BMI was positively associated with offspring externalizing problems from age 2 to 17 and linked to less favourable trajectories of internalizing symptoms from 5-17. These findings persisted despite adjustment for confounders.</p> <p><strong>Conclusions: </strong>Youth born macrosomic have elevated levels of externalizing symptoms, though a more robust association was noted with maternal pre-pregnancy BMI. The data comprising this thesis suggest that associations between macrosomia/maternal BMI and externalizing and internalizing problems in youth may be due to intrauterine exposures rather than confounding variables.</p> / Doctor of Philosophy (PhD)

Although it is understood that stigma about mental ill-health emerges in middle childhood, and that parental communications are highly influential in children’s developing attitudes, almost nothing is known about the messages parents communicate to young children about mental health problems and how these might contribute to the perpetuation of stigma. This study aimed to address this gap in the literature by exploring parents' communications to their primary-school aged children around mental health and ill-health. Semi structured interviews were carried out with ten parents of children aged 7-11. Data collection and analysis was performed according to a Grounded Theory approach; a theoretical model was developed. The model highlights factors that govern parents’ communications to children about mental health issues, and the impact of this on communication purpose and approach. Parents’ communications were governed by the extent to which parents’ representations of ‘Them’ (mental illness) and ‘Us’ (mental health) overlapped or remained distinct. Communications about mental health were deliberate, comfortable, and aimed to promote child wellbeing, whilst unconscious processes driven by taboo meant communications about mental illness were characterized by avoidance, awkwardness, and ambivalence. Factors such as parent experiences, communication context, and child characteristics, fluidly influenced parents’ overlap of ‘Them’ and ‘Us’, and hence the purpose and approach of their communications to their children. Parents’ context-dependent conceptualizations of mental health and ill-health mean children are receiving complex verbal and non-verbal messages from parents, which may contribute to children’s development of stigmatized views via conscious and unconscious processes. Interventions and policy that harness parents’ existing understandings of mental wellbeing to promote a spectrum model of mental health and ill-health may lead to more open parent-child communication, increased help-seeking, and reduced stigma.

Whilst differing perspectives can be an asset, they have also been found to lead to conflict and misunderstanding in multidisciplinary practice. Evidence suggests that different mental health disciplines hold differing attitudes towards mental disorder, reflecting differing implicit models held. To contribute to our understanding of this problem the present study investigates psychologists’ concepts of mental disorder, building on a pilot study conducted by Harland et al. with psychiatrists (2009). The Maudsley Attitude Questionnaire was used in an online survey of trainee clinical psychologists (N = 288). Principal components analysis was used to investigate implicit models. It was hypothesised that psychologists’ understandings of mental disorder would differ from psychiatrists'. The findings showed that psychologists endorsed different models for different diagnostic categories of mental disorder. Psychologists favoured the social realist model overall. Principal components reflecting a biological-psychosocial continuum, and scales of cognitive/behavioural and psychodynamic/spiritual model endorsement were revealed. The study concluded that, when compared to the findings of Harland et al. (2009), psychologists appear to make more use of psychosocial and less use of biological factors in their understanding of mental disorder than do psychiatrists. There appear to be fundamental differences in psychologists' and psychiatrists’ implicit models of mental disorder. A greater emphasis on multidisciplinary training initiatives is recommended.

Dominant narratives about psychosis portray individuals as lonely, dangerous and unable to contribute to society. Such views may be incorporated into an individual’s personal story and are associated with negative outcomes for personal and clinical recovery. Art-making is associated with personal meaning-making and alternative forms of expression. It is therefore considered potentially relevant to narrative modification. Adult service-users with psychosis participated in a gallery-based art-making intervention. At interview, participants used their self-created images to help tell their story. Literary, experience-centred and culturally-oriented lenses were used to analyse narratives. Turning-points as modifiers of stigmatised dominant narratives were explored, as was how the intervention supported recovery. Art-making was associated with achievement, challenge and satisfaction. Story-telling using visual and verbal means opened up stories and alternative perspectives for participants. Recovery-principles including hope and aspiration were supported, identified through goals and recognition of achievement. Sharing experiences with others with similar experiences was viewed as impacting positively on mental-health. The intervention represented effective partnership working between NHS services and a gallery in overcoming barriers to accessing the arts, for people with psychosis. Achievements in art-making and narrating experience using visual and verbal means offered alternatives to personally limiting and illness-dominated narratives.

The present study investigated parental attachment insecurity, specifically Insecure-Anxious and Avoidant attachment styles, and their relationship to children’s ADHD symptoms of hyperactivity, inattention and aggression. The study used a between­ subjects, correlational (cross­sectional) design and quantitative data was collected using reliable and valid self-report questionnaires. Data was analysed using SPSS 19.0. There were no significant differences in attachment insecurity or attachment styles between parents of ADHD and non-ADHD children. However a highly significant association was found between parental attachment insecurity and child aggression, and a moderate association with hyperactivity. There was no significant effect of attachment style, but the study was underpowered and a larger sample size may have differentiated specific effects of parental attachment style. The study used a largely non-clinical sample, with children who were low risk and significantly less impaired than the ADHD participants. A higher risk population would have potentially brought some of the trends of association between parental attachment and child symptoms to significant levels. The study concluded that parental insecure attachment, specifically Dual/Disorganised attachment style, contributes to the emotional environment that increases risk of child aggression and hyperactivity, however methodological limitations were acknowledged. Clinical implications were drawn and recommendations made for future research.

Voice hearing has a diverse history but is currently understood as symptomatic of a disease within psychiatric frameworks. Alternatives to 'treatment' include peer-support 'Hearing Voices Network groups' (HVNGs) which have grown in popularity and exist alongside treatment-based hearing voices groups. Few studies have investigated processes underlying change in HVNGs. Established research into therapeutic factors and personal recovery may provide frameworks elucidating change processes. This study aimed to investigate how HVNG attendees experienced change within the group and how this change influenced their lives. A qualitative design was employed using interpretative phenomenological analysis (IPA) to elucidate group processes through immersion in the perspectives of group attendees. Semi-structured interviews were conducted with eight individuals who were purposively sampled from two HVNGs. Interviews lasted from 34 to 54 minutes, were recorded on a Dictaphone and later transcribed verbatim. Four superordinate themes emerged: 'healing', connecting with humanity; group as an emotional container; making sense of the voices and me; and freedom to be myself and grow. The study concluded that relationships, safety, exploration of voices and group ownership are key components of HVNG and fit into frameworks of therapeutic factors and recovery processes. Development of HVNGs should take these processes into account. Future studies should further elucidate processes.

No description available.

Social anxiety disorder is the third most common mental disorder with the lifetime prevalence rate of 13.3% in the US population. Typically, it causes significant impairment in a wide range of functioning and follows a chronic, unremitting course if untreated. Over the past two decades, there has been a dramatic increase in clinical research aimed at examining underlying mechanisms maintaining social anxiety. One line of research has investigated attentional biases in social anxiety, using various cognitive experiment paradigms, including the emotional Stroop and the modified dotprobe tasks. However, overall findings are equivocal about the nature of attentional biases in social anxiety and several methodological problems limit the interpretability of the data. The present study examined attentional biases associated with social anxiety using a new research paradigm in the field of anxiety disorders: the inattentional blindness paradigm. This paradigm presents a social cue in the absence of the subjects’ expectation while they are engaged in a cognitively demanding task, thereby enabling the more purely attentional aspect of information processing to be examined reducing the influence of potential response biases or effortful strategies. Two independent experiments were conducted using nonclinical student samples consisting of individuals high in social anxiety (HSAs) versus individuals low in social anxiety (LSAs) based on the static and sustained inattentional blindness tasks. Overall, results revealed that HSAs were more likely to detect or identify a socially-threatening cue, relative to LSAs; whereas LSAs were more likely to detect or identify a non-threatening social cue, relative to HSAs. These findings were observed only in the presence of a bogus-speech manipulation. These data suggest the promising utility of the inattentional blindness paradigm in investigating attentional biases in social anxiety and perhaps other psychopathological conditions. Theoretical and clinical implications are discussed. / text