Abstract Bullying behaviour is present in the daily life of many adolescents, but research into the serious problems related to this behaviour is still scarce. The aim of this work was to investigate the putative associations of bullying behaviour with psychiatric disorders, substance use, suicidality and criminal offences in a sample of under-age adolescent inpatients in Northern Finland. The epidemiologically unselected sample of 12–17-year-old inpatients in need of acute psychiatric hospitalization in a closed ward consisted of 508 adolescents admitted to Unit 70 in Oulu University Hospital during a defined 5-year period. These subjects were interviewed during their hospitalization using the diagnostic semi-structured Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL), to identify their psychiatric disorders in terms of DSM-IV and to obtain data on bullying behaviour, substance use, suicidality and somatic diseases. Data on possible criminal offences were extracted from the criminal records of the Finnish Legal Register Centre. Being a bully and a bully-victim (i.e. a person who bullies others and is also bullied) increased the likelihood of externalizing disorders in general, and more specifically of conduct disorders, by over 14-fold in the boys and over 10-fold in the girls. Among the boys being a victim of bullying elevated the risk of internalizing disorders in general, and more specifically of anxiety disorders, by over 3-fold. Also, being a victim of bullying was statistically significantly associated with chronic somatic diseases (e.g. allergy, asthma and epilepsy), but only among the boys, the odds ratio (OR) being over 2-fold. Furthermore, being a bully increased the likelihood of substance-related disorders by over 2-fold in the boys and over 5-fold in the girls. In addition, examination of the use of substances of various types showed that being a bully increased the risk of regular daily smoking and alcohol use in both sexes and also led to more severe substance use such as cannabis and hard drugs among girls. Being a victim of bullying and bullying others both increased the risk of serious suicide attempts in the girls by over 2 and 3-fold respectively. Furthermore, bullying behaviour was also associated with violent crimes, but not with non-violent crimes, but psychiatric disorders were significant mediating factors in this association of bullying behaviour with criminality, however. The findings imply that involvement in bullying behaviour is more likely to be a risk factor for inward-directed harmful behaviour than outward-directed aggression, and also suggest that victimized boys are in general more vulnerable than victimized girls, whereas bullying girls have more problems than bullying boys. / Tiivistelmä Kiusaaminen on hyvin yleinen ilmiö nuorten keskuudessa, mutta siihen mahdollisesti liittyviä vakavia ongelmia on tutkittu vähän. Tässä tutkimuksessa analysoitiin kiusaamiskäyttäytymisen yhteyttä mielenterveyshäiriöihin, itsetuhoisuuteen ja rikollisuuteen psykiatrisessa osastohoidossa olleiden alaikäisten nuorten keskuudessa. Kiusaamiskäyttäytymistermi kattaa sekä kiusaajien, kiusattujen että kiusaaja-kiusattujen toiminnan. Tutkimusaineistoon kuului 508 12–17 -vuotiasta nuorta, jotka olivat hoidossa suljetulla psykiatrisella akuuttihoito-osastolla Oulun yliopistollisessa sairaalassa 1.4.2001 ja 31.3.2006 välisenä aikana. Osastohoidon aikana nuoret tutkittiin käyttäen puolistrukturoitua K-SADS-PL -haastattelua, jonka avulla määritettiin nuorten mielenterveyshäiriöt DSM-IV -diagnoosiluokituksen mukaisesti ja saatiin tiedot nuorten kiusaamiskäyttäytymisestä, päihteiden käytöstä, itsetuhoisuudesta ja somaattisista sairauksista. Oikeusrekisterikeskuksen rikosrekisteristä saatiin tutkittavien rikosrekisteritiedot. Tämä tutkimus osoitti, että nuorilla, jotka ovat kiusaajia tai kiusaaja-kiusattuja, on yli kymmenkertainen riski käytöshäiriöihin verrattuna nuoriin, jotka eivät ole osallistuneet kiusaamiskäyttäytymiseen. Kiusatuilla pojilla on yli kolminkertainen riski ahdistuneisuushäiriöihin. Lisäksi kiusatuksi joutuminen on pojilla yhteydessä kroonisiin somaattisiin sairauksiin kuten allergiaan, astmaan ja epilepsiaan. Tytöillä, jotka kiusaavat, on yli viisinkertainen riski päihdehäiriöihin. Pojilla, jotka kiusaavat, vastaava riski on kaksinkertainen. Molemmilla sukupuolilla toisten kiusaaminen on yhteydessä säännölliseen tupakointiin sekä alkoholin käyttöön ja tytöillä myös kannabiksen ja muiden huumeiden käyttöön. Tytöillä, jotka ovat kiusattuja tai kiusaavat, on yli kaksinkertainen riski vakaviin itsemurhayrityksiin. Lisäksi tämä tutkimus osoitti, että kiusaaminen on yhteydessä väkivaltarikollisuuteen, mutta tätä selittävät merkittävästi nuorten mielenterveyshäiriöt. Tämän tutkimuksen tulokset viittaavat siihen, että nuorilla, jotka altistuvat kiusaamiskäyttäytymiselle, on muita suurempi riski itsensä vahingoittamiseen useilla eri tavoilla. Sen sijaan kiusaamisen ja toisiin kohdistuvan väkivallan yhteys on lievempi. Sukupuolten välisiä eroja tarkasteltaessa havaittiin, että haavoittuvaisimpia ovat kiusaavat tytöt ja kiusatut pojat.

Les personnes atteintes de troubles mentaux, en tant que personnes dotées de la personnalité juridique, sont titulaires de droit. Les maladies mentales et déficiences intellectuelles ayant des incidences sur la perception de la réalité, la conscience et/ou les capacités intellectuelles de la personne, entraînent inévitablement des conséquences sur la capacité de vouloir ou de décider. Répondant à ce constat, le législateur a mis en place des mesures assurant la protection de la personne et de ses biens, tout en veillant à respecter son autonomie. Il existe également des dispositions favorisant l'autonomie des personnes handicapées mentales. En outre, l'altération du discernement de la personne a des répercussions sur les mécanismes de la responsabilité civile et pénale. Par ailleurs, en tant que personne vulnérable, la personne atteinte de troubles mentaux a besoin de protection. Au nom du principe du respect de la dignité, le Droit assure une protection particulière du corps et de la personne. Il encadre également les mesures d'hospitalisation sous contrainte nécessaires à la prise en charge du trouble mental. / The persons affected by mental disorders and illnesses, as persons given the legal personality, have rights. The mental illnesses and the intellectual deficiencies having incidences on the perception of the reality, the consciousness and/or the intellectual abilities of the person, entail inevitably consequences on the capacity to will or to decide. Taking this acknowledgement into consideration, the legislator has set up rules providing the protection of the person and of his goods, while respecting the person's autonomy. There are also legal provisions facilitating the autonomy of the disabled persons. Moreover, the change in judgment of the person has consequences on the person's civil and penal liability. Furthermore, as vulnerable person, the person affected by mental disorders and illnesses needs protection. In accordance with the principle of the respect of dignity, laws and regulations guarantee a specific protection of the body and of the person. Laws and regulations also cover the hospitalization under constraint required by the care of mental disorders.

Orientador: Marilisa Berti de Azevedo Barros / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:22:00Z (GMT). No. of bitstreams: 1 Borim_FlaviaSilvaArbex_D.pdf: 3506256 bytes, checksum: c7999f1cfa22c13aacc1d2225ca52859 (MD5) Previous issue date: 2014 / Resumo: A autoavaliação da saúde é um construto multidimensional e tem sido amplamente utilizada como importante indicador de bem-estar individual e coletivo. Estudos mostram uma associação das variáveis socioeconômicas e demográficas com essa medida. Estes fatores influenciam o estabelecimento de diferentes estilos de vida, que contribuem para a ocorrência ou prevenção de problemas de saúde. Os estudos longitudinais têm apontado a autoavaliação de saúde como robusto preditor de morbidade, incapacidade, depressão e mortalidade. A avaliação subjetiva do estado de saúde inclui a dimensão mental, que para o idoso é imprescindível para a realização das atividades funcionais. Este estudo tem como objetivos: analisar a prevalência da saúde autoavaliada como excelente ou muito boa segundo variáveis demográficas, socioeconômicas e de comportamentos relacionados à saúde, em idosos; analisar a prevalência do transtorno mental comum (TMC), medido pelo Self Reporting Questionnaire 20 (SRQ-20), os fatores associados a este transtorno; e avaliar a relação da autoavaliação de saúde negativa com indicadores de saúde física e mental, com variáveis socioeconômicas e demográficas, e com bem estar subjetivo, nos indivíduos com 60 anos e mais. Trata-se de um estudo transversal, de base populacional, que utilizou dados de inquérito domiciliar de saúde realizado em Campinas, SP, Brasil, em 2008, com amostra por conglomerados em dois estágios. A análise dos dados levou em conta as ponderações relativas ao desenho amostral e foi feita com o uso do software STATA versão 11.0. Foram testadas as associações das diversas variáveis com a autoavaliação da saúde e o TMC. Também foram analisadas as estimativas de prevalências e calculadas as razões de prevalências ajustadas. Os resultados revelaram associação de autoavaliação de saúde com religião, escolaridade, renda, número de moradores no domicílio, possuir computador, consumo de bebida alcoólica, atividade física, consumo de frutas e verduras e índice de massa corpórea. Também foi encontrado associação com os indicadores de saúde física, saúde mental e com sentimento de felicidade. Em relação ao TMC houve uma associação com sexo, idade, renda, ocupação, atividade física, consumo de bebida alcoólica, autoavaliação de saúde e morbidades. Estes resultados apontam para desdobramentos no âmbito das ações em saúde coletiva, tais como: a) investir na autonomia e na vida saudável dos idosos; b) prover atenção adequada às necessidades com ênfase nos hábitos de vida saudáveis; c) enfatizar o trabalho na velhice, que representa uma autonomia e inserção do indivíduo; d) investir na promoção da saúde com controle adequado das doenças crônicas e da saúde mental, com atenção para o quadro depressivo na terceira idade; e) desenvolver programas de saúde e de bem-estar social voltados para os segmentos socioeconômicos menos favorecidos e identificar recursos individuais-psicológicos capazes de atuar como fatores de apoio na velhice / Abstract: The self-rated health is a multidimensional construct and has been widely used as an important indicator of individual and collective welfare. Studies show an association of socioeconomic and demographic variables with that measure. These factors influence the establishment of different lifestyles that contribute to the occurrence or prevention of health problems. Longitudinal studies have pointed to the self-rated health as a robust predictor of morbidity, disability, depression and mortality. The subjective assessment of health includes mental dimension, which for older people is essential to the achievement of functional activities. This study aims: to analyze the prevalence of self-rated health as excellent or very good according to demographic, socioeconomic and health-related behaviors variables in elderly; to analyze the prevalence of common mental disorders (CMD), as measered by Self Reporting Questionnaire 20 (SRQ-20), the factors associated with this disorder; and to evaluate the association of self-rated health as negative with indicators of mental and physical health, socioeconomic and demographic variables, and subjective well-being in individuals 60 and over aged. This is a cross-sectional study, population-based, which used data from a home survey carried out in Campinas, SP, Brazil, in 2008, with two-stage conglomerate sampling. Data analysis considered the weights related to the sampling design and was performed using STATA software version 11.0. Associations of several variables were tested with self-rated health and CMD. Furthermore prevalence estimates and adjusted prevalence ratios were calculated. The results revealed association of self-rated health to religion, education, income, number of household members, owning computer, alcohol consumption, physical activity, consumption of fruits and vegetables and body mass index. It was also found association with indicators of physical health, mental health and feeling of happiness. Regarding the CMD was association with gender, age, income, occupation, physical activity, alcohol consumption, self-rated of health and morbidities. These results point to developments in the context of actions in public health, such as: a) emphasizing the autonomy and healthy life of the elderly; b) provide adequate attention to the needs with an emphasis on healthy lifestyles; c) emphasizes working in old age, which represents an individual's autonomy and integration; d) Investing in health promotion with adequate control of chronic diseases and mental health, with attention to depressive symptoms in elderly; e) develop health programs and social welfare for lowest socioeconomic sectors and identifies individual - psychological resources capable of acting as supporting factors in old age / Doutorado / Epidemiologia / Doutora em Saúde Coletiva

Submitted by Carolina Neves (carolinapon@uefs.br) on 2016-08-11T23:51:59Z No. of bitstreams: 1 DISSERTA??O CARDOSO, MARIANA.pdf: 2574488 bytes, checksum: 9bb271940c329bf7d98ec32b338d8535 (MD5) / Made available in DSpace on 2016-08-11T23:51:59Z (GMT). No. of bitstreams: 1 DISSERTA??O CARDOSO, MARIANA.pdf: 2574488 bytes, checksum: 9bb271940c329bf7d98ec32b338d8535 (MD5) Previous issue date: 2015-03-27 / Considering the work as a determining factor in the health / illness physical and mental this study aimed to describe the main actions in mental health related to work in Brazil based on information provided by professionals from the Worker's Health Reference Centers (Cerest) and the following objectives: a) identify the main actions of mental health related to work carried out by state and regional Cerest in the areas of care, occupational health surveillance and health education; b) identify the actions related to health care workers with Mental Disorders Work Related (TMRT) held by Cerest, by regions of Brazil.A survey was conducted with state and regional Cerest implemented in Brazil from October to December 2014 through a questionnaire on ?line, 161 Cerest participated. Among statewide response rate was 96.2% and 77.7% among regional. It can be observed that the actions in the area of mental health related to work performed by Cerest occur primarily in the area of assistance, health surveillance of the worker, and TMRT of notification. Overall the actions were carried out mostly by regional Cerest and in the Southeast and Northeast. The actions in mental health is still poor, highlighting the assistance measures for establishing diagnosis and nexus of suspected cases of Mental Disorders Work Related (TMRT) were not being carried out by most of Cerest of Brazil (53.1%), and this case distributed differently by regions of the country. The treatment of mental illnesses related to work was sent to the Caps, but Cerest not followed its evolution. SUS health services are not prepared to receive this demand that has been increasing cases of TMRT. Highlighted the importance of actions in mental health-related work being undertaken by all SUS voltage levels, and inter and intrasectoral actions need to be expanded and strengthened between Cerest and the Health Care Network, especially the Psychosocial Care Network devices to ensuring full attention to these workers. It is necessary to build new research instruments and public policies that help the flow of shares to the ratio of the nexus of the establishment of these diseases with the work in the health services, as well as Occupational Health Surveillance actions in mental health, as illnesses related to work are preventable through improvements in work environments. / Considerando o trabalho como fator determinante no processo de sa?de/doen?a f?sica e ps?quica, este estudo teve como objetivo geral descrever as principais a??es em Sa?de mental relacionadas ao trabalho no Brasil, com base nas informa??es prestadas pelos profissionais dos Centros de Refer?ncia em Sa?de do Trabalhador (Cerest) e como objetivos espec?ficos: a) identificar as principais a??es de sa?de mental relacionadas ao trabalho realizadas pelos Cerest estaduais e regionais nas ?reas: da assist?ncia, vigil?ncia em sa?de do trabalhador e educa??o em sa?de; b) identificar as a??es relacionadas ? aten??o a sa?de dos trabalhadores com Transtornos Mentais Relacionados ao Trabalho (TMRT) realizadas pelos Cerest, por regi?es do Brasil. Foi realizado um inqu?rito com os Cerest estaduais e regionais implantados no Brasil nos meses de outubro a dezembro de 2014 atrav?s de question?rio on-line.Participaram 161 Cerest. Entre os de abrang?ncia estadual houve taxa de resposta de 96,2% e de 77,7% entre os regionais. Observou-se que as a??es na ?rea de sa?de mental relacionadas ao trabalho realizadas pelos Cerest ocorrem basicamente na ?rea da assist?ncia, vigil?ncia em sa?de do trabalhador e notifica??o de TMRT. No geral, as a??es eram realizadas em sua maior parte pelos Cerest regionais e nas regi?es Sudeste e Nordeste. As a??es em sa?de mental ainda s?o incipientes, destacando-se a assist?ncia para estabelecimento de diagn?stico e nexo de casos suspeitos de TMRT com o trabalho n?o estavam sendo realizadas pela maioria dos Cerest do Brasil (53,1%), sendo esta a??o distribu?da diferentemente pelas regi?es do pa?s. O tratamento do adoecimento mental relacionado ao trabalho era encaminhado para o Caps, mas os Cerest n?o acompanhavam sua evolu??o. Os servi?os de sa?de do SUS n?o est?o preparados para receber esta demanda que vem aumentando de casos de TMRT. Foi destacada a import?ncia das a??es em sa?de mental relacionadas ao trabalho serem realizadas por todos os n?veis de aten??o do SUS; assim, a??es inter e intrasetoriais necessitam ser ampliadas e fortalecidas entre os Cerest e a Rede de Aten??o ? Sa?de, principalmente os dispositivos da Rede de Aten??o Psicossocial, para a garantia da aten??o integral aos trabalhadores. S?o necess?rias novas pesquisas para a constru??o de instrumentos e pol?ticas p?blicas que auxiliem no fluxo de a??es para o estabelecimento do nexo da rela??o desses agravos com o trabalho nos servi?os de sa?de, como tamb?m a??es de Vigil?ncia em Sa?de do Trabalhador na ?rea de sa?de mental, pois o adoecimento relacionado ao trabalho s?o preven?veis atrav?s de melhorias nos ambientes de trabalho.

The psychological sciences offer a large spectrum of theories, principles, and methodological approaches to understand mental health, normal and abnormal functions and behaviours, as well as mental disorders. Based on continued research progress, psychology has derived a wide range of effective interventions for behaviour change and the prevention, treatment and rehabilitation of mental disorders. Thus, psychology and clinical psychology in particular should be regarded as the ‘mother’ science for psychotherapy and psychotherapeutic practice. This paper provides a selective overview of the scope, strengths and gaps in psychological research to depict the advances needed to inform future research agendas on mental disorders and psychological interventions in the context of psychotherapy. Most maladaptive health behaviours and mental disorders can be conceptualised as the result of developmental dysfunctions of psychological functions and processes, and as associated neurobiological and genetic processes in interaction with behaviour and the environment. An integrative translational model, linking basic and experimental research with clinical research and population-based prospective longitudinal studies is proposed for improving identification of critical core vulnerability and risk factors and core pathogenic mechanisms. The proposed framework is expected to allow a more stringent delineation of targeted preventive and therapeutic psychological interventions and an optimisation and better understanding of cognitive-behavioural therapies and other psychological interventions. Based on a European consultation process, a ‘Science of Behaviour Change’ programme with the promise of improved diagnosis, treatment and prevention of both healthrisk behaviour constellations and mental disorders is proposed. / Psychologie als «Mutterwissenschaft» für Psychotherapie und psychische Gesundheit Psychologie als Wissenschaft bietet ein breites Spektrum an Theorien, Grundlagen und methodischen Ansätzen, um psychische Gesundheit, normale und gestörte Funktionen und Verhaltensweisen sowie psychische Störungen zu erforschen und zu «verstehen». Auf dieser Grundlage haben sich in der Klinischen Psychologie vielfältige effektive, psychologisch begründete Interventionen für die Prävention, Behandlung und Rehabilitation von psychischen Störungen ausdifferenziert. Damit ist die Psychologie als «Mutterwissenschaft » der Psychotherapie und psychotherapeutische Praxis anzusehen. Der Beitrag versucht auf der Grundlage einer Stärken-/Schwächen-Analyse der psychologischen Forschung diejenigen Themenbereiche zu definieren, die für Erkenntnisfortschritte bei psychischen Störungen und die psychotherapeutische Interventionsforschung besonders vielversprechend sein könnten. Dysfunktionale bzw. abweichende Verhaltensweisen wie auch psychische Störungen lassen sich als entwicklungsbezogene Störungen psychologischer Funktionen und Prozesse und damit assoziierter neurobiologischer und genetischer Prozesse konzeptualisieren. Für eine verbesserte Identifikation von zentralen Vulnerabilitäts- und Risikofaktoren sowie ätiologisch relevanten Schlüsselprozessen wird ein integratives translationales Modell vorgeschlagen, welches die Grundlagen- und experimentelle Forschung mit klinischer Forschung, Translation und Public-health-Implikationen verknüpft. Damit soll auf der einen Seite eine stringentere Ableitung gezielter Interventionen erleichtert werden, andererseits aber auch eine bessere Identifikation der zentralen Wirkfaktoren und Wirkprozesse psychologischer Therapien ermöglicht werden. Basierend auf einem europäischen Experten-Beratungsprozess wird ein EU-Programm ‘The science of behavior change’ angeregt.

The human intruder test (HIT) is a noninvasive tool widely used for assessing anxiety in rhesus macaques (Macaca mulatta). This thesis explores the HIT procedure and applies it to a population of monkeys with a self-injurious behavioral pathology. Individual variation on this test can be used to assess anxiety and temperament. The first experiment of this thesis applied two different procedures of the HIT to 17 monkeys at UMass. Monkeys displayed little response to the intruder, and no significant differences were detected for the two procedures. To determine whether these responses were unique to the UMass monkeys, their behavior was then compared to the behavior of monkeys at three other primate facilities. UMass monkeys showed less of a reaction compared to monkeys at other facilities. They came to the front of the cage when the intruder entered the room whereas the monkeys at other facilities moved to the back and showed virtually no threats to the intruder. One possible explanation is the increased exposure to humans that UMass monkeys experience. Even though the human running the HIT was a stranger, monkeys at UMass may not perceive a new human in front of their cage to be a threat. The second experiment tested the hypothesis that monkeys with a record of self-injurious behavior (SIB) would be more anxious in response to the HIT. The cage-side version of the HIT was applied to 41 monkeys with a record of self-injurious behavior and 36 matched controls. In contrast to our prediction, SIB subjects spent significantly less time showing anxious behavior and aggressive behavior toward the intruder as well as spent more time in the front of the cage. SIB subjects showed the same range of behaviors as controls, but significantly less behavioral change overall. These data add to the evidence from experiment one that the HIT may not be a sufficient novelty test to elicit a response in monkeys who are more often exposed to different people. An alternative explanation is that SIB is associated with a depressive like syndrome based on reduced overall activity and possibly lowered affect during the stare phase.

Introduction: The late menopausal transition is a time of increased risk of depression in the general population. Nonetheless, mood course during the late menopausal transition in women with bipolar disorder in relatively unknown. Methods: Mood state data in 519 reproductive age women (5989 clinic visits), 116 late menopausal transition (perimenopausal) women (2046 visits), and 133 postmenopausal women (1,437 visits) with bipolar disorder who were receiving optimized naturalistic treatment in the multisite STEP-BD study over an average of 19.8±15.5 months were analyzed for proportion of clinic visits with syndromal depression, mood elevation and euthymia between the three groups. History of postpartum and perimenstrual mood exacerbation as well as hormone therapy use were evaluated as potential predictors of mood. Results: No significant difference in the proportion of clinic visits with syndromal depression was found between reproductive age (18.1%), perimenopausal (18.1%) and postmenopausal (19.3%) women. Reproductive age women had significantly greater proportion of visits with syndromal mood elevation (5.3%) compared to perimenopausal (4.1%, Z=2.1, p2(3, N = 9960) = 19.8, p Conclusions: While proportion of clinic visits with syndromal depression did not differ among the three reproductive groups, thirteen women who had recorded transition from perimenopause to postmenopause showed significantly greater depression than reproductive age, perimenopausal or postmenopausal women. Proportion of visits with euthymia or with syndromal mood elevation decreased from reproductive age to perimenopausal to postmenopausal women. Reported history of mood exacerbation during times of hormonal fluctuation, or current use of hormone therapy, was not significantly associated with depression during the perimenopause. Limitations include women excluded due to absence of menstrual data. Future studies should include hormonal assessments.

Because parental alcohol misuse is associated with numerous negative outcomes for drinkers and other family members, it is important to examine factors predictive of alcohol misuse patterns among parents living with at least one child under the age of 18. Two possible factors include economic insecurity and poverty. This study sought to address whether measures of economic insecurity (i.e., housing and/or food insecurity in the past 12 months) and a dichotomous measure of poverty predict parental binge drinking and parental heavy alcohol consumption in a large population-based sample. It was hypothesized that economic insecurity and poverty, analyzed separately, would predict both occurrence of parental alcohol misuse and amount of alcohol consumed. Results did not support hypotheses; rather, where significant, they indicated that measures of economic insecurity and poverty negatively predicted parental alcohol misuse. However, effect sizes were small and preclude practical application. Findings are discussed and future research directions are identified.

Background: Chronic cough is a common health problem with variable success rates to standardized treatment. Psychologic symptoms of depression, anxiety, and stress have been reported in association with chronic cough. The purpose of this study was to examine changes in the psychologic symptoms of depression, anxiety, and stress in adults with chronic cough 3 months after management using the ACCP cough treatment guidelines. Methods: This study used a descriptive longitudinal observation design. The major tenets associated with the Theory of Unpleasant Symptoms were examined. Intervention fidelity to the study components was measured. Results: A sample of 80 consecutive patients with chronic cough of greater than 8 weeks duration was recruited from one cough specialty clinic. Mean age of subjects was 58.54 years; 68.7% were female; 98.7% were white, and 97.5% were non-smokers. Mean cough duration was 85.99 months and mean cough severity was 6.11 (possible 0 –10; higher scores equal greater cough severity). Cough severity improved post treatment (n=65, M=2.32, (SE =.291), t (64) =7.98, p=.000); cough-specific quality-of-life also improved (n=65, M=9.17, (SE=1.30), t (64) =7.02, p=.000). Physiologic (urge-to-cough r=.360, ability to speak r=.469) and psychologic factors (depression r=.512, anxiety r=.507, stress r=.484) were significantly related to cough-specific quality-of-life and to cough severity (urge-to-cough r=.643, ability to speak r=.674 and depression r=.356, anxiety r=.419, stress r=.323) (all r, p=.01); social support and number of diagnoses were not related to either variable. Those experiencing greater financial strain had worse cough severity. Women, those experiencing financial strain, and those taking self-prescribed therapy had worse cough-specific quality-of-life. Intervention fidelity to the study plan was rated as high according to observation, participant receipt, and patient/physician concordance. Qualitative review identified potential areas of variability with intervention fidelity. Conclusions: By measuring the factors related to the major tenets of the Theory of Unpleasant Symptoms, this theory has helped to explain why those with chronic cough may have symptoms of depression, anxiety, and stress and why these symptoms improve as cough severity and cough-specific quality-of-life improve. Moreover, by measuring intervention fidelity, it may be possible to determine why cough guidelines may not be yielding consistently favorable results.

Bakgrund: Det finns begränsat med studier som behandlar äldre personer med psykisk ohälsa i mötet med hälso- och sjukvårdspersonalen. Psykisk ohälsa hos äldre personer är vanligt förekommande. Nationella samt internationella kartläggningar visar att äldre personer med psykisk ohälsa har erfarit negativa upplevelser i mötet med hälso- och sjukvårdspersonal. Hälso- och sjukvårdspersonal möter äldre personer med psykisk och fysisk samsjuklighet och de har en skyldighet att erbjuda god vård på lika villkor för hela befolkningen. Hälso- och sjukvårdspersonal påverkar mötet med äldre personer med psykisk ohälsa. Syfte: Syftet med litteraturöversikten var att undersöka hur äldre personer med psykisk ohälsa upplever mötet med hälso- och sjukvårdspersonal inom öppen- och slutenvård Metod: Litteratursökningar från januari 2005 till April 2018 samlades in från CINAHL Complete, PsycINFO och Nursing & Allied Health Database. Artiklar från Australien, Norge, Nederländerna, Sverige, Storbritannien och USA inkluderades från databaserna. Resultat: Resultatet består av huvudtemat Vårdrelation med sex underteman:  Psykosociala faktorer, Personlig relation, Motiverande samtal och praktiskt stöd, Misstro, Meningsskiljaktigheter samt Att inkluderas och att exkluderas. Diskussion: Äldre personer med psykisk ohälsa klargör positiva och negativa aspekter i mötet med hälso- och sjukvårdspersonalen. Vänligt bemötande och en personlig relation där patienter tilläts vara delaktiga och samtala om sådant som de önskade ansågs positivt i mötet med hälso- och sjukvårdspersonalen. Negativa erfarenheter som framkom var patienternas upplevelse av misstro och stigmatisering från hälso- och sjukvårdspersonalen. Vidare resonemang synliggör att bemötandet hos hälso- och sjukvårdspersonalen brister vilket även strider mot den filosofi som Hildegard Peplau förespråkar. Det framgår även att hälso- och sjukvårdspersonalens förhållningssätt skiljer sig åt beroende på i vilken vårdkontext som de är verksamma inom. Det talar för att hälso- och sjukvårdspersonalen saknar adekvat kunskap inom ämnet och är i behov av utbildning för att kunna erbjuda god vård på lika villkor för alla. / Background: There is paucity of research to assess the elderly people with mental disorders encounter with healthcare professionals´. National and international research elucidate that elderly people with mental disorders have had negative experiences in the encounter with healthcare professionals´. Healthcare professionals´ encounter elderly people with physical and psychological comorbidity and they are required to offer satisfactory care on equal terms for the entire population. Healthcare professionals impact the encounter with elderly people with mental illness. Aim: The aim of this literature review was to investigate elderly people with mental illness experiences of the encounter with healthcare professionals in an outpatient and an inpatient care setting Method: Literature searches from January 2005 to April 2018 was conducted using CINAHL Complete, PsycINFO and Nursing & Allied Health Database. Articles from Australia, Norway, Netherlands, Sweden, United Kingdom and USA were drawn from the databases. Results: The result consists of one main theme: Caring relationship and it represents six subtopics:  Psychosocial factors, Personal relationship, Motivating conversation and practical support, Distrust, Difference of opinion and Being included or being excluded. Discussion: Elderly people with mental illness acknowledge positive and negative aspects about the encounter with healthcare professionals. Friendly healthcare professionals who engaged in personal conversations with the patients were considered positive. Negative aspects that emerged were patients' experiences of distrust and stigma. Further argumentations elucidate that healthcare professionals fail to uphold a good standard of the care provided which also contradicts the framework that Hildegard Peplau is advocating. The healthcare professionals approach appear to differ depending on the care setting that they are working in. It indicates that healthcare professionals lack adequate awareness and need education to offer quality care on the same terms for all people.