Introducción: En los últimos años, se ha informado de una variación climática importante que puede generar un impacto en la salud mental. Esta variación genera distintos eventos climáticos que tienden a aumentar el estrés en pacientes con trastornos mentales y desencadenarlo en personas que aún no están enfermas. Objetivo: El objetivo del estudio fue describir y relacionar la temperatura máxima y mínima, humedad relativa media y precipitación máxima con el número de atenciones por trastornos mentales en consulta externa en las redes de salud de las regiones de la costa desde 2002 hasta el 2018 en el Perú. Métodos: Se realizó un estudio ecológico exploratorio, donde la unidad de análisis fue red de salud – mes. El número de atenciones en consulta externa y las variables meteorológicas fueron reportadas por medianas y rangos intercuartílicos. Para el análisis bivariado y multivariado, se utilizó el coeficiente de Spearman y la regresión de Poisson, respectivamente. Resultados: La proporción del número de atenciones por las categorías F00-F09, F10-F19, F30-F39 y F40-48 aumentó a una mayor temperatura máxima y precipitación máxima. Las categorías F20-29, F30-39, F40-48 y F60-F69 mostraron un aumento en sus atenciones cuando incrementó la humedad. Conclusión: Se encontró relación entre una mayor temperatura máxima, humedad y precipitación máxima, y el incremento de la proporción del número de atenciones por trastorno mental en consulta externa. Es necesario realizar investigaciones que evalúen el efecto de las variaciones climáticas sobre los trastornos mentales para implementar estrategias de salud que permitan abordar la carga de la enfermedad. / Introduction: In recent years, significant climate variation has been reported can have an impact on mental health. This variation generates different climatic events that require increasing stress in patients with mental disorders and trigger it in people who are not yet sick. Objective: The aim of the study was to describe and relate the maximum and minimum temperature, average relative humidity and maximum precipitation with the number of attentions for mental disorders in outpatient care in the health networks of the coastal regions from 2002 to 2018 in Peru. Methods: An exploratory ecological study was conducted, where the unit of analysis was health network - month. The number of outpatient visits and meteorological variables were reported by medians and interquartile ranges. For bivariate and multivariate analysis, Spearman coefficient and Poisson regression were used, respectively. Results: The proportion of the number of attentions by categories F00-F09, F10-F19, F30-F39 and F40-48 increased at a higher maximum temperature and maximum precipitation. The categories F20-29, F30-39, F40-48 and F60-F69 showed an increase in their attentions when humidity increased. Conclusion: A relationship was found between a higher maximum temperature, humidity and maximum precipitation, and an increase in the proportion of the number of attentions for mental disorder in outpatient care. Research assessing the effect of climate variations on mental disorders is needed to implement health strategies that will address the burden of disease. / Tesis

The purpose of this study was to examine the differences between female and male prison inmates using the Survey of Inmates of State and Federal Correctional Facilities, 1997. Variables examined included current offense, criminal history, drug use history, victimization history, program participation in the institution, disciplinary infractions in the institution, family history, and interaction with family while in prison. Results indicate that male inmates have worse criminal histories and longer sentences than female inmates. Female inmates have more extensive drug use histories, greater victimization histories, more program participation in the institution, and more criminality in their families of origin than do males. Moreover, males had more numerous disciplinary infractions in the institution and more serious infractions. Females had greater interaction with family while in prison than did males. Implications for future research and correctional practice are discussed.

Major Depressive Disorder (MDD) is a complex and chronic disease that ranks fourth as cause of disability worldwide. Thirteen to 14 million adults in the U.S. are believed to have MDD and an estimated 75% attempt suicide making MDD a major public health problem. Recently several genome-wide association (GWA) studies of MDD have been reported; however, few GWA studies focus on the analysis for MDD related phenotypes such as neuroticism and age at onset of MDD. The purpose of this study is to determine risk factors for MDD, identify genome-wide genetic variants affecting neuroticism and age at onset as quantitative traits, and detect gender differences influencing neuroticism. Bivariate and multiple logistic regression analyses were performed on 1,738 MDD cases and 1,618 non-MDD controls to determine phenotypic risk factors for MDD. Multiple linear regression analyses in PLINK software were used for GWA analyses for neuroticism and age at onset of MDD with 437,547 Single Nucleotide Polymorphisms (SNPs). Gender (OR: 1.43; 95% CI: 1.24 - 1.64) and a family history (OR: 2.88; 95% CI: 2.48 - 3.35) were significantly associated with an increased risk of MDD, which supports the findings of prior studies. Through GWA analysis 34 SNPs were identified to be associated with neuroticism (p < 10-4). The best SNP was rs4806846 within the TMPRSS9 gene (p = 7.79 x10-6). Furthermore, 46 SNPs were found showing significant gene x gender interactions for neuroticism with p<10-4. The best SNP showing gene x gender interaction was rs2430132 (p = 5.37x10-6) in HMCN1 gene. In addition, GWA analysis showed that several SNPs within 4 genes (GPR143, ASS1P4, MXRA5 and MAGEC1/2) were significantly associated with age at onset of MDD (p < 5x10-7). This study confirmed previous findings that MDD is associated with an increased prevalence in women (about 43% more compared to men) and is highly heritable among first degree relatives. Several novel genetic loci were identified to be associated with neuroticism and age at onset. Gender differences were found in genetic influence of neuroticism. These findings offer the potential for new insights into the pathogenesis of MDD.

The α7 subunit of the nicotinic receptor, a ligand gated ion channel with an affinity for nicotine, has long been implicated in the pathophysiology of schizophrenia due to the extremely high rate of smoking within the patient population. However, the exact role of the receptor has never fully been determined. In the following studies, various functions the receptor may assume in disease state are evaluated. There is a strong relationship between the immune system and schizophrenia, with the α7 subunit possibly serving as the link between the two. One of the following studies looks at the possibility of the receptor functioning as antigen in an autoimmune response. Blood sera of schizophrenic patients, as well as controls, were analyzed for the presence of antibodies to the α7 subunit of the nicotinic receptor. A sensitive ligand-based assay revealed schizophrenic patients could possess a pathogenic level of antibody that may exacerbate the degenerative nature of the disease, allowing for the possibility that receptor antibodies may serve as a contributing factor in the etiology of the disorder in at least a subset of patients. In other studies, the expression of the α7 receptor was investigated. Recombinant α7 receptor production has eluded researchers in non-mammalian species and this was the focus of our initial studies. In general, the lack of sufficient molecular recombinant techniques utilizing the receptor makes characterization of the α7 receptor and it's specific protein interactions difficult to evaluate. The regulatory mechanisms of the nicotinic receptor α7 subunit production and receptor formation have yet to be completely elucidated. Results in this investigation found a relationship between a functional CRE-element in the promoter region.

Bakgrund: Fenomenet ensamhet är ett begrepp som har olika betydelser för olika människor men den ofrivilliga ensamheten innebär, oavsett känsla, ett utanförskap och brist på sammanhang. Tidigare forskning har haft stort fokus på äldre men på grund av att ofrivilligt ensam ter sig kunna leda till permanent psykiskt lidande under människans hela livslopp har dagens forskning riktat större fokus på de unga vuxna. Ensamhet som begrepp förknippas som negativt och ett pinsamt tillstånd med stor komplexitet och många unga vuxna uppfattar lida i det tysta. Ensamhet kan utifrån livsvärldsperspektivet vara social, emotionell eller existentiell. Syfte: Syftet är att beskriva unga vuxnas upplevelser och hantering av ofrivillig ensamhet i samband med psykisk ohälsa.  Metod: En litteraturstudie med systematiskt tillvägagångssätt i samstämmighet med Bettany-Saltikov och McSherry (2016). Resultatet baseras på analysen av tretton kvalitativa vetenskapliga artiklar. Resultat: Dataanalysen resulterade i tre teman och åtta subteman som bildade studiens resultat. Resultatet bygger på de beskrivningar och upplevelser som insamlats från befintlig empiri gällande ofrivillig ensamhet hos unga vuxna i samband med psykisk ohälsa. Utifrån denna data kunde deras upplevelse kategoriseras och beskrivas och de bildade åtta subtema som sedan slutgiltligen mynnade ut i de tre tema; Negativa tankar och känslor, sociala faktorers påverkan samt förutsättningar och copingstrategier som visat sig vara centrala och inverka ömsesidigt på deras upplevelse av ensamhet och psykiska ohälsa. Slutsats: Det finns flera olika faktorer till upplevelser av ofrivillig ensamhet hos unga vuxna. Författarna kan se ett komplext samband mellan psykisk ohälsa och ensamhet. Bland annat en negativ spiral där både inre- och yttre faktorer tillsammans med individens förutsättningar har en avgörande roll för hur problematiken utvecklas. Denna studie skulle kunna vara utgångspunkten för fortsatt kvalitativ forskning och på vilka preventiva insatser som skulle kunna leda till minskad ensamhet och psykisk ohälsa hos unga vuxna. / Background: The phenomenon of loneliness is a concept that has different meanings for different people, but loneliness means regardless of feeling, an exclusion and lack of context. Previous research has focused heavily on the aged people, but due to the fact that loneliness can lead to permanent mental suffering throughout a person’s lifetime today´s research has focused more on young adults. Loneliness as a concept is associated as negative and an embarrassing condition with great complexity and many young adults perceive suffering in silence. Loneliness can, from the lifeworld-perspective, be social, emotional or existential. Aim: The aim of this study is to describe young adults' experience and coping strategies with involuntary loneliness in combination with mental illness.  Method: A qualitative literature study with a systematic approach in accordance with Bettany-Saltikov and McSherry (2016). The result is based on an analysis of thirteen qualitative, scientific articles. Results: The data analysis resulted in three themes and eight sub-themes that formed the study’s results. The results are based on the description and experiences collected from existing empirical evidence regarding involuntary loneliness in young adults in connection with mental illness. Based on this data, their experience could be categorized and described, and they formed eight sub-themes which then finally resulted in the themes; negative feelings and thoughts, the influence of social factors and conditions and coping strategies that have been shown to mutually affect their experience of loneliness and mental illness.  Conclusion: There are several different factors to experiences of involuntary loneliness in young adults. The authors can see a complex relationship between mental illness and loneliness. Among other things, a negative spiral where both internal and external factors together with the individual’s conditions have a decisive role in how the problem develops. This qualitative study could inspire others to continue qualitative research and preventive measures could lead to reduced loneliness and mental illness in young adults.

Los trastornos mentales, como la ansiedad y depresión, son un problema de salud pública. Una de las poblaciones más afectadas son los estudiantes universitarios, debido a que están expuestos a diversos factores estresantes. Se ha demostrado que el ejercicio físico tiene una relación inversa con las variables psicológicas de ansiedad y depresión. El objetivo principal de este estudio es describir la relación entre los grados de actividad física con los niveles de ansiedad y depresión en estudiantes de Medicina Humana del primer al sexto año de estudios de una universidad de Lambayeque, año 2022. Los instrumentos de recolección de datos fueron Cuestionario Internacional de Actividad Física (IPAQ) versión corta, Inventario de Ansiedad de Beck (BAI) e Inventario de Depresión de Beck 2da versión (BDI-II). Se utilizó el Coeficiente de correlación Spearman y un modelo de regresión logística binaria (técnica multivariada) para medir la correlación entre las variables estudiadas. El estudio incluyó 188 estudiantes, que cumplieron con criterios de inclusión, con edad media 20 años. Se encontró que en su mayoría los estudiantes presentaron síntomas de ansiedad leves (37.8%), síntomas depresivos graves (8.5%) y realizaba un grado de actividad física bajo (40.4%) En el modelo de regresión logística binaria, se encontró que existe relación inversa entre las variables actividad física y depresión OR es 0.477 (con un intervalo de confianza al 95% del 0.254 al 0.895) con un p-valor es menor a 0.05. No se encontró correlación estadísticamente significativa entre las variables actividad física con ansiedad. / Mental disorders, such as anxiety and depression, are a public health problem. One of the most affected populations are university students, because they are exposed to various stressors. It has been shown that physical exercise has an inverse relationship with the psychological variables of anxiety and depression. The main objective of this study is to describe the relationship between the degrees of physical activity with the levels of anxiety and depression in Human Medicine students from the first to sixth year of studies at a university in Lambayeque, year 2022. The data collection instruments were International Physical Activity Questionnaire (IPAQ) short version, Beck Anxiety Inventory (BAI) and Beck Depression Inventory 2nd version (BDI-II). The Spearman correlation coefficient and a binary logistic regression model (multivariate technique) were used to measure the correlation between the variables studied. The study included 188 students, who met the inclusion criteria, with an average age of 20 years. It was found that the majority of students presented mild anxiety symptoms (37.8%), severe depressive symptoms (8.5%) and carried out a low degree of physical activity (40.4%). In the binary logistic regression model, it was found that there is an inverse relationship between the variables Physical activity and depression, OR is 0.477 (with a 95% confidence interval of 0.254 to 0.895) with a p-value of less than 0.05. No statistically significant correlation was found between the physical activity variables and anxiety.

Bakgrund: Ungefär en av fem kvinnor drabbas av psykisk ohälsa postpartum (PP). Trots detta är det inte alla som får hjälp. Det är därför viktigt att distriktssköterskan har goda kunskaper i att upptäcka och behandla psykisk ohälsa PP, och på så vis kunna mildra konsekvenserna för mor och barn. Det är sedan tidigare känt att kvinnor med psykisk ohälsa postpartum har sämre förutsättningar till en bra anknytning till barnet. Syfte: Syftet var att beskriva distriktssköterskans roll mot nyblivna mammor som visar tecken på psykisk ohälsa. Metod: Tidigare publicerad forskning har analyserats och sammanställts i en litteraturöversikt. Resultatet presenterades utifrån de fyra kategorier som framkom ur de kvalitativa artiklarna. Resultat: Distriktssköterskor har en viktig roll på barnavårdscentralen (BVC), för att upptäcka och behandla psykisk ohälsa postpartum. / Background: Approximately one out of five women suffers from mental illness in the postpartum stage. In spite that, several women suffer without any help. It is therefore important that the district nurse has a good knowledge in how to discover and treat mental illness in the postpartum stage. Aim: The aim was to describe the district nurse’s role towards new mothers with signs of mental illness. Method: Previous research have been analyzed and complied in a literature review. The result was presented from the four different categories, that was revealed in the analysis of the qualitative articles. Result: The districtnurses have an important role in the child care unit, in order to discover and treat mental illness in the postpartum stage. / <p>Godkännandedatum: 2020-11-23</p>

<p>The term ‘stigma’ is formally defined as the assignment of negative perceptions to an individual because of perceived difference from the population at large (The Free Online Dictionary by Farlex). Stigma, pervasive on a micro, mezzo and macro level serves to devalue individuals who have been diagnosed with mental illness and the support systems that are designed to assist them. Although efforts have been made in public awareness campaigns to reduce the stigma associated with mental illness, stigma continues to limit opportunities and restrain individuals from living full and enriching lives. Many individuals “suffer in silence” often resorting to maladaptive coping mechanisms to manage symptoms.</p> <p>The purpose of this study was to uncover the short term and long term impact of stigma from the perspective of those who are labelled with mental illness in order to gain a deeper and more accurate understanding of the effects of such on life satisfaction. Existing literature suggests that the result of anticipated and experienced stigma can affect individuals in multiple ways: diminished self-esteem, self-efficacy, and self-worth; social withdrawal; identity ambivalence; secrecy and reduced opportunities (employment, housing, income).</p> <p>This research utilized qualitative semi-structured interviews and photo elicitation to gain an understanding of experienced and anticipated stigma as perceived by those with mental illness. Theoretically, the study was influenced by the modified labelling theory which posits that social and internalized stigma associated with mental illness is a societal creation in that its’ development exists as a result of disapproving social attitudes about mental illness. Eight individuals with various diagnosed mental disorders participated in the study. The findings suggest that for each of the participants in this study, initial dealings with the mental health care system and its’ components are likely to impact individuals negatively but once effective treatment, medication stabilization and a good practitioner are found, the experience becomes positive and empowering to individuals. Regardless of the level to which internalized stigma exists, all participants engaged in acts of secrecy, withdrawal, passing and selective disclosure adversely affecting life satisfaction. The implications for practice include recognizing the structural factors that influence clients’ internalization of stigma which likely contributes to feelings of empowerment and control over ones’ life. Revealing mental health status to others may be beneficial in contributing to an improved quality of life satisfaction.</p> / Master of Social Work (MSW)

<p>Thank you to all who were involved in this research including Drs. Benicio Frey,<br />Sue Becker, Margaret McKinnon, Luciano Minuzzi, and Lauren Cudney and Marg Coote. I would like to express my very great appreciation to the midwives at Community Midwives of Hamilton for enabling me to visit the clinic and recruit their pregnant clients. Finally, I would like to thank Lorenda Williams, John Williams, and Eric Johnson for their continued support.</p> / <p>Postpartum depression (PPD) is a serious disorder associated with debilitating effects on mothers and their infants. A previous history of depression appears to be the strongest risk factor for PPD. Previous studies showed that individuals with history of depression accurately recall more negative compared to positive content. The objective of this study was to compare emotional memory for negative and positive images between pregnant women with previous depressive episodes and pregnant women with no lifetime depression. This is the first study to investigate emotional memory in pregnant women with or without previous history of Major Depressive Disorder (MDD). A total of 77<br />participants between the ages of 18 - 44 (mean age: 27.3  6.2yo) completed the study (14 pregnant women with previous depressive episodes, 30 pregnant women with no lifetime depression, 13 non-pregnant women with previous depressive episodes, and 20 non-pregnant healthy). Participants took part in an emotional encoding task consisting of positive, negative, and neutral images from the International Affective Picture System (IAPS) where they were asked to rate these images based on perceived emotional intensity. Participants returned a week later for a surprise incidental recognition memory task. A multivariate general linear model revealed a significant main effect of group (F(1,71)= 8.04, p=.01). Women with history of MDD demonstrated poorer memory performance than women with no history for negative images, but the two groups did not<br />differ on memory for positive images. This suggests that having a history of depression selectively impaired the memory recognition of negative images.</p> / Master of Science (MSc)

<p>Functional<strong> </strong>magnetic resonance imaging (fMRI) is a popular technique to study brain function and neural networks. Functional MRI studies are often characterized by small sample sizes and rarely consider statistical power when setting a sample size. This could lead to data dredging, and hence false positive findings. With the widespread use of fMRI studies in clinical disorders, the vulnerability of participants points to an ethical imperative for reliable results so as to uphold promises typically made to participants that the study results will help understand their conditions. While important, power-based sample size calculations can be challenging. The majority of fMRI studies are observational, i.e., are not designed to randomize participants to test efficacy and safety of any therapeutic intervention. My PhD thesis therefore addresses two objectives: firstly, to identify potential obstacles to implementing sample size calculations, and secondly to provide solutions to these obstacles in observational clinical fMRI studies. This thesis contains three projects.</p> <p>Implementing a power-based sample size calculation requires specifications of effect sizes and variances. Typically in health research, these input parameters for the calculation are estimated from results of previous studies, however these often seem to be lacking in the fMRI literature. Project 1 addresses the first objective through a systematic review of 100 fMRI studies with clinical participants, examining how often observed input parameters were reported in the results section so as to help design a new well-powered study. Results confirmed that both input estimates and sample size calculations were rarely reported. The omission of observed inputs in the results section is an impediment to carrying out sample size calculations for future studies.</p> <p>Uncertainty in input parameters is typically dealt with using sensitivity analysis; however this can result in a wide range of candidate sample sizes, leading to difficulty in setting a sample size. Project 2 suggests a cost-efficiency approach as a short-term strategy to deal with the uncertainty in input data and, through an example, illustrates how it narrowed the range to choose a sample size on the basis of maximizing return on investment.</p> <p>Routine reporting of the input estimates can thus facilitate sample size calculations for future studies. Moreover, increasing the overall quality of reporting in fMRI studies helps reduce bias in reported input estimates and hence helps ensure a rigorous sample size calculation in the long run. Project 3 is a systematic review of overall reporting quality of observational clinical fMRI studies, highlighting under-reported areas for improvement and suggesting creating a shortened version of the checklist which contains essential details adapted from the guidelines proposed by Poldrack et al. (2008) to accommodate strict word limits for reporting observational clinical fMRI studies.</p> <p>In conclusion, this PhD thesis facilitates future sample size and power calculations in the fMRI literature by identifying impediments, by providing a short-term solution to overcome the impediments using a cost-efficiency approach in conjunction with conventional methods, and by suggesting a long-term strategy to ensure a rigorous sample size calculation through improving the overall quality of reporting.</p> / Doctor of Philosophy (PhD)