Includes bibliographical references (p. 256-311). / The primary purpose of the study was to explore, analyse and interpret the lived experiences of male intimate partners of female rape victims and the meaning of such experiences within six months of the rape. A secondary purpose was to formulate a framework grounded in the data gathered from the intimate partners to understand and conceptualise their experiences. The research question that guided the study was the following: What are the lived experiences of intimate partners of female rape victims during the six months following the rape? Selection of study participants involved purposeful sampling. After providing informed consent, nine intimate partners of female rape victims living in Cape Town, South Africa, participated in four separate face-to-face, semi-structured interviews: (a) within 14 days of, (b) a month after, (c) three months after and(d) six months after the rape.The hermeneutic-phenomenological approach of Paul Ricoeur formed the framework for the analysis and interpretation of the findings to ensure congruence between the present study‘s philosophical underpinnings and the research method. Colaizzi‘s procedural steps and the within-case and acrosscase approach, as suggested by Ayres, Kavanaugh and Knafl (2003:873), functioned to supplement Ricoeur‘s method (Speziale & Carpenter, 2003:58-64).

Background: Although mental disorders is of great public health concern among Kenyan populations, mental health services remain poor. Some of the reasons attributed to delivery of poor mental health services are unfavourable work environment and lack of policy guidelines including a conceptual model of nursing.Quality of mental health nursing care significantly impacts on general mental health services in Kenya since they are predominantly provided by nurses. Lack of a model to guide care and improve mental health services created the need to develop the Kenyan Human Interaction Model for mental health nursing practice. Purpose: The purpose of the study was to discover and develop a Kenyan model for mental health nursing guided by two research questions, namely: What are the views of Kenyan mental health nurses with regards to human being, environment, mental health nursing and mental health: What is the appropriate model for mental health nursing practice in Kenya? Methodology: Straussian Grounded Theory method was used in the study. Data were collected for 6 months through in-depth interviews with 33 registered mental health nurses selected by open, purposive and theoretical sampling methods. Inductive and deductive data analysis of the nurses' description of their views and recommendations on the nursing metaparadigms were done Findings: A substantive theory of the Kenyan Human Interaction Model for mental health nursing practice was developed .The four metaparadigm concepts of the discovered theory are: 1. Human being as a unique biopsychosocio-spiritual being and causal condition 2. Environment consisting of homely and hostile dimensions 3. Mental health nursing as a holistic care founded on human interaction 4. Mental health (consequence of holistic care) with optimum and illness dimensions. Mental health nursing was discovered as the central phenomena interacting with its causal, contexts and intervening conditions to determine the mental health dimension of the human being. The quality of mental health nursing determines the mental health dimensions and is influenced by the environment and nurses' characteristics as contexts and intervening conditions respectively. These interactions lead to consequences discovered as optimum mental health. The Kenya Human Interaction Model for mental health nursing practice is customized to the Kenyan situation and contributes knowledge which is relevant to mental health nursing practitioners, students, educators and administrators.

Common mental disorders (CMD) which primarily include depression, anxiety disorders and mixed anxiety depression are leading causes of disability in sub-Saharan Africa. They are particularly common in people living with HIV (PLWH) and may hasten HIV disease progression. This thesis consists of 5 articles which have been submitted for publication and provide evidence on the requirements for developing a psychological intervention to be delivered by lay health workers (LHW) and a strategy for scaling up this intervention to over 50 primary health care clinics in Harare, Zimbabwe. The thesis formed part of formative research leading to a cluster randomized controlled trial(RCT) of a psychological intervention and provides supplementary research to the RCT to support the scale up of the intervention. The first chapter describes the magnitude of the problem and the lack of resources to reduce the treatment gap for CMD. It highlights the growing evidence of using Lay Health Workers (LHW) to reduce this treatment gap.

The purpose of the study was to examine the emotional reactions of music therapy students to simulated auditory hallucinations and music. Eighteen music therapy students (13 female, 5 male) participated in the study. After signing a consent form, participants were randomly assigned to either the control (auditory hallucination simulation) or experimental (auditory hallucination simulation with music) group. Participants completed a demographic survey, PANAS (Watson & Clark, 1988) pretest, listened to eight minutes of respective audio, and then completed a PANAS (Watson & Clark, 1988) post-test. Results were analyzed using two independent t-tests to test for significance, one for positive affect post scores and one for negative affect post scores. No statistically significant results were found. However, there was a noticeable difference in the mean scores for negative affect post scores. The results suggest that music may have assisted in preventing a larger increase in negative affect in the experiment group. Future research should include a larger sample to test for possible significance. Likewise, future researchers should implement similar studies with populations actually experiencing auditory hallucinations to explore the potential for development of emotion regulation interventions using music therapy. / A Thesis submitted to the College of Music in partial fulfillment of the Master of Music. / Spring Semester 2016. / April 13, 2016. / Affect, Auditory Hallucination, Emotion, Mental Health, Mood, Music Therapy / Includes bibliographical references. / Lori Gooding, Professor Directing Thesis; Jayne Standley, Committee Member; Dianne Gregory, Committee Member.

Diabetes and depression are both highly prevalent within the U.S. and it is worrisome that these two conditions are related. Several meta-analyses and studies using qualitative, clinical, and nationally representative cross-sectional quantitative data have shown that depression is associated with an increased risk of developing diabetes (Ducat et al. 2014; Lloyd, Hermanns, Nouwen, Pouwer, Underwood, and Winkley 2010; Katon et al. 2010; Mezuk et al. 2008) and/or those who are diabetic have a moderately increased risk of developing depression (Katon at al. 2010; Moulton, Pickup, and Ismail 2015). Controversy exists as to which way the association may be stronger and whether these conditions are causally related. Additionally, although research into the biological links between these diseases exists, little work has been done that examines the social conditions that link diabetes and poor mental health throughout the life course. Using the National Social Life, Health, and Aging Project (NSHAP), this dissertation examines the biopsychosocial connection between marital biography, mental health, and diabetes with an emphasis on gender differences. I examine 1) how mental health and diabetes are associated cross-sectionally and longitudinally; 2) how marital biography impacts the relationships between mental health and diabetes; and 3) how social mechanisms influence the previously established relationships between marital biography, mental health, and diabetes. Each relationship is examined for the women and men separately and compared to the overall sample. Results add to existing literature by demonstrating that diabetes and depressive symptomology are associated cross-sectionally when each health condition is examined as the dependent variable. Longitudinally, those who are diabetic report higher depressive symptoms over time than non-diabetics. Results vary in magnitude and significance based on gender. For women, those who were diabetic at baseline report higher depressive symptoms over time than non-diabetic women. Results also contribute to the field by showing that marital biography impacts the cross-sectional relationships between diabetes and depressive symptomology. Finally, results also demonstrate that social disconnectedness, social isolation, and perceived social stress mediate the association between diabetes and depressive symptoms. The findings highlight the complexity within diabetes-mental health relationship and demonstrate the importance of understanding the biopsychosocial connection throughout the life course between marital biography, mental health, and diabetes. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2016. / May 16, 2016. / Aging, Diabetes, Gender, Marriage, Mental Health / Includes bibliographical references. / Isaac Eberstein, Professor Directing Dissertation; Heather Flynn, University Representative; Amy Burdette, Committee Member; Michael McFarland, Committee Member.

Bipolar disorder is a mood disorder that is recognized by the American Psychological Association and characterized by cycles of depression and manic episodes. These symptoms can be highly disruptive to daily life and introduce unique stressors to those that experience the symptoms. The average age of onset of these symptoms coincides with the typical age of a college student in the United States. These students that experience the onset of bipolar disorder during college may face unique challenges when compared to their peers, and these challenges may impact their ability to perform academically in college. While research has been done on supporting students with various types of mental health disorders within the college environment, little research has focused specifically on bipolar disorder. Using heuristic inquiry, a form of phenomenological research in which the researcher is part of the phenomenon being studied, I sought to discover the experiences of four college students, who experienced the onset of bipolar disorder during college, through semi-structured interviews. My insight into the experience of bipolar disorder provided a unique way in which I could connect with these participants and explore their life experiences. Using those experiences, I was able to create a model to show how many facets of bipolar disorder impact student stress, motivation and self-regulated learning within the college context. This model provides valuable insight into how further research can identify the ways in which college campuses and support services can better serve the needs of these students with bipolar disorder. / A Thesis submitted to the Department of Educational Psychology and Learning Systems in partial fulfillment of the requirements for the degree of Master of Science. / Spring Semester 2017. / March 24, 2017. / Bipolar disorder, Emotion, Heuristic Inquiry, Motivation, Self-regulation, Stress / Includes bibliographical references. / Alysia Roehrig, Professor Directing Thesis; Jeannine Turner, Committee Member; Martin Swanbrow Becker, Committee Member.

Physician health is a growing issue, garnering recognition by virtue and for potential negative impact on patient care. The state of physician mental health is troubling with above average prevalence of burnout, depression, and suicidal ideation across career stages. Well-being in resident physicians requires special consideration, given their dual role as trainees and physicians. The objectives of this study were to: (1) elucidate the mental health experiences of Ontario resident physicians, characterizing help-seeking behaviours in relation to awareness and utilization of available local and provincial services; and (2) generate knowledge that guides the development of resident-focused mental health services, informing wellness directives at the educational and organizational levels. A provincially focused study included an environmental scan of physician health programs and services at six postgraduate faculties of medicine, as well as in-depth, experiential interviews with residents on key trends across different residency contexts, the specific circumstances facing Ontario residents, their help-seeking behaviours, and experiences with physician health services. A total of 40 interviews were conducted with resident physicians across the province of Ontario, from which a subset of 12 was selected for in-depth analysis. This study found that resident physicians in Ontario were aware of resources for supporting their mental health but there were a number of challenges to seeking support. Barriers such as time, confidentiality, helpfulness, and impact on professional development and career trajectory were cited by participants. Factors that facilitated the use of resources included the accessibility and mode of delivery of services. This research offers insight towards the development and dissemination of resident-specific services and wellness resources. Furthermore, the findings of this study inform strategies and interventions to improve physician well-being through medical education in the postgraduate setting in addition to health and wellness directives at the organizational level.

Background: In South Africa and internationally, there is policy written and work done around empowering persons with disabilities to earn an income to become economically independent. Similarly, much has been written about the importance of social inclusion for persons with disabilities. However, very little is known about how persons with disabilities use education and training opportunities to advance their social capital in the South African context through being economically empowered. The ultimate goal of education is to obtain and maintain gainful employment but historically, work and disability were mutually exclusive (Howard, 2005). Ville (2005) suggests that while there are studies around the unemployment of persons with disabilities, few examine the experiences of these persons as players in their own lives. The focus of this qualitative study is to explore how persons with disabilities advance their social capital through participation in auxiliary (non-formal) education and training programmes that prepare them for employment, or as a pathway to economic inclusion or employment. This knowledge will inform training providers providing training to persons with disabilities at various levels, potential employers as well as persons with disabilities, on how skills development can include processes that would encourage both social and economic inclusion. Aim: The study aimed to critically examine the experiences of persons with disabilities who participated in the auxiliary programme to determine whether and to what extent it has strengthened and expanded their social capital to advance their opportunities for economic inclusion and/or employment. Objectives: The objectives of the study were to: • Explore how skills development programmes facilitate economic inclusion and/ or employment for persons with disabilities and why persons with disabilities engage in skills development opportunities; • Describe the profiles of persons with disabilities who undertake skills development opportunities, exploring how database information is and can be used to inform the transition to employment or economic inclusion for persons with disabilities; • Identify features of social capital evident in employers' perspectives on the employment of persons with disabilities. Methodology: An intrinsic exploratory case study design was used. Case study design provided contextual boundedness and situatedness to the research. Data was collected from databases developed and utilised by the QuadPara Association of South Africa that contained demographic and training information of participants. In-depth interviews with eight participants who had completed skills development training contributed to the understanding of the experiences of persons with disabilities in seeking employment or economic inclusion following skills development. Critical conversations with employers of persons with disabilities contributed to the understanding of the perspectives and attitudes held in the employment sector, when considering the employment of persons with disabilities. Other methods of data collection included document analysis, naturalistic researcher observations and reflections. The findings are presented as three separate papers. The first paper presents the voices of persons who have undertaken skills development training. This paper asserts that if training providers are able to recognize the determinants of social capital within their trainees, these determinants can be nurtured and developed alongside skills development in order to make their trainees more ‘employable', as well as to facilitate the transition into the labour force more smoothly. The second article argues that while it is necessary that alternative, suitable and sustainable training pathways are developed and recognized, these programmes need to build and present the prospective employee's social capital. This paper presents how information, which is used to facilitate the transition into employment can be better utilised. A database containing only demographic information is seemingly insufficient in the face of the number of barriers to employment that persons with disabilities have to overcome. The last article in this thesis speaks to the role of employers in the development of social capital. In order to further understand and promote the employment of persons with disabilities, efforts have to be made to increase social capital in all of the factors that influence the role of being a worker. To this end, individuals need to acknowledge and expand their own social capital, training providers need to support the expansion of networks and social capital through their engagements with trainees, and employers are required to look beyond the disability so that employment goals are shared and re-enforced. Conclusion: This study has uncovered that current practices related to the employment of persons with disabilities works in a very colonial, top-down fashion and seem to have been uncritically exported/imported from the Global North. This study has highlighted the absence of the African concept of “Ubuntu” - like interaction, which emphasises the self as part of others. In order to use social capital for mutual benefit, the employment of persons with disabilities must look different and have different considerations. A decolonial framework, which places less emphasis on practices used in the global North, will improve employment practices for persons with disabilities, as employers will be forced to look beyond the disability and relevant legislation only.

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Background Childhood trauma (CT) has been associated with development of substance use disorders (SUDs) and severe mental illness (SMI) in community cohorts. There is a paucity of data on correlates of CT in dually diagnosed clinical populations in South Africa. We investigated the association among mono-substance use, polysubstance use and CT. Additionally, we explored demographic and clinical correlates of CT. Study aims We investigated associations between CT and SUD in patients with SMI. Setting Participants included patients aged 18–59 years with psychotic disorders attending specialist psychiatric hospital. Methods A cross-sectional study was conducted and the structured clinical interview for DSM-IV, (SCID – I) to determine SUD and SMI, and the childhood trauma questionnaire (CTQ) to measure CT were administered. Results Of the 74 patients, the mean age was 29 years (SD = 8.6) and 64% were male; 64% had schizophrenia-spectrum diagnoses, 23% had BMD-I and 14% had SIPD. Of the patients, 41% were taking no drugs, 22% were mono-drug users and 38% were poly-drug users. There was no significant difference between substance use groups in terms of age or level of education. However, those with no SUDs were significantly more likely to be female, whereas those with mono- or-poly-substance use were significantly more likely to be male. Patients with poly-SUD were significantly less likely to have been married and significantly more likely to have had a diagnosis of SIPD. There were no significant differences in CTQ scores by SUD groups. In this sample of patients with SMI, we found no significant association between CT and SUDs. Conclusion More research is needed into the effects CT has on dual diagnoses to inform treatment approaches to explore traumatic experiences.