La santé mentale des adolescent·e·s et adultes émergents est un enjeu mondialement préoccupant. Dans le but de favoriser le développement positif et le rétablissement des jeunes vivant avec des troubles mentaux, l’estime de soi s’avère être une cible de choix. Des interventions de réadaptation par les arts axées sur l’amélioration de l’estime de soi ont été conduites ces dernières décennies, et ont montré des résultats prometteurs. Certains facteurs individuels, tels que la sévérité des troubles mentaux, semblent pouvoir affecter l’efficacité des interventions. Il importe donc de les étudier plus spécifiquement. Ce mémoire s’inscrit dans un projet plus large d’évaluation multicentrique continue des programmes Espace Transition (ET) mené par des chercheures du CHU Ste-Justine. Nous avons analysé les données de 140 jeunes âgés en moyenne de 16 ans et présentant un trouble mental. L’estime de soi positive et l’estime de soi négative des participant·e·s ont été mesurées avant et après la participation au programme, ainsi que leur niveau d’altération fonctionnelle liée aux troubles mentaux avant le début du programme. Des analyses de modération (ANCOVAs mixtes) ont été conduites afin d’observer si les changements diffèrent en fonction de la sévérité de cette altération fonctionnelle. L’âge, le genre et l’indice d’appréciation du programme ont été inclus dans les analyses. Selon les résultats observés, il apparait que la participation au programme est associée à un changement significatif de l’estime de soi de certains jeunes, plus particulièrement chez ceux rapportant un niveau d’altération fonctionnelle plus sévère. Ces jeunes présentaient en effet une estime de soi positive plus élevée ainsi qu’une estime de soi négative plus faible à la suite du programme qu’avant celui-ci. Malgré leurs limites, ces résultats suggèrent que les programmes ET pourraient jouer un rôle dans le rétablissement et le développement positif des jeunes étant davantage affectés par leurs troubles mentaux. Ils mettent aussi en lumière l’importance de s’intéresser plus amplement aux facteurs individuels pouvant faire varier l’efficacité des interventions. / The mental health of adolescents and emerging adults is an issue of global concern. To promote the positive development and recovery of young people living with mental disorders, self-esteem is a prime target. Rehabilitation art-based interventions focused on improving self-esteem have been conducted in recent decades and have shown promising results. Certain individual factors, such as the severity of mental disorders, seem to be able to affect the effectiveness of interventions. It is therefore important to study them more specifically. This dissertation is part of a larger ongoing multicenter evaluation project of Espace Transition (ET) programs led by researchers from the CHU Ste-Justine. We analyzed the data of 140 young people with an average age of 16 and presenting a mental disorder. The positive self-esteem and negative self-esteem of the participants were measured before and after participation in the program, as well as their level of functional impairment related to mental disorders before the beginning of the program. Moderation analyzes (Mixed ANCOVAs) were conducted to observe whether the changes are different depending on the severity of this functional impairment. Age, gender, and program appreciation index were included in the analyses. According to the results observed, it appears that participation in the program is associated with a significant change in the self-esteem of some young people, more particularly among those reporting a more severe level of functional impairment. These young people had higher positive self-esteem and lower negative self-esteem after the program than before. Despite their limitations, these results suggest that ET programs could play a role in the recovery and positive development of young people who are more affected by their mental disorders. They also highlight the importance of paying more attention to individual factors that can vary the effectiveness of interventions.

Objectives: A large number of people cannot afford healthcare services in the United States. Researchers have studied the impact of lack of affordability of health care on the outcomes of various physical conditions. Mental health disorders have emerged as a major public health challenge during the past decade. The lack of affordability of health care also may contribute to the burden of mental health. This research focuses on the association between financial barriers to health care and mental health outcomes in the US state of Tennessee. Methods: We used cross-sectional data contained in the 2019 US Behavioral Risk Factor Surveillance System (BRFSS). We extracted data for the state of Tennessee, which included 6242 adults aged 18 years or older. Multinomial regression analyses were conducted to test the association between not being able to see a doctor with the number of mentally unhealthy days during the past month. We coded the outcome as a three-level variable, ≥20 past-month mentally unhealthy days, 1 to 20 past-month mentally unhealthy days, and 0 past-month mentally unhealthy days. The covariates examined included self-reported alcohol use, self-reported marijuana use, and other demographic variables. Results: Overall, 11.0% of participants reported ≥20 past-month mentally unhealthy days and 24.0% reported 1 to 20 past-month mentally unhealthy days. More than 13% of study participants reported they could not see a doctor because of the cost in the past 12 months. The inability to see a doctor because of the cost of care was associated with a higher risk of ≥20 past-month mentally unhealthy days (relative risk ratio 3.18; 95% confidence interval 2.57-3.92, P < 0.001) and 1 to 19 past-month mentally unhealthy days (relative risk ratio 1.94; 95% confidence interval 1.63-2.32, P < 0.001). Conclusions: Statistically significant associations were observed between the inability to see a doctor when needed because of cost and increased days of poorer mental health outcomes. This research has potential policy implications in the postcoronavirus disease 2019 era with healthcare transformation and significant financial impact.

Background: The proportion of young people with mental health problems increases within the school, which places greater demands on school nurses and their ability to meet these pupils. Upbringing, family social position and living conditions are factors that affect the health of individuals. School nurses are included in student health and has an important role in mental health problems, both in terms of early identification and provide support to students as well as the promotion of health. School nurses are often alone in their profession within the individual school, which places high demands on the ability to work independently, make their own decisions and be confident in their area of expertise. Through their accessibility, the school nurse has a central position to identify and capture pupils with mental health problems and early provide of support to foster students' development and learning. Aim: The aim of this study is to describe the school nurse's work with young people's mental health problems within the school. Method: A systematic literature review. Searches conducted in Cinahl, PsycInfo, PsycArticles and ERIC resulted in six articles for review and analysis underlying the results. Results: The result presents four themes with related categories that emerged through analysis. These consist of: identification of mental illness, measures in mental health, health promotion of mental health/illness and collaboration around pupils with mental illness. Conclusion: By their position at the school, school nurses constitutes a key figure in identifying mental health problems among pupils through their accessibility, communication skills and the use of screening tools. Prevention and health promotion are important, but the time and the conditions specified for this purpose are lacking. / Bakgrund: Andelen ungdomar med psykisk ohälsa ökar inom skolan, vilket ställer högre krav på skolsköterskor och deras kompetens att möta dessa elever. Uppväxt, familjens sociala ställning och levnadsvillkor är faktorer som påverkar hälsan hos individer. Skolsköterskor ingår i elevhälsan och har en viktig roll i arbetet med psykisk ohälsa, både vad gäller att tidigt identifiera och ge stöd till elever samt arbeta hälsofrämjande. Skolsköterskor är oftast ensamma i sin profession inom den enskilda skolan, vilket ställer höga krav på förmågan att kunna arbeta självständigt, fatta egna beslut och vara trygg inom sitt kunskapsområde. Genom sin tillgänglighet har skolsköterskan en centrala position för att kunna identifiera och fånga upp elever med psykisk ohälsa och tidigt kunna erbjuda stöd för att främja elevers utveckling och lärande. Syfte: Syftet är att beskriva skolsköterskans arbete med ungdomars psykiska ohälsa inom skolan. Metod: Systematisk litteraturstudie. Sökningar som utförts i Cinahl, PsycInfo, Psycarticles och ERIC resulterade i sex artiklar som efter granskning och analys ligger till grund för resultatet. Resultat: I resultatet presenteras fyra teman med tillhörande kategorier som framkommit genom analys. Dessa består av: av identifiering av psykisk ohälsa, åtgärder vid psykisk ohälsa, hälsofrämjande arbete kring psykisk hälsa/ohälsa samt samverkan runt elever med psykisk ohälsa. Konklusion: Skolsköterskor utgör, genom sin position på skolan, en nyckelperson vad gäller att identifiera psykisk ohälsa hos elever genom sin tillgänglighet, kommunikativa färdigheter och användning av screeningverktyg. Förebyggande och hälsofrämjande arbete är viktigt, men både tid och förutsättningar saknas för detta ändamål.

There is a consistent research base that shows that class and inequality is associated with poorer mental health and experiences of distress. Various explanations for this link have been proposed, including psychological, social, structural, material and political factors. Experiences of powerlessness and oppression have also been implicated. Nevertheless psychology focuses predominately on explanations and interventions at the individual level. To explore this incongruence, a Foucauldian Discourse Analysis was completed of texts produced by Improving Access to Psychological Therapies (IAPT), related to the development and practice within IAPT and supervision sessions of high-intensity therapists practicing in IAPT. The emerging discourses are discussed.

Bakgrund: Tidigare forskning belyser att personer med bakomliggande psykisk sjukdom eller ohälsa stigmatiseras och diskrimineras både i samhället men även inom hälso- och sjukvården. Det är därför viktigt att se hur sjuksköterskor upplever och uppfattar hur det är att ge omvårdnad till denna patientgrupp. Syfte: Syftet med studien är att utforska sjuksköterskors upplevelser och uppfattningar av att ge omvårdnad till patienter med bakomliggande psykisk ohälsa och psykisk sjukdom medan de vårdas på kirurgiska vårdavdelningar. Metod: Åtta semistrukturerade kvalitativa intervjuer utfördes med sjuksköterskor från fyra olika kirurgiska vårdavdelningar. Intervjuerna analyserades genom kvalitativ innehållsanalys. Resultat: Resultatet redovisas i tre kategorier; upplevelser av att vårda patienter med psykisk sjukdom eller ohälsa, uppfattningar relaterade till ansvarsfördelningar inom vården och upplevelser av kunskap relaterade till psykisk sjukdom och ohälsa. Sjuksköterskorna i denna studie gav uttryck för både positiva och negativa upplevelser och uppfattningar kopplat till att vårda denna patientgrupp. De uppfattade ofta att personer med bakomliggande psykisk sjukdom eller ohälsa var vårdkrävande och tillskrev dem negativa karaktärsdrag. De upplevde även att de inte hade kunskap eller resurser till att ge dessa personer god omvårdnad när de vårdas på kirurgiska vårdavdelningar Slutsats: Sjuksköterskor i denna studie gav uttryck för olika upplever och uppfattningar kopplat till att ge omvårdnad till patienter med bakomliggande psykisk ohälsa och psykisk sjukdom inom somatisk vård. Upplevelserna och uppfattningarna var av så väl positiv som negativ karaktär och upplevelserna kan kopplas samman med tidigare forskning som visar att patienter kan uppleva diskriminering och stigmatisering kopplat till psykisk ohälsa och sjukdom. För att öka förutsättningarna för jämlik och patientcentrerad omvårdnad upplevde sjuksköterskorna att kontinuerlig utbildning kring psykiatrisk omvårdnad är viktig även för sjuksköterskor som är verksamma utanför specialiserad psykiatrisk vård. / Background: Previous research highlights that people with underlying mental illness or disorders are stigmatized and discriminated against, both in society and within the health care system. It is therefore important to see nurses perceive and understand how it is to provide care to this population. Objective: The purpose of the study is to explore nurses' experiences and perceptions of providing care to patients with underlying mental illness and or mental disorders while being treated in surgical wards. Method: Eight semi-structured qualitative interviews were conducted with nurses from four different surgical wards. The interviews were analyzed by qualitative content analysis. Results: The results are reported in three categories; experiences of caring for patients with mental illness, perceptions related to the allocation of responsibilities in care and experiences of knowledge related to mental illness. The nurses in this study expressed both positive and negative experiences and perceptions related to caring for these patients. They are often perceived that people with underlying mental illness was demanding and attributed them there with negative character traits. They also felt that they did not have the knowledge or resources to give these people good care when they are cared for at a surgical wards. Conclusion: Nurses in this study expressed different experiences and perceptions related to providing care to patients with underlying mental health and mental illness in somatic care. The experiences and perceptions were of positive as well as negative character and experiences can be linked with previous research showing that patients may experience discrimination and stigma associated with mental illness and disease. To improve the conditions for equitable and patient-centered care nurses experienced that continuous training in psychiatric nursing is also important for nurses who are active outside specialized psychiatric care.

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.

My passion as a student at the Claremont Colleges is to help children with Autism Spectrum Disorder grow and learn as normal children and to help prepare them for life outside the Autism Center at Claremont McKenna College. In my thesis project, I am exploring the concept of silhouettes through photography and my perceptions of the stories told to me by the children I teach. Esthetically, I am inspired by Kara Walker’s installation of large cutout silhouettes but I am using different mediums to accomplish my project: Artistically, I am inspired by the detailed descriptions of the obsessive stories and information provided to me by the children at the Autism Center. Primarily, I will be using photographs that I have taken of the children and creating silhouetted images of them through Photoshop. Afterwards, I will paint my perceptions of the detailed and creative descriptions of the different information relayed to me by each individual child. Secondary, there will be some life size black cutouts, on black paper, of different imagined scenarios with the children. In the spring, I see this as an installation with many separate pieces that contain different sizes, depth, and simplicity.

Sleep disturbances and insomnia are prevalent, with around 33% of adults indicating that they experience at least one main symptom of insomnia, and bidirectional relationships exist with common psychopathology, particularly major depressive disorder (MDD). However, genetic and environmental (e.g., traumatic event exposure) contributions to the etiology of these phenotypes are not yet well understood. A genetically informative sample of approximately 12,000 Han Chinese women aged 30-60 (50% with recurrent MDD) was used to address several gaps within the sleep literature. Sleep disturbances were assessed in all individuals using a general item addressing sleeplessness (GS). A sleep within depression sum score (SDS) was also created in MDD cases, combining information from the GS and two insomnia items within MDD. A total of 11 traumatic events were assessed and additional information on childhood sexual abuse (CSA) was also obtained. First, factor analyses were conducted to determine trauma factor structure. The best-fit solution included 3 factors: interpersonal, child interpersonal, and non-assaultive, and composite variables were constructed accordingly. A series of hierarchical regressions were run to examine differential effects of trauma type and timing on sleeplessness. All traumatic events predicted sleeplessness at similar magnitudes, although population models indicated that childhood interpersonal trauma may be particularly potent. An association between CSA and sleeplessness was also replicated. A series of genetic analyses demonstrated that the single nucleotide polymorphism-based heritability of sleep phenotypes did not differ significantly from zero. Further, association analyses did not identify any genome-wide significant loci. However, using a liberal false discovery rate threshold of 0.5, two genes of interest, KCNK9 and ALDH1A2, emerged for the SDS. Polygenic risk score (PRS) analyses demonstrated genetic overlap between the SDS in MDD cases and GS in MDD controls, with PRSs explaining 0.2-0.3% of the variance. A final combined model of both genetic and environmental risk indicated that both PRS and traumatic events were significant predictors of sleeplessness. While genetic results should be interpreted with caution given the lack of heritability, additional research into the genetic and environmental contributions to insomnia, utilizing more standardized phenotypes and properly ascertained samples, is clearly warranted.

The increasing importance of music as a therapeutic benefit in mental hospitals has prompted this study. Numerous unscientific reports and papers concerned with music therapy have been published; however, material based upon controlled experiments and results is available which has proven valuable in the study of this growing aid for mental patients. The reference material in the following chapters has been organized and limited to objective reports produced by those who have devoted their interest and time to the facts about the use of music as a therapeutic agent in mental hospitals.

Organophosphates (OPs) are a major class of pesticides and nerve agents that elicit acute toxicity by inhibiting acetylcholinesterase (AChE), the enzyme responsible for the degradation of the neurotransmitter acetylcholine in the central and peripheral nervous systems. Acetylcholine accumulation following extensive AChE inhibition leads to an acute cholinergic syndrome characterized by autonomic dysfunction, involuntary movements, muscle fasciculations, respiratory distress, and seizures. Despite their classification as moderate to highly toxic, OP pesticides are the most widely used class of insecticides in the U.S., and are even more commonly used worldwide. Additionally, there is a growing concern that OP nerve agents could be used to cause mass civilian casualties. It is well known that the survivors of acute nerve gas poisoning and chronic OP pesticide exposure exhibit neurobehavioral deficits including mood changes, depression, and memory impairments. Despite this, there are very few treatments available for OP-intoxication survivors and this topic is under-researched. In this study we investigated whether animals surviving a single severe OP exposure exhibited long-term neurological impairments, using two OP agents: paraoxon (POX) and diisopropyl fluorophosphates (DFP), as well as a non-OP chemoconvulsant, pilocarpine (Pilo), which acts as a muscarinic agonist. Exposure to POX, DFP, or Pilo led to overt signs of cholinergic toxicity. POX and DFP rats were rescued with an optimized atropine, 2-PAM, and diazepam therapy per current OP-exposure treatment guidelines, while Pilo rats were given only diazepam. Saline was administered to control rats at all pharmacological timepoints. Surviving rats were studied using established behavioral assays for identifying symptoms of depression and memory impairment 3-6 months after exposure to toxic agents. In the forced swim test, POX, DFP, and Pilo animals exhibited increased immobility time indicative of a despair-like state. In the sucrose preference test, POX, DFP, and Pilo rats did not display a preference for sucrose water, indicating an anhedonia-like condition. POX, DFP, and Pilo rats also displayed increased anxiety as characterized by significantly lower performance in the open arm of the elevated plus maze. Furthermore, when tested with a novel object recognition paradigm, POX, DFP, and Pilo rats exhibited a significantly lower discrimination ratio, indicating impaired recognition memory. The results indicate that these models of survival from severe POX and DFP exposure can be employed to study chronic behavioral and cognitive comorbidities and to further investigate the molecular bases for these comorbidities, potentially leading to the development of pharmacological therapies.