Thesis (M.S.)--University of Wisconsin--Madison, 1965. / eContent provider-neutral record in process. Description based on print version record. Bibliography: 1 l. at end.

Thesis (M A(Psychology))--University of Pretoria, 2007. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Thesis(Ph.D.)--Case Western Reserve University, 2010 / Title from PDF (viewed on 2010-01-28) Department of Social Welfare Includes abstract Includes bibliographical references and appendices Available online via the OhioLINK ETD Center

Thesis (M.D.) -- University of Adelaide, School of Medicine, Discipline of Psychiatry, 2007. / "Submitted April 2007" Bibliography: leaves 145-160. Also available in print form.

This study explored whether depression is stigmatized, and whether these perceptions of depression vary by gender, a person’s own experience with depression, or knowing other people with depression. These questions were examined through the use of an online survey, which included questions measuring demographics, personal history of depression, tolerance of depression, and stigma toward depression. Responses from 106 participants were analyzed using t-tests. The study found that depression is stigmatizing. There is also more stigma for a male with depression than a female with depression. In regards to personal history with depression and stigma, it was found that personally dealing with depression lessened the amount of stigma imposed on depressed persons. There was no significant difference between men’s ratings of stigma and women’s rating. The study also found no significant difference between knowing people with depression or coming into contact with depressed individuals and the likelihood of stigmatizing those with depression.

In any year, one in four British adults will experience a mental disorder (Singleton, Bumpstead, O’Brien, Lee, & Meltzer, 2001), but barriers to accessing treatment remain, one being fear of stigmatization. In this study perceptions of the stigma associated with mental illness were experimentally manipulated and perceived public stigma of help-seeking, attitudes to mental illness, self-stigma, and attitudes to help-seeking were measured. Results indicated that lowering perceived social stigma of mental illness reduced perceived public stigma attached to help-seeking, but also resulted in less positive attitudes to help-seeking, when compared to a neutral condition. The relationship between perceived societal stigma of mental illness and attitudes to help-seeking was mediated by perceived public stigma of seeking psychological help. This research raises questions about the effect of anti-stigma campaigns, which aim to change perceptions about stigma but may have a negative effect on attitudes to help-seeking.

Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and are considered a core feature of the disorder. Neurocognition has been found to account for functional disability to a greater extent than psychopathology however much of the variance in functional outcome still remains unexplained. How functional outcome is measured also requires clarification. By investigating the relationship between neurocognition and functional outcome in First-Episode Psychosis (FEP), much can be learnt about the trajectory of disability and the course of illness in schizophrenia. Metacognition, or thinking about thinking, has been proposed as a mediating variable between neurocognition and functional outcome. Despite different theoretical backgrounds, authors generally converge on there being higher-order, explicit, conscious metacognitive knowledge and lower-order, implicit metacognitive processes. How these relate to each other requires clarification. The prefrontal cortex (PFC) has been implicated in higher order thought and metacognitive processing, and deficits have been observed in PFC Grey Matter (GM) volume in schizophrenia. These metacognitive deficits may contribute to the relationship between cognitive ability and community functioning. A preliminary meta-analysis demonstrated that a moderate effect size is found between neurocognition and metacognition and a moderate effect size exists between metacognition and functional outcome. The present thesis investigated whether metacognition mediates the relationship between neurocognition and functional outcome in FEP (N=80). Path models were created to investigate the different relationships between neurocognition, metacognition and both capacity to perform everyday tasks and objective functioning in the community. A secondary Voxel-based Morphometry (VBM) analysis was also conducted investigating perceptual metacognitive accuracy and its relationship to GM volume in both FEP (N=41) and a matched healthy control sample (N=21). Current findings support the model that metacognition and negative symptoms mediate the relationship between neurocognition and functional capacity in FEP. Path models also demonstrated a significant mediation effect of metacognition between neorocognition and objective function, and functional capacity and objective function. Significant group differences were found between FEP and controls in perceptual metacognitive accuracy however no significant relationship was found between metacognition and GM volume in the PFC. The present thesis suggests that metacognitive deficits are present at first episode and may account for the relationship between cognitive ability and functioning in the community. Findings also suggest that cognitive remediation programmes may wish to focus on metacognition to maximise the transfer of cognitive skills to community functioning. The findings also suggest the presence of two metacognitive processing routes; explicit, declarable, higher-order knowledge and implicit, intuition-based, lower-order experience which can be accounted for by Nelson and Narens (1990) metacognitive model.

The aim of this flexible, multi-method case-study (after Yin 1994, 2003), was to elicit the 'student perspective' on issues relating to mental well-being within the Higher Education Institution setting. It has been guided by the ideology of the health promotion model, the concept of salutogenesis and the Health Promoting University initiative. Phase One consisted of eleven focus group discussions involving fifty one self-selecting participant undergraduates and a semi-structured interview conducted with the lead medical practitioner of the Medical Centre on site. In Phase Two, a quota sample of 806 undergraduates completed a questionnaire. The three datasets were analysed according to a facilitative and complementary approach (Brannen 2004) and in keeping with assumptions of the paradigms from which they originated. The qualitative data were analysed within the framework provided by Miles and Huberman (1994) and the survey was analysed using the Statistical Package for Social Sciences (SPSS). The findings demonstrated that this multi-site university may have specific difficulties with regard to the provision of equal access to the support services. Reduced pastoral care could pose risks to the mental well-being of some students whereas the allocation of students to a personal tutor might increase levels of social capital and reduce symptoms of 'anomie'. Conclusions of the study suggest that HEIs need an understanding of the concerns of the students and their help-seeking behaviour in order to define 'health assets' and minimise 'health deficits'. Overall, the development of co-ordinated institutional support service provision - that is responsive to the needs of a diverse student body - facilitates and supports the creation of a salutogenic environment that both promotes and sustains mental well-being. Health education programmes need to address the persistence of stigma and discrimination. Attention should be focused on health protection measures so that all groups of students are treated equally and fairly in order to counter-balance a possible residual biomedical approach to health promotion from within the medical sector provision. As a case-study of one university, the findings may be theoretically generalisable to other similar multi-site HEIs in their mental health promotion provision.

Existing research and anecdotal accounts have consistently reported that Jewish people are positively inclined to seek treatment for mental health problems, including making use of psychiatric services and psychotherapy. However, much of this data has been based on samples of American Jewry and there appear to be no existing studies in the UK which have quantitatively investigated whether there are similar help seeking preferences for mental health problems amongst British Jewry. The present study investigated Jewish people’s attitudes and intentions to seek professional help for mental health problems and their experiences of seeking professional help in the UK. Using the theoretical framework of the Theory of Reasoned Action (Fishbein and Ajzen, 1975; Ajzen & Fishbein, 1980) the study also aimed to determine the strongest predictors of intentions and attempts to seek professional help, according to people’s attitudes, perceived social pressure, beliefs about the causes of mental illness and level of religiosity. The study included 126 Jewish people who were predominantly recruited from synagogues and community centres across the UK. Results indicated that a high percentage of this sample would be willing to see a mental health professional if they experienced a mental health problem. According to multiple regression analysis, attitudes towards seeking professional help and stress-related causal beliefs most strongly predicted intention to seek professional help. Despite the sample being non-clinically recruited, 63% of participants reported that they had experienced a mental health problem and the majority of these individuals had sought professional help in the past. Path analysis revealed that actual attempts to seek professional help were directly influenced by intention to seek professional help, perceived social pressure and supernatural causal beliefs. Given the high prevalence of mental health problems and use of professional mental health services amongst this sample, clinical considerations highlighted the need for preventative mental health strategies and culturally sensitive mental health services for Jewish people. Limitations of the study include the use of an opportunity sample which was unable to recruit members of the Ultra-Orthodox Jewish community.

Background: Postnatal depression (PND) is a global problem and an important public health issue. It is estimated that approximately 15% of women experience depression during the first postnatal year but there are problems in recognition because its clinical assessment can be complex. The incidence of postnatal depression continues to rise resulting in serious consequences for the mother, her child and the extended family and a risk of suicide (the leading cause of maternal death in England and Wales) and infanticide in some severely depressed mothers. Treatment programmes vary considerably but many studies are suggesting that psychological interventions can be as equally, if not more, clinically effective in the management of depression as routine care from a general practitioner or anti-depressants in the short term – and may be more cost effective. Method: The aim of this exploratory pilot study is to identify whether the support, on a one to one basis, from a Peer Support Worker (PSW) would assist in the reduction of PND in new mothers. Eight PSW’s were recruited. Each PSW had previously suffered from mild to moderate postnatal depression but had recovered and were not currently receiving any form of psychological support or taking any medication. They were employed, on a six month contract, by the local NHS Trust. References and enhanced criminal records clearance were obtained. A confidentiality statement was also signed by the PSW. Thirty mothers were recruited by their own Health Visitor. This was carried out using the Edinburgh Postnatal Depression Scoring documentation (EPDS) alongside a clinical assessment. The cut off score, as agreed by both the lead researcher and the Health Visitors involved in the study, was 11. Fully informed consent was obtained and participant information sheets given. The mothers were allocated into either a Control group or an Intervention group using number alternating. The PSW’s received formal training about child protection procedures/safeguarding children in addition to the relevance and importance of confidentiality. However, apart from this, a structured training programme was not adhered to. The PSW’s strongly felt, as a combined group, that they wanted to provide the intervention simply as a ‘fellow mum who had survived the rollercoaster journey of PND’. Each PSW wanted to identify the nature of the problem, find a possible solution, and design their own proposed ‘support package’ – from the outset of the study. The PSW visited the mother in their home environment, or a location of their choice, for a period of six weeks on a once weekly basis (intervention group). This was then compared to a number of mothers who received support from their family Health Visitor (HV) alone (control group). Data collected was both qualitative and quantitative. The PSW's and the mothers from both the control group and the intervention group were asked to maintain a log book reflecting upon their feelings and thoughts after each visit (either from their PSW or their HV). Individual and group supervisory sessions were also offered by the lead researcher to both the mothers within the intervention group, and the control group, in addition to the PSW’s. A number of the participants were interviewed on a one to one basis when their infant was six months old. Data from the interviews was subsequently transcribed, coded and categorised, and key themes identified. Quantitative data was collated in the form of an Edinburgh Postnatal Depression Score (EPDS) – an assessment tool which is routinely used to identify mothers at risk or suffering from postnatal depression. The EPDS score was recorded prior to the support commencing by either a PSW or the Health Visitor, after completion of all six visits, and when the infant was six months old. Analysis: The EPDS scores recorded at 6 weeks, 12 weeks, and again when the infant was six months old, were analysed and summarised using graphs and charts. Non parametric analysis using Friedman’s Anova and the Wilcoxon paired test was carried out. A Mann Whitney test, Kolmogorov-Smirrov test and a Shapiro-Wilk test were also performed. A constant comparative method was used as a means of analysing the qualitative data collected from both log books and interview transcript (Denscombe 2008). The lead researcher consistently read and re-read text data, compared new codes and categories as they emerged and repeatedly compared them against existing versions. This process enabled the researcher to refine and improve the explanatory power of the concepts and theories generated from the data. Similarities and differences were highlighted and categories and codes were identified. On completion of this analysis, all participants were contacted to ensure validity of the findings and that each participant agreed with the researchers interpretation of the data collected. Results: Qualitative and quantitative findings from this study suggest that the input from a PSW does assist in the reduction of PND in new mothers. This is demonstrated in both the analysis of the quantitative data and the qualitative. The EPDS scores demonstrated little difference between the participants at 6 weeks but the statistics started to diverge at 12 weeks – the mean at 12 weeks for the control group is recorded at 12.46 and the intervention group is 10.33 – a difference of 2.13. The EPDS at six months demonstrates a difference between the two scores as 2.67 (the control group mean recording is 11.60 compared with the intervention mean which is 8.93). The key themes identified were the immeasurable value of ‘social support’ and ‘shared experiences’. The resounding factor that appears repeatedly throughout the analysis of data is the fact that the mothers could ‘truly relate to their Worker.’ Their PSW gave them ‘hope’, made them feel as if they were ‘not a failure’ and gave them an overwhelming ‘sense of normality’. This, in turn, increased their self-esteem, their positivity towards their parenting role, and their ability to therefore be ‘a good mother.’ A major strength of the work was the involvement of the PSW’s in both the planning and the implementing of the intervention. It was their design, their creation, and their feelings about what may really help their mother. A number of other themes were also identified that were, interestingly, commonalities across the entire data set (participants and PSW’s). These included recognition of their own changing perspective – a realisation that there simply is no ‘quick fix’ solution, that both time and support are required. The PSW’s described feelings of ‘personal benefit’, ‘self-awareness’ and the ‘provision of closure’ for themselves. The intervention group also talked, at length, about their ‘personal benefit’ from the PSW, and their own self-awareness about how they truly felt, their emotions and, in some instances, why they felt this way. The control group recognised the huge advantage from talking to other mothers and, although they did not have the formal support sessions from a PSW, they embraced the opportunity of sharing their thoughts and feelings with ‘fellow mums’. Each participant, and PSW, discussed the sharing of experiences, empathy, the feeling of ‘release’ and, particularly on the mothers’ part, the importance of knowing that, actually, they are not ‘alone’. Conclusion: The aim of this study was to provide early intervention to mothers who were classed as ‘at risk’ of suffering from PND, and, indeed, the support from the PSW’s did appear to have a positive impact upon the mothers’ mental health and wellbeing. However, this was a small scale, pilot study over a relatively short period of time. Larger, more longitudinal studies are certainly required. The importance of the pilot study presented here lies in its usefulness in shaping research to investigate and explore further whether there are indeed beneficial factors to post-natally depressed mothers who receive one to one support from a PSW. The positive results from this study can, potentially, have a huge impact within practice and, most importantly, upon the lives of those affected by postnatal depression.