Thesis of (M.A.)--University of Alberta, 2009. / Title from pdf file main screen (viewed on August 25, 2009). "Fall, 2009." At head of title: University of Alberta. A thesis submitted to the Faculty of Graduates Studies and Research in partial fulfillment of the requirements for the degree of Master of Arts, Department of Sociology, University of Alberta. Includes bibliographical references.

The prevalence of childhood overweight is a major social and public health issue, and primary assessment should focus on early and middle childhood, because weight gain in these phases constitutes a strong predictor of subsequent negative outcomes. Studies on community samples have shown that growth curves may follow linear or non-linear trajectories from early to middle childhood, and can differ based on sex. Overweight children may exhibit a combination of physiological and psychosocial issues, and several studies have demonstrated an association between overweight and internalizing/externalizing behavior. Nevertheless, there is a dearth of longitudinal studies on depressive and aggressive symptoms in children with high BMI. This study adopted a growth curve modeling over three phases to: (1) describe BMI trajectories in two groups of children aged 2±8 (overweight and normal weight) from a community sample; (2) describe the developmental trajectories of children's aggressive and depressive symptoms from 2 to 8 years of age. Results indicate higher BMI in 2-year-old girls, with males catching up with them by age 8. While overweight females' BMIs were consistently high, males' increased at 5 and 8 years. The mean scores for aggressive symptoms at T1 (2 years of age) were the same in all subjects, but a significant deviation occurred from T1 to T2 in both samples, in divergent directions. With regards to children's depressive symptoms, the two groups had different starting points, with normal weight children scoring lower than overweight youths. Overweight females showed lower depressive scores than overweight males at T1, but they surpassed boys before T2, and showed more maladaptive symptoms at T3. This study solicits professionals working in pediatric settings to consider overweight children's psychopathological risk, and to be aware that even when children's BMI does not increase from 2 to 8 years, their psychopathological symptoms may grow in intensity.

The decisions made by Mental Health Professionals (MHPs) are of utmost significance for providing the highest quality care to service users. The assessment of risk is one of the pivotal processes that MHPs undertake frequently, as per government policy guidelines, and in order to safeguard patients and the public. Although Risk Assessment Proformas (RAPs) consume a proportion of MHP time and resources, very little research has been undertaken to address factors that might affect their most optimal utilisation in practice. Previous literature suggests that medical decisions, like decision making of other kinds, is fraught with difficulty including being susceptible to the influence of cognitive biases, pre-decisional affect, overconfidence, and subjectively held attitudes towards organisational policies and regulations. Specifically, the presentation of risk information can influence decisions. It has also been suggested that anxiety has the capacity to elicit risk aversive responses, and that overconfidence and negative attitude may lead to complacency in undertaking policy-led responsibilities and produce non-compliance for the same. However, much of what is known about medical decision making has been gleaned from outside of context of mental health. As such, the current programme of research aimed to explore decision making in mental health settings and with a view to raise awareness of the complexity of decision making amongst MHPs. The implementation of quantitative and qualitative techniques (studies 1 and 2) revealed negative attitudes from psychiatrists towards Risk Assessment Proformas (RAPs), which are essentially structured decision making aids. Psychiatrist, compared to other MHPs, spent less time completing RAPs, which may reflect their differing attitudes towards their usefulness, something that was consistently emphasised during in-depth qualitative exploration. It was also found that experience was an additional differentiating factor between MHPs. Relationships between experience and other factors such as anxiety, confidence and complacency were found via conversations with MPHs, experience members of staff being less inclined to provide comprehensive and detailed accounts of service user risk in RAPs. This is problematic since although there is, in the UK, a policy led requirement that RAPs are completed for each service user, it is clear that there are inter-professional variations in how RAPs are being used and this acts to inhibit the best information sharing between all those involved in patient care. Following previous work in the area of cognitive bias and its influence upon general and medical decisions, a clinical vignette was also developed (study 3) to establish whether the presentation of risk information influences psychiatric admission decisions. The current findings supported previous work in that decisions were susceptible to the framing effect. The findings here, and previously in the literature, reveal a necessity for MHPs to be informed of bias in decision making in an attempt to improve objectivity in risk assessment practices. The unearthing of the framing effect also further signals the need for proper use of RAPs, where many MHPs may not be using them to their full potential - i.e. an aid to the systematic consideration of a range of information about a service user. The final part of the thesis (study 4) turned to the piloting of an educational module incorporating content around the factors affecting decision making in an attempt to raise awareness amongst MHPs. The rationale being better awareness of the complexity of decision making may act to enhance decision making processes. Pre and post intervention analyses revealed an improvement of baseline to follow-up knowledge of decision making bias and statistical concepts and this knowledge was maintained to a moderate level at four weeks follow-up. Although individuals maintained their susceptibility to the framing effect, the bias was less prevalent in those who knew of its presence before taking part in the study. Overall the findings give some support to the use of education as an approach to raising awareness about decision making processes in MHPs, although what remains to be seen is whether such education acts to bring about changes in behaviour - for example, different use of RAPs. The PhD programme suggests that MHPs are just as susceptible to cognitive biases, such as the framing effect, as has been demonstrated in both general population and other groups of health practitioners. At the same time, attitudes to RAPs differ depending on exact job role, which psychiatrist being least likely to spend time on their completion and reporting them as a tool for noting decisions reached as opposed to an aid to the process. This acts reduce the quality and quantity of reported information shared with colleagues about a service user. It is possible that MHP behaviour aligns with general attitude-behaviour models, such as the Theory of Planned Behaviour. As such, whilst the current work has demonstrated that educational interventions may act to improve awareness of decision making processes and their influences, further research would benefit from considering if these types of approach affect actual behaviour. For example, improved used of RAPs as decision-aids, reduced susceptibility to framing effects, consciousness around how information is represented in RAPs given knowledge of how the information may be used by others.

Yes / Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). Due to the well-documented benefits of sport and physical activity on mental health, athletes and non-athletes were recruited to assess any differences. Beyond this, athletes were also grouped by sport-type (contact/non-contact sports) due to the increased prevalence of pain and SRC in contact sports. To our knowledge, there has been no research on how these factors influence the likelihood of depression. In the current study, 144 participants completed a short survey on the above factors and the Center for Epidemiological Studies Depression Scale. Sixty-two of these reported a history of concussion. Logistic regression revealed all the above predictors to be significantly associated with the depression scale. Individuals that had previously sustained SRC, were experiencing greater physical pain and females were more likely to display poor mental health. However, we provide further evidence for the benefits of engaging in sport and physical activity as those that took part in sport were less likely to report depression. Therefore, this study provides a simple risk metric whereby sportspeople can make a better informed choice of their sporting participation, making their own cost/reward judgement.

Yes / The COVID-19 pandemic and associated restrictions caused major disruption globally, shedding light on the unprecedented strain upon the mental health and wellbeing of individuals around the world. Poor mental health in the pandemic is reported to be greater in women, with mothers being at increased risk. It is unclear whether there are differences in the impact of mental wellbeing on some ethnic groups over others. The aim of this study was to explore the experiences of British Muslim Pakistani women with family responsibilities during the COVID-19 pandemic, two years on from the first lockdown. Methods Qualitative interviews with women were conducted via telephone using a semi-structured topic guide. The sample included 25 British Muslim Pakistani women with family responsibilities, both English and non-English speaking. Women lived in households that ranged in number and included extended family. Key themes were determined using thematic analysis. Results Results were grouped under three themes. These were (1) Community, cultural and religious contributors to poor mental wellbeing, (2) religious and cultural mediators of mental distress, and (3) perceived positive impact on lifestyle. British Muslim Pakistani women were psychologically distressed by the high rates of virus transmission and deaths in their communities and at the prospect of older members of their extended family developing the virus. The impact of restrictions on fundamental religious and cultural interactions further exacerbated poor mental wellbeing in this population. Religion, community social capital and larger household structures were all effective coping strategies for British Muslim Pakistani women. Positive impacts of the pandemic included becoming closer to family and faith, and increased work/life harmony. Conclusions An exploration of religious and cultural coping mechanisms should be used to inform future national pandemic preparedness plans, as well as effective strategies for building and maintaining social capital. This may increase adherence to physical distancing and other protective behaviours in populations. / Department of Health, United Kingdom, NIHR200166

OBJECTIVE: Generalized anxiety disorder (GAD) during pregnancy is associated with several adverse maternal and perinatal outcomes. A reliable and valid screening tool for GAD should lead to earlier detection and treatment. Among pregnant Peruvian women, a brief screening tool, the GAD-7, has not been validated. This study aims to evaluate the reliability and validity of the GAD-7. METHODS: Of 2,978 women who attended their first perinatal care visit and had the GAD-7 screening, 946 had a Composite International Diagnostic Interview (CIDI). The Cronbach's alpha was calculated to examine the reliability. We assessed the criterion validity by calculating operating characteristics. The construct validity was evaluated using factor analysis and association with health status on the CIDI. The cross-cultural validity was explored using the Rasch Rating Scale Model (RSM). RESULTS: The reliability of the GAD-7 was good (Cronbach's alpha = 0.89). A cutoff score of 7 or higher, maximizing the Youden Index, yielded a sensitivity of 73.3% and a specificity of 67.3%. One-factor structure of the GAD-7 was confirmed by exploratory and confirmatory factor analysis. Concurrent validity was supported by the evidence that higher GAD-7 scores were associated with poor self-rated physical and mental health. The Rasch RSM further confirmed the cross-cultural validity of the GAD-7. CONCLUSION: The results suggest that the Spanish-language version of the GAD-7 may be used as a screening tool for pregnant Peruvian women. The GAD-7 has good reliability, factorial validity, and concurrent validity. The optimal cutoff score obtained by maximizing the Youden Index should be considered cautiously; women who screened positive may require further investigation to confirm GAD diagnosis. / : This research was supported by an award from the Eunice Kennedy Shriver Institute of Child Health and Human Development (R01-HD-059835) at the National Institutes of Health (NIH). The NIH had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication / Revisión por pares

Aims. Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. Method. 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. Results. Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5–0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1–0.6; NS: OR: 0.2, 95% CI: 0.1–0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3–0.6; NS: OR: 0.5, 95% CI: 0.3–0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4–5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3–8.0) were observed in DS with high combat exposure compared with civilians. Conclusions. Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.