Thesis (Ph.D.)--University of Tulsa, 1994. / Includes bibliographical references (leaves 137-145).

The purpose of this study was to examine the relative risk of psychiatric disorders occurring in patients diagnosed with neurological disorders. This study separately computed the relative risk ratios for identified psychiatric disorder (i.e., anxiety, mood disorders, somatization, schizophrenia, alcohol abuse, and antisocial personality disorder) on seven of the more common neurological disorders (i.e., brain tumor, closed head injury, stroke, dementia, multiple sclerosis, cerebral palsy, and Parkinson's disease). The six psychiatric disorders were chosen based on the epidemiological catchment area (ECA) research (Robins & Reigier 1991) and provided the control group of psychiatric disorders in the general population by which comparisons were made to the neurological care setting. The neurological disorders were included based on the frequency of referrals to a neuropsychological practice. Further, this study provided an overall relative risk ratio of psychiatric disorders for all seven neurological disorders considered together.Participants in this study included a sample of 367 consecutive referrals to a neurology practice in the Midwest. All of the 376 subjects were diagnosed with a neurological disorder. Two hundred forty-six of the subjects were diagnosed with a neurological disorder and no psychiatric disorder. One hundred twenty-one of the subjects were diagnosed with both a neurological and a psychiatric disorder. The MMPI2 was used in the assessment and diagnosis of psychiatric disorders. The control group, represented by the ECA study, was composed of 19,640 participants.Relative risk estimates were made using cross products ratio. Significance of the risk ratio was tested using Chi-square Continuity Correction values. Power analysis was conducted using Fisher's Exact Test.The results of the analysis suggested that patients with neurological disorders are more likely to present with psychiatric disorders compared to the general population. The overall relative risk for this study revealed that patients were 1.669 times more likely to have a comorbid psychiatric disorder following the diagnosis of a neurological disorder. Additionally, three individual disorders had relative risk ratios suggesting an increase in psychiatric disorders above the risk in the general population. These three conditions included stroke (RR = 3.038), dementia (RR = 2.762), and multiple sclerosis (RR = 3.617). / Department of Educational Psychology

The aim of this thesis was to carry out an epidemiological study on mental health related issues in the Kurdish population of Iran. This part of Iran suffered directly during the Iran-Iraq war 1980-1988. Iran is an Islamic republic with strict adherence to Islamic traditions, which has implications for the way of life and gender issues. Suicide is prohibited according to Islamic teaching, but still there is a rather high suicide incidence especially among young women, who burn themselves to death. This thesis deals with mental health in general, the prevalence of post traumatic stress disorder and issues related to suicide. In a cross- sectional study in Sanandaj, the capital of the province of Iranian Kurdistan, 1000 households were approached. One member of each household was asked to respond to the following internationally well-known questionnaires; General Health Questionnaire (GHQ12), Posttraumatic Stress Disorder Checklist (PCL), Life Events Check List (LEC), Beck Depression Inventory (BDI-II) and Attitude Toward Suicide (ATTS). PCL and LEC were translated to Farsi and their psychometric properties were studied. The other instruments have already been translated and used by other researchers in Iran. About 27% of the subjects were found to suffer from mental distress according to GHQ-12. No gender differences were found. Unmarried and unemployed belong to the most afflicted. The participants in the investigation reported, not surprisingly, a low level of personal experiences of suicidal behaviour in their family. Females were more prone to believe that suicide is preventable compared to males. A low number reported suicide attempts during the last year. Being married seemed to have a protective effect against suicide attempts for males but not for females. Suicide behaviour was not substantially related to PTSD, but to severe depression. The idea that there is a continuity of suicidal behaviour from suicidal thoughts to suicide attempts was supported. Younger individuals more often reported thoughts of life weariness and those who reported suicide attempts were younger than individuals with no suicidal attempts. Females reported more death wishes than males during the last year and married women more often reported suicide attempts than men. The prevalence of posttraumatic stress disorder was 10, 9% which is higher than reported in other countries, but still lower than expected. Women suffered significantly more often from PTSD than men. Women reported also more often re-experiencing and more arousal symptoms than men. The finding supported a good construct validity of PCL. One major limitation of these studies is the fact that the sample was drawn from the population of the capital city of the province. So the finding cannot probably be generalized to Iranian Kurds from rural areas. The sample also had a rather high educational level compared to the population of Sanandaj. To this should be added the fact that the instruments used are developed in the western culture, which might influence the way questions are perceived. So, the result should be interpreted with some caution. The results, however, give indications that there are mental health problems of a magnitude that should be taken seriously.

Thesis (Ph. D.)--Florida State University, 2006. / Advisor: R. Jay Turner, Florida State University, College of Social Sciences, Dept. of Sociology. Title and description from dissertation home page (viewed Sept. 22, 2006). Document formatted into pages; contains viii, 97 pages. Includes bibliographical references.

Thesis (M.S.)--University of West Florida, 2006. / Title from title page of source document. Document formatted into pages; contains 89 pages. Includes bibliographical references.

Background: Suicidal thoughts affect 12% of Canadian adolescents. Previous research has linked many factors to suicidality but has not considered how these factors may act together or their effect on non-mental health outcomes. Methods: I used the National Longitudinal Survey of Children and Youth to construct predictive models for suicidal thinking. Recursive partitioning models were constructed and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for suicidal thoughts and secondary outcomes was calculated. I tested the models in the Avon Longitudinal Survey of Parents and Children. Results: Predictive model sensitivity was 24.2%, specificity was 89.8%, PPV was 24.7%, and NPV was 89.5% and had similar accuracy in the second dataset. The models were better at predicting other adverse outcomes compared to suicidal ideas. Conclusion: Exposure to multiple risk factors is predictive of several poor outcomes in adolescence including suicidal thoughts.

Background There is substantial evidence of the protective influence of social support on psychological distress in adults. Yet, levels of social support and psychological distress vary by ethnicity. There is little research investigating prospective associations between social support and psychological distress in an ethnically diverse sample of adolescents. Methods This thesis is based on secondary analysis of data from 'Research with East London Adolescents: Community Health Survey' (RELACHS). RELACHS is a prospective cohort questionnaire study conducted in a representative sample of adolescents aged 11-14 years at baseline and 13-16 years at follow-up. The analyses address three questions: (a) Are there prospective associations between baseline social support and follow-up psychological distress and depressive symptoms? (b) Does a change in social support overtime influence psychological distress or depressive symptoms at follow-up? (c) Are the effects of social support and culturally similar friendship choices independent and can these account for ethnic variations in psychological distress or depressive symptoms at follow-up. Results Low levels of family social support were significantly associated with depressive symptoms for female pupils (adjusted analyses: OR= 2.70 95% CI 1.20,6.08). A decre~se in total and family support overtime was significantly associated with depressive symptoms for female pupils (adjusted analyses: OR= 0.96 950/0 CI 0.93,0.98 and OR=0.61 95% CI 0.47,0.79 respectively). Social support could not account for ethnic variations in psychological distress or depressive symptoms. Culturally similar friendship choices were protective for psychological distress at follow-up. Conclusion Explanations for these findings include the possibility that family members [and peers from the same cultural group] provide a more consistent and healthy source of support than peers overall. Loss of family support appears to be risk factor specifically for girls from diverse ethnic groups.

The role that culture and trauma plays in shaping mental health outcomes continues to dominate debate in the field of transcultural and post-conflict mental health. The broad aim of this thesis is to investigate key issues relevant to these two factors in relation to the Vietnamese. A meta-analysis of international epidemiological research indicated that countries of North and South East Asia appear to manifest low rates of mental disorder compared to English-speaking countries. A meta-regression analysis of research undertaken specifically with refugee and conflict-affected populations, confirmed a robust association between torture and general trauma and risk to mental disorder. The thesis then examines data from three population-based mental health surveys: 1,161 Vietnamese-Australian residents in the state of New South Wales; 3,039 Vietnamese resident in the Mekong Delta region of Vietnam; and 7,961 Australian-born persons drawn from a national survey. All surveys applied the Composite International Diagnostic Interview, with the Vietnamese surveys also applying the Phan Vietnamese Psychiatric Rating Scale, an indigenously-derived measure of mental disorder. The ICD-10 classification system yielded lowest rates amongst Vietnamese in the Mekong Delta, intermediate amongst Vietnamese in NSW; and highest rates amongst the Australian-born population. The Phan Vietnamese Psychiatric Rating Scale added a substantial number of cases in both Vietnamese samples. The findings suggest that sole reliance on a western-derived measure of mental disorder may fail to identify a cases of mental disorder across cultures. Trauma remained a substantial risk factor for mental disorder amongst Australian Vietnamese accounting for a substantial portion of the total burden of mental disorder in that population. The implications of these findings in developing a more refined model for understanding the mental health consequences of mass trauma across cultures are discussed.

The role that culture and trauma plays in shaping mental health outcomes continues to dominate debate in the field of transcultural and post-conflict mental health. The broad aim of this thesis is to investigate key issues relevant to these two factors in relation to the Vietnamese. A meta-analysis of international epidemiological research indicated that countries of North and South East Asia appear to manifest low rates of mental disorder compared to English-speaking countries. A meta-regression analysis of research undertaken specifically with refugee and conflict-affected populations, confirmed a robust association between torture and general trauma and risk to mental disorder. The thesis then examines data from three population-based mental health surveys: 1,161 Vietnamese-Australian residents in the state of New South Wales; 3,039 Vietnamese resident in the Mekong Delta region of Vietnam; and 7,961 Australian-born persons drawn from a national survey. All surveys applied the Composite International Diagnostic Interview, with the Vietnamese surveys also applying the Phan Vietnamese Psychiatric Rating Scale, an indigenously-derived measure of mental disorder. The ICD-10 classification system yielded lowest rates amongst Vietnamese in the Mekong Delta, intermediate amongst Vietnamese in NSW; and highest rates amongst the Australian-born population. The Phan Vietnamese Psychiatric Rating Scale added a substantial number of cases in both Vietnamese samples. The findings suggest that sole reliance on a western-derived measure of mental disorder may fail to identify a cases of mental disorder across cultures. Trauma remained a substantial risk factor for mental disorder amongst Australian Vietnamese accounting for a substantial portion of the total burden of mental disorder in that population. The implications of these findings in developing a more refined model for understanding the mental health consequences of mass trauma across cultures are discussed.

Background: Common mental illnesses are a major public health challenge. Two common mental illnesses, depression and anxiety, were respectively ranked the second and eighth major causes of disability in 2019. However, the mental health treatment gap in low- and middle-income countries (LMICs) is higher than 90%. Systematic reviews suggest that integrated models delivered by primary health or lay providers are effective at reducing symptoms and improving quality of life among those with mental illnesses in LMICs. However, integrated models have not been widely implemented in routine primary care and community settings, beyond researcher-controlled pilot studies in LMICs. This integrated learning experience (ILE) contributes to key gaps in global mental health and implementation research by outlining implementation strategies (the ‘how’) and components of integrated models (the ‘what’) for people living with common mental illnesses in Latin America, a region composed of LMICs and selected high income countries (HICs) widely known for being early adopters of integrated models. Given current literature gaps, this study also provides an applied example of the assessment of contextual implementation factors and the selection of implementation strategies for integrated models for common mental illnesses in Guatemala, a LMIC in Central America where the burden due to common mental illnesses is high and the implementation of integrated models is low. Methods: First, we conducted a scoping review to map and summarize the existing literature on integrated service models for common mental illnesses in primary care and community settings in Latin America. Second, we conducted a multi-methods assessment of the local context prior to selecting the implementation strategies for a collaborative care program for Maya T’zutujil young adults living with common mental illnesses in a rural municipal health district in Sololá, a rural department in Guatemala. We used data collected through the public health system to develop behavior-over-time (BOT) graphs outlining the number of primary care visits for common mental illnesses over time (2018-2022). We followed the Practical, Robust Implementation and Sustainability Model (PRISM) framework to conduct qualitative semi-structured interviews. Participants represented Ministry of Health coordinators and providers; community youth leaders with lived experience; and community providers. We performed matrix-based thematic analysis of interview transcripts. Third, we used group model building (GMB), a participatory systems thinking approach to inform the selection of implementation strategies for a primary care, community-based collaborative care program for common mental illnesses in rural Guatemala. Results: First, our scoping review included 33 publications conducted in 6 countries (Belize, Brazil, Chile, Colombia, Mexico, Peru) about 18 programs commonly addressing depression (N=14, 77.78%). Four studies were experimental. The most and least common components were ‘team-based care’ (N=14, 77.78%) and ‘family/user engagement’ (N=1, 5.55%). The most and least common Expert Recommendations for Implementing Change (ERIC) categories were ‘supporting clinicians’ (N=17, 94.44%), mainly through task-sharing, and ‘changing infrastructure’ (N=4, 22.22%). We found wide heterogeneity across studies about combinations of components and implementation strategies. Second, our multi-methods assessment showed that less than 1% of the total number of public health visits corresponded to common mental illnesses in the study health district. A collaborative care program could help to increase the number of visits. To enhance fit to the study health district, the program would need to ensure the users’ right to privacy and engage community providers (e.g. Maya providers, religious leaders) and Maya explanatory models of mental health. Infrastructural elements at the municipal health district, such as the availability of psychotropic medications, would need to be met to ensure the program’s implementation and sustainability. Third, we identified two health-district subsystems influencing the implementation of public primary mental health services. At the community-level, we identified four subsystems. We identified 32 distinct implementation strategies representing the nine ERIC categories. Conclusion: This ILE indicates the need for additional studies focused on the participatory design and evaluation of implementation strategies that go beyond the provider-level (supply side of implementation) and focus on the community-level (demand side of implementation). Our results and methodologies may be utilized by researchers and implementers seeking to integrate mental health services in Guatemala and other LMICs.