The purpose of the current study was to examine putative mediators and moderators in the association between adiposity and anxiety in a sample of overweight and obese youth. In addition, anxiety was examined as a potential moderator between adiposity and health-related quality of life (HRQOL). Participants were youth (N = 137) between 8 and 17 years old (M = 13.09, SD = 2.61) and their legal caregivers recruited from four medical clinics affiliated with the University of South Florida. Youth were primarily overweight (28.5%) or obese (64.2%) and ethnically diverse. Data were analyzed by path analysis. Weight-related teasing significantly mediated the association between adiposity and child reported anxiety, but competency-related teasing and peer victimization were not significant mediators. Internalization of appearance ideals significantly moderated the association between adiposity and anxiety by child report; however, no significant moderations were found for parent report. Additionally, sociocultural pressures to meet appearance ideals were not significant moderators by child or parent report. Notably, anxiety significantly moderated the association between adiposity and social functioning by child report, with those experiencing greater anxiety evidencing poorer social quality of life. However, anxiety did not moderate the association between adiposity and other domains of HRQOL by parent or child report. Given the significant increase in pediatric overweight and obesity in recent decades, it is particularly important to understand the psychosocial implications of excess adiposity in youth. Clinical and research implications are discussed focusing on the mechanisms between adiposity and anxiety and suggested clinical interventions to address said mechanisms.

Millennial-aged young adults, often referred to as “digital natives,” comprise the typical college-age population, and there has been a growing number college students at risk for mental health problems (Mowbray, Mandiberg, Stein, Kopels, Curlin, Megivern, Strauss, Collins & Lett, 2006; Eisenberg, Gollust, Golberstein & Hefner, 2007). Suicide is the second leading cause of death among college students (Suicide Statistics, 2014); however, their rate of utilizing mental heath counseling is decreasing. Providing the types of mental health services college students are likely to use can mitigate factors thought to impede their use (e.g., stigma, anonymity, confidentiality), as well as help improve students’ learning and success and reduce college attrition rates. Minimal research has been conducted on undergraduate college students’ attitudes about Internet-based mental health interventions, and the findings from those studies are conflicting. This study attempts to fill in the missing data to address undergraduate students’ attitudes about several types Internet-based of mental health counseling, and to determine the extent of their familiarity with its terminology. Forty-two undergraduate college students participated in a survey where they were asked about their familiarity with Internet-based mental health interventions, experience with and preferences for mental health counseling, and the availability of campus-based Internet mental health interventions. Quantitative data was collected, and descriptive statistics and chi square test of independence were calculated. The students’ familiarity with Internet-based mental health interventions did not influence their use of counseling services, but they were interested in knowing more about mental health-related cell phone apps. Other findings are discussed, conclusions are drawn, and recommendations for future study and implications for the field are included.

D.Cur. (Psychiatric Nursing Science) / The researcher was involved in the clinical accompaniment of student nurses working with mentally challenged individuals during their psychiatric nursing practical training. In her role as advanced psychiatric nurse educator, she noticed that student nurses experienced working with mentally challenged individuals as a challenging working context. It created intense emotional discomfort for the student nurses, especially during their initial exposure to the relevant individuals. During the student nurses' last day of working with these individuals, they reflected with the advanced psychiatric nurse educator on their emotional growth and enrichment and how this experience had changed their views of life. Ineffective management of emotional discomfort may lead to emotional exhaustion or burnout and reflect negatively on a person's mental health. The main purpose of this research was to explore and describe the experiences of student nurses working with mentally challenged individuals. Subsequently, to develop, describe and write guidelines to operationalise and evaluate a model for the advanced psychiatric nurse educator to facilitate the mental health of student nurses working with mentally challenged individuals. A qualitative, explorative, descriptive, contextual and theory-generating research design was utilised to achieve the abovementioned purpose. The development of the model comprised four steps. Step one consisted of a concept analysis including identification and definition of central concepts in the model. A concept analysis was done by exploring and describing the experiences of student nurses working with mentally challenged individuals. Two focus groups, naive sketches, reflective journals, a reflective letter and field notes were used to explore their experiences. Focus groups were audiotaped as well as videotaped. Verbal consent was given by the student nurses to be videotaped and a letter of consent was signed to give permission for audiotaping of the focus groups. The audio tapes were transcribed verbatim. The video tapes were only used by the transcriber when she could not hear the sound on the audio tapes clearly. An independent coder utilised Tesch's method of open-coding to code and analyse the data. A consensus was reached between the researcher and the independent coder with regard to the themes and catogories represented by the data. During the concept analysis, engagement on a deeper emotional level was identified as the central concept. Step two consisted of the relationship statements of the model. During step three, a model for the facilitation of a process of engagement on a deeper emotional level for student nurses working with mentally challenged individuals was described. The structure of the model clarified the purpose, assumptions and context. The central concepts were defined and the relationship statements between the central and essential concepts were explained. The structure of the model focused on the relationship-, workingand termination phases within the process of engagement on a deeper emotional level. In step four guidelines were described to operationalise the model in practice. The model, as framework of reference for the advanced psychiatric nurse educator, focused on the facilitation of a process of engagement on a deeper emotional level for student nurses working with mentally challenged individuals. The process description of the model differentiated between three phases: the relationship phase, the working phase and the termination phase. Guidelines for the operasionalisation of the model focused on the objective of each phase as well as the strategy of actions for each different phase.

M. Curr. / Mental health challenges are a worldwide phenomenon, and more people are experiencing these challenges which are related to the life style and psychological stressors facing them. Addressing this burden is a challenge to health care providers, as some are influenced by their perceptions about mental illness in facing the demands made be society. Registered nurses who are not trained in psychiatric nursing do not have the appropriate background information or skill of how to cope with patients with mental health challenges even if they have undergone an introduction into nursing psychology at college. This increases their fears and anxieties when having to interact with these patients. The aim of this study is thus to explore the experiences of registered nurses in interaction with patients with mental health challenges so as to be able to formulate and describe guidelines to facilitate the registered nurses mental health.

Our gut microbiota is involved in human development, nutrition, and the pathogenesis of gut disorders, but has more recently been implicated as a possible mechanism in the pathophysiology of several brain disorders, including disorders of mood and affect, such as depression. Researchers have referred to this dynamic, bidirectional signaling pathway between the gut and the brain as the “gut-brain axis.” However, most research on this axis has been limited to rodent studies, and there has been little insight into the mechanism behind it. I propose that the kynurenine pathway, where tryptophan is converted to kynurenine, is a compelling mechanism mediating the gut microbiota’s influence on depression. Kynurenine is a metabolite associated with depression, and this pathway has been shown to be manipulated through probiotic (Lactobacillus reuteri) consumption. I propose to study a probiotic intervention in humans, which would assess tryptophan metabolism along the kynurenine pathway by measuring metabolites downstream of this pathway. Urine, feces and blood samples would be collected from two groups, control and probiotic treatment, on day zero and day thirty. Colonic biopsies would be obtained on day thirty, and various analyses would be run to measure metabolite concentrations from the collected samples. The results from this study will help clarify a mechanistic connection between gut microbes and depression via the kynurenine pathway. Additionally, findings could indicate that a probiotic intervention has the ability to influence depressive behavior via a two-pronged approach originating from the kynurenine pathway.

During the past 60 years, United States prisons have become one of the primary institutions caring for mentally ill individuals. Factors such as privatization of mental health care with a focus on profit-maximization, ineffective jail diversion programs, and unsuccessful mental health courts have contributed to prisons having an increased population of mentally ill inmates. In fact, about 20% of people who are currently incarcerated suffer from a major mental illness (Mason, 2007). Other elements outside of the justice system such as a lack of mental health awareness and a lack of resources have led to damaging interactions between the mentally ill and law enforcement and have added to this growing rate of mentally ill incarcerated. Given the harsh realities of prison, this overrepresentation of those suffering from mental illness is even more concerning and is worsened by aspects of prisons such as solitary confinement. This issue coupled with the lack of appropriate mental health care services being provided and the lack of support after release has led those suffering from mental illness to be potentially worse off than when they entered prison. This paper focuses on mental health care in prisons from admittance to post-release and provides evidence for the need to overhaul how those suffering from mental illness are treated. The responsibility of mental health care has been placed on prisons due to the escalation of inmates with mental illness, the failure of programs inside the justice system, and the lack of post-release follow-up. The physical setting, behavioral interactions, and personnel influences in prisons have led to worsening symptoms and have inhibited the ability to effectively treat these inmates. Given 95% of inmates will be released, these issues need to be addressed more comprehensively for the benefit of our society as a whole (Binswanger, Nowels, Corsi, Long, Booth, Jutner, & Steiner, 2011).

This study explores cognitive impairment and its correlation to early- life adverse experiences in non-patient population between the ages of 50 to 65. This developmental approach and observational study design explores cognition in pre-clinical Alzheimer’s disease (AD). Using a standardized neuropsychological instrument, the Montreal Cognitive Assessment (MoCA) and clinically administered questionnaire, the ACE (Adverse Childhood Experiences), I hypothesized that participants with high ACE scores will inversely have low MoCA scores. My goal was to use a multiple linear regression model with 3 covariates and 1 predictor of interest (ACEs). At 80% power, a sample size of 40 was calculated as needed. This would mean that the results would have 80 % chance of declaring statistical significance. This corresponds to an R-squared value (percentage of variation in MoCA score explained by the predictor) of 17.2%. The desired sample size was not attained successfully due to several barriers in receiving sample data from the collaborating site and the 2017 Hurricane Irma causing a drop in participation rate. Overall 13 participants had successfully participated. The analysis of the results is demonstrated in a line graph indicating a relationship between ACE and MoCA scores. The accuracy of the descriptive statistics could be argued against due to the low sample size. The analysis of the ethnographic interviews brings out some trends in the participant responses. The focus here has been to discuss these responses as to how they advocate for the entanglement theory of aging. In other words, how the exposure to social and environmental factors at various stages of an individual’s lifecourse can interact with one’s physiology, resulting in exposure- specific health conditions at later life stages. Among the period of exposure, my focus through this study is specifically on the early exposures in the lifecourse. This is facilitated by the use of the ACE questionnaire regarding exposures to adverse experiences such as sexual/ physical abuse, familial mental health issues, alcohol/ drug abuse in the family and loss or separation from parents. The entanglement theory further allows for race or culture specific exposures to adversity that raises the question of varying health consequences among cultural or racial groups and the need for a more critical approach in providing access to healthcare and healthcare policy development. Trends in ethnographic results obtained have allowed for the critical discourse in the transgenerational effects of social adversity, effects of resilience- building from adversity and the need for care- giver mental health services. The study brought out critiques on how the ACE module could be made more inclusive of experiences specific to diverse cultures and regions, as well as the need to address the severity of individual experiences. We conclude by discussing how effects of social or environmental experiences can be used toward AD and aging research and what supporting literature and initiatives currently exist. The discussion is also inspired by the existing political discourse around the medicalization of AD and how that influences the reductionist methods in AD research. This new direction of applied and holistic approach derives its perspective from neuroanthropology and applied medical anthropology. The overall aim of this study is to ask questions challenging existing research methods with the ultimate hope to newly influence the allocation of AD research and risk reduction toward interdisciplinary focus and funding, involving early-life lived experiences and life course perspectives.

D.Cur. (Psychiatric Nursing) / Please refer to full text to view abstract

M.Cur. (Psychiatric Nursing) / Psychiatric nursing forms part of basic nursing education in South Africa which is done in four years, either at diploma level or degree level. The psychiatric nurses are only trained in basic psychiatric nursing and are not well equipped to work effectively with children. Even though psychiatric nurses do not have enough skills and knowledge, it is expected of them to work in child psychiatric wards without adequate knowledge and skills. This creates discomfort to the internal environment of a nurse and the situation can be stressful to the nurse. Psychiatric nursing has two important components which are: supporting people at a reasonable level of functioning which they cannot maintain independently; and facilitating a higher level of functioning in people for whom this is possible. Child psychiatry is one of the specialities in the psychiatric division. ‘The description of the practice of the professional nurse in the field of child psychiatry in South Africa is vague and undeveloped and there are only a few nurses in South Africa with knowledge and skills to set guidelines for this area of practice (Makhele, 2006:36)’. Psychiatric nurses working in psychiatric hospitals undergo different experiences on a daily basis. In this research study, the researcher wondered as to what psychiatric nurses working with children diagnosed with mental illness, experience on a daily basis. The researcher then asks the following questions: 1. What are the lived experiences of psychiatric nurses working with children diagnosed with mental illness? 2. What can be done to assist the psychiatric nurses, working with children diagnosed with mental illness, in order to facilitate their mental health? This research study was done to: 1. To explore and describe the lived experiences of psychiatric nurses, working with children diagnosed with mental illness; and 2. To formulate guidelines in order to facilitate these psychiatric nurses’ mental health. In order to explore and describe the lived experience of psychiatric nurses who work with children diagnosed with mental illness, the researcher used a qualitative design. The researcher utilised phenomenology, in order to explore and describe the experiences of these psychiatric nurses in the context of their working environment. Purposive sampling method was used. In-depth phenomenological interviews were used to collect data. Tesch’s method in Creswell (2011: 113) of open coding was utilised for the analysis of the data. The results were re-contextualised within the literature. The findings of this study provided the detailed content of professional psychiatric nurses’ experience when working with children diagnosed with mental illness. Two themes which were identified are: 1. Theme 1 A challenging experience associated with tensions inherent to the contextual demands of psychiatric nurses working with children diagnosed with mental illness. 2. Theme 2 Psychiatric nurses experience of contextual demands which requires a process of continuous adjustment Guidelines on how to promote the mental health of psychiatric nurses working with children diagnosed with mental illness were derived from the research findings. In conclusion, presently psychiatric nursing training appears to rely upon individual training institutions putting into practice government policy in a fragmented fashion with no cohesive strategy. Where psychiatric nurses receive good quality training which includes child psychiatry, it is clear that good quality and appropriate interventions to children with mental illness and emotional problems can be achieved.

As a universal screening method, teacher nominations have been found to both miss and misidentify a substantial proportion of students with internalizing disorders such as anxiety and depression (Cunningham & Suldo, 2014; Gelley, 2014; Moor et al., 2007). Although some research has explored the accuracy of teacher nominations when used to identify students with anxiety and depression, no research examined the teacher characteristics that are potentially related to accuracy. The current study conducted a secondary analysis of an archival dataset (Gelley, 2014) to determine which characteristics of teachers (N= 19) are more closely related to accuracy in identifying middle school students (N = 233) with elevated levels of anxiety or depression. Teacher characteristics examined include: teacher self-efficacy beliefs in identifying students with anxiety and depression, teacher acceptance of the general method of asking teachers as a whole to identify students with anxiety and depression, teacher gender, years teaching, and subject taught. Multiple regression analyses were used to examine the relationships between the aforementioned teacher characteristics and teacher accuracy, defined by the conditional probability indices sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The combined predictors explained 38 to 69% of the variance in those indicators of accuracy. Results indicated that in predicting sensitivity, being a language arts or math teacher (as compared to being a social studies teacher), having fewer years of professional experience, and reporting greater acceptance of method may predict higher sensitivity rates. In regards to specificity, higher teacher self-efficacy, being a social studies teacher, being male, and having fewer years of professional experience predicted higher specificity rates. In terms of PPV, having higher acceptance of method and more self-efficacy may explain higher PPV rates. Finally, in terms of NPV, having fewer years of professional experience may explain higher NPV rates. Results from this study may be used to guide collaboration and consultation with teachers in universal screenings, and may inform teacher training programs aimed to increase teacher knowledge and confidence identifying students experiencing emotional distress at school.