Purpose: In this study, we compared United States (US) and Taiwanese college students’ using alcohol, coping strategies, anxiety, and depression. Research Questions: 1. What were the differences in demographic characteristics, using alcohol, coping strategies, anxiety, and depression between US and Taiwanese college students? 2. What were the relationships between US and Taiwanese college students’ using alcohol, coping strategies, anxiety, and depression? 3. How much of US and Taiwanese college students’ anxiety and depression were predicted by their use of alcohol, coping strategies? Methods: Four hundred and one US and 180 Taiwanese college students were recruited in this study. This was a cross-sectional comparative research design. SPSS 28.0 was used to do the data analysis. The Descriptive data analysis, Chi-square tests, independent t-tests, Pearson Correlations, and Stepwise Multiple Regressions were used to examine the research questions. Results: More US college students were married, believed in Jesus Christ, had higher incomes, and were older than Taiwanese college students. Compared with Taiwanese college students, US college students had higher scores in using Problem-Focused Disengagement, but lower scores in Emotional-Focused coping strategies, depression, and using alcohol with negative emotions. The significant predictors for the US and Taiwanese college students’ anxiety and depression were using alcohol with negative emotion, using Problem-Focused Disengagement, using Emotion-Focused Engagement, and using Emotional-Focused Disengagement. Taiwanese college students had another significant predictor for depression which was Problem-Focused Engagement. Conclusions/Implications for Practice: The significant factors associated with anxiety and depression were found in this study.

The aim of this thesis was to assess the gaps and deficits in the mental health care staffing and related prescription drug or therapeutic intervention availability in Venezuela using media content analysis. This thesis also assessed the measures suggested by Venezuelan medical professionals for addressing the population's needs for mental health services amid the nation's crisis. The shortage of mental health care in Venezuela was assessed because various stressors, including life events, chronic stressors, and daily hassles, are substantially less than optimal among Venezuelans. The mental health consequences of these factors, along with the detrimental psychosocial demands commonly faced by Venezuelans, was explored within this study. Such an investigation is critical in light of the poor prioritization of intangible mental health care within the already inadequate health care system existing in Venezuela. The used media content included newspapers and periodicals published in Venezuela and foreign newspapers covering the medical crisis in Venezuela, published or posted interviews with Venezuelan medical personnel describing the health care crisis, social media posts involving requests for or availability of medicine and services, and social media posts of videos or images as visual testimony of the crisis. Coder reliability was assessed, and descriptive and inferential statistical tests were implemented for deductive analysis of the study's results and to find possible answers to the presented research questions.

Background: A diagnosis of cancer causes physical and psychological implications that continue throughout the cancer treatment trajectory. Psychological distress, including depression, is one of the most common negative effects experienced by adults with cancer and often remains untreated despite positive screening. Psychosocial interventions are an appropriate method to address depression and can be implemented in the acute care setting, outpatient clinics, or patients’ homes by a registered nurse. Methods: A comprehensive search of CINAHL, MEDLINE, and APA PsycINFO was conducted, and articles were screened for appropriateness. A total of eight randomized controlled trials that met inclusion criteria and contained a rigorous methodological design were analyzed. Results: Implementation of nurse-led psychosocial interventions in adults with cancer indicated a positive correlation in the mitigation of depressive symptoms; however, feasibility (defined as an adherence rate of greater than 80% in the intervention group) remains inconclusive. While four of the articles analyzed showed promise of the feasibility of a nurse-led psychosocial intervention, the remaining articles did not include enough detail about adherence to analyze. Conclusions: To transition nurse-led psychosocial interventions into clinical practice, more primary research documenting strict adherence and withdrawal rates must be conducted to determine feasibility. Additional analysis should seek to examine definitive training required by registered nurses prior to implementation to account for resource barriers that may impact success of this type of intervention in the clinical setting.

The transgender population is makes up about 0.3% of the U.S. population (Gates 2011). The term transgender is both an identity and an umbrella term used to describe people who do not adhere to traditional gender norms (Institute of Medicine 2011). Transgender people experience many barriers to services, negative health outcomes, and discrimination (Fredrikson-Goldsen et al. 2013; Institute of Medicine 2011; Eliason et al. 2009; Hendricks & Testa 2012). Mental health clinics are an important site for understanding transgender peoples' experiences due to being a gatekeeper for other medical services and their role in helping transpeople with issues surrounding coming out, victimization, and discrimination (Grant et al. 2011; Youth Suicide Prevention Program 2011). The mental health field has a contested relationship with the transgender population due to a history of pathologizing gender variance, barriers to accessing services, and insensitivity from mental health providers (American Psychiatric Association 2013; Eliason et al. 2009). I conducted secondary data analysis using the National Transgender Discrimination Survey (2008) in order to understand the relationships between gender non-conforming identities, others' perception of one's gender identity, and discrimination at mental health clinics. Results suggest that there is an association between gender identity, others' perception of one's gender identity, and discrimination. This association depends on which gender identity, the degree to which an individual identifies with each term, and the type of discrimination. Logistic regression results reveal that identity and others' perception are not significant predictors for experiencing discrimination. Rather, income and race are significant predictors for experiencing discrimination at metal health clinics.

It is widely supported that there are significant, positive relationships between the occurrence of some mental health symptoms and physical illnesses. Research indicates that the burden experienced by those with a physical and mental illness are magnified compared to individuals who do not experience an illness. More specifically, one of the burdens experienced by individuals is the monetary burden of affording the necessary health services to properly manage their illness. This study attempts to reveal a difference between mental health symptom count for individuals who do and do not experience difficulty affording health care for their physical problems. The first hypothesis states that the indication of medical problems will be associated with greater mental health symptoms. The second hypothesis states that the relationship between medical concerns and mental health symptoms will be moderated by difficulty affording health services. Lastly, the third hypothesis states that the indication of unhealthy behaviors, such as smoking and irregular exercise, will be associated with greater mental health symptoms. All data used in this study is archived data that was gathered by the Institute for Rural Health’s Mobile Health Units during free community health fairs from September 2012 to February 2014. The first hypothesis was supported because the incidence rate of mental health symptom count was increased with the presence of some physical problems. These findings supported previous research that indicated that the presence of physical illness increases the chance of developing a mental illness. The study results revealed that the second hypothesis was not supported since difficulty affording health services did not have a significant effect on the relationship between indicated physical illnesses and mental health symptom count. Previous research reports that there is monetary burden for individuals who experience a physical or mental illness when accessing appropriate health services. This research aimed to explore if that burden would significantly affect the relationship of those illnesses. Lastly, the third hypothesis was supported because mental health symptom count incidence rate was found to increase for individuals partaking in negative health behaviors, such as smoking, and decrease for individuals partaking in positive health behaviors, such as exercising.

Objectives: Adherence to psychotropic medication is poor among individuals with bipolar disorder (BD). To understand treatment experiences and associated adherence among these individuals, we developed a novel construct of Clinical Net Benefit (CNB) using psychiatric symptoms, adverse effects and overall functioning assessments. We tested whether adherence differed across classes of CNB, whether individuals transitioned between classes over time, and whether these transitions were differentially associated with adherence. Methods: Data come from individuals aged 18+ during five years of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB. Latent transition analysis determined probabilities of transitioning between classes over time. Adherence was defined as taking 75%+ of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics. Results: Five classes of CNB were identified during the first two years (high, moderately high, moderate, moderately low, low), and four classes (removing moderately high) during the last three years. Adherence did not differ across classes or time points. Medication regimens differed by class; those with higher CNB taking fewer medications had lower odds of adherence while those with lower CNB taking more medications had higher odds of adherence compared with monotherapy. Probability of transitioning from higher to lower CNB, and lower to higher CNB was greatest over time. Conclusions: CNB is heterogeneous in individuals treated for BD, and movement between classes is not uncommon. Understanding why individuals adhere despite suboptimal CNB may provide novel insights into aspects influencing adherence.

Social support is the collection of tangible and intangible experiences that surround people as they cope with daily stressors. High quality social support is important among patients with cardiovascular disease (CVD) because it has positive effects on social, psychological and physical well-being, and those with good social support cope better with the travails of CVD. Although there are many studies of social support in CVD, little work has been done on the topic of discrepancies between desired and received social support in the context of gender. The purpose of this dissertation was to determine if there are gender differences in the discrepancies between CVD patients’ desired and received social support. If gender differences exist in desired and received needs for social support, it is necessary to identify how these differences might affect rehospitalization and mortality rates. Three manuscripts are included in this dissertation: 1) a comprehensive review of the literature to examine gender differences in CVD patients’ perception of the concordance between desired and received social support and if gender differences in patients’ perception of concordance are associated with differences in health outcomes; 2) a secondary analysis of a cross-sectional observational study to determine whether there is a differential relationship between perceived social support and depression in African American and Caucasian patients with heart failure (HF), and 3) a longitudinal observational study to determine if the discrepancy between desired and received support for individuals hospitalized with an exacerbation of HF is associated all-cause event-free survival. I identified a gap in the literature regarding the differences in received and desired levels of social support between genders that warrants further investigation. In the secondary analysis, I found that race moderates the relationship between perceived social support and depressive symptoms. Higher levels of perceived social support were associated with lower levels of depressive symptoms among Caucasians who had higher levels of depression. Among African Americans, depression levels were lower and were unaffected by level of social support. In the longitudinal observational study, 157 participants identified desired and received support upon enrollment. The participants had follow-up at one- and three-month post discharge intervals to determine if they had experienced rehospitalization or mortality during the period. In unadjusted and adjusted analyses neither gender nor social support congruency score group were predictive of all-cause event-free survival. This finding belies the common belief that too much support will smother the patient, causing cardiac invalidism. Despite this, further research is needed to continue to evaluate ongoing discrepancies between genders of desired and received support and their impact on health outcomes. Further research is also needed to establish accuracy in more appropriately matching social support received with the social support desired.

From 19th century insane asylums to state sponsored eugenic programs in the 20th century, the state has been an incongruous leader and provider of mental health policy and practice. Current practices that include such treatments as confinement, restraints, forced medication and electro-convulsive therapy continue to raise issues of social justice and humane treatment. Since the 1970s a diverse group of consumers of mental health services from political and radical emancipatory movements to consumer and family initiatives have emerged to question, inform and influence federal and state policies and services. Today state administrators and consumer-advocates meet in formal settings in which they exchange ideas as they work to affect and develop mental health policy and practice. However, such exchanges have raised new questions regarding the relationship between these two groups and their ability, in light of past practices to effectively work together to develop mental health policy and practice. The purpose of this study is to compare how state administrators and consumer-advocates perceive mental illness and how these perceptions impact policy and practice. Through a qualitative research study, the researcher compared and contrasted the perceptions of five consumer-advocates and five state administrators who are involved in major mental health policy in a rural state in order to consider how their perceptions of mental health affect policy and treatment. This study shows an emerging relationship between state administrators and consumer-advocates but a relationship that lacks communication and trust as their discourse attempts to span the gap between their two symbolic universes. The focus of consumer-advocates on the importance of their role in battling pervasive stigma and the need for people with lived experience to be central in the mental health system can be seen as an effort to overcome a historical pattern of coercion and abuse of mental health patients by the state. The focus of state administrators to remain relevant in a mental health system in which consumer-advocates challenge the status quo can be seen as their effort to retain legitimacy as well as their historic control over the mental health system. State administrators and consumer-advocates know that they exist in a new, shared world of mental health care and both groups agreed that the relationship between them needs to improve.

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.

M.Cur. / Violence and aggression in psychiatric hospitals are a worldwide known phenomenon. South Africa is no exception to the rule. Previous researches conducted in psychiatric institutions have mainly focused on the patients, leaving everyone to guess how this violence affects nurses who are in contact with the patients on a daily basis and who are key role-players in the care, treatment, and rehabilitation of the patients under their responsibility. The research aimed to explore and describe the lived experience of aggression and violence by the registered nurses in a Gauteng psychiatric institution, the essence of this violence, and how nurses cope with this violence, in order to formulate guidelines and recommendations that could assist them to manage violence. A qualitative, explorative, descriptive, and contextual study design was utilised. Data was collected by means of semi-structured interviews, and naïve sketches. Tesch’s method was used for data analysis, here and an independent coder was utilised. The uniqueness of this study was to bring to the surface the other side of violence as it is perceived and lived by the nurses. The findings show that the nurses face violence on a daily basis. Among the contributing factors there are: the type of patients admitted in the hospital; the staff shortage; the lack of support among the members of the multidisciplinary team (MDT); and the lack of structured and comprehensive orientation. The consequences of this violence to the nurses are emotional, psychological, and physical and take the form of: fear, anger, frustration, despair, hopelessness and helplessness, substance abuses, absenteeism, retaliation, a development of an “I don’t care attitude”, injuries, and damage to personal properties such as clothes, and spectacles.