EMS personnel were examined for Post Traumatic Stress symptoms and the usefulness of Critical Incident Stress Debriefing (CISD) using the Los Angeles Symptom Checklist (LASC) and a demographics questionnaire. This study revealed that women in this group show higher PTSD symptoms than male coworkers. Level of Training (LOT) of the EMS provider did not demonstrate a significant difference in whether a provider developed PTSD. EMS personnel receiving debriefing actually suffered greater levels of PTSD than those that did not receive debriefing. And 16% of EMS providers in this study suffered from PTSD, while approximately 20% suffered from partial PTSD or PTSS. The results suggest that there are high levels of PTSD within the EMS community, especially in women. This study also suggests that CISD does not help with PTSD symptoms and may actually worsen them.

Every year in the United States approximately 30,000 people commit suicide including approximately 1,100 college students. Furthermore, heavy alcohol consumption is prevalent on many college campuses and has been linked to suicidal behavior. The present study was conducted to examine suicidal ideation and reasons for living in college students with varying levels of risk for alcohol related problems. Undergraduate students (n = 161) were administered a survey to assess demographics, suicide ideation status, reasons for living, and the participant's level of risk for alcohol related problems. Results indicated that suicide ideators are significantly more likely than non-ideators to be at risk for alcohol related problems. Also, women were significantly more likely to be suicide ideators and endorse more reasons for living. The results of this study may be used to identify groups who are at an increased risk for suicide, as well as to implement more efficient intervention and prevention programs on the collegiate level.

The stigma of mental illness endorsed by healthcare professionals has been linked to adverse outcomes. This issue underscores the need for early anti-stigma interventions in the context of professional training. The present study measured stigma change and suicide screening behaviors among medical, nursing, and pharmacy students enrolled in an interprofessional Communication Skills for Healthcare Professionals course. The Mental Health Knowledge Schedule (MAKS; Evans-Lacko et al., 2010), Opening Minds Scale for Health Care Providers (OMS-HC; Modgill, Patten, Knaak, Kassam, & Szeto, 2014), and the Marlowe-Crowne Social Desirability Scale Form C (M-C SDS Form C; Reynolds, 1982) was administered at baseline (T1), a mid-semester assessment (T2), and post-intervention (T3) to 176 students. Post-intervention changes in stigma components (knowledge, attitudes, and behavioral intent) were mixed for all groups. Knowledge, attitudes, and behavioral intent did not predict whether students screened for suicidal ideation (p > .05). Findings from the present study support past research indicating that the stigma can be improved with appropriate intervention. Findings also support interprofessional training as an appropriate context for anti-stigma interventions. Currently, there is no general consensus regarding the best method and combination of tools to measure stigma among healthcare students. Additionally, the relationship between stigma and screening for suicidal ideation is an important area for further scientific inquiry.

In first-year composition courses, there are three aspects of teaching that are researched well so far: disclosure of trauma in student writing, instructor feedback, and emotional labor. The disclosure of trauma is almost completely unavoidable in first-year composition. We encounter an issue with instructor feedback; how do we provide feedback to student writing, like grammar and mechanics, when the student has disclosed trauma in the writing? Additionally, we can build off this with emotional labor, which already occurs consistently in teaching but is heightened in this instance. When providing feedback to a student who has disclosed trauma, this can be emotionally taxing on the instructor, as they may have to hide emotions regarding feedback to disclosure. How can the instructor manage their emotional labor in this instance – or how can instructors provide feedback to student disclosure of trauma in a manner that both prioritizes the student and instructor’s mental health?

Pediatric anxiety disorders characterized as Generalized, Separation, and Social Anxiety Disorders, are chronic debilitating conditions that leave children feeling tense and isolated, both physically and emotionally. Selective serotonin reuptake inhibitors (SSRIs) are a classification of antidepressants that can be prescribed to children diagnosed with these disorders. SSRIs have been shown to be effective in treating anxiety disorders in children. The purpose of this literature review was to examine and determine if there are more risks or benefits associated with SSRIs, as well as evaluate teaching and education regarding anxiety disorder medication compliance in both children and parents. A secondary purpose of this research was to provide recommendations in nursing practice to allow children to feel more involved in their medical regimen. The following databases were used for the search: CINAHL, Academic Search Premier, and Web of Science. Key terms used in the search include but are not limited to: child* and anxiety, not autism, and selective serotonin reuptake inhibitors, OR SSRI*, OR adolsecen*, not med*, pediatric*, OR side effects. The results suggest that the benefits of SSRI therapy in children with anxiety disorder, when taken on a regularly scheduled basis, outweigh the risks, however more research aimed at compliance with SSRI therapy in children and parents is necessary. Further research analyzing children with anxiety disorders is needed to assess SSRI usage based specifically on their developmental age, and the inclusion of appropriate teaching and explanation related to their diagnoses to identifying stressors that can include behavioral therapy as well.

<p><strong>Objectives: </strong>To examine associations between macrosomia, maternal body mass index (BMI) during pregnancy, and psychopathology in youth, and to determine if these are due to prenatal environmental exposures or confounding variables.</p> <p><strong>Methods: </strong>Study 1 reviewed studies examining associations between macrosomia and mental health. Data from the Ontario Child Health Study (OCHS) were then used to explore these links in youth (Study 2). A second review summarized studies assessing associations between maternal pregnancy BMI and psychopathology in offspring (Study 3). Data from the Western Australia Pregnancy Cohort were then used to quantify associations between maternal pre-pregnancy BMI and child behaviour at age 1 and 2 (Study 4), and from 5-17 years of age (Study 5).</p> <p><strong>Results: </strong>Seven of the 15 studies that had examined associations between macrosomia and psychopathology supported a link. In the OCHS, youth born macrosomic had elevated externalizing scores compared those born at appropriate birth weights. Eight of 12 studies suggested that links exist between elevated maternal BMI during pregnancy and psychopathology in offspring. Maternal pre-pregnancy BMI was positively associated with offspring externalizing problems from age 2 to 17 and linked to less favourable trajectories of internalizing symptoms from 5-17. These findings persisted despite adjustment for confounders.</p> <p><strong>Conclusions: </strong>Youth born macrosomic have elevated levels of externalizing symptoms, though a more robust association was noted with maternal pre-pregnancy BMI. The data comprising this thesis suggest that associations between macrosomia/maternal BMI and externalizing and internalizing problems in youth may be due to intrauterine exposures rather than confounding variables.</p> / Doctor of Philosophy (PhD)

<p>The term ‘stigma’ is formally defined as the assignment of negative perceptions to an individual because of perceived difference from the population at large (The Free Online Dictionary by Farlex). Stigma, pervasive on a micro, mezzo and macro level serves to devalue individuals who have been diagnosed with mental illness and the support systems that are designed to assist them. Although efforts have been made in public awareness campaigns to reduce the stigma associated with mental illness, stigma continues to limit opportunities and restrain individuals from living full and enriching lives. Many individuals “suffer in silence” often resorting to maladaptive coping mechanisms to manage symptoms.</p> <p>The purpose of this study was to uncover the short term and long term impact of stigma from the perspective of those who are labelled with mental illness in order to gain a deeper and more accurate understanding of the effects of such on life satisfaction. Existing literature suggests that the result of anticipated and experienced stigma can affect individuals in multiple ways: diminished self-esteem, self-efficacy, and self-worth; social withdrawal; identity ambivalence; secrecy and reduced opportunities (employment, housing, income).</p> <p>This research utilized qualitative semi-structured interviews and photo elicitation to gain an understanding of experienced and anticipated stigma as perceived by those with mental illness. Theoretically, the study was influenced by the modified labelling theory which posits that social and internalized stigma associated with mental illness is a societal creation in that its’ development exists as a result of disapproving social attitudes about mental illness. Eight individuals with various diagnosed mental disorders participated in the study. The findings suggest that for each of the participants in this study, initial dealings with the mental health care system and its’ components are likely to impact individuals negatively but once effective treatment, medication stabilization and a good practitioner are found, the experience becomes positive and empowering to individuals. Regardless of the level to which internalized stigma exists, all participants engaged in acts of secrecy, withdrawal, passing and selective disclosure adversely affecting life satisfaction. The implications for practice include recognizing the structural factors that influence clients’ internalization of stigma which likely contributes to feelings of empowerment and control over ones’ life. Revealing mental health status to others may be beneficial in contributing to an improved quality of life satisfaction.</p> / Master of Social Work (MSW)

<p>Background: The objective of this thesis was to examine the role of psychosocial factors in weight loss success after bariatric surgery. It was proposed that a higher pre-operative body mass index (BMI), greater weight, depression, low self-esteem, and a childhood history of sexual abuse (CSA) would predict poor outcomes one year after Roux-en-y gastric bypass as evidenced by a BMI > 35 kg/m²and a lower percent total weight loss (%TWL). Methods: We administered a battery of psychological screening tools, including the Beck Depression Inventory-II, the Rosenberg Self-Esteem Scale and a self-report measure assessing CSA, to 262 patients seeking bariatric surgery at St. Joseph's Healthcare Hamilton. Patients completed the questionnaires prior to surgery and again one year post-surgery. Results: On average patients (n = 79) achieved good weight loss outcomes (BMI = 32.8 kg/m²) at one-year follow-up. Through multiple regression analysis we found that pre-operative BMI accounted for a significant proportion of variance in postoperative BMI [<em>R²</em> = .60, <em>F</em>(1, 77) = 114.4, <em>p</em> < .001]. Weight before surgery, however, did not predict %TWL after surgery. None of the psychosocial variables significantly predicted post-operative BMI or weight loss. These results are preliminary and are limited by the fact that participants did not present with clinically significant symptomatology and those with active psychopathology were excluded as suitable surgical candidates. Conclusion: These findings indicate that pre-operative BMI is a significant predictor of BMI one year after bariatric surgery, suggesting that more attention should be directed toward managing pre-operative BMI for heavier patients.</p> / Master of Science (MSc)

<p>In recent years, paid work has taken on greater meaning for people living with mental illness. Paid work offers the chance to earn a wage, as well as opportunities for improved self- esteem, greater community participation and can reduce the chances of re-hospitalization. Although employment can offer many rewards, access to mainstream employment for people with mental illness remains been difficult as they often face discrimination and a lack of workplace accommodation. One response to these challenges has been the creation of social enterprises as ‘alternative spaces’ of employment for people with mental illness. Social enterprises are organizations with an entrepreneurial orientation whose focus is building social capacity rather than profit maximization. However, relatively little is known about the kinds of organizations that exist for people with mental illness in Ontario. This thesis uses data from key- informant interviews with organizations across Ontario to document the types of social enterprises that exist. The analysis also critically examines the strategies used by organizations to create jobs that are both suitable for people with mental illness, but also conducive to the ongoing success of the social enterprise.</p> / Master of Arts (MA)

<p>Functional<strong> </strong>magnetic resonance imaging (fMRI) is a popular technique to study brain function and neural networks. Functional MRI studies are often characterized by small sample sizes and rarely consider statistical power when setting a sample size. This could lead to data dredging, and hence false positive findings. With the widespread use of fMRI studies in clinical disorders, the vulnerability of participants points to an ethical imperative for reliable results so as to uphold promises typically made to participants that the study results will help understand their conditions. While important, power-based sample size calculations can be challenging. The majority of fMRI studies are observational, i.e., are not designed to randomize participants to test efficacy and safety of any therapeutic intervention. My PhD thesis therefore addresses two objectives: firstly, to identify potential obstacles to implementing sample size calculations, and secondly to provide solutions to these obstacles in observational clinical fMRI studies. This thesis contains three projects.</p> <p>Implementing a power-based sample size calculation requires specifications of effect sizes and variances. Typically in health research, these input parameters for the calculation are estimated from results of previous studies, however these often seem to be lacking in the fMRI literature. Project 1 addresses the first objective through a systematic review of 100 fMRI studies with clinical participants, examining how often observed input parameters were reported in the results section so as to help design a new well-powered study. Results confirmed that both input estimates and sample size calculations were rarely reported. The omission of observed inputs in the results section is an impediment to carrying out sample size calculations for future studies.</p> <p>Uncertainty in input parameters is typically dealt with using sensitivity analysis; however this can result in a wide range of candidate sample sizes, leading to difficulty in setting a sample size. Project 2 suggests a cost-efficiency approach as a short-term strategy to deal with the uncertainty in input data and, through an example, illustrates how it narrowed the range to choose a sample size on the basis of maximizing return on investment.</p> <p>Routine reporting of the input estimates can thus facilitate sample size calculations for future studies. Moreover, increasing the overall quality of reporting in fMRI studies helps reduce bias in reported input estimates and hence helps ensure a rigorous sample size calculation in the long run. Project 3 is a systematic review of overall reporting quality of observational clinical fMRI studies, highlighting under-reported areas for improvement and suggesting creating a shortened version of the checklist which contains essential details adapted from the guidelines proposed by Poldrack et al. (2008) to accommodate strict word limits for reporting observational clinical fMRI studies.</p> <p>In conclusion, this PhD thesis facilitates future sample size and power calculations in the fMRI literature by identifying impediments, by providing a short-term solution to overcome the impediments using a cost-efficiency approach in conjunction with conventional methods, and by suggesting a long-term strategy to ensure a rigorous sample size calculation through improving the overall quality of reporting.</p> / Doctor of Philosophy (PhD)