Background: Outcomes are integral to psychiatry research for evaluating intervention effectiveness in randomized controlled trials (RCTs) and understanding disease progression in observational research. Carefully defined, measured, and consistently used outcomes guide clinical decision-making and enhance research applicability. Bridging methodological gaps through rigorous assessment is essential for minimizing variability and mitigating research waste. Objectives: This dissertation aims to assess: (i) outcome selection in geriatric depression RCTs, (ii) primary outcome reporting in these trials, and (iii) measurement of multimorbidity patterns in observational research on people with opioid use disorder (OUD). Methods: Three studies were conducted: (i) a systematic survey examining outcome selection heterogeneity in geriatric depression RCTs (2011-2021), (ii) an assessment of primary outcome reporting comprehensiveness in these trials, and (iii) an observational study using hierarchical cluster analysis (HCA) and K-means clustering to compare statistical techniques for measuring multimorbidity patterns among people with OUD. Results: Findings suggest variability in outcome selection, reporting, and measurement in psychiatry research. (i) The systematic survey revealed significant heterogeneity in outcomes and outcome measurement instruments (OMIs) in geriatric depression RCTs, impeding cross-study comparisons. (ii) The assessment of primary outcome reporting highlighted variability and insufficiency in reporting the rationale for outcome selection, measurement properties of OMIs, and criteria for clinically meaningful change, limiting the interpretability of trial findings. (iii) The observational study on multimorbidity patterns among people with OUD identified significant variations in chronic condition clusters using HCA and K-means clustering, indicating the need for careful consideration of statistical techniques in outcome measurement to inform clinical care accurately. Conclusion: These findings highlight the need for standardized practices in outcome selection, reporting, and measurement in psychiatry research. Addressing these issues through developing core outcome sets, improving adherence to reporting guidelines, and refining measurement methodologies will enhance research reliability and applicability, ultimately improving clinical decision-making and patient care in psychiatry. / Dissertation / Doctor of Philosophy (PhD) / When studying mental health, researchers examine outcomes to determine whether treatments are effective and how to measure co-occurring chronic conditions. These outcomes must be defined clearly, measured accurately, and used in the same way across research to help clinicians make treatment decisions and be able to use research in clinical practice. This project focussed on three main issues related to outcomes: how researchers select outcomes for studies on depression among older adults, how well they report these outcomes, and how they measure the outcome of multiple chronic diseases in people with opioid use disorder. The findings revealed significant differences in how outcomes are selected, reported, and measured, making it challenging for researchers to compare studies and for clinicians to use research results. By implementing standardized practices in outcomes and improving their selection, reporting, and measurement, research can become more useful, leading to better care for people with mental illness.

M.A. / Health problems, physical and mental, in industry have an enormous influence on productivity of organisations in South Africa. Certain models of stress implied the perspective that many stressors may serve as possible inputs into the system, for example remuneration, substance abuse, teamwork, management support, change and self control. Outputs from the system include aspects such as accidents, illness, low productivity levels and psycho-social problems. The problem is that illness and absenteeism often have unspecific causes and a complex interaction perspective has been developed in looking at the employee as system in his working environment.

M.A. / The overall objective of the global research project of which the present study is a part, is to create a greater awareness and understanding of the association between physiology and psychology, specifically with regard to IBS. Investigations are being conducted into the contribution of such factors as stress, anxiety, depression, somatization, psychopathology. early sexual abuse and physical abuse to the development and management of IBS. The present study aims to assess the incidence of co-morbid psychopathology in patients with IBS as compared to the general population. 1.3.2 Specific Aims. The aim of the present study is to compare the incidence of concurrent psychopathology in a sample of white, female patients, aged from 25-55 years and diagnosed to have IBS, with the incidence of psychopathology in a sample of white female non-IBS controls aged 25-55 years. Of initial concern will be whether the results of this study confirm the findings of the numerous research projects which attest to the high incidence of comorbid psychopathology in patients with IBS (Chaudhary & Truelove, 1962; Liss et al., 1973; Young et al., 1976), or add support to the limited evidence that disputes these claims (Talley, Kramlinger et al., 1993; Thornton, McIntyre et al., 1990). The study then aims to consider whether the variable of gender has a significant effect on the incidence of co-morbid psychopathology in patients with IBS. As will be discussed in Chapter 3, most of the studies do not differentiate between male and female subjects even though this may well prove to be an important determining factor. As mentioned in section 1.2.1, there is a dearth of research in South Africa into IBS and, more specifically, into the incidence of co-morbid psychopathology and IBS. By restricting participants in this study to those of the white race, the aim of this study is to initiate a process in which the incidence of co-morbid psychopathology in IBS patients of all races will be assessed and compared. In addition, the present study aims to assess whether age and level of education are significant variables in determining the incidence of co-morbid psychopathology in patients with IBS. Inter-group comparisons will be made between three groups of patients with IBS divided first according to age and then according to level of education. Finally, the present study aims to be more methodologically sound than certain of the earlier research projects as reported in the literature. As will become clear in Chapters 2 and 3, a common thread running through much of the literature is the concern that the validity of results may be questionable due to methodological flaws in the design of certain research projects. Small sample size has been a problem in some studies (Liss et al., 1973; Young et al., 1976) whilst in others, the absence of a control group has limited the relevance of data (Liss et al., 1973). Furthermore, a diversity of measuring instruments have been used in the past with little if any standardisation or control of specific variables being assessed. The measuring instrument used in this study, namely the Personality Assessment Inventory (PAI), allows for an accuracy and comprehensiveness of assessment not found in many previous studies (see Chapter 6, section 6.2.1.4). The PAI assesses psychopathological trends in personality functioning. The word "psychopathology" will be used in this study as substitute for the phrase "psychopathological trends in personality functioning".

Epidemiological trends in mental disorders are shown against a background governed by medical aid health policy. The study quantitatively analyzed a dataset of mental disorders for South Africa’s leading medical aid scheme. South Africa’s leading medical aid scheme has been in operation for almost three decades. This degree of longevity allows for a reliable longitudinal analysis of diagnostic trends. Through consent of the Scheme, a database was provided, which lists mental disorder diagnoses over seven years from 2008 to mid-way through 2015. Data from this source were analyzed and interpreted. Data fields provided and made use of from the raw medical scheme database are: Date of admission (Year, Month); Patient gender; Database population per year; Patient diagnosis (DEG Description); Total per DEG Description. Each diagnosis (mental disorder) is presented in the following ways: 1. Bar charts showing the volume of specific mental illnesses each year. 2. Bar charts showing fluctuations of occurrence of a specific mental illness over time. 3. Frequency of specific mental illnesses over time, relative to the entire database population. 4. Male:Female ratio per mental disorder. 5. Female Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015).v 6. Male Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015). 7. Total number of patients per mental disorder across time (2008 – 2015). 8. Frequency polygons showing the fluctuation of a selected mental disorder over time as compared to other selected mental disorders. It is found that there are changes in prevalence rates of mental disorders over time and that these fluctuations are attributed to an economic factor within medical aid scheme cost-driven policy. The effect of cost-driven policy is that members diagnosed with a mental disorder may not be granted provision of adequate treatment because diagnosis is in part, determined by economic structures. Costs for mental illness treatment programmes are curtailed by keeping patient numbers significantly low, by radically over-diagnosing certain mental illnesses treated with comparably cheaper pharmaceuticals or by drastically curbing time spent in a mental health facility. Some members of the medical aid scheme have been deliberately misdiagnosed. Alternatively, those, correctly diagnosed, do not receive the treatment required of such an illness. The scenario then is of thousands of mentally ill people, who are not treated effectively. Members continue to pay fees, paying under the illusion that medical cover ensures effective treatment / Psychology / M.A. Psychology

Indiana University-Purdue University Indianapolis (IUPUI) / Greater levels of loneliness have shown consistent associations with poorer mental and physical health; however, the reason for these relationships is unknown. Engagement in poorer health behaviors among individuals with higher levels of loneliness is one potential explanation for this relationship. Self-regulation theory suggests that coping with feelings of loneliness may impair attempts to control health behaviors. Caregivers of cancer patients have been found to have poor health behaviors (e.g., inadequate exercise) and high levels of loneliness. Thus, the aim of the study is to examine whether health behaviors mediate the relationships between loneliness and mental and physical health outcomes among caregivers of cancer patients. Methods: A secondary data analysis was conducted using data from a longitudinal study of cancer patients and their family caregivers who were staying at the American Cancer Society’s Hope Lodge. Participants completed self-report questionnaires measuring levels of loneliness, engagement in health behaviors (i.e., exercise and fruit and vegetable consumption), mental and physical health, and demographic and medical characteristics at three time points over a 4-month period. A bootstrapping macro was used to examine the indirect effect of loneliness on mental and physical health via health behaviors. Results: Contrary to hypotheses, exercise and fruit and vegetable consumption did not mediate the relationships between loneliness and physical and mental health among cancer patients’ caregivers. Additional research is needed to determine whether health behaviors partially account for the relationships between loneliness and health outcomes or whether alternate explanations for these relationships should be considered.