This research project is located in the context of Aboriginal health and education, and in particular, emotional and social wellbeing, recognising the critical need for effective mental health services and resilient, well-trained workers in the field of mental health.Mental health is understood to include a broad spectrum of conditions with extreme and chronic mental illness at one end and resilience or wellbeing at the other – the socalled ‘soft end’ of the social health spectrum. While recognising that the lines of demarcation between one category and another are grey, my thesis addresses the problems at the latter end of the spectrum: problems of excessive pain; the grief and despair caused by dispossession, loss of place, family and identity; and the deep frustration, humiliation and anger that results in family violence and child sexual abuse, intergenerational substance abuse, neglect and poor physical health. It is my position that very many Aboriginal people who need to make changes in their lives in order to feel well and functional in the world are not suffering from a Western disease but from the transgenerational consequences of colonisation. In recognition of the notion that Aboriginal wellbeing is everybody’s business, this PhD research project represents my response to these consequences.While popular assumptions are made about the relevance of art to Aboriginal health and many Aboriginal people testify to the fact that their engagement with art (writing, drama, dance, music and visual art etc.) has brought about significant change in their lives, there is no available research in Australia that supports the development of an arts-based approach to learning/therapy/wellbeing that has, for reasons that are well understood, the potential to suit the needs of Aboriginal people.Addressing this gap in the research, I inquire into an experiential, arts-based, emotionfocused, narrative-orientated, constructivist approach to healing in the tradition of humanistic psychology, which emphasises the importance of an emancipatory, clientcentred processes that facilitates the development of awareness, creativity, clarity of expression and critical reflection. The position I take breaks with the traditions of the biomedical model and conforms to the now widely held view that psychology and counselling treatment programs for Aboriginal people must address the whole person, emotionally/spiritually, mentally and physically, responding to the individual in his/her sociopolitical and historical context. Expressive arts therapy, the multi-modal approach to healing explored in this thesis, lays claim to these intentions.In this project, I locate myself as the researcher/practitioner whose life-stance is expressive of the phenomenological principles of experiential learning and reflexivity. Accordingly, I have drawn on a number of closely related research methodologies all of which, I argue, are consistent with phenomenology and Indigenous, participatory research practices: critical action research, art-based research and phenomenological research methodology. These modes of inquiry are linked through principles that value subjective experience and allow for a diversity of ways of knowing. Embracing an expanded field of ways of knowing respectful of Indigenous epistemologies is at the core of the arts-based therapy program under investigation.Expressive arts therapy, in this research project, was delivered in two modes: one was a series of nine full-day group workshops conducted over an academic semester; the other was a series of ten intensive individual therapy sessions with three participants conducted over the period of a year. The participants or ‘co-researchers’ were drawn from the College of Indigenous Australian Peoples and the Education and Art departments at Southern Cross University. Three mature-age Aboriginal students who had engaged in the Masters of Indigenous Studies program emerged as the core participants who, having contributed to the development stage of the project, followed the program through the group workshops to the final interviews at the end of the series of individual sessions.This thesis is, in part, an illustrated narrative of the in-depth work the core participants did with me in both the context of the group and individually. It invites the active participation of the reader. Insights into the nature and impact of expressive arts therapy are offered through a focus on the lived experience of the three core participants, their reflections on the program and their observations of the changes they made in their lives. An important parameter that I set, determined that the ultimate voices of authority were to be those of the participants. I was not at liberty to look for meanings that went beyond their experience and understanding.I argue that the experiences of expressive arts therapy re-presented in this thesis demonstrate that expressive arts therapy is in principle consistent with current approaches to Aboriginal psychology and counselling currently recommended by Aboriginal professionals and spokespeople in the field of Aboriginal health. Furthermore this body of work demonstrates that expressive arts therapy is a culturally appropriate intervention grounded in a creative process that has the potential to facilitate healing and change in the lives of people suffering from the long-term consequences of damaging childhoods.It is my hope that this approach to healing will be further researched and developed and, with culturally appropriate terms of reference, adapted to a wide variety of existing community services – rightfully, Aboriginal and Torres Strait Islander practitioners working for the wellbeing of their own people.

This research project is located in the context of Aboriginal health and education, and in particular, emotional and social wellbeing, recognising the critical need for effective mental health services and resilient, well-trained workers in the field of mental health.Mental health is understood to include a broad spectrum of conditions with extreme and chronic mental illness at one end and resilience or wellbeing at the other – the socalled ‘soft end’ of the social health spectrum. While recognising that the lines of demarcation between one category and another are grey, my thesis addresses the problems at the latter end of the spectrum: problems of excessive pain; the grief and despair caused by dispossession, loss of place, family and identity; and the deep frustration, humiliation and anger that results in family violence and child sexual abuse, intergenerational substance abuse, neglect and poor physical health. It is my position that very many Aboriginal people who need to make changes in their lives in order to feel well and functional in the world are not suffering from a Western disease but from the transgenerational consequences of colonisation. In recognition of the notion that Aboriginal wellbeing is everybody’s business, this PhD research project represents my response to these consequences.While popular assumptions are made about the relevance of art to Aboriginal health and many Aboriginal people testify to the fact that their engagement with art (writing, drama, dance, music and visual art etc.) has brought about significant change in their lives, there is no available research in Australia that supports the development of an arts-based approach to learning/therapy/wellbeing that has, for reasons that are well understood, the potential to suit the needs of Aboriginal people.Addressing this gap in the research, I inquire into an experiential, arts-based, emotionfocused, narrative-orientated, constructivist approach to healing in the tradition of humanistic psychology, which emphasises the importance of an emancipatory, clientcentred processes that facilitates the development of awareness, creativity, clarity of expression and critical reflection. The position I take breaks with the traditions of the biomedical model and conforms to the now widely held view that psychology and counselling treatment programs for Aboriginal people must address the whole person, emotionally/spiritually, mentally and physically, responding to the individual in his/her sociopolitical and historical context. Expressive arts therapy, the multi-modal approach to healing explored in this thesis, lays claim to these intentions.In this project, I locate myself as the researcher/practitioner whose life-stance is expressive of the phenomenological principles of experiential learning and reflexivity. Accordingly, I have drawn on a number of closely related research methodologies all of which, I argue, are consistent with phenomenology and Indigenous, participatory research practices: critical action research, art-based research and phenomenological research methodology. These modes of inquiry are linked through principles that value subjective experience and allow for a diversity of ways of knowing. Embracing an expanded field of ways of knowing respectful of Indigenous epistemologies is at the core of the arts-based therapy program under investigation.Expressive arts therapy, in this research project, was delivered in two modes: one was a series of nine full-day group workshops conducted over an academic semester; the other was a series of ten intensive individual therapy sessions with three participants conducted over the period of a year. The participants or ‘co-researchers’ were drawn from the College of Indigenous Australian Peoples and the Education and Art departments at Southern Cross University. Three mature-age Aboriginal students who had engaged in the Masters of Indigenous Studies program emerged as the core participants who, having contributed to the development stage of the project, followed the program through the group workshops to the final interviews at the end of the series of individual sessions.This thesis is, in part, an illustrated narrative of the in-depth work the core participants did with me in both the context of the group and individually. It invites the active participation of the reader. Insights into the nature and impact of expressive arts therapy are offered through a focus on the lived experience of the three core participants, their reflections on the program and their observations of the changes they made in their lives. An important parameter that I set, determined that the ultimate voices of authority were to be those of the participants. I was not at liberty to look for meanings that went beyond their experience and understanding.I argue that the experiences of expressive arts therapy re-presented in this thesis demonstrate that expressive arts therapy is in principle consistent with current approaches to Aboriginal psychology and counselling currently recommended by Aboriginal professionals and spokespeople in the field of Aboriginal health. Furthermore this body of work demonstrates that expressive arts therapy is a culturally appropriate intervention grounded in a creative process that has the potential to facilitate healing and change in the lives of people suffering from the long-term consequences of damaging childhoods.It is my hope that this approach to healing will be further researched and developed and, with culturally appropriate terms of reference, adapted to a wide variety of existing community services – rightfully, Aboriginal and Torres Strait Islander practitioners working for the wellbeing of their own people.

Submitted by LUIZ BOSCO SARDINHA MACHADO JÚNIOR null (luizboscojr@yahoo.com.br) on 2016-09-02T13:46:55Z No. of bitstreams: 1 A construção do bullying nos discursos cientíicos produzidos no contexto brasileiro.pdf: 1993130 bytes, checksum: 63e9c5680a2b51af1c355a008479d889 (MD5) / Rejected by Ana Paula Grisoto (grisotoana@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: Inserir a data de defesa na folha de aprovação e os nomes da comissão examinadora. Corrija estas informações e realize uma nova submissão contendo o arquivo correto. Agradecemos a compreensão. on 2016-09-02T20:06:12Z (GMT) / Submitted by LUIZ BOSCO SARDINHA MACHADO JÚNIOR null (luizboscojr@yahoo.com.br) on 2016-09-02T20:32:40Z No. of bitstreams: 1 A construção do bullying nos discursos científicos produzidos no contexto brasileiro.pdf: 1994117 bytes, checksum: e89b83a7ba658fe45b09ac5ad15667d0 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-09-05T20:47:44Z (GMT) No. of bitstreams: 1 machadojunior_lbs_dr_assis.pdf: 1994117 bytes, checksum: e89b83a7ba658fe45b09ac5ad15667d0 (MD5) / Made available in DSpace on 2016-09-05T20:47:44Z (GMT). No. of bitstreams: 1 machadojunior_lbs_dr_assis.pdf: 1994117 bytes, checksum: e89b83a7ba658fe45b09ac5ad15667d0 (MD5) Previous issue date: 2016-07-15 / Os aspectos econômicos, políticos e sociais são relevantes no valor que um vocábulo, um signo ideológico ou um objeto de sentido possam ter para os interlocutores em um enunciado. São os elementos que constituem o pano de fundo sobre o qual transcorre a vida cotidiana e as ações constitutivas de enunciados mais elaborados. Ao longo deste trabalho são abordados vários aspectos que possibilitaram o surgimento do bullying enquanto objeto científico, no Brasil. O gradativo aumento da valoração social que recebeu possivelmente esteja ligado à crescente preocupação com a violência escolar no país, que recebeu substancial atenção no início do século XXI. Para refletir sobre as questões suscitadas optou-se pelo pensamento do Círculo Bakhtiniano, com ênfase nos conceitos de dialogismo, ideologia e enunciado concreto. São apresentadas as reflexões de Bakhtin sobre as ciências humanas, cujo objeto por excelência é o texto, ato em que o ser humano dá sentido ao mundo. Partiu-se, então, desse ponto para a apresentação do método e das primeiras considerações sobre o material levantado pelo presente estudo. Esboçou-se, ainda, o percurso histórico do signo ‘bullying’ no Brasil, relacionando-o com a atenção dada à violência escolar no meio acadêmico e no mercado editorial do País. Discorreu-se, também, sobre a origem da palavra ‘bullying’ e suas significações, além de uma crítica ao emprego de um termo estrangeiro para denominar um fenômeno cotidiano. Promoveu-se a análise sobre as definições dadas a ‘bullying’ enquanto conceito científico, com sua força e suas limitações. Foram levantados textos do autor que concebeu o referido conceito – Dan Olweus – a fim de se estudar sua teoria e compreender como sua concepção foi absorvida na produção acadêmica brasileira. Também se incluiu uma breve discussão sobre a produção intelectual no Brasil, necessária pelas constatações feitas ao longo deste trabalho. Desdobramentos da pesquisa, que não estavam previstos no início do trabalho, apresentaram-se: trata-se de análise sobre as capas de alguns livros publicados no Brasil sobre o tema e de uma discussão sobre ciberbullying e os discursos do humor, particularmente na Internet. Por fim, debateu-se se a escola, em seus moldes tradicionais, pode oferecer um espaço dialógico para produção do pensamento e de relações não violentas; concluímos que a escola é espaço predominantemente monológico, ainda que nela se encontrem resistências e discursos que escapam à ideologia predominante. / Economic, political and social aspects are relevant for value that a word, an ideological sign or a meaning object can have for utterance interlocutors. Those are elements that constitutes background in which everyday life elapses and actions arise to constitute utterances. Along our work we will speak on many aspects that enabled bullying arises as a scientific object at Brazil. Gradual growing on social valuing for this comes from emerging concern about school violence on our country, what received substantial attention on XXI century. The choice that we have made for think about these questions is for Bakhtinian Circle thought. From its conceptual production we emphasize dialogism, ideology and concrete utterance. We bring Bakhtin’s reflections on human sciences, for whom which object per excellence is the text, act in which human being gives meaning to the world. We have started from this point for present method and first considerations on material researched by us. We draw historical background of ‘bullying’ sign at Brazil, related to attention gave to school violence at academia and publishing. We have debated word ‘bullying’ origins and its meanings and criticized the use of a foreign word for nominate an everyday phenomenon. We bring what we analyze on ‘bullying’ definitions as a scientific concept, with its strengths and limitations. Texts wrote by Dan Olweus, ‘bullying’ concept creator, had been analyzed for understand his theory and its entrance on Brazilian academia. We present a brief discussion about this, what become necessary because our considerations. Further developments from our research bring some questions: an analyses on book covers about bullying, a discussion about ciberbullying and Brazilian Internet humor speech. At least, we debate if school, in its traditional standards, can offer a dialogical space for thought production. We concluded that school is mainly a monological space, even if may exist resistances and voices that scape from dominant ideology. / Los aspectos económicos, políticos y sociales son relevantes en el valor que una palabra, un signo ideológico o un objeto de sentido puedan tener para los interlocutores en un enunciado. Son los elementos que constituyen el trasfondo sobre lo cual transcurre la vida cotidiana y las acciones constitutivas de enunciados más elaborados. A lo largo de nuestro trabajo hablaremos de aspectos variados que hicieron posible el surgimiento del bullying como objeto científico en Brasil. El aumento gradual de la valoración social que recibió probablemente esté relacionado a la creciente preocupación con la violencia escolar en el país, que recibió sustancial atención en el siglo XXI. La elección que hicimos para pensarnos las cuestiones suscitadas fue por el pensamiento de lo Círculo Bajtiniano. De su producción conceptual enfatizamos el dialogismo, la ideología y el enunciado concreto. Presentamos las reflexiones de Bajtín respecto las ciencias humanas, cuyo objeto por excelencia es el texto, acto en que el ser humano da sentido al mundo. Partimos de ese punto para la presentación del método y de las primeras consideraciones respecto el material elegido por nosotros. Bosquejamos un camino histórico de lo signo ‘bullying’ en Brasil, a relacionarlo a la atención dedicada a la violencia escolar en el medio académico y en el mercado editorial del País. Debatimos el origen de la palabra ‘bullying’ y sus significaciones, incluso presentando una crítica al uso de un término extranjero para nominar un fenómeno cotidiano. Traemos lo que analizamos respecto las definiciones atribuidas a ‘bullying’ como concepto científico, con su fuerza y limitaciones. Levantamos textos del autor que lo concibió a ese concepto, Dan Olweus, para estudiar su teoría y comprender como su concepción fue absorbida en la producción académica brasileña. Incluimos breve discusión respecto la producción intelectual en Brasil, necesaria por las constataciones que hicimos a lo largo de nuestro trabajo. Desdobles de nuestra pesquisa que no estuvieron previstos en su início fueron presentados: el análisis de las capas de algunos de los libros publicados en Brasil sobre el tema y de una discusión sobre ciberbullying y los discursos del humor, particularmente en Internet. Finalmente, debatimos si la escuela, en sus formato tradicional, puede ofrecer un espacio dialógico para la producción del pensamiento. Concluimos que la escuela es, predominantemente, un espacio monológico, aunque se encuentren resistencias y discursos que se escapan de la ideología dominante.

The purpose of the present study was to examine general loneliness, hospital loneliness, and the patient-physician relationship in regards to their associations with Bone Marrow Transplant (BMT) recovery outcome variables (days until engraftment and quality of life). Fifteen (66.7% female, 33.3% male; 93.3% white, 6.7% Black/African American; average age 61.73) individuals who had an allogeneic or autologous BMT at The Mayo Clinic of Jacksonville completed the FACT-BMT, UCLA-Loneliness Scale Version 3, the CARE Measure, and provided disease and treatment information at the 6 month posttransplant date (+/- 30 days). Patients recovering from BMT indicated significantly higher scores of hospital loneliness in comparison to their general loneliness scores. This increase is believed to represent the outcome of experiencing hospital isolation during the post-transplant recovery process. Increases in hospital loneliness were marginally significant in predicting decreases in the patients overall quality of life. The patient physician consultational relationship was found to have a significant relationship with the number of days until engraftment, however the direction of the relationship was opposite the hypothesized direction. This may suggest that engraftment influences the quality of the relationship instead of vice versa. These results imply that there is a relationship between hospital isolation and increases in the amount of loneliness experienced during recovery from a BMT. Loneliness has been found to have a negative relationship with a number of physiological and quality of life outcomes. The present study also elucidates possible correlates with the patient-physician relationship.

The present study investigated factors related to social connectedness and social support in a college population. Participants in the study were 486 volunteer students at the University of North Florida. All data were collected through a world wide web surveying program that allowed each participant to complete surveys on computers from any location. The surveys administered were the Social Connectedness Scale, the Multidimensional Scale of Perceived Social Support (MSPSS), the Perceived Stress Scale 10, the Patient Health Questionnaire 15 (PHQ15), and the Center for Epidemiological Studies Depression Scale- Revised (CESD-R) along with a demographics questionnaire. Results show that participants in the ethnic majority group report greater social connectedness and social support than minority participants. Social connectedness is associated with perceived stress and health symptoms, even when controlling for other related factors. The impact of social connectedness on perceived stress explains the health effects of social connectedness, as perceived stress mediates the relationship between social connectedness and stress.

Introduction: The late menopausal transition is a time of increased risk of depression in the general population. Nonetheless, mood course during the late menopausal transition in women with bipolar disorder in relatively unknown. Methods: Mood state data in 519 reproductive age women (5989 clinic visits), 116 late menopausal transition (perimenopausal) women (2046 visits), and 133 postmenopausal women (1,437 visits) with bipolar disorder who were receiving optimized naturalistic treatment in the multisite STEP-BD study over an average of 19.8±15.5 months were analyzed for proportion of clinic visits with syndromal depression, mood elevation and euthymia between the three groups. History of postpartum and perimenstrual mood exacerbation as well as hormone therapy use were evaluated as potential predictors of mood. Results: No significant difference in the proportion of clinic visits with syndromal depression was found between reproductive age (18.1%), perimenopausal (18.1%) and postmenopausal (19.3%) women. Reproductive age women had significantly greater proportion of visits with syndromal mood elevation (5.3%) compared to perimenopausal (4.1%, Z=2.1, p2(3, N = 9960) = 19.8, p Conclusions: While proportion of clinic visits with syndromal depression did not differ among the three reproductive groups, thirteen women who had recorded transition from perimenopause to postmenopause showed significantly greater depression than reproductive age, perimenopausal or postmenopausal women. Proportion of visits with euthymia or with syndromal mood elevation decreased from reproductive age to perimenopausal to postmenopausal women. Reported history of mood exacerbation during times of hormonal fluctuation, or current use of hormone therapy, was not significantly associated with depression during the perimenopause. Limitations include women excluded due to absence of menstrual data. Future studies should include hormonal assessments.

Background: Puerto Ricans experience high prevalence of type 2 diabetes (diabetes). Stress is a risk factor for diabetes. The allostatic load (AL) model explains how stress influences disease through a chain of physiological changes. Puerto Ricans experience psychological and physiological (obesity and high glycemic load (GL)) stressors linked with diabetes, yet how these stressors impact the AL chain and how their interplay affects glucose metabolism remains unknown. Methods: Using data from the Boston Puerto Rican Health Study, this thesis sought to examine: 1) the relationship between GL and primary AL markers, 2) the interaction between perceived stress and GL on HbA1c, and if primary AL markers mediate this interaction, and 3) the interaction between change in weight and in perceived stress on HbA1c. Results: 1) GL change over 2 years was associated with increases in primary AL markers in women. 2) Women with high perceived stress and high GL had higher HbA1c and primary AL markers did not mediate this interaction. 3) In women, there was an interaction between change in weight and perceived stress on HbA1c over 2 years, with the effect of weight change on HbA1c being greater with increases in perceived stress. None of these associations were observed in men. Conclusion: This study partially confirms the AL model in Puerto Rican women but not in men. It provides data to inform intervention targets to prevent and manage diabetes in Puerto Rican women and identifies women at high risk of diabetes in this minority group.

Background: Management of atrial fibrillation (AF) is complex and requires active patient engagement in shared decision making to achieve better clinical outcomes, greater medication adherence, and increased treatment satisfaction. Efficacy in patient-physician interactions is a critical component of patient engagement, but factors associated with efficacy in older AF patients have not been well-characterized. Methods: We performed a cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) study, a cohort study of older adults (age ≥ 65) with non-valvular AF and CHA2DS2-VASc score ≥ 2. Participants were classified according to their Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) score (lower: 0-44; higher: 45-50). Logistic regression analysis was used to identify sociodemographic, clinical (AF type, AF treatment, medical comorbidities), and geriatric (cognitive impairment, sensory impairment, frailty, independent functioning) factors associated with lower reported efficacy. Results: Participants (n = 1209; 49% female) had a mean age of 75. A majority (66%) reported higher efficacy in their interactions with physicians. Lower efficacy was associated with persistent AF (adjusted odds ratio [aOR] = 1.52; 95% confidence interval [CI] = 1.13-2.04) and with symptoms of depression (aOR = 1.67; CI = 1.20-2.33) or anxiety (aOR = 1.40; CI = 1.01-1.94). Decreased odds of lower efficacy were observed in participants with chronic kidney disease (aOR = 0.68; CI = 0.50-0.92) and those classified as pre-frail compared to those classified as not frail (aOR = 0.71; CI = 0.53-0.95). Conclusion: Older patients with persistent AF or symptoms of depression or anxiety have decreased efficacy in patient-physician interactions. These individuals merit greater attention from physicians when engaged in shared decision making.

Background: Chronic cough is a common health problem with variable success rates to standardized treatment. Psychologic symptoms of depression, anxiety, and stress have been reported in association with chronic cough. The purpose of this study was to examine changes in the psychologic symptoms of depression, anxiety, and stress in adults with chronic cough 3 months after management using the ACCP cough treatment guidelines. Methods: This study used a descriptive longitudinal observation design. The major tenets associated with the Theory of Unpleasant Symptoms were examined. Intervention fidelity to the study components was measured. Results: A sample of 80 consecutive patients with chronic cough of greater than 8 weeks duration was recruited from one cough specialty clinic. Mean age of subjects was 58.54 years; 68.7% were female; 98.7% were white, and 97.5% were non-smokers. Mean cough duration was 85.99 months and mean cough severity was 6.11 (possible 0 –10; higher scores equal greater cough severity). Cough severity improved post treatment (n=65, M=2.32, (SE =.291), t (64) =7.98, p=.000); cough-specific quality-of-life also improved (n=65, M=9.17, (SE=1.30), t (64) =7.02, p=.000). Physiologic (urge-to-cough r=.360, ability to speak r=.469) and psychologic factors (depression r=.512, anxiety r=.507, stress r=.484) were significantly related to cough-specific quality-of-life and to cough severity (urge-to-cough r=.643, ability to speak r=.674 and depression r=.356, anxiety r=.419, stress r=.323) (all r, p=.01); social support and number of diagnoses were not related to either variable. Those experiencing greater financial strain had worse cough severity. Women, those experiencing financial strain, and those taking self-prescribed therapy had worse cough-specific quality-of-life. Intervention fidelity to the study plan was rated as high according to observation, participant receipt, and patient/physician concordance. Qualitative review identified potential areas of variability with intervention fidelity. Conclusions: By measuring the factors related to the major tenets of the Theory of Unpleasant Symptoms, this theory has helped to explain why those with chronic cough may have symptoms of depression, anxiety, and stress and why these symptoms improve as cough severity and cough-specific quality-of-life improve. Moreover, by measuring intervention fidelity, it may be possible to determine why cough guidelines may not be yielding consistently favorable results.

Rationale: Delirium is a serious, morbid condition affecting 2.6 million older Americans annually. A major problem plaguing delirium research is difficulty in identification, given a plethora of existing tools. The lack of consensus on key features and approaches has stymied progress in delirium research. The goal of this project was to use advanced measurement methods to improve delirium’s identification. Aims and Findings: (1) Determine the 4 most commonly used and well-validated instruments for delirium identification. Through a rigorous systematic review, I identified the Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS). (2) Harmonize the 4 instruments to generate a delirium item bank (DEL-IB), a dataset containing items and estimates of their population level parameters. In a secondary analysis of 3 datasets, I equated instruments on a common metric and created crosswalks. (3) Explore applications of the harmonized item bank through several approaches. First, identifying different cut-points that will optimize: (a) balanced high accuracy (Youden’s J-Statistic), (b) screening (sensitivity), and (c) confirmation of diagnosis (specificity) in identification of delirium. Second, comparing performance characteristics of example forms developed from the DEL-IB. Impact: The knowledge gained includes harmonization of 4 instruments for identification of delirium, with crosswalks on a common metric. This will pave the way for combining studies, such as meta-analyses of new treatments, essential for developing guidelines and advancing clinical care. Additionally, the DEL-IB will facilitate creating big datasets, such as for omics studies to advance pathophysiologic understanding of delirium.