A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods. The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms. Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms. Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character.  Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved. Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge. In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.

Background Dementia has been a global priority for over a decade, with a recognition that it presents a growing challenge for all those directly affected, as well as for health and social care services. For those who are caring for a relative at home, carer burden has been found to be predictive of physical and mental health problems, and can impact on the decision to place a relative in fulltime residential care. Gaining a fuller understanding of factors that impact on caregiver burden may help inform the development of effective interventions for this population. This thesis comprises a systematic review of the literature on individual behavioural and psychological symptoms of dementia (BPSD) and their impact on carer burden, a cross-sectional study of one hundred and ten dementia caregivers, exploring the impact of executive functioning deficits, and potential mediating mechanisms, on carer burden and positive gain, and a development and feasibility study of an Acceptance and Commitment Therapy (ACT) group intervention for dementia caregivers. Systematic Review Twenty-one studies measured the association between at least one individual symptom, or symptom cluster, and carer burden, and are included in the review. All studies found at least one symptom to be significantly associated with burden. However, due to the heterogeneity of studies in this field, there was insufficient evidence to establish whether any symptoms are more closely associated than others. Issues regarding the conceptualisation of burden and measurement of BPSD are highlighted and suggestions for addressing this in future studies proposed. Method One hundred and ten dementia caregivers completed five self-report questionnaires as part of a cross-sectional design, aiming to explore the role of executive functioning deficits, dementia management strategies and experiential avoidance in 2 the development of carer burden and positive gain. Drawing on these findings, a group intervention, based on ACT, was developed and delivered to twenty-three dementia caregivers. Data on attendance, attrition and qualitative feedback was collected as an indication of acceptability, and a quasi-experimental design, involving four pre, post and follow-up measures was employed to provide preliminary data on effectiveness. The measures used in both studies were the Dysexecutive Questionnaire (DEX) (study 1 only), Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Questionnaire (PAC), Dementia Management Strategies Scale (DMSS) and Experiential Avoidance in Caregiving Questionnaire (EACQ). Results & Conclusions In study one, executive functioning deficits were found to account for most variance in burden. The use of negative management strategies and Active Avoidant Behaviour (a subscale of the EACQ), were also associated with higher levels of burden, while positive management strategies were associated with positive gain. The results suggest that management strategies and experiential avoidance could be potential mediating mechanisms in the development of carer burden, and so were targeted in the ACT group intervention in study two. Findings from study two indicate that the group intervention was feasible and acceptable to caregivers, with subjective change reported in understanding of behavioural changes in the care-recipient, ability to handle negative emotions and valued living. Suggestions are made regarding alternative outcome measures for future studies in order to capture participants’ experience more fully, as there was little statistically significant change in this study. Suggestions are also made regarding future directions for the intervention.

Depression and anxiety are common psychiatric disturbances in Parkinson's disease (PD). Past studies have demonstrated a relationship between depression and cognitive decline in PD; however, the unique influence of anxiety has not been well studied. The objective of the present study was to differentiate the unique influences of depression and anxiety on cognitive functioning in PD. Sixty-eight cognitively intact PD patients with mild to moderate motor disease severity completed self-report questionnaires and neuropsychological tests. Two hierarchical regression analyses were conducted with executive functioning performance as the criterion variable, and two additional hierarchical regression analyses were conducted with memory performance as the criterion variable. Depression and anxiety, as measured by the Depression Anxiety and Stress Scales (DASS), served as predictors for all analyses. Each set of analyses examined the amount of added, unique variance accounted for by anxiety when depression was entered as the first predictor, and also examined the amount of added, unique variance accounted for by depression when anxiety was entered as the first predictor. It was found that depression significantly predicted delayed recall memory performance when entered as the first and second predictor. In contrast, anxiety did not significantly predict performance on any of the cognitive measures. Two DASS subscales assess for the physical symptoms of anxiety, and these subscales were not significantly correlated with any cognitive variables. However, the DASS subscales tapping into non-physical aspects of anxiety were significantly associated with several cognitive variables. Patients may have endorsed physical symptoms of anxiety due to the symptoms associated with PD, and not as a result of the genuine presence of anxiety. This could have masked a potential relationship between anxiety and cognitive functioning in PD, and suggests that specific components of anxiety may be associated with cognition in PD. Future adaptation of the DASS may be necessary to differentiate the unique influences of depression and anxiety in PD patients.

The present study firstly aimed to examine specific metacognitions as unique predictors of various psychological symptoms including anxiety, depression, worry and social anxiety. The second aim of the study was to investigate the moderator role of coping styles in the relationship between metacognitions and these psychological symptoms. Based on these aims, the study was conducted with 435 participants between the ages 18-35 and the following scales were administered in addition to demographic forms / Trait Anxiety Inventory, Beck Depression Inventory, Penn State Worry Questionnaire, Libowitz Social Anxiety Scale, Metacognitions Questionnaire-30 and The Ways of Coping Inventory. According to the results, Negative Beliefs Concerning Uncontrollability of Thoughts and Danger (MCQ-2) was found to be as significant predictor of all examined psychological symptoms. Positive Beliefs about Worry (MCQ-1) was also revealed as significant predictor of anxiety, worry and social anxiety and avoidance. Furthermore, the results revealed negative associations between Cognitive Self-Consciousness (MCQ-5) and anxiety, worry and social anxiety. Finally, Beliefs about Need to Control Thoughts (MCQ-4) was found to be related with increase in depression and decrease in worry. In addition, regression analyses revealed negative relationship between Problem-Focused Coping and anxiety, depression and worry / and positive relationship between Emotion-Focused Coping and anxiety, social anxiety and avoidance. The moderation models of coping styles was also supported in which coping ways moderate the relationship between metacognitions and psychological symptoms including depression, absence of worry, social anxiety and avoidance. Findings were discussed based on relevant literature / and clinical implications of the study and future directions were also provided.

I Sverige finns det ca 150 000 personer som lider av demenssjukdom. Hos 90 procent av dessa förekommer beteendemässiga och psykiska symtom vid demens (BPSD). BPSD avser symtom som vanföreställningar, hallucinationer, agitation, depression, ångest, upprymdhet, apati, hämningslöshet, irritabilitet, motoriskt avvikande, sömnproblem och aptit. Syftet med studien var att kartlägga registrerade omvårdnadsåtgärder relaterade till beteendemässiga och psykiska symtom vid demens skattade i tre kommuner i sydvästra Sverige. Studien är en deskriptiv retrospektiv registerstudie som studerar historiska mätdata inmatad i BPSD-registret, gällande beteendemässiga och psykiska symtom vid demens samt dess omvårdnadsåtgärder. Studien innefattar registreringar på personer med demenssjukdom och beskrivs kvantitativt. Urvalet i studien är de registreringar där personerna erhållit omvårdnadsåtgärder för beteendemässiga och psykiska symtom vid demens i de tre kommunerna mellan åren 2011-2014. Sammanlagt inkluderades 621 registreringar. Symtomen som visade sig vara mest frekventa vid skattningarna var agitation, irritabilitet samt motoriskt avvikande. De mest registrerade omvårdnadsåtgärderna vid beteendemässiga och psykiska symtom vid demens visade sig vara, lugn ljudmiljö, massage, fysisk aktivitet och musik. Det behövs mer kunskap om omvårdnadsåtgärder och hur dessa kan underlätta symtomen och öka livskvalitén för personer med demenssjukdom. / About 150 000 people in Sweden are suffering from dementia. 90 percent of these experience behavioral and psychological symptoms of dementia (BPSD). BPSD refers to symptoms such as delusions, hallucinations, agitation, depression, anxiety, euphoria, apathy, disinhibition, irritability, aberrant motor behavior, problem sleeping and problems with appetite. The goal of this study was to identify the registered nursing measures related to behavioral and psychological symptoms of dementia estimated in three municipalities in southwestern Sweden. The study is a descriptive retrospective registry study that looks at historical data in the BPSD registry with regard to behavioral and psychological symptoms of dementia and its nursing measures. The study is described quantitatively and includes registrations of people with dementia. The selected records in the study are those where  people received nursing interventions for behavioral and psychological symptoms of dementia in the three municipalities between the years 2011-2014. 621 registrations were included. The symptoms that turned out to be most frequent in the estimates were agitation, irritability, and aberrant motor behavior. Most registered nursing measures in behavioral and psychological symptoms of dementia included quiet environment, massage, physical activity and music. More knowledge is needed about the nursing interventions and how these can facilitate the symptoms and increase quality of life for people with dementia.

The present study compared children's perceptions of mothers' and fathers' parental rearing styles in White and Hispanic families. Participants included 173 3rd, 4th, and 5th grade children recruited from after-school care programs in the School District of Hillsborough County, Florida. Children completed measures of perceived parenting for both mothers and fathers and a self-report inventory of their own current psychological symptoms. No differences between perceptions of parental acceptance in Hispanic and White families were expected. However, perceptions of hostile control were predicted to be higher for Hispanic fathers than for White fathers. In contrast, perceptions of maternal inconsistent discipline were hypothesized to be higher for Hispanic mothers than for White mothers. Ethnicity was hypothesized to act as a moderator between perceptions of negative parenting and internalizing and externalizing symptomology. Results indicated that there were few differences in parenting practices between White and Hispanic mothers and fathers. Only perceptions of maternal hostile control were higher for Hispanic participants in comparison to White participants when family socioeconomic status was not controlled statistically. Maladaptive parental rearing behaviors were more associated with children's internalizing than externalizing symptomology. These results indicate that Hispanic and White families are more similar in parental rearing styles than theorized originally. For fathers in particular, an emergent view of fatherhood in Hispanic families was supported. Results are discussed in terms of parenting in diverse families.

The goal of this study was to examine how mothers and fathers view children's internalizing and externalizing behavior problems. More specifically, the relationship between certain factors, such as parental psychological symptoms, levels of interparental conflict, characteristics of the behaviors, and discrepancies in mothers' and fathers' ratings of behavior problems were studied in more depth. Using a between subjects, experimental design, mothers and fathers were randomly assigned to view a videotape and rate the behavior of a male or female child acting in either an internalizing, externalizing, or non-clinical manner. Results showed that there were no differences between mothers' and fathers' ratings of the videos and the parents' own psychological symptoms and interparental conflict were not associated with higher ratings of the child in the videos. However, main effects were found for the type of video that the participant watched and the gender of the child in the video. In addition, interactions between the type of video and the gender of the child in the video were found for ratings on the Anxious-Depressed, Withdrawn-Depressed, and Aggressive Behavior subscales of the Child Behavior Checklist (CBCL). In order to explain the present findings, level of contact with children, child socialization, and gender roles were explored in further depth.

Anxiety for adverse health effects attributed to dental restorative materials especially dentalamalgam, have been discussed extensively off and on the last 30 years. The possible health effect ofamalgam and health effect of replacements of amalgam, have been extensively studied but theresults are inconclusive and the etiology of the reactions are not entirely elucidated. Furthermore,the question of psychological influence on symptoms attributed to dental restorative materials hasbeen raised and need further examination. The aims of this thesis were to describe the change in health over time for patient with symptomsattributed to their dental materials and to determine whether replacement of their dentalrestorative materials had any impact on their perceived health. Furthermore, to determine anddescribe the personality, self-image, level of psychological symptoms and stress among thesepatients and compare the results with those of healthy controls. Finally, to evaluate regression ofLichenoid Contact Reactions and Oral lichen Planus after replacement of the dental materials. A questionnaire was mailed to 614 patients that had been referred to the School of Dentistry, Umeå,Sweden with symptoms attributed to dental materials. Among these patients a subgroup with orallichen also underwent a clinical examination at follow-up. The result showed that patients with complex symptoms had a more unfavorable long-termprognosis concerning persistent complaints than those with local symptoms only. The oralsymptoms had decreased between baseline and follow-up and the general symptoms had increased.The increase in general symptoms was contradictory since many patients experienced healthimprovement after removal of their dental restorative materials. Concerning personality thepatients was characterized mainly by high persistence and by high fatigability and asthenia as wellas psychosocially learned high self-acceptance. Regarding self-image, both patients with LocalSymptoms Only and patients with Multi Symptoms, scored significantly higher on "spontaneous"and "positive self-image" than the reference group. The Multi symptoms group scored significantlyhigher on psychological symptoms compared to the reference group. However, the Local symptomsgroup did not differ from the references. The remission of oral lesions was after an exchange ofdental materials was seen to a greater extent in patients with Lichenoid Contact Reaction than inpatients with Oral Lichen Planus. Regarding psychological parameters, there were no significantdifferences between the groups. In conclusion symptoms related to dental restorative materials seem to be multi-factorial wheredental, medical, social, and psychological factors may be involved. Patient with complex symptomshave a more unfavorable prognosis than patient with local symptoms only. Patient with symptomsself-related to their dental materials may feel improvement in general health after an exchange ofdental materials. The group of patients seems to represent personalities that could be vulnerable inthe demanding modern society, and the various mental and somatic symptoms can be interpretedas attributed to dental fillings. Patients with Local Symptoms or Multi Symptoms are equalconcerning self-image, they are impulsive with an elevated positive self-image, that can result indifficulties in setting limits. Thus in combination with high demands may result in mental stress.The Multi Symptoms group was more psychologically stressed than the group with Local SymptomsOnly and the references. Therefore, before an exchange of dental materials is commenced inpatients with oral lichenoid lesions, a correct diagnosis is needed.

Magister Psychologiae - MPsych

Child abuse has been shown to have a detrimental effect on the emotion development of the abused child. Due to a history with the parent that includes a high proportion of negative interactions and an impaired parent-child relationship, the child who has been subjected to physical abuse often manifests psychological symptoms. The purpose of this study was to investigate the effect that treatment aimed at increasing the frequency of positive interaction in the parent-child relationship had on the emotional status of the abused child. Results showed that parent-child interaction play sessions were effective in increasing positive interaction and decreasing subsequent abusive behavior in the parent-child dyad. Self-reported parental attitudes toward the child became more positive. Treatment did not generalize totally and was not maintained totally during follow-up. The effect that treatment had on the emotional status of the abused child was less clear, although some improvement was noted. The results of this study have important clinical implications for therapists working with abusive parents in terms of providing an effective intervention for treatment of child abuse. Further investigation of the treatment is warranted. Suggestions for future research are offered.