Haiti reports the second highest prevalence of HIV among the Caribbean nations. People living with HIV/AIDS (PLWH) report stigmatic experiences, inadequate social support, depression, and anxiety, thereby affecting treatment adherence. This study examined the relationship between HIV-related stigma and treatment adherence, considering the effects of depression, anxiety, social support, and coping. The current study is a secondary analysis of baseline data collected from 362 PLWH from Haiti. The measures included: Community Programs for Clinical Research on AIDS (CPCRA) adherence questionnaire; Perceived Stigma scale; Brief COPE questionnaire; State-Trait Anxiety Inventory (STAI); Centers for Epidemiological Studies Depression Scale (CES-D); and modified Medical Outcome Study Social Support Survey (mMOS-SSS). Descriptive statistics were used for demographic characteristics. T tests, Person correlations, multivariable linear regressions and structural equation modeling (SEM) were used for estimating the strength of associations and mediating effects. Mean age of the sample was 35.72±8.50 years and 37.0% were men. The mean self-reported treatment adherence was 93.1 percent. About 50.2% reported high levels of perceived stigma, 58.1% reported high levels of social support, 51.1% reported high levels of coping, 45.6% reported depression and 47.2% reported anxiety. Multivariable regression showed that treatment adherence was directly associated with quality of care satisfaction scores (Beta = .032, p = .041) and inversely associated with perceived stigma (Beta = -0.049, p = .031). Depression was directly associated with perceived stigma-public view (Beta = 1.877, p = .037) and inversely associated with tangible/informational social support (Beta = 1.877, p = .020). SEM analyses showed significant associations between perceived sigma and coping (Beta = .175, p = .003), perceived sigma and anxiety (Beta = .164, p = .005), coping and anxiety (Beta = .229, p In summary, HIV-related stigma was associated with lower levels of treatment adherence, and higher levels of depression and anxiety. These findings could be informative for future large scale studies on stigma, coping, anxiety and depression and planning effective interventions for improving treatment adherence.

The aim of this investigation was to determine whether i) affective touch has a role in mediating beneficial social influences on resilience to depression and ii) whether affective touch acts through specific skin CT afferents to enhance central serotonin function. To develop and validate the Touch Experiences and Attitudes Questionnaire (TEAQ), 117 items about experiences and attitudes to touch were completed online by 618 participants. Principal components analysis reduced this to 57 items and 6 factors. Three factors concerned touch experienced; in social situations (CST), in intimate relationships (CIT) and during childhood (ChT) and 3 factors concerned attitude to touch; in intimate relationships (AIT), with unfamiliar people (AUT) and in Skin Care (ASkC). The shortened TEAQ was completed by a second sample of 704 participants. Confirmatory factor analysis found the 6 factor structure to be a good fit of the data, suggesting the TEAQ to be valid and reliable. Participants completed some demographic questions and some questionnaires to determine their current psychiatric symptoms, social circumstances, recent life events, childhood adversity and personality alongside the TEAQ. Currently depressed participants had lower touch scores for all factors compared to healthy controls. Remitted depressed participants had significantly lower touch scores on all factors except CST, ASkC and AIT compared to healthy controls. A multiple regression analysis found neuroticism, satisfaction with social support, recent life events, CIT and childhood adversity (CHA) to be predictive of depression, whereas extraversion, number of social supports, ChT and CST, did not significantly predict depression score. Logistic regression analysis found ChT, CHA and neuroticism to predict vulnerability to depression, but not AIT or AUT. It was concluded that CIT was the most important aspect of affective touch for promoting resilience to depression. The CNS effects of pleasant and unpleasant touch were investigated using fMRI in healthy female volunteers. It has been hypothesised that a novel class of CT afferent fibres in hairy skin encodes affective touch. Therefore, CNS responses to pleasant stroking of the forearm with stroking of the fingers were compared. No differential CNS effects of forearm stroking over finger stroking were seen. Indeed, more brain regions were activated by pleasant brush stroking of the fingers which lack CT afferents. Pleasant brush responses in left inferior frontal gyrus were attenuated by tryptophan depletion. However, the midbrain raphe was activated by unpleasant brush stroking and de-activated by pleasant and this effect was abolished by tryptophan depletion. This study found little evidence that CT afferents in hairy skin have a specific role in affective touch and serotonin cells of the raphe appear engaged by unpleasant stimuli rather than pleasant. In conclusion, the results of the questionnaire study indicated touch (hugs, kisses, stroking) in intimate relationships may promote resilience to depression whereas touch with other social contacts does not, suggesting type of affective touch to be important. It is suggested that future studies of the role of current social support and of early adversity in depression should include assessments of the correlated dimension of affective touch. The fMRI study found little evidence for a specific peripheral touch receptor encoding pleasant affective touch. The median raphe nucleus was inhibited by pleasant touch and this is in keeping with the idea that that aversive stimuli activate serotonin projections to the forebrain but not that this is strengthened by affective touch. Further investigation is required to identify CNS mechanisms of affective touch.

Despite a rise in the number of studies looking at the relationship of psychosocial factors (coping style, personality type, and social support) on HIV/AIDS severity, there remains a lack of conclusive answers about the specific association between these factors. This study used a meta-analytic method of analysis to address these issues in the post anti-retroviral treatment modality world. A systematic search of major psychology and medical computerized databases led to 110 studies used in the meta-analysis. Social support was found to have the strongest relationship with HIV progression. Structural social support had greater protective effect on HIV progression than functional social support. A significant relationship between coping type and HIV severity was found, with a greater protective benefit seen in studies that utilized CD4 count as the outcome variable. Positive coping had a beneficial effect on HIV progression while passive and negative coping had a detrimental effect on disease progression. Among studies of personality, a weak relationship was found between personality type and HIV severity. In conclusion, the meta-analytical review found significant associations between psychosocial factors and HIV severity that could be used to refine individual treatment plans for people living with HIV/AIDS.

Background: Symptomatic heart failure is a chronic and disabling condition that affects over 350 000 Canadians and is characterized by inevitable progression. Historically, research on the ways to increase survival has focused on biomedical factors. However, the continued poor prognosis of heart failure has prompted the search for other ways to improve the lives of these patients. Research in other chronic conditions demonstrates that social circumstances, described collectively as individual social interactions (e.g. social support, social participation) and community social factors (e.g. social capital, social norms), can influence health outcomes. Purpose: The purpose of this research was to describe and assess the impact of selected social circumstances potentially related to heart failure outcomes. Methods: Two literature reviews and one empirical study were performed. Conceptual models were proposed to describe the hypothesized pathways between selected social circumstances and heart failure outcomes. The first review was a systematic review of quantitative studies evaluating the relationship between social support and both rehospitalization and death. The review included a critical analysis of the methods employed by previous studies. The second review integrated the qualitative and quantitative literature describing the relationship between individual social interactions (including support, roles and participation) and the quality of life of patients or experience of living with heart failure. A narrative summary was provided and an integration of findings from both qualitative and quantitative study designs was performed. In the empirical study, patients‘ demographic and clinical information was examined simultaneously with selected community factors in a multilevel analysis. Outcomes of interest included rehospitalization or death of heart failure patients. Results: The systematic review shows that previous quantitative research has linked social support to reduced rehospitalization, but there is little evidence to link it with prolonged survival. The critique of the methods describes an inadequate conceptualization and inconsistent measurement of social support. A conceptual model showing how social support can influence rehospitalization is proposed. The integrative review presents qualitative research that identified the following social interactions as important components of the heart failure experience: social support, social participation and role fulfillment. However, no quantitative relationship between social support and quality of life was found. The potential reasons for the discrepant findings between the qualitative and quantitative studies include: the focus on social support as the only component of social interactions assessed in the quantitative literature; and the inconsistent measurement of social support. A conceptual model is presented to describe the multiple components of social interactions and the theoretical basis for their effects. The multilevel analysis demonstrates that individual factors exerted the strongest effect on heart failure outcomes in most models. Community characteristics had little influence on rehospitalization or death. Study design and analysis issues are proposed to explain these findings. Conclusion: The literature reviews and the empirical study provide a contribution to the population health literature, offering a broad approach to assessing the determinants of disease progression in heart failure patients. This thesis research advances the discussion about which social circumstances may influence heart failure outcomes and their pathways. The use of the proposed conceptual models in future research will help clarify the role of social circumstances in the prognosis of heart failure.

Coworkers can play an important role in helping each other overcome stressful circumstances (Beehr, Jex, Stacy, & Murray, 2000; LaRocco & Jones, 1978; Viswesvaran, Sanchez, & Fisher, 1999), yet work-family researchers have paid significantly less attention to coworker-provided support than they have to supervisor-provided support (Kossek, Pichler, Bodner, & Hammer, 2011). This thesis contributes to the occupational health literature by providing empirical evidence of the benefits of a novel construct termed work-family supportive coworker behavior (WFSCB) – defined as any supportive action that a coworker can take to contribute to the improved management of an individual’s work and family role demands. A phenomenological qualitative investigation revealed five categories of WFSCB that were tested using three quantitative samples to develop and validate a multidimensional measure. The findings indicated that four dimensions of behavior best reflect WFSCB including: 1) emotional support, 2) facilitating work adjustments, 3) sharing resources and knowledge, and 4) proactively developing solutions. In testing the criterion-related validity of the new measure, this research provides evidence of the positive relationship between these behaviors and various work-family outcomes, as higher levels of WFSCB were associated with lower levels of work-to-family conflict, and higher levels of work-family balance, work-family positive spillover, and overall life satisfaction. In addition, the utility of WFSCB as a source of informal workplace support was underscored based on evidence of its incremental validity in the prediction of these same outcome variables over and above a measure of general coworker support (i.e., emotional and instrumental support). Practically, these findings suggest that general measures of coworker support may fall short in assessing a broad spectrum of supportive coworker behaviors that can significantly contribute to improved work-family outcomes. Overall, the results of this research program will place scholars in a better position to provide prescriptive advice to organizations and employees on the behaviors that they can engage in towards one another to promote improved work-family integration for individuals and more broadly, to contribute to a work-family supportive organizational climate.

Masters in Public Administration - MPA / Globally, substance abuse has had a profound impact on society, compounding factors around public health and safety, as well as the social fabric of family systems and communities. The substance abuse problem is complex and requires a comprehensive approach to addressing the phenomenon. Treatment for substance abuse is one aspect of addressing the problem and aims to reduce the harm associated with the use thereof. Treatment demand has increased consistently in South Africa over the past few years and the need for services has been articulated in key legislative and policy documents. Substance abuse is a well-researched field in South Africa; however, limited research exists that captures the experience and perceptions of service users that received outpatient treatment. Various studies conducted in Cape Town in the Western Cape have confirmed an inextricable link between substance abuse and the structural challenges present in historically disadvantaged communities. This study explores the experiences of service users who had completed an outpatient substance-abuse treatment programme in the City of Cape Town's health clinics in Parkwood and Delft South. The objectives of the study are to explore the individual-level and service-level factors impacting on service users' experiences of outpatient substance-abuse treatment, to explore the outcomes of outpatient substance-abuse treatment for service users and to make service-level recommendations and recommendations for further study. Nine research participants for the qualitative study were purposively sampled, as they required certain attributes to respond to the area of study. Data was collected in the form of semi-structured interviews in order to allow for the in-depth exploration into the experiences of service users. Data was analysed with the use of conceptual analysis, where themes were thematically grouped and analysed. Key findings in the study were that the City's outpatient treatment programme is designed exclusively for adult service users. It was, however, found that the age of substance use and the onset of abuse occurred between the ages of 11 and 17-years. The study highlighted the need for the City to modify its outpatient programme to address the needs of youth service users and children of service users to facilitate their adjustment to a parent in recovery. A further finding in the study was the challenges experienced by service users, particularly female service users. It emerged that female service users experienced more stigmatisation than males accessing the service. The need for aftercare treatment post-treatment was a gap identified in the study. In the exploratory study, participants' experiences and perceptions of the City's outpatient programme were positive. The scope of the study was therefore narrow. Recovery, however, remains a challenge for service users due to triggers brought on by structural challenges present in disadvantaged communities, again highlighting the need for coordinated efforts by all government spheres to address the scourge of substance abuse. As a prospect for further study, it is proposed that the long-term impact of the City’s outpatient programme be considered with a larger sample of participants.

Metabolic syndrome is a constellation of risk factors, including abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose, that commonly cluster together and can result in cardiovascular disease. The prevalence of metabolic syndrome and the components that comprise the syndrome vary by age and by racial/ethnic group. In addition, previous research has indicated that the risk factors contributing to metabolic syndrome may be exacerbated by exposure to perceived stress. This study utilized data from the 2002, 2004, and 2006 Health and Retirement Study (HRS) and National Health and Nutrition Examination Survey (NHANES) data sets. It was hypothesized that depression and anxiety (conceptualized as stress in this study) increase the risk of presenting with metabolic syndrome while social support decreases the risk of metabolic syndrome. While results of cross-sectional analysis do not indicate a significant relationship between depression and metabolic syndrome (t = -.84, ns), longitudinal analysis does indicate a significant relationship between depression and metabolic syndrome over time (t = -5.20, p <.001). However, anxiety is not significantly related to metabolic syndrome when the relationship is examined through cross-sectional analysis (t = -1.51, ns) and longitudinal analysis (&#967;² = 13.83, ns). Similarly, social support is not significantly related to metabolic syndrome when examined in cross-sectional (&#967;² = .63, ns) and longitudinal (t = 1.53, ns) analysis. Although level of stress is not significantly related to metabolic syndrome as a whole, there is a significant relationship between stress and both triglyceride level (t = -2.94, p = .003) and blood glucose level (t = -3.26, p = .001).

Forskning kring stressrelaterad ohälsa är vanligt förekommande idag, speciellt kring arbetsrelaterad stress och utmattning. Dock är forskning om återgång i arbete efter utmattning bland läkare tämligen begränsad. Syftet med studien är att undersöka hur läkare som har varit sjukskrivna i utmattning upplever återgången i arbetet, samt vilka faktorer som underlättat eller försvårat återgången. 12 läkare intervjuades med hjälp av en semistrukturerad intervjuguide. Den tematiska analysen av faktorer som underlättade återgången identifierade fem teman, vilka var rehabiliteringsplan från organisationen, socialt stöd från chefen, byte av arbetsplats, tydliga gränser och socialt stöd från anhöriga och kollegor. Den tematiska analysen av faktorer som försvårade återgången identifierade 4 teman, vilka var ansvarsförskjutning av rehabiliteringsplan, frånvarande chefskap, skam och skuld, och kollegialt utanförskap. Viktigast för en lyckad återgång var en anpassad rehabiliteringsplan med en närvarande närmaste chef.

The purpose of this study was to examine the effect of participation in music therapy support groups (MTSG) on physical, psychological, and social functioning of cancer patients and caregivers. Participants were 24 cancer patients and 17 caregivers randomly assigned to experimental (n=21) or wait-list control (n=20) groups. The primary dependent variables were mood, coping, social support, and quality of life as measured by the Profile of Mood States (POMS), State Trait Anxiety Inventory-State (STAI-S) and Trait (STAI-T) scales, Personal Resource Questionnaire 85-Part 2 (PRQ85-Part 2), and Functional Assessment of Cancer Therapy-General Form (FACT-G). These measures, completed by all participants at baseline, midpoint, and end of three weeks, assessed the long-term effect (three weeks) of MTSG participation. The Music Therapy Support Group Numerical Rating Scales (MTSG-NRS) evaluated the short-term effect of each 60-minute music therapy session on mood, pain, stress, anxiety, and quality of life. All participants also completed the Music Therapy Support Group Assessment Form (MTSG-AF) beforehand to provide demographic information and music preferences, and the Music Therapy Support Group Evaluation Questionnaire (MTSG-EQ) after participation in music therapy sessions. Experimental participants completed six MTSG sessions over a three-week period; interventions included singing, songwriting, playing instruments, movement with music, creative arts with music, and music-assisted relaxation. The data from the POMS, STAI-S, STAI-T, PRQ85-Part 2, and FACT-G questionnaires were analyzed using five individual repeated measures ANOVA. The MTSG experimental group showed a significant improvement in mood and a significant decrease in anxiety as a result of participation in the music therapy support groups; the control group showed no significant change over time. The MTSG also showed improvement, though non-significant, on social support and quality of life; the control group remained stable on these measures over time. Data from the MTSG-NRS were analyzed using a Wilcoxon Rank Sum test. Analyses revealed that the MTSG achieved significant improvement in mood and significant decrease in stress and anxiety throughout each 60-minute MTSG session. Participation also significantly decreased the perception of pain and significantly improved quality of life in four of six sessions.

Cancer affects nearly 15 million Americans, and is the second leading cause of death in the U.S. Persons with cancer, including those in recovery, are at increased risk for mental health difficulties; 15% - 25% experience clinically significant depressive symptoms and approximately 12% meet criteria for an anxiety disorder. Poor mental health may be due to heightened levels of stress related to the illness experience, such as uncertainty about the course of disease or adapting to functional impairments (e.g., cleaning, walking) and illness symptoms (e.g., pain). Lack of predictability regarding symptoms and physical limitations may lead to negative mood states, such as fear, worry, or sadness. However, not all persons living with or recovering from cancer, experience psychological distress, perhaps due to individual-level factors, such as social support. An available network of persons (e.g., friends, family) who can provide emotional (e.g., empathy), instrumental (e.g., health advice), or tangible (e.g., assistance with chores) support may lower levels of perceived stress and, in turn, may reduce the likelihood of experiencing psychological distress. Based on this, we examined the linkage between social support and symptoms of psychopathology, and the mediating role of perceived stress. At the bivariate level, we hypothesized that social support would be negatively related to stress and symptoms of depression and anxiety, and that stress would be positively related to both depressive and anxiety symptoms. At the multivariate level, we hypothesized that stress would mediate the relations between social support and symptoms of anxiety and depression, such that higher levels of social support would be associated with lower levels of perceived stress and, in turn, to fewer symptoms of depression and anxiety. Our sample of persons living with, or in remission from, cancer (N = 236) was primarily White (91.5%; n = 216) and female (64.4%; n = 152). Participants completed self-report measures including the Modified Social Support Survey, Perceived Stress Scale, and Multidimensional Health Profile – Psychosocial Functioning. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, all variables were significantly related to one another in the hypothesized directions (p < .01). In serial mediation analyses, the total effect of social support on depressive symptoms was significant (t = -5.22, p < .001), and the direct effect was nonsignificant when stress was added to the model (t = -1.72, p = .09), indicating mediation. In the second model, stress also mediated the relation between social support and anxiety symptoms; the total effect was significant (t = -4.56, p < .001), and the direct effect was nonsignificant (t = -1.73, p = .09). Supporting hypotheses, our results suggest that to the extent one has available social support, illness-related stress may be lessened and, in turn, cancer-affected persons may experience fewer symptoms of depression and anxiety. Therapeutic interventions focused on enhancing one’s social support network (e.g., cancer support groups) or lowering perceived stress (e.g., Mindfulness Based Stress Reduction) may reduce experiences of psychological distress among persons living with, or in remission from, cancer.