Among several difficulties associated with immigration, acculturation process has been recognized as one of the main stressors and one of the major risk factors associated in the incidence of mental disorders. The strategies adopted by individuals to deal with the acculturation process appear to be predictive of different mental health outcomes. This exploratory study investigated the relationship between acculturation strategies and the occurrence of symptoms of depression in the context of the Brazilian immigrant community living in the Greater Toronto Area. The results demonstrated that Separation and Assimilation were the predominant strategies for this sample and that acculturation strategies failed to serve as significant predictors of depression scores. However, participants with Separation as their predominant acculturation strategy exhibited higher depressive symptom endorsement. The significance of these findings in the context of previous research as well as its implications for future research and critical multicultural practice in mental health are discussed.

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.

Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress.

Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress. / <p>Name change: Paper 2, "Psychological health in lesbian and heterosexual couples undergoing assisted reproduction" in the list of papers has been changed to "Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study"</p>

Background: Alongside experiencing physical symptoms with no identifiable organic cause, patients with MUS commonly experience comorbid anxiety and depression. They also have high health utilisation costs, which has implications for the health service. Interventions which target these symptoms in a cost effective way need to be developed and evaluated. Objective: To develop and evaluate a self-help mindfulness-based stress reduction (MBSR) intervention for patients with medically unexplained symptoms (MUS). Methods: A systematic review of the literature was carried out to evaluate the effectiveness of MBSR for reducing psychological distress in people with MUS. Study 1 developed and evaluated a self-help MBSR intervention in a clinical setting. Fifteen participants were recruited from eight practice, however only five completed post-intervention measures. A combination of t-tests and descriptive statistics were used to compare changes in levels of psychological distress, quality of life, symptoms and mindfulness at post-intervention. Pearson‘s correlations were used to identify relationships between improvements in mindfulness and improvements in outcomes. Study 2, exploring the reasons for the difficulties recruiting participants to Study 1, was then carried out through questionnaires to GPs. Results: Though more evidence is needed, the systematic review found MBSR to have moderate effects on psychological distress, which are largely maintained or improved at follow-up. Study 1 found symptom frequency and levels of acceptance to have improved at post-intervention. Study 2 found that the main reasons for GPs not recruiting participants was that they were busy and found it difficult to prioritise given other demands. Conclusions: Evidence to date suggests that MBSR is an effective intervention for patients with MUS. Future studies may benefit from recruiting participants from relevant organisations or using alternative methods such as database searches. No firm conclusions can be made about the self-help MBSR intervention‘s efficacy due to the study‘s limitations, however changes seen in the completer group suggest that further research would be warranted.

Chronic illness affects nearly half of all American adults, yet this experience is often regarded as socially normative for older adults. In this study, I examined chronic illness onset early in the life course and its effects on mastery, a person’s self-perception as capable of coping with and managing life’s circumstances, and depressive symptoms as informed by the life course perspective and the stress process model. Using multilevel modeling of American Changing Lives Survey (ACLS) data, I examined the following questions: What is the relationship between early onset chronic illness and mastery? Second, what is the relationship between early onset chronic illness and depressive symptoms? Does mastery mediate the relationship between early onset chronic illness and depressive symptoms? Is early onset chronic illness (24-35) more strongly associated with decreased mastery and increased depressive symptoms than illness onset at the more socially normative life stages of mid-life (36-64) and late-life (65 years and older)? Lastly, does mastery mediate or moderate the relationship between timing of illness onset and depressive symptoms? Through this study, I aim to contribute to sociological knowledge of whether and how chronic illness impacts mastery and depression among young adults. I argue that ill-timed chronic illness impacts young adults’ sense of control over their lives, which has enduring psychological and social consequences. Findings support that healthy and chronically ill young adults do not significantly differ on mastery, but ill young adults report significantly higher depressive symptoms than healthy same age peers. Mastery moderates the effects of timing of illness onset on depressive symptoms with older adults reaping greater benefit from mastery against depressive symptoms than young adults with early onset illness. These findings suggest that early onset chronic illness positions people at greater risk for poor mental health outcomes and that the chronic illness experience and its effects are not uniform across the life course. Consequently, work in this area must consider age as an important context in which the life event of chronic illness onset occurs.

The purpose of the study is to examine young children's internalizing and externalizing behaviors in the context of post paternal incarceration by focusing on both risks (i.e., parental depressive symptoms), protective factors (i.e., coparenting alliance), and their impact considered together. The final sample included 426 previously incarcerated fathers and the biological mothers of their three-year-old children. Using hierarchical multiple regression, I examined three sets of analyses: 1) the association between parental depressive symptoms and children's behavior outcomes, 2) the association between coparenting alliance and children's behavior, 3) the association between parental depressive symptoms and children's behavior as moderated by coparenting alliance. Expectedly, higher paternal depressive symptoms were associated with higher externalizing behavioral problems in children. Unexpectedly, higher maternal depressive symptoms were associated with lower externalizing behavioral problems. Also, unexpectedly, the associations between maternal and paternal coparenting alliance and both child behavioral outcomes were not statistically significant. Further, when mothers reported lower coparenting alliance with their child's father, the negative association between fathers' depressive symptoms and children’s internalizing behavioral problems was not attenuated; in fact, children had higher internalizing behavioral problems. My findings suggests father's depressive symptoms are an important point of consideration given the deleterious effects parental depressive symptoms can have on children, and the risks for depressive symptoms among formerly incarcerated fathers. Further, my findings have implications for addressing and treating fathers' depressive symptoms when children are relatively young in order to lower internalizing behavior problems from persisting across and beyond childhood.

Background: Dysfunctional breathing (DB) is a respiratory disorder involving an upper chest breathing pattern and respiratory symptoms that cannot be attributed to a medical diagnosis. Aim: The overall aim of this thesis was to describe patients with DB and investigate clinical outcomes after physiotherapy treatment. Methods: Study I was descriptive and comparative, that included 25 patients with DB and 25 age- and sex-matched patients with asthma. Health-related quality of life (HRQoL), anxiety, depression, sense of coherence, influence on daily life due to breathing problems, respiratory symptoms, emergency room visits and asthma medication were investigated. Study II, a 5-year follow-up study based on the same sample as study I (22 patients with DB, 23 patients with asthma), studied treatment outcomes after information and breathing retraining. Study III was descriptive and correlational (20 healthy subjects), investigating whether the Respiratory Movement Measuring Instrument (RMMI) can discriminate between different breathing patterns in varying body positions. Study III also studied correlations between respiratory movements and breathing volumes (12 healthy subjects). Study IV was a single-subject AB design with follow-ups. Self-registered patient-specific respiratory symptoms and respiratory-related activity limitations and breathing pattern (measured with the RMMI) were evaluated after an intervention consisting of information and breathing retraining in five patients with DB. Results: Patients with DB had lower HRQoL (SF-36): vitality (mean 47 vs. 62), social functioning (70 vs. 94) and role emotional (64 vs. 94) (p&lt;0.05) than patients with asthma. The DB group had a higher prevalence of anxiety (56% vs. 24%) and experienced more breathing problems than the asthma group. Patients with DB had made several emergency room visits and had been treated with asthma medication. At the 5-year follow-up, patients with DB showed improved HRQoL (SF-36): physical function 77 to 87 (p=0.04), decreased breathing problems and emergency room visits, and they were not treated with asthma medication. The RMMI can differentiate between different breathing patterns in different body positions. Strong correlations between respiratory movements and breathing volumes were observed (rs 0.86-1.00). The results in study IV indicate that patients with DB benefit from information and breathing retraining regarding decreased respiratory symptoms and activity limitations and improved breathing pattern.

Bakgrund: Hjärtsvikt är en av de vanligaste folksjukdomarna som drabbar båda könen, men främst äldre människor. Vid hjärtsvikt krävs optimal behandling och bra egenvård i form av patientutbildning för förbättrad livskvalitet. Egenvård kräver patientutbildning i syfte att stärka patientens förmåga att lindra effekten av sin hjärtsvikt. Syfte: Syftet är att beskriva vad som hindrar att genomföra egenvård och vad som påverkar livskvaliteten hos patienter med hjärtsvikt. Metod: Det här arbetet är en litteraturöversikt. Fjorton vetenskapliga artiklar med olika metoder hämtades i databaserna CINAHL, Pub och PsycINFO. Artiklarna lästes igenom och utmynnade i huvudkategorier och underkategorier. Resultat: Resultatet visar brist på egenvårdutbildning medför brist på kunskap, ekonomiska begränsningar och brist på förtroende. Ensamboende och brist på förtroende och multisjuklighet. Fysiska förändringar sker på grund av kliniska symtom och dessa komponenter utgör hinder för egenvård, vilket försämrar livskvalitet. Symtomen från hjärtsvikt har negativ inverkan på dagliga och sociala aktiviteter. Kognitiva förändringar i samband med hjärtsvikt leder till försämrad koncentrationsförmåga och dåligt minne. Diskussion: Minskad egenvård relaterade till fler besök till sjukhuset. Kliniska symtom på hjärtsvikt var det som mest påverkade patienternas livskvalitet och hindrade dem från att fortsätta leva som tidigare. Nedsatt fysisk förmåga försvårade för patienterna att kunna fortsätta jobba som tidigare, vara social eller bibehålla sina tidigare hobbyer. / Background: Heart failure is one of the most common diseases that affect both sexes, but mainly elderly people. In heart failure requires optimal treatment and good self-care in the form of patient education to improve quality of life. Self-care requires patient education in order to enhance the patient's ability to mitigate the effects of its failure. Aim: The purpose is to describe what prevents implement self-care and what affects the quality of life in patients with heart failure Method: This work is a literature review. Fourteen scientific papers with different methods was picked in the databases CINAHL, PsycINFO and Pub. The articles were read through and resulted in major categories and subcategories. Results: The results show a lack of self-care education means lack of knowledge, financial constraints and lack of confidence. Living alone and lack of trust and multimorbidity. Physical changes happen because of clinical symptoms and these components constitute barriers to self-care, which impairs the quality of life. Symptoms of heart failure have a negative impact on daily and social activities. Cognitive changes associated with heart failure leads to impaired concentration and poor memory. Discussion: Reduced self-care related to more visits to the hospital. Clinical symptoms of heart failure was the most affected patients' quality of life and prevented them from continuing to live as before. Reduced physical ability it difficult for patients to be able to continue working as before, be social or maintain their previous hobbies.

ABSTRACT Heart disease is the number one killer of American women regardless of age or race. Women still face disparity in the assessment and recognition of heart disease. One key element that contributes to this delay is a prodromal symptom presentation that may impede quick assessment and streamline treatment for cardiovascular events. The aims of this project, using best evidence and initial testing with data from Arizona Health Sciences Center Clinical Research Data Warehouse, is to construct a women's Cardiac Prodromal Symptoms Recognition Assessment List to increase early recognition of cardiovascular etiology, resulting in earlier diagnostics and treatment. A literature review was completed to determine a list of current cardiac prodromal symptoms in women. Symptom data was mined from the clinical research data warehouse and compared to the symptom list. The project results support that prodromal symptoms are valid as identifiers of women experiencing a cardiac event. The literature review identified ten prodromal symptoms; Chest Pain/Discomfort, Shortness of Breath, Fatigue, Arm/Shoulder Pain, Weakness, Nausea/Indigestion, Back Pain, Jaw Pain, Sleep Disturbance and Dizziness/Syncope that are consistent in the literature. The Clinical Research Data Warehouse (CRDW) clinical elements did match the literature prodromal symptoms list with the additional elements of edema defined as a physical finding and depression defined as a risk factor. Application of the literature review and mined clinical data provide an opportunity to explore a clinical issue such as cardiac prodromal symptoms recognition for women and to assist providers in rapid identification and treatment initiation for women experiencing cardiac events.