The most effective and useful way to diagnose and subtype depression has been a long debated topic which even now does not have a definite answer. The biopsychosocial approach to diagnosis may be a solution to this problem by linking various etiologies to symptom presentation. The biopsychosocial model, in regard to depression, takes into account biological risk factors/contributors, psychological or cognitive risk factors/contributors, and social risk factors/contributors to depression when making diagnosis and subtyping determinations. However, the most effective way to use this model in the assessment, diagnosis, and treatment of depression is not yet clear. In this study, the utility of the biopsychosocial model as an effective approach to conceptualizing and treating depression was assessed by testing hypotheses that showed that etiological contributors are related to the presence and differential presentation of depression, and that these etiologically-based subtypes of depression respond differently to different forms of treatment. These hypotheses were tested using data from the National Comorbidity Survey - Replication (NCS-R). Results showed that the biopsychosocial model can effectively predict the presence, severity and chronicity of depression, and may inform specific biopsychosocially-based subtypes. No conclusions could be drawn regarding success in treatment based on the biopsychosocial model. Future directions for research based on the current study are discussed.

Master of Science / Family Studies and Human Services / Joyce Baptist / This qualitative study explored 65 rural adolescents' perceptions of health issues and needs. Focus groups were conducted with adolescents in six rural communities in Kansas. Analysis of transcripts suggested that the adolescents’ face numerous health issues that strongly influence their behaviors and expressed need for assistance. Adolescent health issues stemmed across biological, psychological, and social factors. Major themes evolved around challenges pertaining to healthy choices in food and nutrition, physical activity, stress management, sexual health, perceptions of invincibility, and poor role-modeling. To improve well-being adolescents need privacy, effective conversations, accessible health services, reliable education, and prioritization of healthy lifestyles. Implications for clinical and research are discussed.

Psychological and contextual factors play an important role in the development and maintenance of chronic spine-related pain, and effective treatment of pain-related conditions requires an understanding of how these factors contribute to pain and disability. The present study examined the relative contributions of spine pathology, psychological complications, and demographic factors to perceived pain intensity and disability in patients with chronic spine-related pain. Because most patients were assessed in the context of a compensable injury, exaggeration of symptoms and disability was systematically controlled for using multiple validity indicators. A high prevalence of psychological complications was observed in the present sample. Analysis indicated that psychological factors were not significantly related to pain intensity, but were significantly related to reported pain-related disability. Further, psychological factors were found to predict pain-related disability beyond demographics, medical findings, and pain intensity. Clinical implications of these findings are discussed.

Childhood obesity has been prevalent for a number of years despite programs designed to educate children and families on healthy diets and activities. Multiple disciplines have reported chronic stress can interfere with normal neuroendocrine functions in the body which include energy balance. Research into alternate mechanisms contributing to childhood obesity is just beginning to include psychosocial factors’ and their influence on biology. Healthy coping strategies can reduce the effects of stress and influence perceptions of what is stressful. Warm, secure relationships with parents, family connectedness, and a secure stable environment all contribute to the buffering of chronic stress as well as promote the ability to cope with stress. Through the years, changes in the family environment through divorce, single parenthood, and cohabitation may play a role in the child’s ability to cope with stress. Therefore, the purpose of this study was to explore relationships between the child’s perceptions of chronic stress, coping strategies, family connectedness, family characteristics, and weight in 4th and 5th grade children. This study used a cross sectional and correlational design. The conceptual framework guiding this study was the Bio-Psycho-Social Model for Health integrating the three dimensions (biological, psychological, and sociological) as they relate to obesity in children. Well established instruments were used to measure chronic stress, coping, family connectedness, and weight. Results did not reveal a relationship between chronic stress and children’s weights. The ‘frequency the family sat down to eat dinner together’ was significantly related to weight: the more dinners together the lower the body mass indices and accounted for 14.7% variance in children’s body mass indices. Frequency of family meals was also correlated with the frequency of cooking dinner and negative trending of both ‘frequency’ and ‘helpfulness’ of coping strategies: possibly suggesting less need for the coping strategies. Parents’ education was positively correlated with more sleep on school nights for children. The findings suggest the importance of family time together is related to lower body mass indices in children. / text

The objective of this study was to elucidate the possible importance of factors from the social environment for the development of depression. As a theoretical framework, Engel's biopsychosocial model (Engel, 1980), based on systems theory, has been applied. Proceeding from the single individual (characterized by experience, personality, behaviour) as the highest level of the organismic hierarchy the following system levels have been taken into account: dyads, family, community, culture-subculture. The depressive patients (n=lll) showed to be living in a narrowed social network and to lack confiding relationships compared with a non-psychiatric control sample (n=98). The personality characteristics (e.g. anxiety, detachment, suspicion) of the patients were related to experienced loneliness, contact difficulties, social network features and leisure activities. By means of a discriminant analysis 83% of the subjects could be correctly classified. In a study of perceived parental rearing, depressives showed to have experienced lack of emotional warmth. As regards social class an overrepresentation of social class III in the subgroups of unipolar, bipolar and unspecified depression was observed. Finally, implications for treatment are discussed in favour of a combination of drug and cognitive psychotherapy. Future research strategies are also suggested. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1985, härtill 8 uppsatser.</p> / digitalisering@umu

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The current research examined the proposition that individuals who were securely attached had a fundamentally different reaction and experience of chronic pain to the experience of individuals with an insecure attachment style. A biopsychosocial model of chronic pain was created that included the variables of attachment style, pain, depression, anxiety, somatisation, quality of life, function, disability, neuroticism, age and gender. Three cross-sectional quantitative studies and one qualitative study were conducted. Participants were (a) patients from a multidisciplinary pain centre in a major public hospital, and (b) members of the general population with chronic pain who were recruited from both urban and rural settings, across various community support groups. The total sample was 470. Instruments for the quantitative studies included the Revised Adult Attachment Scale (Collins & Read, 1990), the McGill Pain Questionnaire (Melzack, 1975), the Pain Patient Profile (Tollinson & Langley, 1992), the Quality of Life Inventory (Frisch, 1994), the International Association for the Study of Pain Assessment Protocol (International Association for the Study of Pain, 1986), the Migraine Disability Scale (Stewart, Lipton, Kolodner, Liebermann, & Sawyer, 1999), and the short form of the Eysenck Neuroticism Scale (Eysenck, Eysenck, & Barret, 1985). The clinical and non-clinical participants with a diagnosis of chronic pain syndrome were partitioned as securely or insecurely attached. In the clinical sample, the proportion of securely attached individuals was less than one quarter of the group, while in the non-clinical sample the proportion of individuals in the securely attached group was 50%. For Study 1, (200 individuals from the clinical sample), the groups were partitioned using the classification criteria of Collins and Read (1990). Securely attached participants = 27%, insecurely attached 73%. An analysis of effect of attachment style on overall pain showed that the Securely Attached group reported less overall pain than the Insecurely Attached group. For Study 2, (using the total clinical sample), the sample comprised 27.3% securely attached and 72.7% insecurely attached participants. The Securely Attached group reported less overall Pain, less Negative Affect and Somatisation than the Insecurely Attached group, and higher levels of Quality of Life. Somatisation provided a significant unique contribution of variance to predicting overall Pain, providing some support for the biopsychosocial model, and Negative Affect (Depression and Anxiety combined) made a significant unique contribution to Quality of Life, explaining 26% of the variance. Gender was unrelated to any variable. For Study 3, the sample consisted of rural and urban participants, and the rural group was significantly older than the urban group. No other differences were found. The groups were combined to form the non-clinical group. The group was evenly divided (50%) between securely and insecurely attached groups. Gender was unrelated to any variable. For the non-clinical group, using the variables investigated in Study 2, there was no difference on overall pain scores, but negative affect and somatisation were higher and quality of life lower in the insecure group than in the secure group. No differences were found on Pain Intensity but Pain Pattern differed between the groups. Three new variables were added to the model - Neuroticism, Function and Disability. Disability and Function were significantly different between the attachment style groups. Age was significantly related to lower pain scores, less loss of function, less disability and higher quality of life. Pain scores were most related to somatisation, with age and quality of life contributing significant variance. Neuroticism added further to this explanation. Negative Affect made the most contribution to the variance explained in quality of life, and neuroticism and function made no significant contribution. Neuroticism and Attachment Style contributed significant amounts of variance to Function. To compare the Secure and Insecure Attachment groups in the Clinical and Non-clinical samples, a matched groups study, N = 190, was conducted. Clinical and non-clinical participants were matched for Age, Gender and Attachment Style. No differences were reported on overall pain between the attachment groups, but differences existed on negative affect, somatisation and quality of life. For sample type, the clinical group reported higher overall pain scores, less negative affect and less somatisation, but no differences were found on quality of life, compared to the non-clinical group. Study 4 was a qualitative study that used structured interviews of 24 clinical and non-clinical participants matched for age, gender, attachment style and etiology. The securely attached group reported having extensive, positive social support, high community involvement and appropriate reliance on medical and allied health care and medications. The insecurely attached group reported more problems with physical pain and psychological distress, less social support, less function and more perceived disability. The insecurely attached group reported more use of medical, allied and alternative health resources. Older securely attached individuals reported the lowest overall pain scores and the highest quality of life. These results support the hypotheses that a secure attachment style contributes to more positive outcomes for individuals with chronic pain syndrome and were consistent with a model of chronic pain that includes biological, psychological and social variables.

Workplace bullying is recognised as a major psychosocial stressor in various professions and can have severe effects on health. Teachers are distinguished as an occupational group that is severely affected by this phenomenon. The general objectives of this research study were to firstly investigate teachers’ experiences of workplace bullying and its effects on health, and secondly, to develop a multi-level intervention programme that can be implemented to address workplace bullying and its effects on health in this context. This research study was conducted in two phases. The biopsychosocial model was applied as a theoretical foundation in the first phase. Participants were sampled by means of informative and educational articles that were placed online and in printed media. Selection criteria were applied to sample a group that was representative of victims of workplace bullying. Ultimately, twenty-seven teachers were included in this study. A qualitative, phenomenological research design was used to explore teachers’ experiences of workplace bullying and its effects on health. Data was specifically gathered by means of semi-structured interviews and personal documents. Semi-structured interviews were audio-recorded and data was transcribed verbatim. Methods of Interpretative Phenomenological Analysis were applied to analyse and present the data. Findings were supported with verbatim quotes and a literature control. Teachers’ reports indicated that workplace bullying is mostly perpetrated by principals and that colleagues are often also involved in the process. Bullying behaviours were aimed at attacking the character, as well as the work of teachers. Organisational channels were often exploited to bully teachers. Certain behaviours were an infringement of teachers’ human and labour rights. Findings are also analogous to the theory and dynamics that is depicted by the biopsychosocial model. Escalating stress and trauma were reflected in teachers’ physical, psychological and social health. The experience of workplace bullying firstly impacted on their psychological health, which was also accompanied by various physical health problems. Major depressive episodes and/ or symptoms of depression were mostly reported. Some teachers also reported symptoms of posttraumatic stress disorder, complex-posttraumatic stress disorder, and panic attacks. Teachers’ ill-health experiences further negatively impacted on their social and professional relationships. The school organisation is affected. The result is teachers with a lost passion for the profession, lowered work performance, increased absenteeism, and teachers’ intention to leave the profession. Findings finally indicated that certain personal and organisational characteristics facilitate and sustain workplace bullying. Relevant literature, field notes during the research process and findings in the first phase of this study guided the development of a multi-level intervention programme for the South African teaching profession. Strategic intervention activities were suggested to address some of the causes, as well as the physical, psychological and social health effects of workplace bullying. A strategic and methodological approach to multi-level intervention was also developed and proposed. Strategic intervention activities were ultimately suggested for the professional, social/ community, individual/ familial, dyadic, organisational, managerial, and work group level. / Thesis (PhD (Educational Psychology))--North-West University, Potchefstroom Campus, 2013

Workplace bullying is recognised as a major psychosocial stressor in various professions and can have severe effects on health. Teachers are distinguished as an occupational group that is severely affected by this phenomenon. The general objectives of this research study were to firstly investigate teachers’ experiences of workplace bullying and its effects on health, and secondly, to develop a multi-level intervention programme that can be implemented to address workplace bullying and its effects on health in this context. This research study was conducted in two phases. The biopsychosocial model was applied as a theoretical foundation in the first phase. Participants were sampled by means of informative and educational articles that were placed online and in printed media. Selection criteria were applied to sample a group that was representative of victims of workplace bullying. Ultimately, twenty-seven teachers were included in this study. A qualitative, phenomenological research design was used to explore teachers’ experiences of workplace bullying and its effects on health. Data was specifically gathered by means of semi-structured interviews and personal documents. Semi-structured interviews were audio-recorded and data was transcribed verbatim. Methods of Interpretative Phenomenological Analysis were applied to analyse and present the data. Findings were supported with verbatim quotes and a literature control. Teachers’ reports indicated that workplace bullying is mostly perpetrated by principals and that colleagues are often also involved in the process. Bullying behaviours were aimed at attacking the character, as well as the work of teachers. Organisational channels were often exploited to bully teachers. Certain behaviours were an infringement of teachers’ human and labour rights. Findings are also analogous to the theory and dynamics that is depicted by the biopsychosocial model. Escalating stress and trauma were reflected in teachers’ physical, psychological and social health. The experience of workplace bullying firstly impacted on their psychological health, which was also accompanied by various physical health problems. Major depressive episodes and/ or symptoms of depression were mostly reported. Some teachers also reported symptoms of posttraumatic stress disorder, complex-posttraumatic stress disorder, and panic attacks. Teachers’ ill-health experiences further negatively impacted on their social and professional relationships. The school organisation is affected. The result is teachers with a lost passion for the profession, lowered work performance, increased absenteeism, and teachers’ intention to leave the profession. Findings finally indicated that certain personal and organisational characteristics facilitate and sustain workplace bullying. Relevant literature, field notes during the research process and findings in the first phase of this study guided the development of a multi-level intervention programme for the South African teaching profession. Strategic intervention activities were suggested to address some of the causes, as well as the physical, psychological and social health effects of workplace bullying. A strategic and methodological approach to multi-level intervention was also developed and proposed. Strategic intervention activities were ultimately suggested for the professional, social/ community, individual/ familial, dyadic, organisational, managerial, and work group level. / Thesis (PhD (Educational Psychology))--North-West University, Potchefstroom Campus, 2013

Vulvodynia, a common form of chronic vulvovaginal pain, is conceptualized as a multifactorial chronic pain condition. Research has examined the role of numerous physiological, psychological, and social factors in the development and maintenance of vulvodynia, however, health care experiences have not been closely examined in this clinical population. Three online studies were conducted to investigate the health care experiences of women with chronic vulvovaginal pain. Study 1 examined pelvic examination (PE) experiences in women with and without chronic pain during intercourse. During their last PE, women with pelvic and vulvovaginal pain reported significantly more pain and anxiety compared to women without pain during intercourse. Various predisposing (first PE experience), examination (quality of patient- physician interaction, physician gender), and psychological factors (vaginal penetration cognitions, body image) predicted PE ratings in women with and without pain during intercourse. Study 2 more broadly examined pain and adjustment in women with vulvovaginal pain. Pain-related beliefs (i.e., attributional style, perceived control) were related to health care variables and predicted adjustment. First, global attributions predicted depressive symptoms and pain-related cognitions/responses after controlling for pain severity and interference. Second, chance beliefs moderated the relationship between pain-related cognitions/responses and internal attributions. Third, women with higher chance and lower physician pain beliefs reported lower social support. Study 3 investigated the knowledge, attitudes, and comfort of Canadian medical residents in Family Medicine and Obstetrics and Gynecology (OBGYN) about vulvodynia. OBGYN residents later in their training reported greater knowledge and comfort with vulvodynia and its symptoms than their more junior counterparts; ratings did not significantly differ between specialties. Residents did report significantly more positive attitudes toward patients with ii vulvovaginal pain of identifiable pathology in comparison to patients with no physical findings. Comfort discussing sexuality in medical practice was a significant predictor of knowledge, attitudes, and comfort with vulvodynia after controlling for demographics/training variables. These findings offer a multidimensional perspective on the role of health care in biopsychosocial models of vulvovaginal pain, and have implications for the assessment and treatment of vulvodynia and Genito-Pelvic Pain/Penetration Disorder. / Thesis (Ph.D, Psychology) -- Queen's University, 2014-04-24 16:39:05.723