This thesis was concerned with determining the scope, nature and impact of pain on quality of life (QOL) among a community-based sample of people with multiple sclerosis (MS). An analysis of the research literature on pain in MS reveals that pain is a significant problem which has historically been underinvestigated and is currently poorly understood. The vast majority of the published literature consists of prevalence studies, descriptive research and clinical reports. Where available, empirical data are often limited by methodological and analytical problems such that substantive conclusions about the scope and nature of MS-related pain remain unclear. Among the most fundamental issues is the extent to which pain is problematic in a population which is already impaired by other physical disabilities. Little is known about how pain contributes to MS-related disability, distress and QOL. Moreover, research examining the psychosocial aspects of MS-related pain is noticeably absent. It is clear that there are substantial gaps in the literature and that many basic questions about the scope, nature and impact of pain problems among individuals with MS remain unanswered. Thus the primary aim of this study was to begin to fill some of these gaps by systematically investigating the following research questions: (1) What is the prevalence and nature of pain experienced by people with MS? (2) What is the impact of pain on the QOL of people with MS, over and above the impact of disability itself? (3) To what extent do physical and psychosocial factors influence adjustment to chronic pain in people with MS? (4) What meaning is given to the pain experience by people with MS? The present study utilised a multimethod research design involving cross-sectional postal survey, structured in-person pain interviews and focus groups. Survey respondents were a 219-person sample recruited from the Queensland MS Society membership database via systematic random sampling. All participants completed a piloted questionnaire containing questions about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the previous two weeks. Respondents who reported pain then completed face-to-face structured pain interviews assessing pain characteristics (viz. intensity, quality, location, extent and duration), pain-related beliefs and coping strategies, and pain management techniques used. Four focus groups were also conducted that included 32 people with MS living in the community. Study participants were a purposive sample drawn from four MS support groups located in the South-East Queensland region. Pain was found to be common with some 67.1% of the sample reporting pain during the two weeks preceding the study. Comprehensive pain assessment revealed that a substantial subset of these individuals experience chronic pain conditions characterised by moderate-to-severe pain intensity. Pain prevalence and intensity were found to be strongly correlated with QOL: physical health, psychological health, level of independence and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. Pain-related beliefs and coping strategies were also associated with and explained a significant proportion of the variance in adjustment to pain among people with MS, over and above that accomplished by demographic and MS-related variables and pain intensity. Finally, qualitative data analysis revealed four broad conceptualisations of the experience of chronic MS-related pain including: pain is pervasive, nobody understands, I'm fine, and always a factor in the equation. These findings suggest that for people with MS, pain is an important source of distress and disability over and above that caused by neurological impairments. These data also lead to the hypothesis that recognition and effective treatment of pain would improve the QOL of people with MS, irrespective of their level of neurologic disability. Although correlational, the findings provide support for a biopsychosocial model of pain and adjustment to pain in people with MS.

abstract: Despite the strong link between pain and depressive symptoms, the mechanisms by which they are connected in the everyday lives of individuals with chronic pain are not well understood. In addition, previous investigations have tended to ignore biopsychosocial individual difference factors, assuming that all individuals respond to pain-related experiences and affect in the same manner. The present study tried to address these gaps in the existing literature. Two hundred twenty individuals with Fibromyalgia completed daily diaries during the morning, afternoon, and evening for 21 days. Findings were generally consistent with the hypotheses. Multilevel structural equation modeling revealed that morning pain and positive and negative affect are uniquely associated with morning negative pain appraisal, which in turn, is positively related to pain’s activity interference in the afternoon. Pain’s activity interference was the strongest predictor of evening depressive symptoms. Latent profile analysis using biopsychosocial measures identified three theoretically and clinically important subgroups (i.e., Low Functioning, Normative, and High Functioning groups). Although the daily pain-depressive symptoms link was not significantly moderated by these subgroups, individuals in the High Functioning group reported the lowest levels of average morning pain, negative affect, negative pain appraisal, afternoon pain’s activity interference, and evening depressive symptoms, and the highest levels of average morning positive affect across 21 days relative to the other two groups. The Normative group fared better on all measures than did the Low Functioning group. The findings of the present study suggest the importance of promoting morning positive affect and decreasing negative affect in disconnecting the within-day pain-depressive symptoms link, as well as the potential value of tailoring chronic pain interventions to those individuals who are in the greatest need. / Dissertation/Thesis / Doctoral Dissertation Psychology 2018

Epileptic seizures are usually stressful episodes for individuals, not least as they are often experienced in public. Most research into epilepsy has been conducted in Western cultures, and we know little about the experiences of people with epilepsy and living in Middle Eastern countries. This study aims to examine the influence of social comparison on the perception of quality of life for people with epilepsy in Iran and in the United Kingdom. Three studies were completed. Two studies were qualitative; exploring individuals’ experiences of living with epilepsy and investigating coping strategies, respectively, (UK = 10, Iran = 10), for each study. Thematic analysis was used for data analysis. The third quantitative study was examined to determine whether social comparison dimensions, (upward negative, upward positive, downward negative, downward positive), predict quality of life in both countries, (N = 100 for each country), and a hierarchical multiple regression was used to analyse data. The first study indicated people compare themselves to others and the unpredictable nature of a seizure causes individuals to perceive negative feelings and experience anxiety, furthermore urinary incontinence attached to seizures appeared to leave people feeling ashamed and anxious. Study two revealed that whilst Iranian people used emotion-focused coping strategies, individuals from the United Kingdom applied problem-focused coping strategies. In Iran religious coping strategies were used to cope with incontinency; however positive social comparison (downward) was used as a coping strategy for incontinency in the United Kingdom. Study three found that self-esteem was the main predictor for quality of life in Iran and the United Kingdom. Whilst a seizure’s severity negatively predicts quality of life in the United Kingdom, positive social comparison (upward) accounted for quality of life in Iran. This study suggests that providing positive role models can help Iranians have a better perception for their quality of life, whereas British people potentially maximise their quality of life through seizure management.

Background: Children and adolescents with intellectual disabilities are at increased risk for peer victimization in schools. Due to the deficits in their social, cognitive, and adaptive skills, these children face greater challenges to stand up for themselves thus, facing continued victimization.   Aim: This systematic literature review sought to critically identify the existing literature on predictors and outcomes which are associated with peer victimization in children and adolescents with intellectual disabilities in a school environment using the Biopsychosocial model. Method: To conduct this study, a systematic search procedure was formulated to retrieve relevant scholarly articles from the chosen databases. Peer reviewed journals were searched to retrieve articles from education, psychology, and social sciences, published in English language between years 2000-2020. Only studies with children and adolescents ages 6 - 21 years were considered. A total of eight articles with five cross-sectional, two cohort, and one case-control studies qualified to answer the research questions. Results: Findings varied across the social and psychological aspects. Social predictors and outcomes were found to be dominant for peer victimization. Internalizing Behaviour Disorders as a whole was identified as a psychological predictor with low self-esteem and depressive feelings as individual predictors and outcomes of peer victimization. Conclusion: Children and adolescents with intellectual disabilities are vulnerable to peer victimization due to deficits in disability characteristics. Exposure to peer victimization can pose serious consequences on their social and psychological well-being. Implications for future research and methodological limitations of this study are also discussed.

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Understanding underlying mechanisms and pathways that lead to chronic homelessness would help develop intervention strategies that could help prevent subsequent episodes of homelessness. Quantitative data for this cross-sectional study was gathered by interviewing individuals who were homeless in the State of Arkansas, using a structured survey between 2007 and 2011. Qualitative data was gathered using semi-structured interviews between 2016 and 2018. Chi-square statistics and a multivariate logistic regression model was used to analyze the quantitative data, while phenomenological methods were used to analyze the qualitative data. Nearly half of the study participants identified themselves as being chronically homeless. Chronically homeless adults in this region were significantly more likely to be older men with no family ties, more likely to be victims of domestic violence, have higher rates of physical health problems, and have alcohol and substance abuse problems. Results from the multivariate nominal regression revealed that individuals who reported themselves as chronically homeless were more likely to be in the 50 years or older age group. In addition, study findings highlighted a dynamic interplay between three biopsychosocial risk factors for homelessness. Fostering development of inclusive sustainable communities, intergenerational relationships, and shared housing practices could help ease such social inequities and prevent problems such as chronic homelessness in older homeless adults.

This study aimed to assess the impact of an Mindfulness-based stress reduction (MBSR) intervention in a program serving women who survived Intimate partner violence (IPV). The biopsychosocial model, formulated by Engel, was the theoretical basis of this study. The impact of the MBSR intervention was assessed by qualitatively evaluating researcher notes and 5 participants' journals and reflections, and quantitatively evaluating 16 participants' self-reported stress, mindfulness, well-being, and optimism before and after the intervention. The themes that emerged from the qualitative data included participants' feelings of relaxation or balance, improved self-awareness, mindfulness exercises becoming easier over time, and improved intentionality. The Kentucky Inventory of Mindfulness Skills (KIMS) self-report inventory was used to assess participants' mindfulness. The KIMS instrument is composed of four subscales: observe, describe, act, and accept. There were significant improvements in the describe and accept dimensions of mindfulness from pretest to posttest, after Bonferroni adjustment. The subscale describe measures how well the participants report being able to describe, identify, or observe mental phenomena in a nonjudgmental manner. There were no significant differences from pre to posttest on stress, well-being, and optimism, a non-equivalent dependent variable not expected to change as a result of the intervention, as optimism is presumed to be a stable personality trait. This study may provide a valuable link to the development of coping and treatment strategies for IPV survivors that can be integrated into therapy programs and individual treatment.