The objective of this dissertation was to examine the relation between shyness and quality of life (QoL) among adults with schizophrenia in a series of three studies. I first began by understanding whether commonly used measures of shyness and sociability were reliable in this population (Study 1). Next, I examined two moderating variables related to stress-responses subserved by the central (Study 2) and peripheral (Study 3) nervous systems. Study 1, used self-report questionnaires of shyness and sociability to determine whether individuals with schizophrenia responded to these questionnaires in the same way as healthy controls. Studies 2 and 3 used linear regression analyses to determine whether passive neural responses (ERP’s) to social stimuli (emotional faces) and hormonal levels (baseline salivary cortisol and testosterone), respectively, moderated the relation between shyness and QoL. I found that individuals with schizophrenia responded to self-reported shyness and sociability items in a similar way as their nonclinical peers, suggesting that self-reported shyness and sociability are equivalent across populations (Study 1). Study 2, found that individuals who were shy and displayed a hyposensitivity to the processing of fearful faces displayed the lowest QoL. Those who were shy and took longer to process happy faces also demonstrated hindered QoL. Finally, individuals who were shy and had relatively lower baseline salivary cortisol levels also had the lowest QoL. In all circumstances, individuals who were relatively less shy were not susceptible to factors relating to the central and peripheral nervous system. The results of these three studies show that interpretations of findings using self-reported measures of shyness and sociability can be made with confidence in this population. The results also provide support that factors related to processing stressful stimuli can influence the relation between shyness and QoL, thereby further increasing our understanding of this nuanced relation. Theoretical and practical implications of these findings are discussed. / Dissertation / Candidate in Philosophy / Individuals with schizophrenia have been shown to experience reduced quality of life (QoL). Many studies have tried to understand what factors lead to reduced QoL, with one of them being individual differences in personality. This dissertation focused on the personality trait of shyness and addressed two main questions: 1. Are we correctly measuring shyness in people with schizophrenia? 2. What other factors influence the relation between shyness and QoL among individuals with schizophrenia? I first examined whether the meaning of shyness was equivalent between adults with schizophrenia and nonclinical controls. I then examined two different biological factors (i.e., neural and hormonal) related to stress responses to see if they influenced the relation between shyness and QoL in adults with schizophrenia. The answers to these questions have theoretical and practical implications for helping us understand who is at increased and decreased risk for experiencing hindered QoL, and possible targets for intervention.

Cancer is the second leading cause of death in the United States and a leading cause of death worldwide. The rate of mortality is currently approximately 171.2 out of every 100,000 individuals with a terminal cancer diagnosis annually. Individuals with terminal cancer diagnoses facing probable mortality utilize various coping mechanisms or internal resources in an attempt to maintain an internal sense of well-being, commonly referred to as quality of life (QOL). The purpose of this literature review was to investigate themes prevalent in the literature pertaining to internal coping mechanisms and analyze any correlation or causation linking these resources to a change in QOL in individuals with a terminal cancer diagnosis. The secondary purpose of this review was to interpret and define the healthcare provider’s role in supporting this relationship. A systematic review of the literature was conducted from multiple online databases. Multiple studies related to the overarching themes of internal resources and QOL for individuals with a terminal cancer diagnosis were selected for the review. Results revealed major themes pertaining to correlation between hope and QOL. Studies which analyzed the relationship between hope and QOL found a positive correlation. The literature suggests that healthcare providers are capable of facilitating this relationship between hope and QOL. Healthcare provider facilitation of the relationship between hope and QOL is valuable in the clinical setting, and can aid an individual in achieving a desirable QOL.

Introduction: Dementia is a debilitating health condition affecting all aspects of an individual’s well-being. Quality of life (QOL) and health related quality of life (HRQOL) assessments play a large role in understanding the limitations within the patients’ lifestyle and helping care providers manage their needs better. Therefore, our aims for this thesis were twofold: 1. Explore the symptoms, behaviors, or activities deemed as priorities by caregivers for monitoring dementia progression, impact of treatment, or exploring alternative care, and 2. Examine the measurement properties of QOL and HRQOL measures used for people with dementia living in the community. Methods: For the first aim, a qualitative descriptive study was performed with caregivers of individuals living with dementia. Caregivers from various regions in Canada were enlisted, and virtual listening sessions took place between November 2022 and January 2023. Open-ended questions were employed to prompt participants to express their viewpoints. For the second aim, a systematic review guided by COsensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed to identify literature surrounding measurement properties of QOL and HRQOL measures used in community-dwelling adults with a diagnosis of dementia. A search was performed through four databases (Ovid MEDLINE, EMBASE, CINAHL, and PsychInfo) to identify literature published up until June 2022, followed by abstract and title screening and full-text review, which was performed in duplicate. Measurement properties extracted included structural validity, internal consistency, reliability (test-retest and inter-rater reliability), construct validity, and responsiveness. Risk of bias assessments and quality assessments were also performed for all identified QOL and HRQOL measures. Results: Through the listening sessions, we identified that mobility limitations, social interactions, emotions, feeding behaviors, cognitive difficulties and extrinsic factors were priority topics that caregivers wanted to highlight when assessing QOL for people with dementia. There were 13 dementia-specific and generic QOL and HRQOL measures included in the systematic review. Results showed varying quality of evidence for each of the measures with many having a moderate to very low score for some of the measurement properties. Conclusion: The first study showed dementia caregivers’ perspectives on how routine activities, mobility, social interactions, and behaviors, are important pillars of QOL and should be assessed in clinical and research settings for individuals living with dementia. The second study highlighted the importance of rigorously testing QOL instruments in order to provide accurate measurements when evaluating health concerns and impact of therapy. QOL measures can help researchers and healthcare providers obtain a comprehensive assessment of the individual they are treating. / Thesis / Master of Science (MSc) / Dementia is a disease that affects an individual’s thinking and memory and can affect one’s quality of life (QOL). Family caregivers have firsthand knowledge of their loved ones’ dementia progression and their needs. QOL questionnaires can be used to better understand the health and well-being of an individual who is living with dementia. For individuals with dementia these measures tell us how dementia is changing an individuals QOL over time and how effective the treatment is on their QOL. In this thesis, we explored caregivers’ perspectives on the behaviours and activities of the person living with dementia that should be assessed when monitoring symptom progression and impact of treatment on QOL. We found that domains related to difficulty with everyday activities, changes in mood and behaviour, cognitive difficulties and extrinsic factors are all important to assess when evaluating the impact of treatment on the individual living with dementia. We also reviewed studies that evaluated the measurement properties of QOL questionnaires in individuals living with dementia in the community. QOL questionnaires can be used to measure these outcomes, but there is mixed quality of evidence on the reliability and validity of QOL questionnaires in people living with dementia.

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