The main purpose of this study is to examine the relationships between drugs of choice that family members abused and the non-addicted family member's levels of self-disclosure, self-disclosure avoidance, and trust.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

INTRODUÇÃO: A dependência de álcool é um grave problema de saúde publica no Brasil. Seu tratamento ainda é um desafio, mesmo para os melhores programas terapêuticos disponíveis. Esta dificuldade ocorre pelo pequeno número de medicamentos aprovados para o uso e também pela elevada taxa de abandono, próximo a 50%. A ondansetrona tem surgido como uma medicação promissora para o tratamento de alcoolistas. A identificação de pacientes com maior risco de desistência do tratamento é uma estratégia para reverter essa taxa. Os objetivos deste estudo são: (a) avaliar a eficácia e segurança da ondansetrona na dose de 16 mg/dia; (b) investigar variáveis clínicas e psicossociais capazes de prever maior aderência ao tratamento; (c) desenvolver uma tipologia para alcoolistas com características presentes no início do tratamento; (d) testar se os diferentes tipos podem prever o abandono ao tratamento. METODOS: Trata-se de estudo realizado em três etapas. Na primeira foi realizado ensaio clinico randomizado duplo-cego placebo controlado, com ondansetrona, por 12 semanas, desenvolvido na Universidade de São Paulo - Brasil. A amostra era composta por 102 dependentes de álcool com idade entre 18 - 60 anos. A análise foi realizada com os dados brutos e com os dados imputados. Na segunda etapa, foi combinado o banco de dados deste estudo com os de outros dois ensaios realizados no mesmo local (acamprosato versus placebo e naltrexona, topiramato versus placebo), com número total de 332 dependentes de álcool. A partir da análise de quatro fatores clínicos (idade de início dos problemas com uso do álcool, alcoolismo familiar, gravidade da dependência do álcool e intensidade de sintomas depressivos) foi realizada a análise de cluster tipo K-Means e, após a identificação dos tipos, foi avaliada a associação destes com a adesão ao tratamento. Na última etapa, analisando apenas os participantes avaliados quanto ao desejo pelo álcool (257 alcoolistas) foi realizada uma regressão logística, com variáveis clínicas e psicossociais, para analisar a influência dessas na retenção ao tratamento. RESULTADO: A ondansetrona foi capaz de retardar o tempo para o primeiro consumo de álcool (54,7 versus 40,9 dias) e, também, o primeiro consumo pesado de álcool (58,4 versus 45,4 dias) quando comparado ao placebo. Essa droga não influenciou a percentagem de dias bebidos durante o estudo, mas esteve associada com menor percentagem de dias com consumo pesado de álcool (7,8% versus 11,7%), quando comparado ao placebo, na análise de dados imputados. Na análise de tipologia foram identificados dois grupos de alcoolistas. O tipo de alcoolista caracterizado pelo início precoce dos problemas com álcool, maior histórico familiar de dependência, elevada gravidade de alcoolismo e poucos sintomas depressivos esteve associado a maior chance de descontinuar o tratamento, independente da medicação usada e da participação nos alcoólicos anônimos (AA). Entre as variáveis clínicas e psicossociais estudadas, ter idade mais elevada, participar do AA e o consumo preferencial pela cerveja foram fatores independentes associados a maior adesão ao tratamento. Maiores escores de depressão aumentaram o risco de abandono. CONCLUSÃO: A ondansetrona mostrou ser segura e bem tolerada na dose de 16mg/dia. Foi mais eficaz que o placebo em retardar o primeiro consumo e primeiro consumo pesado de álcool, deixou dúvida sobre seu efeito na percentagem de dias bebidos e de consumo pesado de álcool. O tipo de alcoolista com idade precoce de problemas com álcool, elevada dependência dessa substância, mais história familiar de alcoolismo e menos sintomas depressivos, esteve associado ao maior risco de abandono. Idade mais elevada, frequentar o AA e ter preferência pela cerveja aumenta a chance de completar o tratamento proposto / INTRODUCTION: Alcohol dependence is a serious public health problem in Brazil. Its treatment remains a challenge, even for the best available treatment programs. This difficulty is due to the small number of drugs approved for use and also the high dropout rates, close to 50%. Ondansetron has emerged as a promising drug for the treatment of alcoholics. The identification of patients with increased risk of treatment discontinuation is a strategy to reverse these rates. The aims of this study are: (a) to evaluate the efficacy and safety of ondansetron in a dose of 16 mg/day; (b) to investigate clinical and psychosocial variables that could predict treatment retention, (c) to develop a typology of alcoholics based on clinical factors present at the beginning of the treatment; and (d) to test if different types of alcoholics could predict the higher withdrawal from treatment. METHODS: This study was conducted in three stages. Firstly, a randomized, double-blind, placebo- controlled clinical trial was conducted with ondansetron for 12 weeks, developed at the University of São Paulo - Brazil. The sample consisted of 102 alcoholics aged between 18 and 60 years old. The analysis was performed by using only the sample of adherents and an imputed sample. Secondly, the database of this study was combined with two other clinical trials that were carried out in the same setting (acamprosate versus placebo, and topiramate, naltrexone versus placebo), with a final sample size of 332 alcohol dependents. From the analysis of four clinical factors (problem drinking onset age, family alcoholism, severity of alcohol dependence and intensity of depressive symptoms) a K-means cluster analysis was performed to identify types of alcoholics. In addition, the association between the resulting types of alcoholics and treatment retention was verified. Thirdly, using only the participants who were evaluated for craving on alcohol (257 alcoholics), a logistic regression analysis was run with clinical and psychosocial variables as independent variables to analyze their influence on treatment retention. RESULTS: Ondansetron was able to delay the first alcohol consumption (54.7 versus 40.9 days) and the first heavy alcohol consumption (58.4 versus 45.4 days) compared to placebo. Ondansetron did not have effect on the percentage of drinking days. However, ondansetron was associated with a lower percentage of days with heavy alcohol consumption (7.8% versus 11.7%) in an imputed sample, when compared to placebo. Two types of alcoholics were identified. The type characterized by earlier problem drinking onset age, more family alcoholism, high severity of alcoholism, and fewer depressive symptoms, was associated with a greater chance of discontinuing treatment regardless of medication used and participation in alcoholic anonymous groups (AA). Out of the clinical and psychosocial variables, older age, AA attendance, and beer preference drinkers were independent factors associated with higher treatment retention. Higher scores on depression also increased the risk of dropout. CONCLUSION: Ondansetron showed to be safe and well tolerated at the dose of 16mg/day. It was more effective than placebo in delaying both the first use and the first heavy alcohol consumption. In addition, ondansetron was not effective in decreasing the percentage of drinking days throughout this study. The type of alcoholics characterized by earlier problem drinking onset age, more family alcoholism, high severity of alcoholism and fewer depressive symptoms, was associated with greater risk of dropout. Separately, the variables higher age, AA attendance, and beer preference increased the chance of completing the proposed treatments

Mental health is a major child public health issue in Sweden. The overall aims of this thesis are to explore girls’ and boys’ perspectives on mental health and on mental health-promoting initiatives, and to deepen the knowledge of disclosure and support for ado-lescents at risk of abuse and neglect. Four studies are included in the thesis, and a qualitative descriptive design was chosen. In three of the studies (Studies I, II, and III), adolescents in Sweden were interviewed individually or in focus-groups. In the fourth study (IV) officials and politicians in nine municipalities in Sweden were interviewed, and documents were analysed in a multiple-case-study design. In study I the adolescents were asked about the mental health-promoting dialogue with the school nurse. The results reveal that what the adolescents found important were trustiness, attentiveness, respectfulness, authenticity, accessibility, and continuity. The adolescents also had certain views on what issues to talk about in the health dialogue; physical and psychological issues should be included. In Study II, the adolescents perceived “mental health” to be an emotional experience with positive and negative aspects of internal and relational feelings. Family, friends, and school were regarded as important determinants of mental health by the adolescents. Neither girls nor boys thought that there were any major differences in mental health between girls and boys, but did think they were subject to different expectations. In Study III the results show that adolescents with families with alcohol problems are unsure whether to disclose their home situation to an adult; the adolescents seem to make a risk assessment when looking for trustworthy adults. It is a disclosure process. Friends are confidants and supportive, and sometimes facilitators for contacting adults, when support from adults is needed. Study IV show that even small grants to municipalities for children-at-risk projects lead to more activities for these children and adolescents. But children or adolescents were not involved in the planning or decision-making of the activities. The studies in this thesis show that most important thing for adolescents’ mental health is the relation between adolescents and adults, foremost parents, and between adolescents and friends. In addition, gender and age, adolescents’ perspec¬tives and par-ticipation, and society’s support, including the implementation of the UN Convention on the Rights of the Child, have an impact on adolescents’ mental health, both for ado-lescents in general and for adolescents at risk of abuse and neglect. The results are viewed in relation to the bioecological model, to illustrate how all levels in society influence mental health among adolescents, on an individual and a population plane. The findings have implications for adults: to learn more about adolescents and puberty, and about the home situation for children and adolescents at risk of abuse and neglect; to listen to suggestions from children and adolescents; to include friends in support to adolescents at risk of abuse and neglect; and to include girls and boys in all matters concerning them.

Com a dissolução do matrimônio, a identidade conjugal é desconstruída e vive-se um novo momento, no qual o estabelecimento dos novos projetos existenciais e a oportunidade de um resgate de si mesmo conduz à ressignificação da identidade individual. Partindo desse princípio, esta dissertação teve como objetivo compreender os sentimentos que emergem em homens e mulheres quando perdem o vínculo conjugal. A pesquisa seguiu um desenho qualitativo, tendo como participantes três homens e quatro mulheres divorciados, que residem na cidade de Recife e Região Metropolitana. O instrumento utilizado foi a entrevista semiestruturada e os dados coletados foram submetidos à Análise de Conteúdo Temática. Os resultados indicaram que os sentimentos e emoções mais frequentes apresentaram equivalência em suas aparições nas entrevistas. Entre os positivos estão os sentimentos de liberdade, felicidade e paz. Os sentimentos negativos evidenciam sensação de deslocamento, ciúmes e raiva, mesclados de tristeza, fracasso e saudade. No que se refere às características do luto manifestadas no percurso da ruptura conjugal, constatamos que a maioria dos entrevistados vivenciou sentimentos relativos ao quadro de luto presente na separação. Todavia, três dos participantes, aparentemente, não vivenciaram o luto pela perda sentida, o luto veio de forma tardia, ou seja, a reação emocional surgiu após algum tempo da perda sofrida, apresentando-se de forma exacerbada e intensa, consideradas inadequadas ao momento atual deles. Na tentativa de identificar as interferências provocadas pela separação sobre a saúde dos entrevistados, percebemos que houve novamente um equilíbrio: ora a desvinculação amorosa favorece a manutenção ou a busca por uma melhor qualidade de vida, ora interfere negativamente, afetando a manutenção da saúde. Sobre as estratégias utilizadas para a ressignificação da identidade individual, observamos que a busca e o estabelecimento de um novo vínculo afetivo foi uma estratégia empregada entre os sujeitos estudados, para servir de apoio a esse ressignificar. A maioria deles conquistou a ressignificação da sua identidade individual, conseguindo tornar-se autônomo e capaz de desenvolver a sua individualidade. Eles experienciaram o processo de subjetivação que promoveu o contato consigo, e a partir disso conseguiram conquistar mudanças individuais, significativas desconstruindo identidades conjugais e oportunizando a vivência de novos enfoques de si mesmo. Criaram projetos existenciais capazes de contribuir para a singularidade, crescimento e amadurecimento de si, e do ser com o outro. Esperamos que este trabalho acadêmico propricie discussões sobre o tema, como também inovações nos serviços assistenciais oferecidos pelos órgãos competentes a esse público alvo, favorecendo o resgate da identidade individual / With marriage dissolution, the marital identity is deconstructed and one comes to live a new moment, in which the setting of new existential projects and the opportunity of restoring oneself lead to a new significance of the individual identity. Based on such assumption, this dissertation aimed to comprehend the feelings that emerge in men and women when they lose the power of marital bond. The research followed the qualitative model and had as its participants three divorced men and four divorced women, who reside in the city of Recife and its metropolitan region. The instrument used was a semi-structured interview and the data collected were submitted to a Thematic Content Analysis. The results indicated that the most frequent feelings and emotions were equally present in the interviews. Among the positive ones are the feelings of freedom, happiness and peace. The negative ones evidence the sense of alienation, jealousy and anger, mixed with sadness, failure and missing. Regarding the mourning characteristics shown during the marital break-up process, we found that the majority of the people interviewed had feelings linked to the divorce. However, three of the participants apparently did not experience the mourning, which just came lately, that is, the emotional reaction rose after some time of the loss occurrence, in an exaggerated and intense way, which was no longer compatible to their moment. Attempting to identify the interferences caused by the divorce in the health of the people interviewed, we noticed again a certain balance: now the termination influenced to keep or seek for a better quality of life, now it influenced negatively, affecting their health. About the strategies used to grant new significance to the individual identity, we observed that searching and establishing a new affective bond was a tool used by the individuals studied, in order to support such new significance. The majority of them achieved granting new significance to their individual identities and could become self-reliant and able to develop their own individuality. They experienced the process of subjectivity that put them in touch with themselves, from what they could achieve individual and meaningful changes, and deconstruct marital identities and make possible living new perspectives of themselves. They created new existential projects able to contribute to their own singularity, growing and maturation, including their being towards the other. We hope that this academic work has enhanced the discussions about the theme, as well as innovations in the assistance services offered by the legal bodies to such target audience, favoring the rescue of individual identity.

The MA thesis compares cognitive-behavioral, spiritual and holotropic breathwork approaches in drug abuse treatment. The theoretical part briefly describes a function of some psychotropic substances and drugs in history. It follows the description of drug addiction genesis and drug addiction types. Other chapter of the theoretical part deals with system of treatment for drug addicts and role of psychotherapy in the treatment. There is also a description of three fundamental approaches for three methods used in drug abuse treatment at the end of the theoretical part. The practical part of the MA thesis characterizes the comparison of three institutions, which use different methods in drug abuse treatment. The chosen institutions were: cognitive-behavioral method {--} Červený Dvůr Psychiatric Hospital, spiritual approach {--} Postovice Therapeutic Community, holotropic breathwork method {--} Atelier II Private Psychotherapeutic Centre. Although, each of these institutions provides a treatment for substance (alcohol or other psychotropic drugs) abuse and addiction, their methods / approaches to the treatment have different fundamental bases. This part also contains transcriptions of structured talks with clients who experienced the mentioned methods / approaches. At the end of the MA thesis the selected approaches based on monitored marks are analyzed and compromise approach for drug abuse treatment is suggested.

INTRODUÇÃO: A dependência de álcool é um grave problema de saúde publica no Brasil. Seu tratamento ainda é um desafio, mesmo para os melhores programas terapêuticos disponíveis. Esta dificuldade ocorre pelo pequeno número de medicamentos aprovados para o uso e também pela elevada taxa de abandono, próximo a 50%. A ondansetrona tem surgido como uma medicação promissora para o tratamento de alcoolistas. A identificação de pacientes com maior risco de desistência do tratamento é uma estratégia para reverter essa taxa. Os objetivos deste estudo são: (a) avaliar a eficácia e segurança da ondansetrona na dose de 16 mg/dia; (b) investigar variáveis clínicas e psicossociais capazes de prever maior aderência ao tratamento; (c) desenvolver uma tipologia para alcoolistas com características presentes no início do tratamento; (d) testar se os diferentes tipos podem prever o abandono ao tratamento. METODOS: Trata-se de estudo realizado em três etapas. Na primeira foi realizado ensaio clinico randomizado duplo-cego placebo controlado, com ondansetrona, por 12 semanas, desenvolvido na Universidade de São Paulo - Brasil. A amostra era composta por 102 dependentes de álcool com idade entre 18 - 60 anos. A análise foi realizada com os dados brutos e com os dados imputados. Na segunda etapa, foi combinado o banco de dados deste estudo com os de outros dois ensaios realizados no mesmo local (acamprosato versus placebo e naltrexona, topiramato versus placebo), com número total de 332 dependentes de álcool. A partir da análise de quatro fatores clínicos (idade de início dos problemas com uso do álcool, alcoolismo familiar, gravidade da dependência do álcool e intensidade de sintomas depressivos) foi realizada a análise de cluster tipo K-Means e, após a identificação dos tipos, foi avaliada a associação destes com a adesão ao tratamento. Na última etapa, analisando apenas os participantes avaliados quanto ao desejo pelo álcool (257 alcoolistas) foi realizada uma regressão logística, com variáveis clínicas e psicossociais, para analisar a influência dessas na retenção ao tratamento. RESULTADO: A ondansetrona foi capaz de retardar o tempo para o primeiro consumo de álcool (54,7 versus 40,9 dias) e, também, o primeiro consumo pesado de álcool (58,4 versus 45,4 dias) quando comparado ao placebo. Essa droga não influenciou a percentagem de dias bebidos durante o estudo, mas esteve associada com menor percentagem de dias com consumo pesado de álcool (7,8% versus 11,7%), quando comparado ao placebo, na análise de dados imputados. Na análise de tipologia foram identificados dois grupos de alcoolistas. O tipo de alcoolista caracterizado pelo início precoce dos problemas com álcool, maior histórico familiar de dependência, elevada gravidade de alcoolismo e poucos sintomas depressivos esteve associado a maior chance de descontinuar o tratamento, independente da medicação usada e da participação nos alcoólicos anônimos (AA). Entre as variáveis clínicas e psicossociais estudadas, ter idade mais elevada, participar do AA e o consumo preferencial pela cerveja foram fatores independentes associados a maior adesão ao tratamento. Maiores escores de depressão aumentaram o risco de abandono. CONCLUSÃO: A ondansetrona mostrou ser segura e bem tolerada na dose de 16mg/dia. Foi mais eficaz que o placebo em retardar o primeiro consumo e primeiro consumo pesado de álcool, deixou dúvida sobre seu efeito na percentagem de dias bebidos e de consumo pesado de álcool. O tipo de alcoolista com idade precoce de problemas com álcool, elevada dependência dessa substância, mais história familiar de alcoolismo e menos sintomas depressivos, esteve associado ao maior risco de abandono. Idade mais elevada, frequentar o AA e ter preferência pela cerveja aumenta a chance de completar o tratamento proposto / INTRODUCTION: Alcohol dependence is a serious public health problem in Brazil. Its treatment remains a challenge, even for the best available treatment programs. This difficulty is due to the small number of drugs approved for use and also the high dropout rates, close to 50%. Ondansetron has emerged as a promising drug for the treatment of alcoholics. The identification of patients with increased risk of treatment discontinuation is a strategy to reverse these rates. The aims of this study are: (a) to evaluate the efficacy and safety of ondansetron in a dose of 16 mg/day; (b) to investigate clinical and psychosocial variables that could predict treatment retention, (c) to develop a typology of alcoholics based on clinical factors present at the beginning of the treatment; and (d) to test if different types of alcoholics could predict the higher withdrawal from treatment. METHODS: This study was conducted in three stages. Firstly, a randomized, double-blind, placebo- controlled clinical trial was conducted with ondansetron for 12 weeks, developed at the University of São Paulo - Brazil. The sample consisted of 102 alcoholics aged between 18 and 60 years old. The analysis was performed by using only the sample of adherents and an imputed sample. Secondly, the database of this study was combined with two other clinical trials that were carried out in the same setting (acamprosate versus placebo, and topiramate, naltrexone versus placebo), with a final sample size of 332 alcohol dependents. From the analysis of four clinical factors (problem drinking onset age, family alcoholism, severity of alcohol dependence and intensity of depressive symptoms) a K-means cluster analysis was performed to identify types of alcoholics. In addition, the association between the resulting types of alcoholics and treatment retention was verified. Thirdly, using only the participants who were evaluated for craving on alcohol (257 alcoholics), a logistic regression analysis was run with clinical and psychosocial variables as independent variables to analyze their influence on treatment retention. RESULTS: Ondansetron was able to delay the first alcohol consumption (54.7 versus 40.9 days) and the first heavy alcohol consumption (58.4 versus 45.4 days) compared to placebo. Ondansetron did not have effect on the percentage of drinking days. However, ondansetron was associated with a lower percentage of days with heavy alcohol consumption (7.8% versus 11.7%) in an imputed sample, when compared to placebo. Two types of alcoholics were identified. The type characterized by earlier problem drinking onset age, more family alcoholism, high severity of alcoholism, and fewer depressive symptoms, was associated with a greater chance of discontinuing treatment regardless of medication used and participation in alcoholic anonymous groups (AA). Out of the clinical and psychosocial variables, older age, AA attendance, and beer preference drinkers were independent factors associated with higher treatment retention. Higher scores on depression also increased the risk of dropout. CONCLUSION: Ondansetron showed to be safe and well tolerated at the dose of 16mg/day. It was more effective than placebo in delaying both the first use and the first heavy alcohol consumption. In addition, ondansetron was not effective in decreasing the percentage of drinking days throughout this study. The type of alcoholics characterized by earlier problem drinking onset age, more family alcoholism, high severity of alcoholism and fewer depressive symptoms, was associated with greater risk of dropout. Separately, the variables higher age, AA attendance, and beer preference increased the chance of completing the proposed treatments

Made available in DSpace on 2017-06-01T18:08:51Z (GMT). No. of bitstreams: 1 janaina_andrade_tenorio_araujo.pdf: 43285042 bytes, checksum: 7c7d6b326cfdb4d6422a4f609edb99be (MD5) Previous issue date: 2014-02-25 / With marriage dissolution, the marital identity is deconstructed and one comes to live a new moment, in which the setting of new existential projects and the opportunity of restoring oneself lead to a new significance of the individual identity. Based on such assumption, this dissertation aimed to comprehend the feelings that emerge in men and women when they lose the power of marital bond. The research followed the qualitative model and had as its participants three divorced men and four divorced women, who reside in the city of Recife and its metropolitan region. The instrument used was a semi-structured interview and the data collected were submitted to a Thematic Content Analysis. The results indicated that the most frequent feelings and emotions were equally present in the interviews. Among the positive ones are the feelings of freedom, happiness and peace. The negative ones evidence the sense of alienation, jealousy and anger, mixed with sadness, failure and missing. Regarding the mourning characteristics shown during the marital break-up process, we found that the majority of the people interviewed had feelings linked to the divorce. However, three of the participants apparently did not experience the mourning, which just came lately, that is, the emotional reaction rose after some time of the loss occurrence, in an exaggerated and intense way, which was no longer compatible to their moment. Attempting to identify the interferences caused by the divorce in the health of the people interviewed, we noticed again a certain balance: now the termination influenced to keep or seek for a better quality of life, now it influenced negatively, affecting their health. About the strategies used to grant new significance to the individual identity, we observed that searching and establishing a new affective bond was a tool used by the individuals studied, in order to support such new significance . The majority of them achieved granting new significance to their individual identities and could become self-reliant and able to develop their own individuality. They experienced the process of subjectivity that put them in touch with themselves, from what they could achieve individual and meaningful changes, and deconstruct marital identities and make possible living new perspectives of themselves. They created new existential projects able to contribute to their own singularity, growing and maturation, including their being towards the other. We hope that this academic work has enhanced the discussions about the theme, as well as innovations in the assistance services offered by the legal bodies to such target audience, favoring the rescue of individual identity. / Com a dissolução do matrimônio, a identidade conjugal é desconstruída e vive-se um novo momento, no qual o estabelecimento dos novos projetos existenciais e a oportunidade de um resgate de si mesmo conduz à ressignificação da identidade individual. Partindo desse princípio, esta dissertação teve como objetivo compreender os sentimentos que emergem em homens e mulheres quando perdem o vínculo conjugal. A pesquisa seguiu um desenho qualitativo, tendo como participantes três homens e quatro mulheres divorciados, que residem na cidade de Recife e Região Metropolitana. O instrumento utilizado foi a entrevista semiestruturada e os dados coletados foram submetidos à Análise de Conteúdo Temática. Os resultados indicaram que os sentimentos e emoções mais frequentes apresentaram equivalência em suas aparições nas entrevistas. Entre os positivos estão os sentimentos de liberdade, felicidade e paz. Os sentimentos negativos evidenciam sensação de deslocamento, ciúmes e raiva, mesclados de tristeza, fracasso e saudade. No que se refere às características do luto manifestadas no percurso da ruptura conjugal, constatamos que a maioria dos entrevistados vivenciou sentimentos relativos ao quadro de luto presente na separação. Todavia, três dos participantes, aparentemente, não vivenciaram o luto pela perda sentida, o luto veio de forma tardia, ou seja, a reação emocional surgiu após algum tempo da perda sofrida, apresentando-se de forma exacerbada e intensa, consideradas inadequadas ao momento atual deles. Na tentativa de identificar as interferências provocadas pela separação sobre a saúde dos entrevistados, percebemos que houve novamente um equilíbrio: ora a desvinculação amorosa favorece a manutenção ou a busca por uma melhor qualidade de vida, ora interfere negativamente, afetando a manutenção da saúde. Sobre as estratégias utilizadas para a ressignificação da identidade individual, observamos que a busca e o estabelecimento de um novo vínculo afetivo foi uma estratégia empregada entre os sujeitos estudados, para servir de apoio a esse ressignificar . A maioria deles conquistou a ressignificação da sua identidade individual, conseguindo tornar-se autônomo e capaz de desenvolver a sua individualidade. Eles experienciaram o processo de subjetivação que promoveu o contato consigo, e a partir disso conseguiram conquistar mudanças individuais, significativas desconstruindo identidades conjugais e oportunizando a vivência de novos enfoques de si mesmo. Criaram projetos existenciais capazes de contribuir para a singularidade, crescimento e amadurecimento de si, e do ser com o outro. Esperamos que este trabalho acadêmico propricie discussões sobre o tema, como também inovações nos serviços assistenciais oferecidos pelos órgãos competentes a esse público alvo, favorecendo o resgate da identidade individual

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Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.