The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

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

Although professionals in psychiatry, psychology and medicine claim to endorse the biopsychosocial model as proposed by George L. Engel (1977), clinicians in all three fields still tend to underutilize it. Some academics have also criticized the model for its inadequate emphasis on cultural contextualization. To improve upon the model, I sought to empirically establish the relationship between culturally-specific social factors and psychological disorder, in this case depressive symptoms in Mexican-American adults. Eighty-six Mexican-American participants living on the US-Mexico border completed scales measuring depressive symptoms, bidirectional acculturation, living situation, diabetes, and health beliefs regarding the origins of diabetes. The results revealed that diabetes, acculturation, and gender were not associated with depressive symptoms in this population, even when controlling for mental health biases. This finding is in contrast to findings from other literature that associated diabetes, low acculturation and gender with depression in Hispanic adults. Extended family cohabitation was also not associated with lower numbers of depressive symptoms, despite the importance of familism and the extended family unit in Mexican-American culture. Unemployment was significantly related to number of depressive symptoms in both genders. There was no significant relationship between acculturation and health beliefs. These results indicate the importance of studying psychological disorders within the context of specific population groups that transcend vague censual terms. The discussion addresses methodological concerns and further directions for research concerning gender roles, chronic illness, depression and out-of-home employment in Mexican-American adults.

Summary: Low back pain is the most common reason for referral to musculoskeletal care in the Canadian military. With healthcare seeking for musculoskeletal care rising over the past five years, and healthcare easily accessible for all military personnel, it is important to investigate factors that may contribute to high usage of the military healthcare system. Objective: To explore the association between LBP prognostic factors and musculoskeletal healthcare seeking for LBP in Canadian military population Methods: Historical cohort study, using data linkage. Results: In our exploratory analysis, fear of movement/(re)injury, Veterans Affairs compensation status, post-traumatic stress disorder, previous high use of musculoskeletal services, history of LBP, and military duty status were associated with healthcare seeking. For our confirmatory analysis, pain-related fear had an independent association with healthcare seeking in this population. Conclusion: Psychological and social factors are associated with the rate of musculoskeletal healthcare seeking in this military population.

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

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.

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Considering that work represents the main goal in people lives, the Quality of Work Life (QWL) and occupational health become relevant when work market is instable and insecure (COHEN, 2003). Regarding this, the biopsychosocial approach of QWL assessment understand the individual as part of the whole, comprehending its own potentials and biological, psychological and organizational aspects, which contribute to frame the human condition (LIMONGI-FRANÇA, 2007). Besides QWL, the Burnout Syndrome (MASLACH e LEITER, 1999; BENEVIDES-PEREIRA, 2010; ENACHE, 2013) has been treated as one of the harm aspects of the physical and mental health worker, also being related to the operational and organizational performance, which may be an important factor on the interpersonal relationships as well as on social contexts. The study has as main goal identifying the possible relations between the Quality of Work Life and the Burnout Syndrome. Regarding that, it was performed a survey applied to a sample of 575 public and private workers from Santa Cruz do Sul/RS. The research was developed based on a descriptive and exploratory approach, considering two theoretical models: (1) Maslach Burnout Inventory (MBI-GS) developed by Maslach (1996); 2) Biopsychosocial Model (BPSPO-96) developed by Limongi-França (1996). The data shown the general characterization of the sample profile is mainly comprehended by women, married, graduated, and age from 26 to 35 years. Regarding to the professional profile it was noticed that the majority works in the private sector developing operational activities. Beyond understanding the levels of QWL and Burnout, this study sought signs that would enable the targeting of strategies that would minimize dissatisfaction and illness in the workplace. The main goal of the study was answered by applying the correspondence analysis technique. Can be highlighted that the results have evidenced a direct relationship between the aspects of Biopsychosocial Model of QWL and the dimensions of Burnout. However, it can be noticed that the biological and psychological aspects do not have any relation with the correspondence analysis with the Burnout. On the other hand, social and organizational aspects, in low levels, present relation with the Burnout in high level. In this sense, the results from this analysis have shown that generally the satisfaction with QWL aspects in low levels results in emotional exhaustion depersonalization in high levels as well as the Burnout Syndrome. It is evidenced that the contribution of this study is located at the identification of the relationships between the Burnout and the QWL aspects. It can be highlighted the need of a deeper analysis on the results, investigating different variables and different populations as well as specific occupations related to work experience, once the literature related to the triangulation of themes is still incipient in Brazil. As suggestions of future works, is pointed the reproduction of the study in different contexts as well as the application of the structural equation modeling, aiming to propose a model that explains the Burnout Syndrome in Brazilian works. / Considerando que o trabalho representa o principal foco na vida de muitas pessoas, a Qualidade de Vida no Trabalho QVT e a saúde ocupacional adquirem relevância à medida que o mercado de trabalho se apresenta instável e inseguro (COHEN, 2003). Neste sentido, a abordagem biopsicossocial de avaliação da QVT compreende o indivíduo como parte do todo, abrangendo suas potencialidades, os aspectos biológicos, psicológicos, sociais e organizacionais, aspectos esses que contribuem para a concepção integral da condição humana (LIMONGI-FRANÇA, 2007). Além da QVT, a Síndrome de Burnout tem sido tratada (MASLACH e LEITER, 1999; BENEVIDES-PEREIRA, 2010; ENACHE, 2013) como um dos aspectos associados à ocorrência de agravos à saúde física e mental do trabalhador, além do funcionamento e desempenho organizacional, podendo ter importante reflexo nas relações interpessoais e de contexto social. Este estudo teve como objetivo geral, identificar as possíveis relações entre a qualidade de vida no trabalho e a Síndrome de Burnout.. Desta forma, foi realizado um levantamento do tipo Survey, aplicado a uma amostra de 575 profissionais de organizações públicas e privadas de Santa Cruz do Sul / RS. A pesquisa foi desenvolvida a partir de abordagem exploratória e descritiva, sendo utilizados dois modelos teóricos: (1) Maslach Burnout Inventory (MBI-GS) elaborado por Maslach (1996); (2) Abordagem Biopsicossocial (BPSPO-96) desenvolvido por Limongi-França (1996). Os dados revelaram que a caracterização geral do perfil da amostra é composta predominantemente por mulheres, casadas, com nível superior e idade de 26 à 35 anos. Em relação ao perfil profissional verificou-se que a maior parte dos respondentes atua em organizações do setor privado, desenvolvendo atividades de nível operacional. Muito mais do que compreender níveis de QVT e burnout, este estudo buscou sinalizações que possibilitassem o direcionamento de estratégias que minimizassem a insatisfação e adoecimento no ambiente de trabalho. A partir da técnica análise de correspondência o objetivo geral deste estudo pode ser respondido. Destaca-se que os resultados obtidos evidenciaram relação direta entre os aspectos da abordagem biopsicossocial de QVT com as dimensões do Burnout. Contudo, pode-se observar que, os aspectos biológicos e psicológicos não têm relação próxima na análise de correspondência com o Burnout. Por outro lado, os aspectos sociais e organizacionais em níveis baixos possuem relação próxima com o Burnout em nível alto. Neste sentido, os resultados desta análise demonstram que no geral, a satisfação com os aspectos de QVT em níveis baixos gera esgotamento emocional e despersonalização em níveis altos, bem como, a síndrome de burnout. Evidencia-se que a contribuição deste estudo reside na identificação das relações entre o burnout, com os aspectos de QVT. Ressalta-se a necessidade do aprofundamento dos resultados aqui obtidos, investigando outras variáveis, assim como diferentes populações, ou ocupações específicas relacionadas à experiência laboral, uma vez que, a literatura sobre a triangulação dos temas no Brasil, ainda é considerada incipiente. Como sugestão de estudos futuros, indica-se a replicação desse estudo em outros contextos, assim como, o uso da análise de equações estruturais, a fim de propor um modelo para a explicação da Síndrome de Burnout em profissionais brasileiros.

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