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本研究是一項關於北京中年抑鬱症患者主觀經驗的敘事分析。研究的目的在於探尋患者對於自身患病歷程的主觀詮釋，他們的服務需求以及對於中國大陸精神衛生社會工作進行反思。研究的參與對象為目的性抽樣所得到的來自北京的一個抑鬱癥自助團體的八名中年抑鬱癥患者。 / 患者回顧了他們不同階段的經歷：發病期、住院期以及康復期。然後他們對於這些經歷做了詮釋。基於不同領域的社會服務需求，對於醫院、社區、大眾傳媒以及政府，他們都給出了寶貴的意見。 / 研究發現，既有的理論觀點對於關著對自身經歷的詮釋有著重要的影響，尤其是生物醫學模型。認知觀點和性別觀點也可以在患者們的敘事中找到蹤跡。精神科醫生在患者的整個經歷中都處於重要的地位，他們的觀點和行為對患者也產生了重要的影響。 / 患者還受到社會和歷史因素的影響。他們的詮釋會受到社會觀念和文化價值的影響，比如命運、面子、孝順以及性別角色等等。而歷史事件諸如文化大革命以及天安門事件也會對他們的人生經歷以及他們的主觀詮釋造成影響。而中國目前的社會情境也是另一項重要的影響因素。 / 從他們的故事中，我們可以看到，最重要的主題就是他們在患病過程中認知模式的轉變，包括對待抑鬱癥本身，所接受的服務以及自身的看法。在他們的敘述中，另外兩個主題也是非常值得注意的，那就是和抑鬱症有關的“喪失以及醫院裡非人道的治療方式。 / 他們的故事為我們對於北京中年抑鬱症患者經歷的理解提供了非常豐富詳實的材料。這些發現對於知識理論的發展、政策的制定以及針對抑鬱症患者的臨床社會工作實踐都有著很大的啟示。整個社會以及不同領域的精神衛生專業人士都應該攜起手來幫助他們，共同去創造一個更加包容和諧的社會。 / This research was a narrative analysis of the subjective experiences of the depressed middle-aged adults in Beijing, China. The purposes of the research were to explore the clients’ subjective interpretation of their lived experience of depression, their service needs and reflect on the improvement of mental health social work in Mainland China. A purposive sample of eight depressed clients from a self-help group in a mental health hospital in Beijing participated in this study. / The clients talked about their experiences at different stages: the onset, in the hospital and the rehabilitation, and interpreted their experiences. They also gave some advice to the hospital, the community, the mass media and the government based on their social service needs. / The theoretical perspectives influenced the clients’ interpretations of their experiences, especially the biomedical model. The cognitive perspective and the gender perspective could also be found in the client’s narratives. The psychiatrists were very important in the whole process of the clients’ experiences. Their perspectives and behaviors also influenced the clients. / It is found that the clients were also influenced by social and historical factors. Their interpretations were affected by social beliefs and cultural values such as fate, face, filial piety and gender roles. The historical events such as Cultural Revolution and June.4th Movement also affected their experiences and interpretations. The current social context in China was another important factor affecting them. / From their stories, we could see that the main theme was change of their cognitive styles, including view of depression, service and themselves. Another two themes were highlighted in their narratives as well: the linkage of their losses with depression and the dehumanized treatment in the hospital. / Their stories have provided comprehensive materials for an in-depth understanding of depressed middle-aged adults in Beijing. Based on the findings, recommendations are made to knowledge development, policymakers and clinical social workers in helping the depressed clients. It is necessary for our society and mental health professionals in different areas to work together to help them and build an inclusive society. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Shi, Song. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 228-245). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts and appendixes also in Chinese. / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Rationale of the study --- p.1 / Chapter 1.2 --- Background of the study --- p.2 / Chapter 1.3 --- Research Questions --- p.3 / Chapter 1.4 --- Purposes and significance of the research --- p.4 / Chapter Chapter 2 --- Literature Review --- p.7 / Chapter 2.1 --- Adult depression --- p.7 / Chapter 2.1.1 --- Definition of adults’ depression --- p.7 / Chapter 2.1.2 --- Different perspectives on “depression“ --- p.9 / Chapter 2.1.3 --- Social factors associated with adult depression --- p.24 / Chapter 2.1.4 --- Cultural influences in Chinese society --- p.32 / Chapter 2.2 --- Treatment of depressed adults --- p.36 / Chapter 2.2.1 --- Psychotherapy --- p.36 / Chapter 2.2.2 --- Medication --- p.38 / Chapter 2.3 --- Research on subjective experiences of people with mental disorders --- p.39 / Chapter 2.4 --- Research on depression in Mainland China --- p.48 / Chapter 2.5 --- The roles of social work in mental health services --- p.51 / Chapter Chapter 3 --- Research Methodology --- p.58 / Chapter 3.1 --- Paradigmatic Considerations --- p.58 / Chapter 3.1.1 --- Social constructionism --- p.58 / Chapter 3.1.2 --- Social construction and mental illness --- p.61 / Chapter 3.1.3 --- Theoretical Framework --- p.63 / Chapter 3.2 --- Research Design --- p.70 / Chapter 3.2.1 --- Qualitative research strategy --- p.70 / Chapter 3.2.2 --- Sampling strategies --- p.75 / Chapter 3.2.3 --- Data collection procedures --- p.84 / Chapter 3.2.4 --- Data analysis procedures --- p.86 / Chapter 3.2.5 --- Strategies for validating findings --- p.88 / Chapter 3.3 --- Ethical issues --- p.91 / Chapter Chapter 4 --- Research findings --- p.93 / Chapter 4.1 --- The experiences of the participants --- p.93 / Chapter 4.1.1 --- The experience during the onset of depression --- p.94 / Chapter 4.1.2 --- The experience in hospital --- p.118 / Chapter 4.1.3 --- The experience in the rehabilitation period --- p.131 / Chapter 4.2 --- The interpretation of their experiences --- p.142 / Chapter 4.2.1 --- The interpretation of the process of suffering from depression --- p.143 / Chapter 4.2.2 --- The interpretation of the process of recovery --- p.148 / Chapter 4.3 --- Advice on their needs --- p.154 / Chapter 4.3.1 --- The hospital --- p.154 / Chapter 4.3.2 --- The community --- p.159 / Chapter 4.3.3 --- Mass media --- p.161 / Chapter 4.3.4 --- The government --- p.164 / Chapter 4.4 --- Summary --- p.170 / Chapter Chapter 5 --- Discussion and Recommendation --- p.171 / Chapter 5.1 --- Characteristics of the participants in this study --- p.171 / Chapter 5.2 --- Social and historical factors affecting the clients’ interpretation of suffering from depression --- p.173 / Chapter 5.2.1 --- Social beliefs and cultural values --- p.174 / Chapter 5.2.2 --- Social context --- p.183 / Chapter 5.2.3 --- Historical events --- p.184 / Chapter 5.3 --- Themes --- p.186 / Chapter 5.3.1 --- Change of Cognitive Style --- p.187 / Chapter 5.3.2 --- The linkage of loss with depression --- p.190 / Chapter 5.3.3 --- The dehumanized treatment of hospitalization --- p.193 / Chapter 5.3.4 --- The interrelationships among the themes --- p.195 / Chapter 5.4 --- Revisiting the proposed conceptual framework --- p.197 / Chapter 5.5 --- Significance and recommendations --- p.200 / Chapter 5.5.1 --- Significance and recommendations --- p.201 / Chapter 5.5.2 --- Limitations --- p.214 / Chapter Appendix A: --- Possible Probes for interview (English Version & Chinese Version) --- p.218 / Chapter Appendix B: --- Oral Consent form (English Version & Chinese version) --- p.225 / References --- p.228

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A depressÃo à um dos mais prevalentes transtornos psiquiÃtricos. Os principais sintomas clÃnicos da depressÃo sÃo humor deprimido, anorexia, anedonia, reduÃÃo da atividade locomotora. Hà evidÃncias acumuladas de que a depressÃo pode se desenvolver em resposta à ativaÃÃo do sistema imune inato, sendo caracterizada por uma resposta inflamatÃria com aumento da produÃÃo de interleucina IL-1β, IL-6, TNF-α e outras. Com base nas propriedades anti-inflamatÃrias e antioxidantes da doxiciclina e supondo que esta droga apresenta menos efeitos colaterais e um melhor perfil farmacocinÃtico, em comparaÃÃo com a minociclina, a hipÃtese de que esta droga pode apresentar efeitos antidepressivos, utilizando o modelo de depressÃo induzido por lipopolissacarÃdeo (LPS) foi estudada. Para determinar as alteraÃÃes de comportamento, camundongos Swiss machos foram submetidos aos testes de campo aberto e nado forÃado. Para avaliar a capacidade da doxiciclina em prevenir ou reverter o comportamento tipo-depressivo induzido pela administraÃÃo sistÃmica de LPS, esta foi administrada nas doses de 25 ou 50 mg/kg, i.p. 30 min antes de LPS (prÃ-LPS) ou 1,5 e 23,5 horas apÃs a LPS (pÃs-LPS). A imipramina foi utilizada como antidepressivo padrÃo nas mesmas condiÃÃes de tempo. Em ambas as situaÃÃes, prevenÃÃo (prÃ-LPS) e tratamento (pÃs-LPS), o comportamento dos animais foi avaliado 24 horas apÃs a administraÃÃo de LPS, um perÃodo conhecido pela ocorrÃncia de um comportamento tipo-depressivo. Os nÃveis de citocinas (IL-1β e TNF-α) e nitrito foram avaliados no sangue (plasma) e as Ãreas cerebrais: cÃrtex prÃ-frontal (PFC), hipocampo (HC) e corpo estriado (ST). A administraÃÃo de LPS, 0,5 mg/kg aumentou significativamente o tempo de imobilidade em comparaÃÃo com os animais controle, enquanto que a doxiciclina, nas doses de 25 e 50 mg/kg e imipramina (10 mg/kg) foram capazes de prevenir e reverter a imobilidade induzida pelo LPS. A doxiciclina e imipramina, quando administrados prà e pÃs-LPS reduziram significativamente o tempo de imobilidade, mostrando um efeito antidepressivo. Em relaÃÃo a citocina IL-1β, seus nÃveis foram diminuÃdos, enquanto os nÃveis de TNF-α nÃo foram alterados significativamente. A doxiciclina e imipramina, preveniram e reverteram a diminuiÃÃo dos nÃveis de nitrito induzido por LPS. Com base nos resultados do presente estudo, avaliando o uso da doxiciclina, sugere-se que este antimicrobiano possa atuar como um antidepressivo. / Current evidences support inflammation, oxidative and nitrogen stress, as well as brain-derived neu-rotrophic factor (BDNF) signaling mechanisms as important in depression pathophysiology. Tetracycline antibiotics have anti-inflammatory and antioxidant properties. Preliminary evidence indicates that minocycline has antidepressant properties. Doxycycline (DOXY) has favorable pharmacokinetic and safety profiles when compared to other tetracycline congeners. The antidepressant activity of DOXY has not been adequately investigated. This study evaluated the effects of DOXY (25 and 50 mg/kg, i.p.) on LPS-induced (0.5 mg/kg, i.p.) depressive-like behavior. Doxycycline was administered 30 min before LPS (pre-LPS) or 1.5 and 23.5 h following LPS (post-LPS) administration in mice. LPS-treated animals pre-sented an increase in immobility time in the forced swimming test (FST) when compared to controls 24 h after endotoxin administration. Similarly to imipramine (IMI-10 mg/kg, i.p.), DOXY at both doses pre-vented and reversed LPS-induced alterations in the FST. IL-1b content was increased 24 h after LPS administration in striatum, hippocampus and prefrontal cortex. IMI and DOXY prevented and reversed LPS-induced increase in IL-1b. IMI and DOXY also prevented and reversed LPS-induced alterations in nitrite content and oxidative stress parameters (lipid peroxidation and reduced glutathione levels). Both DOXY and IMI prevented LPS-induced decrease in hippocampal BDNF levels. Taken together, our results demonstrate that DOXY is comparable to IMI in effectively ameliorate LPS-induced depressive-like behavior, providing a rationale for testing DOXYâs antidepressant efficacy in humans.

The primary goal of the current study was to examine the association between maternal distress during pregnancy, conceptualized as stress, anxiety, and depression, and infant reproductive outcomes. It was hypothesized that women who report high levels of distress during pregnancy would be more likely to experience adverse reproductive outcomes. An additional goal of the study was to examine the hypothesis that social support and coping style moderate the association between prenatal maternal distress and birth outcomes. This study utilized a prospective, longitudinal design. Pregnant women (N = 257) completed self-report questionnaires and clinical interviews at two time points during pregnancy. Following delivery, birth weight, week of delivery, head circumference, and Apgar score were extracted from medical records. Results suggested that women who were clinically depressed during pregnancy were more likely to experience adverse birth outcomes. In addition, maternal stress, anxiety, and depression were best conceptualized as one general "distress" factor, which did not predict variance in birth outcomes over and above demographic variables. However, when self-report measures were considered individually, they decreased over the course of pregnancy, and were associated with birth outcomes, particularly at time 2. Significant interactions between maternal distress and social support, as well as maternal distress and coping emerged as predictors of birth outcomes. Results suggest that women with high levels of stress, who also have small support networks, are at higher risk of adverse birth outcomes than women with large networks, who were relatively insulated from effects of higher distress. This study points to the need for ongoing assessment of maternal distress and resources throughout pregnancy, such that women at risk for adverse birth outcomes can be identified and supported as soon as possible.

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

Although recent research has demonstrated that intrusive memories of negative autobiographical events are an overlapping cognitive feature of depression and PTSD, there is still a general paucity of research investigating the prevalence and maintenance of these memories in depression. Accordingly, the current thesis represented a much-needed program of empirically-driven research that delineated the cognitive processes that underpin the manifestation, experience, and persistence of intrusive memories in depression. Firstly, Study 1 used descriptive and correlational methodologies to outline the content and features of these memories, and explored whether intrusion characteristics linked to intrusive memories in PTSD are also features of intrusive memories in depression. In accord with studies in PTSD samples, sensory features accounted for unique variance in the prediction of depression severity, over and above that accounted for by intrusion frequency. This commonality raised the possibility that cognitive management strategies linked to the persistence of intrusive memories in PTSD may also play a role in depression. Accordingly, Study 2 utilized a cross-sectional and prospective design to investigate whether negative appraisals and cognitive avoidance strategies, which are key to the persistence of intrusive memories in PTSD, similarly play a role in depression. The results demonstrated that assigning negative appraisals to one???s intrusive memory, and attempts to control the memory, were positively associated with intrusion-related distress, level of depression, and cognitive avoidance mechanisms. Additionally, negative appraisals and the use of cognitive mechanisms were predictive of depression concurrently, but not prospectively. Studies 3, 4, and 5 further investigated avoidant intrusion- response strategies by assessing the role of recall vantage perspective in mediating the effects of intrusion-related distress. Study 3 found that although field memories were not experienced as more distressing than observer memories, the results supported an association between an observer vantage perspective and cognitive avoidance mechanisms. As this study employed a correlational design, Study 4 addressed the question of directionality by experimentally manipulating mode of recall to ascertain whether shifting participants into a converse perspective would have differential effects on the reported experience of their intrusive memory. Results indicated that shifting participants from a field to an observer perspective resulted in decreased experiential ratings; specifically, reduced distress and vividness and increased detachment and observation. Also, as anticipated, the converse shift in perspective (from observer to field) did not lead to a corresponding increase in experiential ratings, but resulted in reduced ratings of observation. Study 5 attempted to investigate the stability of this memory orientation phenomenon by investigating mode of recall vantage perspective prospectively. Attrition of participants across the 12-month study limited analyses to the descriptive level, but illustrated that, at least for some individuals, recall vantage perspective remained stable across assessments periods. Collectively, the findings supported the notion that recall perspective has a functional role in the regulation of intrusion-related distress and represents a cognitive avoidance mechanism. Studies 6 and 7 employed experimental methodologies to investigate whether adopting an abstract/analytical mode of processing following a negative event would result in poor emotional processing, or increased distress associated with intrusive memories. Study 6 found no differences in either intrusion frequency or associated levels of distress across the processing conditions, as hypothesized. The results of Study 6 suggested that the predicted effects of ruminative self-focus on intrusion severity may be dependent upon the self-referential nature of the material being processed. Results of Study 7 indicated that inducing an analytical ruminative mode of processing resulted in participants rating their naturally occurring, self-referential intrusive memories as more negative, more distressing, and evoking a more negative emotional response compared to inducing distraction. Taken together, Studies 6 and 7 suggest the possibility that depressed individuals may get caught up in a ruminative cycle that, due to the documented effects of analytical self-focus, may exacerbate the emotional response elicited by the intrusions and perpetuate biased attentional focus towards them. Finally, Studies 8 and 9 explored suppression as a cognitive avoidance mechanism and addressed some methodological concerns regarding the measurement of this construct. Study 8 investigated the effects of repeated suppression using a method to index the frequency, duration, and associated levels of distress of an experimentally-induced intrusive memory, and assessed whether any observed effects were differentially linked to depressive symptomatology. Results supported a secondary rebound effect in those participants who were most successful at suppressing target intrusions. Study 9 was an investigation of the English version of the TCAQ (Luciano, Algarabel, Tom??s, & Mart??nez, 2005), an index of cognitive control. Study 9 evaluated the association between this measure and performance on a thought suppression task. The results indicated that low TCAQ-20 scorers experienced intrusions of a longer duration and rated these intrusions as more distressing than high TCAQ-20 scorers, supporting the validity of the measure. These findings highlight the role of suppression as a maladaptive mental control strategy and the potential for elevated intrusion-distress to perpetuate its use. Together, the findings of this program of research confirm the importance of intrusive memories in depression, and underscore the need for an empirically-supported model to account for the occurrence and maintenance of these memories.

Cognitive theories of depression include maladaptive thinking styles as depressive vulnerabilities. The hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) particularly implicates stable and global attributions for negative events as influences upon depression. Positive event attributions are considered less influential, yet they have shown equal predictiveness to negative event attributions for depression-specific mood. Previous research has provided equivocal results largely because of cross-sectional design and modest psychometric properties of the measures. The present research aimed to: create a new instrument to measure optimistic and pessimistic attributions; test the relatedness of attributions for positive and negative events; and, clarify relationships of the scales with optimism and mood. Three studies were undertaken, all of which used structural equation modeling. Two cross-sectional studies, using 342 and 332 community participants respectively, developed and validated the Questionnaire of Explanatory Style (QES). A final longitudinal study with 250 community participants tested the predictive validity of the QES. Overall, six scales were developed, three of which were optimistic and three of which were negative. The scales were acceptable to community samples and had adequate psychometric properties. The optimistic scales were attributions for positive events and the negative scales were attributions for negative events rather than pessimistic scales. Cross-sectional results indicated that only one of the negative scales weakly directly predicted depression-specific mood, but all predicted general psychological distress. By contrast, the optimistic scales were more directly predictive of depression-specific mood, particularly the Positive Disposition scale. Longitudinal results indicated that two of the optimistic scales were the most important QES predictors of depression-specific mood two months later. The optimistic scale Positive Disposition appears most central to the prediction of both concurrent and subsequent depression-specific mood. The scale content represents explanations for positive events that are internal and stable characteristics. These may be construed as personal competencies to bring about positive outcomes. This scale is closely allied to measures of optimism. Findings affirm the importance of optimistic attributions to the understanding of depression-specific mood and provide a productive focus for therapeutic intervention and future research.

Introduction. Recent studies have suggested a secular increase in the prevalence of self-harm, suicidal ideation and depression in young people. This study aims to report the changes in prevalence of psychological disturbance over time in a clinic population. Method: Data on the prevalence of psychological symptoms was measured by the Youth Self-Report (YSR) and Child Behaviour Checklist (CBCL), in a 21-year clinic cohort of adolescents aged from 12 to 17. This data was analysed to investigate secular changes and predictors of disorder. Results: Significant secular increases were demonstrated in parent reports of self-harm and suicidal ideation, of 5percent and 4percent per cohort year respectively, but there was no significant change in the anxious/depressed sub-scale. There were no changes demonstrated in self-reports of self-harm, suicidal ideation or anxiety/depression. Self-harm and suicidal ideation, both parent reported and self-reported, significantly increased with increasing age, female gender, drug use, anxiety/depression and other clinically significant scores on the YSR and CBCL sub-scales. The YSR was a more accurate predictor of both self-harm and suicidal ideation than the CBCL. Conclusions: The results of this study suggest that there has not been a significant increase in psychological disorder in this population. There was, however, an apparent increase due to increasing parental awareness of some symptoms, particularly self-harm and suicidal ideation. While parents have a higher rate of reporting disorder, young people's self-reports remain a more accurate predictor of specific symptoms, including self-harm and suicidal ideation.

Bibliography: leaves 339-361. / xii, 361 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Psychiatry, 1993

Thesis (M.Soc.Sc.)--University of Hong Kong, 2006. / Title from title page (viewed Apr. 23, 2007) Includes bibliographical references (p. 39-51).