No description available.

Abstract Background: Cognitive Behaviour Therapy, (CBT) is well established as an effective treatment for depression. Its applicability in routine public mental health practice is however unknown, as most published studies excluded participants with suicide risk or if co-morbid with other disorders such as schizophrenia or bipolar affective disorder. Clients of public mental health services are characterised by symptom severity, chronic course of illness, treatment resistance and / or co-morbidity. In order to determine whether CBT has utility in routine public mental health practice, it is important to find out whether symptoms of depression (and anxiety) in this client population will respond to a course of CBT provided as part of standard care. Aims and Hypotheses: This effectiveness study aimed to ascertain if CBT is effective in treating depressed and/or anxious symptoms when such symptoms exist within the clinically more complex population found within Community Mental Health Services / Settings, (CMHSs). It was hypothesised that clients receiving CBT would show reliable and clinically significant improvement in symptoms of depression and anxiety but that the amount of improvement would be less than that reported in efficacy studies with less complex client groups. Method: This was a repeated measures, uncontrolled intervention study with results benchmarked against published data. Forty six adult clients of the Inner North Brisbane Mental Health Service (INBMHS) with diagnoses of Depression and / or Anxiety, in isolation or in conjunction with Schizophrenia, Bipolar affective disorder, or a Personality Disorder were treated with an eight (8) session manualised CBT program as part of routine clinical care. Standardised measures of depression, anxiety and stress were taken at time of referral, time of the commencement of treatment, time of treatment completion and at six-month post completion of treatment. Results: Participants showed reliable and statistically significant improvement in self reported symptoms from commencement to completion of treatment. Gains were retained at follow-up. Effect sizes were in the moderate to large range and improvements were clinically significant for approximately one third of the participants. Conclusions: CBT seems to be an effective treatment for depression and anxiety where such symptoms exist within a mental health population. Further research addressing the limitations of this study would add strength to the argument that the mental health population could benefit from the broad availability of such treatment.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Partial embargo. Vita. Bibliography: 84-91.

Provisional Question for the thesis to address: Indicated and selective prevention of common mental health problems in later life: Is there a theoretical rationale for an Acceptance and Commitment Therapy approach? Background The burden of late life depression and anxiety is significant. Even subthreshold symptoms result in great individual, community, economic and societal cost. However, common mental health problems in later life are under‐recognised and under‐treated despite evidence in support of pharmacological and psychological intervention. Previous research regarding psychological therapy for late life mental health problems has been dominated by cognitive behavioural therapy. However, the effectiveness of this approach has been questioned, leading researchers to explore alternative approaches. Acceptance and Commitment Therapy has received increasing attention from researchers keen to explore an alternative and some have argued that this approach is particularly suited to older people. In the context of demographic change and a significant increase in the proportion of community dwelling elderly there is a need to provide evidence to support the use of alternative management strategies for late life mental health problems, for example, focusing on prevention. Methods A systematic review will evaluate the current evidence for the use of ‘indicated’ and ‘selective’ prevention interventions for older people at risk of developing a major depressive or anxiety disorder due to the experience of subsyndromal symptoms or the presence of significant physical, socioeconomic, and psychosocial risk factors. This paper will be followed by an empirical article in which the relationship between psychological processes and ageing will be explored. Specifically, this study will explore psychological flexibility, the use of Selection, Optimisation and Compensation strategies, and the presence of psychopathology in a non clinical sample of community dwelling older people. Results Findings of the systematic review provide preliminary evidence for indicated and selective prevention of late life depression, however there is no clear evidence of benefits of these interventions in late life anxiety. The relationships between variables in the empirical study were explored using descriptive statistics, correlation analysis, and conditional process modelling. Although the study did not find age to be a specific predictor of variance in psychological variables explored, the study did provide empirical support for the potential to use Acceptance and Commitment Therapy with older people. Discussion The systematic review article provided preliminary evidence for the efficacy of selective and indicated prevention interventions for late life depression. However, further research is required to consolidate these findings. The empirical paper found significant relationships between the perception of positive health, reduced psychopathology and theoretical variables including cognitive fusion, engagement in valued living, and the use of Selection, Optimisation, and Compensation strategies. Cognitive fusion was found to mediate these relationships and as such, findings provide support for the use of an Acceptance and Commitment Therapy approach with older people. The theoretical and clinical implications of these findings are discussed in detail.

Introduction: In Pakistan there is dearth of research on deliberate self-harm (DSH) and its predictors among adolescents. While the lack of research in Pakistan can be partly attributed to the sacrilegious status, criminalization and stigmatization attached to DSH, it is also an attribute of paucity of Urdu versions of the standardized psychological instruments. Previous research in developed countries has indicated that attachment theory can be used as a useful framework to understand the development of austere psychopathologies like DSH, as well as for studying pathways of interaction of interpersonal and intrapersonal factors of psychopathologies. In this study, standardized psychological instruments are translated into Urdu language as a first step. These instruments are then used to study pathways of interaction of interpersonal and intrapersonal factors of DSH, conceptualized within attachment framework. Method: The study was conducted in two steps. In step 1, Youth Health Risk Behavior Survey (YHRB), Inventory of Interpersonal Problems-32 (IIP-32) and Significant Others Scale (SOS), were translated into Urdu language. Along with these scales, Urdu translated versions of Hospital Anxiety and Depression Scale (HADS), Adolescent Relationship Scales Questionnaire (ARSQ), Life Events scale (LES) from CASE questionnaire and Family Affluence Scale-II (FAS-II) were reviewed for accuracy of translation through expert judgement and psychometric evaluation. Secondly, a cross sectional survey was conducted with 1290 adolescents (10 - 19 years age) using the translated Urdu versions of the instruments and demographic pro forma. Structural equation modelling was used to study the pathways of associations between predictors of DSH. Results: The extensive process of translation resulted in establishment of semantic, content, technical and construct equivalence of the translated instruments with the original English versions. Multiple imputation was performed to account for missing values in SPSS 20. Important structural adaptations were made in the scales based on factor analyses conducted in M plus. After modifications, all scales showed satisfactory CFI (≥ 0.90) and RMSEA (≤ 0.06). Results of the survey indicated that the prevalence of DSH (with, without and ambivalent suicidal intentions) was 7%. Two SEM models were constructed involving both mediation and moderation pathways. Results of Model 1 showed association of attachment with DSH was double mediated by social support, depression and anxiety. Model 2 also confirmed association of attachment with DSH with double mediation through relationship style problems, depression and anxiety. In order to understand the contextual picture of the concepts studied in this research both SEM models were also constructed by controlling for demographic factors. This resulted in confirming age, gender and family affluence as significant contributors but with very small effects. Discussion and conclusion: In the present study translation of the instruments helped in building a reservoir for future research. The results of translation and validation of instruments indicated that cultural differences, language needs and age must be accounted for while using standardized psychological instruments. Taking into consideration specific cultural and demographic background of Pakistan, this study also confirms the key role of attachment in influencing interaction of predictors of DSH. It is suggested that intrapersonal and interpersonal factors are influential points of intervention for designing clinical, school and community based awareness and prevention programs for DSH. The thesis also discusses the implications for policy guidelines along with recommendations for future research and other applications of the study.

Background: The human ability to adapt to extreme environments is fascinating. Research into this adaptation has been lacking in Arctic isolated teams because it has concentrated on Antarctic teams. The hazards of the poles often confine the researchers indoors with their colleagues, reducing their privacy. This deployment also limits their contact with loved ones at home. Subsequently, over the course of polar night, rates of anxiety, depression, irritability and sleep disturbance increase (Suedfeld & Palinkas, 2008). Often, the teams complain of cognitive impairments. The High Arctic’s distinctive feature is the polar bear. The presence of bears requires Arctic research station teams to handle fire arms for their personal safety. It also means that fire arms – which are highly restricted in the Antarctic – are ever-present and easily accessible at Arctic stations. This poses a unique psychological challenge for these teams which has not been well-researched. Methodology: This thesis is an original contribution to science in that it employs a mixed-methods approach combining phenomenological interviews, cognitive testing and mental health assessment via questionnaires with a team spending a year at the Polish Polar Station, Hornsund, Svalbard. The participants were ten of the eleven winter team members who spent the year between July 2015 and June 2016 at Hornsund (“Explorers”) and an age-/gender-/education-matched control group (“Controls”). They filled in the Symptom Checklist-90-Revised and the Profile of Mood States-Brief Version in July, September, January, April and June of that year. Cognitive testing was completed in September, January and June; it comprised the Figural Learning and Memory Test, the Sustained Attention to Response Task (SART), the elevator tasks of the Test of Everyday Attention (TEA) and the Raven Standard Progressive Matrices. The interviews took place at the same time as the cognitive testing. Results: The results showed that the most stressful time reported in the questionnaires was April 2016, just after the winter isolation had ended and the sun had risen again. The Explorers reported little subjective complaints about their cognition but they performed near-ceiling on the TEA while scoring far below their Controls on the SART. This implies a dichotomy between sustained attention and inhibition in the Explorers. Their lived experiences were shaped by a struggle to adapt to the other team members rather than by struggling to adapt to the hazardous environment. The environment was perceived as awe-inspiring. Over time, the Explorers shifted their view of the team from informal colleagues to a family which they did not choose to be a member of and then, to friends. Unanimously, other people were seen as the most difficult aspect of the mission. Conclusions: This thesis provides unique insight into a non-Anglo-Saxon Arctic wintering team: the conclusions suggest that participants should receive social training to get along better and be emotionally prepared. The findings can be implemented by my research partner, the Institute of Geophysics (Warsaw) to better select and prepare their future expeditions to Hornsund. Some of the insights such as the nature of the interpersonal stressors may be applicable to space missions.

Firefighters respond to a wide range of critical incidents in which they face exposure to multiple stressors. Previous studies have reported prevalence rates of various symptomatology and identified some risk factors for firefighters, but accord has not been reached across studies on the extent of vulnerability or resilience and potential predictors of each have not all been identified. Studies with firefighters in the United Kingdom are comparatively rare. The purpose of this series of studies was, therefore, to investigate the prevalence of PTSD symptomatology and that of its associated comorbid conditions (depression, anxiety and alcohol misuse) in UK firefighters. On the basis of a literature review, the role of thought control, counterfactual thinking and humour style in predicting symptoms was examined. Study I examined this together with the demographic, occupational, event-specific and cognitive factors associated with these conditions in a retrospective, cross-sectional analysis of multiple exposure in firefighters. Results indicated that these firefireghters demonstrated high levels of resilience, recording relatively low rates of PTSD, depression, anxiety and alcohol misuse symptomatology. No DSM-IV Criterion A1 exposure variable independently predicted symptomatology of PTSD, but A2 responses of fear and helplessness predicted PTSD symptomatology, and A2 fear predicted alcohol misuse. Individual aspects of A1 exposure did predict symptomatology of depression, anxiety and alcohol misuse; one operating schedule predicted symptomatology of depression and anxiety; and both previous divorce and previous psychiatric diagnosis predicted symptomatology of alcohol misuse. Of the three cognitive predictors, nonreferent counterfactual thinking and self-defeating humour independently predicted higher levels of PTSD symptomatology, whilst self-enhancing humour predicted lower symptomatology of depression. Results were essentially the same in both regression models, indicating no difference between the predictive power of these cognitive constructs between the models where humour was used at work and when used with the person closest to the participant. Study 2 evaluated the same symptomatology in a longitudinal investigation of firefighters exposed to a single critical incident in which the casualty's life could not be saved, again addressing the cognitive factors of thought control strategies, counterfactual thinking and humour style. Results showed high levels of resilience with firefighters recording relatively low rates of PTSD, depression, anxiety and alcohol misuse symptomatology, although symptomatology of depression, anxiety and alcohol misuse increased over time for a small number. Factors associated with development of symptomatology were firefighter type and rank, A2 horror, body recovery, and the use of thought suppression and 'if only' counterfactuals). However, these were not long-lasting. Similarly, associations between depression/anxiety symptomatology and A2 helplessness; anxiety and previous psychiatric diagnosis also had a short term effect on symptoms. Those who were younger and who had not been involved in body handling had higher depression scores at T2 although the sample size was small and these results may be anomalies. Study 3 explored the firefighters' responses to the same critical incident in greater depth in order to draw out any aspects of it which caused distress and any factors which were found to be helpful in coping with such distress. This qualitative exploration was designed to identify the meaning attached to aspects of critical incidents and how firefighters individually experienced such a critical incident response in comparison with other critical incidents. Results showed positive emotions, professional pride and a strong sense of duty were expressed far more than 'negative' emotions, suggesting a high degree of resilience. Identification with the dying or dead is a marker for distress because meaning has been attributed to the event through recognition of the deceased's humanity. Dissonance arose because of the struggle between this recognition and the desire to protect colleagues and it appears that it is this dissonance which adversely affects those with responsibility for making decisions. Feelings of helplessness arose through operational limitations and are also a marker for distress. Avoidance techniques were utilised, but thought suppression was not identified as such, although the transposition of distressing images through humour was reported. Downward counterfactuals were reported more frequently than upward, and the latter related to decision making and operational difficulties. The type of humour commonly used is banter which includes 'taking the piss' out of colleagues and situations although it was not experienced the same way by all firefighters. The purpose of banter is to cope with the stressors inherent in the job of firefighting and to facilitate bonding through its use as a private language. This study identified three 'rules of banter': it is reciprocal, the timing of it is critical, and it has contextual restrictions. Adaptive banter may be expressed as the self-enhancing or affiliative styles of humour and maladaptive as self-defeating, or banter may itself be a separate style of humour. Together, the studies' findings show that these firefighters were resilient to exposure to a range of stressors but that suffering may be seen on a spectrum. This has implications for theory and further research, and for the development of psychoeducational interventions to increase resilience in those first responders who may be at risk of developing symptoms.

The diploma thesisfocuseson the issue of depression,anxiety and quality of life in adult patients after burn trauma. The literature review section presents current scientific studies that apply to the diagnosis,prevalence,treatmentand selectedrisk factorsfordepressionand anxiety in this patient population. This part of the thesis also deals with the definition and methodsof assessing the quality of life in patients with burns, including factors that may affect the subjectively perceived quality of life in this population. The empirical part aims to identify patients with MDE and GAD according to M.I.N.I. and to examine risk factors not only for these mental disorders but also for reduced quality of life. Furthermore, the research focuses on the validation of the visual analog screening method of Emotional Thermometers in patients after burn trauma. A total of 292 hospitalized patients with burns participated in the study, of which 27 (9 %) met the diagnostic criteria for MDE (current, past, recurrent). 10 patients (3.5 %) met the diagnostic criteria of GAD. Statistically significant predictors of MDE are: antidepressant use and surprisingly a lower extent of burns. The use of antidepressants and unexpectedly a less frequent occurrence of burns in visible places of body (head, neck, upper limbs)...

No description available.

Die vorliegende Arbeit befasst sich mit Folgen der COVID-19-Pandemie und der damit verbundenen Infektionsschutzmaßnahmen auf die psychische Gesundheit von Kindern und Jugendlichen. Im Mittelpunkt der Untersuchung stehen dabei Kinder und Jugendliche zwischen 2 und 17 Jahren, die in Praxen von Fachärztinnen und Fachärzten für Kinder- und Jugendmedizin behandelt wurden. Ziel einer ersten Studie war es zu klären, ob und in welchem Umfang die Gruppe dieser jungen Patientinnen und Patienten in den pädiatrischen Praxen gegenüber einem präpandemischen Vergleichszeitraum häufiger unter Störungen mit ängstlicher oder depressiver Symptomatik litten. Als Vergleichszeitraum wurde hier April 2020 bis Dezember 2020 versus April 2019 bis Dezember 2019 gewählt. Der erste Ergebnisparameter war die Anzahl der Kinder und Jugendlichen mit den Diagnosen Depression (ICD-10: F32, F33) und Angststörung (ICD-10: F41) pro Praxis. Der zweite Ergebnisparameter der Studie war die Veränderung der Prävalenz von Depressions- und Angststörungsdiagnosen im Zeitraum April 2020-Dezember 2020 gegenüber April 2019-Dezember 2019 (Studie 1). In einer zweiten Studie wurden alle psychischen Störungen des Kapitels F des ICD-10 untersucht. Hier war ein längerer Vergleichszeitraum von 2018 bis 2021 möglich. 2018 und 2019 waren präpandemische Jahre und 2020 und 2021 wurden als pandemische Jahre eingestuft. Im Zentrum stand hier die Gesamtzahl der Patienten mit psychischen Störungen und die Anzahl von Patienten mit diesen Störungsbildern in den einzelnen Praxen (Studie 2). Die Ergebnisse der ersten Studie zeigten, dass die Anzahl der Kinder und Jugendlichen mit Depressions- und Angstdiagnosen pro Praxis im Zeitraum April 2020 bis Dezember 2020 im Vergleich zum gleichen Zeitraum 2019 zugenommen hatte (Angst: +9%, Depression: +12%). Der Anstieg war bei Mädchen deutlich größer als bei Jungen (Angst: +13% vs. +5%; Depression +19% vs. +1%). Die Prävalenz der Angststörung stieg von 0,31% auf 0,59% (p<0,001), die der Depression von 0,23% auf 0,47% (p<0,001). Die größten Anstiege wurden bei Mädchen beobachtet (Angst von 0,35% auf 0,72% (+106%, p<0,001), Depression von 0,28% auf 0,72% (+132%, p<0,001) (Studie 1). In der Folgestudie zeigten die Ergebnisse, dass in den Pandemiejahren 2020 und 2021 im Vergleich zu den beiden Vorjahren signifikant mehr psychische Störungen diagnostiziert (chi2 p<0,001) wurden. Ein Anstieg von 2018 zu 2021 wurde besonders bei affektiven Störungen deutlich. Allerdings war die Zunahme der Anzahl dieser Patienten in der einzelnen Praxis mit einer durchschnittlichen Zunahme von 7 Patienten pro Praxis im Jahr sehr gering und war vermutlich für die einzelne Ärztin oder den einzelnen Arzt kaum wahrnehmbar (Studie 2). Während in der ersten Studie für einen kürzeren Zeitraum von 9 Monaten gezeigt wurde, dass die Zahl der pädiatrischen Diagnosen von Depressionen und Angststörungen im Pandemiejahr 2020 im Vergleich zum Vorjahr zugenommen hatte, konnte in der zweiten Studie für einen Zweijahreszeitraum belegt werden, dass die Summe aller psychischen Störungen des Kapitels F der ICD 10 zugenommen hatte. Beide Studienergebnisse weisen auf die Chance hin, dass wenige standardisierte Fragen zur psychischen Gesundheit z. B. in die pädiatrischen Vorsorgeuntersuchungen implementiert werden können, um ungedeckte Bedarfssituationen im Hinblick auf die psychische Gesundheit besser wahrzunehmen.:1. Einleitung 1 1.1. Hintergrund 1 1.2. Fragestellungen 2 1.3. Methoden 3 2. Publikationen 5 2.1. Zunahme von Depressions- und Angststörungsdiagnosen während der Covid-19-Pandemie bei Kindern und Jugendlichen 5 2.2. Psychische Störungen in deutschen pädiatrischen Praxen vor und während der COVID-19-Pandemie 14 3. Diskussion 19 4. Schlussfolgerungen, Implikationen für Forschung und Praxis 23 5. Zusammenfassung der Arbeit 25 5.1. Zusammenfassung 25 5.2. Studienziele 25 5.3. Ergebnisse 26 5.4. Schlussfolgerung 27 5.5. Implikationen für die weitere Forschung 27 6. Literaturverzeichnis 28 7. Anlagen 34 7.1. Darstellung des eigenen Beitrages 34 7.2. Selbstständigkeitserklärung 38 7.3. Lebenslauf 39 7.4. Wissenschaftliche Veröffentlichungen 40 7.5. Danksagung 42