Thesis (M. Phil.)--University of Hong Kong, 2010. / Includes bibliographical references (p. 85-93). Also available in print.

Epidemiologic studies have found that approximately one third of individuals will experience either alcohol abuse or dependence during their lifetime. However, only a minority will seek help or perceive a need for help. The purpose of this thesis is to provide a longitudinal investigation of the predictors of new onset perceived need for care and help-seeking in individuals with a lifetime alcohol use disorder who have no prior history of perceived need or help-seeking. Methods: Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n=34,653), a 3-year longitudinal nationally representative survey of the United States population. Results: Respondents with an incidence of perceived need and help-seeking were more likely to be male, younger, less educated, and black. Those who sought help and perceived a need for help were more likely to have a concurrent Axis I or II disorder after controlling for sociodemographic differences and social, legal, economic problems. They also had very high odds of having a persistent alcohol use disorder (OR=4.68) and experiencing social or legal problems related to their alcohol use after controlling for sociodemographics and psychiatric comorbidity (AOR’s from 5.59-38.42). Conclusion: Individuals with a history of having no perceived need for care or help-seeking may represent a unique group among those with an alcohol use disorder. Psychiatric comorbidity and social or legal problems related to alcohol use were both independent predictors of perceived need and help-seeking.

Researchers have found that youths react in a variety of ways when faced with a bullying incident in their schools (Kochenderfer-Ladd, 2004). Despite being aware of the negative consequences of being victimized and holding generally negative attitudes towards bullying, youths tend to show reluctance to seek help from an adult or to intervene in defense of their victimized peer (Hawkins, Pepler, & Craig, 2001; Newman, Murray, & Lussier, 2001). Given the importance of the aforementioned behaviours in reducing bullying in schools, two studies were designed to examine the determinants of victim help seeking and bystander intervening behaviours in young people using Ajzen’s Theory of Planned Behaviour (TPB: Ajzen, 1991). In Study 1, I examined the full TPB model using short-term longitudinal data collected from a sample of 609 secondary school students. To further examine the utility of the TPB model and to determine the impact of school climate on the model, in Study 2 I examined cross-sectional data collected from 113 middle school students. In Study 1, multiple regression analyses and path analyses indicated that the TPB model significantly predicted student’s intentions to intervene on behalf a bullied peer and their actual self-reported intervention behaviour. The results for help seeking intentions and behaviours were mixed, with the TPB variables significantly predicting victim help seeking intentions but not self-reported behaviour. In Study 2, the TPB model significantly predicted both help seeking and intervention intentions. Additionally, the TPB variables of attitude, subjective norms, and perceived behavioural control significantly mediated the relationship between school climate and victim help seeking and bystander intervention intentions. The results are discussed in terms of their implications for methodology, theory, and policy.

Epidemiologic studies have found that approximately one third of individuals will experience either alcohol abuse or dependence during their lifetime. However, only a minority will seek help or perceive a need for help. The purpose of this thesis is to provide a longitudinal investigation of the predictors of new onset perceived need for care and help-seeking in individuals with a lifetime alcohol use disorder who have no prior history of perceived need or help-seeking. Methods: Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n=34,653), a 3-year longitudinal nationally representative survey of the United States population. Results: Respondents with an incidence of perceived need and help-seeking were more likely to be male, younger, less educated, and black. Those who sought help and perceived a need for help were more likely to have a concurrent Axis I or II disorder after controlling for sociodemographic differences and social, legal, economic problems. They also had very high odds of having a persistent alcohol use disorder (OR=4.68) and experiencing social or legal problems related to their alcohol use after controlling for sociodemographics and psychiatric comorbidity (AOR’s from 5.59-38.42). Conclusion: Individuals with a history of having no perceived need for care or help-seeking may represent a unique group among those with an alcohol use disorder. Psychiatric comorbidity and social or legal problems related to alcohol use were both independent predictors of perceived need and help-seeking.

Researchers have found that youths react in a variety of ways when faced with a bullying incident in their schools (Kochenderfer-Ladd, 2004). Despite being aware of the negative consequences of being victimized and holding generally negative attitudes towards bullying, youths tend to show reluctance to seek help from an adult or to intervene in defense of their victimized peer (Hawkins, Pepler, & Craig, 2001; Newman, Murray, & Lussier, 2001). Given the importance of the aforementioned behaviours in reducing bullying in schools, two studies were designed to examine the determinants of victim help seeking and bystander intervening behaviours in young people using Ajzen’s Theory of Planned Behaviour (TPB: Ajzen, 1991). In Study 1, I examined the full TPB model using short-term longitudinal data collected from a sample of 609 secondary school students. To further examine the utility of the TPB model and to determine the impact of school climate on the model, in Study 2 I examined cross-sectional data collected from 113 middle school students. In Study 1, multiple regression analyses and path analyses indicated that the TPB model significantly predicted student’s intentions to intervene on behalf a bullied peer and their actual self-reported intervention behaviour. The results for help seeking intentions and behaviours were mixed, with the TPB variables significantly predicting victim help seeking intentions but not self-reported behaviour. In Study 2, the TPB model significantly predicted both help seeking and intervention intentions. Additionally, the TPB variables of attitude, subjective norms, and perceived behavioural control significantly mediated the relationship between school climate and victim help seeking and bystander intervention intentions. The results are discussed in terms of their implications for methodology, theory, and policy.

Diabetes is a psychologically demanding disease with a major impact on a patient’s quality and quantity of life. The outcome of diabetes is highly dependent on the self-care activities of the person with diabetes. Depression is common among people with diabetes, complicating this self-management and thereby increasing the risk of developing diabetes-related complications. Despite depression’s specific relevance to diabetes and the serious impact it has on the disease, it is estimated that only one third of people with both diabetes and major depression are recognized and appropriately treated for both disorders. The aim of this thesis therefore was to investigate the interrelationship between depression and diabetes and evaluate methods of improving recognition rates and access treatment within a health care setting. Routine screening for depression using standardised depression screening instruments has been recommended for all adults in primary care to improve the low recognition rates of depression in this population. The aim of Study 1 was therefore to compare the effectiveness of four commonly used depression screening instruments (CES-D, HADS, DMI, SCAD) in identifying depression in a diabetes sample. This research was important as little previous research had investigated the efficacy of these depression screening measures within this specialist group and an evaluation of their comparative performance had not yet been conducted. 150 patients with diabetes receiving care at the endocrinology outpatient clinics of two major public hospitals in Brisbane, Australia completed a battery of questionnaires and were also involved in a structured clinical interview (CIDI-SF) to establish a criterion standard. Results indicated that three of the screening measures (CES-D, HADS, DMI-10) could be considered reliable predictors of depression in this sample. There was however evidence that the CES-D could be considered the preferred measure as it had the best ability to discriminate between depression and non-depression, it showed reasonable sensitivity, high specificity, and it was able to stand alone as a predictor of major depression with its predictive ability not improved with the inclusion of diabetes symptoms. Study two of this thesis investigated the demographic, medical, and psychosocial correlates of depression in patients with diabetes. This research was important as information about risk profiles can help improve rates of diagnosis and treatment and may provide a method by which screening can be more focused and cost effective. 1069 hospital outpatient patients with diabetes were asked to complete a battery of questionnaires to accomplish this aim. The results found that co-morbid depression in patients with diabetes was associated with type-1 diabetes, younger age, poor glycaemic control, insulin treatment, co-morbid medical illness, increased diabetes symptoms, lack of a partner, lower income, stressful life events, low social support, and poor quality of life. Of particular interest was the finding that the inclusion of psychosocial predictors reduced the predictive ability of many demographic and medical factors. Study three of this thesis investigated the impact of a depression screening and feedback procedure on a patient’s level of depression, glucose control, and quality of life. While routine screening for depression has recently been recommended for all patients with diabetes, no previous research had been conducted to evaluate the efficacy of this approach on treatment and patients outcomes. 164 patients with diabetes who were found to be depressed in study 2 were involved in a randomised controlled trial which compared patients who received feedback regarding their depression status with those patients who did not receive any feedback. The results found high rates of depression in this sample and suggested that screening for depression and providing feedback to patients regarding the outcomes of screening had beneficial effects on depression at six months but not on glycaemic control or quality of life. The final study in this thesis attempted to investigate the help seeking behaviours of patients following feedback and to identify barriers to seeking care. 82 participants who received feedback regarding their depression status in study 3 were contacted for a structured telephone interview. Results indicated that only 52.44% of depressed diabetes patients followed the recommended advice and sought help for their depression. Of the patients that did not seek help, several barriers to seeking care were reported. Overall, the results indicated that attitudes relating to the severity of the disorder and the need for treatment were more salient barriers for participants in this study than logistical issues, stigma, or current levels of depression.

Thesis advisor: Belle Liang / Previous research on mentoring has primarily focused on outcomes associated with these relationships. This body of literature has shown that youths can reap academic, psychological, social, and vocational benefits from the support and guidance provided by these relationships. In addition to outcomes, there has been a slow, but steady, shift to understand the process, or experience, of mentoring from the perspectives of both the mentor and youth. Yet both of these lines of inquiry tend to presuppose that youths are ready, willing, and able to engage in a relationship with a mentor, as long as one is available. Indeed, other research shows that not all youths are ready to be mentored. Therefore, in an attempt to address the conceptual gap regarding the understanding of how youths come to participate in mentoring relationships, the current study used developmental frameworks to investigate precursors to youths' readiness to be mentored. Specifically, this study considered the role of demographic characteristics and parental attachment with eighth grade youths' readiness to be mentored. Readiness to be mentored was conceptualized as consisting of attitudinal and probable-action elements, based on help-seeking theory, and was assessed using adapted scales that were piloted in the current study. Youths in eighth grade from four K-8 elementary schools in the Northeast (N=104) completed self-report questionnaires assessing parental attachment, attitude towards seeking a mentor, likelihood to engage a mentor, demographic characteristics, and mentor characteristics. The gender differences that were hypothesized were not supported; rather, mentor presence was linked to positive attitudes towards seeking a mentor and increased likelihood to engage a mentor. Among the youths with mentors, aspects of parental attachment differentially predicted attitude towards seeking a mentor and likelihood to engage a mentor. Of particular interest was that those without mentors most frequently reported not needing a mentor. This finding draws attention to the understandings youths have of the role and potential utility of mentoring in their lives, and the factors that shape these understandings. Theoretical considerations, implications for future research, and practice implications are discussed. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

A West Coast university has had an increase of students who have experienced anxiety or depression over the last few years and have not sought professional assistance. Students have stated that multiple factors contributed to their anxiety or depression, including difficulty adjusting to their new college environment. This challenge has disrupted students' academic performances and often left them without professional help to deal with their anxiety or depression. The purpose of this qualitative narrative inquiry was to increase understanding of factors that lead undergraduate students to experience anxiety and depression and factors that led to their decision to seek or not seek assistance on campus during their 1st year of college. The conceptual framework that was used encompasses how Ajzen's theory of planned behavior relates to help-seeking behaviors of students. Research questions addressed factors that contribute to an undergraduate's anxiety or depression and what led them to seek or not seek professional assistance during their first year. Eleven undergraduates with a history of anxiety or depression were asked to participate in face-to-face interviews to address the research questions. Narrative analysis was used to analyze the data. The most common themes that were found to have contributed to mental health challenges were pressure, transition and adjustment, and roommate and familial challenges. In addition, the factors that led participants to seek or not seek professional help included influence by peers, affordability, and perceived stigma. Based on findings from the study, a white paper was developed to attempt to improve the institution's culture of mental health by encouraging students to seek assistance for their anxiety and depression without any internal and external barriers.

Thesis (M. Soc. Sc.)--University of Hong Kong, 2003.

Thesis (M. Soc. Sc.)--University of Hong Kong, 2004.