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The purpose of this study was to investigate breast cancer patients’ experiences of their illness and of traditional nursing care (TNC) or supportive nursing care (SNC) respectively, as well as nurses' experiences of support and of caring for cancer patients. An intervention including extended co-operation between the surgical ward and primary health care, shorter waiting times, and changed routines concerning the information about the diagnosis, as well as training and systematic clinical supervision for the nurses, was implemented. Newly diagnosed breast cancer patients (n=47) from two county councils in the south-east of Sweden were interviewed (IV, V). Thirty-four of them completed scales about well-being, burnout, hopelessness, anxiety and depression (VII). The women who had TNC reported lack of professional support during the initial phase of the disease and suggested changes in the care similar to those implemented in the SNC. In the SNC group the women expressed feelings of safety and security after the professional support and the organizational changes in the care. There were significantly more single women and women who had had breast conserving surgery in the SNC group than in the TNC (VII). The hopelessness scores in the SNC group were significantly higher than in the TNC group. Thirty-nine district nurses (DNs) were interviewed at baseline (I), and thirty-three of them completed scales about burnout, empathy, and sense of coherence (SOC) before and after systematic clinical supervision (VI). Twenty-three of the 39 DNs, as well as 9 hospital nurses (HNs) who participated in the clinical supervision, were interviewed about their experiences of this intervention (III). Twenty-nine tape-recorded supervision sessions in three groups of DNs (n=23) were analysed (II). Baseline interviews and analyses of the content of the supervisory sessions strongly emphasized that DNs experienced problems in the home care of seriously ill cancer patients. Deep human contacts were a source of both strain and enrichment. The clinical supervision was said to provide relief from undesirable thoughts and feelings, confirmation of themselves both as individuals and in their professional role, a broader and deeper knowledge and increased self-confidence. There were no significant differences in the burnout, empathy, and SOC scores between the supervisory group (n=21) and a comparison group (n=12) at the first and second measures, nor over time within the groups. There were some correlations between these phenomena and the Karolinska scales of personality, as well as cor­relations between burnout, empathy and SOC. The groups of women were not entirely similar as regards demographic and medical characteristics, and the sample size of patients and nurses was small. It is obvious that patients in the TNC missed those factors that were implemented in the SNC, at the same time the latter women expressed hopelessness more often than those who had received TNC. This result may be due to the fact that support from nurses had made the women more prepared to express their feelings, that support had not been provided to an adequate extent or in the right way, or that the applied scales were not appropriate. The finding that the nurses experienced the clinical supervision as very positive but that, despite this, there were no significant differences in attitudes measured by scales within or between the groups, can be interpreted in a similar way. Consequently, further research is needed to judge the effects of intervention. The study has, above all, produced qualitative descriptions of patients' experiences of the nursing care after discharge from hospital, and of DNs’ experiences of the care of cancer patients in their homes, and of systematic clinical supervision. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 7 uppsatser.</p> / digitalisering@umu

Thesis (MEdPsych)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The contexts of the experiences of teachers in South Africa, particularly in communities with low income levels, seem to invite meanings of hopelessness. These meanings appear to be supported by dominant discourses that could determine and limit the practices or actions of these teachers. Within these contexts, however, there are teachers whose actions, reflections or motivations suggest the possibility of alternative or preferred meanings that may be marginalised or silenced by dominant discourses of hopelessness. The theoretical framework that provided the foundation for this study was social constructionism, which argues that meaning is constructed through social interaction and that there is no underlying or objective reality that can be revealed through observation or experience. An understanding of this social construction of meaning allows for the construction of alternative or preferred meanings by individuals or groups in contexts where dominant discourses do not serve their best interests. The aim of the research was therefore to explore and describe the meanings that the participants make of their experiences as teachers in a primary school in Cape Town in a community where low income levels are prevalent. The study further aimed to describe how these teachers experience contextual factors and how these factors contribute to their meaning-making. Furthermore, the purpose of the study was to explore local knowledge in the form of actions, motivations and reflections of the teachers that suggest possibilities for alternative or preferred meanings. In keeping with the social constructionist nature of the study, a qualitative, interpretivist research approach was used. Participants were selected through purposive sampling and focus group discussions were used to generate data. Digital audio recordings were made of the group sessions, which were then transcribed and analysed using the constant comparative method. The research findings indicated that the teachers who participated in the study experienced various contextual factors that contributed to their meaning-making. Their experiences of most of these factors were described in similar ways to comparable contextual factors as portrayed in the literature. Furthermore, these contextual factors were linked by the teachers, and dominantly in the literature, to meanings that could be summarised as hopelessness. However, alongside these meanings, the teachers gave rich or detailed descriptions of a range of actions, reflections and motivations that suggest possible alternative or preferred meanings to the hopelessness that their context seems to invite, and that dominant discourses in the literature appear to portray. These findings led to recommendations that were centred largely on meeting some of the support needs of teachers and children in communities with low income levels. / AFRIKAANSE OPSOMMING: Onderwysers se ervarings in Suid-Afrika, veral in gemeenskappe met ‘n lae inkomstevlak, word belewe binne kontekste wat lyk asof dit die betekenisse van hopeloosheid ontlok. Hierdie betekenisse word blykbaar deur dominante diskoerse ondersteun, wat hierdie onderwysers se werksaamheid of optrede kan bepaal en beperk. Binne hierdie kontekste is daar egter onderwysers wie se handelinge, nadenke of motivering die moontlikheid van alternatiewe of verkieslike betekenisse aandui, maar wat gemarginaliseer of stilgemaak kan word deur die dominante diskoerse van hopeloosheid. Die teoretiese raamwerk wat die grondslag vir hierdie studie verskaf het, was sosiale konstruksionisme, wat daarop dui dat betekenis deur sosiale interaksie gekonstrueer word en dat daar geen onderliggende of objektiewe realiteit is wat deur waarneming of ervaring geopenbaar kan word nie. ‘n Begrip van die sosiale konstruksie van betekenis maak voorsiening vir die konstruksie van alternatiewe of verkieslike betekenisse deur individue of groepe binne kontekste waar dominante diskoerse nie hul beste belange dien nie. Die doel van die navorsing was daarom om die betekenisse wat die deelnemers, as onderwysers in ‘n laerskool in Kaapstad binne ‘n gemeenskap met lae inkomste, aan hul ervarings heg, te verken en te beskryf. Die studie was verder daarop gemik om te beskryf hoe hierdie onderwysers kontekstuele faktore ervaar en hoe hierdie faktore ‘n bydrae lewer tot hoe hulle betekenis skep. ‘n Verdere doel van die studie was om plaaslike kennis in die gedaante van die optrede, motivering en nadenke van onderwysers, waardeur moontlike alternatiewe of verkieslike betekenisse na vore kom, te verken. Vanweë die sosiaal-konstruksionistiese aard van die studie, is ‘n kwalitatiewe, interpretiewe navorsingsbenadering as navorsingsmetodologie vir hierdie studie gebruik. ‘n Doelgerigte steekproef is gebruik om potensiële deelnemers te identifiseer en data is deur middel van fokusgroeponderhoude gegenereer. Digitale oudio-opnames van die fokusgroeponderhoude is getranskribeer en is met gebruik van die konstante vergelykende metode ontleed. Die navorsingsbevindings het aangedui dat die onderwysers wat aan hierdie studie deelgeneem het, verskillende kontekstuele faktore belewe wat bydra tot die betekenis wat deur hulle geskep word. Hulle belewenis van die meeste van hierdie faktore is op soortgelyke wyse beskryf as vergelykbare kontekstuele faktore wat in die literatuur bespreek word. Hierdie kontekstuele faktore is verder deur die onderwysers en in die literatuur aan betekenisse wat as hopeloosheid beskryf kan word, gekoppel. Naas hierdie betekenisse het die onderwysers egter ook ryk of gedetailleerde beskrywings van ‘n reeks handelinge, nadenkings en motiverings gebied wat moontlike alternatiewe of verkose betekenisse bied tot die hopeloosheid wat deur hulle konteks uitgelok word en deur die dominante diskoerse in die literatuur uitgebeeld word. Die navorsingsbevindings het gelei tot aanbevelings wat hoofsaaklik daarop gerig is om in sommige van die behoeftes aan ondersteuning wat deur onderwysers en kinders in gemeenskappe met lae inkomstevlakke ervaar word, te voorsien.

<p><strong>Bakgrund: </strong>Smärta vid svårläkta ben- och fotsår är ett vanligt förekommande problem som ofta är underbehandlad. Smärta påverkar sårläkningen negativt och är ett komplext hälsoproblem. Smärta kan ses utifrån olika dimensioner vilka påverkar personen på olika sätt. <strong>Syfte:</strong> Syftet var att beskriva hur personer upplever smärta vid svårläkta ben- och fotsår. <strong>Metod:</strong> En allmän litteraturstudie baserad på kvalitativa empiriska studier. <strong>Resultat:</strong> De olika upplevelserna av smärta delades in i tre huvudkategorier; upplevelser av konstant smärta, upplevelser av oförståelse samt upplevelser av själslig smärta. Det framkom att personer med svårläkta ben- och fotsår upplever konstant smärta och hur den konstanta smärtan påverkade vardagen. Oförståelse från närstående och vårdpersonal ledde till frustration och påverkade självkänslan negativt. Själslig smärta framträdde i form av hopplöshet, ångest, skuld och skam samt ett förändrat socialt liv. <strong>Slutsats: </strong>Sjuksköterskan bör identifiera de olika dimensionerna av smärta som skapar en ond cirkel vid svårläkta ben- och fotsår. Sjuksköterskan bör ha en helhetssyn och försöka bryta den onda cirkeln av konstant smärta, hopplöshet och oförståelse.</p> / <p><strong>Background: </strong>Pain in hard-to-heal leg- and foot ulcers is a problem of frequent occurrence and is often under-treated. Pain affects the wound healing negatively and is a complex health problem. There are different dimensions of pain which affects the person in various ways. <strong>Aim:</strong> The aim of the study was to describe the personal experience of pain in hard-to-heal leg- and foot ulcers. <strong>Method:</strong> A literature review based on qualitative empirical studies. <strong>Results: </strong>The different experiences of pain were divided into three head categories; experiences of constant pain, experiences of incomprehension and experiences of emotional pain. The result showed that persons with hard-to-heal leg- and foot ulcers experienced constant pain and how it influenced the every-day-living. Incomprehension was experienced from relatives and health professionals and led to experiences of frustration. Incomprehension had a negative impact on the self-esteem. Emotional pain was illustrated by experiences of hopelessness, guilt and shame, anxiety and changed social life. <strong>Conclusions: </strong>The nurse should identify the different dimensions of pain that creates a vicious circle of pain with hard-to-heal leg- and foot ulcers. The nurse should have a holistic view and try to break the vicious circle of constant pain, hopelessness and incomprehension.</p>

Bakgrund: Smärta vid svårläkta ben- och fotsår är ett vanligt förekommande problem som ofta är underbehandlad. Smärta påverkar sårläkningen negativt och är ett komplext hälsoproblem. Smärta kan ses utifrån olika dimensioner vilka påverkar personen på olika sätt. Syfte: Syftet var att beskriva hur personer upplever smärta vid svårläkta ben- och fotsår. Metod: En allmän litteraturstudie baserad på kvalitativa empiriska studier. Resultat: De olika upplevelserna av smärta delades in i tre huvudkategorier; upplevelser av konstant smärta, upplevelser av oförståelse samt upplevelser av själslig smärta. Det framkom att personer med svårläkta ben- och fotsår upplever konstant smärta och hur den konstanta smärtan påverkade vardagen. Oförståelse från närstående och vårdpersonal ledde till frustration och påverkade självkänslan negativt. Själslig smärta framträdde i form av hopplöshet, ångest, skuld och skam samt ett förändrat socialt liv. Slutsats: Sjuksköterskan bör identifiera de olika dimensionerna av smärta som skapar en ond cirkel vid svårläkta ben- och fotsår. Sjuksköterskan bör ha en helhetssyn och försöka bryta den onda cirkeln av konstant smärta, hopplöshet och oförståelse. / Background: Pain in hard-to-heal leg- and foot ulcers is a problem of frequent occurrence and is often under-treated. Pain affects the wound healing negatively and is a complex health problem. There are different dimensions of pain which affects the person in various ways. Aim: The aim of the study was to describe the personal experience of pain in hard-to-heal leg- and foot ulcers. Method: A literature review based on qualitative empirical studies. Results: The different experiences of pain were divided into three head categories; experiences of constant pain, experiences of incomprehension and experiences of emotional pain. The result showed that persons with hard-to-heal leg- and foot ulcers experienced constant pain and how it influenced the every-day-living. Incomprehension was experienced from relatives and health professionals and led to experiences of frustration. Incomprehension had a negative impact on the self-esteem. Emotional pain was illustrated by experiences of hopelessness, guilt and shame, anxiety and changed social life. Conclusions: The nurse should identify the different dimensions of pain that creates a vicious circle of pain with hard-to-heal leg- and foot ulcers. The nurse should have a holistic view and try to break the vicious circle of constant pain, hopelessness and incomprehension.

Background The definition of self-harm used in this project is repeated, impulsive behaviour causing tissue damage, yet not intended as a suicide attempt. Instead of wishing to die, the person who self-harms wishes to be relieved from anxiety. The thesis comprises four studies and the overall aim was to describe experiences of care among people who self-harm, professional caregivers, and close relatives (parents), and to explore interpretative repertoires that jointly construct the interaction between people who self-harm and their professional caregivers. Methods The participants were nine women who self-harmed (I), six nurses, three of each sex (II), five mothers and one stepfather (III), and six women who self-harmed in two psychiatric inpatient wards and their caregivers (IV). Data were collected through narrative interviews (I, II, III), participant observations (IV), and informal interviews (IV). The interviews lasted between 40 and 50 minutes (I), between 40 and 65 minutes (II), and between 30 and 85 minutes (III). The observations including informal interviews in study IV comprised 150 hours of descriptive observations and 40 hours of focused observations. The data were analysed using qualitative content analysis (I, II), phenomenological hermeneutics (III), and discursive psychology (IV). Results People who self-harmed experienced care as inferior, not satisfying their needs. The findings presented a paradox; on the one hand, the women realised that society considered self-harm an inappropriate way to alleviate mental suffering, and on the other hand, they experienced self-harm as the only way to survive and to foster hope in themselves (I). Caregivers felt powerless and burdened when unable to identify and satisfy the women’s needs. Feelings of fear, frustration, and abandonment created a significant burden for caregivers (II). Parents’ lived experience of the professional care and caregivers of their self-harming adult children could be described as a hostage drama. As in a hostage situation, parents felt held to emotional ransom by deficient care and sometimes hostile caregivers (III). The interpretative repertoires that jointly constructed the interaction between those who self-harmed and their professional caregivers, were for the caregivers a fostering and a supportive repertoire, and for the women who self-harmed a victim and an expert repertoire. The interactions between a fostering caregiver and a woman as expert or as victim, and between a supportive caregiver and a woman as victim, were complicated and promoted feelings of hopelessness among the participants. Interactions between a supportive caregiver and a woman as expert were more satisfying and raised hope among the participants (IV). Synthesis of findings Hope and hopelessness ran together as a thread of meaning throughout the studies. All participants experienced and expressed hope and hopelessness in various ways. The self-harming women hovered between hope and hopelessness, hoping for help and support, but led back to hopelessness by their experiences in care. The women used self-harm as a way to cope and to maintain hope in themselves. The parents initially had confidence in healthcare and hoped for help. However, their experiences of meeting deficient care often made them feel hopeless. Parents paid an emotional ransom when they accepted deficient care for their daughters. The caregivers felt frustrated, angry, and powerless, and their view of self-harm as an endless behaviour led to hopelessness. However, they struggled to see the women’s abilities, not only their difficulties, and described how they had to try to see self-harm in another way. Caregivers who were convinced that it was possible to stop self-harming and leave it behind were able to bring hope to themselves, to parents, and to the women who self-harmed. The present studies suggest that there is a difference between self-harm and suicide attempts or suicide. Other researchers echo these findings. Conclusions Paradoxically, self-harm usually seems to be a life sustaining act, a way of raising hope in oneself. The importance of caregivers who listen and try to understand people who self-harm, as well as their close family members, is evident. By asking open-ended questions and being non-judgemental, listening, and showing a genuine interest in the person’s lived experience; caregivers can inspire hope in people who self-harm. / Bakgrund Självskadebeteende definieras i denna avhandling som ett upprepat, impulsivt beteende där hudskada uppstår. Avsikten med handlingen är inte att begå självmord, stället har personen en önskan att lindra ångest. Avhandlingen består av fyra delstudier och det övergripande syftet var att beskriva erfarenheter av vård bland personer med självskadebeteende, professionella vårdare och närstående (föräldrar), samt att belysa tolkningsrepertoarer som konstruerar interaktionen mellan personer med självskadebeteende och deras professionella vårdare. Metod Deltagarna var nio kvinnor med självskadebeteende (I), sex sjuksköterskor, tre av vardera kön (II), fem mammor och en styvpappa (III) samt sex kvinnor med självskadebeteende som vårdades vid två psykiatriska slutenvårdsavdelningar och deras professionella vårdare (IV). Datainsamlingsmetoder var narrativa intervjuer (I, II, III), deltagande observationer samt informella intervjuer (IV). De narrativa intervjuerna varade mellan 40 och 50 minuter (I), mellan 40 och 65 minuter (II) samt mellan 30 och 85 minuter (III). Beskrivande deltagande observationer genomfördes, totalt 150 timmar, varav ca 40 timmar var fokuserade deltagande observationer. Data analyserades med hjälp av kvalitativ innehållsanalys (I, II), fenomenologisk hermeneutik (III) samt diskurspsykologi (IV). Resultat Personerna med självskadebeteende upplevde att vården var undermålig och att den inte tillfredställde deras behov. Resultaten visar en paradox, å ena sidan insåg kvinnorna att samhället i stort anser att självskadebeteende är ett oacceptabelt sätt att hantera psykiskt lidande, å andra sidan, upplevde kvinnorna att självskadandet var det som gjorde det möjligt att överleva och att inge sig själv hopp (I). Professionella vårdare kände sig maktlösa och tyngda när de inte kunde identifiera och tillfredsställa kvinnornas behov av vård. Vårdarnas rädsla, frustration och känsla av övergivenhet, vilka medförde en känsla av att vara belastad, framkom (II). Den levda erfarenheten av professionell vård och vårdare bland föräldrar till vuxna barn med självskadebeteende beskrevs som ett gisslandrama. Föräldrar till en dotter i en gisslansituation betalade en känslomässig lösensumma när de mötte en undermålig och ibland fientlig vård (III). De dominerande tolkningsrepertoarerna som tillsammans konstruerade interaktionen för vårdarna var en fostrande och en stödjande repertoar. För kvinnorna med självskadebeteende dominerade en offer och en expertrepertoar. Interaktionen mellan en fostrande vårdare och kvinna som expert eller offer, samt en stödjande vårdare och en kvinna som offer, var mer komplicerad och ingav hopplöshet bland deltagarna. Interaktionen mellan en stödjande vårdare och en kvinna som expert var mer tillfredsställande och främjade hopp bland deltagarna. Syntes av resultat Hopp och hopplöshet visade sig vara ”en röd tråd” genom delstudierna. Alla deltagare upplevde och uttryckte hopp och hopplöshet på olika sätt. Kvinnorna svävade mellan känslor av hopp och hopplöshet, med önskningar om hjälp och stöd men deras erfarenheter av vård ingav hopplöshet. Kvinnorna använde självskada som en hanteringsstrategi och som ett sätt att inge sig själv hopp. Föräldrarna hade initialt ett förtroende för vården och hade förhoppningar om hjälp, men deras erfarenheter av att möta en undermålig vård ingav istället en känsla av hopplöshet. Föräldrarna betalade en känslomässig lösensumma när de accepterade en dålig vård för sin dotter. Vårdarna kände sig frustrerade, arga och maktlösa och deras syn på självskadebeteende som något ändlöst ingav hopplöshet. Vårdarna kämpade för att se kvinnornas förmågor, inte bara deras svårigheter och försökte förstå självskadebeteende. Vårdare som var övertygade om att det var möjligt att sluta skada sig och lämna det bakom sig lyckades inge sig själv, föräldrarna och kvinnorna med självskadebeteende hopp. Resultaten från föreliggande studier tyder på en skillnad mellan självskadebeteende och självmordsförsök eller självmord, vilket även stöds av andra forskare. Slutsatser Paradoxalt nog verkar självskadebeteende vara ett livsuppehållande beteende, ett sätt att inge sig själv hopp. Betydelsen av vårdare som lyssnar och försöker förstå personen som skadar sig och närstående är tydlig. Genom att ställa öppna frågor och tala på ett icke dömande sätt, samt genom att lyssna och visa ett genuint intresse för personens upplevelser, kan vårdare förmedla hopp.

本研究結合Clark與Watson（1991）的三角模式（Tripartite Model）以及Brown、Chorpita和Barlow（1998）提出的階層性概念，結構正向情感、負向情感、焦慮、憂鬱、無望感、自傷、自殺的關係，建立自傷與自殺的階層預測模式，說明自傷與自殺的同異處。研究對象為487位大學生，325位女性與162位男性，採取自陳式問卷的方式施測，包含自我傷害行為量表、自殺危險程度量表、貝克無望感量表、正負向情感量表、症狀檢核表-90-修正版（摘錄測量焦慮與憂鬱的題目）、相關背景變項的測量，並以描述性統計、相關性考驗、階層迴歸分析、結構方程模式等統計方式對資料進行處理。主要的研究結果為：（1）負向情感能預測與解釋焦慮和憂鬱，且能透過焦慮預測自傷與自殺，唯焦慮對自傷的解釋力較高；負向情感亦能透過憂鬱預測自殺，但無法透過憂鬱預測自傷。（2）正向情感能預測與解釋憂鬱，且能透過憂鬱預測自殺。（3）加入無望感分析後，發現憂鬱能透過無望感預測自殺，憂鬱也能直接預測自殺，顯示無望感為憂鬱與自殺的部分中介變項。最後，結果發現有15.81%的自傷比例、24.64%的自殺意念比例、8.01%的自殺企圖比例。 / This study combined Clark & Watson’s (1991) tripartite model with Brown, Chorpita, and Barlow’s (1998) hierarchical model to structure the relationship of positive affect (PA), negative affect (NA), anxiety, depression, hopelessness, non-suicidal self-injury (NSSI), and suicide. This study attempted to establish hierarchical predictor model of NSSI and suicide, and explain the relationship of NSSI and suicide. The participants were 487 university students, 325 females and 162 males, who were participating in a study of test of deliberate self-harm inventory, suicide risk inventory, Beck hopelessness scale, positive and negative affect schedule, symptom checklist-90-R, and background variables. The data were examined by descriptive statistics, correlation, hierarchical analysis, and structural equation modeling. The main results were : (1) NA could predict anxiety and depression ; anxiety could not only mediate the relationship of NSSI and NA, but also mediate the relationship of NA and suicide ; anxiety accounted for more of the variance in NSSI than in suicide ; depression could mediate the relationship of NA and suicide, but could not mediate the relationship of NSSI and NA. (2) PA could predict depression, and depression could mediate the relationship of PA and suicide. (3) the role of hopelessness was partial mediator of depression and suicide. Finally, the result found 15.81% NSSI, 24.64% suicidal ideation, and 8.01% suicidal attempt.

La suicidalité (idéations suicidaires avec ou sans plan, tentatives de suicide) est une problématique très importante à l’adolescence. Les adolescents ayant des traits liés au trouble de la personnalité limite (TPL) constituent un sous-groupe à risque suicidaire. Il est aussi largement reconnu que le désespoir, les symptômes dépressifs, anxieux et extériorisés augmentent la vulnérabilité aux idéations et aux comportements suicidaires. Cependant, le rôle médiateur de ces problèmes de santé mentale, dans la relation entre les traits du TPL et la suicidalité n’a pas été vérifié dans les études antérieures. En s’inspirant des modèles théoriques sur l’émergence de la suicidalité, cette thèse propose un nouveau paradigme conceptuel concernant le rôle médiateur des problèmes intériorisés et extériorisés dans cette relation, chez les adolescents de 12 à 15 ans. L’objectif du premier article de la thèse était d’examiner le rôle de quatre médiateurs (désespoir, symptômes dépressifs, anxieux et extériorisés) dans l’association entre les traits du TPL et la suicidalité. Le deuxième article avait pour but d’approfondir cette question en explorant le rôle médiateur de sept problèmes spécifiques, chez les filles et les garçons : désespoir, symptômes dépressifs, de phobie sociale, d’anxiété généralisée, du déficit d’attention avec ou sans hyperactivité, symptômes oppositionnels et des conduites. L’intégration de certaines hypothèses provenant des modèles théoriques a permis de suggérer des trajectoires hypothétiques de médiation. Concernant la méthodologie, les problèmes de santé mentale ont été évalués par le Dominique Interactif pour Adolescents-Révisé (DIA-R) et l’Échelle de désespoir de Beck. La base de données utilisée pour effectuer l’analyse de cheminement incluait un échantillon de 446 adolescents francophones et anglophones âgés de 12 à 15 ans recrutés dans les écoles et les établissements cliniques de Montréal. Les modèles obtenus à partir des analyses de cheminement ont mis en évidence un bon ajustement des données suggérant la plausibilité des trajectoires hypothétiques proposées. Une association directe a été observée entre les traits du TPL et l’échelle de suicidalité du DIA-R. Tel que prévu, plusieurs problèmes de santé mentale interviennent comme variables médiatrices dans cette relation. Les symptômes dépressifs expliquent l’effet médiateur du désespoir, des symptômes anxieux et extériorisés. Cet effet était observé chez les filles et les garçons. De plus, les résultats mettent en évidence que le lien indirect entre les traits du TPL, le désespoir et la suicidalité était plus important chez les filles. Le lien indirect entre les traits du TPL, les symptômes de phobie sociale, le désespoir et la suicidalité était aussi plus important chez les filles. En conclusion, cette recherche doctorale contribue à enrichir les connaissances au sujet de l’association entre les traits du TPL et la suicidalité, chez les filles et les garçons de 12 à 15 ans. Le cadre conceptuel intégratif suggéré, dans chacun des articles de la thèse, pourrait aider les cliniciens à identifier précocement les problèmes de santé mentale afin de diminuer le risque suicidaire. / Suicidality (suicidal ideations with or without a plan, suicide attempts) is a very important issue in adolescence. Adolescents with borderline traits (BT) represent a high-risk group for suicidality. It is also widely recognized that hopelessness, depressive, anxiety and externalizing symptoms increase the risk of suicidal ideations and suicide attempts. Theoretical models suggested a mediating effect of mental disorders/symptoms between personality characteristics similar to BT and suicidality in adolescence. However, previous studies did not examine this research question. In this present thesis, the integration of theoretical considerations provides a new conceptual framework regarding the mediating role of internalizing and externalizing problems in the relation between BT and suicidality in adolescents aged 12 to 15 years. The objective of the first article of the thesis was to examine the role of four mediators (hopelessness, depressive, anxiety and externalizing symptoms) in the association between BT and suicidality. The aim of the second article was to extend this question by analyzing the role of seven specific problems in boys and girls: hopelessness, depression, social phobia, generalized anxiety, attention deficit/hyperactivity, opposition and conduct symptoms. The integration of certain hypotheses from theoretical models allowed to suggest hypothetical mediational pathways. With regard to the methodology, mental health problems were assessed by the Dominic Interactive for Adolescents-Revised and the Beck Hopelessness Scale. A path analysis was conducted using a sample of 446 adolescents aged 12 to 15 years recruited from school and clinical settings from Montreal. The model obtained from path analysis showed a good fit to the data suggesting the plausibility of pathways. A direct association was observed between BT and the DIA-R Sucidality Scale. As hypothesized, several mental health problems intervened as mediating variables in this relation. Depressive symptoms explained the mediating effect of hopelessness, anxiety and externalizing symptoms. This effect was observed in girls and boys. In addition, the results highlighted that the indirect association between BT, hopelessness and suicidality was more important in girls. The indirect relation between BT, social phobia symptoms, hopelessness and suicidality was also more important in girls. In conclusion, this doctoral thesis contributed to extend our knowledge about the association between BT and suicidality, in girls and boys aged 12 to 15 years. The suggested integrative conceptual framework could help clinicians to early identify mental health problems to prevent the suicidal risk.

Text in English / This research was aimed at giving a voice to three women, who are constructed as having had a traumatic event recalled from their autobiographical memory. To achieve this objective an epistemological framework of social constructionism was used to investigate autobiographical memory recall of trauma. Three in-depth interviews were conducted with participants who constructed themselves as having had a traumatic event. A case study approach was used to gain access to the information and to compare themes. The research explored the way in which dissociation, voluntary thought suppression, minimisation and outright denial enabled the three participants to alter unbearable memories through the use of recurring themes. To interpret these stories the content of the themes was analysed using thematic content analysis. The participants represented different cultures, languages and religions. In sharing their symptoms this did not necessarily mean they attached the same meaning to a specific theme, as individual meaning-making corresponded to the individual‟s background and history and their perception of the trauma. The stories related by the three participants revealed a shattered worldview that brought them into opposition with community norms and standards, which the narrators experienced as silencing and judgemental. In this regard the researcher‟s aim was to generate information from the participants themselves. This inquiry into the personal trauma stories and meanings suited a qualitative research approach, a form of methodology that allowed personal insight into the meanings the three participants attributed to their trauma and the autobiographical recall of trauma. At the same time it allowed a co-constructed reality to take shape between the researcher‟s reality and the participant‟s reality, always acknowledging the importance of their being the expert of their own individual trauma memory. This is in contrast to a quantitative approach which focuses on numbers to quantify the results; a qualitative approach on the other hand is a personal, rich information-gathering tool that takes into account the emotions and meaning-making of each individual story without any intention to generalise the information gathered to a larger population It is hoped that through this research there is a realisation that although trauma victims share symptoms, the meaning-making of the individual attached to this trauma is influenced by their society and history within their respective environments. / Psychology / M.A. (Psychology)

En el moment en què els ballarins pateixen una lesió l'atenció dels professionals de la medicina de la dansa se centra prioritàriament en els aspectes físics del tractament i de la recuperació. Amb tot, la lesió sovint té conseqüències pel que fa a les funcions psicològiques. L'objectiu d'aquesta recerca de tipus exploratori, de disseny empíric, transversal, descriptiu i correlacional/causal és conèixer les respostes emocionals davant la lesió de ballarins lesionats de dansa mesurant depressió, desesperança, estat emocional i estratègies d'afrontament. Per això, es varen administrar el POMS, BDI-II, BHS i CHIP, a més d'un qüestionari sobre els factors associats a la lesió, a una mostra de 94 ballarins lesionats a Nova York. Els resultats més destacats assenyalen que el 31,9% dels ballarins va presentar una simptomatologia de depressió en les categories de lleu, moderat i sever en el BDI-II i un 42,9% d'ells desesperança. Quant al perfil de l'estat d'ànim (POMS), constatem una tendència a nivells elevats de tensió i confusió, seguits de depressió, fatiga i hostilitat. El vigor destaca per la seva absència. Les estratègies d'afrontament utilitzades inclouen l'afrontament instrumental i el de distracció, mentre que tendeixen a no utilitzar en la mateixa mesura estratègies pal·liatives. Pel que fa a d'altres factors associats cal destacar, en primer lloc, les preocupacions econòmiques com a factor que pot arribar a ser un impediment a l'hora d'obtenir tractament mèdic i/o psicològic. En segon lloc, en relació a les conductes dels ballarins és rellevant que el 64,8% va continuar ballant malgrat la lesió, i que el 31,9% va cuidar la lesió per sí mateix, sense cap ajut mèdic. Finalment, pel que fa al suport i l'ajuda que pot oferir un psicòleg especialitzat en dansa, els ballarins valoren positivament les tècniques de relaxació, i el seu suport davant les respostes emocionals davant les lesions, així com en la transició psicosocial de la carrera de ballarí. / En el momento en que los bailarines sufren una lesión la atención de los profesionales de la medicina de la danza se centra prioritariamente en los aspectos físicos del tratamiento y de la recuperación. Sin embargo, la lesión tiene a menudo consecuencias sobre las funciones psicológicas. El objetivo de esta investigación de tipo exploratorio, de diseño empírico, transversal, descriptivo y correlacional/causal es conocer las respuestas emocionales en bailarines lesionados midiendo depresión, desesperanza, estado emocional y estrategias de afrontamiento. Para ello, se administraron el POMS, BDI-II, BHS y CHIP, además de un cuestionario sobre los factores asociados a la lesión, a una muestra de 94 bailarines lesionados en Nueva York. Los resultados más destacados señalan que el 31,9% de los bailarines presentó una sintomatología de depresión en las categorías de leve, moderado y severo en el BDI-II y un 42,9% de ellos desesperanza. En cuanto al perfil del estado de ánimo (POMS), constatamos una tendencia a niveles elevados de tensión y confusión, seguidos de depresión, fatiga y hostilidad. El vigor destaca por su bajas puntuaciones. Las estrategias de afrontamiento empleadas incluyen el afrontamiento instrumental y el de distracción, mientras que tienden a no utilizar en la misma medida estrategias paliativas. En cuanto a otros factores asociados es importante destacar, en primer lugar, las preocupaciones económicas como factor que puede llegar ser un impedimento para obtener tratamiento médico y/o psicológico. En segundo lugar, en relación con las conductas de los bailarines cabe destacar que el 64,8% continuó bailando aún estando lesionado, y que el 31,9% cuidó la lesión por sí mismo. Finalmente, en cuanto al apoyo y la ayuda que puede ofrecer un psicólogo especializado en danza, los bailarines valoran positivamente las técnicas de relajación, y su apoyo ante las respuestas emocionales ante las lesiones, así como en la transición psicosocial después de la carrera de bailarín. / When dancers are injured dance medicine professionals focus their attention primarily on the physical aspects of treatment and recovery. However, injuries usually have an impact on the individual's psychological functions as well. The objective of this exploratory study, of experimental, transversal, descriptive and correlational/causal design, is to know the emotional responses towards injury in injured dancers measuring depression, hopelessness, emotional state and coping strategies. In order to do that, the POMS, BDI-II, BHS and CHIP were administered, together with a questionnaire regarding injury-associated factors, to a sample of 94 injured dancers in New York. As for the results, 31.9% of the dancers showed depression symptomatology in the categories mild, moderate and severe in the BDI-II and 42.9 of them showed hopelessness. Regarding the profile of mood states (POMS), results show a tendency towards high levels of tension and confusion, followed by depression, fatigue and hostility. Vigor stands out due to its low scores. The coping strategies used include instrumental and distraction, while not using palliative strategies in the same degree. Regarding other injury-associated factors it is important to note, firstly, the dancers' economical worries as a factor that can even prevent them from accessing medical and/or psychological treatment. Secondly, as regards dancers' behavior, 64.8% of them continued dancing despite being injured, and that 31.9% took care of their injuries themselves, without any professional medical help. Finally, regarding the support and help a dance psychologist can provide, dancers considered positive the relaxation techniques, and their support when emotionally responding to injuries as well as in the psychosocial transition at the end of their professional career.