Made available in DSpace on 2014-06-11T19:29:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-14Bitstream added on 2014-06-13T20:38:08Z : No. of bitstreams: 1 ferrazza_da_me_assis.pdf: 979464 bytes, checksum: 588a7035d40ca9b58068b18623e46852 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Atualmente, qualquer sinal de sofrimento psíquico pode ser rotulado como uma patologia cujo tratamento será a administração de psicofármacos. Com o advento dos modernos psicofármacos e com a ênfase preventiva que assumiu o atendimento psiquiátrico após a II Guerra Mundial, a psiquiatria modificou suas práticas e deixou de ser um saber voltado exclusivamente ao tratamento da loucura para dedicar-se a medicar qualquer mal-estar cotidiano. Essa tendência tem-se ampliado de tal modo que é possível perceber a ocorrência de uma generalizada “medicalização do social”. Neste trabalho, desenvolvemos dois movimentos de pesquisa distintos para estudar o tema da medicalização social e da atual expansão da prescrição de psicofármacos. O primeiro desenvolve um enfoque histórico-social de contextualização geral do processo de medicalização do social. Nele procuramos percorrer a trajetória da constituição do saber e das práticas médico-psiquiátricas desde a fundação manicomial do alienismo até a atual ênfase psicofarmacológica da psiquiatria contemporânea. O segundo movimento busca aproximar-se da capilaridade do processo de medicalização por meio do desenvolvimento de um estudo exploratório amostral sobre a prescrição de psicofármacos no âmbito de um serviço de atendimento à saúde mental de uma pequena cidade do interior paulista. Nossa pesquisa mostra que todos aqueles que passaram pelo atendimento psiquiátrico receberam prescrição de psicofármacos... / Currently, any sign of distress can be labeled as a pathology which treatment will be the administration of psychotropic drugs. With the advent of modern psychiatric drugs and with the preventive emphasis that psychiatric care assumed after World War II, psychiatry has changed its practices and no longer is a knowledge exclusively turned to madness but has been devoted itself to medicate any daily discomfort. This trend has been expanded in such way that is possible to notice the occurrence of a generalized medicalization of society. In the present work we developed two distinct research movements to study the issue of medicalization and social expansion of the current psychotropic drugs ´prescription. The first develops a historical-social emphasis at the general process of contextualization in the social medicalization. For that, we sought to travel through knowledge´s constitution and medical-psychiatric practices going through the asylum alienisms foundation to the current emphasis on psychopharmacology of contemporary psychiatry. The second movement seeks to approximate itself to the capillarity of the medicalization process by developing an exploratory sample of psychotropic prescription in a mental health service care from a small town in São Paulo. Our research shows that everyone who went through psychiatric treatment received psychotropic prescription... (Complete abstract click electronic access below)

abstract: Intimate couple relationships are integral to the lives of most adults, and a typical stepping-stone in beginning a family. Thus, it is imperative to understand personal and interpersonal factors associated with healthy, long-lasting relationships (e.g., relationship satisfaction). One factor that may promote healthy relationships is mindfulness. Mindfulness has been linked to positive physical and psychological outcomes (see Kabat-Zinn, Lipworth, & Burney; Carmody & Baer, 2008), but has been minimally studied in the context of couple relationships. Research has also identified the corrosive effect of hostile communication cues on relationships (Gottman, 1994). The current study examined associations between mindfulness, corrosive communication cues, and relationship satisfaction in the context of cohabiting couples using actor-partner interdependence models (APIM; Kenny, Kashy, and Cook, 2006). Self-report questionnaires assessed five aspects of mindfulness: observing, describing, awareness, non-judgment of inner experience, and non-reactivity to inner experience. Women's non-judgment of inner experience, one of five mindfulness facets, was positively associated with the women's own relationship satisfaction. Other facets of mindfulness were not significantly associated with relationship variables. These findings and considerations for future research are discussed. / Dissertation/Thesis / M.S. Family and Human Development 2014

<p> In the United States suicide is the second leading cause of death for 15-24 year olds. It is the tenth leading cause of death in the general population. The United States Surgeon General made a call to action to address this epidemic. The call was for more research for screening and interventions for those at risk for depression and suicide. Research has suggested that individuals adopt implicit mindsets that inhibit their ability to cope with adversity, rendering them less resilient and more susceptible to succumbing to depression and suicidal ideation. Growth mindset has been positively correlated with resilience in a variety of contexts. The purpose of this quantitative study was to investigate growth mindset in the context of emotions to discern if there was a relationship between emotional growth mindset and depression and suicidal ideation. Specifically, this study investigated the predictive power of emotional growth mindset on depression and suicide. Online surveys were administered to 164 participants. The surveys measured emotional growth mindset, depression and suicidal ideation. Multiple regression analyses were performed using SPSS to discern relationships between variables. The results indicated a negative relationship between variables. Emotional growth mindset was negatively correlated with both depression and suicidal ideation. However, the relationship was only strong enough to be predictive of suicidal ideation (<i>r</i>(<i> N</i>=164)=-.249,<i>p</i>=.001). This suggests that emotional growth mindset could be an effective screening tool for those at risk for suicide. More research is needed to confirm the results of this study as well as investigate growth mindset&rsquo;s potential as an intervention for those at risk for suicide.</p><p>

Nurses are an integral part of the health care system and their job encompasses a wide range of responsibilities including the promotion of health, prevention of illness and care for physically, mentally ill and disabled people. Nurses have a mandate to be responsible and accountable to the public they serve. For these reasons, it is crucial that nurses possess attitudes that allow them to provide optimal care in a supportive manner for patients. Despite the fact that considerable research on the experiences of nurses caring for the mentally ill in general hospitals has been done globally, none has been conducted in the Eastern Cape, South Africa. Additionally, no studies could be obtained from anywhere in the world on the experiences of non-psychiatric trained nurses caring for mental health care users on 72 hour observations. Studies indicated that nurses have different experiences when caring for mental health care users. It was therefore considered necessary to find out how non-psychiatric trained nurses perceive the caring of mental health care users during the 72 hour observations. The research design used to explore and describe their experiences was qualitative, descriptive, explorative, phenomenological and contextual in character. Semi-structured interviews were conducted with eight (8) participants who were purposively selected. This was done after necessary permission from the Department of Health and informed consent from the research participants. Steps were taken throughout the course of the study to ensure trustworthiness. Data were analysed using Tesch’s methods and the services of an independent coder were used. The results indicate that there are different experiences with regard to the caring for mental health care users during the 72 hour observations. The major themes identified are: feelings experienced by these nurses, lack of knowledge, challenges and strategies used for coping with a violent user, need for support from security staff and lack of policies. v Guidelines as a supportive action are suggested. From the results of the study recommendations are made in the areas of nursing education, nursing practice and nursing research. It is concluded that for non-psychiatric trained nurses to provide optimal care to mental health care users, the nurses need knowledge and skills in order to facilitate the promotion, maintenance and restoration of mental health of these patients as an integral part of health.

<p> The Health and Retirement Study (HRS) is a twenty-five-year longitudinal study that studies populations over the age of fifty. There is a lack of studies that examine depression and social isolation as comorbid conditions. The purpose of this study was to examine secondary data from the 2014 wave of the HRS regarding associations between depression, social isolation and demographic characteristics, including age (50&ndash;104 years), gender, and marital status. Self-reported data from 18,289 participants (10,703 females and 7,586 males) suggested a positive association between depression and social isolation (<i> r</i> = .365, <i>p</i> &lt; .001) in that as levels of depression increase so do feelings of social isolation. Significantly more females than males reported having depression. Those who were married reported less depression and social isolation. Younger ages experienced depression and older ages social isolation. Further research should explore solutions to decreasing depression and social isolation among older adults in the United States.</p><p>

Restraint has been used as a method of managing untoward incidents in mental health practice since mental health care began. Although methods of managing untoward incidents have evolved over time, restraint remains to this day the principal model for managing violent and aggressive behaviour in acute mental health settings. Despite restraint being a dominant force in acute mental health care, the psychological impact of this intervention upon staff and patients is relatively unknown with very little research devoted to this area. Guidelines suggest that some form of Post Incident Review should take place following untoward incidents but this is patchy in many areas, and the efficacy of approaches to Post Incident Review has not been clearly documented in related literature. Furthermore, some staff and patients have reported that the experience of restraint triggers memories of previous traumatic encounters which have caused further distress to them during, and in the aftermath of, restraint. This study explores the psychological impact of restraint for staff and patients who are involved in these procedures. In addition, a framework for Post Incident Review is evaluated to establish whether this is a helpful tool to address some of the limitations of current approaches to Post Incident Review. The phenomena of restraint reawakening memories of previous traumatic encounters is also considered within the study to establish whether this has a bearing upon the experience of restraint for those involved in the procedure. The results highlight that the experience of restraint is distressing for staff and patients. The psychological impact ranges from minimal effects, to distress, through to full-blown Post Traumatic Stress Disorder (PTSD). The framework for reviewing incidents was well received by staff and patients and is offered as a way forward in providing a more structured approach to considering untoward incidents between staff and patients. This study has found that the experience of restraint does reawaken memories of previous traumatic encounters for both staff and patients. The study concludes with recommendations for education, further research and clinical practice.

Growth in stepfamily research in recent years has mirrored the growth in the number of stepfamilies in society, however research specific to the role of the stepmother has been recognised to be limited (Coleman, Ganong & Fine, 2000). This study has been designed to address this limitation by conducting a mixed methods approach to research on stepmothers in order to understand the effects of the stepmother role on women’s wellbeing. The research was conducted on a representative stepmother sample of two hundred and fifty stepmothers and eighty biological mothers. The sample was further segmented by residency of the stepchildren and family complexity, to identify differences both between stepmothers and biological mothers, and between different types of stepmother. Results indicated that stepmothers display significantly higher depression and anxiety than biological mothers together with lower perceived social support when compared with biological mothers, particularly from extended family and friends. They were also found to engage in significantly more maladaptive coping mechanisms than biological mothers. The adaptability of stepmothers to their role was found to be predicted by their satisfaction in their spousal relationship and the length of the relationship. The findings from the qualitative study suggested that stepmothers’ anxiety was predominantly related to the presence of the biological mother, the stepchildren and the inherent difficulties with the role itself; with social support from extended family members also affected by the enduring relationship between the stepmother’s in-laws and the biological mother. Further significant differences between the four identified types of stepmother were also found leading to the recommendation that future research recognises and distinguishes between stepmother led families, based on their family complexity and the residency of the stepchildren. The evidence overwhelmingly identifies an urgent need for stepfamily interventions that will facilitate the development of more effective functioning stepfamily units via education and support.

An increasing body of evidence suggests that, in comparison to the general population, patients with severe mental illnesses such as schizophrenia or bipolar disorder have worse physical health and a far shorter life expectancy, due primarily to co-morbid chronic diseases. The standardised mortality ratio for all forms of mental disorder is at least 1.5 and varies with the type and severity of the disorder. Whilst data on the prevalence of chronic diseases in primary care is available nationally, there is a lack of health intelligence on medical co-morbidities associated with chronic mental illnesses. The aim of this PhD was to develop and validate epidemiological models for predicting expected prevalence of two major chronic medical conditions namely, coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD), on general practice data for people with concurrent serious mental illness (SMI) group. The study probed the national epidemiological synthetic estimation of the two physical disorders to determine their prevalence within a local primary care setting and their co-existence within the serious mentally ill (SMI) group identified through the Quality Framework dataset (QOF) within GP practices and their localities. The expected prevalence was compared with recorded cases.

<p> The purpose of this qualitative study was to explore correctional mental health clinicians&rsquo; views of the role mental illness plays in offending behavior, barriers to effective treatment and receptiveness to criminogenic interventions. The sample consisted of 15 mental health clinicians working in an urban jail. The consensus among participants that was untreated mental illness is a vulnerability factor leading to criminal risk factors. As such, limited support was found for the criminalization hypothesis. There was general endorsement of implementing criminogenic interventions to target criminal risk factors. Barriers to effective treatment largely pertained to lack of collaboration with the sheriff&rsquo;s department and environmental constraints. There was a perceived need for increased community services for continuity of care of inmates following release. The results suggest that social workers should advocate for an integrated treatment approach to target criminal risk factors in addition to mental health needs.</p><p>

<p> The US wields the most powerful military in the history of the world, and deploys military personnel throughout the globe to fight, kill and die in atoned conflict. US veterans number around 22.5 million or about 14% of the US population. Some veterans, troubled by violence, enroll in the Veterans Health Administration (VHA) and receive care from mental health providers who have developed, through their particular framework, the medical constructs of post-traumatic stress disorder (PTSD) and moral injury (MI) to diagnose and/or "treat" these veterans as "patients." The PTSD construct casts veterans as "patients with a disorder," minimizes legitimate moral pain, and enables the US public to avoid the work of reckoning with harmful consequences of US military action for which they hold ultimate responsibility. MI, a more recent and fluid construct, occurs at the intersection of religion and violence and thus invites the contribution of chaplains. A focused MI group for combat veterans within the VHA co-facilitated by a chaplain and psychologist provides veterans the opportunity for <i>frame breaking</i> and <i> reframing</i> and holds the possibility of systemic change in a response grounded not in individual therapy or treatment but rather in shared spiritual and moral community. A public ceremony with ritual and spiritual discipline creates sanctuary for veterans to provide <i>adaptive leadership</i>, as they transform themselves from patient to prophet, bearing witness to unsanitized and inglorious truths while the US public listens and wrestles with issues of culpability, obligation, and moral responsibility. The outcome is post-traumatic growth and spiritual development&mdash;indicated by greater moral engagement, awareness, forgiveness, and compassion. Such adaptive change may lead to increased resistance to militarism and greater reverence for all life on this fragile earth.</p><p>