The central premise of this thesis was that pain is a problem in persons living with HIV/AIDS (PLWHA), that this pain is biopsychosocial in nature, and as such may have different characteristics in different sub-groups. It was also hypothesised that pain in PLWHA can be effectively managed using a biopsychosocial treatment.

Indiana University-Purdue University Indianapolis (IUPUI) / Persons with opioid use disorder (OUD) often receive intensive outpatient treatment (IOT) but these programs are associated with low rates of completion and high rates of relapse. Enhancing patient activation - taking an active role in one’s healthcare - would likely improve outcomes for persons with OUD in IOT. The overarching purpose of this dissertation is to describe how persons with OUD experience IOT, especially regarding activation. The dissertation includes three components. The first is an integrative review of 29 studies of activation in persons with mental health disorders generally. Results revealed that activation was related to several heath and treatment-related factors and some interventions, most notably educational programs, increased activation. The second and third components were based on interviews with 14 persons who had been enrolled in an IOT program in academic health centers. The second component was a constructivist grounded theory study conducted to describe the process people undergo as they participate in an IOT program. Participants described a process of connecting and disconnecting that included eight stages: (1) connecting with drugs, (2) disconnecting from everyday life, (3) connecting with the IOT program, (4) connecting with others in the IOT program, (5) disconnecting from drugs, (6) reconnecting with others, (7) reconnecting with self, and (8) disconnecting from the IOT program. The third component was a qualitative descriptive study conducted to describe types of instances in which persons play an active role in their IOT (activation). Participants described six types of instances: (1) making and enacting one’s own treatment decisions, (2) actively engaging in treatment planning with staff, (3) choosing to actively engage in groups, (4) making a commitment to treatment, (5) taking responsibility for one’s own recovery, and (6) taking actions to avoid relapse. The results of this dissertation will inform the development of strategies to enhance activation among persons with OUD in IOT with the goal of improving engagement and program outcomes.

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BACKGROUND: In Ontario, school closures due to the pandemic lasted 20 weeks at various times throughout March 2020 to June 2021; longer than any Canadian province or territory. School closures may have had a detrimental impact on school-aged children’s academic and psychological functioning. OBJECTIVES: The objective was to examine the variability in child mental/emotional mental health in association with family factors (caregiver depression, caregiver anxiety, overreactive parenting, partner conflict, work-family conflict) and COVID-19 experiences (health-related stressors, resource-related stressors, positive experiences) among children from two-caregiver working households in Ontario METHODS: Data came from the second iteration of the Ontario Parent Survey. The cross-sectional analysis (n=5787) was restricted to working adults, part of a two-caregiver household, with a child aged 4 to 17 years. Sample selection reflected the focus on work-family conflict and partner-conflict as important predictors of interest. Parent-reported, child negative affect and the negative impact on child functioning since the pandemic started, were the main outcomes of interest. Hierarchal linear regression models were constructed, and each group of predictors (covariates, family factors and COVID-19 experiences) were added in a step-wise fashion. Findings were also stratified by child age and child gender. Missing data were handled via multiple imputations. RESULTS: The final model accounted for 38.7% of the variability in negative affect scores, and 24.1% of the variability in COVID-19 negative impact scores. Negative affect was significantly associated with all family factors, resource-related COVID-19 stressors and positive COVID-19 experiences. The negative impact of COVID-19 on child functioning was significantly associated with all COVID-19 experiences and all family factors except overreactive parenting. Caregiver depression was the strongest predictor of worsening child mental/emotional health in all models. Upon stratifying the analyses by child gender and age, partner-conflict was only a predictor of child mental/emotional health for females and child adolescents. Additionally, health-related COVID-19 stress was a significant predictor for males/other only and caregiver anxiety, overreactive parenting and health-related COVID-19 stressors were significant predictors for children, but not for adolescents. CONCLUSIONS: The pandemic recovery period in Ontario should consist of significant efforts to provide preventative family-based programming and interventions to address the growing mental health crisis in children. Future research efforts should aim to explore the mechanisms by which family factors and COVID-19 specific experiences interact to produce various family dynamics and psychological presentations in children. Further research should also replicate the present study in marginalized and culturally diverse populations. / Thesis / Master of Public Health (MPH) / School closures in Ontario due to the COVID-19 pandemic may have impacted child development and wellbeing. The objective of this study was to examine the variability in child mental/emotional mental health scores, in association with family factors (caregiver depression, caregiver anxiety, overreactive parenting, partner conflict, work-family conflict) and COVID-19 experiences (health-related stressors, resource-related stressors, positive experiences). A cross-sectional study was conducted using the second iteration of the Ontario Parent Survey (n=5787). Parent-reported child negative affect and negative impact of COVID-19 on child functioning, as indicators of their mental health, were the outcomes of interest. The final model accounted for about 40% of the variability in negative affect scores, and about one-quarter of the variability in child functioning scores. Poor child mental/emotional health were associated with all family factors and COVID-19 experiences. Caregiver depression was the strongest predictor of worsening child mental/emotional health in all models. Consistent with other findings, this research can be used to support the provision of family-centered community mental health services.

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