Thèse (M.A.)--McGill University, 1998. / Comprend des réf. bibliogr.

This qualitative interview study explored the responses of child participants and their primary caregivers to the experience of completing a multi-stage screening process designed to identify depressed youth. Participants were sixteen girls ages 9 to 11 and caregivers of twelve of the girls. The child participants selected for this study were those who reported symptoms of a depressive disorder at the initial stages of screening without receiving diagnosis of a depressive disorder at the final stage of screening. Qualitative interviews were completed separately with child participants and their caregivers using a semi-structured interview format. A grounded theory approach was used to analyze interview transcripts and generate an integrated explanation of child and caregiver responses to depression screening and assessment (Strauss & Corbin, 1998). Results of this study indicate that depression screening and assessment serves the function of creating a forum for the child perspective by raising the child‘s emotional state and concerns to the attention of both the child and the parent. The child participants in this study reported experiencing emotional distress or a sense of burden prior to the first stage of screening. A process of reflecting on their emotions, beliefs, and stressors began as child participants completed screening questionnaires, followed by a sense of relief or improved mood in response to talking with interviewers during a brief interview. The forum for the child perspective expanded as parents received interviewer feedback about child emotions and concerns and began to assess the information in light of their own observations and situational factors. The extent to which parent and child maintained the forum for the child perspective through sustained communication about the child‘s emotions and concerns influenced the type and intensity of interventions subsequently introduced by parents. The chief means through which depression screening affected the child participants was through enhancing their understanding of themselves, promoting positive coping processes, facilitating parent/child communication, and influencing parent perceptions and the parenting agenda. / text

Background Postnatal depression (PND) has become a world-wide public health problem. Maternal Child Health Centers (MCHCs) provide maternal and child healthcare with community-based Comprehensive Child Development Services (CCDS) aimed for early identification for provision of appropriate referral for intervention. There were 13.8% suspected PND cases in 2011(Department of Health PND Report, 2011). Antenatal Interpersonal Psychotherapy (IPT) has found efficacious for high depression risk (HDR) pregnant women. Evidence-based practice (EBP) antenatal IPT guideline best suited for MCHCs implementation. Purpose This dissertation intends to develop an effective EBP antenatal IPT guideline for HDR pregnant women, and to offer plans for implementation and evaluation. Methods Six electronic databases searched for updated relevant studies. Randomized controlled trails (RCTs) with antenatal IPT intervention for HDR pregnant women targeted. Evidence data related to EBP guideline development were extracted for critical appraisal. Program implementation potentials assessed for transferability, feasibility and cost-benefit ratio. Guideline with level of evidence and recommendation grading developed. Communication plan for different stakeholders and potential users were developed. Pilot test planned for process evaluation. Impact evaluation, outcome evaluation and economic evaluation planned to verify empirical evidences to initial changes in MCHCs. Results Eight RCTs studies, which compare group receiving antenatal IPT intervention with routine antenatal education group, were reviewed. Target population was HDR pregnant women. Antenatal IPT intervention found effective for HDR pregnant women with PND. The studies suggest antenatal IPT intervention give0.89 reductions in EPDS, improved psychological well-being, 0.77 reductions in GHQ and improved role competence2.43 increases in PSOC-E. After critical appraisal of reviewed studies, antenatal IPT guideline developed. Pregnant women should be screened between 20 to 32 gestation weeks. Those with EPDS≥13 scores should enrolled into two 2-hour antenatal IPT program educated by trained nurse educators in class size ≤10. Those refusing to join the program receive routine education. Three-point measurements of EPDS, GHQ and PSOC-E at baseline, postnatal 6 to 8 weeks and 3 to 6 months of both groups are conducted. Postnatal EPDS ≥13 participants referred for psychiatric services upon their consent. Program will propose implementation in MCHCs. Steering Committee is established and communicates with various stakeholders. Pilot test implement in one MCHC and reviewed for clinical applicability, feasibility and to obtain process evaluation for quality improvement. Program should have quasi-experimental non- equivalent pretest-posttest control group and analyze data with ‘two-sample t-test’, ‘paired t-tests’ and ‘chi-square test’. Target achievement should be: i. Primary outcomes: EPDS score reduced to0.89, GHQ reduced to0.77 and PSOC-E score increased to2.43; ii. Secondary outcomes: Reduction of PND incidence and PND management caseloads by 20%. Participants’ gestation ages, program attendance and satisfactory rates recorded. Economic evaluation indicates for every $1invested, the return is $8.45, program is a sound investment suggested. Conclusions Eight RCT studies provide evidence that antenatal IPT program is effective for HDR pregnant women in reducing PND, and in promoting higher maternal role efficacy level and psychological well-being. Implementation of this EBP program guideline can potentially help PND prevention and ease antenatal depression management of HDR pregnant women in MCHCs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

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Background: Studies showed differences in attitudes towards patients with mental illness in nurses who worked in somatic care compared to nurses who worked in psychiatric care. The nurses in somatic care stated more negative attitudes to mental illness in relation to the nurses in psychiatric care. Studies also showed that work experience affected attitudes towards mental illness. Nurses who often came in contact with people with mental illness had less negative attitudes and prejudices against mental illness. Aim: The aim was to examine the experiences from nurses in somatic care, caring for patients who also have a psychiatric diagnosis. Method: The study was conducted as a semi-structured interview. The study was conducted through interviews with six nurses from the departments with a focus on somatic care. Qualitative content analysis was used for the analysis, which resulted in 48 pieces of sub-categories and six categories. Results: The analysis resulted in six categories: “often psychiatric patients in the somatic care”, “difficult patients”, “sees the whole patient as a person, not a diagnose”, “if it is not written, it does not exist”, “I know how to do, but” and “psychiatric disorder, not for real”. Conclusion: Nurses experienced that caring for patients with psychiatric comorbidity was caring for patients who required a lot of time and attention. The nurses felt they lacked some knowledge how they should respond to, and how to provide the best care, for these patients. Nurse’s experience was that they did not get the support from the psychiatric clinic that they wanted.

Background Stigma and discrimination because of medical conditions is a global phenomenon. Epilepsy and mental illness belong to the most stigmatizing disorders world-wide. Culture, religion, education, life-style influences the perception of stigma. There are two aspects of stigma of special interest for this thesis; internalized stigma, which is the perception of a person suffering from a condition and the public perception of this disorder. This study investigates both aspects of stigma because of mental illness and epilepsy. Internalized stigma of mental illness and epilepsy are also studied in Umea, Sweden, with the same instrument as in Iran in order to look at the cultural influence. Methods Paper 1 and 2 on internalized stigma because of mental disorders and epilepsy in Tehran: These studies are cross-sectional with 138 persons with mental illness recruited from three different hospitals in Tehran and 130 persons with epilepsy from one neurologic clinic in Tehran and the Iran epilepsy association. Internalized stigma because of mental illness was measured using ISMI (Internalized Stigma of Mental Illness) questionnaire and because of epilepsy with the same instrument adapted for epilepsy (ISEP). ISMI/ISEP contains 29 items measured by a 4-point Likert scale. An open-ended question about the experiences of discrimination was added. Paper 3 and 4 on public attitudes towards mental disorders and epilepsy in Tehran: These two studies were performed with 800 individuals randomly chosen from households in four districts of Iran (north, south, east and west). In Paper 3 on attitudes and knowledge of mental illness a modified version of a questionnaire developed for the World Association program to reduce discrimination and stigma because of schizophrenia was used. In Paper 4 on awareness of and attitudes towards epilepsy a questionnaire originally developed by Caveness and Gallup in United States as early as 1949 was used and since used in many studies all over the world. Paper 5 and 6 comparing internalized stigma because of mental disorders and epilepsy in Tehran and Umea: These two studies included patients suffering from mental disorders (N=163) and epilepsy (N=93) recruited from the university hospital in Umea, Sweden. The same questions as used in Paper 1 and 2 were applied. Results The experience of stigma because of mental disorders was high in the Iranian sample. The Swedish sample generally reported lower levels of experienced stigma than the Iranian except for items covering self-blame and feelings of alienation. As regards epilepsy the Iranian sample reported quite a high level of experienced stigma compared to the Swedish sample. Generally the patients with epilepsy reported lower levels of experienced stigma compared to patients with mental illness in the two settings. Attitudes towards mentally ill persons in Tehran were at the same levels as in western high income countries. The knowledge about and attitudes towards persons with epilepsy was also generally at the same level as found in other European studies expect for a much lower acceptance as regards accepting a person with epilepsy to marry someone in the family. Conclusion Stigma because of mental illness and epilepsy is a reality even in Iran, which is an Islamic setting in spite of the teachings of the Koran to show mercy with people who suffer from different ailments and rather well developed health services. The levels of experienced stigma is higher in Iran compared to Sweden, but still there is quite a lot of stigma because of mental illness even in Sweden in spite of several national efforts to reduce stigma. The lower levels of stigma because of epilepsy in both settings and especially in Sweden, is suggested to be the consequence of effective treatments available for epilepsy compared to the less successful treatments available for mental illness. The differences in internalized stigma reported and the public perceptions of stigma because of both mental illness and epilepsy between Iran and Sweden is suggested partly a consequence of the different cultural settings, Sweden being an extremely individualistic society compared to the more collectivistic Iranian society.

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This study aims to examine howdifferent forms of social support are perceived to affect the recovery process of people with severe mental health difficulties, and what factors people within this group perceive as being most beneficial for their recovery. This study was conducted in Uganda for eight weeks during November 2013 and December 2013 and is based on semi-structured interviews with people in recovery from severe mental illness such as bi-polar affective disorder and schizophrenia. This study is using Interpretative phenomenological analysis (IPA), which is a qualitative research approach, and the strength of IPA is its commitment to examine lived experience and personal meaning in detail. This study has shown that social support received from service user organisations was perceived to highly affect the recovery process in a most fundamental way. The service user organisations/associations were seen as platforms providing acceptance, understanding and recognition of what one has been or are going through. In terms of social support from family members, this was neither described as particularly helpful or hindering for the recovery process by most of the participants; this finding was somewhat unexpected but could be explained due to the complexity that proved to exist within the relationships between the participants and their family members. Medication was perceived as very important in terms of recovery, however it was strongly pointed out that medication alone was not enough. Despite this a majority of the participants had negative perceptions regarding both the dosage and the prescribed medicine itself particularly the prescription of Chlorpromazine, here feelings of being overmedicated and dealing with severe side effects were expressed, leading to some of the participants changing the prescribed dose on their own, so called manipulative medication.

My study is an investigation of the discourse of madness in Timothy Findley's fiction, where madness is defined as a discursive element that is both structural and thematic. The work encompasses Findley's short stories, novels, a work of non-fiction, and personal archival material. I argue that what has been called a diverse body of work (Hunter) is, in fact, solidly cohesive in its use of the discourse of madness that systematically subverts patterns of authority. My purpose is to reveal a discursive structure that both supports and subverts narrative coherence, locating its degree of disruption within a psychodynamic exchange. / My theoretical model situates the reader as the recipient of and participant in the initiating text's psychodynamic discourse, and so implicates the reader in the subversion of authority. The study amalgamates psychocriticism and reader response theory to demonstrate that Findley's writing actively engages the reader in a visceral exchange that I liken to that encountered within the psychoanalytic interview (Bollas). With the addition of the psychoanalytic component, my research moves substantially beyond the position taken by Wolfgang Iser on reader response and by Norman Holland, both of whom acknowledge the value of psychocriticism but maintain a dualistic (reader/text) model. While Iser and Holland assign the status of co-production of the text to the activity of reading, both neglect to address specific production value to the activity of writing which, in effect, leaves the reader as lone producer. / By introducing the "idiom" of the author my theoretical model becomes triadic so that my reading can move beyond the simple oscillation between text and reader to engage the author in a way that amplifies important questions of status raised by the psychodynamic model, such as: "Who is reading whom?" "Who is the analyst and who the analysand? Who is maintaining or manipulating authority?" These, in turn, raise further questions regarding subject/object relations and the ways in which transference-countertransference between selves and others, subjects and objects, conscious and unconscious states take place. In addressing these questions in terms of the triadic process of reading, which re-instates the initiating author, the value and originality of this study becomes apparent in its investigation of biographical material to literary production.