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The National Institute of Health has estimated that over 1 million new cancer cases will occur yearly. Posttraumatic stress disorder (PTSD) is commonly associated with near death experiences or traumatic events, such as cancer diagnosis and treatment. There is a lack of knowledge and awareness by healthcare professionals in identifying PTSD in cancer patients. In this population, PTSD symptoms often contribute to anxiety, and there is no standardized protocol being used to screen these individuals for the trauma they are facing or have faced. The purpose of this project was to develop a clinical practice guideline for screening cancer patients for PTSD in a clinic population serving cancer patients. The stress theory developed by Lazarus and Folkman guided this project. The project questions were to identify the most appropriate screening tool for PTSD in cancer patients and recommend a clinical practice guideline to the clinic healthcare providers. Five widely used PTSD screening tools were reviewed. Based on the project question the Clinician Administered PTSD Scale was identified as the most appropriate for this clinic setting and patient population. An expert panel consisting of 3 experienced psychiatric nurse practitioners reviewed the proposed guideline using the AGREE II tool. Using a scale of 1 (strongly disagree) to 7 (strongly agree), the team members agreed with a score of 5 or higher in each domain with the proposed guideline. Utilization of this guideline will promote a positive social change towards mental health awareness and improve the quality of life for these patients and their families.

The thesis as a whole aims to demonstrate that the socialization model, presented in Chapter VIII, is an appropriate model for use in analysing mental hospital practices and that the classificatory schema based on it is appropriate for describing the processes at work in these practices. The classificatory schema itself takes into account (a) culturally embedded criteria for assessing patient behaviour and patterns of construing, (b) culturally embedded means of 'shaping' patient behaviour and patterns of construing, (c) culturally embedded forms of ambiguity latently presented in the appraising and shaping of patient behaviour and patterns of construing and (d) the potential ways in which this ambiguity can interfere with the process of patient resocialisation itself. The model serves to focus attention on two existential problems which members of staff face in committing themselves to their institutional roles: that of disclosing therapeutic rationale to patients and that of embodying this rationale in concrete commitments to patients.

Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Community Psychology in the Department of Psychology in the Faculty of Arts at the University of Zululand, 2006. / The present study investigated the role that is played by family members in helping psychiatric patients cope with their illnesses. Twenty-seven psychiatric patients participated in the study. Of these, eighteen had been admitted to the local hospital for various complaints, and had been referred to the psychologist for psychotherapy. Nine participants were seen during private consultation sessions with the author/researcher. A convenient sample was used in that the criterion for inclusion of participants in the sample was based on patients suffering from certain psychiatric illnesses for example mood disorders, psychotic disorders or anxiety disorders. A semi-structured questionnaire was used to collect data for the study. The questionnaire covered participants' biographical information, details about psychiatric patients' illness such as their initial reactions to the diagnosis, knowledge about the illness, the level of support they received from family members and the community and the perceived causes of the illness. The procedure for data collection involved directed conversations in which patients reflected on their experiences both in and out of the hospital, for example the level of support they received from the family and community members, and information about their psychiatric conditions after being discharged from hospital. In addition, family members were asked to express their feelings and perceptions about the patients' conditions including the challenges they encountered as a result of having a family member with a psychiatric illness. The results of the study were that many psychiatric patients reacted with shock, fear and confusion to their illness diagnosis. Many also appeared to have some knowledge of the illness, including the belief by some that they had been bewitched. Some of the patients were unemployed as a result of being mentally ill, and this led to financial strains in the family. The main finding of the study was that most psychiatric patients still continue to be discriminated against in the communities in which they live. Most family members, however, were found to be supportive to their mentally ill relative. Some of the challenges faced by family members included a lack of knowledge about the illnesses affecting their relatives. The results of the study are generally consistent with the findings by other investigators regarding the important role that is played by family members in helping their relatives cope with psychiatric illnesses. In addition the study highlighted an urgent need by the government to improve mental health services by, among other things, providing adequately qualified professionals who may facilitate the process of integrating mentally ill persons with their communities.

Suicidality is a major public health issue and is more common among people with disabilities. However, relatively little is known about the context and specifics of suicidality among adults with disabilities compared to their peers without disabilities. This dissertation presents three different analyses of suicidality and disability using a sample of American adults. Chapter I introduces the topic and dataset. Chapter II presents an analysis of the internal consistency, mean scores, and response patterns on the Suicidal Behavior Questionnaire—Revised (SBQ-R) by disability status in order to establish the internal of the measure in people with disabilities and explore the uniformity of suicidality in people with and without disabilities. Participants with disabilities tended to more frequently endorse response choices consistent with increased past, current, and perceived future suicidality. Chapter III presents an analysis of the relationship between suicidality, disability, and psychiatric disability. Disability remained a significant predictor of suicidality even when depressive symptoms were included in the analysis, and psychiatric disability predicted greater suicidality within the disability subsample, even when depressive symptoms were controlled for via statistical analysis. Chapter IV presents an analysis of suicidality and disability within the context of both depressive symptoms and sociodemographic risk and protective factors for suicidality. Participants with disabilities experienced more sociodemographic risk factors than participants without disabilities; however, disability status remained a significant predictor of suicidality even when sociodemographic risk and protective factors, as well as depressive symptoms, were included in the analysis. Chapter V summarizes and concludes the dissertation, including our consistent and major finding that disability is linked to significantly higher suicidality, even when depression and sociodemographic risk factor are accounted for in statistical analysis.

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This work explored the ways in which the theoretical constructs of gay identity development, relational satisfaction, and outness interact in gay-male emerging adults. Informed by the literature on these constructs, the researcher developed a structural model to evaluate the interactive and mediating roles within the model. Three instruments were selected to assist in measuring these theoretical constructs. The Lesbian, Gay, and Bisexual Identity Scale (LGBIS) measured gay identity development, the Gay and Lesbian Relationship Satisfaction Scale (GLRSS) measured relational satisfaction, and the Nebraska Outness Scale (NOS) measured outness. A sample of 206 cisgender gay men in Emerging Adulthood (ages 19-29) were recruited from LGBTQ+ Community Centers, Post-secondary Pride Centers, and electronically through the MTurk crowd sourcing platform. Data gathered from these participants was evaluated via Structural Equation Modeling (SEM) to examine the relationship between the variables and understand how outness (NOS) and relationship satisfaction (GLRSS) mediate gay identity development (LGBIS). Results of confirmatory factor analysis of all three measures show considerable concerns. This study was unable to confirm author supplied factor structures for any of the instruments used in this work. Results of this study should be considered with extreme caution as the instrumentation used may be flawed and may not have actually measured the intended theoretical constructs. Discussion, consideration of findings, limitations, and areas for future research are given with caution.

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Impacting millions of youth in the United States and across the globe, early parental death can be a very stressful and traumatic event and is an important topic to investigate. Utilizing an Eriksonian developmental perspective, this study (N = 256) examined a group of young adults who experienced a parental death during adolescence and a group of young adults who had not experienced an early parental death. The researcher examined the developmental impact of early parental death, and developed a predictive model of posttraumatic growth (PTG) for young adults who have experienced early parental death. When compared to non-bereaved peers, young adults who experienced a parental death during adolescence had lower psychosocial developmental strength; this impact did not vary due to demographic variables (e.g., gender, SES, ethnicity, age), type of parental death, gender of the deceased parent, age when death occurred, or the closeness of the relationship with the deceased parent. This study also affirmed the relationships between psychosocial development, social support, religiosity/spirituality, and PTG, emphasizing social support, spirituality, and psychosocial development as statistically significant predictors of PTG in young adults who experienced an early parental death. The strong statistical relationship between psychosocial development and PTG also affirmed the literature that has theorized this relationship. Investigating two different developmental periods contributed to the limited research on the long-term trajectory of PTG in individuals who experienced early parental death, and provided insight into sustaining PTG throughout the lifespan as well. Limitations and suggestions for future research are presented, along with implications for the profession of counseling.