<p>Arbetslöshet innefattar fler faktorer än brist på arbete och ekonomiska begränsningar. Tidigare studier uppvisar samband mellan arbetslöshet och stressrelaterade sjukdomar och som arbetslös kan upplevelse av kategorisering medverka till känsla av att förlora sin identitet. I denna kvalitativa intervjustudie bestående av sex stycken arbetslösa, kvinnliga deltagare diskuteras olika coping strategiers betydelse för hur situationen som arbetslös hanteras. Datamaterialet har bearbetats induktivt genom meningskoncentrering. Studien visar att stöd från omgivningen samt självförtroende är avgörande faktorer som medverkar till adaptiv, problemfokuserad coping. Det sociala stödet anses betydelsefullt även vid känslomässigt fokuserad coping samt reducerar oro och depressivitet. Studien bidrar till förståelse för hur viktig yttre coping upplevs av individen, samt självförtroendets betydelse.</p>

Active Surveillance (AS) for the clinical management of prostate cancer (PC) is a treatment option for men with low-risk PC. Screening procedures have led to the overdetection of PCs that would have never caused problems. Active treatment (e.g., surgery or radiation) for these non-aggressive tumors may not be necessary given the slow-growing nature of PC. AS provides a way to monitor the disease and delay treatment-related compromises on quality of life until clinically indicated (e.g., rising PSA level). However, the intensive monitoring in AS may be a stressful experience and lead to greater anxiety, an emotional state that has been associated with undergoing active treatment despite physician recommendation for AS. The current study aimed to identify psychosocial correlates of anxiety in men undergoing AS. Using Mishel’s Reconceptualized Uncertainty in Illness Model as a framework, the proposed study aimed to examine the relationships between perceived stress management skills, PC psychosocial concerns, and anxiety/arousal. Hierarchical multiple regression analyses were conducted on a sample of 71 men undergoing AS, who were on average 65.40 years old (SD=7.85) and ethnically diverse (52% non-Hispanic White; 31% Hispanic; 17% African American). Results indicated that greater PSMS were significantly associated with less IES-R anxiety (β=-.28, p<.04). PSMS were not significantly associated with PC concerns (β=-.02, p>.05), but greater PC concerns were significantly associated with greater IES-R anxiety (β=.61, p<.01) and PSA anxiety (β=.42, p<.01). These associations held after controlling for relevant covariates. The results suggest a possible role for stress management skills as perceived ability to manage stress was related to less anxiety in the AS experience. Future studies should examine the relationship among these factors in longitudinal designs and whether greater stress is associated with unnecessary active treatment in low-risk PC.

Arbetslöshet innefattar fler faktorer än brist på arbete och ekonomiska begränsningar. Tidigare studier uppvisar samband mellan arbetslöshet och stressrelaterade sjukdomar och som arbetslös kan upplevelse av kategorisering medverka till känsla av att förlora sin identitet. I denna kvalitativa intervjustudie bestående av sex stycken arbetslösa, kvinnliga deltagare diskuteras olika coping strategiers betydelse för hur situationen som arbetslös hanteras. Datamaterialet har bearbetats induktivt genom meningskoncentrering. Studien visar att stöd från omgivningen samt självförtroende är avgörande faktorer som medverkar till adaptiv, problemfokuserad coping. Det sociala stödet anses betydelsefullt även vid känslomässigt fokuserad coping samt reducerar oro och depressivitet. Studien bidrar till förståelse för hur viktig yttre coping upplevs av individen, samt självförtroendets betydelse.

Chronic physical illnesses, such as rheumatoid arthritis (RA), that are painful and disabling not only impact on a person’s ability to complete normal daily activities (e.g. dressing, bathing, walking etc.) but may also have a negative impact on psychological well-being. Although a large number of prospective observational studies have examined psychological well-being in RA, none has used appropriate statistical techniques to examine variability in change over time at the individual level. The overarching aim of this dissertation is to use advanced quantitative methods to examine how psychological well-being in RA changes over the course of the disease; and to identify demographic, clinical and psychosocial factors that influence how the disease affects psychological well-being. This aim is addressed via a programme of research with three objectives: (i) to describe patterns of change in psychological well-being during the RA disease course; (ii) to quantify the association between psychological well-being and somatic symptoms; and (iii) to investigate the impact of illness cognitions and coping on psychological well-being. The programme of research consists mainly of analysis of a subsample of data collected as part of the Early RA Study (ERAS, N = 784), an ongoing observational study of RA patients followed prospectively from first presentation to a rheumatologist. A major problem relating to the assessment of psychological distress in individuals with chronic physical illness is the overlapping symptomatology with depression. An examination of the factorial validity of the Hospital Anxiety and Depression Scale (HADS), in the ERAS cohort, indicated the presence of a bifactor structure. Specifically, a general distress factor along with orthogonal (autonomic) anxiety and (anhedonic) depression factors was found to provide the optimal empirical explanation of the covariance in item responses. Further analysis, revealed that responses to one of the depression items were biased by disease severity. However, the magnitude of this bias was negligible, confirming the suitability of this tool in RA populations. For the ERAS cohort, general psychological distress was observed to reduce rapidly early in the course of the disease, stabilising after around two to three-years. However, further analysis suggested that subgroups with distinct longitudinal patterns of distress were present within the sample. Confirming observations in other disease groups, four distinct longitudinal patterns of distress were identified: resilient, chronic distress, delayed distress and recovered. Interestingly, changes in distress were related to self-reported somatic symptoms but not serological markers of disease activity. Building on these findings, analyses that jointly modelled changes in psychological distress with changes in the common somatic symptoms of pain and functional limitation revealed strong cross-sectional and longitudinal associations. This extends the findings of previous research by showing the importance of considering the impact of the disease course on the underlying trajectory of distress. Due to the lack of psychosocial data available in the ERAS cohort a further prospective study, involving 230 RA patients, was conducted to examine the influence of illness cognitions and coping on the affect of the disease on psychological well-being over a period of 6-months. Coping was not found to be related to changes in psychological well-being. Analysis revealed two groupings of patients with similar patterns of illness cognitions that were labelled adapters and non-adapters. Furthermore, cognitions concerning the attribution of symptoms to RA and the perceived personal consequences of their condition were related to changes in psychological distress, even after controlling for demographic and clinical characteristics; and there was some indication that a higher reported level of understanding of their condition was related to increased future positive outlook. In conclusion, the findings of this programme of research highlight the need for the early identification and treatment of RA, not only to slow the progression of the disease but also to maintain or improve psychological well-being. Early treatment is currently focused on pharmaceutical interventions. A tailored psychosomatic approach to treatment involving the skills of a wide range of health professionals, such as nurses, physiotherapists, occupational therapists and psychologists is likely to improve outcomes in RA.

Master of Public Health / Department of Kinesiology / Emily Mailey / INTRODUCTION: Research has focused on the relationship between socioeconomic status and physical activity, yet there are limited examinations which directly address social groups dealing with major issues associated with insufficient income. Studies have neglected the role of psychosocial stressors, such as financial stress, food insecurity, availability of government assistance programs, as well as psychological distress relative to the relationship between physical activity and low-income status. The purposes of this study were threefold: 1) to describe the multidimensional characteristics of life among low-income populations; 2) to examine how psychosocial stressors and health conditions vary across subsets of low-income groups; and 3) to examine the relationship among income, psychological distress and physical activity within low-income populations. METHODS: Data from the 2015 National Health Interview Survey (NHIS) were analyzed for the purposes of this investigation. Descriptive statistics were calculated for the low-income status individuals who provide complete data for all variables of interest to this study. A series of chi-square analyses were conducted to determine whether key psychosocial stressors, health behaviors, and health conditions differed by low-income (FIPR) groups. Two stepwise logistic regression analyses were conducted to examine these factors and their relationships with moderate-intensity (MPA) and vigorous (VPA)-intensity physical activity. RESULTS: Overall, women made up 58.5% of the sample size. Blacks/African Americans accounted for 20.6% of the sample, yet 28.0% of FIPR Group 1 identified as Black/African American. FIPR Group 1 was disproportionately unemployed, with 63.5% unemployed compared to 46.9% for the sample. One-quarter (25.9%) of the entire sample reported severe psychological distress, yet 33.9% of FIPR Group 1 and 30.8% of FIPR Group 2 reported severe distress. Nearly three-quarters (70%) of the sample was overweight or obese and 44.2% lived with at least one chronic disease at the time the survey was taken. Overall, 67.9% of the sample reported zero minutes of VPA and 51.3% reported zero minutes of MPA. Both psychological distress and income showed significant relationships with VPA. Psychological distress remained significantly associated with VPA after controlling for all covariates; however, income was no longer related to VPA after demographic and health-related variables were added to the model. Income was not related to MPA. Psychological distress demonstrated a weak relationship with MPA before the other covariates were added to the model, at which point the relationship became non-significant. Only the relationship between psychological distress and VPA was significant in the final models. Although some of the psychosocial stressor, demographic, and health-related variables contributed to the relationships between income, physical activity, and psychological distress, these variables explained only a small portion of the variance in both MPA and VPA. CONCLUSION: Low-income individuals are faced with difficult decisions and are limited in the choices they can make to improve health. It is important to understand the multidimensional characteristics of life under limited income to better serve and improve the health of low-income populations. Further study of the relationships among income, physical activity and psychological distress is needed to further this understanding.

Background: Obesity has been identified as a global epidemic and is associated with significant morbidity and mortality. Although obesity has been widely recognized for its consequences on physical health, its psychological burden in the adult populations remains unclear. Objectives: Our purpose was to address the relationship between Obesity status and psychological health within the adult young population in the Middle East and particularly in Lebanon (first aim). In addition, we intended to develop and validate a screening tool for the assessment of psychological distress (PD) in the obese young adult populations (second aim). Methods: To achieve the first aim, three studies were conducted. The first study was a systematic review and meta-analysis of observational studies that investigate the association between obesity and depression among adult populations in Middle Eastern countries. The second study was a cross sectional that aimed to explore the relationship between obesity and PD among the Lebanese University Students. The third study was conducted to examine the effects of actual body weight and body image on PD using a convenient sample of obese Lebanese young adults. The second aim was accomplished by conducting a fourth study to develop and validate a measure of PD related to obesity using three different samples of obese young adults. Results: The systematic review identified eight observational studies from six countries of the Middle East. Meta-analysis showed a significant positive association between obesity and depression (OR 1.27; 95% CI 1.11–1.44) particularly in women (Study1). Among the Lebanese university students, no evidence of a positive association was found between obesity and PD for both genders (Study 2). This result was confirmed in our third study in which body image dissatisfaction rather than obesity per se was associated with greater risk for PD. Finally, the “Obesity Specific Distress scale” (OSD) developed to measure distress in the obese young adult population demonstrated good psychometric properties regarding internal consistency, test-retest reliability, and construct validity (Study 4). Conclusions: Our meta-analysis suggests a positive association between obesity and depression among adult population in the Middle East which appeared to be more marked among women. This is of public health significance and provides a framework for establishing policy interventions to diagnose and treat depression in obese adults. In Lebanon, young obese adults who suffer from body image dissatisfaction are at increased risk of PD. Public health interventions targeting PD at the population level may need to promote healthy attitudes towards body weight, body shape and self-acceptance, regardless of weight status. Finally, the developed instrument used to assess young obese persons with high risk of PD can help promote a better understanding of the association between PD and obesity. This might improve the outcome and provide the patients with more efficient treatment. / Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished

Objectives: The management of depression and anxiety in primary care in the UK is not consistent with clinical guidelines. This has led to training initiatives that aim to change practice by improving the implementation of research evidence, but little is known about what constitutes effective healthcare professional training in this area. This thesis addressed this issue by identifying what determines effective training to improve the management of psychological distress in primary care. Methods: The research was undertaken in three stages. A systematic review and narrative synthesis was conducted to investigate the effects of controlled trials of training interventions delivered to primary care practitioners (PCPs) to improve the management of psychological distress on process outcomes (practitioner behaviour, knowledge, attitudes). Then two qualitative studies using semi structured interviews with PCPs (n=18) and experts in training/behaviour change (n=16) were conducted to explore their perceptions of effective healthcare professional training in this area and in general. The qualitative data were synthesised to produce recommendations for designing effective healthcare professional training to improve the primary care management of psychological distress. The research findings were used to develop a taxonomy of training intervention components for use in the design and reporting of healthcare professional training interventions in this area and more widely. Results: Forty Papers (36 studies) were included in the systematic review. The papers reviewed provide a mixed picture of the effective characteristics of training interventions. Two components: the inclusion of skills practice (role-play) and the use of theory to inform intervention content were associated with positive outcomes. Limitations with outcome measures, absence of theory and poor descriptions of the interventions made it difficult to determine effective intervention components. The analysis of the qualitative studies resulted in the development of the Perceived Effectiveness of Training (PET) framework. It incorporates five themes or core areas that underpin effective training: social interaction, credibility, relevance, information processing, and practicalities. The PET framework was used to identify effective training intervention components. Finally, the qualitative synthesis led to the development of a taxonomy of training intervention components, which was evaluated for comprehensiveness by mapping the training components to the interventions identified in the systematic review. This culminated in a 171 item taxonomy with hierarchical groupings divided into three phases: pre-training, training delivery and post training. Conclusions: Healthcare professional training to improve the management of psychological distress in primary care can be optimised for effectiveness using the PET framework to address core quality training standards. It is recommended that the taxonomy of training intervention components should be used to improve the science of healthcare professional training interventions. Further research to develop the taxonomy and to establish valid training evaluation measures would provide further scope to identify which training components can predict healthcare professional behaviour change and improve the management of psychological distress in primary care.

Magister Psychologiae - MPsych / 30% of the country's population are currently unemployed and this statistic is increasing steadily. Further deterioration of the South African economy and increased unemployment, is likely to increase social instability and continue to marginalise a major proportion of society. Global economic downturn as well as the crash of the Asian economies in the mid-1990's resulted in job losses for both the working class and middle class sectors of society. The literature however suggests that the effects of unemployment are likely to be experienced differently by working and middle class individuals. This reiterates the argument that the unemployed should not be perceived as a homogenous group. The study utilises a broad epistemological framework of social constructionism and employs the theoretical assumptions of Marxism as the theoretical basis for the research.

Stigma has a negative effect on individuals, which may include psychological distress, anxiety, and social isolation (Pachankis, 2007). Stigma can be either concealable or visible. A concealable stigma is an attribute that is not visibly apparent, but would be devalued if known by others (e.g., sexual orientation, Page 30 2014 Appalachian Student Research Forum mental illness, sexual abuse). Some believe that individuals with a concealable stigma do not face prejudice and discrimination because the stigma is not apparent to others. However, research suggests that those with a concealable stigma may feel the constant need to hide that identity or characteristic, and this may increase distress and anxiety due to the threat of discovery (Pachankis, 2007). We hypothesized that individuals with a concealable stigma will have higher levels of stigma, rejection sensitivity, distress, and anxiety as well as lower levels of self-esteem, relative to those individuals with a visible stigma. The current sample was taken from a larger study (N=408) and consist of participants (n=70) who selfidentified a stigmatizing characteristic. The self-reported characteristics were independently coded by two research assistants as concealable or visible and finally, the assistants collectively assigned the characteristics to each group. Our sample consists of 35.7% concealable (e.g., sexuality, mental illness, history of abuse) and 64.3% visible (e.g., physical appearance, physical disability, race/ethnicity). To test our hypotheses, we used an independent t test to assess the differences in levels of stigma, self-esteem, distress, anxiety, and rejection sensitivity between concealable and visible stigma groups. Results show that self-stigma (t(68)=-.798, p=.428), public stigma (t(68)=-.149, p=.882), and self-esteem (t(68)=-1.320, p=.191) do not differ between groups. By contrast, and in support of our hypotheses, those with concealable stigma reported more rejection sensitivity (t(68)=2.315, p=.024) and anxiety (t(68)=3.030, p=.003) than those with visible stigma. Contrary to our hypotheses, distress (t(68)=-2.599, p=.011) was higher for those with visible stigma than concealable stigma. Future research should be conducted to examine levels of anxiety and rejection sensitivity in individuals with concealable stigma to understand the differences among stigmatized identities and characteristics.

Research indicates that young adults have relatively high rates of psychological distress and substance use. Research also suggests that psychological distress and substance use are correlated as individuals may turn to substance use as a coping mechanism for psychological distress. The goal of the current research is to examine the relationship between psychological distress and substance use among college students. A secondary question is to determine if the relationship between psychological distress and substance use is different for men and women. College students are a good sample for this research question for a number of reasons. First, more young adults are enrolled in college today than ever, with about 70% of high school graduates in 2011 enrolling in college the following fall. Second, research indicates that the prevalence of substance use is relatively high among college students and that young adults enrolled in college are at increased risk for certain types of substance use compared to their same age peers who do not attend college. Third, research indicates that college students are at greater risk for psychological distress compared to their same age peers who do not attend college. This may be due to the fact that college students are exposed to unique stressors that are likely to increase risk for psychological distress. The current research uses data from a sample of college students to examine the relationship between psychological distress and substance use. Several forms of substance use are included for the dependent variable. First, a measure of binge drinking is used based on the Harvard School of Public Health College Alcohol Study to measure binge drinking. Second, a measure of marijuana use is included. Third, a measure of prescription drug misuse is included based on the National Survey on Drug Use and Health. All substance use measures are coded 0 = No and 1 = Yes.; The independent variable of interest is psychological distress, measured with Kessler's Psychological Distress Scale (K10). We also measure respondent's sociodemographic characteristics (e.g., age, gender, race/ethnicity) and correlates of substance use (e.g., Greek affiliation, peer substance use, and grades) to include as controls in our analysis. A positive correlation is expected between psychological distress and substance use, as respondents with higher levels of psychological distress will be more likely to report binge drinking, marijuana use, and prescription drug misuse. In addition, it is expected that the relationship between psychological distress and all forms of substance use is moderated by gender. The relationship between psychological distress and substance use is expected to be stronger for females. To test research hypotheses several logistic regression models are estimated.