Background: It is debated whether temporary employment compared to permanent employment entails an elevated risk of illness or not, as the empirical studies have not shown a unified picture. Since a significant part of the Swedish workforce is currently working under temporary employment contracts, it is important for public health research to pay close attention to what the implications in terms of illness might be. Therefore the aim of this thesis was to explore the relationship between temporary employment and illness. Methods: This thesis was based on data from the Northern Swedish Cohort, consisting of all pupils in grade 9 in Luleå in 1981 (n=1083). The cohort was followed with extensive questionnaires. The latest follow-up was performed in year 2007, when 94% participated. To analyse the quantitative questionnaire data, logistic regression and trajectory analysis were used. A qualitative method, Grounded Theory, was also applied in this thesis to analyse interviews performed in 2011, with a strategic selection of 12 participants from the cohort. Results: Quantitative data showed that temporary employees had overall higher odds ratios for illness in terms of psychological distress and non-optimal self-rated health compared to permanent employees. This general difference in odds ratios was evident irrespective of how temporary employment was measured as well as after control for earlier health status and confounders. The qualitative analysis gained insight into temporary employment as social processes of: underling the driving force for employment; working hard for a job. The structural conditions emerged in terms of, being used and exploited on the labour market and these conditions were related to the individual strategies of adaptation and coping. In the intersection of agency, structural conditions and adaption, emotional and bodily reactions emerged, such as being worn out, worried and wrathful. Conclusion: Illness is unevenly distributed between temporary and permanent employees, with temporary employees being the unfavourable group. Striving for good and evenly distributed health conditions in the population, policy makers should aim at reducing the number of employees working in temporary contracts. In addition, there is a need to improve surveillance of the health situation among temporary employees and to reduce unfavourable conditions, such as job and financial insecurity and unemployment, among temporary employees.

Research suggests that single mothers experience poorer mental and physical health than their partnered counterparts. This health differential has been attributed, in large part, to the chronic economic and social stressors to which many single mothers are exposed. Less research, however, has focused on the well-being of single mothers who are employed, despite their growing presence in the Canadian labour force. Using data from a telephone survey of employed parents in a mid-sized Western Canadian city conducted in 2005, the aim of this study was to: (1) compare the mental health of employed, single mothers relative to partnered mothers; and (2) explore the potential role of work-family conflict and psychosocial job characteristics as explanations for any observed differences in psychological distress. Analyses were restricted to 674 employed mothers (438 partnered and 236 single), who were 25-50 years old, with at least one child in the household under the age of 20 years. Bivariate analysis indicated that compared to partnered mothers, employed single mothers reported significantly higher levels of psychological distress, work-to-family conflict and family-to-work conflict. Single mothers were also more likely to be employed in a high-strain psychosocial work environment (i.e., high demand and low control). Multiple linear regression revealed that after adjusting for key sociodemographic characteristics, psychosocial work quality and work-family conflict, single parenthood was no longer statistically significantly associated with psychological distress. These findings suggest that being a single mother in and of itself need not result in poorer mental health, but greater attention needs to be paid to the economic and psychosocial work environment of single mothers, including policies to facilitate work-family balance.

ABSTRACT THE RELATIONSHIP AMONG ATTACHMENT STYLE, AFFECT REGULATION, PSYCHOLOGICAL DISTRESS AND MENTAL CONSTRUCTION OF THE RELATIONAL WORLD Ruganci, Ruhsar Neslihan PhD., Department of Psychology Supervisor: Assoc. Prof. Dr. Tulin Gen&ccedil / &ouml / z February 2008, 271 pages In this study interpersonal world of the individual was tried to be conceived with its cognitive and affective domain. Two Studies were carried out. In the first study, adaptation of the Difficulty of Emotion Regulation Scale (DERS) developed by Gratz &amp / Roemer (2004), into Turkish was carried out. Additionally, the relation of secure (Ss), dismissing (Ds), preoccupied (Ps), fearful (Fs) and mixed insecure attachment styles with emotion regulation, and the mediator role of the emotion regulation in the association between each attachment style and psychological distress were analyzed, the results of which were also expected to serve for the strength of the validity of Turkish version . As a result of Study I, Turkish version of DERS was established with considerable reliability regarding alpha coefficient, test-retest and split-half reliabilities. Aapproximately similar factor structure with the original version indicating Construct Validity , as an indication of Concurrent Validity DERS and its subscales displayed significant relation with psychological symptoms, and DERS differentiated high and low distress level regarding Criterion Validity. Additionally, Ss were displayed significantly better emotion regulation in general compared to three insecure categories (i.e., except Ds but including Ps, Fs, Mixed insecures), and Ss significantly differed from total insecures in terms of every strategy of emotion regulation as well . Furthermore, psychological distress and Ss, Ps, Fs, (but not Ds) relationship were mediated by emotion regulation. These results were providing additional support for the validity of the Turkish version of DERS. In the second study, possible Clinical and Control Group differences were investigated through comparing the secure, insecure attachment styles of the participants in relation to emotion regulation, psychological distress and their personal construct system regarding the internal representation of self and significant others. Again, mediation of emotion regulation in the association between attachment style and psychological distress were examined both in Clinical and Control Group. Results revealed that Clinical Group had more difficulty to regulate their emotions, except awareness skill and had more psychological distress compared to Control Group. The strength of Ss was displayed with better emotion regulation and less psychological distress even in Clinical Group compared to insecure attachment styles. Effective emotion regulation, as a mediator was associated to low level of psychological distress for Ss, while problem in emotion regulation as a mediator was associated to high level of psychological distress for insecure attachment style both in Clinical and Control Group. Additionally, Ss seemed to integrate the &amp / #8216 / positives&amp / #8217 / and &amp / #8216 / negatives&amp / #8217 / into &amp / #8216 / self&amp / #8217 / and &amp / #8216 / others&amp / #8217 / rather than splitting and have better cognitive complexity or multi-dimensional view besides more integrated system compared to insecure attachment styles. Results were discussed considering the promising efficiency of instruments that can be used in Clinical Psychology research and considering the implications regarding the prevention and intervention in Clinical practice.

A severe burn is one of the most traumatic injuries a person can experience. Posttraumatic stress disorder (PTSD) is relatively common after burns, and can be devastating for the individual’s possibilities for recovery. The principal aims were to gain knowledge regarding posttraumatic stress symptoms and cognitive processes after burn and to evaluate methods for assessing symptoms of PTSD up to one year after burn. The psychometric properties of a Swedish version of the Impact of Event Scale-Revised (IES-R) were examined. The results indicate that the IES-R is a valid screening instrument for measuring PTSD symptoms in patients with burns and it can be used during hospitalisation to identify resilient individuals. The pattern of PTSD symptoms over time was also investigated. Four distinct trajectories of PTSD symptoms were identified, i.e. four groups of patients with significantly different onsets and courses. The trajectories differed in the expected direction regarding several risk factors associated with PTSD symptoms. Several previously known risk factors for PTSD symptoms were also identified including burn severity, psychiatric history, previous life events, early psychological symptoms, neuroticism-related personality traits, avoidant coping and low social support. The risk factors correspond well with those reported in the international trauma literature, which strengthens the findings in this thesis. Finally, using the emotional Stroop task at one year post burn it was found that burn-specific attentional bias was common and associated with more previous life events, more perceived life threat, larger burns and higher levels of PTSD symptoms. In summary, there are individual differences in the development and course of PTSD symptoms after burn and attentional bias is a common cognitive phenomenon related to these symptoms. The findings also support the use of the IES-R as a screening instrument for PTSD symptoms in patients with burns.

Anxiety sensitivity (AS; fear of anxiety-related bodily sensations) is a risk factor for anxiety and related psychological disorders. Preliminary evidence also associates high AS with reduced levels of physical exercise and fitness. The primary objectives of the five studies comprising this dissertation were 1) to further explore the relationships between AS levels and exercise/fitness levels, and 2) to evaluate outcomes and processes of a brief group cognitive behaviour therapy (CBT) that included a novel exercise-based interoceptive exposure (IE; exposure to feared anxiety-related sensations) component of running, with female undergraduate students. High AS female undergraduate participants endorsed more barriers to exercise than low AS participants, and these accounted for the inverse relationships between AS group and exercise/fitness levels (Study 1). The brief CBT/IE led to decreases in AS levels (Studies 2 and 4) and in symptoms of stress, depression, and anxiety (Study 4) for high AS participants. Processes involved in the brief CBT’s therapeutic effects were explored by examining cognitive (i.e., catastrophic thoughts), affective (i.e., feelings of anxiety), and somatic (i.e., physical sensations) reactions to the running IE component with an existing measure, the hyperventilation questionnaire (HVQ; Study 2), and a brief version of the measure, the HVQ-B, developed and validated in Study 3 (Study 5). Changes in cognitive and affective reactions to running were most closely associated with the brief CBT/IE’s therapeutic benefits, underlying the importance of changing the meaning of and emotional reaction to physiological arousal. Surprisingly, a health education control (HEC) intervention consisting of an interactive discussion on exercise, nutrition and sleep for health, including problem-solving barriers to health behaviours, also led to decreases in AS levels and in symptoms of depression and anxiety (Study 4). Physical exercise, the common link between the two interventions, may be partially driving the interventions’ therapeutic benefits. More specifically, perhaps both interventions addressed barriers to exercise, either by altering the meaning of and emotional reaction to exercise (CBT/IE), or through problem-solving (HEC). Encouraging physical exercise in high AS individuals by acknowledging and addressing barriers to exercise might help decrease these individuals’ AS levels and improve their overall mental health

This study examines psychological distress and relationship satisfaction in cancer patients and their partners. It is widely recognized that spouses coping with a cancer diagnosis are at risk of psychological distress, and changes in relationship satisfaction. Debate exists within the literature regarding the level of distress and satisfaction experienced by patients, and to what extent they are influenced by their partners. Twenty six couples coping with a breast or prostate cancer diagnosis, completed two questionnaires over six months assessing: psychological distress, relationship satisfaction, attachment style, self -esteem and matching of partner ideal standards. The cross-sectional results indicate that higher patient distress was associated with their own lower levels of self esteem, less secure, and more anxious attachment styles. Patient relationship satisfaction was increased in those with a less anxious attachment style and in patients who perceived their partner as matching more closely their own ideal standards and perceptions of the patients on vitality and attractiveness. Longitudinal results show an increase in patient distress was also predicted by their partner’s perceiving lower matching between their own ideal standards and perceptions of the patients on warmth and trustworthiness. Unexpectedly, higher relationship satisfaction over time, was also predicted by lower matching of their own ideal standards and perceptions of their partners on warmth and trustworthiness, as measured initially. An increase in patient satisfaction was also predicted over time when patient distress was low, self esteem high and they had higher matching between their own ideal standards and partner perceptions of the patient partner on both warmth and trustworthiness as well as vitality and attractiveness. Explanations for the results, together with clinical and research implications are discussed.

The current study examined the links and mechanisms associated with intergenerational cultural conflict, psychological distress, and the intergenerational differences in acculturation and model minority stereotype (MMS) endorsement for South Korean immigrants. Specifically, Korean American adolescents’ (ages 12-19, M = 15.3, SD = 1.71) and their mothers’ (N = 209 dyads) acculturation difference and MMS endorsement difference were measured and analyzed as predictors of intergenerational cultural conflict and psychological distress for adolescents. Furthermore, the study analyzed intergenerational cultural conflict as a mediator in the acculturation gap-distress and the MMS endorsement-distress paths. Results indicated that when mothers and their adolescents differed in their acculturation, they also differed in their endorsement of the MMS. Next, as expected, the adolescents who had mothers who were not as acculturated to the American culture, experienced more cultural conflict with their parents and, in turn, felt more psychological distress. Furthermore, the adolescents who had mothers who endorsed the MMS to a greater degree, experienced more cultural conflict with their parents and, in turn, felt more psychological distress.

The current study addressed the deficiency in research by examining risk factors for immigrant children that may lead to academic disengagement (such as ethnic discrimination by peers and teachers, and psychological distress) and resilience factors that promote academic engagement (such as the development of a positive ethnic identity). Children who had stronger, more positive ethnic identities had more positive academic attitudes. Furthermore, the more the children were teased by their peers and graded unfairly by their teachers because of their ethnicity, the more they thought school was less important, less useful and felt less efficacious about school and valued school less. Also as expected, the more the children perceived discrimination, the more depressed and anxious they felt. Perceptions of discrimination negatively predicted self-regulation such that children who perceived more discrimination were less capable of regulating their attention and inhibitory control. In turn, children who were less able to self-regulate reported more psychological distress and lower academic attitudes. These results support the importance of supporting children’s ethnic identities, being sensitive to perceived discrimination experiences, and working to offset depression and anxiety. Other important implications include using the school setting and including teachers in an active way to influence the children’s environment.

Background Shame is a powerful emotion involved in a wide variety of phenomena including psychopathology. The propensity to react with shame to situations of transgression is formed early in life, but the processes by which elevated shame-proneness causes higher levels of psychological distress and functional impairment in some people rather than in others is as yet poorly understood. Objectives The main objective of this thesis was to further elucidate these processes by investigating the implications for shame states, guilt, general coping strategies, attachment styles, and shame-related coping in this context, as well as to evaluate an assessment method for shame-proneness. Methods The self-report questionnaires Test of Self-Conscious Affect (TOSCA), Compass of Shame Scale (CoSS-5), Harvard Trauma Questionnaire (HTQ), Ways of Coping Questionnaire (WCQ), Attachment Style Questionnaire (ASQ), Symptom Checklist 90 (SCL-90), and an interview measure for event-related shame and guilt were used for assessment in adult normative, healthy-only, crime victim, and patient samples (n=25-361). A combination of uni- and bivariate approaches and multivariate soft and hard modeling approaches were used for statistical analysis. Results Paper I showed that the TOSCA could be used as a reliable measure for shame-proneness. Paper II showed that guilt was unrelated to post-victimization distress. Elevated shame-proneness was related to higher levels of post-victimization distress. This effect was partially mediated by event-related shame. Paper III showed that in CFS patients, higher levels of shame-proneness, escape-avoidance, and accepting responsibility coping contributed to elevated levels of psychological distress. Seeking support, positive reappraisal coping, and proneness to detachment contributed in the opposite direction. These relationships were weaker in the comparison groups. Paper IV showed that shame-proneness was associated with secure attachment style in a negative direction. Higher levels of secure attachment style contributed to lower levels of psychological distress, whereas shame-proneness, insecure attachment styles and withdrawal, attack self, and attack other shame coping strategies contributed in the opposite direction. There were mean differences between women and men regarding most of the variables, butiithe relationships between variables did not differ between men and women. Conclusions The association between shame-proneness and psycho-logical distress seem to involve a complex balancing act between motives toward preserving close relationships and protecting a relatively positive sense of self. If others are perceived as trustworthy and compassionate and are utilized for support in times of need, the effects of shame-proneness may be less debilitating, whereas if others are perceived as distancing or disapproving, and life stress and social transgressions are managed by escape strategies, social withdrawal, self-blame or by transferring blame onto others, the distress effects become more severe. The inner psychodynamics of these functional patterns seem to be rather similar in women and men.

In research, it is typical to analyse and discuss the utility of education in economic terms—specifically the market value of a particular degree or the financial returns associated with additional years in higher education. However, education may also generate outcomes that belong to the non-market sphere, such as open-mindedness, societal cohesion, community involvement, better health, and gender equality; yet these outcomes have received little scholarly attention. The main objective of this thesis, therefore, is to investigate the relationship between education and four non-market outcomes: agency, voice, health behaviour and psychological distress. By utilizing two longitudinal data sets, the Swedish Survey of Living Conditions and the Northern Swedish Cohort, it is possible to assess the long-term effects of education on each of these four non-market outcomes. Results clearly demonstrate that education has a critical impact on each of the outcomes of interest. Having a higher education—and in particular a university degree–enhances individuals’ agency and voice, reduces psychological distress, and improves individuals’ health behaviour. Further, results show that different academic subjects generate field-specific resources. In contrast to a market perspective, where the value of the specific field of study is assessed only in economic terms, results indicate that fields that are commonly viewed as having low market value may actually yield non-economic rewards that benefit individuals in critically important ways. Analyses also show that individual and social factors shape the extent to which education leads to positive outcomes. In terms of agency and voice, results indicate that education can compensate for social differences. Among those with a working class background, earning a university degree contributes to increasing levels of agency and voice, while no significant effects of education exist for those with a white-collar background. Results also demonstrate that the impact of education on psychological well-being differs for men and women. For men, labour market resources (i.e., being employed) was important for reducing psychological distress, while for women social resources (i.e., having a partner) was more important. Due to its use of high quality, longitudinal data, this thesis makes a significant contribution to the scholarly literature and to what we know about the impact of education attainment. A limitation of cross-sectional analyses is that it is difficult to separate causal effects from selection effects. By adopting a longitudinal approach, it is possible to control for earlier (baseline) circumstances and therefore assess the causal impact of education on individual outcomes. This strategy yields robust results that make clear the long-term effects of educational attainment on individuals.