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Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Life expectancy in countries of Central and Eastern Europe (CCEE) is substantially shorter than in Western Europe, and similar divide exists in self-rated health. The project described in this thesis was set up to study the effects of socio-economic factors (such as material deprivation, education and inequalities) and psychosocial factors (perceived control, psychosocial work environment) on self-rated health (a predictor of mortality in prospective studies). Cross-sectional surveys were conducted in seven CCEE: Russia, Lithuania, Latvia, Estonia, Poland, Czech Republic and Hungary. Data were collected by interviews in randomly selected national samples in all seven countries (total 7,599 subjects), and by questionnaires in random community samples in 4 countries (total 6,642 subjects). The data included socio-economic and psychosocial factors, self-rated health (SRH) and behavioural risk factors. Overall, 17% of men and 23% of women rated their health as worse than average. In the national samples, perceived control, material deprivation and education were strongly related to poor SRH. In the pooled data, adjusted odds ratio (OR) of poor health for 1 standard deviation (SD) increase in perceived control was 0.59 (95% Cl 0.54-0.63). The OR for 1 SD increase in the material deprivation score was 1.35 (95% Cl 1.26-1.46). The ORs for vocational, secondary and university education, compared with primary education, were 0.75,0.58 and 0.53, respectively. We also examined the ecological effects of income inequality; the OR for the most versus the least unequal populations (using the Gini coefficient of income inequality) was 1.88 (95% Cl 1.55-2.28). In multivariate analyses, however, the effect of inequality was eliminated by adjustment for material deprivation and perceived control. In the community samples, the results were similar. Among psychosocial factors at work, the effort-reward imbalance appeared to be the strongest predictor of self-rated health; work variety was also a predictor of self-rated health. Job strain was not associated with SRH. Our results suggest that (a) the prevalence of poor SRH in CCEE is high, and (b) socioeconomic and psychosocial factors are strongly related to self-rated health in these populations. The gradients were present in all populations, and were of the same direction and similar magnitude as in the West. Prospective studies are needed to address the problems of temporality and reporting bias, which are the major problems of these results.

On January 12, 2010, a 7.0 wide magnitude earthquake hit Haiti and thousands of Haitians were left to cope with the aftermath, and many mental health concerns began to surface (Amnesty International, 2011; Cénat & Derivois, 2014). The main purpose of this study is to understand post-earthquake psychosocial issues in the Haitian context by studying the experiences of Natives in Haiti. This study provides implications for counseling support from international emergency response workers, counselors, counselor educators interested in providing mental health training in Haiti or other developing countries, and researcher's interested in increasing knowledge that has real impact on mental health issues in Haiti. This study aims to answer: "What are the experiences of Haitian Natives post-2010 earthquake in Haiti and the implications for providing appropriate post-crisis psychosocial support?" <br>This qualitative inquiry used Bronfenbrenner's bio-ecological model of human development (Bronfenbrenner, 2005) as a theoretical framework. Seven Haitian Natives who survived the earthquake in La Ville, Haiti shared their beliefs, personal narratives, and the culturally responsive care they received after the earthquake. Some of the participants also took part in a focus group. Informants' responses were translated and transcribed, and Interpretative Phenomenology Analysis (IPA) was used to analyze the transcription and field notes. Conceptual models captured the process and outcomes of psychosocial issues related to post-earthquake context in this study and were compared with previously developed conceptual frameworks. The findings of the study yielded nine themes and 27 sub themes. The findings suggest that the interviewee's experiences were both negative and positive. Some of the negative experiences were continuous trauma symptoms such as panic, worry, and fear. Some of the positive experiences were unity, leadership development, posttraumatic growth, and new appreciation for professional mental health. Based on the conclusions and results from this study, implications will be stated as they relate to practice, teaching, and scholarship. / School of Education; / Counselor Education and Supervision (ExCES) / PhD; / Dissertation;

with Dr. Mary Gail Frawley-O'Dea / Gasson Hall 100

Background: The use of health data from sources such as administrative and medical records to examine efficacy of health interventions is becoming increasingly common. Addressing selection bias inherent in these data is important; treatments are allocated according to clinical need and resource availability rather than delivered under experimental conditions. Propensity score (PS) methods are widely used to address selection bias due to observed confounding. This project used PS methods with observational cohort data relating to individuals who had attended an Emergency Department (ED) following self-harm (including self-poisoning and self-injury). This group is at greatly increased risks of further self-harm, suicide and all-cause mortality compared to the general population. However, it is not clear how hospital management affects risks of these adverse outcomes. Methods: A systematic review of PS methods with record-based mental health care data was used to determine the most appropriate methodological approach to estimate treatment effects following presentation to ED following self-harm. Following this review, PS stratification and PS matching methods were used with observational self-harm data to address observed baseline differences between patients receiving different types of clinical management following their hospital presentation (specialist psychosocial assessment, medical admission, referral to outpatient mental health services and psychiatric admission). Effects on repeat attendance for self-harm, suicide and all-cause mortality within 12 months were estimated. Advice on the interpretation and dissemination of results was sought from service users. Results: The systematic review resulted in 32 studies. The quality of the implementation and reporting of methods was mixed. Sensitivity analysis of the potential impacts of unobserved confounding was largely absent from the studies. Results from analysis of the self-harm cohorts showed that, broadly, prior to PS adjustment, individuals receiving each of the four categories of hospital management had higher risks of repeat attendance for self-harm, suicide and all-cause mortality than those not receiving that management. The use of PS methods resulted in attenuation of most of these increased risks. Psychosocial assessment appeared to be associated with reduced risk of repeat attendance for self-harm (risk ratio 0.87, 95% CI 0.80 to 0.95). Three advisors attended a group meeting and a further two provided responses by email. As a result of advisors' recommendations, an information sheet is being developed containing information about what patients can expect when attending hospital following self-harm and how treatment might influence future risk. Conclusions: Propensity score methods are a promising development in evaluating routine care for individuals who have self-harmed. There is now more robust evidence that specialist psychosocial assessment is beneficial in reducing risk of further attendances for self-harm. Advisors offered different perspectives to the researchers, leading to novel suggestions for dissemination.

Thesis (M.A. (MW))--North-West University, Potchefstroom Campus, 2008.

Nausea and vomiting are commonly experienced by women in pregnancy (NVP). Symptoms are usually limited to the first trimester, but can persist until birth. Both mild and more severe symptoms can have negative effects for the mother, her unborn child, and the family. Despite the frequency of NVP and associated distress, the exact cause is unknown and the condition remains poorly understood.<p> This secondary analysis explores nausea and vomiting in pregnancy, as determined by the Nausea and Vomiting in Pregnancy Instrument (NVPI), in a cohort of Canadian pregnant women at two gestational time points. The data analyzed in this study were originally from a longitudinal and epidemiological study of depression in pregnancy and into the postpartum. A population health approach has been used to examine psychosocial determinants of nausea and vomiting in pregnancy.<p> During the second trimester, the prevalence of nausea and vomiting in this sample of 551 women was 63.3%, with 24% of women reporting moderate nausea and vomiting and 18.9% reporting severe symptoms. These rates are similar to other studies of women during the first and second trimester of pregnancy. In the final model, nausea and vomiting in pregnancy was associated with gestation (weeks), antiemetic medication use, employment status, worry, and symptoms of major depression.<p> During the third trimester, the prevalence of NVP in this sample of 575 women was 45.4%, with 8.2% reporting moderate nausea and vomiting and 14.3% reporting severe symptoms. These results exceed previous reports on prevalence beyond 20 weeks in pregnancy. In the final model, nausea and vomiting in pregnancy was associated with antiemetic medication use, worry, and symptoms of major depression. The presence of support and maternal smoking were found to have a protective effect.<p> The co-morbidity of nausea and vomiting, worry, and symptoms of major depression in this sample of pregnant women represents a significant public and mental health problem. Care providers need to screen pregnant women for nausea and vomiting and also screen women for depression in the presence of more severe NVP symptoms. Supportive measures that address both conditions may be necessary in order to improve the quality of life of pregnant women, their families, and to protect the unborn child from the effects of both nausea and vomiting and depression in pregnancy.

Nausea and vomiting are commonly experienced by women in pregnancy (NVP). Symptoms are usually limited to the first trimester, but can persist until birth. Both mild and more severe symptoms can have negative effects for the mother, her unborn child, and the family. Despite the frequency of NVP and associated distress, the exact cause is unknown and the condition remains poorly understood.<p> This secondary analysis explores nausea and vomiting in pregnancy, as determined by the Nausea and Vomiting in Pregnancy Instrument (NVPI), in a cohort of Canadian pregnant women at two gestational time points. The data analyzed in this study were originally from a longitudinal and epidemiological study of depression in pregnancy and into the postpartum. A population health approach has been used to examine psychosocial determinants of nausea and vomiting in pregnancy.<p> During the second trimester, the prevalence of nausea and vomiting in this sample of 551 women was 63.3%, with 24% of women reporting moderate nausea and vomiting and 18.9% reporting severe symptoms. These rates are similar to other studies of women during the first and second trimester of pregnancy. In the final model, nausea and vomiting in pregnancy was associated with gestation (weeks), antiemetic medication use, employment status, worry, and symptoms of major depression.<p> During the third trimester, the prevalence of NVP in this sample of 575 women was 45.4%, with 8.2% reporting moderate nausea and vomiting and 14.3% reporting severe symptoms. These results exceed previous reports on prevalence beyond 20 weeks in pregnancy. In the final model, nausea and vomiting in pregnancy was associated with antiemetic medication use, worry, and symptoms of major depression. The presence of support and maternal smoking were found to have a protective effect.<p> The co-morbidity of nausea and vomiting, worry, and symptoms of major depression in this sample of pregnant women represents a significant public and mental health problem. Care providers need to screen pregnant women for nausea and vomiting and also screen women for depression in the presence of more severe NVP symptoms. Supportive measures that address both conditions may be necessary in order to improve the quality of life of pregnant women, their families, and to protect the unborn child from the effects of both nausea and vomiting and depression in pregnancy.