No description available.

Objective: This study examined (a) the distribution of physical symptoms in youth with specific primary anxiety disorders (i.e. separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and social phobia [SP]) and (b) their response to treatment with cognitive-behavioral therapy (CBT; 14 sessions of CBT over the course of 12 weeks), medication, combination therapy (CBT + medication), or pill placebo in a sample. Method: Anxiety disordered youth (N = 488, age 7-17) who met criteria for a primary diagnosis of GAD, SAD, and/or SP as part of the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al. 2008) were included in this study. The sample was diverse and included children with comorbid secondary diagnoses. Results: The most common somatic complaints were headache, stomach pain or aches, feeling drowsy or too sleepy, head cold or sniffles, and sleeplessness. The distribution of these complaints did not differ across diagnostic groups. The number and severity of physical symptoms decreased over the course of treatment. Treatment condition, including placebo, was unrelated to the number and severity of physical symptoms posttreatment. Conclusions: Treatment of anxiety leads to a decrease in the number and severity of physical symptoms experienced in anxiety-disordered youth, irrespective of treatment type. / Psychology

L’objectif de cette recherche est de contribuer à mieux comprendre l’impact du travail émotionnel dans l’émergence du burnout et des troubles somatiques des soignants. Pour cela, le premier chapitre commence par exposer le concept de travail émotionnel, son histoire, son évolution et ses liens avec le burnout et les troubles somatiques. Tout en développant la critique sociologique du travail émotionnel d’Hochschild, nous exposons sa pertinence dans le contexte actuel de l’institution hospitalière. L’évolution du concept est ensuite présentée et nous proposons de nous focaliser sur l’approche intra psychique du travail émotionnel. Celle-ci privilégie trois composantes du concept : la dissonance émotionnelle, l’acting de profondeur et l’acting de surface. A partir de cette approche, notre revue de la littérature expose les liens de ces trois composantes au burnout, aux troubles somatiques et à la performance des salariés. Diverses problématiques associées à l’état actuel des connaissances portant sur le lien entre le travail émotionnel et la santé des salariés sont alors abordées et les chapitres suivants proposent d’apporter, par le biais d’études empiriques, des éléments de réponses à celles-ci. Le deuxième chapitre expose les problématiques liées aux limites méthodologiques des mesures actuelles du concept de travail émotionnel. Une mesure alternative est proposée : celle-ci distingue les deux processus de régulation jusqu’ici confondus dans la conceptualisation de l’acting de profondeur, à savoir la réévaluation cognitive et le déploiement attentionnel ; les deux stratégies de régulations expressives jusqu’ici confondues dans la conceptualisation de l’acting de surface, à savoir la suppression et l’amplification expressive des émotions. Enfin, ces processus de régulation ont clairement été dissociés de l’état de dissonance émotionnelle. Nos résultats présentent plusieurs intérêts. Premièrement, ils indiquent que la dissonance émotionnelle constitue la composante du travail émotionnel la plus fortement associée au burnout et aux troubles somatiques. Deuxièmement, cette étude révèle que les mesures actuelles de l’acting de surface et de profondeur englobent différents processus aux effets opposés sur le burnout. Alors que la suppression expressive des émotions est liée de façon positive au burnout, l’amplification expressive des émotions l’est de façon négative. Et si la réévaluation cognitive s’avère une stratégie de régulation négativement liée au burnout, le déploiement attentionnel apparaît plus délétère à la santé des salariés. Afin de déterminer la valeur ajoutée du travail émotionnel au modèle exigences-ressources, le troisième chapitre évalue les liens entre celui-ci et le burnout en prenant en considération différents stresseurs/ressources organisationnelles (exigences émotionnelles, charge de travail, justice organisationnelle…). Basées sur les principes du modèle exigences-ressources, les données indiquent que les composantes du travail émotionnel expliquent une part de variance importante du burnout et des troubles somatiques au-delà des parts de variance expliquées par les exigences et le manque de ressources organisationnelles. Puisque la dissonance émotionnelle joue un rôle prédominant dans l’émergence du burnout, le quatrième chapitre évalue dans quelle mesure la réflexivité des équipes de travail permet de modérer ses effets négatifs sur la santé des salariés. Les données indiquent que la réflexivité sociale modère les effets de la dissonance sur le burnout. Enfin, le chapitre cinq explore les liens entre le travail émotionnel, le burnout et la maltraitance des soignants vis-à-vis des patients. Les résultats confirment l’impact de la dissonance émotionnelle et du burnout sur les comportements de maltraitance. En effet, le burnout et la dissonance médiatisent les effets des stresseurs liés à l’environnement de travail sur la maltraitance. / The aim of this research was to better understand the links between emotional labor, burnout and somatic complaints. The first chapter constitutes a literary review that exposes the concept, its history, and its links with burnout and somatic complains: Hochschild’s sociological analysis of emotional labor is developed and its relevance to the hospital context is exposed. The evolution of the concept is then presented and we propose to focus on the intra psychic perspective of emotional labor which pays attention to three components of the concept: emotional dissonance, surface acting and deep acting. Based on this approach, we realized a literature review that exposed the associations between these three components and burnout, somatic complaints and job performance. Diverse problems associated with the comprehension of the impact of emotional labor on health outcomes are developed. The second chapter exposes the problems associated with the limitations of the measure used to evaluate the concept of emotional labor. An alternative measure is proposed: this one distinguishes the two emotion regulation processes included in the conceptualization of deep acting, which are, re-evaluation and attentional deployment. It also distinguishes the two expressive regulation strategies included in the conceptualization of surface acting, that are expressive suppression and expressive amplification. Finally, these emotion regulation processes are separate from the emotional dissonance state. Our results present several issues: First, they indicate that emotional dissonance is positively associated with burnout and somatic complains and that the variance part of these two variables are broadly explained by the emotional dissonance state. Second, they reveal that surface acting and deep acting measures include different processes with opposite effects on burnout: while expressive suppression is positively linked with burnout, expressive amplification is negatively related to it. Moreover, re-evaluation presents a positive impact on health outcomes while attentional deployment has a negative impact on them. The aim of the third chapter is to determine the added value of emotional labor to the job demands-resources model: links between emotional labor, burnout and somatic complaints were analyzed by taking into account different organizational demands and resources (emotional demands, workload, organizational justice…). Based on the job-demands-resources principles, our result show that emotional labor components explain a great part of burnout and somatic complaints beyond the parts of variance explained by demands and lack of resources. As emotional dissonance plays a determinant role in the burnout process, the fourth chapter examines to what extent reflexivity among work teams moderates its negative effects. Results indicate that social reflexivity moderates burnout induced by emotional dissonance. Finally, chapter five explores the links between emotional labor, burnout and mistreatments toward patients. Results confirmed the link between emotional dissonance and burnout on mistreatments. Indeed, burnout and emotional dissonance mediate the effects of stressors linked with the work context on mistreatment.

No description available.

La somatisation est la manifestation de symptômes physiques en réponse à une détresse psychologique. Chez les enfants victimes d’agression sexuelle (AS), la somatisation et les facteurs associés sont peu documentés dans la littérature. Puisque la somatisation peut diminuer la qualité de vie, il est important d’identifier les facteurs qui seraient des cibles d’interventions. L'étude a pour objectif d’examiner les caractéristiques de l’AS, ainsi que les facteurs personnels, familiaux et environnementaux associés aux symptômes somatiques dans cette population. L'échantillon comprend 655 enfants (68,9 % de filles; M = 8,96, SD = 1,87) ayant dévoilé une AS. Des modèles de régression linéaire hiérarchique ont été utilisés pour étudier les associations entre les caractéristiques de l'AS, les facteurs personnels, familiaux et environnementaux et les symptômes somatiques. Les interactions avec le sexe ont été testées. La majorité (80 %) des enfants avaient au moins un symptôme somatique. En contrôlant pour le sexe et l'âge, le stress lié au dévoilement de l’AS (B = 0,17, IC à 95 % [0,10, 0,25], la détresse parentale (B = 0,22, IC à 95 % [0,14, 0,29]), le nombre d’évènements de vie stressants (B = 0,15, IC à 95 % [0,08, 0,23]) et la défavorisation sociale du quartier (B = 0,25, IC à 95 % [0,05, 0,45]), étaient indépendamment associés à plus de symptômes. Des interventions axées sur le contexte familial et environnemental peuvent être considérées pour atténuer les conséquences de l’AS sur les plaintes somatiques. / Somatization is the manifestation of physical symptoms as a response to psychological distress. In children victims of sexual abuse (SA), somatization and the associated risk and protective factors are understudied. Given that somatic symptoms can lead to functional impairment and decreased health-related quality of life, identifying areas of intervention at all levels of the child’s environment is essential. The study aimed to identify SA characteristics, personal, family, and environmental factors associated with somatic complaints among child victims of sexual abuse. The sample included 655 children (68.9% girls; M = 8.96 years, SD = 1.87) seeking services after SA disclosure. Hierarchical linear regression models were used to investigate the associations between SA characteristics, personal, family, and environmental factors, and somatic symptoms. Interactions with sex were systematically tested. In the sample, 80% of children reported at least one somatic symptom. After controlling for sex and age, stress related to the SA disclosure (B = 0.17, 95% CI [0.10, 0.25], parental distress (B = 0.22, 95% CI [0.14, 0.29]), the number of stressful life events (B = 0.15, 95% CI [0.08, 0.23]) and neighborhood social deprivation (B = 0.25, 95% CI [0.05, 0.45]), were independently associated with increasing somatic complaints. Children therefore depend on the support of adults around them and on their entire social environment to mitigate the consequences of SA on somatic complaints. Interventions focused on family and environmental factors should be considered to support this vulnerable population.

Stress och psykosomatiska besvär har under de senaste åren varit ett växande hälsoproblem i samhället, där barn och unga självrapporterat att de mår sämre. Skolan är en arena där barn och unga befinner sig till stor del av sin vakna tid, vilket avser vikten till att förebygga den ökade stressnivån bland elever. Studier och rapporter visar att stress och psykosomatiska besvär har ökat inom skolan där eleverna möts av höga krav och prestationer. Om elever möter stressiga situationer som de kan hantera kan det öka deras prestationsförmåga, dock har en hög stressnivå tendensen till att sänka elevernas hanterbarhet av situationen, vilket kan orsaka ohälsa. Syftet i denna studie är att undersöka könsfördelningen och förekomsten av skolrelaterad stress samt att om det finns en koppling till psykosomatiska besvär bland gymnasieelever i årskurs tre på en gymnasieskola i Västmanlands län. För att besvara syftet användes en enkät som lämnades ut till fyra årskurs tre klasser på en gymnasieskola i Västerås, där 80 elever medverkade. Studiens resultat visar att förekomsten av skolrelaterad stress bland eleverna var relativt hög där två tredjedelar motsvarande (77,6%) av medverkande elever besvarade att de var pressade av skolarbetet. Resultatet visar också att det finns en koppling mellan skolrelaterad stress och psykosomatiska besvär. Det teoretiska perspektivet i denna studie tillämpades av teorin känsla av sammanhang, för att tolka sambandet mellan skolrelaterad stress och psykosomatiska besvär. / Stress and somatic complaints have under the last decades grown and become a health problem in todays’ society, as children have reported to feel worse than in the past. School is an arena where children spends most of their time. Therefore, it is crucial to work preventive against increasing levels of stress among the students. Studies and reports show that stress and somatic complaints has increased among students that faces higher demands and accomplishment. If students face stressful situations that they can manage it might increase their accomplishment levels. However, if the levels of stress are high, it tends to lower the student’s manageability of situations, which could cause illness. The purpose of this study was to investigate gender differences and prevalence of school-related stress and if there was a relation between somatic complaints and school-related stress in students that attend a high-school in Västmanlands County.  The author sent out a survey to four classes in the last year of high school and 80 students answered the survey. The results showed that the prevalence of school-related stress among the students where relatively high with over two thirds (77,6%) of the students answering that they were pressured by their schoolwork. The results also showed that there was a relation between school-related stress and somatic complains. The theory sense of coherence was used to explain the relation between school-related stress and somatic complaints.

I uppsatsen undersöktes faktorer som bidrar till skolstress och somatiska symtom hos ungdomar på studieförberedande- och yrkesförberedande gymnasium av båda könen. Deltagarna var 105, varav 59 från de studieförberedande programmen, 23 elever var killar och 36 var tjejer samt, 46 var från de yrkesförberedande programmen, varav 25 var killar och 21 var tjejer. Undersökningen var kvantitativ och enkäter skapades som innehöll 42 frågor varefter 10 variabler skapades av dessa och en fråga analyserades med kvalitativ ansats. Resultaten visade att studenterna på de studieförberedande programmen generellt upplevde mer skolstress. Tjejerna upplevde mer skolstress, externa krav, somatiska-, psykosomatiska besvär och de ansåg sig ha för höga krav på sig själva. Korrelationen mellan somatiska besvär och skolstress var positiv och resultatet var signifikant. Studien visade att elever led av både Skolstress, Somatiska- och Psykosomatiska besvär och dessa borde tas i åtanke av både vårdnadshavare och lärare i skolsituationer. Relibiliteten för alla variabler utom Somatiska besvär var god och eftersom reliabiliteten var låg fanns risk för att samband inte var signifiktanta . Det fanns även en risk att Skolstressen var högre på grund av att det var nära terminsavslut. Förslag till vidare studier var att undersöka varför killar inte upplever samma besvär som tjejer. / The essay investigated factors that could contribute to school-related stress and somatic complaints among adolescents at academic- and vocational programs in high school in both sexes. There were 105 participants, whereof 59 from the academic programs, 23 where boys and 36 were girls and 46 from the vocational programs, whereof 25 were boys and 21 were girls. The study was a quantitative one and questionnaires were created from which contained 42 questions after which 10 variables were created and one question was analyzed with a qualitative approach. The results showed that students at the academic programs generally experienced more school-related stress. Girls experienced more school-related stress, external demands, somatic- and psychosomatic complaints and they thought they had too much demands on themselves. The correlation between somatic complaints and school-related stress was positive and the result was significant. The study showed that students suffered from both school-related stress, somatic- and psychosomatic complaints and this should be taken into consideration from both caregivers and teachers in school situations. The reliability for all variables other than Somatic complaints was good. There was a risk that the school-related stress was high because of closeness to end of semester. A suggestion for further studies was to examine why boys does not experience the same difficulties as girls

La teoria della mente (toM) è la capacità di attribuire stati mentali a se' e agli altri e di prevedere il comportamento sulla base di essi. recentemente gli studiosi della tom hanno adottato un'ottica life-span (che ha portato alla costruzione di nuovi strumenti per valutare la tom) e iniziato a studiare le differenze individuali in questa capacità (includendo la comprensione delle emozioni e i legami tra tom e funzionamento socio-emotivo). Il presente lavoro ha lo scopo di approfondire lo studio dello sviluppo della comprensione di stati mentali (epistemici ed emotivi) e i suoi legami con le difficoltà emotive nei bambini. Affronta così alcune nuove tematiche nell'ambito degli studi sulla tom, relative alla valutazione della tom in bambini con sviluppo tipico frequentanti la scuola primaria e la relazione tra tom e problemi internalizzanti. Viene presentato un nuovo compito avanzato di ToM e la sua validazione e standardizzazione su un campione italiano di bambini di 6.5-11.4 anni: il voice test. esso valuta l'abilità di comprendere stati mentali complessi da indici vocali. Infine, viene studiata la relazione tra tom e rischio psicologico e, in particolare, analizzato il legame tra la scarsa tom e le frequenti lamentele somatiche nei bambini in eta' scolare. / Theory of Mind (ToM) is the ability to impute mental states to the self e to the others as a way of making sense and predicting behaviour. Recently ToM researchers has been adopted a life span perspective, that leads to the construction of new instruments to assess ToM, and studied individual differences in ToM, including emotion understanding and the relationship between ToM and socio-emotional functioning. The present work is aimed to analyze deeper the development of mental states (both epistemic and emotional) understanding and its link with emotional difficulties, dealing with some novel topics within ToM studies, regarding ToM assessment in school age children and the relationship between ToM and internalizing problems. After reviewing ToM studies, it presents the Voice Test, a new advanced ToM instrument, and its validation and standardization on an Italian school age children sample aged 6,5-11,4 years; the test assesses the ability to understand a wide range of complex mental states from vocal cues. finally, it is studied the relationship between ToM and psychological risk and, in particular, it points out the link between poor ToM and frequent somatic complaints in a normal school age children population.

This thesis consists of a quantitative and a qualitative study. The quantitative study (articles I-III) aimed to examine how self-reported health in adolescence is associated with behavioral, parental, and school factors. Through a survey directed at all adolescents in grades 7-9, data were collected in 2005 in a region in northern Sweden (n=5060). Statistical methods were used to analyze the survey data: chi2tests, multivariate logistic regressions and multilevel logistic regressions. Results showed that even though most adolescents reported good health, there were also rather large proportions of adolescents who reported headaches, stomach aches and feelings of stress. Girls reported poor health to a higher extent than boys, a difference that was larger in grade 9 than in grade 7. The results also showed that being norm compliant was associated with good self-reported health. Furthermore, perceiving relations and communication with parents as poor was associated with poor self-reported health; however, this relationship could not explain gender differences in self-reported health. Continuing on, analyses showed that there exist greater variations in self-reported health between students (within a school) than between different schools. On an individual level, poor relations to teachers, bullying and truancy were associated with poor general health. The qualitative study  (article IV) sought to examine barriers to and facilitators of utilization of local school survey results within a school setting. In 2011, 21 school district managers and principals within a Swedish municipality were interviewed. Analyses were performed using a qualitative content analysis. The results from the qualitative study showed that the dissemination and utilization of school survey results appeared as two interrelated phases in one process. Barriers and facilitators differed qualitatively depending on the phase, dissemination or utilization. In conclusion, professionals as well as researchers need to consider the complexity of adolescent health and its social determinants. Adolescent health is a concern for multiple sectors in society, which highlights the need for further development of collaborations between professionals in relevant fields, such as health care, school and social services. / Den här avhandlingen består av en kvantitativ och en kvalitativ studie. Syftet med den kvantitativa studien (artikel I-III) var att undersöka sambandet mellan ungdomars självrapporterade hälsa och deras normrelaterade beteende samt föräldra- och skolfaktorer. Data samlades in under 2005, genom en enkät som riktade sig till alla ungdomar i årskurs 7-9 i en region i norra Sverige (n=5060). De statistiska metoder som användes i den kvantitativa studien var bland annat chi2- test, logistisk regression samt flernivåanalys. Resultaten visade att även om de flesta ungdomar rapporterade en god allmän hälsa, så var det också en relativt stor andel som rapporterade huvudvärk, magont samt upplevelser av stress. Flickor rapporterade sämre hälsa än pojkar, en skillnad som var större i åk 9 jämfört med åk 7. Resultaten visade också att normföljsamhet hade ett signifikant samband med god självrapporterad hälsa. De ungdomar som upplevde relationen och kommunikationen med sina föräldrar som dålig, rapporterade också dålig hälsa i högre utsträckning än övriga. Sambandet mellan självrapporterad hälsa och föräldrarelationer kunde inte förklara skillnaderna i ohälsa mellan pojkar och flickor. Vidare, analyser visade att det fanns större variationer i självrapporterad hälsa mellan ungdomar (inom en skola) än mellan olika skolor. Dåliga relationer med lärare, skolk, samt att bli utsatt för mobbning hade ett signifikant samband med dålig självrapporterad hälsa, på en individuell nivå. Syftet med den kvalitativa studien (artikel IV) var att undersöka vilka faktorer inom skolan som möjliggör och som utgör barriärer för användningen av enkätresultaten från en lokal skolenkät. 2011 genomfördes 21 intervjuer med skolområdeschefer och rektorer inom en kommun i Sverige. Analyser av intervjumaterialet genomfördes med hjälp av kvalitativ innehållsanalys. Resultaten från denna studie visade att spridningen och användningen av resultaten från skolenkäten kan beskrivas som två relaterade faser i en process. De faktorer som underlättade samt utgjorde barriärer för spridningen och användningen av enkätresultaten var kvalitativt olika varandra beroende på vilken fas i processen respondenterna hänvisade till. Dessa resultat illustrerar den mångfacetterade komplexitet som inryms i ungdomars hälsa och dess sociala determinanter, en komplexitet som både forskare och professionella behöver ta hänsyn till. Ungdomars hälsa angår ett flertal samhällssektorer, vilket visar på betydelsen av en fortsatt utveckling av samverkan mellan professionella inom exempelvis hälso- och sjukvården, skolan och socialtjänsten.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular measure of psychosocial functioning and psychopathology in the assessment of individuals in a variety of settings. However, the method of construction employed with the MMPI more than 60 years ago with psychiatric patients challenges the applicability of the scales for determining the psychosocial functioning of individuals from different settings. The restandardisation conducted in 1987 made no effort to eradicate the item overlap that was a result of the criterion keying method with contrasted groups. Although restandardized and updated with more contemporary language and content, the original psychiatric constructs were retained in order to maintain continuity with its predecessor. The aims of this investigation were to develop a new structure for the MMPI-2 constructed at the item-level, empirically derived and which specifically represents the dimensions that are relevant and appropriate in evaluating the psychosocial functioning of personal injury claimants. This task included comparisons with a comparable scale-level analysis and developing optimal scoring strategies where items in components and facets are allocated weightings based upon their strength of association. Study 1 was conducted using a sample of 2989 personal injury claimants assessed in Australia and the United States of America. The final sample of 3230, included 241 normal individuals, was utilized to develop a scale-level structure from 79 standard MMPI-2 scales and subscales. A nine-component solution consisting of General Maladjustment /Emotional Distress, Asocial Beliefs, Social Vulnerability, Somatic Complaints, Psychological Disturbance, Impulsive Expression, Antisocial Practices, Stereotypic Fears and Family Difficulties was derived using principal component analysis. However, intercorrelation between components in the structure signaled the need to develop a structure that would eradicate problems that were perpetuated by item overlap. The second study was conducted with a set of best practice procedures with the same clinical sample of 2989 personal injury claimants as Study 1. Forty-one components were derived through principal component analysis. Through the application of a set of criteria, a 35-component solution was retained. The pattern coefficients from the allocation of items to components determined the weightings to be applied to each item. Further analysis of the 35 components derived a substructure of 37 facets. The 35 components included only 442 of the 567 items, with the reliability coefficients of the first 25 components that ranged between .5 and .97, and the remaining 10 components that ranged from .29 to .49. The latter unreliable components were not included in the final Structural Summary, leaving 25 components (400 items) and their 33 facets for interpretation. Hence, in demonstrating the utility of the newly-derived structure, only 25 components and their 33 facets were interpreted. The 25 components were grouped conceptually into six domains. In the emotional domain were Psychological Distress (PsyDist), Anger, Fears, Psychotic Symptoms (PsyS), Paranoia (Par), Irritability (Irrit), Elation (Elat), Fear of the Dark (FD), and Financial Worry (FinWo). Somatic Complaints (SomC), Sexual Concerns (SexCon), and Gastrointestinal Problems (GasP) made up the measures in the physiological domain. In the behavioural domain were Cognitive Difficulties (CogDiff), Stimulus-Seeking (StimuS), Discipline (Dis), and Delinquency (Del) whilst the interpersonal domain was formed by Social Withdrawal (SoW), Negative Interpersonal Attitude (NIA), Timidity (Tim), Lie, Dissatisfaction with Self (DWS) and Family Relationship Difficulties (FReD). Alcoholism (Alco) was the only measure in the substance abuse domain, and the gender domain was comprised of Masculinity (Mas) and Femininity (Fem). The third study established preliminary normative means and standard deviations using a small opportunistic Australian university student sample (N = 219). No substantial gender differences were found but gender norms were maintained to facilitate comparisons with the traditional MMPI-2 approach. Comparisons of frequency of 'true' item response between the Australian university student sample and the U.S. restandardisation sample found relatively little differences and permitted evaluation of between sample differences on components and facets. The utility of the structure was demonstrated with the illustration of two clinical case examples, and a comparison was made with the standard MMPI-2 scales and subscales. The Structural Summary for the MMPI-2 demonstrated discriminative measures of psychosocial functioning that were a result of no item overlap, and the ability to attend to the different levels of intensity of self-report items because of differential weightings.