<p>The overall aims of this thesis were to prospectively investigate how specific challenges among patients with commonly occurring cancers are related to adaptation and well-being, to predict later well-being using a range of psychosocial aspects and to compare two ways of measuring coping with cancer. This was studied at diagnosis in patients with gastrointestinal cancers and their spouses and at termination of cancer treatment and during follow-up in a heterogeneous group of cancers. At <i>diagnosis,</i> higher levels of psychological distress were accompanied both by more coping attempts and less perceived control over the stressful events. Somatic aspects and Everyday concerns were frequent stressful events. The most frequently used coping strategies were emotion-focused. The Daily Coping Assessment (DCA) rendered a varied picture of ways of handling the stressful events (Study I). When studying coping as a process, the DCA has advantages compared to the commonly used measure MAC, since DCA better separates coping from both the stressful event and outcome. A comparison of the DCA and the MAC rendered differences regarding the usage of coping strategies (Study II). Patients with higher levels of anxiety/depression also had higher discrepancies between attainment and importance for most life values compared to patients with less anxiety/depression. For the patients, but not for the spouses, the discrepancies for several life values along with anxiety and depression decreased over time (Study III). Anxiety/depression at<i> termination of treatment</i> are strong predictors for anxiety/depression and QoL at follow-up. However, other variables like psychiatric history, the bother an event caused, the coping strategy Acceptance, the stressful event Thoughts/affects and emotional and instrumental aspects of social support contributed to the prediction (Study IV). Thus, it is concluded that detailed information regarding specific and frequent situations among cancer patients is possible to reveal and necessary for a better understanding of what influences well-being.</p>

The overall aims of this thesis were to prospectively investigate how specific challenges among patients with commonly occurring cancers are related to adaptation and well-being, to predict later well-being using a range of psychosocial aspects and to compare two ways of measuring coping with cancer. This was studied at diagnosis in patients with gastrointestinal cancers and their spouses and at termination of cancer treatment and during follow-up in a heterogeneous group of cancers. At diagnosis, higher levels of psychological distress were accompanied both by more coping attempts and less perceived control over the stressful events. Somatic aspects and Everyday concerns were frequent stressful events. The most frequently used coping strategies were emotion-focused. The Daily Coping Assessment (DCA) rendered a varied picture of ways of handling the stressful events (Study I). When studying coping as a process, the DCA has advantages compared to the commonly used measure MAC, since DCA better separates coping from both the stressful event and outcome. A comparison of the DCA and the MAC rendered differences regarding the usage of coping strategies (Study II). Patients with higher levels of anxiety/depression also had higher discrepancies between attainment and importance for most life values compared to patients with less anxiety/depression. For the patients, but not for the spouses, the discrepancies for several life values along with anxiety and depression decreased over time (Study III). Anxiety/depression at termination of treatment are strong predictors for anxiety/depression and QoL at follow-up. However, other variables like psychiatric history, the bother an event caused, the coping strategy Acceptance, the stressful event Thoughts/affects and emotional and instrumental aspects of social support contributed to the prediction (Study IV). Thus, it is concluded that detailed information regarding specific and frequent situations among cancer patients is possible to reveal and necessary for a better understanding of what influences well-being.

The 5-HTT gene (SLC6A4) is regulated by a common polymorphism in the promoter region (5-HTTLPR), which has functional consequences. Two major alleles have been observed and shown to have differential transcriptional activity with the long (L) allele having greater gene expression than the short (S) allele. 5-HTTLPR appears to modulate depression, anxiety and personality traits such as neuroticism. Additionally, a significant influence of 5-HTTLPR genotype on amygdala reactivity in response to fearful stimuli has been reported. Moreover, 5-HTTLPR seems to impact on the role of stressful life events (SLEs) in the development of depression. An elevated risk of depression and suicidal behaviors has been found in carriers of at least one low expressing S allele who had experienced SLEs, suggesting a gene x environment interaction. However, a recent meta-analysis showed that several findings failed to replicate this finding. Since genetic polymorphisms of the dopaminergic and serotonergic neurotransmission interact at the molecular, analyses with another polymorphism of the dopaminergic system, the dopamine D4 receptor (DRD4) was included to consider these likely gene-gene interactions (epistasis). The aim of this series of studies was to investigate the role 5-HTTLPR and SLEs on the endocrine stress response in different age samples. While newborns have been examined by a heel prick, stress responses were provoked in children (8-12 yrs) and younger adults (19-31 yrs) and older adults (54-68 yrs.) with the Trier Social Stress Test (TSST). The Life History Calendar (LHC) and Life Events Questionnaire (LEQ) were used to acquire data on SLEs. While in newborns the S/S genotype showed a significantly higher acute endocrine stress response than L/L or S/L genotypes, no significant difference between genotype groups was found in children. In the younger adult sample, the genotype impacted on cortisol stress responsiveness was reversed. Adults carrying the more active L allele of the 5-HTTLPR polymorphism showed a significantly larger cortisol response to the TSST than individuals carrying at least one of the lower expressing S allele. In older adults, no significant difference between genotype groups was found. However, results point in the same direction with showing highest cortisol response in individuals with L/L genotype. These data suggest that the association between 5-HTTLPR and endocrine stress reactivity seems to alter across lifespan, more specific the effects of genotype turns around. In addition, a significant interaction effect of 5-HTTLPR and SLEs has been found in the sample of younger adults, i.e. that early SLE as well as a severe number SLEs across the entire lifespan seem to modulate the interaction between HPA axis activity and 5-HTTLPR genotype. Additionally, a DRD4 by 5-HTTLPR interaction emerged which point to independent and joint effects of these polymorphisms on stress responsivity with regard to the concept of genegene interaction.

The thesis deals with the issue of self-concept and stress. Determination of theoretical links focuses on defining of basic concepts connected with this issue. University studies are considered a demanding and stressful situation that can cause a wide range of problems in some students. There are considerable interindividual differences in stress perception - the personality can either create various defense mechanisms against critical situations or can cope with them by means of constructive perception and actions. The objective of the empirical part was to find out what is the relationship between self-concept of students of Faculty of Health and Social Studies in České Budějovice and perception and living stressful situations connected with their university study. Information necessary for quantitative research was obtained by the method of questioning. The technique applied was a questionnaire, filled in by students of both daily and combined studies. The research showed that there exists a moderate dependence between these two variables, which means that low values of self-concept and self-esteem correspond with high values of stress perception. It was also revealed that stress perception is associated mostly with an examination or a public speech of a student. This fact indicates that a situation that is directly. Thus it would be appropriate for students to know different techniques of preventing and coping with stress and they could try to reduce the tension or to eliminate stress through these techniques. Adequate self-image or self-concept is an important condition for psychical balance and satisfaction with own life and thus I believe that professional psychological care within psychological counseling at universities can contribute to solving the problem.

In my thesis, I focused on the ethical and cultural dimension of social work, application of ethical principles and choice of attitude by a helping professional when working with a client. Subsequently, I followed changes in application of these ethical principles and changes of attitude in high-strain situations in the contact with a so-called difficult client. Further, I focused on the defence mechanisms which a helping professional chooses to cope with high-strain situations and manage his job well. In the individual chapters of the theoretical parte, by the analysis of scientific literature I described theoretical bases of the professional relationship between a social/health social worker and a klient and I focused on the realization of this relationship and on what it brings the worker in high-strain situations when working with the so-called difficult client. In the empirical part, I set one main goal to find out how social workers react on the ethical level in high-strain situations while interacting with difficult clients. Partial goals were designed to find out what ethical principles social workers apply, what attitudes they choose, which clients they consider difficult and what defence mechanisms they develop to cope with high-strain situations. To reflect these goals, I set one main research question and four partial ones. For the collection of data, I opted for the method of quantitative research and I used the questioning method in the form of a half-structured interview. I chose the set of respondents for my research by the method of simple random sampling. To process the research data, I chose the method of case study. Processing the interviews and analysing them, I found out that social workers in high-strain situations do not change their application of ethical principles. Further, I found out that the choice of attitude in high-strain situations changes and that social workers choose, instead of a partner attitude based on equality, a more or less directive stance. All of the respondents met a difficult client at work and dealing with high-strain situations causes them certain indisposition they have to cope with. The answer to the main research question is thus that on ethical level social workers react in high-strain situation by a shift in the choice of their attitude and solving ethical dilemmas. It was a hostile client that the social workers listed most frequently in the typology of clients. It became evident during the interviews what kind of defence mechanisms social workers choose to be able to cope with high-strain situations. The thesis may provide information to the general public and experts.

This study focuses on the stress perception, stressful academic situations, andstress management strategies in studies of Swedish and Peruvian students from ateacher-training program. The research design that is applied for this purpose iscomparative. The sample includes Swedish and Peruvian second year students andadministrative staff from a teacher-training program. The research instruments arequestionnaires and interviews.Percepción de estrés, experiencias académicasestresantes y afrontamiento en los estudiosUna investigación comparativa entre estudiantesde educación de Perú y SueciaMaría del PilarGonzález VigilEducación Vol. XVII, N° 32, marzo 2008, pp. 49-66 / ISSN 1019-940350Educación Vol. XVII, N° 32, 2008 / ISSN 1019-9403María del Pilar González VigilThe main findings of this study indicate that in spite of the cultural differences,both groups of students present as many similarities as differences. On theone hand, Swedish and Peruvian students present some similarities consideringspecific stressful academic situations; their perception of stress as negative intheir academic performance, emotional state and health; their variable competenceto manage stress in studies; and their desire for having a course on stressmanagement. On the other hand, both groups manifest a particular profile in theway they perceive stress, experience specific stress effects, and manage stressfulacademic situations. These findings show the importance of education in stressmanagement strategies, taking cultural differences into account. This will allowstudents to handle stressful academic situations and deliver performance accordingto their capacities. / La investigación a continuación se enfoca en describir la experiencia de estrés académicode estudiantes peruanos y suecos que cursan el segundo año de la carrerade Educación. La investigación es de tipo comparativo y analiza cualitativamentela información recolectada mediante un cuestionario de preguntas abiertas, creadopara esta investigación, además de entrevistas realizadas al personal administrativode las universidades de la muestra.Los resultados indican que los estudiantes peruanos y suecos coinciden en lassituaciones académicas que consideran estresantes, en su percepción negativa delos efectos del estrés en su desempeño, salud y estado de ánimo, y en su interés enun curso sobre afrontamiento. En cambio, los estudiantes difieren considerablementeen su forma de definir el estrés, en algunos efectos negativos específicos yen sus estilos de afrontamiento.Finalmente, esta investigación señala la importancia de formar a los estudiantesen el tema de estrategias de afrontamiento teniendo en cuenta sus característicasculturales, porque de esta manera podrán manejar adecuadamente las situacionesacadémicas estresantes y sus desempeños reflejarán sus capacidades.

Introduction : Identifier des mécanismes sous-tendant l’association entre les évènements stressants et la dépression est essentiel pour développer des interventions de santé publique ciblées. Pour faire face aux évènements stressants, les individus adoptent des styles d'adaptation qui sont associés différemment aux symptômes dépressifs. Cependant, aucune étude n'a évalué si le style d'adaptation est médiateur et/ou modérateur de cette association. Objectifs : Examiner chacun des styles soit l’adaptation centrée sur le problème, l’adaptation centrée sur les émotions et l’adaptation évitante comme médiateur et/ou modérateur de l’association entre les évènements stressants et les symptômes dépressifs chez les jeunes adultes. Méthodes : Nicotine Dependence in Teens (NDIT) est une étude longitudinale portant sur 1294 participants recrutés en secondaire I dans 10 écoles secondaires de Montréal, Québec entre 1999–2000. L’analyse actuelle utilise les données (n = 782) de questionnaires auto-rapportés recueillis après le secondaire entre 2011–2012. En utilisant la décomposition en quatre parties de VanderWeele, l’effet total d’évènements stressants sur les symptômes dépressifs a été décomposé en composantes représentant la modération uniquement, la médiation uniquement, l’interaction médiée et ni la médiation ni la modération par chaque style d’adaptation. Résultats : Nous avons observé une modération par l’adaptation centrée sur le problème (β ̂(IC à 95%)=-1.51(-2.22, -1.06)) et une médiation (0.15(0.05, 0.17)) et une modération (1.16(1.05, 1.68) par l’adaptation centrée sur les émotions. L’adaptation évitante n’a ni médiatisé ni modéré cette association. Ainsi, les individus ayant une adaptation centrée sur le problème présentent moins de symptômes dépressifs lorsqu’ils sont exposés à plus d’évènements stressants. Ceux ayant une adaptation centrée sur les émotions présentent plus de symptômes dépressifs. Conclusion : Ces résultats suggèrent que les interventions préventives contre la dépression chez les jeunes adultes devraient inclure des éléments pour renforcer les stratégies d'adaptation centrées sur le problème et pour minimiser les stratégies d'adaptation centrées sur les émotions. / Introduction: Identifying potential mechanisms underpinning the association between stressful life events and depression is key to developing targeted public health interventions. To cope with stressful experiences, individuals adopt coping styles which are differentially associated with depressive symptoms. However, no study has assessed whether coping style mediates and/or moderates this association. Objectives: To examine each of problem-focused, emotion-focused and avoidant coping style as a mediator and/or moderator of the association between stressful life events and depressive symptoms in young adults. Methods: The Nicotine Dependence in Teens (NDIT) is a longitudinal study including 1294 participants recruited in grade 7 from 10 high schools in Montreal Quebec between 1999–2000. The current analysis uses data (n = 782) from self-report questionnaires collected post-high school between 2011–2012. Using VanderWeele’s four-way decomposition approach, the total effect of stressful life events on depressive symptoms was decomposed into components representing moderation only, mediation only, mediated interaction and neither mediation nor moderation by each coping style. Results: We observed moderation by problem-focused coping (β ̂(95%CI)=-1.51(-2.22, -1.06)) and mediation (0.15(0.05, 0.17)) and moderation (1.16(1.05, 1.68) by emotion-focused coping. An avoidant coping style neither mediated nor moderated this association. Thus, individuals reporting more problem-focused coping experienced fewer depressive symptoms when exposed to more stressful life events; those reporting more emotion-focused coping experienced more depressive symptoms. Conclusion: These results suggest that preventive interventions for depression in young adults should include components to reinforce problem-focused coping strategies and should minimize negative emotion-focused coping strategies.

In line with the Vulnerability-Stress-Adaptation (VSA) model of marriage, this study examined the role of neuroticism, stressful life events, mutual problem solving and negative relationship attributions on marital quality and adjustment among a sample of newlywed couples in Addis Ababa. A quantitative cross-sectional study design involving a sample of 192 newlywed couples was employed. Data were analysed using correlation and multiple regression analysis methods. The PROCESS module in SPSS and Structural Equation Modeling was also used to test indirect effects and actor and partner effects, respectively. The results showed that for both wives’ and husbands’, neuroticism significantly predicted their own marital satisfaction but only husbands’ neuroticism significantly predicted their partners’ marital satisfaction. Stressful life events did not have a significant actor and partner effect for both wives’ and husbands’. Negative relationship attribution was found to be a significant predictor of actors as well as partners' marital satisfaction for both wives’ and husbands’ while only husbands’ mutual problem solving, not that of wives’, had a significant effect on their own marital satisfaction. Tests of indirect effects also showed that, for both wives’ and husbands’, neuroticism had a significant negative intrapersonal and interpersonal indirect effect on marital satisfaction through the mediation of both mutual problem solving and negative relationship attribution. Wives’ and husbands’ stressful life events had a significant negative intrapersonal and interpersonal indirect effect on marital satisfaction through the mediation of negative relationship attribution. Mutual problem solving only mediated a significant indirect effect of husbands’ stress on marital satisfaction at the intrapersonal level and wives’ stress on marital satisfaction at the interpersonal level. This research contributed to enhancing scientific knowledge that guides the design and implementation of policies, programs, and services to promote newlyweds’ marital quality and adjustment in the Ethiopian context. The research also made a theoretical contribution to the VSA model by indicating that adaptive processes play a varying mediational role for wives’ and husbands’ in the indirect effect of stress on marital satisfaction and by confirming that adaptive processes such as mutual problem solving and negative relationship attribution play a more prominent role in affecting marital quality and satisfaction than the other two components of the model, that is neuroticism and stressful life events. / Psychology

The topic of my diploma thesis is - a social worker, life experience. In the text of the thesis I focused mainly on a social worker, on the social worker who does this work for the Child Social and Legal Protection Authority. In my diploma thesis, I elaborated five chapters on the basis of academic literature. The sixth chapter of my work deals with methodological research. In the first chapter I dealt with the history of social work. This chapter is included in my work due to the experience acquired from my practice. What social work looks like today is thanks to the history and the lessons taken from it. It is the basis for the further development of new experience for new social workers. In the second chapter, I focused on the aspects that are needed in order to become a social worker. What should be the prerequisites to be able to do this work, and what ethical rules should the worker follow. In the third chapter, I focus on a particular OSPOD worker, and on his most common job content. There I describe the job, which is the most demanding for the worker. The first contact with the child, social investigation and individual planning. The fourth and fifth chapters follow each other. In the fourth chapter I describe what complications can arise while carrying out the job as a social worker. In...

Background. There are inconclusive findings regarding whether danger and loss events differentially predict the onset of anxiety and depression. Method. A community sample of adolescents and young adults (n=2304, age 14–24 years at baseline) was prospectively followed up in up to four assessments over 10 years. Incident anxiety and depressive disorders were assessed at each wave using the DSM-IV/M-CIDI. Life events (including danger, loss and respectively mixed events) were assessed at baseline using the Munich Event List (MEL). Logistic regressions were used to reveal associations between event types at baseline and incident disorders at follow-up. Results. Loss events merely predicted incident ‘pure’ depression [odds ratio (OR) 2.4 per standard deviation, 95% confidence interval (CI) 1.5–3.9, p<0.001] whereas danger events predicted incident ‘pure’ anxiety (OR 2.3, 95% CI 1.1–4.6, p=0.023) and ‘pure’ depression (OR 2.5, 95% CI 1.7–3.5, p<0.001). Mixed events predicted incident ‘pure’ anxiety (OR 2.9, 95% CI 1.5–5.7, p=0.002), ‘pure’ depression (OR 2.4, 95% CI 1.6–3.4, p<0.001) and their co-morbidity (OR 3.6, 95% CI 1.8–7.0, p<0.001). Conclusions. Our results provide further evidence for differential effects of danger, loss and respectively mixed events on incident anxiety, depression and their co-morbidity. Since most loss events referred to death/separation from significant others, particularly interpersonal loss appears to be highly specific in predicting depression.