Chronic kidney disease (CKD) is a multifaceted health problem with both physical and psychological manifestations. Increased symptom burden is associated with higher risk of mortality, decreased treatment adherence, and impaired quality of life. Despite the recognition of the importance of symptoms, the symptoms and mental health of individuals with CKD remain poorly understood in terms of their measurement, epidemiology and associated service use. The chapters in this dissertation aim to inform these knowledge gaps. Chapter 2 focusses on the symptom burden of patients receiving maintenance hemodialysis treatment and uses exploratory analyses to identify intra-dialytic symptom clusters associated with prolonged dialysis treatment recovery time. Chapters 3 and 4 are population-based studies examining mental health and addictions service utilization in patients with CKD using administrative data in Ontario, Canada. Chapter 3 is a cross-sectional study evaluating the prevalence of individuals with a history of mental health and addiction service use by levels of kidney function. Chapter 4 is a retrospective cohort study evaluating the rates of mental health and addiction service use over time in patients with CKD. Together, these chapters provide further understanding of how symptoms of dialysis and mental health and addiction service use may be measured in this patient population. They also inform considerations for the design of future symptom management and system-level mental health strategies in CKD. / Thesis / Doctor of Philosophy (PhD)

The overall goal of the current study was to determine whether experiences of relational and physical victimization were related to anxiety and depressive symptoms in a sample of emerging adults. This study also investigated whether these associations were moderated by gender, as well as by sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) reactivity to peer stress. Although work in this area has focused on children (e.g., Cullerton-Sen & Crick, 2005; Rudolph et al., 2009), it appears the presence and function of victimization changes with age, and the negative effects of victimization can last through early adulthood (e.g., Gros et al., 2010; Kumpulainen et al., 1999; Roth et al., 2002). Despite the potential for victimization to influence outcomes in emerging adults, research on these associations is lacking in this age group (Heilbron & Prinstein, 2008). A goal of the current study was to examine these processes in an older sample. Additionally, as individuals may react to peer victimization differently, factors that may help explain these differences were investigated. Specifically, evidence suggests that the interaction of the SNS and the PNS may serve as a moderator in the relationship between stressors and adjustment outcomes (Cummings et al., 2007; El-Sheikh et al., 2009; ObradoviÄ? et al., 2010). Further, research suggests that different patterns of interaction of the SNS and the PNS provide important information in the prediction of adjustment outcomes (El-Sheikh et al., 2009) and that both systems must be examined in order to more fully understand the relationship between physiological reactivity and adjustment outcomes (Beauchaine, 2001). Thus, in the current study, the interaction between two physiological measures, SNS reactivity to stress (as measured by skin conductance reactivity [SCL-R]) and PNS reactivity to stress (as measured by respiratory sinus arrhythmia [RSA-R]), was examined as a moderator of the association between peer victimization and adjustment outcomes. The moderating role of gender was also examined. Two hundred and forty-six emerging adults participated in the current study (74% female; Mage = 18.77) and were recruited from introductory psychology courses at a northeastern public university. Participants' SCL-R and RSA-R were assessed using a stress protocol during which they discussed an experience of relational victimization (e.g., being left out). Levels of relational and physical victimization, anxiety and depressive symptoms, and gender were gathered using self-report. Findings suggested that both physical and relational victimization were related to both anxiety and depressive symptoms. Additionally, females were more likely to experience relational victimization than males, while males were more likely to experience physical victimization than females. Relational victimization was related to depressive symptoms only in individuals demonstrating coactivation (i.e., blunted RSA withdrawal and increased SCL-R) and coinhibition (i.e., RSA withdrawal and blunted SCL-R) patterns of stress reactivity, although the interaction for this effect only approached conventional levels of statistical significance. These patterns may have emerged as a result of the breakdown of regulation in the physiological response to stress, with either the SNS or the PNS failing to perform adequately (El- Sheikh & Erath, 2011; El-Sheikh et al., 2009). These findings suggest that experiences of victimization are related to negative adjustment outcomes in emerging adults, as well as highlight potential areas that may serve as mechanisms for future interventions.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Orientador: Ana Gabriela Sálvio / Resumo: Introdução: O melanoma é um tipo de câncer de pele agressivo, gerando diferentes comportamentos ao diagnóstico, dependendo da situação emocional do indivíduo. O modo como o paciente recebe o diagnóstico pode estar associado à personalidade e sua relação com a vida. Objetivo: Identificar as características emocionais e as dimensões da personalidade do paciente com melanoma no momento diagnóstico. Métodos: Foram selecionados 30 pacientes no momento do diagnóstico de melanoma e 30 sem diagnóstico oncológico sendo, ambos os grupos submetidos à avaliação psicológica através de dois instrumentos: Escala de Ansiedade e Depressão (HADS) e Inventário Fatorial de Personalidade (IFP II). Resultados: Neste estudo os sintomas de ansiedade e depressão não tiveram significância estatística e foram sintomas predominantes no grupo controle do que no grupo melanoma. Na interpretação e análise de correspondência do IPF II deste estudo as variáveis estatisticamente significativas que caracterizam os pacientes com melanoma foram Assistência, Afago, Deferência, Afiliação, Persistência e Autonomia. A dimensão Ordem é característica no que se refere aos estádios clínicos mais avançados (III e IV). Discussão: Neste trabalho não observa uma associação direta de sintomas de ansiedade e depressão na fase diagnóstica, ponto que merece atenção na escuta clínica e evolução do tratamento. Notamos as pessoas com melanoma a tendência abandono de si e busca de reconhecimento, para manter o trabalho, boa execuç... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Melanoma is a type of aggressive skin cancer, generating different behaviors at diagnosis, depending on the individual's emotional situation. How the patient receives the diagnosis may be associated with personality and its relation to life. Objective: To identify the emotional characteristics and personality dimensions of the patient with melanoma at the moment of diagnosis. Methods: 30 patients were selected at the time of diagnosis of melanoma and 30 without oncological diagnosis. Both groups were submitted to psychological evaluation through two instruments: Anxiety and Depression Scale (HADS) and Factorial Personality Inventory (IFP II). Results: In this study the symptoms of anxiety and depression were not statistically significant and were predominant symptoms in the control group than in the melanoma group. In the interpretation and correspondence analysis of the IPF II of this study, the statistically significant variables that characterize patients with melanoma were Assistance, Cuddling, Deference, Affiliation, Persistence and Autonomy. The Order dimension is characteristic for the more advanced clinical stages (III and IV). Discussion: This study does not observe a direct association of anxiety and depression symptoms in the diagnostic phase, a point that deserves attention in clinical listening and treatment evolution. We note that people with melanoma tend to abandon themselves and seek recognition, to keep the job, good execution and admiration of... (Complete abstract click electronic access below) / Mestre

Background: Worldwide, about 300 million people have some kind of visual impairment (VI). Most people with VI are in the older age range, as visual deficits increase with age. It is not unusual that people with VI suffer both from neck pain or scapular area symptoms and reduced balance, which they consider to be symptoms of old age. However, their symptoms may not be attributable to age, but rather to poor vision. Aims: First, to identify associations between visual, musculoskeletal and balance symptoms in people engaging in near work every day and in people with VI. Second, to design and validate a suitable instrument for gathering information about visual, musculoskeletal and balance symptoms in people with VI. Third, to explore differences in perceived symptoms between VI patients and people with normal vision in cross-sectional studies and by following a group of age-related macular degeneration (AMD) patients in a longitudinal study. Fourth, to identify the most specific predictors of higher levels of visual, musculoskeletal and balance symptoms. Methods: A specific instrument was developed: the Visual, Musculoskeletal and Balance symptoms (VMB) questionnaire. Patients with VI were compared to an age-matched reference group with normal vision in three different studies in order to detect differences in self-reported symptoms between the groups. In addition, a follow-up was conducted in a group of AMD patients. Results: Patients with VI reported higher levels of VMB symptoms than controls, and this increased over time. Visual deficits and the need for visual enhancement increased the risk of VMB symptoms. Conclusion: People with VI run a potentially higher risk of VMB symptoms than age-matched controls.

The purpose of the present study was to examine the effects of positive and negative symptoms, and duration of illness on emotion processes / ability to understand emotion related cues, experience of emotion, and expression of emotion. A total of 46 schizophrenia patients from Ankara Oncology Hospital Psychiatry Clinic / 23 of them were diagnosed with schizophrenia for at least 10 years, and 23 of them were diagnosed for less than 10 years, participated in the study. Besides, a total of 23 non-clinical subjects / which were similar to the clinical group in terms of educational information, participated to the study. A video-clip which consists of scenes that elicited four types of emotions (fear, disgust, sadness, happiness) was presented to the participants. Understanding of emotion related cues and the experienced emotion were rated through self-report. Facial expressions of the participants were rated through their recorded faces by three psychologists, who were specifically trained for emotional facial expression rating. Symptomatology was assessed by Positive and Negative Symptom Scale (PANSS), and Calgary Depression Scale for schizophrenia patients. Presence of any psychopathology of healthy group was measured through Brief Symptom Inventory. Multivariate Analysis of Variance (MANOVA) revealed that chronic patients presented more understanding of context impairments than acute patients and non-clinical group. In addition to these findings, positive symptoms assessed by PANSS were found to be positively correlated with the understanding context impairment. Therefore, It was suggested that positive symptoms, such as hallucinations and delusions interfere with understanding context task. The results were discussed in the light of the literature and clinical and research implications of the study presented. Finally, necessity of using neurological, biological and cognitive assessment methods for further studies was suggested in order to understand deficits in emotional processes.

The aims of the thesis were to study relationships between the effects of online gaming and gambling and negative social consequences and ill health among adolescents and to determine whether gaming and gambling activities occur together. The papers in this thesis used epidemiological methods to obtain self-report information from Swedish adolescents aged 13–18 years. Time spent in online gaming was associated with negative social consequences, and this relationship was explained by online gaming motives. Gaming for fun and social motives was associated with a reduced risk of negative social consequences, whereas gaming to escape problems, gain status, or meet demands from others was associated with an increased risk. Increased online gaming time on weekdays increased the probability of having depressive, musculoskeletal, or psychosomatic symptoms, and was related to online gaming motives. The probability of ill health was low in those who reported gaming for fun or social motives. Adolescents with symptoms of attention deficit hyperactivity disorder (ADHD) were more sensitive to gambling frequency and to developing a gambling problem. However, among those identified as susceptible, adolescents with ADHD were equally affected compared with other susceptible participants in terms of their gambling frequency. Boys had a higher probability than girls of participating in online gambling in association with online gaming. Having at least one parent born outside Scandinavia was associated with a higher probability of online gambling, especially among girls. The effect of alcohol use as a factor contributing to online gambling was greater among boys than among girls. The results of this thesis contribute new knowledge about sex differences in online gaming and gambling behaviours and add to the limited research on online gaming and online gambling behaviours among adolescent girls. Gaming motives may be helpful for identifying online gamers needing support to reduce their unhealthy gaming behaviour. Information about factors related to gaming and gambling problems may be of interest to clinicians in psychiatry, psychology and social work, as well as to policymakers, parents and teachers involved in adolescent health and development. Effect preventive strategies should consider the sex differences in gaming and gambling behaviour in adolescents.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

This thesis examines the effectiveness of acupuncture therapy in the treatment of psychological and somatic distress in the context of medically unexplained symptoms (MUS). Also, it explores the role of psychological attachment and experiential avoidance in an effort to explain potential mechanisms of acupuncture’s effect. Existing literature demonstrates some level of effectiveness of acupuncture therapy for the treatment of depression, anxiety and somatic symptoms. However, a lack of experimental rigor in methodology means that existing results cannot be shown to be superior to a placebo and thus current treatment protocols for patients with MUS do not include a recommendation of acupuncture therapy. MUS are defined as any set of symptoms that cannot be explained by organic disease, these clusters of symptoms are theorised to be of psychological aetiology. Sufferers of MUS find themselves stuck in a perpetual loop of secondary care referrals with little or no treatment options being made available. Whilst there is some evidence that talking therapies, such as cognitive behavioural therapy, are effective, their availability, efficacy and stigma mean they are often not desired by patients who suffer with MUS. Previous research has shown that insecure attachment predicts higher instances of, psychological and somatic distress, as well as MUS. Previous work undertaken by the author of this thesis also suggests that there may be a moderating effect of attachment in acupuncture therapy outcomes. In order to investigate acupuncture’s efficacy a double-blind randomised control trial was undertaken; 63 participants were randomised to receive either five treatments of genuine acupuncture or a non-penetrating sham form of acupuncture using the Park sham acupuncture device. A rigorous procedure ensured participant and practitioner blinding to group allocation. Primary measures of psychological (GHQ) and somatic (BSI) distress were taken at pre, post and follow-up time points (8 weeks). Secondary measures included general attachment (RQ), experiential avoidance (MEAQ) and client attachment to therapist (CATS). Results showed a significant effect of acupuncture over placebo in the reduction of both psychological (GHQ) and somatic distress (BSI). This therapeutic effect was maintained at 8-week follow-up. Further results showed moderation effects of secure attachment on somatic symptoms in the treatment group but not placebo group. Experiential avoidance also moderated somatic symptom outcomes in the treatment but not placebo group. A subsequent study utilising a quasi-experimental multi-centre methodology, which used identical measures to the previous experiment, revealed the same significant reduction of both psychological and somatic distress. This study consisted of 184 participants across five clinics, each participant receiving five sessions of acupuncture. Similar results were observed regarding moderation effects of secure attachment on treatment outcomes of somatic symptoms. Results also showed differences in moderation effects between participant with a MUS diagnosis vs. those without. Findings of both studies suggest acupuncture is an effective treatment for psychological and somatic distress, as well as MUS. The differences in attachment moderation effects between treatment and placebo may indicate acupuncture’s ability to elicit endogenous opioid release in the brain. However, further neurological studies are required to confirm this hypothesis.

abstract: This dissertation used the risk and resilience framework to examine the associations between perceived racial discrimination, family racial socialization, nativity status, and psychological distress. Regression analyses were conducted to test the links between perceived racial discrimination and psychological distress and the moderation on these associations by family racial socialization and nativity status. Results suggest, for U.S.-born adolescents, cultural socialization strengthened the relation between subtle racial discrimination and anxiety symptoms. In addition, promotion of mistrust buffered the relations of both subtle and blatant racial discrimination on depressive symptoms. For foreign-born adolescents, promotion of mistrust exacerbated the association between blatant racial discrimination and depressive symptoms. Overall, the findings revealed the detrimental effects of perceived racial discrimination on the mental health of Asian American adolescents, how some family racial socialization strategies strengthen or weaken the relation between perceived racial discrimination and psychological distress, and the different ways foreign-born and U.S-born adolescents may interpret racial discrimination and experience family racial socialization. / Dissertation/Thesis / Ph.D. Family and Human Development 2012