Dissertations / Theses on the topic 'Psychological risk factor'

The two main aims of this thesis were first, to predict health behaviour and, second, to apply and test the existing psychological theories in this field. The health behaviours concerned were the responses to screening for risk factors for cardiovascular disease. Three empirical studies were carried out. The first response to screening is whether one attends or not. Results showed that uptake of screening in worksite settings (N=425) (Chapter 2) could be predicted by the health beliefs derived from social cognition models. Intention to attend was the best predictor of attendance. However, differences in predictive beliefs between worksites suggested communication factors were also an issue. Subsequently, communication factors were investigated in a study of uptake in general practice (N=210) (Chapter 4) finding that the method of offering screening affected uptake significantly. The second response to screening is the impact it has on the screenee. Results found that communication factors had little effect on screening impact in that there was little difference between three methods of offering screening in terms of their subsequent impact on patients' satisfaction, knowledge, intention or behaviour change (Chapter 4). Social cognitions, however, were found to predict impact in terms of behaviour change with a sample of attenders (N=59) at a screening clinic in general practice (Chapter 3). In the latter study, perceived threat was the best predictor of behaviour change. Four social cognition models were compared against each other in the classification of attenders and non-attenders in the Worksite study (Chapter 2). Apart from Social Learning Theory the other models performed adequately, but the Theory of Reasoned Action was the most successful. More recent theories were examined in the prediction of behaviour change following screening (Chapter 3). The data supported the stage model, the Precaution Adoption Process. The internal structure of the Health Action Process Approach was questioned, but the addition of an 'action phase' in tills model showed promise.

This thesis systematically investigated molecular risk and protective markers of Posttraumatic Stress Disorder (PTSD). PTSD poses a significant health and societal burden in Australia, especially in at-risk groups such as military personnel. The molecular aetiology of the disorder is poorly understood and it is unclear why many people recover quickly after trauma exposure while others continue to suffer. The thesis significantly contributes to the field of stress and resilience research by identifying novel markers for replication and adding to the knowledge-base of molecular markers for resilience, a burgeoning research field. This area of research is important to develop prevention and early intervention strategies.

The current study examines the utilization of religiosity as a protective factor and marijuana use as a risk factor for ethnically diverse female survivors of sexual victimization against the development of Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), Irritable Depression (ID), and sexual revictimization. A sample of ethnically diverse female adult participants who endorsed sexual victimization from the National Comorbidity Survey Replication (NCS-R) were included in the study (n = 1115). Logistic regression analyses were used determine the probability of the predictor variables of religiosity, religious identification and marijuana use impacting the outcome variables and whether or not the moderating variable (i.e., ethnicity) changed the relationship between the predictor and outcome variables. Results suggest that individuals who endorsed higher rates of PTSD were more likely to identify with a religious organization, with Latinas experiencing significantly higher rates of PTSD as compared to the other groups. Sexual assault victims who met criteria for Marijuana Abuse or Dependence were significantly more likely to have experienced MDD than sexual assault victims who did not meet criteria. The study highlights the importance of understanding religious coping strategies utilized by ethnically diverse survivors of sexual victimization. This study also highlights implications for providing culturally congruent care. Limitations and implications are discussed.

Clinically significant eating disorders (EDs) are associated with significant mortality and morbidity. Despite the existent of a considerable body of research literature and published clinical guidelines, a significant proportion of individuals who received psychological therapy for Anorexia Nervosa (AN), Bulimia Nervosa (BN) and other clinically significant EDs, do not significantly improve. As consequence it is important to determine which factors may predict outcome following psychological therapy and to what extent these are in line with current models of EDs. Experimental methods have been used to explore emotional processing deficits, and also the presence of ED specific beliefs, in AN in order to enhance understanding of the cognitive and affective factors underpinning EDs. To date these experimental methods have not been used to investigate BN. The theoretical paper considers the role of psychological factors in predicting outcome for individuals with clinically significant EDs following psychological therapy and relates these to a cognitive model of AN and a cognitive model ofBN. The factors examined in the review were found to be broadly in line with what the main cognitive models would predict. The other factors found were considered in the context of the available research evidence. The empirical paper considered possible emotional processing deficits and the presence of self referential ED-specific beliefs in BN. The responses of 12 individuals with BN on a Self Schema Processing Task (SSPT) and a Facial Expression Recognition Task (FERT) were compared to the responses of a control group consisting of 12 healthy volunteers. Individuals with BN reported significantly more deficits in the expression of emotions and endorsed significantly more negative self referential words than the control groups. A pattern was observed in the reaction times in the BN group that suggested that higher levels of eating disorder psychopathology may be associated with impairment in emotional recognition. It is important that further research is carried out in order to determine the specific nature of these deficits.

This follows an earlier study of the same data set, which, through its findings, presented new questions that are investigated in this study. Both studies used a prospective controlled design, wherein women receiving genetic counseling for breast cancer risk were randomized into two groups. Subjects receiving an audiotaped recording of their genetic consultation (tape group) were compared to subjects who also had a genetic consultation but did not receive an audiotaped recording of it (no-tape group). Participants were drawn from attendees at the genetic clinics of two London hospitals and included 115 women with a family history of breast cancer. Cancer worry and psychological distress were assessed before genetic consultation (baseline), and at one- and six-month follow-ups by post. Objective risk was estimated by the geneticist during the consultation, and subjective risk was assessed at one month follow-up. The goals of the current study were to investigate relationships between cancer worry, psychological distress, and recall of genetic risk for breast cancer in a sample of women receiving genetic counseling for breast cancer risk, and to investigate the role sociodemographic variables on cancer worry, psychological distress, or risk recall for these women. Results for this sample of women with a family history of breast cancer found that there were consistent relationships between cancer worry, psychological distress, objective risk, and subjective risk before and after genetic consultation. This suggests that women=s psychological responses are appropriate to their level of cancer risk. There were no differences found between the tape and no-tape groups for objective or subjective risk, or for nearness of recall accuracy or degree of under-/over-estimation. Provision of an audiotaped recording of the genetic consultation did not appear to enhance recall of risk information. The role of sociodemographic variables on the psychological and risk variables assessed in this study was very minor. Age was mildly correlated with cancer worry, and employment was predictive of cancer worry only at baseline.

The ability to identify individuals considered at high-risk for psychosis has undergone significant development over the past few years and is now an established paradigm combining both state and trait risk factors. This ability to accurately identify these individuals has led to the development of cognitive interventions aimed at reducing transition to psychosis in this high-risk cohort.

This study investigated the connection between Body Dissatisfaction and Drive for Thinness to several psychological correlates- Ineffectiveness, Interpersonal Distrust, Perfectionism, Interoceptive Awareness, and Maturity Fears. Regression analyses indicated that these five correlates together accounted for 23% of the variance in a measure of Body Dissatisfaction. Body Dissatisfaction and the five correlates together accounted for 52% of the variance in a measure of Drive for Thinness. Results of the path analysis confirmed that Ineffectiveness, Interoceptive Awareness and Maturity Fears were the strongest predictors of Body Dissatisfaction. In turn, Body Dissatisfaction, Ineffectiveness and Interoceptive Awareness were the strongest predictors of Drive for Thinness. Gender differences and prevalence rates of eating disordered behavior were reviewed. Consistent with other research, this study confirmed high levels of bingeing and purging behavior (44%) among college men and women.
Ph. D.

In a series of studies, rural and urban suicides were compared and the psychological factors underlying suicidal behaviour investigated. In the first study suicides in a Nfid-Wales county were examined and contrasted with a group of urban suicides. The pattern of rural suicides was found to differ from the urban suicides. Rural suicides were more evenly spread through the age bands, mostly married and used more violent means of death. Farmers comprised a large proportion of rural suicides and seem to differ from rural suicides in general in that 88% were over 45 years of age, most died of hanging, only 13% left notes and they had no record of previous suicide attempts. The factors that might cause farmers stress were examined. This showed that farmers found form filling and adjusting to government policy most stressful. Isolation was relatively unimportant as a stressor. In the third study the role of mood and problem solving in suicidal behaviour was investigated in three matched groups (suicidal, psychiatric control and non-psychiatric control). The suicidal group was found to display a careless and impulsive problem solving style and unique deficits in decision making and generation of alternative solutions. They were also more depressed, angry and confused. The problem solving deficits remained even when the effects of the mood differences were removed. The last study investigated the relationship between autobiographical memory and problem solving and found the suicidal group to be significantly more overgeneral in their memories, they produced fewer means and less effective problem solving solutions and these deficits were found to persist over time. These results were interpreted as support for these factors being trait features or alternatively requiring more time to recover. The findings were incorporated into a revised version of the "Cry of Pain" model of suicidal behaviour (Williams, 1997).

Antecedentes: Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de morbi-mortalidad y discapacidad en el mundo. Aunque España tiene una de las tasas de morbimortalidad cardiovascular más bajas, las ECV continúan siendo la principal causa de muerte. Así mismo, la prevalencia de factores de riesgo cardiovascular clásicos, como la hipertensión, la diabetes, la dislipemia y la obesidad en la población general es alta. Las causas que conducen a padecer una ECV son multifactoriales, y varios factores de riesgo y estilos de vida poco saludables están frecuentemente involucrados. En las últimas tres décadas, la evidencia científica ha mostrado que condiciones socioeconómicas y psicológicas desfavorables a nivel individual y ecológico están directa e indirectamente relacionadas con la prevalencia de estilos de vida poco saludables, un perfil alto de riesgo cardiovascular, la incidencia y un peor pronóstico de las ECV. A pesar de ello, los mecanismos por los cuales estas condiciones pueden afectar la salud cardiovascular no están completamente establecidos. En España, el papel de esas circunstancias en el riesgo cardiovascular ha sido poco estudiado. Objetivo General: La presente tesis tiene como objetivo estudiar el papel de la depresión, la posición socioeconómica y el apoyo social sobre tres aspectos del riesgo cardiovascular: (1) el tratamiento recibido en la prevención primaria cardiovascular; (2) el grado de control y los valores de la presión arterial; y (3) el aumento del riesgo de sufrir infarto agudo de miocardio (IAM), accidente cerebrovascular (AC) y muerte cardiovascular en una población adulta con de alto riesgo cardiovascular, en España (participantes en el estudio PREDIMED). Métodos: tres estudios fueron llevados a cabo en 7447 adultos con alto riesgo cardiovascular, sin ECV al inicio de los estudios. Un estudio transversal se llevó a cabo para evaluar (1) la relación entre el nivel socioeconómico y las desigualdades en recibir tratamiento para la prevención cardiovascular primaria; y (2) para evaluar el efecto de la depresión tratada y no tratada en los valores de la presión arterial. Un estudio prospectivo longitudinal (seguimiento medio de 4,8 años) se realizó para determinar si la depresión, el nivel educativo bajo, y un bajo apoyo social contribuían a aumentar el riesgo de sufrir IMA, AC y muerte por ECV. Otras características como el sexo, edad, IMC, comorbilidad cardiovascular, estilos de vida al inicio del estudio fueron también consideradas en todos los estudiados realizados. Resultados: En cuanto al impacto de los factores psicológicos y socioeconómicos sobre los tres aspectos de riesgo cardiovascular estudiado, se encontró: (1) los participantes con medio y bajo nivel de educación fueron tratadas de forma similar para la hipertensión (OR (IC95%): nivel educativo medio (NEM): 0.75 (0.56 a 1.00), nivel educativo bajo (NEB): 0.85 (0.65-1.10); diabetes (NEM: 0.86 (0.61 a 1.22), NEB: (0.90 (0.67 a 1.22), y dislipidemia (NEM: 0.93 (0.75 a 1.15), NEB: 0.99 (0.82 a 1,19) comparados con aquellos con nivel educativo alto; (2) participante hipertensos con depresión no tratada (OR (IC95%): 1.28 (1.06 a 1.55), y tratada (1.30 (1.03-1.65) mostraron mejor control de la presión arterial que aquellos sin depresión; (3) participantes con nivel educativo bajo presentaron mayor riesgo de accidente cerebrovascular (HR (IC 95%): 1.83 (1.09 a 3.09) comparados con aquellos con un nivel educativo superior Conclusiones: en la población estudiada, (1) no se observaron diferencias socioeconómicas en el tratamiento recibido en prevención cardiovascular primaria; (2) en los pacientes hipertensos con alto riesgo cardiovascular, el control de la presión arterial fue mejor en las personas diagnosticadas con depresión, en comparación con aquellos sin depresión.; y (3) los participantes con bajo nivel educativo tenían un mayor riesgo de accidente cerebrovascular. La depresión y el bajo apoyo social no se asociaron con la incidencia de ECV.
Background: Cardiovascular diseases (CVDs) remain the leading cause of morbimortality and disability in the world. Although Spain has one of the lowest cardiovascular morbimortality rates worldwide, CVDs continue to be the main cause of death. In addition the prevalence of classic cardiovascular risk factors such as hypertension, diabetes, dyslipidaemia and obesity in the general population is high. Causes leading to cardiovascular diseases are multifactorial and several modifiable and non-modifiable risk factors are involved. In the last three decades, the scientific evidence has shown that socioeconomic and psychological disadvantaged conditions at individual and ecological levels are directly and indirectly related with prevalence of unhealthy lifestyles, poor cardiovascular profile, and incidence and worsening progression of CVDs. However, the mechanisms or pathways through which these conditions lead to adverse cardiovascular outcomes are not completely clear. In Spain, the role of those circumstances in the cardiovascular risk has been scarcely studied. General Objective: The present thesis is aimed at studying the role of socioeconomic position, depression and social support on three topics of the cardiovascular risk.: (1) the treatment received in primary cardiovascular prevention; (2) the degree of control and the values of blood pressure; and (3) the increased risk of suffering primary major cardiovascular events (acute myocardial infarction, stroke and cardiovascular death) in an adult population with high cardiovascular risk (PREDIMED study participants), living in Spain. Methods: This thesis is composed of three research studies carried out on 7447 adults at high cardiovascular risk, free of CVDs at baseline. A cross-sectional study was carried out to assess (1) the relationship between the socioeconomic status and inequalities in receiving treatment for primary cardiovascular prevention; and (2) to assess the effect of treated and untreated depression on blood pressure values. A prospective cohort study (average follow up of 4.8 years) was performed to determine whether depression, lower educational level and weak social support contributed to increase the risk of suffering myocardial infarction, stroke, and death from CVDs. Other characteristics such as sex, age, BMI, cardiovascular comorbidity, lifestyles at study baseline, were also taken into account in the studies performed. Results: Regarding the impact of the psychological and socioeconomic factors on the three aspects of cardiovascular risk studied, it was found: (1) participants with low and middle education level were similarly treated for hypertension (OR (95% CI): middle education level (MEL): 0.75 (0.56-1.00), low educational level (LEL): 0.85 (0.65-1.10); diabetes (MEL: 0.86 (0.61-1.22), LEL: (0.90 (0.67-1.22), and dyslipidaemia (MEL: 0.93 (0.75-1.15), LEL: 0.99 (0.82-1.19) if compared with those at high education level; (2) hypertensive participants with not treatment (OR (95% CI): 1.28 (1.06-1.55), and treatment (OR (95% CI): 1.30 (1.03-1.65) for depression shown better blood pressure control than those without depression; (3) Participant with low education presented higher risk of suffering stroke (HR (95% CI): 1.83 (1.09–3.09) ) compared with those with high education. Conclusions: in the studied population, (1) socioeconomic differences did not affect the treatment prescribed for primary cardiovascular prevention; (2) among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression compared to those without depression; and (3) participants with low educational level had a higher risk of stroke. Depression and low social support were not associated with CVD incidence.

Domestic workers, also known as house maids or handmaids, are a predominately female workforce that traditionally provides labor in upper-class households. With the increase of dual income families and the global expansion of the middle class, the demand for domestic workers increased, which facilitated the practice of importing lower-cost foreign domestic workers (FDWs) from developing areas. Hong Kong has the highest concentration of FDWs when compared to other metropolitan areas, such as Taiwan, Singapore, or New York. Since the trade began in the 1970s, qualitative research and journalistic investigations have reported that FDWs frequently encounter exploitation, including emotional, physical, and sexual abuse; being underpaid and overworked; and racial discrimination. With sparse quantitative research identifying risk factors that predict psychological well-being, this study hypothesized two models: (a) racial and ethnic microaggressions, job satisfaction, and family concern predict psychological distress and (b) resilience mediates the association in the first model. We surveyed 478 female FDWs in Hong Kong, and the results suggested that racial and ethnic microaggressions, job satisfaction, and family concerns were significant predictors of psychological distress, supporting the first hypothesis. The women demonstrated very high levels of psychological resilience; however, due to a ceiling effect in the measure of resilience, the data collected on resilience were unrelated to job satisfaction and family concerns. Thus, the second model was not supported, apparently due to a problem in the measurement of the construct of resilience in this sample of FWDs. Overall, FDWs’ working conditions and their level of resilience to those conditions did significantly influence their levels of psychological distress. These findings serve as pilot data for future quantitative research that investigates female FDWs’ employment experience.

The present research proposes the analysis of specific aspects of psychosocial functioning and development with a focus on issues related to internalizing symptoms, attachment styles and interpersonal dimensions of interpersonal functioning. Developmental theories emphasized the importance of transitions, as periods of biologically and socially characterized changes (Arnett, 1997; Gurevitz Stern, 2004; Schulenberg, Magges, Hurrelmann, 1997; Schulenberg & Zarrett, 2006). The developmental phase of young adulthood, which can be detectable between 18 and 30 years of age, represents the transition from the dependency and social marginality of childhood and adolescence, to the independent and fully recognized social position of adulthood (Aldermen & Iafrate, 2003; Neyer & Asendorpf, 2001; Scabini & Iafrate, 2003). Thie crucial developmental stage of young adulthood involves the progressive articulation of decision-making and planning skills, which will shape health and psychosocial well-being of the young adult (Savage, 2010; Schulenberg & Schoon, 2012). Symptoms belonging to the internalizing spectrum, particularly depressive and anxiety are among the most common during this period (Quintana, Kerr, 1993; Guttmannova, Szanyi, & Cali, 2007). Within this context of individual development, the relational dimension is central in the lives of young adults (Chicken, 2006). Although the protective role of the parents is reduced when young adults become independent, they still need support which intimate personal relationships, such as romantic ones, are able to provide (Jones, 2005). Otherwise, insecure attachment styles may cause separation anxiety and make the individual vulnerable to future psychological disorders (Manicavasagar, Silove, Marnane, & Wagner, 2009; Silove et al., 1993). Even if university life may have a beneficial effect for students (Andrews & Wilding, 2004), life in the university environment presents many social and emotional challenges, such as academic, relational, and financial ones, which can negatively influence students’ psychological healt, eliciting the onset of internalizing symptoms (Andrews & Wilding, 2004; Cooke, Bewick, Barkham, Bradley & Audin 2006; Grant, 2002; Monaco, 2004; Negovan, 2010; Roberts & Zelenyanski, 2002). In turn, levels of anxiety and depression can represent a risk of poor academic achievement or impaired social functioning (e.g. Andrews & Wilding, 2004; Cooke et al., 2006; Monk, 2004; Misra & McKean, 2000; Roberts & Zelenyanski, 2002; Ross, Cleland, Macleod, 2006; Verger, et al. 2009). Attachment security, both to family and peers, showed associations with psychosocial adjustment (Wei, Russell, Zakalik, 2005) and emotional regulation (Love et al., 2009), while insecure attachment of the anxious/preoccupied spectrum was associated with internalizing symptoms, such as anxiety and depression (Bonab & Haddadi Koohsar, 2011; Dozier et al., 2008). Insecure attachment style was found to be strongly related with separation anxiety (SAD) (Brumariu & Kerns, 2010), which can represent a core form of anxiety, which operates as a general vulnerability factor for internalizing disorders and symptoms in young adults (Shear, Jin, Ruscio, Walters, & Kessler, 2006; Silove et al., 1993). Dimensional approach was considered accurate and valid with regards to several psychological constructs, such as personality, psychopathology, and attachment (Fraley & Spieker, 2003; Fraley & Shaver, 2000; Krueger et al., 2011; Krueger & Markon, 2013; Silove et al., 2007; Widiger & Simonsen, 2006). The present work analyzed the relation between attachment styles and internalizing symptoms, mediated by separation anxiety and interpersonal traits of personality functioning. Another aim of the present work was to provide contribution to the assessment of psychometric characteristics of the Personality Assessment Inventory (PAI; Morey, 1991), with young adults in the Italian context. For each questionnaire, attention was devolved also to aspects of reliability and validity . With regards to the analysis of the relation between attachment styles, internalizing symptoms, and interpersonal traits the sample comprised 308 non clinical young adults (80% university students, 74% women). With regards to the assessment of PAI psychometric properties, the non clinical sample included 1180 young adults (77% university students, 59% from psychology courses, 69.4% women). Multigroup confirmatory factor analyses (CFA) has been performed to assess factor structure invariance of the separate scales of the PAI, as presented by the author of the instrument (Morey, 2007). With regards to the overall scale, which revealed non homogeneous factor structures in literature, in the present work several CFA model have been tested in order to evaluate which model represented the best adaptation to data in the present sample. Univariate and multivariate analysis of variance (ANOVA) was carried out to assess differences in considered variables with regards to gender in order to compare. Instruments were selected for their utility in assessing constructs which were the focus of the present study, and particular attention was devolved to select questionnaires which were endowed with international diffusion, both in research and in clinical contexts: (a) the PAI (Morey, 1991, 2007) for the assessment of personality traits and internalizing symptoms, (b) the Symptom Checklist-90-R (SCL-90-R, Derogatis, 1994; Sarno, Preti, Prunas, & Madeddu, 2011) to assess individuals’ current level of psychosocial distress on internalizing symptom dimensions, (c) the State-Trait Anxiety Inventory (STAI-Y; Spielberger, 1983; Pedrabissi & Santinello, 1996), to measure anxiety, (d) the Relationship Questionnaire (RQ; Bartholomew & Horowitz, 1991; Carli, 1995 ) to assess adult attachment styles, (e) the Experiences in Close Relationships Scale-Revised (ECR-R; Fraley, Waller, & Brennan, 2000; Calvo, 2008) for the classification of anxiety and avoidance attachment styles related to romantic relationships, (f) the Adult Separation Anxiety (ASA-27; Manicavasagar, Silove, Wagner, Drobny, 2003; Manicavasagar, Silove, Franzcp, Curtis, Franzcp, & Wagner, 2000) for adult separation anxiety symptoms, and (g) the Separation Anxiety Symptom Inventory (SASI; Silove et al., 1993), for adults’ memories of Separation Anxiety symptoms experienced in the first 18 years of life. Overall, participants showed scores in line with normative data present in the literature, both with regards to internalizing symptoms and attachment styles. As expected, women were higher compared to men in internalizing symptoms. In conclusion, the relation between internalizing symptoms and attachment has been investigated by means of regression analyses, revealing an association between the constructs involved.
La presente ricerca si propone l'analisi di aspetti specifici evolutivi e del funzionamento psicosociale, con particolare attenzione ai sintomi del versante internalizzante, e a dimensioni del funzionamento interpersonale, come ad esempio gli stili di attaccamento. Le teorie evolutive hanno sottolineato l'importanza delle transizioni, come periodi di cambiamento caratterizzato da aspetti sia di tipo biologico che sociale (Arnett, 1997; Gurevitz Stern, 2004; Schulenberg, Magges, Hurrelmann, 1997; Schulenberg & Zarrett, 2006). La fase di sviluppo dell’età giovane adulta, o young adulthood, che si riferisce all’età tra i 18 ei 29 anni di età, rappresenta il passaggio dalla dipendenza e marginalità sociale dell'infanzia e dell'adolescenza, alla posizione sociale indipendente e pienamente riconosciuta dell'età adulta (Neyer & Asendorpf, 2001; Scabini & Iafrate, 2003). La fase di sviluppo della young adulthood comporta la progressiva articolazione del processo decisionale e di pianificazione delle competenze, che influisce sulla salute e il benessere psicosociale dei giovani adulti (Savage, 2010; Schulenberg & Schoon, 2012). I sintomi appartenenti allo spettro interiorizzante, in particolare depressione e ansia, sono tra i più comuni in questo periodo (Quintana, Kerr, 1993; Guttmannova, Szanyi, e Cali, 2007). All’interno del contesto di sviluppo individuale della young adulthood, la dimensione relazionale ricopre un ruolo centrale (Pollo, 2006). Sebbene il ruolo protettivo dei genitori si riduce quando i giovani diventano indipendenti, essi hanno ancora bisogno di sostegno che i rapporti intimi, come quelli delle relazioni di coppia, sono in grado di fornire (Jones, 2005). In caso contrario, lo sviluppo di un attaccamento di tipo insicuro può causare ansia di separazione e rendere l'individuo vulnerabile a disturbi psicologici futuri (Manicavasagar, Silove, Marnane, e Wagner, 2009; Silove et al., 1993). sebbene la vita universitaria possa avere un effetto benefico per gli studenti (Andrews & Wilding, 2004), la vita in ambito universitario presenta molte sfide sociali ed emotive, in termini di difficoltà accademiche, relazionali, e finanziarie, le quali a loro volta possono influire negativamente sul benessere psicologico degli studenti causando l’insorgere di sintomi internalizzanti (Andrews & Wilding, 2004; Cooke, Bewick, Barkham, Bradley & Audin 2006; Grant, 2002; Monaco, 2004; Negovan, 2010; Roberts & Zelenyanski, 2002). A loro volta, sintomi ansia e depressione possono rappresentare un rischio di scarsi risultati scolastici o compromissione del funzionamento sociale (ad esempio Andrews & Wilding, 2004; Cooke et al, 2006;. Monk, 2004; Misra & McKean, 2000; Roberts & Zelenyanski 2002 ; Ross, Cleland, Macleod, 2006; Verger, et al 2009). La sicurezza legata all’attaccamento, sia verso i componenti della famiglia che verso i coetanei, ha mostrato associazioni con l’adattamento psicosociale (Wei, Russell, Zakalik, 2005) e la regolazione emotiva (Amore et al., 2009), mentre l'attaccamento insicuro dello spettro ansioso / preoccupato ha rivelato associazioni con sintomi internalizzanti, come ansia e depressione (Bonab & Haddadi Koohsar, 2011;. Dozier et al, 2008). Gli stili di attaccamento del versante insicuro sono risultati fortemente correlati con ansia di separazione (SAD) (Brumariu & Kerns, 2010), che a sua volta opera come fattore di vulnerabilità generale per disturbi e sintomi internalizzanti nei giovani adulti (Shear, Jin, Ruscio, Walters, e Kessler, 2006;. Silove et al, 1993). L’approccio dimensionale è stato considerato accurato e valido per quanto riguarda i diversi costrutti psicologici, come la personalità, la psicopatologia, e l'attaccamento (Fraley & Spieker, 2003; Fraley & Shaver, 2000; Krueger et al, 2011;. & Markon Krueger, 2013; Silove et . al, 2007; Widiger & Simonsen, 2006). il presente lavoro analizza la relazione tra stili di attaccamento e sintomi internalizzanti, mediati da ansia da separazione e tratti di funzionamento interpersonale. Un altro scopo del presente lavoro è stato fornire un contributo alla valutazione delle caratteristiche psicometriche del Personality Assessment Inventory (PAI; Morey, 1991), riscontrate nel contesto italiano con soggetti di età giovane adulta. Per ogni questionario, l'attenzione è stata rivolta anche agli aspetti di affidabilità e validità. Per quanto riguarda l'analisi del rapporto tra stili di attaccamento, sintomi internalizzanti, e tratti interpersonali, il campione comprendeva 308 giovani adulti non-clinici (80% studenti universitari, 74% donne). Per quanto invece riguarda la valutazione delle proprietà psicometriche del PAI, il campione comprendeva 1.180 giovani adulti non-clinici (77% studenti universitari, 59% di psicologia, 69,4% donne). Un’analisi fattoriale confermativa (CFA) multi gruppo è stata effettuata per indagare aspetti di invarianza per quanto riguarda la struttura delle singole scale del PAI, così come indagate dall’autore dello strumento (Morey, 2007). Inoltre, per quanto riguarda la struttura complessiva del PAI, che in letteratura ha mostrato risultati non sempre concordi, nel presente lavoro sono stati confrontati diversi modelli CFA, al fine di indagare quale di essi mostrasse il migliore adattamento ai dati nel presente campione. Analisi univariate e multivariate della varianza (ANOVA) sono state effettuate per valutare le differenze di genere per quanto riguarda le variabili considerate, e cioè sintomi internalizzanti e attaccamento. Gli strumenti sono stati selezionati per la loro utilità nel valutare i costrutti considerati nel presente studio, e particolare attenzione è stata volta a selezionare questionari dotati di diffusione internazionale, sia in ambito di ricerca che in ambito clinico: (a) il PAI (Morey, 1991 , 2007) per la valutazione dei tratti di personalità e sintomi internalizzanti, (b) il Symptom Checklist-90-R (SCL-90-R, Derogatis, 1994; Sarno, Preti, Prunas, e Madeddu, 2011) per valutare il livello attuale di stress psico-sociale per quanto riguarda sintomi internalizzanti, (c) lo State-Trait Anxiety Inventory (STAI-Y, Spielberger, 1983; Pedrabissi e Santinello, 1996), per misurare l'ansia, (d) il Relationship Questionnaire (RQ; Bartholomew & Horowitz , 1991; Carli, 1995) per l’assessment degli stili di attaccamento adulto, (e) lo Experiences in Close Relationships Scale-Revised (ECR-R; Fraley, Waller, e Brennan, 2000; Calvo, 2008) specifico per la classificazione di ansia e di evitamento legati all’attaccamento romantico, (f) l'Adult Separation Anxiety (ASA-27; Manicavasagar, Silove, Wagner, Drobny, 2003; Manicavasagar, Silove, Franzcp, Curtis, Franzcp, e Wagner, 2000) per sintomi di ansia di separazione adulta, e (g) il Separation Anxiety Symptom Inventory (SASI;. Silove et al, 1993), per la valutazione dei sintomi di ansia di separazione riferiti dagli adulti riguardo alle loro esperienze precedenti ai 18 anni. I partecipanti hanno mostrato complessivamente punteggi in linea con i dati normativi presenti in letteratura, sia per quanto riguarda i sintomi internalizzanti che per quanto riguarda gli stili di attaccamento. Come previsto, le donne hanno mostrato livelli più elevati di sintomi internalizzanti rispetto agli uomini. In conclusione, la relazione tra i sintomi di internalizzazione e di attaccamento analizzata mediante modelli di regressione, hanno rivelato un'associazione tra i costrutti coinvolti.

Psychological resilience has been described as a multidimensional, context specific concept, and has been defined in numerous ways that attempt to encapsulate the process by which individuals positively adapt following stress or significant adversity. Research within competitive sport has highlighted several components that influence this process, which include; meta-cognitions and challenge appraisals, coping strategies, personal risk and protective factors, and sociocultural influences (Brown et al., 2015; Galli & Vealey, 2008; Fletcher & Sarkar, 2012; Sarkar & Fletcher, 2014a). Significantly, resilience is described as a dynamic process that is developed through exposure to challenge within the competitive environment (Galli & Vealey, 2008); however, little is known about the nature of psychological resilience at a junior level. The understanding of how resilience is conceptualised at this level is important as this knowledge can help to foster the appropriate protective and promotive factors required to thrive in a competitive junior environment, and best equip athletes for future periods of unrest. The aims of the current research program were to investigate the nature of psychological resilience within a junior sport context, and to explore appropriate measures or methodological approaches by which to achieve this. To achieve these, eight research objectives are presented. To address these objectives, five research investigations were proposed: Study 1. This study aimed to explore the psychometric qualities of the original 25-item CD-RISC (Connor & Davidson, 2003) amongst a sample of junior athletes. Three hundred and forty seven athletes (M age=15.42, SD=1.72) completed the original CD-RISC questionnaire. Participants represented a range of individual and team sports. Internal consistency and factor structure were analysed using confirmatory factor analysis (CFA) and exploratory factor analyses (EFA). CFAs did not support the original 5-factor or unitary factor structure of the 25-item CD-RISC, but did support a unidimensional shortened 10-item measure (Cambell-Sills & Stein, 2007). Subsequently, an EFA and CFA also supported a valid and reliable 2-factor sport specific version of the CD-RISC, which was favoured based on stronger conceptual and theoretical support. This study supports the contention that resilience is not consistent across all populations and context specific measures may be required e.g., sport specific. The emergent 2-factor measurement model suggests an underlying structure of resilience in sport that represents an individual's control through adversity and growth mindset. Study 2. The aim of this study was to explore the nature of resilience within junior sport, with a specific focus on sport type, gender and age differences, and the association between resilience and sensation seeking characteristics. Participants completed the modified version of the CD-RISC, which emerged in the previous study and the Brief Sensation Seeking Scale (BSSS; Hoyle at al., 2002), which measures dispositional risk taking behaviours. The results suggested that male and team athletes have significantly higher resilience scores than their female and individual sport counterparts. In general, protective factors associated with resilience positively relate to sensation seeking characteristics. Specifically, feelings relating to ‘control through adversity' more broadly relate to tendencies leading to greater risk exposure. These findings may suggest that those with a greater perception of control take more calculated risks and set goals that are more challenging. This may offer the opportunity to increase personal mastery through developed interpersonal relations, emotional expression, problem solving skills and coping resources. Nevertheless, our understanding of resilience seems limited by the capacity of a psychometric questionnaire to encapsulate such a complex construct. Study 3. This study aimed to provide a review of the literature concerning resilience in athletes, with a specific focus on identifying the differing methodological approaches to examine the nature of the construct in sport. Fourteen research articles that attempted to directly measure psychological resilience with an athlete sample were identified using both quantitative (n=8) and qualitative (n=6) approaches. Quantitative research has increased conceptual understanding of resilience in sport, relating to its positive associations with similar constructs (e.g., mental toughness), and its moderation qualities. This approach permits statistical analyses to track development, however is unlikely to offer sufficient depth to understanding given the complexities surrounding both the construct of psychological resilience and the nature of an elite sporting environment. Qualitative studies have helped to develop theoretical understanding of psychological resilience amongst athletes through adopting phenomenological methodologies, however, the application of knowledge relies on user generalisability alone and does not offer an objective measure of the construct. The review proposes an exploration of novel methodological approaches that consider the positive elements of both qualitative and quantitative research, but does not consolidate their pitfalls. Study 4. The purpose of this study was to develop a novel tool to measure psychological resilience using a Q-method approach. Specifically, this study aimed to construct a Q-set, by identifying the subjective viewpoints of junior rugby league players, associated with how they would respond to stress or adversity and their perceptions of the resilience process. Twenty-nine junior rugby league players (aged 13-14) were recruited to take part in one of two focus groups designed to generate statements relating to responses to adversity. Thirty statements emerged following inductive thematic analysis, and were retained for the Q-set. There are commonalities between these statements and characteristics of theoretical models and previous research concerning psychological resilience in sport. Study 5. The purpose of this study was to use the Q-set developed in the previous study to explore the nature of psychological resilience in the context of junior Rugby League, using a novel Q-sort method. Sixty junior rugby league players (aged 13-14) completed a standard Q-sort protocol, ranking the previously developed 30-item Q-set using a fixed quasi normal distribution, with anchors of +5 (most like me) to -5 (least like me). PQ Method statistical analysis software was used to analyse the data. Principle component analysis with varimax rotation identified four distinct subgroups that explained 72% of the total variance. These groups were distinguished through patterns relating to: social support, emotional control, unpleasant emotions, personal resources, and cognitive strategies. Shared qualities across the four subgroups were also identified, and included low ratings for evasion strategies, and seeking support, whilst generally high ratings for perseverance. The results from this study showed that junior rugby league players display a range of psychological responses when experiencing adversity and four subgroups with both defining and shared characteristics emerged. This study provides preliminary evidence for the potential usefulness of a Q-method approach for understanding the process of resilience in junior sport. Q-methodology provides an alternative to previous research designs attempting to understand the nature of resilience, and offers an engaging activity to participants, encouraging analytical reflections of their experiences. In summary, the data collected within the current research program has presented an original contribution to knowledge concerning the nature of psychological resilience in junior sport.
The thesis has delivered the first study of its kind, by employing Q-methodology to understand psychological resilience, revealing previously untapped complexities associated with the construct. This approach offers future researchers and practitioners the depth of insight and level of objectivity associated with qualitative and quantitative measures respectively, and recommends this as a viable alternative to psychometric measures of resilience.

Psychological trauma may affect higher-order executive functions, which include selective attention, inhibition, and task-switching processes. Difficulty in these executive processes can in turn influence individuals' daily functioning and may also negatively affect the psychological treatment of post-trauma symptoms. Women may be most at risk for developing problems with executive functioning following trauma, consistent with their overall greater risk of developing post-trauma symptoms. Yet, little is understood about the influence of psychological variables, premorbid functioning, and specific trauma factors in determining post-trauma cognitive functioning in women. Additionally, individual variability in susceptibility to psychological distress and neuropsychological deficits following trauma remains an open area of study. The present study investigated the relationship between psychological and trauma factors with neuropsychological outcomes in women with trauma histories as well as individual variability in risk for poor neuropsychological outcomes. In total, 60 participants' data (age M = 29.73, SD = 10.91) were included in analyses. The final sample consisted of 33 community members recruited from the UNT Psychology Clinic and the UNT student body and 27 veterans recruited from the Veterans Affairs North Texas Healthcare System (VANTHCS). Regression and path analysis identified premorbid intellectual functioning as a predictor of better neuropsychological outcomes and anxiety and depression symptoms as risk factors for worse neuropsychological functioning. Person-centered cluster analyses focused on individual differences in outcomes identified three groups differing in psychological distress and neuropsychological functioning. Additional analyses identified differences in trauma exposure, psychological functioning, and neuropsychological performance between subgroups of civilians and veterans and those with and without a history of PTSD.

Self-injurious thoughts and behaviors are life-threatening, prevalent, and challenging clinical outcomes to predict. This dissertation explores the use of behavioral measures to improve prediction of nonsuicidal self-injury (NSSI) and suicidal ideation. This builds on the growing body of literature supporting the clinical application of behavioral measures such as the Implicit Association Test (IAT) and emotional Stroop Task with self-injurious and suicidal individuals. I tackle three questions to inform continued research and application. First, can the Self-Injury IAT be used in acute care settings to predict NSSI? Study 1 shows that the Self-Injury IAT can be used for short-term prediction: it predicted NSSI occurring during hospital stays above and beyond other risk factors, but did not predict NSSI occurring after hospital discharge. Surprisingly, patients’ explicit self-report was a more robust predictor of NSSI than the Self-Injury IAT. Admission-to-discharge change in patients' explicit self-report, but not IAT performance, predicted whether they engaged in NSSI after hospital discharge. Second, how does transient mood affect the predictive validity of the Suicide IAT and Stroop task? In Study 2, suicide ideators demonstrated significantly stronger implicit identification with death after (vs. before) the mood induction, as indicated by post-induction IAT performance. Controlling for history of suicidal ideation, post-induction performance was most predictive of suicidal ideation when assessed categorically (i.e., identification with Death vs. Life). Suicide Stroop performance remained unrelated to suicidal ideation on its own, but enhanced prediction of suicidal ideation when combined with Suicide IAT performance. All baseline suicide ideators who achieved one particular type of IAT/Stroop scoring profile experienced suicidal thoughts six months later. Third, is it safe to administer behavioral measures related to self-injurious thoughts and behaviors? Study 3 reveals that there is minimal change in self-injurious or suicidal urges from before to after completing Suicide and Self-Injury IATs. This was found across three distinct samples. A small to moderate mood decline was consistently detected, which was isolated to female respondents and one type of IAT that presented NSSI-related images. Female participants’ negative mood after viewing NSSI-related images appeared to be transient in nature--possibly be alleviated by viewing positive images. This collection of studies balances clinical application and psychological science, and presents a number of important considerations for future research and practice.
Psychology

Introduction. This study examines the age-specific risk factors associated withradicalization that could contribute to Swedish research and responsible investigativeauthorities. Specific knowledge of individual risk factors for radicalization isremarkably limited, especially compared to what we know about other forms ofviolence.Methods. A total of 1240 cases are included after a data cleaning of the PIRUS-dataset. An exploratory factor analysis examined youths (<21), adults (>22), and a noage-specific group.Results. The younger population tends to have more often been abused as a child,had some traumatic experience, and are currently part of a gang. In comparison, theolder population tend to have alcohol or drug abuse problems and more unstructuredtime, have a radicalized friend and have actively searched for their radicalized group.The All-group shares a variety of variables with the age-specific groups.Conclusion. The results imply a need for specified risk factors according to age. Theage-specific analysis provides a deepened understanding of age-specific risk factorsthat contribute to radicalization and make individuals susceptible to radicalizedgroups. Since different authorities are responsible for minors and adults and alreadywork with a risk factor approach, the findings in this essay imply that the authoritiesshould investigate their current policies and update them to age-specific risk factors ifnecessary.

The purpose of this study was to explore the efficacy of juvenile offender assessments. Data from 104 juvenile offender assessments were analyzed and followed up with placement, subsequent offending, and outcome data from the juvenile and adult systems. Constructs consistently assessed included intellectual functioning, academic achievement, and personality functioning; however, under-diagnosis of intellectual deficits, learning disabilities, and personality disorders was found. Results indicated the assessment of family functioning, substance use, and social functioning should be included in comprehensive assessments, as they may result in alternative placement and treatment options of benefit to the juvenile offender. A juvenile offender typology proposed by DiCataldo and Grisso (1995) was successfully utilized and proved predictive of recidivism, future harm to others, and outcome.

Insecure Attachment Style is increasingly acknowledged as an important developmental risk factor for psychological disorder. However, in adolescence, its association with different types of disorder, intergenerational transmission and continuity of insecurity from infancy require further investigation. The thesis investigated three main themes in mother adolescent-offspring dyads: A) A cross-sectional analysis examining the relationship of insecure Attachment Style and internalising disorder (in both generations) and disorder (in adolescence alone). B) Concurrent investigation of intergenerational transmission of mothers' Attachment Style and disorder to the adolescent offspring. C) Continuity of Attachment Style over time: within an individual (from infancy to adolescence in the younger generation), and trans-generational (from the mothers to the offspring in infancy) and how it affects the adolescent's current functioning. The study utilised an existing sample of non-clinical mother-offspring dyads studied 15 years earlier and newly followed up. New data from 43 mother-adolescent dyads were collected both by questionnaire and interview to determine clinical symptoms and Attachment Style. The Attachment Style Interview was used for the adolescents while the Vulnerable Attachment Style Questionnaire (VASQ) was used for mothers. Previously collected data using the Adult Attachment Interview and the SSP Procedure in infants were also utilised. Findings show that Anxious Attachment Style in the adolescents' was associated with both internalising and Externalising disorder. Avoidant Style (Withdrawn) was not associated with any disorder. In mothers the total VASQ insecurity scale was highly significantly associated with both their depression and trait anxiety (theme A). Mothers' internalising disorder was associated with adolescent disorder, both internalising and Externalising. However, there was no association between mothers' and adolescents' Attachment insecurity, and mother's insecure Attachment Style was unrelated to adolescent disorder (theme B). Finally, there was continuity of insecure Attachment in mothers over the intervening years, but not in adolescents. The results indicate that insecure Attachment Style is a risk factor for psychological disorder at different life stages and it is important to acknowledge this in clinical treatment and interventions in high risk children and families.

While research highlights a number of risk factors for suicide, not all individuals displaying these characteristics will go on to attempt suicide. Depressed mood is a proximal indicator of suicide, with deterioration in already depressed mood increasing the likelihood of a suicide attempt. The overall aim of this thesis was to empirically test the Cognitive Model of Suicide by Wenzel and Beck (2008). This model proposes that each of the three components, dispositional vulnerabilities, mood disturbance and suicide related cognitions, may influence each other to enhance the propensity for a suicidal crisis. The thesis starts by examining the relationship between two personality characteristics (neuroticism and trait aggression) and current depressed mood, and then focuses on the relationship between suicidality and current depressed mood. Although autobiographical memories have been implied as a possible risk factor for suicidality, meta-analytical studies have highlighted discrepancies between sampling techniques which may limit interpretablity. Therefore, the first series of studies aimed to establish a protocol for assessing autobiographical memories. The second and third series of studies aimed to investigate whether the relationships between current depressed mood and specific personality factors (neuroticism and trait aggression) were indirectly influenced by other known risk factors that may affect cognitive processing of information (rumination, overgenerality, impulsivity). Moreover, these studies aimed to determine whether the same cognitive processing factors effected current depressed mood in non-suicidal and suicide attempt groups. The final series of studies aimed to determine whether these risk factors (neuroticism, trait aggression, brooding, impulsivity, and overgenerality) mediated the relationship between suicidality and current depressed mood. Findings indicated that compared to the non-suicidal group, individuals in the suicide attempt group was more likely to be influenced by the effects of trait aggression and brooding, and that the combination of these factors were positively associated with current depressed mood. In contrast, neuroticism and impulsivity appeared to influence individuals who had experienced suicidal ideation more than individuals who report never having suicidal thoughts or attempting suicide. Compared to the non-suicidal group, however, neuroticism and impulsivity did not show a significant association for current depressed mood in the suicidal ideation group. Findings supported the Interacting Sub-Systems model and are discussed in relation to the Cognitive Model of Suicide model.

This thesis aimed to investigate the interaction of chronic dietary and psychological stress on health and disease, specifically, the impacts on the biological pathways implicated in altered cardiometabolic and mood states. As will be discussed in Chapter 1: Literature Review, numerous pathophysiological mechanisms and pathways associated with dietinduced obesity (DIO) can be modulated by chronic psychological stressors (CPS) to ultimately alter disease outcomes. However, our understanding of these interactions is incomplete due to the complex relationship between the stress-response and metabolic, immunological, behavioural, and microbial systems across the human lifespan. Furthermore, while being driven primarily by chronic overnutrition and obesity, the development of cardiometabolic disorders is multifactorial, with dysfunction of several tissues and homeostatic mechanisms contributing to disease outcomes. This complexity in the aetiology of these disease states requires a systems-based approach to properly understand the interactions between dietary and psychological stimuli across multiple organ systems and communication networks. This thesis aims to contribute to our understanding of the pathophysiology of metabolic and mood disorders by investigating the interactions that could occur between metabolic, cardiovascular, neuronal, and gastrointestinal systems to influence cardiometabolic risk, behaviour, and myocardial tolerance to injury. In this thesis, data from clinical research trials and data generated using animal models and ex vivo experiments were used to assess the impact of DIO and CPS on health and disease. The main research areas discussed within this thesis are cardiometabolic risk, colonic health, mood disorders, and myocardial ischaemic/reperfusion (I/R) injury. The contents of this thesis is organised into seven chapters and an appendix. Chapter 1 is a literature review that is broken down into four distinct sections. The first section focuses on the impact of dietary and stress-related disturbances on Australian and global communities and aims to highlight the significance of this research. The second section describes biological pathways relevant to obesity and the development of metabolic diseases. In the third section, some significant effects of chronic stress on pathways that impact obesity are described. The fourth section will detail the cardiovascular and cognitive consequences of the interactions described in section three. Chapter 2 outlines the findings of a study investigating whether there is an association between biological correlates of abnormal mood and cardiovascular disease (CVD) and depressive-like symptoms (DLS) in a human cohort. Number of DLS was determined using the Centre for Epidemiological Studies Depression scale (CES-D). Biological associations with DLS were assessed within a cross-sectional human cohort (n=516). Traditional biomarkers (anthropometric, metabolic, cardiovascular) were compared between participants experiencing a high number of depressive-like symptoms and those experiencing few DLS (DLS cohorts; n=77 per group). In addition, novel biomarkers associated with abnormal mood states in obesity (Chapter 1: Section 6) were assessed within a subgroup of the DLS cohorts (n=23 per group). Within the heterogenous population, pulse rate, systolic blood pressure, hip circumference, and insulin were found to be significantly different between low and high DLS participants. However, no significant alterations to the remaining traditional and novel circulating biomarkers were observed within participants experiencing a high number of DLS. Furthermore, only pulse rate, alcohol consumption, and BMI could significantly predict CES-D score. The most likely explanation for this outcome is the heterogeneity of the sample population, the non-specific DLS questionnaire utilised, and the complex relationship between stress, biology, and behaviour. Chapter 3 describes an animal model (n=48) used to investigate the impact of CPS and DIO's alone and when combined. The chapter focused on the impact on metabolism, anxiety-like behaviour, and myocardial tolerance to an I/R insult. Recognising the need for accessible and automated tools to facilitate the collection and analysis of animal behaviour data; an automated tracking tool for behavioural analysis using machine learning algorithms was developed and the work was subsequently published in Computers in Biology and Medicine (Appendix B). For the animal model, half the mice were fed a western diet (WD) for 18 weeks to develop phenotypical characteristics of DIO (weight gain, glucose intolerance). Diets were maintained for a further four weeks while half the mice from each dietary group were subjected to daily chronic restraint stress (CRS). Body weight, glucose tolerance, and behaviour reflective of anxiety were assessed at multiple time points. At the endpoint, hearts were excised and perfused using a Langendorff perfusion system. Myocardial functional recovery was evaluated after 25 minutes of normothermic global ischaemia and 45 minutes of reperfusion. The WD resulted in an increased body weight, worsened blood lipids, and a loss of glucose tolerance in mice. Furthermore, the study noted that WD-fed mice exhibited modest anxiety-like behaviour after 15-weeks of feeding. CRS temporarily reduce body weight and body weight gain in both dietary groups, however a differential effect on glucose tolerance was noted. WD feeding and CRS did not promote robust changes to ex vivo cardiovascular function, however, the study did demonstrate minor differences in how each intervention impacted cardiovascular function. Furthermore, the obesogenic diet combined with chronic stress did not act synergistically to worsen cardiovascular function. This lack of change may have been due to the type of stressor and chronicity that may have resulted in habituation and consequently a reduced stressresponse. This paper was subsequently accepted for publication on 17/12/2021, doi: 10.14814/phy2.15170 Chapter 4 utilised tissue from the animal model described in Chapter 3 to investigate the individual and combined effect of the WD and CRS on microbiome composition and distal colonic gene expression. Microbiome composition of caecal contents was determined using 16s RNA sequencing. RNA was extracted from colonic tissue, and the expression of genes related to inflammation, tight junction proteins (TJP), neuroendocrine, stress hormones, and microbial metabolite receptors was quantified using multiplex technology and real-time qPCR. CRS improved the Firmicutes/Bacteroidetes ratio in WD-fed animals while expanding the pathological Proteobacteria phyla suggesting a complex microbial response in WD mice exposed to CRS. WD-fed mice exhibited lower expression levels of colonic TJP and Tlr4, suggesting alterations to the expression of proteins regulating intestinal permeability and colonic immunity. CRS did not alter these genes, nor any additional regulatory genes, and no synergistic effect with WD was observed; however, CRS exposure altered colonic bile acid receptor expression. The reduced stress-response due to habituation discussed in Chapter 3 potentially impacted the gastrointestinal results that were assessed in this chapter. A paper outlining the findings of this study has been accepted for publication by Neurogastroenterology & Motility (10/11/2021) and is presented here in its accepted format, doi: 10.1111/nmo.14300 Chapter 5 investigated the effects of DIO and CRS on adipose tissue (AT) and hippocampal tissue gene expression using the animal model described in Chapter 3 and 4. The genes quantified were ones that have been implicated in insulin resistance, mood disorders, and cognitive decline. Associations between behavioural indices, biomarkers of metabolism, and expression of regulatory pathway genes across multiple tissues were also investigated. Neither WD feeding nor CRS were found to promote robust changes in either AT or hippocampal tissue gene expression. The findings from this study suggest that the WD and CRS intervention did not induce a robust pathological DIO or stressed phenotype to drive tissue-specific gene expression changes. Hippocampal and AT gene expression results could not explain the anxiety-like behaviour observed in WD mice in Chapter 3. Interestingly, it was noted that a subpopulation of mice exposed to CRS exhibited reduced gene expression of AT adiponectin which is consistent with other studies in stress-susceptible mice. Chapter 6 aimed to investigate the impact of kynurenine (KYN), a tryptophan (TRP) metabolite, on myocardial tolerance to I/R. Dysregulation of KYN metabolism has been noted in obesity, stress-related mood disorders, and cardiovascular disease; however, the molecular mechanisms of action are still poorly understood. In this chapter, mouse hearts were Langendorff perfused, exposed to low and high concentrations of KYN and subjected to an I/R insult. Functional recovery and cell death were analysed to determine the impact of the two KYN concentrations on myocardial tolerance to the I/R insult. Mitochondrial respiration, antioxidant capacity, and changes to gene expression were assessed to identify possible mechanisms of action for KYN in the myocardium. Exposure of hearts to both KYN and an I/R insult worsened myocardial ischaemic tolerance, however, a paradoxical concentration-dependent response was noted. The loss of myocardial ischaemic tolerance could not be explained by changes in myocardial respiration ortotal antioxidant capacity (TAC). An aryl hydrocarbon receptor (AHR)- dependent mechanism for the different outcomes observed in KYN exposed hearts is proposed that warrants further research. Chapter 7 discusses findings and outlines the general conclusions of each study presented in this thesis and the contributions of this work to the literature regarding the combined impact of CPS and DIO on the gastrointestinal tract, metabolism, mood states and behaviour, and cardiovascular disease. Overall, the thesis documented several changes within the WD-fed mice and observed several complex biological responses to stress that are highly context-dependent. The type, duration, and frequency of the stressor, the resilience/susceptibility of the individual animal, and the historical context all play an important role in determining the stress-response and its relationship with WD-feeding and DIO and therefore should be taken into consideration in future research.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Pharmacy & Med Sci
Griffith Health
Full Text

This PhD thesis is based on the Spanish sample of the International “Cultural and Psychosocial Influences on Disability” (CUPID) study. This multicentre study is coordinated by Professor David Coggon at the University of Southampton (UK) and the project focuses on 47 occupational groups (nurses, office workers and manual workers) from 18 countries. At the beginning, it was planned that each participating country would include the three occupational groups mentioned before. However, the Spanish sample of the study was composed only by nurses and office workers; due to logistic reasons, it was not possible to access local postal workers who carried out sorting mail tasks. This dissertation aims to assess the importance of health beliefs, mental health, and somatising tendency as predictors of incidence and persistence of musculoskeletal pain and to investigate if these psychological risk factors primarily influence the development and persistence of pain, or whether their impact is more on the disability that musculoskeletal pain causes. Dataset was collected in the workplace, both at baseline (between November 2007 and February 2010), and again after a follow-up interval of 12 months, at four hospitals (Badalona Serveis Assistencials, Consorci Sanitari Integral, Consorci Hospitalari Parc Taulí and Parc de Salut Mar) and a university (Universitat Pompeu Fabra) in Barcelona. To be included in the study, participants had to be aged 20–59 years and been in their current job for ≥12 months. Written informed consent was obtained from all who agreed to take part, and the Parc de Salut Mar Ethics Committee of Barcelona and the Health and Safety Committee of each participating centre approved the study. The baseline and follow-up questionnaires were originally drafted in English, translated into Spanish, and then checked by independent back-translation. Participants were asked at baseline about socio-demographic and lifestyle characteristics, current working conditions, health beliefs concerning pain, mental health, somatising tendency and musculoskeletal pain in the past month and past year at six different anatomical areas (back, neck, and shoulders, elbows, wrists/hands, and knees). Pain was classed as disabling if it made ≥1 specified everyday activities difficult or impossible. At 12-month follow-up, pain in the past month and associated disability was again ascertained. Log binomial and multilevel multinomial logistic regression models were used to explore associations of baseline risk factors with pain outcomes at follow-up.
Esta tesis doctoral está basada en la muestra española del Estudio Internacional “Cultural and Psychosocial Influences on Disability” (CUPID) Este estudio multicéntrico es coordinado por el Profesor David Coggon de la Universidad de Southampton (Reino Unido), y el proyecto se centra en 47 grupos ocupacionales (enfermeras, trabajadores de oficina y trabajadores manuales) de 18 países. Al principio estaba previsto que cada país participante incluiría los tres grupos de trabajo antes mencionados. Sin embargo, la muestra española del estudio CUPID está compuesta sólo por enfermeras y trabajadores de oficina; por razones logísticas, no fue posible acceder a los trabajadores de correos que realizaban tareas de clasificación de correo. Esta tesis doctoral tiene como objetivo evaluar la importancia de las creencias sobre la salud, salud mental, y la tendencia a somatizar como predictores de la incidencia y persistencia de dolor músculo-esquelético y para investigar si estos factores de riesgo psicológicos influyen principalmente en el desarrollo y la persistencia del dolor, o si su impacto es más en la discapacidad que provoca el dolor músculo-esquelético. El conjunto de datos del estudio se recogió en el lugar de trabajo, tanto al inicio del estudio (entre Noviembre de 2007 y Febrero de 2010), como después de un intervalo de seguimiento de 12 meses, en cuatro hospitales (Badalona Serveis Assistencials, Consorci Sanitari Integral, Consorcio Hospitalario Parc Taulí y el Parc de Salut Mar) y una universidad (Universitat Pompeu Fabra) en Barcelona. Para ser incluidos en el estudio, los participantes debían tener entre 20 a 59 años y haber estado en su puesto de trabajo por lo menos los últimos 12 meses. Se obtuvo consentimiento informado escrito en todos aquellos que aceptaron participar, y proyecto fue aprobado por el Comité de Ética del Parc de Salut Mar en Barcelona y el Comité de Seguridad y Salud de cada centro participante. Tanto los cuestionarios basales como del seguimiento fueron redactados originalmente en Inglés, traducido al español, y luego retro-traducido al inglés. Los participantes fueron entrevistados al inicio del estudio sobre sus características socio-demográficas y de estilo de vida, condiciones de trabajo actuales, salud mental y tendencia a somatizar, creencias sobre la salud aplicables al dolor y la presencia de dolor músculo-esquelético en el último mes y en el último año en seis zonas anatómicas diferentes (espalda, cuello, hombros, codos, muñecas/manos y rodillas). El dolor fue clasificado como discapacitante si se reportaban 1 o más actividades cotidianas difíciles o imposibles de realizar. A los 12 meses de seguimiento, se volvió a entrevistar a los participantes sobre la presencia de dolor en el último mes y la discapacidad asociada. Se utilizaron modelos de regresión log-binomial y logística multinomial multinivel para explorar las asociaciones de los factores de riesgo basales con el dolor al seguimiento.

The population of China is ageing. Accompanying this aging population, dementia and frailty have a growing importance. However there is little consensus on the association between dementia and frailty, in terms of how the criteria that are part of this two syndromes overlap, as both disorders are age-related and increase the risk for falls, further leading to loss of independence. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI) and frailty. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment. It was found that advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we employed these two cognitive measures to investigate whether they were part of the frailty syndrome among elderly from the community-based studies. We investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI). We found four distinct subtypes of elderly characterised by increasing care needs: 1. Persona elderly as defined by age >78, year of education<6 years, grip strength <11.8 KG, and a MMSE total score <25; 2. Persona Physical frailty (fitness), defined by a total score on the Timed-Up and Go (TUG) test >12.7 seconds and 15 feet gait speed >4.4 seconds; 3. Persona Cognitive impairment, defined by a MMSE total score <25, a HVLT Immediate Recall (IR) score <15, and a HVLT Delayed Recall (DR) <5; 4. Persona Physical frailty (balance,) defined by a Berg Balance test score of <53. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators, Frailty here was defined as: 1. Low BMI as measured by this algorithm: BMI= Weight (kg)/Height (m)2 2. Weakness (upper and lower body): grip strength in the lowest quintile, adjusted for gender; and TUG get up with assistance or unable to get up 3. Slowness (lower body): TUG score in the lowest quintile, adjusted for gender; and 15 feet gait speed in the lowest quintile, adjusted for gender; 4. Poor balance: Berg Balance test score in the lowest quintile, adjusted for gender; 5. Low physical activity: engaging in exercise less than once per week. An individual with 4 or more present frailty components out of a total of 7 was considered to be frail , whereas equal or less than 3 characteristics were hypothesized to be pre-frail . Those with no present frailty components were considered as robust. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment (as defined by a HVLT IR score of ≤19). The results of our studies show that compared to the MMSE, the HVLT is superior in differentiating MCI and dementia from NCI, and is also less affected by demographic factors in detecting frailty. Furthermore, in the current study, physical, psychological, demographic and other modifiable risk factors cluster together into different phenotypes of cognitive impairment and functional disability in these cohorts. A phenotype of frailty is built up using BMI, grip strength, TUG, 15 feet gait speed, balance and exercise frequency as indicators. The most common was the elderly phenotype followed by the cognitively impaired. A novel finding of the current study is that only 4.8% (8 out 168) of the whole sample fulfilled all three categories in the current study (cognitive impairment, functional disability and frailty). Finally, advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China.

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder and the leading female infertility. PCOS is characterized as a clustering of clinical concerns, which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. These characteristics were examined with regard to their impact on women's psychosocial concerns and health related quality of life. Design: Cross-sectional, correlational Setting: Private endocrinology practice in the rural Southeastern U.S. Participants: The study sample consisted of 126 women with PCOS. Methods: Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to conceive had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life.

The purpose of this research was to investigate the perceptions of refugee children, refugee parents and school staff regarding what they believe contributed to the positive adaptation of refugee children after facing adversity. This research examined how the participants understood the factors inherent in the new social milieu and its effect on refugee children’s mental health and psychological well-being. This included an exploration of resilience and the role of risk and protective factors. Few studies have focused on exploring views from a resilience perspective and studies that have, have also tended to focus on exploring factors through quantitative rather than qualitative measures. This mixed methods piece of ‘real world’ research, adopted a ‘what’s working well’ perspective, aimed to explore the important voices of children, parents and staff. The views of three refugee parents and twenty one refugee children aged between 9 and 19 years old, of various ethnic origins and length of stay in the UK (six months to eight years) were explored through semi-structured interviews. Data were analysed using a thematic analysis approach. The children’s level of well-being in different domains such as school was assessed using the Multidimensional Student Life Satisfaction Survey (Huebner, 2001). The views of sixty-three staff members were also gathered via questionnaire. Findings from this research reveal the valuable perspectives parents and young people can offer. The psychological construct of resilience was of relevance to the children in the present research, with several themes reflecting factors that have been shown to impact on resilience in positive or adverse way. Young people’s comments suggested that they were not protected from all negative experiences, but were able to succeed in the face of such adversity due to a number of factors that provided a defence against it. The key differences that children identified, that could be protective as well as a risk for them featured in the following main themes: factors within the family, experiences at school and individual/personal characteristics. Staff, parent and child responses were triangulated to provide a rich picture of the potential protective factors operating within the school and family environment. Implications for future practice for schools and Educational Psychologists in areas such as the voice of the child, bullying, home-school and community partnerships and mental health interventions are discussed. Methodological issues are also considered, together with suggestions for future research to create a deeper understanding of the role of culture, schools, coping styles and the community. Further opportunities for research exploring risk and resilience in unaccompanied refugee children are suggested.

In this study, the relationship between the risk factors of perfectionism and depression and eating disorder symptomatology was examined. A sample of female undergraduates completed the following three measures: the Beck Depression Inventory-II (BDI-II), the Multidimensional Perfectionism Scale (MPS), and the Questionnaire for Eating Disorder Diagnoses (Q-EDD). Results indicated that perfectionism is significantly positively correlated with depression. Higher levels of perfectionism were also associated with the presence of eating disorder symptoms, whereas lower levels of perfectionism were associated with the absence of eating disorder symptoms. Finally, an increase in perfectionism levels was predictive of eating disorder symptoms. Directions for future research and clinical implications are discussed.
Department of Counseling Psychology and Guidance Services

Background: Orphanhood is a major consequence of the HIV/AIDS epidemic in sub-Saharan Africa. There is little evidence concerning psychological problems for AIDS-orphaned children. This thesis explores the relationship between orphanhood status and mental health. It also examines mediating influences of environmental risk and protective factors, and interactions between factors, on children’s psychological problems. Methods: 1200 isiXhosa-speaking children were interviewed, using standardised questionnaires, in deprived urban settlements of Cape Town. A qualitative stage with 60 AIDS-orphaned children, 42 caregivers and 20 professionals explored participant perceptions of risk and protective factors. A quantitative stage compared 1025 AIDS-orphaned children to control groups of other-orphans and non-orphans. Data were analysed with t-tests, chi-sq, anovas, regression and log-linear analyses. The study took place in collaboration with Cape Town Child Welfare. Results: AIDS-orphaned children reported more depression (p<.001), peer relationship problems (p<.001), post-traumatic stress (p<.001), suicidal ideation (p<.05), delinquency (p<.001) and conduct problems (p<.001) than other-orphans and non-orphans. Anxiety showed no differences. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. These differences remained when controlling for socio-demographic factors. A number of factors strongly mediated the relationship between AIDS-orphanhood and mental health. These include poverty-related factors (food, education and social security, p<.001). caregiving-related factors (caregiver illness, p<.001, excessive housework p<.001, being a streetchild, p<.001) and AIDS-related stigma (p<.001). Cumulative effects were also found. Food insecurity and AIDS-related stigma interacted to raise likelihood of disorder from 19% to 83%, and orphanhood status and bullying interacted to raise likelihood from 12% to 76%. Conclusions: This thesis shows clear evidence of heightened psychological problems amongst AIDS-orphaned children. It also indicates mediating factors and points to areas of possible intervention. The South African Ministry of Social Development plans to scale up the study to a national survey of AIDS-orphanhood.

Risk factors for psychological insult following deployment to Operation Enduring Freedom or Operation Iraqi Freedom among veterans: A systematic review: The systematic review aimed to establish more clearly the risk factors for mental health problems in the veteran population. Five databases were searched. Included studies (n = 10) required that veterans served in Operation Enduring Freedom (OEF) and/or Operation Iraqi Freedom (OIF) and included risk factors of mental health problems among the veteran population. Data from included studies were extracted and critically appraised based on critical appraisal tools following a narrative approach to synthesise data. All of the studies reviewed identified risk factors, although due to their heterogeneous nature key findings varied considerably. However, it was consistently reported that combat exposure and deployment experiences were associated with emergence of post operational mental health problems. The current review provides preliminary evidence that there are a number of specific risk factors that may increase susceptibility to mental health problems subsequent to military deployment. It is suggested that interventions are needed in order to mitigate risk factors and bolster protective factors. A cross-sectional study investigating the impact of disease activity and disease related cognitions on adjustment in Inflammatory Bowel Disease: The research journal aimed to investigate the degree to which psychological illness related cognitions will mediate the effect of disease activity on Quality of Life (QoL). In addition, to assess the impact of disease activity, and several psychological factors, in several adjustments outcomes in IBD to see whether the adjustment variables are significant predictors of multiple outcomes. Mediation was used followed by an exploratory cross-sectional correlational design. Three hundred and thirty eight participants were recruited through an IBD charity and invited to respond to a self-report questionnaire online. Measures targeted different aspects of the IBD profile to give an indication of adjustment associated with IBD diagnosis, psychological factors and Quality of Life (QoL). Mediation analysis found support for significant indirect effects on the relationship between disease activity and QoL through Gastrointestinal (GI) anxiety, perceived disability and illness representations. The subsidiary analysis indicated that pain catastrophising, disease activity, stigma, illness representations and GI anxiety were found to be significant predictors of adjustment in IBD. The results indicate that there is an important relationship with the adjustment factors, QoL, and psychological functioning. In addition, stress, depression, anxiety and QoL were found to be predicted by the adjustment factors. The current study has provided insight into psychological factors and adjustment indicators from a multi-faceted perspective, which will facilitate advancement of managing IBD from a biopsychosocial framework with a view to enable more effective disease management.