Dissertations / Theses on the topic 'Psychosocial factors'

The psychosocial correlates of adolescent gambling behavior were assessed among 7th, 9th, and 11 th graders. Participants (N = 587) completed questionnaires concerning their gambling behavior, coping skills, locus of control, depression, and substance use. Adolescents were grouped into 1 of 4 groups based upon their performance on the DSM-IV-J (Fisher, 1992) gambling screen: non-gamblers, social gamblers, problem gamblers, and probable pathological gamblers. This research examined whether individuals belonging to the 4 groups differ with respect to locus of control, coping skills, depression, and substance use. Results indicated that probable pathological gamblers were characterized by an external locus of control and reported higher levels of maladaptive coping styles, depression, and regular substance use than non-gamblers and social gamblers. Logistic regression analyses suggest that coping skills, locus of control, substance use, and depression alone do not adequately predict pathological gambling, but do seem to play an important role in the etiology nonetheless. Implications are discussed.

This study examined 214 New Zealand women, both during pregnancy and in the postpartum, in order to determine the influence of infant-related stressors, unplanned pregnancy, social support and the role of the marital relationship in the development of postpartum depression. The relationship of demographic factors, the woman's feelings about having a new baby in the family and previous history of depression were also analyzed. The prevalence of depressive symptomatology was 30.8% during pregnancy and 39.7% in the postpartum. Postpartum depression was predicted by depression during pregnancy, by poorer postpartum marital adjustment and by lower levels of postpartum social support. The strongest predictor of the change in depression scores over time was depression during pregnancy. The important role of depression during pregnancy in the etiology of postpartum depression, suggests that postpartum depression is a continuation of depression during pregnancy. Women who were more depressed during pregnancy tended to be younger, of lower socio-economic status, and to have a reported history of depressive episodes prior to their pregnancies. Higher levels of prepartum depression were also related to women's feelings of being unhappier about having a new baby in the family, to poorer marital adjustment, and to lower levels of social support during pregnancy. Depression during pregnancy was found to be more likely to have a negative effect on marital adjustment than poor marital adjustment on depression. Similarly, depression during pregnancy was found to be more likely to have a negative effect on social support, than vice versa. However, further regression analyses, showed that postpartum marital adjustment and postpartum social support had a strong relation to postpartum depression, irrespective of the levels of prepartum marital adjustment, prepartum social support, and prepartum depression. Contrary to predictions, neither infant temperament, nor infant risk were related to postpartum depression.

Metabolic syndrome is a constellation of risk factors, including abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose, that commonly cluster together and can result in cardiovascular disease. The prevalence of metabolic syndrome and the components that comprise the syndrome vary by age and by racial/ethnic group. In addition, previous research has indicated that the risk factors contributing to metabolic syndrome may be exacerbated by exposure to perceived stress. This study utilized data from the 2002, 2004, and 2006 Health and Retirement Study (HRS) and National Health and Nutrition Examination Survey (NHANES) data sets. It was hypothesized that depression and anxiety (conceptualized as stress in this study) increase the risk of presenting with metabolic syndrome while social support decreases the risk of metabolic syndrome. While results of cross-sectional analysis do not indicate a significant relationship between depression and metabolic syndrome (t = -.84, ns), longitudinal analysis does indicate a significant relationship between depression and metabolic syndrome over time (t = -5.20, p <.001). However, anxiety is not significantly related to metabolic syndrome when the relationship is examined through cross-sectional analysis (t = -1.51, ns) and longitudinal analysis (χ² = 13.83, ns). Similarly, social support is not significantly related to metabolic syndrome when examined in cross-sectional (χ² = .63, ns) and longitudinal (t = 1.53, ns) analysis. Although level of stress is not significantly related to metabolic syndrome as a whole, there is a significant relationship between stress and both triglyceride level (t = -2.94, p = .003) and blood glucose level (t = -3.26, p = .001).

A group of 21 HIV-positive gay or bisexual men was compared with a matched group of 22 HIV-negative individuals. All subjects were sexually active gay or bisexual males matched for age, as well as age at first intercourse with males. Subjects completed a detailed sexual history questionnaire as well as a series of standardized measures of psychosocial functioning. Results indicated that subjects engaged in a wide range of unsafe sexual behaviours, and frequently combined drugs with sex. Scores on the Michigan Alcoholism Screening Test (MAST) were significantly correlated with lifetime condom use. Social support was also found to be significantly associated with the lifetime number of homosexual partners. Regression analysis revealed a significant negative association between MAST scores and social support and a positive relationship between social support and CD-4 cell count. The groups were found to be similar in terms of clinical levels of anxiety and depression, self-esteem in interpersonal situations, and risk-taking personality.

Rising levels of metabolic syndrome across Europe and India, and scant research on psychosocial determinants prompted these studies. Stress, depression and physical inactivity were hypothesized to predict obesity and metabolic syndrome; constant mood and increased resilience to confer protection. Abundant vegetable/fruit intake; lower saturated fat intake from dairy, meat and olive oil, and low/moderate wine intake were predicted determinants of health. Secondary modelling of representative data from GB and Portugal (Lipgene study) assessed psycho-social, dietary and lifestyle predictors of metabolic syndrome. Cultural adaptation of the Lipgene questionnaire was informed by qualitative research incorporating 24hr dietary recall for use in India (ChurpE). Qualitative themes suggested that urbanisation negatively impacted upon social structure, food choice, physical activity and health. Stress arising from the changing role of women was perceived to have affected familial wellbeing. Healthy eating referenced freshness, convenience, meal skipping, high fat/sugary foods, and nostalgia for tradition and rural lifestyle. Latent class analyses of the Indian and both European samples indicated three classes: 'healthier' lacking metabolic syndrome symptoms; 'metabolic syndrome' with comorbidities; and, 'obese/high blood pressure'. Additionally, an 'overweight' group in Europe was distinguished. In both studies older age, less sedentary behaviour and stress distinguished the 'healthier' from all other classes. Compared with the 'healthier', 'metabolic syndrome' members were more likely Portuguese experienced lower resilience and smoking cessation; and more British, younger and stressed members typified 'overweight' among Europeans. The 'obese' class were predominantly female with high BP. Among Indians, 'happier' mood characterised 'high BP' membership. That comorbidities varied between classes suggests disease progression from overweight/obesity to metabolic syndrome. Among Indians, alcohol, smoking, higher earnings, chatting to relax and dietary habits predicted obesity and comorbidities. Developing public health policy to prevent and treat obesity and metabolic syndrome should intervene to reduce sedentary behaviour, tackle stress, promote resilience and healthy eating.

Two over-arching research questions are examined in this thesis. These questions concern call centre organisational features (dialogue scripting and performance monitoring), work design (e.g., autonomy, workload, role properties) and health outcomes (psychological strain and MSDs) which are examined using data from 1,141 employees taken from 36 call centres. In the Study 1 the "lean service characteristics" of dialogue scripting and performance monitoring are examined in relation to the prediction of call handler job-related strain. Findings confirm that employees who experience greater dialogue scripting and more intensive performance monitoring show higher levels of strain. These relationships are fully mediated by work design. These findings demonstrate the importance of considering the impact of lean working practices on employee health. In the Study 2, the work characteristics of autonomy and workload are examined in relation to the prediction of musculoskeletal disorders (upper back, lower body and arms). I find that the relationship of workload to upper body and lower back musculoskeletal disorders is largely accounted for by job-related strain. This mediating effect is less evident for arm disorders. Contrary to expectation, job autonomy has neither a direct nor a moderating effect on any musculoskeletal disorder. In Study 3, a systematic literature review of intervention studies in call centres is presented. Sixteen papers are categorised into four intervention domains, namely, i) physical work environment ii) ergonomic iii) job design and iv) health. The majority of studies are ergonomic in nature and the physical work environment is considered also. Study 3 implies that whilst work psychologists examining call centre working practices is a valid exercise it only forms part of a psychosocial risk story and that work psychologists need to work in a more interdisciplinary manner if we are to positively intervene in call centres.

Do Maternal Psychosocial Factors Predict Adolescent Weight? Sandra Jody MarksDepartment of Exercise Sciences, BYUMaster of SciencePurpose: This study investigated the possible relationship between maternal psychosocial factors, mainly maternal stress and maternal depression, and adolescent weight status. Also, this study examined the predictive effect of these maternal psychosocial factors on adolescent weight loss during a health education intervention as well as the months following the health education. Methods: Study design was a longitudinal pretest posttest with a health education intervention. We assessed 40 adolescents and their mothers on four occasions over a 1-year period. At each occasion, the Stress Index for Parents of Adolescents (SIPA) was used to measure maternal stress and the Beck Depression Inventory (BDI-II) was used to measure maternal depression. Also, at the four occasions, adolescent anthropometric data were obtained by research assistants using a digital scale for weight and a portable stadiometer for measuring height. Body Mass Index scores (BMI = [weight (kg)]/[height (m)]2) were calculated and converted into a percentile score (zBMI), adjusting for age and gender, using the standard Center for Disease Control and Prevention calculator. At the onset of the study, the adolescent participants and their mothers all received 12 weeks of health education, which included group behavioral therapy, family-based intervention, motivational interviewing and electronic intervention. Results: Hierarchical regression analysis revealed that no significant relationships existed between maternal stress and adolescent zBMI or between maternal depression and adolescent zBMI at baseline (Time 1). Nor did the study find that maternal stress and/or depression scores at Time 1 significantly predicted a greater amount of adolescent weight loss. Lower stress and/or depression also did not significantly predict adolescent weight maintenance after the 12-week intervention (Time 2). However, results did indicate that the adolescent component of the maternal stress domain (AD) from Time 1 to Time 2 was a significant predictor of adolescent zBMI from Time 1 to Time 2, (R2 = 0.238, F (1,21) = 6.571, p = 0.018). This means that 23.8% of the variability in overall zBMI change from Time 1 to Time 2 is being accounted for by change in the maternal AD stress domain from Time 1 to Time 2. Conclusion: Adolescent zBMI decreased concurrently with maternal stress during the health education intervention stage. Although the correlational nature of this study prevents causal claims, this result suggests that decreasing maternal stress may strengthen the ability of obese adolescents to effectively lose weight. This study encourages further research to examine the effects that maternal psychosocial factors may have on adolescent weight status, weight loss, and weight maintenance.

Submitted in partial fulfilment of the requirements for the degree of Masters of Education (Educational Psychology) in the Department of Educational Psychology & Special Education Faculty of Education at the University of Zululand, South Africa, 2012.
Cyberbullying is a new form of bullying and harassment that is also referred to as electronic or online bullying. It may involve the following: sending mean, vulgar or threatening messages or images, posting sensitive or private information online, pretending to be someone else online in order to make a person look bad or intentionally exclude a person from an online group. Viewed as covert psychological bullying conveyed through electronic means it has been identified as the most problematic form of emerging cruelty among adolescents in schools. Existing research studies on cyberbullying suggests that it is increasing at a phenomenal rate and it is not clear whether online perpetrators and victims possess the same characteristic behaviours and psychosocial profiles as their traditional bullying counterparts. However in South Africa there is a paucity of research. The present study seeks to examine the behavioural and psychosocial factors associated with cyberbullying among Grade 8 to 10 learners, in a cross-section of schools, in KwaZulu-Natal. The purpose of the research was to determine: the prevalence of cyberbullying; the relationship between age, gender, rural and urban dichotomy and socioeconomic status of victims and perpetrators of cyberbullying; school personnel’s management of cyberbullying; and the relationship between psychosocial factors and behavioural characteristics and cyberbullying. Two questionnaires were used. The first was a 3-part psychosocial questionnaire and the other a cyberbullying questionnaire (Riebel, Jager, & Fischer, 2008). The data from this study confirms that cyberbullying is prevalent in various forms, in secondary schools, in KwaZulu-Natal. The total sample was N=450. Of which 199 (44.22%) reported that they were victims or perpetrators of cyberbullying. There were 127 (28.22%) who identified themselves as victims and 72 (16.0 %) admitted to be perpetrators. The most frequent form of cyberbullying experienced was rumours and slander using the internet or cellular phone. The electronic communication preferences of participants were: instant messaging (50%); 47% used social networking; about 44% used chatrooms and 32% used email. Females spent more time in chatrooms and sent more instant messages than the males. The results show that friends and fellow learners were responsible for the cyberbullying most frequently. The victims rarely choose to reveal that they were cyberbullied to their teachers. Participants chose their friends as the primary person to talk to about their victimisation while the secondary person was their parents. Teachers were the last person of choice to seek help. Comparison of victims, non-victims, perpetrators and non-perpetrators of cyberbullying on the Life Satisfaction Scale (LSS), indicated that victims of cyberbullying were the most dissatisfied group (9.83%) while perpetrators reported high satisfaction. There was a significant difference between victims and non-victims on their performance on the psychological well-being scale and this was also the case for perpetrators and nonperpetrators of cyberbullying. Victims did not like themselves; expressed a poor sense of self, low self-esteem and lack of self-confidence and had more negative self-perceptions which affected their psychological well-being. They expressed feeling of helplessness, loneliness, sadness, despair, anger, and self loathing. Perpetrators also had strong feelings of worthlessness, guilt, sadness and hopelessness. They were tearful and expressed a loss of interest in daily activities, experienced difficulty cThe behavioural characteristics described by the groups showed considerable variations. Victims of cyberbullying rated themselves highest on being serious and they rated themselves lower on being friendly, emotional, stubborn and happy. Perpetrators of cyberbullying rated themselves highest on being aggressive, nervous, stubborn, happy, awkward and sad. Victims and perpetrators had experienced more difficulty learning to read and were in trouble more often in school than the non-victims and non-perpetrators. Cyberbullying is prevalent in South African secondary schools, among Grade 8, Grade 9 and Grade 10 learners and occurs among males and females, from rich and poor backgrounds, rural and urban areas irrespective of racial and ethnic backgrounds. Implications of these results are discussed with special focus on intervention and management of cyberbullying concentrating on school work and expressed a lack of enthusiasm and motivation.

Many drivers in highly motorised countries believe that aggressive driving is increasing. While the prevalence of the behaviour is difficult to reliably identify, the consequences of on-road aggression can be severe, with extreme cases resulting in property damage, injury and even death. This research program was undertaken to explore the nature of aggressive driving from within the framework of relevant psychological theory in order to enhance our understanding of the behaviour and to inform the development of relevant interventions. To guide the research a provisional ‘working’ definition of aggressive driving was proposed encapsulating the recurrent characteristics of the behaviour cited in the literature. The definition was: “aggressive driving is any on-road behaviour adopted by a driver that is intended to cause physical or psychological harm to another road user and is associated with feelings of frustration, anger or threat”. Two main theoretical perspectives informed the program of research. The first was Shinar’s (1998) frustration-aggression model, which identifies both the person-related and situational characteristics that contribute to aggressive driving, as well as proposing that aggressive behaviours can serve either an ‘instrumental’ or ‘hostile’ function. The second main perspective was Anderson and Bushman’s (2002) General Aggression Model. In contrast to Shinar’s model, the General Aggression Model reflects a broader perspective on human aggression that facilitates a more comprehensive examination of the emotional and cognitive aspects of aggressive behaviour. Study One (n = 48) examined aggressive driving behaviour from the perspective of young drivers as an at-risk group and involved conducting six focus groups, with eight participants in each. Qualitative analyses identified multiple situational and person-related factors that contribute to on-road aggression. Consistent with human aggression theory, examination of self-reported experiences of aggressive driving identified key psychological elements and processes that are experienced during on-road aggression. Participants cited several emotions experienced during an on-road incident: annoyance, frustration, anger, threat and excitement. Findings also suggest that off-road generated stress may transfer to the on-road environment, at times having severe consequences including crash involvement. Young drivers also appeared quick to experience negative attributions about the other driver, some having additional thoughts of taking action. Additionally, the results showed little difference between males and females in the severity of behavioural responses they were prepared to adopt, although females appeared more likely to displace their negative emotions. Following the self-reported on-road incident, evidence was also found of a post-event influence, with females being more likely to experience ongoing emotional effects after the event. This finding was evidenced by ruminating thoughts or distraction from tasks. However, the impact of such a post-event influence on later behaviours or interpersonal interactions appears to be minimal. Study Two involved the quantitative analysis of n = 926 surveys completed by a wide age range of drivers from across Queensland. The study aimed to explore the relationships between the theoretical components of aggressive driving that were identified in the literature review, and refined based on the findings of Study One. Regression analyses were used to examine participant emotional, cognitive and behavioural responses to two differing on-road scenarios whilst exploring the proposed theoretical framework. A number of socio-demographic, state and trait person-related variables such as age, pre-study emotions, trait aggression and problem-solving style were found to predict the likelihood of a negative emotional response such as frustration, anger, perceived threat, negative attributions and the likelihood of adopting either an instrumental or hostile behaviour in response to Scenarios One and Two. Complex relationships were found to exist between the variables, however, they were interpretable based on the literature review findings. Factor analysis revealed evidence supporting Shinar’s (1998) dichotomous description of on-road aggressive behaviours as being instrumental or hostile. The second stage of Study Two used logistic regression to examine the factors that predicted the potentially hostile aggressive drivers (n = 88) within the sample. These drivers were those who indicated a preparedness to engage in direct acts of interpersonal aggression on the road. Young, male drivers 17–24 years of age were more likely to be classified as potentially hostile aggressive drivers. Young drivers (17–24 years) also scored significantly higher than other drivers on all subscales of the Aggression Questionnaire (Buss & Perry, 1992) and on the ‘negative problem orientation’ and ‘impulsive careless style’ subscales of the Social Problem Solving Inventory – Revised (D’Zurilla, Nezu & Maydeu-Olivares, 2002). The potentially hostile aggressive drivers were also significantly more likely to engage in speeding and drink/drug driving behaviour. With regard to the emotional, cognitive and behavioural variables examined, the potentially hostile aggressive driver group also scored significantly higher than the ‘other driver’ group on most variables examined in the proposed theoretical framework. The variables contained in the framework of aggressive driving reliably distinguished potentially hostile aggressive drivers from other drivers (Nagalkerke R2 = .39). Study Three used a case study approach to conduct an in-depth examination of the psychosocial characteristics of n = 10 (9 males and 1 female) self-confessed hostile aggressive drivers. The self-confessed hostile aggressive drivers were aged 24–55 years of age. A large proportion of these drivers reported a Year 10 education or better and average–above average incomes. As a group, the drivers reported committing a number of speeding and unlicensed driving offences in the past three years and extensive histories of violations outside of this period. Considerable evidence was also found of exposure to a range of developmental risk factors for aggression that may have contributed to the driver’s on-road expression of aggression. These drivers scored significantly higher on the Aggression Questionnaire subscales and Social Problem Solving Inventory Revised subscales, ‘negative problem orientation’ and ‘impulsive/careless style’, than the general sample of drivers included in Study Two. The hostile aggressive driver also scored significantly higher on the Barrett Impulsivity Scale – 11 (Patton, Stanford & Barratt, 1995) measure of impulsivity than a male ‘inmate’, or female ‘general psychiatric’ comparison group. Using the Carlson Psychological Survey (Carlson, 1982), the self-confessed hostile aggressive drivers scored equal or higher scores than the comparison group of incarcerated individuals on the subscale measures of chemical abuse, thought disturbance, anti-social tendencies and self-depreciation. Using the Carlson Psychological Survey personality profiles, seven participants were profiled ‘markedly anti-social’, two were profiled ‘negative-explosive’ and one was profiled as ‘self-centred’. Qualitative analysis of the ten case study self-reports of on-road hostile aggression revealed a similar range of on-road situational factors to those identified in the literature review and Study One. Six of the case studies reported off-road generated stress that they believed contributed to the episodes of aggressive driving they recalled. Intense ‘anger’ or ‘rage’ were most frequently used to describe the emotions experienced in response to the perceived provocation. Less frequently ‘excitement’ and ‘fear’ were cited as relevant emotions. Notably, five of the case studies experienced difficulty articulating their emotions, suggesting emotional difficulties. Consistent with Study Two, these drivers reported negative attributions and most had thoughts of aggressive actions they would like to take. Similarly, these drivers adopted both instrumental and hostile aggressive behaviours during the self-reported incident. Nine participants showed little or no remorse for their behaviour and these drivers also appeared to exhibit low levels of personal insight. Interestingly, few incidents were brought to the attention of the authorities. Further, examination of the person-related characteristics of these drivers indicated that they may be more likely to have come from difficult or dysfunctional backgrounds and to have a history of anti-social behaviours on and off the road. The research program has several key theoretical implications. While many of the findings supported Shinar’s (1998) frustration-aggression model, two key areas of difference emerged. Firstly, aggressive driving behaviour does not always appear to be frustration driven, but can also be driven by feelings of excitation (consistent with the tenets of the General Aggression Model). Secondly, while the findings supported a distinction being made between instrumental and hostile aggressive behaviours, the characteristics of these two types of behaviours require more examination. For example, Shinar (1998) proposes that a driver will adopt an instrumental aggressive behaviour when their progress is impeded if it allows them to achieve their immediate goals (e.g. reaching their destination as quickly as possible); whereas they will engage in hostile aggressive behaviour if their path to their goal is blocked. However, the current results question this assertion, since many of the hostile aggressive drivers studied appeared prepared to engage in hostile acts irrespective of whether their goal was blocked or not. In fact, their behaviour appeared to be characterised by a preparedness to abandon their immediate goals (even if for a short period of time) in order to express their aggression. The use of the General Aggression Model enabled an examination of the three components of the ‘present internal state’ comprising emotions, cognitions and arousal and how these influence the likelihood of a person responding aggressively to an on-road situation. This provided a detailed insight into both the cognitive and emotional aspects of aggressive driving that have important implications for the design of relevant countermeasures. For example, the findings highlighted the potential value of utilising Cognitive Behavioural Therapy with aggressive drivers, particularly the more hostile offenders. Similarly, educational efforts need to be mindful of the way that person-related factors appear to influence one’s perception of another driver’s behaviour as aggressive or benign. Those drivers with a predisposition for aggression were more likely to perceive aggression or ‘wrong doing’ in an ambiguous on-road situation and respond with instrumental and/or hostile behaviour, highlighting the importance of perceptual processes in aggressive driving behaviour.

Magister Educationis (Adult Learning and Global Change) - MEd(AL)
Adult learners’ perception of factors that are internal to their perceived control of their lives can be challenging to overcome when making a decision to participate in learning. There are complex relationships between psychological, and social barriers to participation in adult learning. Psychosocial barriers can deter adults’ participation in learning programmes. Understanding the nature of such barriers can enable policymakers, educators and adult learners create strategies to reduce such barriers in order to increase adults’ participation in adult learning. This study investigated the research question: What are adult learners’ perceptions of psycho-social factors that undermine participation in adult education and learning? The psycho-social interaction model adopted as a conceptual framework allowed the study to contextualise and analyse the effects of socio-economic status on the adult learner’s decision and readiness to participate. The model provided the broad segments of the adult learners’ pre-adulthood and adulthood learning years and through a thematic analysis attempted to analyse psychosocial factors that emerged as barriers to participatory behaviour in learning. An interview guide was used during a semi-structured interview. The study investigated a group of adult learners attending a non-formal learning programme in Central Johannesburg, South Africa. The selection of participants included 6 males and 4 females between 21 years to 49 years of age. The study findings showed that the adult learners’ perceptions of family support as well as the learning environment support are key enabling factors, which assist the adult learner to develop learning capabilities. Negative experiences with prior schooling was also described as a psychosocial barrier to participation. Age was a socio-economic variable that influenced the type of stimuli participants identified as a psycho-social factor which influenced their decision to take up further learning. Adult learners felt confident to successfully complete their current and future studies however perceived their learning press as a motivating factor that impacted their decision to participate. Findings also suggested that experiences of adult learners are unique to their specific context and educational planning can integrate ways to address enhancement of learning experiences for a diverse learner audience in non-formal learning programmes. The study concluded that while adult learners acquire social competencies through accessing non-formal programmes, further learning support is necessary to overcome the social and psychological complexities needed to develop basic academic learning capabilities.

Les recherches actuelles sur la résilience s’intéressent à l’intervention psychoéducative sur les facteurs de risque, en vue de passer d’une résilience naturelle à une résilience assistée : nous considérons la promotion des pratiques de résilience comme un facteur de développement des capacités psychologiques des enfants. Dans ce sens, le milieu scolaire peut constituer un espace d’interactions sociales et avec le soutien de la famille favoriser l’émergence de ressources socio-affectives, cognitives et conatives. Comment les pratiques scolaires peuvent-elles promouvoir la résilience ? Pour répondre à cette question, nous avons travaillé auprès d’un échantillon de 119 enfants à haut risque fréquentant des écoles défavorisées du Pérou. Notre approche méthodologique a pris en compte la perception qu’ont les enseignants et les élèves du climat social scolaire, en particulier des relations entre élèves, des relations entre enseignants, des relations entre élèves et enseignants, de l’organisation, de l’établissement des règles, et du développement d’activités périscolaires. En outre, nous avons identifié les besoins psychosociaux des élèves sur la base de leurs déclarations. Ces analyses nous ont apporté des éléments de réponse qui nous servent à proposer des pratiques psychoéducatives de résilience.Les pratiques psychoéducatives sont réparties en quatre catégories : la salle de classe et l’école, l’école et la famille, les parents et l’enfant, et les besoins psychosociaux de l’enfant/élève
The research on resilience has focused mainly on psycho educational intervention on risk factors in children. Studying not only "natural resilience" but how "assisted resilience" helps children deal with trauma. This change of strategy suggests that promoting practices of resilience may be a means of developing psychological skills of resilience into children. To that respect, the schools’ social environment, with the help of the family, can be used as a place of interaction that promotes the emergence of social, emotional, cognitive and volitional skills whitin the students. The key question of this study is how schools can include practices that enhance the development of resilience skills into children? To answer this question, we used a sample of 119 high-risk children attending disadvantaged Peruvian schools. Our methodology takes into account the teachers’ and students’ perceptions of the school’s social climate, in particular the relationship among students, among teachers, and between students and teachers, the school’s organization, the establishment of rules, and the development of extracurricular activities. The study also includes the students’ thoughts about their psychosocial needs. The analysis of these elements provides a basis to suggest psychoeducational practices to promote resilience. These psychoeducational practices come into four categories: practices related to the classroom and the school, to the school and the family, to the parents and their children, and to the psychosocial needs of the child/student

The thesis describes a number of qualitative and quantitative studies in the investigation of psychosocial risk factors for back pain and absenteeism. A study of information processing 'biases' was completed comparing three diagnostically different chronic pain groups. Back pain and arthritis patients devote greater processing resources towards illness information than healthy controls. Development of a pain schema is suggested to be related to the personal meaning of pain. A further cross sectional investigation of psychosocial factors associated with back pain in a care assistant population was conducted. Work factors including perception of physical strain and job satisfaction; psychological factors such as pain beliefs, emotionality and family pain history and measures of pain in the last month were assessed. Results found that people reporting back pain had significantly lower job satisfaction, were older and worked significantly longer as care assistants than those reporting a mixture of pain symptoms. Reporting of general pain symptoms and absenteeism was also investigated. This was followed by a longitudinal study of care workers at risk of back pain. Negative emotionality and job satisfaction were identified in a logistic regression as being significant predictors of back pain at six months. High negative emotionality scores at baseline were significantly correlated with high numbers of pain symptoms at follow-up. Difficulties in conducting longitudinal risk research are discussed. The development of the pain schema was investigated by distributing word stem tasks to a variable pain population at baseline and follow-up. People reporting three or more pain symptoms and high pain frequencies were more likely to give higher pain sensory completions. At follow-up, as number of pain symptoms increased over six months so did the number of pain affective responses. The final study was a qualitative investigation of the meaning of back pain in thirty two care assistants using semi structured interviews. Findings suggest that patients delay seeking treatment when they perceive high susceptibility of back pain in the iii working environment, low severity of back pain and few benefits of treatment. Such findings are further discussed within the principals of the Health Belief Model (Becker, 1974).

Current prevention recommendations for ovarian cancer are limited, and the underlying etiology is not fully elucidated. The associations of common modifiable factors, such as psychosocial and lifestyle factors, with ovarian cancer risk need to be more fully evaluated. Thus, I examined the association of ovarian cancer with depression, physical activity, hypertension, and antihypertensive medication use among participants from two prospective cohort studies: the Nurses' Health Study and Nurses' Health Study II. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for these associations. Depression was associated with about 30% increased risk of ovarian cancer (HR = 1.30, 95% CI 1.05-1.60). Higher risk was also observed among women with persistent positive depression status than women intermittently positive or persistently negative for depression. Contrary to the hypothesis that physical activity may lower ovarian cancer risk, we observed that both low and high physical activity was associated with a modest increase in ovarian cancer risk (HR for ≥27 [approximately equivalent to 1 hr/day of brisk walking] versus 3-9 MET-hrs/week = 1.26, 95% CI 1.02, 1.55; HR for <3 versus 3-9 MET-hrs/week = 1.19, 95% CI 0.94, 1.52). However, these associations were only restricted to premenopausal physical activity, and postmenopausal activity was not associated with ovarian cancer risk. While hypertension was not associated with risk (HR = 1.03, 95% CI 0.87, 1.21), use of thiazide diuretics was associated with an increased risk of ovarian cancer (HR = 1.35, 95% CI 1.04, 1.74), and use of calcium channel blockers was associated with a suggestively lower risk (HR = 0.73, 95% CI 0.53, 1.01). Our results need to be confirmed by other studies, but suggest that these common modifiable factors may have a moderate impact on ovarian cancer risk. This represents an opportunity to broaden our understanding of ovarian cancer etiology and potentially improve prevention strategies for ovarian cancer.
Epidemiology

This research addresses the role that psychosocial factors currently play in selection of candidates for heart transplantation, and the predictive validity of these factors to selection decisions and patient outcomes. The initial focus of this research was on what psychosocial factors are considered and how much impact they have individually and collectively on selection decisions. This investigation examined how individual members of a cardiac transplant team (University Medical Center, Tucson, Arizona) arrive at these decisions and how these individual judgments are combined into a consensual team decision. Further, in an effort to usefully standardize the psychosocial information used in patient assessments, we developed a consensus weighting formula for the whole transplant team. Our findings from the initial phase of the research indicate general agreement among team members that psychosocial factors are of some importance in screening transplant candidates. Most team members give primary attention to medical factors, though all were attentive to the influence of psychosocial factors on patient eligibility for transplant and on post-transplant adjustment. We next examined the relationship between what the team believes they are doing in selecting candidates for transplantation against empirical data from the cases the team has evaluated. However, when belief was tested against empirical evidence we find some disparity between what the team reported as important to their decision making and the actual decisions the team had made. Our results showed that team members use some, but not all, psychosocial factors in their transplant eligibility decisions. Lastly, we investigated the relationship between psychosocial factors and various patient outcomes. We investigated the extent to which outcome measures: mortality, morbidity, functional status, quality of life, patient management, and patient compliance, can be predicted by measures, including psychosocial measures, available at the time of initial evaluation. Our results indicate an association between pre-transplantation psychosocial evaluation and certain behavior aspects of transplant outcome, patient management and compliance. However, no relationship was found between psychosocial factors and medical and functional outcomes. The findings from this empirical prediction model should add to the information available to the team at the time of the pre-transplant screening decision.

This study is based on a comprehensive review of psychosocial factors in alcohol dependency presented by 214 African American and white patients in Grady Memorial Hospital. The purpose of this study was to extend and elaborate descriptive research of psychosocial differences to create and sustain the appropriate prevention and treatment strategies. Therefore, this research relies on Biopsychoecological Integrative Contextual Model that not only permits competing explanations of the etiology and epidemiology but also embarks on prevention and treatment plans. Prevention Research Institute (PRI), George L. Engel, Jerrold S. Maxmen, Nicholas G. Ward and others have presented models of drinking vulnerabilities that have utilized the above model. As an alternative, this study has confirmed the validity of this model, and structured the theoretical and empirical approaches based on its framework. The model serves as a foundation for generating hypotheses and general research questions that are set in the context of ethnic experiences among the races and their psychosocial and environmental factors. Therefore, the contextual information drawn from the above model have guided this research to the following question: will there be any relationship and/or difference between the races (African American and white) regarding psychological (self-esteem, attitude, personality, stress, and logical thinking) and social (lifestyle and legal status) factors in alcohol dependency levels (use, abuse, psychological, and physical)? Furthermore, the null hypotheses postulate that there will be no relationship and/or difference between the races regarding their psychosocial factors in alcohol dependency. The rational for these hypotheses are derived from the literatures which indicate that acculturation strains, conflicts, gaps, stressors, and altered psychological or interpersonal circumstances are related to social disorganization and personal dysfunctionality and, therefore, these processes are conducive to a wide variety of social and behavioral deviances which are high-risk in increasing alcohol use and abuse among the races. The findings, of this study, not only stress the above rational but also mitigate perceptions of risk related to cultural, racial, and ethnical factors that have been speculated to African Americans. Patients' races and alcohol dependency levels (dependent variables) enabled this study to address eight cross-ethnic comparisons and cross-behavioral issues (independent variables). In this study, it was permitted to utilize the Statistical Package for the Social Sciences (SPSS).

Abstract. This research shows different methodologies applied on different platforms in order to extract both social and psychosocial factors that might be related to caner by applying natural language processing tools on text from different platforms as social media or other online forums. We also present challenges associated with every platform and the corresponding tools used on it. From text mining to text analysis and then data visualisation, this research compares different analysis methods and outputs. We discuss many tools either tested, used or modified in order to achieve such analysis. Meanwhile, we were able to get interesting findings for the medical fields to explore and research more. We developed a modular system that can help clinicians and medical experts use to analyse similar forums.Syöpäpotilaiden psykososiaalisten tekijöiden vaikutusten paljastaminen. Tiivistelmä. Tämä tutkimus esittelee erilaisia menetelmiä sovellettuina eri alustoilla, tavoitteena hahmottaa sekä sosiaalisia että psykokososiaalisia tekijöitä, jotka voivat liittyä syöpään sovellettaessa luonnollisia kielenkäsittelyvälineitä eri alustojen tekstille sosiaalisen median tai muiden online-foorumeiden muodossa. Esitämme myös haasteita, jotka liittyvät jokaiseen alustaan ja siihen liittyviin työkaluihin. Teksti-mining, tekstianalyysiin ja sitten datan visualisointiin tässä tutkimuksessa verrataan erilaisia analyysimenetelmiä ja -tuloksia. Keskustelemme monista työkaluista, jotka on testattu, käytetty tai muunnettu tällaisen analyysin saavuttamiseksi. Samaan aikaan saimme mielenkiintoisia tuloksia lääketieteen aloille tutkia ja tutkia lisää. Kehitimme modulaarisen järjestelmän, jonka avulla lääkärit ja lääketieteen asiantuntijat voivat analysoida samanlaisia foorumeita.

The concept of youth active citizenship is a complex and challenging issue to deal with. Youth participative behaviors are rapidly decreasing in the contemporary scenario, but more attention must be given to the psychological aspects of citizenship and various forms of youth participatory practices. The aims of this research were to describe the citizenship participation behaviors of youth; to explore how the factors at individual, micro and sociodemographic level are related to the different behavioral components of youth active citizenship; to evaluate a participatory school-based intervention co-led by youth and adults; to examine the practices of youth active citizenship in youth organizations. Mixed-methods are used to account for the different and complementary aspects of youth citizenship. Methods used for the overall research design were: a longitudinal questionnaire for the analysis of the process of construction of active citizenship (chapter 2); a mixed-method evaluation of a school-based intervention consisted in a questionnaire, focus group and interviews (chapter 3), and qualitative case studies for the analysis of organizational practices (chapter 4). Results from the longitudinal study show that the levels of participative behaviors are decreasing in time, while political interest, family context and membership in students, religious and dealing with social issues organizations seem to be important factors that enhance active citizenship. Results from the evaluation of the school-based participatory research show that open school climate and an improvement of quality of participation at school favor forms of political participation. Moreover, the process and the outcome of critical awareness are perceived as fundamental in the process of constructing active citizenship. Results from the analysis of two youth organization practices reveal the importance to create opportunities to develop youth agency and power. A final discussion is focused on the implications for future research and interventions.

The stress effect on Multiple Sclerosis (MS) has yielded disparate results. One reason may be the heterogeneity in the stress measure and the presence of potential moderators/mediators. Aims: to analyse the stress effect on MS under a transactional approach and to elucidate the role of coping, social support, anxiety, alexithymia and early-life stress in this relationship. Methods: the study consisted in three phases: a systematic review, a case-control study (n= 82), and a longitudinal one year follow-up study (n=26). Linear and Multiple Hierarchical models were conducted. Results: people with MS (pwMS) showed more passive coping, less perceived social support and greater anxiety and alexithymia. The bidirectional hypothesis was confirmed with self-reported stress and functionality. Coping and anxiety showed a moderator effect. Conclusions: stress and MS may follow a deteriorating cycle. Psychotherapeutic interventions should be conducted in early stages of MS to improve functionality and quality of life in pwMS.
L’efecte de l’estrès en l’Esclerosi Múltiple (EM) ha mostrat resultats diversos. L’heterogeneïtat en l’avaluació de l’estrès i la presencia de factors mediadors/moderadors poden ser-ne la causa. Objectius: analitzar l’efecte de l’estrès en l’EM (aproximació transaccional) i explicar el paper moderador de l’afrontament, el suport social, l’ansietat, l’alexitimia i l’estrès primerenc. Mètodes: l’estudi té tres fases; una revisió sistemàtica, un estudi cas-control (n=82), i un estudi longitudinal de seguiment d’un any (n=26). L’anàlisi va incloure models jeràrquics lineals i mixtes. Resultats: les persones amb EM van mostrar un afrontament més passiu, menys suport social i més ansietat i alexitimia. La hipòtesi bidireccional es confirmà amb mesures auto-reportades d’estrès i funcionalitat. L’afrontament i l’ansietat mostraren un efecte moderador. Conclusions: l’estrès i l’EM poden seguir un cicle deteriorant. Les intervencions psicoterapèutiques s’haurien d’implementar en els primers estadis de l’EM per millorar la funcionalitat i la qualitat de vida en les persones amb EM.

Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population.

The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades.

In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire.

Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively.

In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well.

There is evidence that emotional and behavioural (psychosocial) factors influence the natural history of coronary artery disease (CAD) and the incidence of acute coronary syndromes (ACS). However there are many inconsistencies in the methodologies and results of existing studies, and carefully controlled data are scarce. This thesis examines the theoretical background and mechanisms by which psychosocial factors influence ACS. The evidence assessing timing and triggering of ACS, mental stress-induced myocardial ischaemia and the role of psychosocial factors in the development of CAD and ACS is examined. This information is used to identify areas in which there is currently a lack of knowledge and generate several hypotheses which are tested in three studies. Firstly, a prospective, multi-centre cohort study was performed, interviewing ACS patients within 4 days of hospital admission. Case-crossover methodology was used to assess the impact of acute psychosocial factors on ACS triggering. Increased relative risk of ACS following acute mental stress, anger or depression was demonstrated, and these factors interacted with social and temporal factors affecting ACS incidence. Clinical, electrocardiographic and biochemical correlates were also analyzed, and an increased incidence of ST segment elevation and greater release of markers of myocyte necrosis was observed in patients exposed to acute psychosocial triggers. Secondly a laboratory study was conducted to assess the effects of mental stress upon haemostatic and haemodynamic responses in CAD patients compared with age-matched healthy controls. This demonstrated abnormal blood pressure, peripheral resistance and platelet responses to mental stress in CAD patients. The third study examined psychobiological reactivity in a sub-set of patients from the first cohort study, assessing correlations between laboratory stress-reactivity, clinical findings and psychosocial exposure at ACS onset. This demonstrated that social deprivation affects haemodynamic and platelet psychobiological reactivity, and that patients with trigger-induced ACS display greater platelet stress-reactivity than controls. The implications of these findings for future research and therapeutic interventions are discussed.

Sex offender legislation is designed to make communities feel safer, with little or no empirical data utilized in the law's creation. The existing research indicates that rates of rapes have decreased since major sex offender legislation was developed and implemented. However, the research has also demonstrated that no significant effect occurred regarding recidivism rates following the passage of sex offender legislation.

Self-regulatory abilities have a great significance for a child’s optimal development and so far it is important to explore which of the factors are associated with individual self-regulatory differences. The aim of the doctoral work is to explore the main biological and psychosocial (family environment) factors of self-regulation, which of them account for self-regulatory abilities at the age of four years. The work is conceptualized in the term of the ecological and transactional theory. On the level of dimensions the two-dimension model of hot and cool self-regulation is chosen. The participants of the study were 142 children (71 boy and 71 girls). The data collected on the second or third day after delivery, 3 months, 6 months, 12 months, 18 months, 2 years, 3 years and 4 years is reported. There were two sources of the information about children’s self-regulation at four years: maternal reports and observational measures. Higher hot self-regulation was related to female gender, delivery by emergency Caesarean section, and better maternal emotional state during the 2nd and 3rd years of the child’s life. Higher cool self-regulation was related to greater age, higher parental education, higher child’s reasoning ability, pregnancy planning, and better evaluated quality of a couple’s relationship. Maternal reports of self-regulation were directly predicted by maternal supportive responses and maternal self-efficacy, though the maternal early depression had an indirect effect... [to full text]
Savireguliacijai gebėjimai yra labai svarbūs optimaliai vaiko raidai, todėl svarbu aiškintis, kokie veiksniai yra susiję su individualiais vaiko savireguliacijos skirtumais. Pagrindinis darbo tikslas yra įvertinti pagrindinius vaikų savireguliacijos biologinius ir psichosocialinius (šeimos aplinkos) veiksnius, kurie iš jų geriausiai paaiškina ketverių metų vaikų savireguliacijos gebėjimus. Darbas yra konceptualizuojamas remiantis ekologine ir transakcine teorija. Savireguliacijai tirti dimensijų lygmenyje yra pasirinktas „karštos“ ir „šaltos“ savireguliacijos modelis. Tyrime analizuojami duomenys apie 142 vaikus (71 berniuką ir 71 mergaitę). Empirinė medžiaga buvo renkama 8 tyrimo pjūviais: antrą – trečią dieną po vaiko gimimo, praėjus 3 mėn., 6 mėn., 12 mėn., 18 mėn., 2 metams, 3 metams ir 4 metams po gimimo. Savireguliacijai įvertinti buvo pasitelkti du informacijos šaltiniai: motinos stebėjimu paremti duomenys ir psichologinio testavimo rezultatai. Nustatyta, kad didesnė „karšta“ savireguliacija yra susijusi su tokiais veiksniais: mergaitės lytis, gimimas po skubaus cezario pjūvio ir gera motinos emocinė būsena antraisiais ir trečiaisiais vaiko gyvenimo metais, o didesnė „šalta“ savireguliacija – su vyresniu vaiko amžiumi, aukštesniu tėvų išsilavinimu, didesniais vaiko samprotavimo gebėjimais, planuotu nėštumu, motinos geriau įvertintais santykiais su sutuoktiniu antraisiais ir trečiaisiais vaiko gyvenimo metais. Motinos įvertintą vaikų savireguliaciją tiesiogiai... [toliau žr. visą tekstą]

The conventional sources to assess cortisol levels are saliva, plasma or urine specimens, which are subject to a variety of factors and provide only momentary cortisol exposure. A rather new technique is the analysis of hair cortisol which might overcome some of the methodological issues associated with the other specimens. The aim of the PhD was two-fold. Firstly, I investigated the associations between hair cortisol concentration and different socioeconomic factors, work-related stress and psychosocial factors. Study I employed a design with two time points four years apart and therefore was able to evaluate psychosocial and socioeconomic factors cross-sectionally and as a dynamic entity. Lower income and worsening income change was associated with elevated hair cortisol. Moreover, an effect of status incongruity, a mismatch between education and income, on hair cortisol was found. Study III looked at the impact of examination stress on cortisol in hair and saliva in medical and law students. The student groups differed slightly in their hair cortisol levels at baseline and also in levels of anxiety, impeding proper conclusive findings. Perceived stress and anxiety were not related to hair cortisol but to salivary cortisol. The use of avoidant coping mechanisms was associated with elevated hair cortisol levels. My second aim was to evaluate the long-term consistency of cortisol in saliva and hair and also saliva-hair correlations over corresponding time-intervals. Using two distinct longitudinal studies (Study I and II), the findings indicate that a flatter rate of decline in salivary cortisol over the day was associated with elevated hair cortisol concentrations several years later, 4 (female sample) and 8 years ago (in men only), while no relationship could be found between hair cortisol in relation to the AUC and the CAR. Another dataset (Study III) assessing salivary and hair cortisol over corresponding intervals revealed positive associations between the AUC and hair cortisol.

Climate change and the need for taking an urgent action against it are two tightly related factors strongly characterizing the current global society. Car use and the increasing reliance on cars among people, its effects in terms of societal costs, traffic congestion and road accidents are considered a significant contributing factor to climate change. Promoting a behavioural shift towards a sustainable mode of transport is considered as a crucial strategy to ensure both a better quality of life for actual generation and a clean and sustainable environment for future generations. This dissertation investigated psychologically, how people can best be supported in understanding their modal choice and who policymakers and relevant stakeholders can be supported in handling this challenging with substantial and relevant actions. Since people handle their travel behaviours differently (e.g., depending on their attitudes, values as well as location or the environment where they live), this dissertation followed a human-centred approach to provide additional knowledge on users’ needs, perceptions and decision-making processes. Four studies on psychosocial and behavioural aspects have been conducted among academic commuters, using multiple methods and approaches. The main aim was to deepen the understanding of psychosocial factors and their relationship with situational and environmental characteristics in influencing the commuting modal choice which can be of help in crafting tailored and diversified interventions, both at organizational and policymaking level. In light of the present dissertation findings, a multidisciplinary approach seems to be essential. Indeed, a traffic management system, even if technically perfect, could not reach satisfactory standards if it is not esteemed based on users’ perceptions, motivations, social and built environment, travel behaviour reasons and preferences. In line with this perspective, this thesis contributed to understanding the role of psychosocial factors in mode choices and travel behaviours.

Introduktion: Sjukfrånvaron i Sverige är hög och kunskap om vad som påverkar återgång i arbete efter sjukskrivning behöver utvecklas. I processen kring återgång i arbete är bedömning av arbetsförmåga en viktig del. Bristen på valida, reliabla och teoretiskt förankrade bedömningsinstrument inom området är dock ett bekymmer eftersom tillförlitliga bedömningar av arbetsförmåga är en förutsättning för utformning och genomförande av interventioner för att stödja återgång i arbete. Denna typ av interventioner kräver multidisciplinär kompetens där arbetsterapeuter utgör en viktig funktion. Vid bedömning av arbetsförmåga bör personens subjektiva uppfattning om sin situation beaktas, då den har betydelse för utfallet av återgång i arbete. Worker Role Interview (WRI) och Work Environment Impact Scale (WEIS) är två arbetsrelaterade intervjuinstrument, som har utvecklats i syfte att bedöma subjektiva psykosociala och miljömässiga faktorers påverkan på arbetsförmåga. Den teoretiska grunden till WRI och WEIS är Model of Human Occupation, som är en modell med fokus på aktivitetsutförande i relation till psykosociala faktorer. Inledande prövningar av WRI och WEIS reliabilitet och validitet har genomförts. Bedömningsinstrumenten har bearbetats och översatts till svenska och används främst av arbetsterapeuter, som arbetar med personer med arbetsrelaterad problematik. Syfte: Det övergripande syftet med avhandlingen är att undersöka användbarheten av bedömningsinstrumenten Worker Role Interview och Work Environment Impact Scale för identifiering av psykosociala och miljömässiga rehabiliteringsbehov av betydelse för återgång i arbete. Metod: Avhandlingen består av fem empiriska studier. I samtliga studier har erhållen information bearbetats kvantitativt. I studie IV har även kvalitativ bearbetning genomförts. Studie I, II och IV är tvärsnittsstudier och studie II och V är två års longitudinella studier. I studie I samlades information in via enkät. I studie II, III och V bestod den huvudsakliga informationen av skattningar utifrån WRI variabler och i studie IV var bedömningar utifrån WEIS i form av skattningar och nedskrivna kommentarer till skattningarna den huvudsakliga informationen. Resultat: I studie I undersöktes vilka teoretiska utgångspunkter och professionsspecifika modeller arbetsterapeuter i Sverige ansåg påverka den psykiatriska vården och den psykiatriska arbetsterapin. Det psykosociala perspektivet var den teoretiska utgångspunkt som hade störst påverkan både på psykiatrisk vård och på psykiatrisk arbetsterapi. Den arbetsterapeutiska modell som flest identifierade var Model of Human Occupation. Detta resultat indikerar att Model of Human Occupation verkar vara användbar inom arbetsterapi och motiverade vidare användning av modellen i denna avhandling. Det som dock också framkom i studie I var att arbetsterapeuter inom psykiatrisk vård använde professionsspecifika modeller i en relativt liten utsträckning. Ett sätt att öka tillämpningen av teori i praktik är att använda teoretiskt grundade bedömningsinstrument. I studie II, III, IV och V har endera av de Model of Human Occupation- baserade bedömningsinstrumenten WRI och WEIS använts och värderats. I studie II och V prövades WRI:s förmåga att predicera återgång i arbete efter långvarig sjukskrivning. Det område i WRI som uppvisade bäst prediktivitet var området ”Självuppfattning” vars variabler beaktar personens motivation för återgång i arbete i form av personens upplevelse av kompetens och effektivitet för att utföra arbetsuppgifter och hantera utmaningar i arbetet. De två WRI variabler som bäst kunde predicera vilka som skulle återgå respektive inte återgå i arbete vid uppföljning efter två år var: ”Tro på sin arbetsförmåga”, och ”Dagliga vanor och rutiner”. Resultaten tyder på att kunskap om hur tro på den egna förmågan stärks och kunskap om dagliga vanor och rutiners påverkan på utförande av arbete är central vid genomförande av interventioner i syfte att stödja personer att återgå till arbete efter sjukskrivning. I studie III prövades WRI:s konstrukturella validitet i en internationell studie. Samtliga variabler i WRI, förutom de som tillhör miljöområdet, uppvisade en god konstrukturell validitet dvs mätte psykosociala faktorers påverkan på arbetsförmågan. WRI:s skattningsskala verkar stabil och valid mellan olika länder och för personer med olika diagnoser. I analysen framkom att WRI kunde särskilja mellan personers psykosociala arbetsförmåga på tre olika nivåer. I studie IV undersöktes hur personer med erfarenhet av långtidssjukskrivning uppfattar att faktorer i arbetsmiljön stödjer respektive hindrar personens utförande av arbete och välbefinnande genom bedömningar utifrån WEIS. De faktorer som uppfattades som mest stödjande var olika former av sociala interaktioner på arbetet samt uppfattningen om arbetets värde och mening. De faktorer som uppfattades som mest hindrande var olika krav i relation till arbetsgenomförandet samt den belöning som erhålls för arbetet. Konklusion: Sammanfattningsvis så kan WRI användas för bedömning av psykosociala faktorers påverkan på arbetsförmågan. I WRI ingår variabler som kan predicera återgång till arbete upp till två år efter genomförd bedömning. WEIS verkar användbart för att identifiera arbetsmiljöfaktorer som stödjer respektive hindrar personers välbefinnande och utförande av arbete. Att komplettera olika datainsamlingsmetoder är en förutsättning för att uppnå en så god bedömning av arbetsförmåga som möjligt. Den information som WRI- och WEISintervjuer genererar är värdefull, då den kan utgöra en viktig grund för planering av individspecifika rehabiliteringsinsatser. Bedömningsinstrumenten WRI och WEIS med sin teoretiska förankring i Model of Human Occupation kan anses vara användbara för att identifiera psykosociala och miljömässiga rehabiliteringsbehov i syfte att stödja personer i processen åter till arbete efter sjukskrivning.
Introduction: In Swedish society the sick-leave rate is high and a better understanding is required of the factors that facilitate return to work. In the return to work process, assessments of peoples’ work ability play an important role. However, the lack of usable, valid, reliable, and theoretically sound assessment instruments for assessing work ability is a concern. Credible and theoretically sound assessment methods for assessing clients’ work ability strengthen the possibilities for making valid interpretations and obtaining important information for composing further intervention strategies which can guide suitable interventions in the process of returning to work. Such interventions need multi-professional expertise. In this area occupational therapists can offer valuable contribution. In the overall assessment of work ability the unique individual’s subjective perception of the situation needs to be considered since this has been found greatly relevant for return to work. The Worker Role Interview (WRI) and the Work Environment Impact Scale (WEIS) are two work-related interview assessment instruments that have been developed to assess subjective psychosocial and environmental factors of work ability. The WRI and the WEIS have been primarily tested for reliability and validity and are theoretically founded in the Model of Human Occupation (MOHO), which is an occupation-focused model addressing psychosocial factors. They have been adapted and translated to Swedish and are used among Swedish occupational therapists working with clients experiencing work-related problems. Aim: The overall aim of this thesis was to evaluate the usefulness of the assessment instruments the Worker Role Interview and the Work Environment Impact Scale for identifying psychosocial and environmental rehabilitation needs essential for returning to work. Methods: Five empirical studies were performed, all of which were analysed quantitatively, with the exception of study IV in which both qualitative and quantitative analysing methods were used. Studies I, III and IV were cross-sectional while studies II and V were two-year longitudinal studies. In study I, data were collected by a questionnaire, in studies II, III and V the primary data constituted of ratings on the WRI items. In study IV the primary data were ratings of the WEIS items and the written notes beside the rating on each item. Results: In study I, theoretical approaches and professional models that influenced psychiatric care and psychiatric occupational therapy practice among occupational therapists in Sweden was investigated. The most common approach in psychiatric care was the psychosocial approach, and the practice model which was most often used was the Model of Human Occupation. The results indicated that the psychosocial approach and the Model of Human Occupation seemed applicable in occupational therapy, motivating further use of that model. However, it was also found that occupational therapists in psychiatric care used professional practice models to a rather low extent. One way to enhance the application of theory into practice is the use of theory- based assessment instruments. Consequently, the Model of Human Occupation- based assessment instruments, the WRI and the WEIS, have been evaluated and used in the other studies in the present thesis The value of the WRI for predicting return to work after long term sick-leave was investigated in studies II and V. The content area in the WRI with best overall predictive validity for return to work was ‘Personal causation’. Its items focus on the individual’s motivation for return to work in relation to the individual’s feeling of competence and effectiveness in doing work tasks and facing challenges at work. The two WRI items which best predicted whether the participants would be in the working or the non-working groups at the two-year follow up were ‘Expectations of job success’, which concerns beliefs in personal abilities in relation to returning to work, and the item ‘Daily routines’ which concerns the individual’s routines and organisation of time outside work. These results suggest that knowledge about how to strengthen the person’s belief in his or her abilities, how routines impact occupational performance, and how to support the individual in structuring his or her daily doings are needed in interventions aiming at supporting the individual to return to work. In study III the construct validity of the WRI was investigated in an international study. All the WRI items except those related to the environment area seemed to capture the intended construct of the WRI, namely psychosocial ability for return to work. The construct of the WRI seems to be stable and valid across different countries and populations, and the WRI showed an ability to separate clients into three distinct levels of psychosocial ability for return to work. In study IV the impact of the work environment was investigated by using the WEIS among people with experiences of sick-leave. Social interactions at work and the meaning of the work had the most supportive impact and different work demands and the rewards received for the work were perceived as most interfering with work performance, well-being, and satisfaction. Conclusion: The WRI seems to be suitable for estimating psychosocial work ability. In addition it contains items which can predict return to work up to two years after the assessment is conducted. The use of the WEIS revealed supportive and interfering factors for work performance, well-being, and satisfaction among people with experiences of long term sick-leave. The interview format of the WRI and the WEIS seems valuable since it provides comprehensive information which can contribute to the planning of rehabilitation interventions for the unique client. Thus, the WRI and the WEIS, which are theoretically founded in the Model of Human Ocupation are juged to be useful for identifying psychosocial and environmental rehabilitation needs in order to support the individual in returning to work after sick-leave.

Despite a rise in the number of studies looking at the relationship of psychosocial factors (coping style, personality type, and social support) on HIV/AIDS severity, there remains a lack of conclusive answers about the specific association between these factors. This study used a meta-analytic method of analysis to address these issues in the post anti-retroviral treatment modality world. A systematic search of major psychology and medical computerized databases led to 110 studies used in the meta-analysis. Social support was found to have the strongest relationship with HIV progression. Structural social support had greater protective effect on HIV progression than functional social support. A significant relationship between coping type and HIV severity was found, with a greater protective benefit seen in studies that utilized CD4 count as the outcome variable. Positive coping had a beneficial effect on HIV progression while passive and negative coping had a detrimental effect on disease progression. Among studies of personality, a weak relationship was found between personality type and HIV severity. In conclusion, the meta-analytical review found significant associations between psychosocial factors and HIV severity that could be used to refine individual treatment plans for people living with HIV/AIDS.