Rozprawy doktorskie na temat „Mental discipline”

The psychological sciences offer a large spectrum of theories, principles, and methodological approaches to understand mental health, normal and abnormal functions and behaviours, as well as mental disorders. Based on continued research progress, psychology has derived a wide range of effective interventions for behaviour change and the prevention, treatment and rehabilitation of mental disorders. Thus, psychology and clinical psychology in particular should be regarded as the ‘mother’ science for psychotherapy and psychotherapeutic practice. This paper provides a selective overview of the scope, strengths and gaps in psychological research to depict the advances needed to inform future research agendas on mental disorders and psychological interventions in the context of psychotherapy. Most maladaptive health behaviours and mental disorders can be conceptualised as the result of developmental dysfunctions of psychological functions and processes, and as associated neurobiological and genetic processes in interaction with behaviour and the environment. An integrative translational model, linking basic and experimental research with clinical research and population-based prospective longitudinal studies is proposed for improving identification of critical core vulnerability and risk factors and core pathogenic mechanisms. The proposed framework is expected to allow a more stringent delineation of targeted preventive and therapeutic psychological interventions and an optimisation and better understanding of cognitive-behavioural therapies and other psychological interventions. Based on a European consultation process, a ‘Science of Behaviour Change’ programme with the promise of improved diagnosis, treatment and prevention of both healthrisk behaviour constellations and mental disorders is proposed.
Psychologie als «Mutterwissenschaft» für Psychotherapie und psychische Gesundheit Psychologie als Wissenschaft bietet ein breites Spektrum an Theorien, Grundlagen und methodischen Ansätzen, um psychische Gesundheit, normale und gestörte Funktionen und Verhaltensweisen sowie psychische Störungen zu erforschen und zu «verstehen». Auf dieser Grundlage haben sich in der Klinischen Psychologie vielfältige effektive, psychologisch begründete Interventionen für die Prävention, Behandlung und Rehabilitation von psychischen Störungen ausdifferenziert. Damit ist die Psychologie als «Mutterwissenschaft » der Psychotherapie und psychotherapeutische Praxis anzusehen. Der Beitrag versucht auf der Grundlage einer Stärken-/Schwächen-Analyse der psychologischen Forschung diejenigen Themenbereiche zu definieren, die für Erkenntnisfortschritte bei psychischen Störungen und die psychotherapeutische Interventionsforschung besonders vielversprechend sein könnten. Dysfunktionale bzw. abweichende Verhaltensweisen wie auch psychische Störungen lassen sich als entwicklungsbezogene Störungen psychologischer Funktionen und Prozesse und damit assoziierter neurobiologischer und genetischer Prozesse konzeptualisieren. Für eine verbesserte Identifikation von zentralen Vulnerabilitäts- und Risikofaktoren sowie ätiologisch relevanten Schlüsselprozessen wird ein integratives translationales Modell vorgeschlagen, welches die Grundlagen- und experimentelle Forschung mit klinischer Forschung, Translation und Public-health-Implikationen verknüpft. Damit soll auf der einen Seite eine stringentere Ableitung gezielter Interventionen erleichtert werden, andererseits aber auch eine bessere Identifikation der zentralen Wirkfaktoren und Wirkprozesse psychologischer Therapien ermöglicht werden. Basierend auf einem europäischen Experten-Beratungsprozess wird ein EU-Programm ‘The science of behavior change’ angeregt.

Over the period of the last century in the United Kingdom mental health nursing roles have evolved and adapted in response to changes in mental health related policy and associated changes in the ethos, structure and delivery of mental health services. The conceptual framework informing this thesis drew upon the theoretical perspective of symbolic interactionism underpinning a qualitative, grounded theory approach augmented with the use of situational analysis to explore the processes involved in the development and maintenance of professional role congruity. 'Role congruity' is defined as a functional balance between aspects of role adequacy, role legitimacy and role support. Nine student and ten registered mental health nurses were depth interviewed between 2012 and 2016. Analysis of data was conducted using grounded theory data analysis approaches, with the research context incorporated into analysis using the mapping processes of situational analysis. This analysis yielded the formulation of a grounded theory model entitled 'Establishing Role Congruity', capturing the processes involved in developing and maintaining professional role congruity for this group of mental health nurses. Situational analysis enriched this model by contextualising the captured processes within 'social worlds' and discourses evident within the mental health practice arena. On the basis of this analysis, a conceptual model of 'Role Congruity Alignment' is proposed together with recommendations for contemporary and future mental health nursing roles with regard to the balance between 'generic/eclectic' functions and roles specialising in terms of service user groups and/or therapeutic interventions. Attendant implications for the initial education and subsequent continuing professional development of mental health nurses are summarised.

Major challenges facing sport psychology researchers, practitioners, coaches, and athletes include understanding mental toughness and knowing how to train for it. Athletes and coaches have long identified mental toughness as an important attribute for performance. Practitioners have devised training approaches for mental toughness—often based on anecdotal notions of what mental toughness is and how it should be developed. The research available on mental toughness is scarce, with only a few recent but limited advances. Fundamental to the challenge of understanding and training mental toughness, there is a critical need for research to develop a model of mental toughness that is not based on anecdote, but rather on sound research methods and theoretical underpinnings. Following on from conceptualisation, there is a need to develop an instrument to measure mental toughness. Taken together, a conceptual model and a measurement approach are the tools needed by researchers to develop and test mental toughness training programs. The purpose of this thesis was to address some of these issues by capitalising on the strengths of both qualitative and quantitative methods to: (a) critically examine a popular test of mental toughness; (b) determine specific characteristics of mental toughness and understand the interrelationship between those characteristics; (c) develop a model of mental toughness that draws together specific characteristics; (d) produce a mental toughness definition; (e) develop the Mental Toughness Inventory, a robust and valid instrument that demonstrates a sound factor structure, strong reliabilities, and invariance across gender, age, and level of competition (i.e., demonstrating within-network validity); and (f) determine the relative congruence between scores on the Mental Toughness Inventory and theoretically related constructs (i.e., demonstrating between-network validity). In line with these aims, Study 1 evaluated the psychometric properties of an existing, popular, and yet unsubstantiated test of mental toughness—the Psychological Performance Inventory (PPI). Given the breadth and depth of mental toughness as evidenced by the literature, the PPI was not expected to provide a reasonable model. Instead, the study was intended to inform the researcher on the psychometric strengths of the PPI and guide the development of a new measure of mental toughness throughout the remainder of the thesis. The PPI was examined using both within-network and between-network validity checks and responses from 263 student-athletes in Years 7–12 (12 to 19 years of age). Study 2 was a qualitative study that examined the interview data of over 30 elite sportspeople to determine the characteristics of mental toughness. The purpose of this study was to develop a conceptual model and definition of mental toughness that draws together all the characteristics in a way that adds meaning and clarity to the concept. The purpose of Studies 3 and 4 was to construct, refine, and validate the Mental Toughness Inventory (MTI)—a measure of mental toughness emanating from the findings of Studies 1 and 2. Studies 3 and 4 critically examined the construct validity of the MTI using both within-network and between-network validation on the basis of responses from institution-based athletes (from sports programs such as those run by the Australian Institute of Sport) and school-based athletes (from a selective sports high school). Furthermore, Studies 3 and 4 provided the scope to examine invariance of the mental toughness factor structure across groups, group mean-level differences, and interaction effects. The results of Study 1 provided a number of insights into the status of the PPI, raised an interesting conundrum regarding the interface between conceptualisation and instrumentation, and provided guidance for instrument development that would become the empirical basis of subsequent quantitative studies. The qualitative results of Study 2 unearthed a multidimensional model of mental toughness, containing 12 first-order factors each of which contribute to a higher order (or Global) mental toughness factor. The 12 mental toughness characteristics identified are: self-efficacy, potential, mental self-concept, value, personal bests, commitment, stress minimisation, perseverance, positive comparisons, positivity, task familiarity, and task focus. Study 3 involved the construction of the Mental Toughness Inventory (MTI), with results revealing excellent validity from a within-network perspective (including confirmatory factor analysis, goodness of fit, internal reliability, and invariance across groups). Study 4 results revealed that MTI factors correlated more strongly with theoretically-related concepts and less strongly with unrelated concepts—thus demonstrating between-network validity (convergent and discriminant). Study 4 also revealed a number of significant main effects of age (favouring older athletes), gender (favouring male athletes) and group (a contextual effect where institution-based athletes rate themselves more ―rigorously relative to strong contextual effects, which need to be carefully considered when assessing and developing mental toughness. For sporting organisations, this research points to a number of things that can be done at an institutional level—particularly in relation to creating an environment that is most likely to facilitate the positive development of various components of mental toughness. Finally, for research and continued theorising about mental toughness, the findings from this thesis support viewing mental toughness as a combination of cognitive, behavioural, and emotive processes that work together in combating adversity or pressure. Taken together, the conceptualising and empirical works conducted in this study are proposed to advance the field of research—creating opportunities to study the effectiveness of interventions designed to enhance mental toughness. Furthermore, the results provide practitioners, coaches, and athletes with a concrete understanding of mental toughness such that they are better equipped to devise training approaches and to handle pressure and adversity en route to athletic success.

Thesis (Ph.D.)--University of Western Sydney, 2007.
A thesis submitted to the University of Western Sydney, School of Psychology, in fulfilment of the requirements for the degree of Doctor of Philosophy (Psychology). Includes bibliography.

The professional turn in sports has prompted the search for explanations beyond the physical when discussing quality of performance. Mental Toughness has been recognised as one of the most important psychological attributes in achieving performance excellence across multiple sport settings. Yet, despite this, little research has been conducted into mental toughness development. This research seeks to answer the question: What insights can the development and implementation of a mental toughness programme for a semi-professional South African cricket team provide regarding Mental Toughness development? Based on a theoretical framework of mental toughness in cricket, a programme was developed in collaboration with the Border Cricket Team and Coaches. Incorporating elements that focussed on education, environment, awareness and mental skills, the programme was implemented in both individual and group settings during the off- and pre-seasons. An analysis of the participants’ experiences identified the need for a theoretical understanding of mental toughness within teams, facilitating the design of interventions that integrate the team and the individual. Future programmes should include measures of mastery, and individually customised approaches to mental toughness enhancement that acknowledge the potential contextual and individual variation in mental toughness.

Modern research being conducted on Mental Toughness is now shifting away from efforts aimed at developing definitions for the construct and instead moving toward efforts at understanding its development. This particular research study focuses on the development and implementation of a Mental Toughness programme designed specifically for, and tailored exclusively to, the needs of schoolboy cricket at Kingswood College in Grahamstown, Eastern Cape. The programme development was an intricate process and the research procedure was guided by the Organisational Development Process model. Data from a focus group as well as various individual interviews were integrated with currently existing Mental Toughness literature and theory to devise this particular Mental Toughness programme. The programme entails educating the athletes on six specific mental skills and incorporates elements of practical application as well as awareness of the importance and influence of Mental Toughness and mental training in a sporting sphere. The programme took the form of mental skills workshops held over a three week period. An analysis was conducted post-programme to document the experience of the athletes as a result of exposure to the programme. Results drawn from the array of analysis procedures were used to help identify the level of success of the Mental Toughness intervention as well as help validify current Mental Toughness models. In addition to highlighting the benefits as a result of the programme experience, various recommendations were drawn in order to shed light on the programme limitations and assist future researchers with understanding the intricacies behind better and more efficient programme implementation.

The state´s responsibility for the health and well-being of the population was part of the development towards the welfare state. Government agencies at various levels were helpful in surveys and were also the state´s tool for enforcing social policy goals. The main purpose of the essay is to investigate in what way mental health care 1935-1939 was a tool for the growth of the welfare state. The pronounced questions are about what mental health care looked like regarding patients’ activation, mental care in families’ homes, sterilization and forensic psychiatry, and in what way mental health care can be said to have been a state administrative unit. The investigated material is documents from the administration at St. Olof's Hospital in Visby and the source material is examined on the basis of Michel Foucault's theories on discipline, control, exclusion mechanisms and biopolitics. The result of the essay is that mental health care and St. Olof's Hospital can be seen as one of the tools for the growth of the welfare state both as part of the administration, as a prerequisite for biopolitics, and as an entertainer and messenger of norms and discipline.

The New South Wales Medical Board established a Health Programme for the assessment and rehabilitation of doctors whose clinical performance was impaired by alcohol or psychoactive substance use, mental or physical illness. This programme was developed to be individualized to the needs of each registrant. The present study has three aims: 1. To describe those doctors who participated in the Board???s Health Programme. 2. To chart the duration of involvement of these doctors through the programme. 3. To examine the outcomes associated with this programme. The study is based on the prospective cohort of all 181 impaired doctors who participated in the Health Programme between July 1st 1993 and April 30th 2001. Information on each registrant was collected at the time of the initial assessment and at each review conducted as part of the programme. Additional qualitative data was also collected and supplemented by a file audit conducted in August and September 2001. One hundred and eighty-one doctors were prospectively monitored as part of this study. The largest source of impairment was psychiatric illness (45.3%), 77% of the doctors were male. The average age of the cohort was 41.6 (sd 11.1) years. Impaired doctors were more likely to be working in emergency medicine or psychiatry and be based in a rural area. Of those who had finished their involvement in the programme, successful graduates participated for a mean of 38.2 (sd 22.3) months. In general outcomes of involvement were positive, 64 of 113 (56.6%) of doctors successfully graduated from the programme. One hundred and ten of 168 (65.5%) improved during the period of their involvement and 111 of 126 (88.1%) were working in medicine. Five, 2.8% of the participants died during the period of this study. Measures of registrant insight and support tended to increase during the period of involvement with the Health Programme. Future studies will need to establish evidence for the most appropriate interventions with impaired doctors. This process would be strengthened by the collection of standardized data across intervention programmes, supplemented with functional assessments and the collection of qualitative data.

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This dissertation examines the legal regulation of involuntary psychiatric hospitalization, the main legal instrument becomes the 10.216/2001 Act, known as the Brazilian Psychiatric Reform Law. In a democratic state of law, the fundamental mission of ordinary legislator, at all levels, is to make effective the values enshrined in the Constitution, notably the fundamental rights. This is the central premise of the inquiry conducted with this dissertation. It has been approached, then, the theory of fundamental rights, as well as the one about social rights, focusing on the right to health, all in order to prepare and support the critical analysis of the specific legislation for involuntary psychiatric hospitalizations. In addition, still as a preparatory stage and to better understand the context of the Brazilian Psychiatric Reform, it has been explained how the so called mental hospitals have appeared and how the need for the humanization of mental health care has become a worldwide concern over the undignified and inhumane treatment of asylum. Anyway, we decided to bring data that subscribes UN guidelines, as well as a study of Portuguese and Argentinian legislation on psychiatric hospitalization, especially involuntary, with the purpose of conducting a mapping of the needs, problems and solutions most relevant to theme, to be used as a historical frame of reference in understanding the national order. Aligns hypotheses of situations protectable by a mental health legislation and suggests that an interpretation according to the constitution allows a greater range for the mental health law in Brazil. It was found that in the Brazilian legal order there are instruments to protect the fundamental rights of all those affected by involuntary psychiatric admissions, especially those of people with mental disorder. Doctrine, legislation and case law the resources used through a search of a qualitative approach. Keywords: Fundamental rights. Mental health. Brazilian psychiatric reform. Involuntary psychiatric hospitalization.
Esta dissertação analisa a disciplina jurídica das internações psiquiátricas involuntárias, cujo principal diploma legal é a Lei 10.216/2001, conhecida como a Lei da Reforma Psiquiátrica Brasileira. Num Estado Democrático de Direito, missão fundamental do legislador infraconstitucional, em todos os níveis, é a realização os valores consagrados na Constituição, notadamente os direitos fundamentais. Esta e' a premissa central da investigação realizada na presente dissertação. Foi feita, portanto, uma abordagem da Teoria dos Direitos Fundamentais, bem como dos direitos sociais, focalizando no direito à saúde, tudo de modo a preparar e fundamentar a análise crítica da legislação específica relativa às internações psiquiátricas involuntárias. Ademais, ainda como etapa preparatória e para melhor compreender o contexto da Reforma Psiquiátrica Brasileira, explica-se como surgiram os chamados manicômios e de como a necessidade de humanização dos cuidados com a saúde mental foi tornando-se preocupação mundial face à forma indigna e desumana de tratamento manicomial. Enfim, optou-se por trazer dados que perfilham as diretrizes da ONU, bem como um estudo da legislação portuguesa e da argentina sobre as internações psiquiátricas, especialmente a involuntária, com a finalidade de realizar um mapeamento dos anseios, problemas e soluções mais relevantes sobre a temática abordada, a ser utilizado como quadro de referencia histórico na compreensão do ordenamento nacional. Alinha hipóteses de situações tuteláveis por uma legislação de saúde mental e sugere-se que uma interpretação conforme à constituição permite um maior alcance da Lei de saúde mental brasileira. Verificou-se que no ordenamento jurídico brasileiro existem instrumentos de proteção dos direitos fundamentais de todos aqueles afetados por internações psiquiátricas involuntárias, principalmente aqueles dos portadores de transtorno mentais. Doutrina, legislação e jurisprudência serão as fontes bibliográficas utilizadas, por meio de uma pesquisa de abordagem do tipo qualitativa. Palavras-chave: Direitos fundamentais. Saúde mental. Reforma psiquiátrica brasileira. Internação psiquiátrica involuntária.

El objetivo de la presente investigación fue analizar la relación que existe entre la Autoeficacia y la Fortaleza Mental en Deportistas Federados de Disciplinas Individuales de Lima Metropolitana, para ello se evaluaron 144 deportistas de cuatro disciplinas (Karate, Judo, Taekwondo y Atletismo). Se utilizó la escala de autoeficacia general (Grimaldo, 2010) y el Cuestionario de la Fortaleza Mental en el deporte (Sheard et al., 2009). Los resultados muestran que la relación entre ambas variables es positiva y estadísticamente significativa. Además, cabe mencionar la relación positiva entre la Autoeficacia con la Edad de los participantes y la correlación directa entre la Fortaleza Mental con los días/horas que entrenan los deportistas.
Abstract The objective of this research was to analyze the relationship between Self-Efficacy and Mental Strength in Federated Athletes of Individual Disciplines of Metropolitan Lima, for which 144 athletes from four disciplines were evaluated (Karate, Judo, Taekwondo and Athletics). We used the general self-efficacy scale (Grimaldo, 2010) and the Mental Strength Questionnaire in sports (Sheard et al., 2009). The results show that the relationship between both variables is positive and statistically significant. In addition, it is worth mentioning the positive relationship between self-efficacy with the age of the participants and the direct correlation between Mental Strength and the days / hours that athletes train. No significant differences were found between the sex of the participants in both variables.
Tesis

Il presente elaborato proporrà delle riflessioni intorno al lavoro osservato all' interno dei progetti SIPROIMI d'accoglienza migranti. Tramite l'esperienza etnografica svolta nel SIPROIMI per persone con disagio mentale, la discussione tenterà di intersecare quanto osservato con una revisione bibliografica, a partire da quanto emerso sul campo. Aiutandomi con il diario di campo, infatti, tenterò un'analisi delle due etichette osservate ("richiedente asilo" e "malato mentale") per poi riflettere sulle modalità di intervento dell'équipe multidisciplinare del servizio, con particolare attenzione alla mansione degli operatori sociali.

Aquesta tesi parteix del supòsit que els malestars expressats pels treballadors i les treballadores socials entorn de la identitat professional es troben directament relacionats amb les dificultats de consolidació de la disciplina. L’exploració d’aquest plantejament s’ha acotat a un dels espais específics en què actua el treball social, com és la salut mental. La recerca s’ha focalitzat en l’anàlisi de cinc dimensions vinculades a aquesta configuració disciplinària: l’objecte d’intervenció; la dimensió teòrica; l’avaluació de les intervencions; els espais interdisciplinaris, i la relació entre ideologia i deontologia. Des d’un punt de vista metodològic, s’ha emprat una perspectiva d’investigació qualitativa centrada en els discursos professionals. Les tècniques utilitzades han estat l’entrevista i els grups de discussió. La mostra, de tipus intencional, ha estat formada per treballadors i treballadores socials de l’àmbit de la salut mental a Catalunya. A tall de conclusió, es mostren en primer lloc els resultats obtinguts per a cadascuna de les cinc dimensions. Finalment, se sintetitza el conjunt dels discursos d’acord amb tres categories que representen maneres diferents de projectar la identitat professional.
Esta tesis parte del supuesto que los malestares expresados por los trabajadores y las trabajadoras sociales en torno a la identidad profesional, se encuentran directamente relacionados con las dificultades de consolidación de la disciplina. La exploración de este planteamiento se ha circunscrito en uno de los espacios específicos en los que actúa el trabajo social, como es la salud mental. La investigación se ha focalizado en el análisis de cinco dimensiones vinculadas a esta configuración disciplinar: el objeto de intervención; la dimensión teórica; la evaluación de las intervenciones; los espacios interdisciplinarios; y la relación entre ideología y deontología. Desde un punto de vista metodológico, se ha utilizado una perspectiva de investigación cualitativa centrada en los discursos profesionales. Las técnicas utilizadas han sido la entrevista y los grupos de discusión. La muestra, de tipo intencional, ha estado conformada por trabajadores y trabajadoras sociales del ámbito de la salud mental en Cataluña. A modo de conclusión, se muestran en primer lugar los resultados obtenidos para cada una de las cinco dimensiones. Finalmente, se sintetizan los discursos de acuerdo a tres categorías que representan formas diferentes de proyectar la identidad profesional.
This thesis is based on the assumption that the concerns expressed by social workers with regard to professional identity are directly related to the difficulties of consolidation of the discipline. The exploration of this approach has been targeted on one of the specific areas in which social work operates, namely mental health. The research has focused on the analysis of five dimensions linked to the discipline: the object of the intervention; the theoretical dimension; the evaluation of interventions; the interdisciplinary areas; the relationship between ideology and deontology. From a methodological point of view, a qualitative research perspective focusing on professional discourses has been used. The techniques used were the interview and discussion group. The sample, a purposive one, has been made up of social workers in the field of mental health in Catalonia. In conclusion, the results obtained for each of the five dimensions are shown first. Finally, the discourses according to three categories that represent different ways of projecting professional identity have been summarized.

Adults with mental illnesses are at an increased risk to be diagnosed with one or more comorbid physical illnesses compared to the general population. Much of the disparities faced by adults with serious mental illnesses (SMI) can be attributed to medication side effects, increased risk for metabolic diseases, inability to communicate about severity and monitor physical health symptoms, poor health behaviors, high rates of smoking, and poor quality health care. The rate of physical illnesses for adults with mental illnesses are even higher among those who have been involved with the criminal justice system. In order to understand the relationship between physical and mental illnesses, longitudinal study designs are needed. Longitudinal studies can provide greater understanding of the temporal relationship of physical and mental illnesses. Despite the benefits of longitudinal studies, there also are challenges, including missing data. The first manuscript of this dissertation explores the physical and mental health status of adults with mental illnesses. Secondary data were used from three different studies: a sample of adults with SMI enrolled in a mental health court jail diversion program (n=91); a sample of Medicaid enrollees with SMI in Florida (n=688) who were part of a larger Substance Abuse and Mental Health Services Administration (SAMHSA) study; and a sample of inpatient and outpatient adults with SMI from five different study sites (n=969). The samples were combined into two data sets, consisting of the jail diversion sample and the SAMHSA sample, and the jail diversion sample and the 5-site sample. Participants in these samples answered questions on the Short-Form Health Survey (SF-12), recent arrests, drug and alcohol use, socio-demographic information, and mental illness symptom severity (measured only in the criminal justice and 5-site samples). Overall, the mental and physical health status scores were significantly lower for all of the participants compared to the general population mean scores. The participants reporting a recent arrest had a higher physical health score compared to those who did not have a recent arrest, and in the jail diversion and 5-site sample, had a lower mental health status score than those without a recent arrest. After taking age, drug and alcohol use, and psychiatric symptom severity into account, arrest was no longer associated with the physical health status score in either of the data sets. In the jail diversion and 5-site data set, arrest was still significantly associated with mental health status score after controlling for age, drug and alcohol use, and psychiatric symptom severity. The second manuscript of this dissertation explores the analysis of missing data in a longitudinal study to determine the missing data mechanisms and missing data patterns, and subsequently, how to prepare the data for analysis by using multiple imputation or maximum likelihood estimation. Secondary data were drawn from the same jail diversion sample as in the first manuscript. Data were collected at baseline, three months, six months, and nine months. Only participants with the potential to have data collected at these time points were included (n=50). Analysis revealed missing data due to missing item-level information, missing participant data at one time point but complete data at a subsequent time point, and missing participant data for those who dropped out of the study completely. The missing data mechanism for the missing item-level data were missing completely at random, whereas the participant-level missing data were missing at random. Multiple imputation was used for the item-level data and for the participant-level missing data. Maximum likelihood estimation was also used for the participant-level missing data and compared to the multiple imputation results. Findings suggest that multiple imputation produced more accurate parameter estimates, possibly due to the small sample size. The findings from this study indicate that more research needs to be done to fully understand the physical illnesses experienced by adults with mental illnesses who are involved with the criminal justice system. Understanding mental and physical illness comorbidity is important in public health as it dictates appropriate treatments and training for behavioral health practitioners and staff. In addition, missing data in longitudinal studies cannot be ignored, as it can bias the results, and appropriate techniques for exploring the missing data must be used. When missing data is ignored in analyses, the subsequent results can be incorrect and unable to detect treatment effects, thereby preventing effective programs from receiving necessary funding. In addition, ignoring missing data can impact funding for behavioral health services by underestimating the prevalence and severity of mental illnesses. Future research should focus on exploring how mental and physical health are related in adults with a recent arrest compared to the general population, and ways to integrate services to address both mental and physical health.

La ricerca in oggetto ha analizzato le relazioni tra migrazione e salute mentale nel Distretto di Pianura Est dell'AUSL di Bologna. Attraverso un dispositivo d’indagine multi-disciplinare basato sui quadri teorici dell'Antropologia Medica Critica, della Salute Pubblica e della Psichiatria, la ricerca si è inserita nell’ampio contesto di sperimentazione di un innovativo modello di assistenza per pazienti migranti, denominato Centro di Consultazione Socio- Culturale. L'architettura dello studio si rifà a un modello di Ricerca-Azione Partecipata e Multi-Situata fondato su un approccio analitico e auto-riflessivo, il quale ha consentito di problematizzare, oltre alle azioni e alle traiettorie dei vari soggetti che operano nel campo della ricerca, anche le categorie oggetto della ricerca stessa. L'analisi, profondamente radicata nel dato empirico, è stata condotta a partire dall'esperienza degli attori sociali coinvolti. Le esperienze, le informazioni e le rappresentazioni reciproche sono state co-costruite in forma partecipativa attraverso l'uso combinato di metodologie quali-quantitative proprie sia delle discipline sanitarie sia di quelle sociali. Come materiali della ricerca sono stati utilizzati: dati primari e secondari prodotti dalle istituzioni e dalle organizzazioni del territorio stesso; informazioni provenienti dall'osservazione partecipante; colloqui con informatori-chiave; interviste semi-strutturate con decisori politici, amministratori, organizzazioni del territorio, operatori dei servizi, cittadini e pazienti. La ricerca ha dimostrato la validità delle prospettive teoriche utilizzate e delle strategie di lavoro proposte. Il modello di lavoro multi-disciplinare e multi-metodologico si è rivelato produttivo nell'indagare congiuntamente le prospettive degli attori coinvolti insieme alle loro traiettorie, alle reciproche interconnessioni e alle relazioni tra processi locali e globali. L’analisi auto-riflessiva ha consentito di analizzare le attività del Centro di Consultazione evidenziandone vantaggi e limiti. Infine, la collaborazione tra Salute Pubblica e Antropologia Medica Critica ha dimostrato una grande potenzialità e produttività sia sul versante della ricerca scientifica sia su quello dell'assistenza sanitaria.
This research has analysed the relationship between migration and mental health in the Distretto di Pianura Est of Bologna AUSL. Through a multi-disciplinary investigation tool based on the theoretical frameworks of Critical Medical Anthropology, Public Health and Psychiatry, the research was included in the broad context of testing an innovative model of care for migrant patients, called Socio-Cultural Advisory Centre. The study design relates to a model of Participatory and Multi-Situated Action Research, analytical and self-reflective, which made it possible to problematize, in addition to the actions and trajectories of the various actors of the research, also the categories addressed by the research. The analysis, deeply rooted in empirical data, was conducted starting from the real experience of the social actors involved. Experiences, mutual information and representations have been co-constructed in a participatory way through a combination of qualitative and quantitative methodologies well known both to social and health disciplines. The following research material was used: primary and secondary data gathered from institutions and organizations in the field; information from participant observation, interviews with key informants, semi-structured interviews with policymakers, administrators, local organizations, service personnel, citizens and patients. The research has demonstrated the validity of the theoretical perspectives that were applied and the strategies proposed. The working model of multi-disciplinary and multi-methodological approach has proved effective in investigating the perspectives of those involved as well as their own trajectories, the mutual interconnections and relationships between local and global processes. The self-reflective analysis has allowed the exploration of the activities of the Advisory Centre, highlighting advantages and limitations. Finally, the collaboration between Public Health and Medical Anthropology Critique has shown a great potential and productivity both in the field of scientific research and of health care.
A pesquisa tem analisado as relações entre o fenômeno da migração e a saúde mental no Distrito Sanitário de Pianura-Est da AUSL de Bolonha. Através de um dispositivo de indagação multi-disciplinar e multi-metodológico baseado na perspectiva da Antropologia Médica Crítica, da Saúde Pública e da Psiquiatria, a pesquisa tem se inserido na experimentação de um modelo de atendimento aos pacientes migrantes, chamado Centro de Consultação Sócio-Cultural. O esquema do estudo se inspira ao modelo da Pesquisa-Ação-Participativa e Multi-situada, baseada em um abordagem analítica e auto-reflexiva, que tem permitido problematizar, além das ações e trajetórias dos diferentes atores que operam no campo da pesquisa, também as categorias-objeto de investigação. A análise, fortemente baseada nos dados empíricos, tem sido desenvolvida a partir da experiência dos atores envolvidos. As experiências, as informações e as mútuas representações dos diferentes atores foram co-construídas de forma participava por meio de uma combinação de metodologia qualitativas e quantitativas pertencente às ciências sociais e de saúde. Como materiais de pesquisa foram utilizados: dados primários e secundários produzidos por instituições e organizações do próprio território; informações obtidas a partir da observação participante, entrevistas com informantes-chaves; entrevistas semi-estruturadas com gestores, administradores, o organizações locais, operadores dos serviços, cidadãos e os doentes. A pesquisa têm demonstrado a validade do quadro teórico e das estratégias utilizadas nos trabalho. A abordagem multi-disciplinar e multi-metodologia tem se demonstrado produtiva na investigação das perspectivas de todos os atores envolvidos, em conjunto com as suas trajetórias, as mútuas interconexões e as relações entre os processos locais e globais. A análise auto-reflexiva permitiu analisar as atividades do Centro de Consultação, destacando vantagem e limitações. Finalmente, a colaboração entre Saúde Pública e Antropologia Médica Crítica tem mostrado um grande potencial em termos de produtividade, tanto no campo da pesquisa científica tanto quanto no dos serviços de saúde.

La ricerca in oggetto ha analizzato le relazioni tra migrazione e salute mentale nel Distretto di Pianura Est dell'AUSL di Bologna. Attraverso un dispositivo d’indagine multi-disciplinare basato sui quadri teorici dell'Antropologia Medica Critica, della Salute Pubblica e della Psichiatria, la ricerca si è inserita nell’ampio contesto di sperimentazione di un innovativo modello di assistenza per pazienti migranti, denominato Centro di Consultazione Socio- Culturale. L'architettura dello studio si rifà a un modello di Ricerca-Azione Partecipata e Multi-Situata fondato su un approccio analitico e auto-riflessivo, il quale ha consentito di problematizzare, oltre alle azioni e alle traiettorie dei vari soggetti che operano nel campo della ricerca, anche le categorie oggetto della ricerca stessa. L'analisi, profondamente radicata nel dato empirico, è stata condotta a partire dall'esperienza degli attori sociali coinvolti. Le esperienze, le informazioni e le rappresentazioni reciproche sono state co-costruite in forma partecipativa attraverso l'uso combinato di metodologie quali-quantitative proprie sia delle discipline sanitarie sia di quelle sociali. Come materiali della ricerca sono stati utilizzati: dati primari e secondari prodotti dalle istituzioni e dalle organizzazioni del territorio stesso; informazioni provenienti dall'osservazione partecipante; colloqui con informatori-chiave; interviste semi-strutturate con decisori politici, amministratori, organizzazioni del territorio, operatori dei servizi, cittadini e pazienti. La ricerca ha dimostrato la validità delle prospettive teoriche utilizzate e delle strategie di lavoro proposte. Il modello di lavoro multi-disciplinare e multi-metodologico si è rivelato produttivo nell'indagare congiuntamente le prospettive degli attori coinvolti insieme alle loro traiettorie, alle reciproche interconnessioni e alle relazioni tra processi locali e globali. L’analisi auto-riflessiva ha consentito di analizzare le attività del Centro di Consultazione evidenziandone vantaggi e limiti. Infine, la collaborazione tra Salute Pubblica e Antropologia Medica Critica ha dimostrato una grande potenzialità e produttività sia sul versante della ricerca scientifica sia su quello dell'assistenza sanitaria.
This research has analysed the relationship between migration and mental health in the Distretto di Pianura Est of Bologna AUSL. Through a multi-disciplinary investigation tool based on the theoretical frameworks of Critical Medical Anthropology, Public Health and Psychiatry, the research was included in the broad context of testing an innovative model of care for migrant patients, called Socio-Cultural Advisory Centre. The study design relates to a model of Participatory and Multi-Situated Action Research, analytical and self-reflective, which made it possible to problematize, in addition to the actions and trajectories of the various actors of the research, also the categories addressed by the research. The analysis, deeply rooted in empirical data, was conducted starting from the real experience of the social actors involved. Experiences, mutual information and representations have been co-constructed in a participatory way through a combination of qualitative and quantitative methodologies well known both to social and health disciplines. The following research material was used: primary and secondary data gathered from institutions and organizations in the field; information from participant observation, interviews with key informants, semi-structured interviews with policymakers, administrators, local organizations, service personnel, citizens and patients. The research has demonstrated the validity of the theoretical perspectives that were applied and the strategies proposed. The working model of multi-disciplinary and multi-methodological approach has proved effective in investigating the perspectives of those involved as well as their own trajectories, the mutual interconnections and relationships between local and global processes. The self-reflective analysis has allowed the exploration of the activities of the Advisory Centre, highlighting advantages and limitations. Finally, the collaboration between Public Health and Medical Anthropology Critique has shown a great potential and productivity both in the field of scientific research and of health care.
A pesquisa tem analisado as relações entre o fenômeno da migração e a saúde mental no Distrito Sanitário de Pianura-Est da AUSL de Bolonha. Através de um dispositivo de indagação multi-disciplinar e multi-metodológico baseado na perspectiva da Antropologia Médica Crítica, da Saúde Pública e da Psiquiatria, a pesquisa tem se inserido na experimentação de um modelo de atendimento aos pacientes migrantes, chamado Centro de Consultação Sócio-Cultural. O esquema do estudo se inspira ao modelo da Pesquisa-Ação-Participativa e Multi-situada, baseada em um abordagem analítica e auto-reflexiva, que tem permitido problematizar, além das ações e trajetórias dos diferentes atores que operam no campo da pesquisa, também as categorias-objeto de investigação. A análise, fortemente baseada nos dados empíricos, tem sido desenvolvida a partir da experiência dos atores envolvidos. As experiências, as informações e as mútuas representações dos diferentes atores foram co-construídas de forma participava por meio de uma combinação de metodologia qualitativas e quantitativas pertencente às ciências sociais e de saúde. Como materiais de pesquisa foram utilizados: dados primários e secundários produzidos por instituições e organizações do próprio território; informações obtidas a partir da observação participante, entrevistas com informantes-chaves; entrevistas semi-estruturadas com gestores, administradores, o organizações locais, operadores dos serviços, cidadãos e os doentes. A pesquisa têm demonstrado a validade do quadro teórico e das estratégias utilizadas nos trabalho. A abordagem multi-disciplinar e multi-metodologia tem se demonstrado produtiva na investigação das perspectivas de todos os atores envolvidos, em conjunto com as suas trajetórias, as mútuas interconexões e as relações entre os processos locais e globais. A análise auto-reflexiva permitiu analisar as atividades do Centro de Consultação, destacando vantagem e limitações. Finalmente, a colaboração entre Saúde Pública e Antropologia Médica Crítica tem mostrado um grande potencial em termos de produtividade, tanto no campo da pesquisa científica tanto quanto no dos serviços de saúde.

Infants who experience multiple risk factors, such as preterm birth, developmental delay, and low socioeconomic status, are at greater risk for mental health problems. Mental health interventions for infants typically target infants from high-risk groups, and there is strong evidence that some intervention programs for infants can prevent long-term negative outcomes and promote long-term positive outcomes. Despite emerging research and federal initiatives promoting early intervention, minimal research has examined community-based mental health services during infancy. Improving the effectiveness and efficiency of routine care requires close examination of current practices. The current study characterized current usual care practices in infant mental health through a survey of mental health providers. Provider, practice, and client characteristics, provider use of intervention strategies and intervention programs, and provider attitudes toward and knowledge of evidence-based practices are described. Study findings are discussed in the context of previous usual care research. Implications and directions for future research are discussed.

The Individuals with Disabilities Education Act (IDEA) mandated that each child who qualifies for special education must have an individualized education program (IEP). Disciplinary issues and procedures under IDEA have been a source of concern among parents, schools, and advocates from disability groups. At issue are fundamental concerns about the protection of rights for students with disabilities, which must be balanced with the ability of school personnel to maintain safe school environments that benefits all students. This research examined the four survey questions related to discipline from a state-wide survey conducted by Education Service Center (ESC) Region 9 through a comparison of selected disability categories as they compare to the responses received from parents of students with the disability category of emotional/behavioral disorders (E/BD). In addition, the research examined the open-ended questions from surveys to determine the types of concerns reported by parents. Data accrued from a focus group of parents receiving special education services are also reported. Parents of students identified as having an E/BD rated their understanding of the school's discipline policy lower than parents of students from other eligibility categories. Almost 67% of parents of students identified as having E/BD stated that they knew that their child might be eligible for alternative discipline procedures. Parents of students identified as E/BD reported at a much higher percentage that they were aware that services must be continued if the child was removed from the instructional setting for discipline problems. In a focus group discussion, a majority of the parent's (67%) responded that they felt like they understood the school's discipline policies. When given a chance to respond through an open-ended questionnaire, parents addressed a variety of problems, such as children being continually suspended for behaviors related to their disability or the behavior intervention plan not being implemented.

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O objetivo central desta Tese doutoral consistiu em analisar como as professoras primárias internadas no Hospital Juliano Moreira no Pará foram subjetivadas como loucas a partir de relações de saber-poder instituídas naquele espaço institucionalizado para a loucura em nosso Estado. Especificamente almejou refletir sobre as perspectivas teórico-metodológicas que envolvem a produção da verdade sobre a temática da Loucura e sua constituição enquanto campo epistemológico da produção científica no Brasil; problematizar as relações de saber-poder que orientaram a produção da Loucura a partir da institucionalização do modelo hospitalar no HJM nos anos de 1964-1984; analisar como os discursos oficiais dos governos paraenses engendrados pelos mecanismos de poder da disciplina e da biopolítica constituíram as práticas de tratamento da loucura nessa unidade hospitalar; e analisar como as professoras primárias internadas nesse espaço psiquiátrico foram subjetivadas como loucas a partir das relações de saber-poder prescritas em seus prontuários médicos. Sob quais dispositivos, a temática relacionada à Loucura vem se constituindo enquanto campo epistemológico da produção científica no Brasil a partir das relações de saber-poder? Como as relações de saber-poder produziram os modos de subjetivação a partir dos discursos da Loucura no Hospital Juliano Moreira, no Pará, entre os anos de 1964-1984? Como os mecanismos de poder da disciplina e da biopolítica se constituíram nos discursos oficiais dos governos paraenses nesse período por meio da análise das práticas de tratamento da Loucura nessa instituição hospitalar? Como as professoras primárias internadas nesse espaço clínico foram subjetivadas enquanto loucas a partir das relações de saber-poder prescritas em seus prontuários médicos? Pesquisa histórico-educacional sob lastro teórico-metodológico da genealogia foucaultiana com aporte documental nos prontuários médicos do HJM, em Mensagens dos governadores paraenses, jornais, relatórios da SESPA, os Boletins do Centro de Estudos do Hospital Juliano Moreira que circularam entre os anos de 1967-1971 e da Revista Paraense de Psiquiatria editada em 1984. A tese considerou que no campo da educação, a loucura constitui temática de pouco interesse epistemológico, contudo, os estudos de Michel Foucault sobre as categorias analíticas saber, poder, disciplina, biopolítica, discurso e subjetivação são importantes instrumentos teóricos capazes de auxiliar na compreensão das biopolíticas de saúde mental engendradas pelo Estado do Pará por ocasião do funcionamento do Hospital Juliano Moreira, pois no interior dessa instituição havia confronto de paradigmas de tratamento dos sujeitos internados e seus discursos produzidos para o enquadramento das mulheres professoras primárias como loucas emergiram das relações de saber-poder advindas dos domínios da Medicina e seus correlatos, assim como da força operante da sociedade disciplinar atravessada pelas políticas oficiais governamentais, cuja capilaridade se estende de maneira prescritiva aos ciclos familiares que também contribuíram para a legitimação do processo de subjetivação dessas professoras como loucas. Concluiu-se que as professoras primárias internadas no Hospital Juliano Moreira tinham seus saberes também orientados por uma racionalidade técnico-cientifica, porém, plenamente preteridos ante as relações de saber-poder da psiquiatra, assim como as manifestações de resistências dessas mulheres-professoras quanto ao seu processo de subjetivação, despontavam como indícios de afirmação de sua loucura e não como estratégias de resistências ao controle de seus corpos, sem prescindir do atravessamento das questões de gênero e sexualidade, permeadas pelas normatividades e poder das famílias.
The main objective of this doctoral thesis was to analyze how the primary teachers hospitalized in the Juliano Moreira Hospital, in Pará, were conceptualized as insane from relations knowledge-power instituted in that space institutionalized for madness in our state. The specific purpose is directed to reflect on the theoretical and methodological perspectives that involve the production of truth about the theme of Madness and its constitution as epistemological area of scientific production in Brazil; to problematize relations of power-knowledge that guided the production of Madness from the institutionalization of HJM hospital model in the years 1964-1984;to analyze how the official discourse of Para governments engendered by the power mechanisms of discipline and biopolitics constituted the madness treatment practices in this hospital; and analyze how primary teachers hospitalized in this psychiatric space were conceptualized as insane based on the relations of power-knowledge prescribed in their medical records. What devices is under, the thematic related to madness has been constituted as epistemological area of scientific production in Brazil based on the relations of power-knowledge? How relations know-power produced the ways of subjectivity from the Madness of speeches in Juliano Moreira Hospital, in Pará, between the years 1964-1984?How the mechanisms of power of discipline and biopolitics was constituted in official speeches of Pará governments in this period for through the analysis of Madness treatment practices in this hospital? How the primary teachers hospitalized in this clinical space were conceptualized as insane based on the relations of power-knowledge prescribed in their medical records? It is a historical and educational research under theoretical and methodological ballast Foucault's genealogy with documentary contribution in the medical records of HJM in Pará governorsmessagesof the period in question, newspapers, SESPA reports and two important journals begotten by professionals of psychiatry from Paráthe Bulletins of the Juliano Moreira Hospital Research Centre that circulated between the years 1967-1971 and Psychiatry Para Magazine edited in 1984. The formulated thesis consists of the assertion according to which the field of education the madnessconstitutes themed of little epistemological interest, however, studies of Michel Foucault about the analytical categories knowledge, power, discipline, biopolitics, speech and subjectivity are important theoretical tools able to helpin the understanding of mental health biopolitics engendered by the Pará Stateduring the functioning of Juliano Moreira Hospital, because within this institution had confrontation treatment paradigms of hospitalized subjects andtheir speeches produced for framing women as primary teachers as insane emerged from relations know-power coming from the areas of medicine and its related, as well as the operating force of the disciplinary society traversed for government official politics, whose capillarity extends of prescriptive way to family cycles that also contributed to the legitimacy of the subjective process of these teachers like mad. Sustenance starting from Foucault analytical anchors, which these primary teachers resisted to subjective process they have suffered, and the various manifestations of these invisibilized teachers, including their knowledge, were characterized as transgression mechanisms against the abduction of their bodies. I reiterate also that the forms of resistance of these teachers have subverted the discursive rationality centered on freedom and humanization of relations in the HJM from 1964 and all its prescriptive apparatus. It was concluded that primary teachers hospitalized in the Hospital Juliano Moreira and their various formsof manifestations that produced them like insane, had their knowledge also guided by a technical-scientific rationality, however, fully deprecated versus relations know-power psychiatrist, as well as the manifestations of resistance of these women-teachers about their subjectivation process, emerged as claim evidence of their madness and not as resistance strategies to control their bodies, without giving the crossing of gender and sexuality issues, permeated by normativities and power of families.
L'objectif principal de cette thèse de doctorat était d'analyser comment les enseignants primaire admis à l'hôpital Juliano Moreira au Pará, elles étaient considerées comme folles, à partir des relations savoir-pouvoir institué dans cet espace institutionnalisé pour la folie dans notre État. Les revendications particulières sont dirigés à réfléchir sur les perspectives théoriques et méthodologiques relatives à la production de la vérité sur le sujet de la folie et de sa constitution en champ épistémologique de la production scientifique au Brésil; problématiser les relations de pouvoir-savoir qui a guidé la production de la folie, a partir de l'institutionnalisation du modèle d‟ hôpital HJM dans les années 1964-1984; analyser comment le discours officiel des gouvernements du Pará a ete engendrée par les mécanismes de pouvoir de la discipline et de la biopolitique constitué les pratiques de traitement de la folie dans cet hôpital; et d'analyser la façon dont les enseignants du primaire ont admis que l'espace mental étaient considerées comme folles dans les relations de pouvoir-savoir prescrites dans leurs dossiers médicaux. Dans quelles dispositifs, la question relative à la folie a constitué comme champ épistémologique de la production scientifique au Brésil à partir des relations de savoir-pouvoir? Comme les relations savoir-pouvoir ont produit les termes pour être consideré a partir de discours de la Folie à l'hôpital Juliano Moreira, à Para, entre les années 1964-1984? Comme les mécanismes du pouvoir de la discipline et de la biopolitique constitués dans les discours officiels des gouvernements de Pará dans cette période pour moyens d‟analyser les pratiques de traitement de la folie dans cet hôpital? Comme les enseignants du primaire ont été internés dans cette cliniques et ont été considerées comme folles a partir des relations de pouvoir-savoir prescrites dans leurs dossiers médicaux? Il est une recherche historique et éducatif sur l‟aspect théorique et méthodologique de la généalogie de Foucault avec le soutien documentaire sur aux dossiers médicaux de HJM, dans les messages des gouverneurs de Pará pendant la période en question, des journaux, des rapports de SESPA et deux revues importantes engendrées par des professionnels de psychiatrie de Pará, la bulletins de Centre de recherche Hôpital Juliano Moreira qui circulaient entre les années 1967-1971 et de Magazine de Pará en Psychiatrie, édité en 1984. La thèse formulée est l'affirmation selon laquelle le domaine de l'éducation est la folie thème peu d'intérêt épistémologique, cependant, des études de Michel Foucault sur l'analyse des catégories de savoir, la discipline, biopolitique, de le discours et de la subjectivité sont des outils théoriques importantes capable de aider à la compréhension de la biopolitique de santé mentale engendrés par l'État du Pará pour l‟ocasion de l'opération de l'Hôpital Juliano Moreira, alors au sein de cette institution a été paradigmes de traitement de confrontation de sujets hospitalisés et ses discours produites pour encadrer les femmes des enseignants du primaire comme folles, ont émergé a partir des relations savoir-pouvoir provenant des domaines de la médecine et de son ainsi que la force connexe, d'exploitation de la société disciplinaire traversé par des politiques officielles du gouvernement dont ce sujet étend de manière prescriptif aux cycles de la famille qui a également contribué à la légitimité du processus pour considerer les enseignants comme folles. Donc, il a été conclu que les enseignants du primaire admis à l'hôpital Juliano Moreira et ses diverses manifestations qui les ont produits comme des folles, a eté aussi guidé par une rationalité technico-scientifique, cependant, totalement obsolète devant les relations savoir-pouvoir du psychiatre, quand même les manifestations de résistance de ces femmes-enseignants au sujet et en relation à le processus de subjectivation, émergé comme la preuve de sa folie et de n‟ai pas eu les stratégies de résistance de leur corps, sans oublier et sans donner la traversée des questions de genre et de sexualité, imprégné par normativités et le pouvoir de leurs familles.

Millennial-aged young adults, often referred to as “digital natives,” comprise the typical college-age population, and there has been a growing number college students at risk for mental health problems (Mowbray, Mandiberg, Stein, Kopels, Curlin, Megivern, Strauss, Collins & Lett, 2006; Eisenberg, Gollust, Golberstein & Hefner, 2007). Suicide is the second leading cause of death among college students (Suicide Statistics, 2014); however, their rate of utilizing mental heath counseling is decreasing. Providing the types of mental health services college students are likely to use can mitigate factors thought to impede their use (e.g., stigma, anonymity, confidentiality), as well as help improve students’ learning and success and reduce college attrition rates. Minimal research has been conducted on undergraduate college students’ attitudes about Internet-based mental health interventions, and the findings from those studies are conflicting. This study attempts to fill in the missing data to address undergraduate students’ attitudes about several types Internet-based of mental health counseling, and to determine the extent of their familiarity with its terminology. Forty-two undergraduate college students participated in a survey where they were asked about their familiarity with Internet-based mental health interventions, experience with and preferences for mental health counseling, and the availability of campus-based Internet mental health interventions. Quantitative data was collected, and descriptive statistics and chi square test of independence were calculated. The students’ familiarity with Internet-based mental health interventions did not influence their use of counseling services, but they were interested in knowing more about mental health-related cell phone apps. Other findings are discussed, conclusions are drawn, and recommendations for future study and implications for the field are included.

Dal 2008, in testa all'indice dei cosiddetti “failed states” la Somalia riveste un ruolo di primo piano a livello massmediatico quando si parli di guerre civili, violenza, terrorismo, devastazione, tribalismo, perdita di speranze. La clessidra del tempo contemporaneo somalo ha subito una fortissima scossa nel 1991 in seguito al crollo dell'allora Repubblica Democratica Somala e i conseguenti conflitti che, in molte aree dell'ex-Stato Somalo, perdurano. Per alcuni quella frattura storica collettiva ha segnato anche il tempo del proprio fermarsi, bloccati dal peso della sofferenza in una condizione di riconosciuto disagio mentale. Molti, siano essi rifugiati in paesi terzi o rimasti in Somalia, hanno fatto esperienza di atrocità “letteralmente di là dall’immaginazione per la maggior parte delle persone”(Malkki,1995). Ciononostante non hanno bisogno di attenzione “psichiatrica” oppure non manifestano alcun quadro clinico ascrivibile alle narrative dominanti della memoria traumatica oppure, ancora, non sono inquadrabili in un quadro nosologico internazionalmente riconosciuto. L'attenzione, poca, al tema della salute mentale in Somalia si è concentrata su queste dimensioni essenzializzandolo e riducendolo a un rapporto tra l'individuo e il proprio passato (“traumatico”) o tra il primo e la violenza (intesa come atto di rottura comprensibile a uno sguardo occidentale). Con questo lavoro si mostrerà come sia necessario affrancarsi da approcci medicalizzanti dell'esperienza di guerra (Almedon et al., 2004) per dare senso, attraverso il lavoro etnografico, all'articolazione tra biografie individuali e dinamiche sociali nel quadro delle trasformazioni in corso nella società Somala contemporanea. Portando al centro del discorso l'esperienza di sofferenza delle famiglie e la comprensione locale delle forme di disagio mentale, ci chiederemo inoltre se alcune di queste manifestazioni ci aiutino a comprendere le modalità in cui la violenza muta forma e se ci dicano qualcosa delle sfide verso il futuro di cui molti, soprattutto giovani, fanno esperienza.

The clashing of Cuba and the capitalist world economy has heralded a new beginning in Cuba’s revolutionary historiography. This paper analyzes the psychotherapy as a way to reconceptualise subjectivity in this era of shifting ideology. My research has been carried out in a Mental Health Community centre in La Habana (Cuba). Patients of this kind of Service are referred to as “neurotics”, people who, even though without a severe mental disorder, need psychological support because in a difficult moment of their lives. In a situation where the patient is disoriented about his/her perception of the "state of things", psychiatrists and psychologists may become the patient’s guide. Nevertheless, as the results of my ethnographic research suggest, psychiatrists and psychologists don’t use their role to shape the psychiatric care into a form of governmentality. Instead, they use the therapy, and the ironic speech sometimes included in it, also to highlight the social contradictions that bring citizens to a neurotic behaviour.

Evidence suggests comorbidity of ADHD and eating disorders (EDs) among females. Capitalizing on the comorbidity of ADHD and EDs and subsequent obesity could lead to improved prevention and treatment of all three conditions. However, additional information regarding the comorbidity is necessary to develop such interventions, as little is known about how or why this co-occurrence exists. A comprehensive model of the underlying mechanisms associated with comorbid ADHD and EDs is needed to improve understanding of the development of the comorbidity. Moreover, while there are gender differences within each disorder, literature is limited regarding to the comorbidity among males, leading to a call for further investigation. Based on the literature, this study investigated three hypotheses of the underlying mechanisms of the ADHD/ED comorbidity, including: 1) ADHD and EDs are the expression of a common genetic or neurobiological dysfunction that manifests itself as binge eating and ADHD, 2) psychosocial factors common to both EDs and ADHD mediate the association between the two conditions, and 3) a third underlying mental health condition mediates the relationship between the two conditions. Underlying factors proposed within these three hypotheses include dopamine, serotonin, and monoamine oxidase A genes, family support, social support, neuroticism, conscientiousness, cognitive control, working memory, major depression, anxiety disorder, alcohol use and substance use disorders, and childhood abuse. In order to simultaneously investigate the three hypotheses, this study utilized secondary data analysis from 6,289 females and 5,248 males as part of the National Longitudinal Study of Adolescent Health. This data was used to test a model constructed via a combination of five theories, specifically, the Biopsychosocial Model, the Life Course Approach, the Risk Regulator Framework, the Research Domain Criteria Matrix, and the Person-Environment Transaction Theory. Findings of this study suggest that cognitive control, family support, and additional comorbid mental health illnesses such as depression, anxiety, and substance abuse disorder all mediate the relationship between ADHD and EDs. However, rather than leading to the comorbidity, ADHD led to other mental health issues which were then subsequently correlated to EDs; suggesting a comorbidity between these additional disorders and EDs with ADHD being a possible predictor of that comorbidity. In regards to genetics, the factors investigated in this study were not found to be directly associated with the comorbidity. Rather, these factors were connected to the psychosocial and psychiatric mediators, suggesting an indirect relationship between genetics and the comorbidity. With regards to males, differences were found between males with the comorbidity, ADHD alone, EDs alone, and neither disorder in regards to education attainment, BMI and obesity, delinquent behavior, and sexual behaviors were all observed. However, very few of the proposed underlying mechanisms among females were significantly associated with the comorbidity among males. Results provide initial support for continued research on the underlying mechanisms of the ADHD/ ED comorbidity. This research has potential implications in many areas including primary and secondary prevention of EDs, improved treatment plans, prevention of psychostimulant medication abuse, and prevention and treatment of obesity. Next steps include the use of advanced statistical techniques in order to explore multiple combinations of underlying factors to the comorbidity and direct interactions between factors, including gene x environment interactions. Additional study replications are also needed with the incorporation of additional genetic components.

Broadly, the purpose of this study was to address the gaps in the knowledge base of caregiver strain through an examination of this and other theoretically related constructs in a sample of parents of high-risk youth. In the last two decades, a growing body of research has pointed to the significance of strain that can result from this caregiving experience, particularly as it relates to patterns of mental health services utilization. Despite the fact that the majority of children who receive mental health receive them from the school, few studies have examined caregiver strain in the context of school-based mental health services or with caregivers of youth in special education for Emotional Disturbance (ED). Additionally, while the Modified Double ABCX Model of family stress and coping has been identified as a useful model to understand caregiver strain and its related constructs, questions remain about how all of the components of this model work together to influence caregiver strain and the mechanism by which caregiver strain influences youth mental health service use and parent engagement in services. The specific aims of this study were to: (1) explore the construct of caregiver strain and its relationship with theoretically related constructs in caregivers of youth in special education for ED, and (2) examine the factors, including caregiver strain, that predict school-based mental health services utilization and parent engagement in services. Secondary analyses were conducted using data collected as part of a randomized controlled trial of a parent support intervention for caregivers of youth in special education for ED. Participants included 112 caregivers and you their youth recruited from 22 schools and special education centers. Data were provided by caregivers and school-based mental health service providers. Caregivers completed phone interviews conducted upon entry into the study and again approximately nine months later. These semi-structured interviews included measures of youth functioning, caregiver strain, and caregivers’ perceptions related to their child’s problems and engagement in services. School-based mental health service providers supplied data related to the amount of school-based mental health counseling services received by youth and whether caregivers consulted with service providers during the study period. Data were analyzed using a variety of quantitative methods, including descriptive statistics, dependent samples t-tests, one-way ANOVA, Structural Equation Modeling (SEM), multiple linear regression, and multiple logistic regression. Results revealed that caregivers reported the highest levels of subjective-internalizing strain, and that the level of three types of caregiver strain decreased from time 1 to time 2. Additionally, caregivers of males tended to report higher levels of strain than caregivers of females, and parents tended to report higher levels of strain than other caregivers. Consistent with previous studies, non-Hispanic Black caregivers tended to report the lowest levels of caregiver strain compared to all other racial/ethnic groups. Findings from SEM analyses revealed that following slight modifications to the originally hypothesized model, the model tested fit the data well and all of the paths included in the model (other than those related to race/ethnicity) had statistically significant parameter estimates. Findings from the multiple linear regression analyses revealed that collectively the predictors included in the model accounted for only a small percentage of the variance in the outcome (11.9%), and none of the predictors included in the regression model significantly predicted the amount of school-based counseling received by students. Results from the multiple logistic regression analyses revealed that only youth gender and youth conduct problems were significant predictors of the outcome; caregivers of male youth and caregivers of youth with more conduct problems were less likely than caregivers of female youth and caregivers of youth with fewer conduct problems, respectively, to have consulted with their child’s school-based mental health services provider during the school year. Collectively, findings from this study demonstrate that caregivers of youth in special education for ED experience caregiver strain to a similar degree as caregivers of youth receiving services through mental health systems. Further, findings provide evidence for the usefulness of the Modified Double ABCX Model in studying and understanding caregiver strain in this population. While findings from this study provide support for the relationships among the constructs of this model, findings from this study also suggest that this model may not hold up in terms of predicting the amount of school-based services received by youth or the likelihood of parent engagement with their child’s school-based mental health service provider. Additional research is needed that includes a more complete representation of the constructs of this model to determine if this model holds for school-based service use and engagement.

It is no secret that 'managerial' solutions are not, on average, nearly as reliable as 'technical' solutions. The focus of this work is to clarify the reasons why this is so, and to seek ways to increase the reliability of managerial solutions. The causes of this situation are both subjective (human factor failure), which can be influenced, and objective (complexity of the problem, the specifics of human behaviour, etc.) that can be only minimally influenced. Significant subjective causes at work were identified as: a. cognitive distortions at the mental level of thinking of the problem solvers; b. deficiencies in making inference and drawing conclusions; c. incorrect argumentation. There are two ways to reduce these causes: 1. cultivation of managerial thinking of the problem solvers; 2. the use of reserves in the implementation of approaches and tools of theoretical disciplines that already operate successfully elsewhere and are beneficial for managerial solutions. The first way deals with procedures for managerial solutions formulated in the language of the relevant discipline (the language of management), expressed by natural language and the chain of formulas (calculations) and visual (graphic) tools in the form of managerial decision trees, diagrams and charts with the rules of 'managerial logic'. This is generally defined as a set of approaches, tools, methods and skills needed for credible justification when solving managerial problems. Specifically it deals with: - the 'case-based reasoning' approach, which aims at finding the best point of view on a given problem and analysing all considered aspects within its context step-by-step in detail; - translating the tools and methods of modern logic (especially its intuitionistic version) from the language of logic into the language of management taking into account the factual content of expressive means of the language of management including the ability of their effective application; - respecting the principles of rational and ethical argumentation within managerial solutions. The second way circumvents managerial solution procedures by recasting the managerial task to the task of a scientific discipline (logic, game theory, etc.) and derives the correct result therein. In this context we talk about the use of knowledge of theoretical disciplines in management. Both of these ways are demonstrated in the work in a number of illustrative examples and the annexed case studies addressing the specific tasks of managerial practice.

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2017.
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A proteção das crianças e adolescentes (CAs) foi aprimorada no século passado. No Brasil, após a década de 1980 políticas e regulamentos foram implementados para garantir a proteção de CAs. No entanto, o uso parental de disciplinas severas continua a ser um desafio nacional, e quando uma CA e/ou sua mãe apresentam um problema de saúde mental. A maioria dos estudos sobre esse tema tem sido conduzida na Europa e na América do Norte, e faltam pesquisas de países em desenvolvimento, incluindo o Brasil. Assim, são necessários estudos no contexto nacional. Objetivo: Explorar as associações entre o uso de disciplinas moderadas e severas, e as condições de saúde mental materna e de CAs. Metodologia: Estudo transversal realizado em dois bairros vulneráveis socioeconômica com, aproximadamente, 80.000 habitantes, em Ceilândia. Foi utilizada amostragem complexa. As casas foram selecionadas por amostragem probabilística em duas fases. O número de 401 casas (erro amostral=0,1) foi definido pela variância maximizada (P =0,5). A amostragem por cluster permitiu obter o total de 33 cluster selecionados (erro amostral=0.05). O poder de compra foi avaliado de acordo com a Associação Brasileira de Empresas de Pesquisa (ABEP). Questões adicionais sobre violência conjugal e escolaridade também foram aplicadas. Usamos a versão brasileira do WorldSAFE Core Questionnaire para identificar Disciplinas Verbais Moderadas (DVM), Disciplinas Verbais Severas (DVS), Disciplinas Físicas Moderadas (DFM) e Disciplinas Físicas Severas (DFS). Para avaliar saúde mental materna, utilizamos o Self-Reporting Questionnaire (SRQ-20 ) e, para avaliar as condições de saúde mental de CAs, foi utilizado o Strengths and Difficulties Questionnaire (SDQ). Todas as questões foram aplicadas à mãe ou cuidadora legal/fatual dos últimos 12 meses. Resultados: A média de idade das CA foi de 9 anos (DP: 4.5), a taxa de reprovação escolar no último ano foi de 28,5% [95%IC 23,6-33,4%]. Um grande número de mulheres esteve exposta à violência conjugal, e tiveram uma CA como testemunha. A prevalência de DVS foi de, aproximadamente, 37%. A prevalência DFS foi de, aproximadamente, 30%. Meninos têm maior chance de DFS [OR: 1,56, p<0,05]. A prevalência de problemas de saúde mental materna foi estimada em 21,4% [17,9-24,9%], ideação e pensamento suícida em 18,9% [15,9-21,9%], e tentativa de autoextermínio em 8,0% [5,5-10,6%]. Na média global, aproximadamente, 10% das CAs apresentaram problemas em n v l l ni o s ú m nt l s n o qu n sub s l ―probl m s on ut ‖ pr v l n i chegou a 19,7% [16,7-22,8]. Identificamos associação do uso de DFM com problema de saúde mental materna. Meninos com problemas de saúde mental têm maior chance de sofrer DVS imposta pelo pai (OR 4,1, 95% IC 1,2-13,4) e mãe (3,5, 95% IC 1,6-7,4). Quando combinados os problemas de saúde mental materna e de CAs, observou-se associação do uso de DVS por mães, independente do sexo da CA (OR 3,1, 95%IC 1,0-9,6). Da mesma forma, o uso de DFM teve elevada odds das análises em relação aos meninos nas diferentes díades, sendo de 9,6 (95%IC 1,5-60,3) para a díade pai-filho e 7,9 (95%IC 1,3-45,9) para a díade mãe-filho. Conclusões: Abuso parental está contido nas práticas cotidianas de disciplina nestes dois bairros. Problemas de saúde mental materna e de CAs aumentam a chance de abuso parental, especialmente para meninos.
Child and adolescent (CA) protection has been enhanced in the past century. In Brazil, especially after the 1980s policies and regulations were implemented to guarantee the protection of CAs. However, parental use of harsh physical and verbal discipline when raising CAs remains a challenge, especially among low-income families when a CA and/or their mother has a mental health problem. Most studies on this topic, prevalence of parental abuse and mental health problems have been conducted in Europe and in North America, and research from low- and middle-income countries, including Brazil, is lacking. Methods: A cross-sectional study was conducted in two underprivileged neighborhoods with nearly 80,000 inhabitants. Complex sampling was used. The households were selected by applying two-stage probabilistic sampling with stratification. A total of 401 households (sample error=0.1) were selected by maximizing the variance (P=0.5). The cluster sampling indicated 33 census units (Sample error=0.05). The families‘ socioeconomical status was assessed according to the Associação Brasileira de Empresas de Pesquisa (ABEP) protocol. Aditional questions regarding partner violence, and the level of education were made. We used the WorldSAFE Core Questionnaire to assess parental use of Moderate Verbal Discipline (MVD), Harsh Verbal Discipline (HVD), Moderate Physical Discipline (MPD) and Harsh Physical Discipline (HPD). This questionnaire asks how often mothers (respondent) and/or their husband or partner use specific disciplinary tactics. To assess maternal mental health we used the Self-Reporting Questionnaire (SRQ-20) and to assess CA mental health we used the Strengths and Difficulties Questionnaire (SDQ). Mothers were the respondent to all questions. Results: The average age of CA was 9 years (SD: 4.5). The prevalence of CAs that failed in school was 28.5% [95%IC 23.6-33.4%]. A large number of women were expouse to intimate partner violence and had their CAs as witness. The prevalence of HVD was approximately 37% (28.3% [95% CI: 23.4–33.3%] for more than three times). The prevalence of HPD was approximately 30% (21.8% [CI: 18.2–25.4%] for using HPD more than three times). Boys had higher odds of HPD [OR: 1.56, p<0.05]. The last-year prevalence of maternal mental health problems was 21.4% [17.9- 4 9%] th pr v l n of lif tim moth r‘s sui i l thoughts was 18.9% [15.9-21.9%], and suicide attempts was 8.0% [5.5-10.6%]. Considering the global mean of SDQ about 10% of the CA had clinical mental health problems, in the subs l ‗ on u t‘ th pr v l n of lini l probl ms w s high r bout 9 % [ 6 -22.8]. MPD was associated to maternal mental health problems. Boys with mental health problems presented higher odds for HVD from both parents, being 4.1 [95% IC 1.2-13.4] for father and 3.5 [95% IC 1.6-7.4] for mother. When both mother and the CA had a mental health problem, mother present higher odds of using HVD when compared to father, regardless of the CA sex, boys also had higher odds to be expose to MPD in the different dyads their were inclued, 9.6 (95%IC 1.5-60.3) for father-son and 7.9 (95%IC 1.3-45.9) for mother-son. Conclusions: Parental abuse was embedded within CA rearing practices in these two underprivileged neighborhoods. Maternal and CA mental health problems increase the chance of parental abuse, especially in male CAs.

Questa ricerca vuole descrivere e riflettere sulle dimensioni di un margine (limen) come luogo creativo-attivo capace di proporre una relazione umana positiva attraverso la pratica artistica, con la diversità esclusa, creando originali spazi di esercizio e sperimentazione di una (nuova?) cittadinanza attiva che si discosti dalla cultura politica egemonica, quella manicomiale. L’oggetto della riflessione antropologica è come la pratica artistica in un “dispositivo” innovativo della rete pubblica di Salute mentale di Belo Horizonte (Minas Gerais, Brasile), il Centro di Convivenza (CdC) dia vita a nuove forme di cittadinanza nello “stato d’eccezione” della logica manicomiale. I CDC sono luoghi liminari espressioni attive della lotta antimanicomiale e della riforma psichiatrica brasiliana e mondiale. Nei CDC, attraverso la pratica artistica si fa micropolitica, si costruisce cittadinanza; “luoghi di sperimentazione che possono contribuire alla riconsiderazione della relazione intima tra cosrporeità, multisensorialità e place making” (Minelli 2017), superando la crisi della presenza. L’esperienza dei CDC è al margine della politica pubblica di Salute Mentale di Belo Horizonte, ma è l’emblema (attraverso la prassi quotidiana) della logica del cambiamento che Basaglia prima e Rotelli poi hanno indicato come direzioni da seguire ai “caminantes” che già dalla metà degli anni 70 iniziavano a muoversi criticamente nei confronti della politica manicomiale. La riflessione dopo una necessaria analisi del processo di deistituzionalizzazione brasiliano (ancora in atto?) “che da più di un ventennio persegue una coraggiosa riforma del sistema di salute mentale” (B. Saraceno 2014) e che attraverso lotte, riflessioni ed innovazioni “ha visto nascere e svilupparsi un compatto movimento per il rinnovamento dei servizi pubblici di salute mentale, che coinvolge tecnici, familiari utenti e società civile” (Ib. 2014) , si concentrerà sulla prassi artistica-quotidiana dei Centri di Convivenza contestualizzandola obbligatoriamente con il resto della rete della salute mentale della capitale minerense (per gran parte funzionante secondo uno schema biomedico) e nel loro rapporto con la comunità esaminando “il rapporto problematico tra riproduzione e discontinuità nelle azioni terapeutiche e riabilitative, in una fase di superamento dell’ospedale psichiatrico.” (Minelli 2014”). A livello metodologico si utilizzerà un’antropologia dell’esperienza, e dello studiare con (Ingold 2013), quindi partecipando al processo, e instaurando attraverso la presenza, delle relazioni intersoggettive importanti attraverso “l’impegno sensoriale e pragmatico”(Malighetti 2016, p.17), utilizzando quindi il corpo come strumento principe di conoscenza. L'approccio poetico evocativo sarà l'orientamento metodologico dello scrivere al fine di mantenere una certa assonanza col vissuto etnografico. Inoltre considerando la pluralità dei luoghi interessati la ricerca verrà attuata in un “campo spazialmente discontinuo” (Marcus, 1995), seguendo le prassi incorporate negli e dagli attori cartografandone il percorso in un paesaggio che cambia ogni momento.
This research aims to describe and reflect on the dimensions of a margin (limen) as a creative-active place capable of proposing a positive human relationship through artistic practice, with diversity excluded, creating original spaces for exercise and experimentation of a (new?) Citizenship. active that deviates from the hegemonic political culture, that asylum. The object of the anthropological reflection is how the artistic practice in an innovative "device" of the public mental health network of Belo Horizonte (Minas Gerais, Brazil), the Center for Coexistence (CdC) gives life to new forms of citizenship in the "state of exception "of the asylum logic. The CDCs are liminal places, active expressions of the antimanicomial struggle and of Brazilian and world psychiatric reform. In the CDC, through the artistic practice one becomes micro-politics, one builds citizenship; "Places of experimentation that can contribute to the reconsideration of the intimate relationship between conspiracy, multisensory and place making" (Minelli 2017), overcoming the crisis of presence. The CDC experience is on the sidelines of the public mental health policy of Belo Horizonte, but it is the emblem (through daily practice) of the logic of change that Basaglia and Rotelli then indicated as directions to follow to the "caminantes" who already in the mid-70s they began to move critically towards the asylum policy. The reflection after a necessary analysis of the Brazilian deinstitutionalization process (still in progress?) "Which for more than twenty years has pursued a courageous reform of the mental health system" (B. Saraceno 2014) and which through struggles, reflections and innovations "has having seen the birth and development of a compact movement for the renewal of public mental health services, involving technicians, family users and civil society "(Ib. 2014), it will focus on the daily artistic practice of the Coexistence Centers, obligatorily contextualizing it with the rest of the mental health network of the mineral capital (largely functioning according to a biomedical scheme) and in their relationship with the community by examining "the problematic relationship between reproduction and discontinuity in therapeutic and rehabilitative actions, in a phase of overcoming the psychiatric hospital. " (Minelli 2014 "). At a methodological level, an anthropology of experience will be used, and of studying with (Ingold 2013), thus participating in the process, and establishing through the presence, important intersubjective relationships through "sensory and pragmatic commitment" (Malighetti 2016, p .17), thus using the body as the main instrument of knowledge. The evocative poetic approach will be the methodological orientation of writing in order to maintain a certain assonance with the ethnographic experience. Furthermore, considering the plurality of the places involved, the research will be carried out in a “spatially discontinuous field” (Marcus, 1995), following the practices incorporated in and by the actors, mapping their path in a landscape that changes every moment.

This comparative case study aimed to explore the elements that align with Senge&rsquo
s framework of the Learning Organization, comprised of the disciplines of Personal Mastery, Shared Vision, Mental Models, Team Learning, and Systems Thinking, in the English Language Preparatory Programs of two selected higher education institutions to determine what characteristics of a learning organization they possess. In this study, qualitative case study method was employed. The study was conducted in two organizations, one (Organization A), part of a private Englishmedium university, and the other (Organization B), part of a public Englishmedium university, in Ankara, Turkey. The sample contained seven administrators and twenty-two instructors from Organization A and seventeen instructors and 3 administrators from Organization B. The data collected through semi-structured interviews were analyzed using content analysis technique. The findings revealed that both organizations are evolving towards a learning organization, but have not institutionalized the five disciplines to an ideal state yet. Organization A is doing somewhat better than Organization B as regards the disciplines of Team Learning and Personal Mastery
however, there is no considerable difference between the organizations in terms of the disciplines of Shared Vision, Mental Models and Systems Thinking. Overall, in both organizations there are impediments in terms of the development and achievement of personal visions, learning of individuals and teams, development of a shared vision, surfacing and questioning mental models, and acting from a comprehensive systems approach.

A growing literature suggests that experiencing positive emotions provides psychological benefits (e.g., Coifman et al. 2007), and interventions increasing positive emotions may reduce depression risk (Geschwind et al., 2011). The present study tested whether reminiscence, a method of positive emotion savoring (Quoidbach et al., 2010), can mitigate depression risk by increasing positive emotions in an unselected sample and a subsample of at-risk anxious individuals. Female participants (n=336) were randomized to a reminiscence or control condition and asked to complete daily mental imagery exercises focusing on a positive memory (reminiscence) or a neutral laboratory memory (control) for one week. As expected, reminiscence exercises produced immediate positive emotion increases compared to control exercises. Contrary to prediction, reminiscence participants did not report higher positive affect or lower depression symptoms at the end of the study week or one month follow up period compared to controls. Future studies in treatment-seeking samples are needed before strong conclusions can be drawn about the long term affective benefits of reminiscence in at-risk or clinical populations. Findings in the anxious subsample revealed no greater benefit of reminiscence versus neutral mental imagery for those with high anxiety. However, across both conditions, anxiety was a strong predictor of positive emotional functioning, with high anxiety predicting low positive emotions even after accounting for depression symptoms. These findings add to prior work suggesting anxiety can blunt positive emotional functioning, and warrant future studies to further elucidate the impact of anxiety on positive emotional functioning and the potential utility of intervening on positive emotions in anxious individuals.

School-Wide Positive Behavior Interventions and Support (SWPBIS) is an evidence- based application of Applied Behavior Analysis (ABA) to address and prevent problem behaviors from occurring, promote pro-social behaviors, and create a positive learning environment for all students. There are many secondary interventions that have been utilized within the framework of SWPBIS that have high success rates. However, the research conducted on the use of Check-In/Check-Out (CICO), a secondary intervention, has focused its attention more on its effectiveness in public elementary schools. There is a lack of research evaluating the effectiveness of CICO in alternative school settings. This study provides an extension to the literature by examining the effects of the CICO program with school-aged children residing in a mental health treatment facility. Using a concurrent multiple baseline across participants design, students were exposed to a CICO intervention strategy in which problem behaviors were targeted for reduction and academic engagement was targeted for acquisition. All three students showed substantial decreases in problem behavior and increases in academic engagement when the CICO intervention was in place.

Post Intensive Care Syndrome-Family (PICS-F) refers to acute and chronic psychological effects of critical illness on family members of patients in intensive care units (ICU). Evidence about the increase and persistence of PICS-F warrants the need for prevention interventions. This study evaluated the feasibility of providing Sensation Awareness Focused Training (SĀF-T) during the ICU stay for spouses of mechanically ventilated patients. Methods: A randomized controlled trial of SĀF-T versus a control group was conducted (n=10) to assess safety, acceptability, feasibility, and effect size of the intervention on PICS-F symptoms. Symptoms assessed as outcome measures included stress, anxiety, depression, posttraumatic stress disorder, and sleep efficiency. Those randomly assigned to SĀF-T received one session daily over 3-days in the ICU. Repeated measures (day 1, day 3, day 30, and day 90) of PICS-F symptoms in both groups were analyzed. Results: Mean age was 58 ± 12 years; 70% were female. Feasibility success criteria were met in weekly recruitment (8 ± 3.5), enrollment rate (67%), SĀF-T acceptability (100% of doses received, no adverse events) with significantly lower post SĀF-T stress levels (p<.05) compared to pre SĀF-T stress levels, ActiWatch acceptability rate (90% agreed to wear, no adverse events) with no significant difference in sleep efficiency between groups (p>.05), and repeated measures completion rate (>90%). Conclusions: This study provided guidance for modifications to protocol outcome measures and evidence of a large effect size, which will inform a larger clinical trial to assess the effectiveness of the SĀF-T intervention in reducing PICS-F.

This study aims to investigate the political reformation of the psychiatric care in Sweden, that took place 1995. The main purpose is to illuminate the transformation of subjectivity for mentally ill people after the reform 1995. The group of people which are present in the study are those who former were subjects of care in psychiatric hospitals, but with regarding to the reform have moved out from the institutions and instead become clients for community care. This new group of mentally ill people became, in connection with the reform, subjects for a new concept psykiskt funktionshinder. This new label and concept, that were attached to the present group, is the main concept for the investigation in the present study. The method, that was used in the study, develops a textual based analysis of the official documents, that were produced in connection with the political decision to reform the care of mentally ill people. With a theoretical conceptuality taken from Michel Foucault, with concepts such as discourse, power, and subjectivity, are the documents analysed in order to illuminate how the new subjectivity, under the concept of psykiskt funktionshinder arise. The results shows how concepts as time and space are intertwined with strategies of power, that simultaneously function as conditions of possibility for this new subjectivity to exist. The main conclusion, in the study, is that the concept psykiskt funktionshinder must be understood with regard to an analysis of power relations, and that the power, which are latent in the present discourse, is a decisive condition for both clients and social workers to become subjects.

There are many challenges that come with diagnosing attentiondeficit/ hyperactivity disorder (ADHD), including shared symptoms with many similar disorders, high comorbidity of other mental disorders, and subjective bias from informant reports. Three clinical guidelines for diagnosing ADHD currently exist, published by the American Academy of Pediatrics (AAP), the National Institute for Health and Care Excellence (NICE), and the American Academy of Child and Adolescent Psychiatry (AACAP). However, these guidelines are outdated as they are based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and do not include more recent research. This project was intended to update these guidelines by incorporating the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as well as a selection of research on ADHD diagnosis published in the last ten years. This updated set of guidelines can be found in Appendix A of this document. Emphasis is on the evidence-based assessment model of using only psychometrically strong assessment measures and basing diagnostic decisions on posterior probabilities. Review of the literature also indicated a need to assess for differential and comorbid diagnoses in ADHD evaluations. Recommendations for doing so are discussed. Lastly, results of the review provided a strong argument against the use of continuous performance tests (CPTs) and other executive functioning measures in diagnosing ADHD, as their diagnostic accuracy is generally not acceptable.

The aim of the present dissertation is to investigate attitudes toward individuals suffering from functional disorders or categorized as disabled and the conditions under which they have lived. The present author applies an historical perspective and identifies three significant turning points: the end of the eighteenth century and beginnings of the nineteenth and twentieth centuries. The terms ”care” and ”control” reflect the complexity and conflict inherent in the perception and handling of these individuals. In the first period, folklore helped both explain and shape the way people apprehended infants born with functional disabilities or whose mental or physical developmet was aberrant. The inroads made by science during the eighteenth century helped combat these notions with knowledge and information. Upon ”discovering” the handicapped, the advocates of science identified them as an untapped source of labor. All that was needed was a conscientious upbringing and education. As a consequence, and with the blessings of the state and private charitable institutes, an increasing number of experts assumed parental obligation, thereby initiating a comprehensive institutionalization. The second period is epitomized by the founding of the first special needs school in Sweden, the National Institute for the Blind and Deaf-Mute in Stockholm in 1809. The actions of individuals like the energetic Per Aron Borg and the blind woman Charlotta Seuerling´s desire to receive a better education were small events with major significance. The diverging views of politicians and teachers on the form and content of lessons, which can be boiled down to a matter of theoretical knowledge versus practical vocational training, are also discussed. In the third period I focus on the increased control to which individuals with functional disabilities, specifically the vision-impaired and blind, were subjected at the outset of the twentieth century. Beginning in 1903, a countrywide inspection tour visited the blind in their homes. The inspectors were given the dual task of offering concrete support to the blind and look into their abilities to support themselves and live socially-approved, moral lives. It was an invasion of privacy with good intentions. The accumulated results showed that only a small number of individuals were able to support themselves in the trades they had acquired at blind school. Most continued to be dependent on relatives, social services and charitable donations.

This study analyses the fact that young adults under the age of 21 were sent to mental institutions in the early 20th century. To further examine this statement, three main questions provide insights about life inside of the mental hospital in Växjö, Sweden. What factors did overall result in psychiatric care for young adults in the early 20thcentury? By using microhistory as a historical method, what aspects can indicate patient's subordinate role at the hospital? How can the psychiatric institutions be viewed from a disciplinary standpoint while focusing on the power they possess over underage individuals? The chosen institution is called Sankt Sigfrid's hospital (alsoWexio hospital) and provides valuable records and journals between the years of 1907and 1921, on which the study is based on. The results show that a total of 38 patients were admitted to the hospital under this period. Generally, there were 5 different illnesses that resulted in psychiatric care and dementia primaria was the most common one. The ages ranged between 11 and 20, with 20 as the most common age when arriving at the hospital. According to the results, most patients came from a background of farming and landowning. Poor relief was the most common factor for young adults being admitted to the hospital, whereas the second most common factor was the father overseeing the decision. Furthermore, 4 patients were part of a microhistorical study which primarily concluded that they were being subjected to constraint by the hospital. Since the material is examined from a disciplinary standpoint where the hospital is viewed in a position of power, the result is an example of psychiatric expansion through the country. This maintains the belief that psychiatric care developed through different phases of the 19th and 20th century and thus were in constant reform, whereas this study is merely an example of this process of developing.

A review of the research related to Medical Family Therapy demonstrates that the inclusion of marriage and family therapists as part of the healthcare team offers benefits such as decreased utilization of healthcare, decreased costs, increased positive outcomes for patients and healthcare systems. However, studies demonstrate the difficulty with communication between providers limiting access to marriage and family therapists. Results of this study identified benefits to working with medical family therapists including broadening the understanding and using a collaborative effort to help the patient improve and get better. Participants also identified barriers to collaboration such as the lack of knowledge of and access to MedFTs, their inclusion in the system, MDs finding value in the MedFT profession, and that the communication process is lacking. Further need for improved communication at the referral and follow-up stages in collaborative practices is shown. In order to move more toward collaborative practices, PCPs and MedFTs need to develop and disseminate training on treatment notes, communication, team meetings, and continuance of collaborative work with one another.

Background. Primary and secondary prevention trials have shown that implantable cardioverter-defibrillators (ICD) reduce the risk of cardiac death, but concerns have been raised regarding the psychological well-being of ICD patients. Anxiety can affect a significant proportion of these patients, but there is limited information about prevalence and determinants of anxiety after the implementation of the more recent guidelines for ICD implantation. Several behavioral interventions have been effective in improving anxiety in these patients, however the efficacy of mindfulness-based interventions (MBI) has not been investigated in ICD patients, and there is limited information regarding the characteristics of pre-intervention, “dispositional” mindfulness in patients with cardiovascular disease never exposed to mindfulness training. The aims of this dissertation project were: 1) To determine the feasibility of a randomized clinical trial of a phone-administered, mindfulness-based training program, as measured by recruitment and retention rates, treatment adherence and fidelity; 2) To evaluate the current baseline prevalence and determinants of anxiety in the study population and 3) To describe the correlates of dispositional mindfulness in the study population. Methods. The study was conducted at the Electrophysiology Service at the UMass Memorial Medical Center. All consecutive patients who recently underwent an ICD procedure or received ICD shocks were screened for eligibility to participate in a pilot randomized controlled trial in which an eight session, phone-delivered, weekly MBI was compared to a usual care condition. Assessments were performed at baseline and post-intervention. A cross-sectional design was used for aims 2 and 3. Anxiety was assessed using the Hospital Anxiety and Depression Scale; a shortened version of the Five Facets of Mindfulness questionnaire was used to evaluate mindfulness. Results. Thirty patients (21 M, 9 F; mean age 63.1 ±10.3 years) were enrolled in the study. The methods ultimately adopted to screen, recruit, and retain study participants were feasible to conduct and satisfactory to ICD outpatients, and the study intervention was safe. Phone delivery resulted in excellent retention rates and limited costs. Assessments of treatment fidelity showed that the content of the intervention was delivered as intended in almost 100% of cases. The study findings do not show a decrease in the overall prevalence of anxiety in ICD patients compared with earlier cohorts; anxiety was associated with young age, low socio-economic status and previous psychological morbidity, but not with ICD-related factors including prior shock delivery. Finally, baseline mindfulness was most strongly associated with previous psychological morbidity (in particular, depression), and current anxiety symptoms. Conclusion. Psychological morbidity appears to be the major determinant of anxiety in the patients currently enrolled in the study. Dispositional mindfulness is inversely associated with current anxiety and depression and with prior psychological morbidity, supporting the hypothesis of a modulating role of mindfulness on the processing of negative emotions. A phone-delivered, individual MBI is feasible, acceptable to patients and can be adequately delivered by trained instructors. The findings from this dissertation work support the need for larger clinical trials of MBI in ICD patients.

This project examines the meaning-making of art through multiple disciplinary lenses: Art Therapy, Art History, Studio Art, Art Education and Anthropology. Disciplines were selected for their inherent ability to enhance an understanding of meaning-making through the art making process and art product. An arts-based methodology was utilized in conjunction with the Outliers and American Vanguard Art exhibition at The Los Angeles County Museum of Art (LACMA), which featured a juxtaposition of formally trained and self-taught artists. Each of the five researchers selected a piece of art included in the exhibition, rendered the piece, documented the rendering process, and viewed each piece and its accompanying documentation from their respective disciplinary lenses to understand meaning-making of the original artist and their work. Results of this systematic investigation exposed common themes across disciplines that inform meaning-making: Culture, Context, Comparison, Communication, Formal Elements, and Accuracy. Through an understanding of elements that comprise each exposed theme, the discipline of art therapy can expand its theoretical and practical knowledge that currently informs its approaches toward the meaning-making of art. Results of this arts-based investigation imply that continued investigation of adjacent art and culture-centric disciplines can question, corroborate, and supplement existing assumptions about the meaning-making of art process and art product in the discipline of art therapy.

碩士
國立臺北大學
社會學系
98
This study discusses the relation between parenting and adolescent mental health by using quantitative data. According to literature reference, we can distinguish “parenting” into two different parts which are “parental care” and “parental control”. 　This study uses TEPS(Taiwan Education Panel Survey) “Wave-2 student questionnaire” as the main analytic data. The respondents of this project are junior high school students and their parents. Besides, this study uses “Factor Analysis” to create the measure of adolescent mental health, making use of “OLS simple regression” to conduct statistical analysis. 　After controlling for economic change、marriage status、gender、family income and parental educational level, the regression model showed that “parental care” has a positive effect on adolescent mental health. However, the effect of “parental control” depends on the degree of “parental care”. These results also show the interaction between “parental care” and “parental control”, implying that “parental care” would provide the “buffer” effect for mediating the negative influence of “parental control” on adolescent mental health.

Major challenges facing sport psychology researchers, practitioners, coaches, and athletes include understanding mental toughness and knowing how to train for it. Athletes and coaches have long identified mental toughness as an important attribute for performance. Practitioners have devised training approaches for mental toughness—often based on anecdotal notions of what mental toughness is and how it should be developed. The research available on mental toughness is scarce, with only a few recent but limited advances. Fundamental to the challenge of understanding and training mental toughness, there is a critical need for research to develop a model of mental toughness that is not based on anecdote, but rather on sound research methods and theoretical underpinnings. Following on from conceptualisation, there is a need to develop an instrument to measure mental toughness. Taken together, a conceptual model and a measurement approach are the tools needed by researchers to develop and test mental toughness training programs. The purpose of this thesis was to address some of these issues by capitalising on the strengths of both qualitative and quantitative methods to: (a) critically examine a popular test of mental toughness; (b) determine specific characteristics of mental toughness and understand the interrelationship between those characteristics; (c) develop a model of mental toughness that draws together specific characteristics; (d) produce a mental toughness definition; (e) develop the Mental Toughness Inventory, a robust and valid instrument that demonstrates a sound factor structure, strong reliabilities, and invariance across gender, age, and level of competition (i.e., demonstrating within-network validity); and (f) determine the relative congruence between scores on the Mental Toughness Inventory and theoretically related constructs (i.e., demonstrating between-network validity). In line with these aims, Study 1 evaluated the psychometric properties of an existing, popular, and yet unsubstantiated test of mental toughness—the Psychological Performance Inventory (PPI). Given the breadth and depth of mental toughness as evidenced by the literature, the PPI was not expected to provide a reasonable model. Instead, the study was intended to inform the researcher on the psychometric strengths of the PPI and guide the development of a new measure of mental toughness throughout the remainder of the thesis. The PPI was examined using both within-network and between-network validity checks and responses from 263 student-athletes in Years 7–12 (12 to 19 years of age). Study 2 was a qualitative study that examined the interview data of over 30 elite sportspeople to determine the characteristics of mental toughness. The purpose of this study was to develop a conceptual model and definition of mental toughness that draws together all the characteristics in a way that adds meaning and clarity to the concept. The purpose of Studies 3 and 4 was to construct, refine, and validate the Mental Toughness Inventory (MTI)—a measure of mental toughness emanating from the findings of Studies 1 and 2. Studies 3 and 4 critically examined the construct validity of the MTI using both within-network and between-network validation on the basis of responses from institution-based athletes (from sports programs such as those run by the Australian Institute of Sport) and school-based athletes (from a selective sports high school). Furthermore, Studies 3 and 4 provided the scope to examine invariance of the mental toughness factor structure across groups, group mean-level differences, and interaction effects. The results of Study 1 provided a number of insights into the status of the PPI, raised an interesting conundrum regarding the interface between conceptualisation and instrumentation, and provided guidance for instrument development that would become the empirical basis of subsequent quantitative studies. The qualitative results of Study 2 unearthed a multidimensional model of mental toughness, containing 12 first-order factors each of which contribute to a higher order (or Global) mental toughness factor. The 12 mental toughness characteristics identified are: self-efficacy, potential, mental self-concept, value, personal bests, commitment, stress minimisation, perseverance, positive comparisons, positivity, task familiarity, and task focus. Study 3 involved the construction of the Mental Toughness Inventory (MTI), with results revealing excellent validity from a within-network perspective (including confirmatory factor analysis, goodness of fit, internal reliability, and invariance across groups). Study 4 results revealed that MTI factors correlated more strongly with theoretically-related concepts and less strongly with unrelated concepts—thus demonstrating between-network validity (convergent and discriminant). Study 4 also revealed a number of significant main effects of age (favouring older athletes), gender (favouring male athletes) and group (a contextual effect where institution-based athletes rate themselves more ―rigorously relative to strong contextual effects, which need to be carefully considered when assessing and developing mental toughness. For sporting organisations, this research points to a number of things that can be done at an institutional level—particularly in relation to creating an environment that is most likely to facilitate the positive development of various components of mental toughness. Finally, for research and continued theorising about mental toughness, the findings from this thesis support viewing mental toughness as a combination of cognitive, behavioural, and emotive processes that work together in combating adversity or pressure. Taken together, the conceptualising and empirical works conducted in this study are proposed to advance the field of research—creating opportunities to study the effectiveness of interventions designed to enhance mental toughness. Furthermore, the results provide practitioners, coaches, and athletes with a concrete understanding of mental toughness such that they are better equipped to devise training approaches and to handle pressure and adversity en route to athletic success.
Doctor of Philosophy (PhD)

Some of our teachers are so imbued with the idea that violence solves problems for them at school that they don't realize that there is an effective alternative discipline that is humane and violence free. They are not alone in this trap. Parents and learners too also strongly believe that inflicting reasonable pain is morally an acceptable disciplinary measure, and a deterrent. This study seeks to understand the reasons that make teachers perpetuate the culture of corporal punishment today, despite the fact that the 1996 South African Schools Act abolished the practice in all public and private institutions by declaring that the use of any form of physical punishment is unlawful and unconstitutional. Anyone, therefore, who contravenes the act, is guilty of an offence. This legal concept seems to be confined within public and private institutions, and does not extend to the parents at home and to society at large, where the culture of physical punishment is still widely practiced. From the point of view of Systems Theory we regard a school as a social system. Regard for the perspectives of the people involved in this human system is important in identifying problem situations, exploring them, and developing a grounded theory to account for them. In this study I employ the Primary Research Paradigm and use surveys as a means of collecting the research data. Winberg (1997:30) says that Primary research occurs through direct interaction between the researcher and the researched. It is sensitive and sees with the eyes of the researched and walks in their shoes. I use triangulation, combining conversations, interviews, observations, questionnaires and documentary analysis to collect data on the feelings, attitudes and perceptions of teachers, learners and parents.
Thesis (M.Com.)-University of KwaZulu-Natal, 2008.

According to the literature, borderline personality disorder (BPD) is often viewed negatively by mental health clinicians. The primary aim of this research was to assess the attitudes of clinicians working in mental health continuing care teams (CCTs) in Melbourne . A purpose-designed questionnaire, Attitudes to Borderline Personality Disorder Scale (BPD-APS), was used to gather demographic information from a sample of 91 participants and to assess clinicians' attitudes. Participants were from four main disciplines: 22 nurses (24%), 16 psychologists (18%), 17 social workers (19%), 12 consultant psychiatrists (13%), 11 psychiatric registrars (12%). Clinicians' discipline, years of practice, consultation and training with a specialised service (Spectrum) and level of burnout, measured by the Maslach Burnout Inventory (MBl-HSS), were all factors expected to influence clinicians' attitude towards BPD patients. Fifty-eight per cent of the participants had positive attitudes to BPD patients but a substantial proportion ( 42%) had negative attitudes. Years of experience in mental health impacted on clinicians' levels of interest in working with BPD patients but were not associated with their attitudes towards such patients. Significant statistical differences were found between the four main disciplines: psychiatrists/registrars and psychiatric nurses had more negative attitudes to patients with BPD. Social workers and clinical psychologists were more positive. Analyses indicated that clinicians (58%) experienced moderate to high levels of emotional exhaustion. Thirty eight per cent of the clinicians reported moderate to high levels of depersonalisation, while 61 per cent rated low to moderate levels of personal accomplishment on the MBl-HSS. The attitudes of the clinicians were correlated with depersonalisation but not with emotional exhaustion. Consistent with recent literature, clinicians with access to consultation and training had more positive attitudes. The findings of this study clearly indicate the need for clinicians working in mental health services to receive specific training, supervision and support for working with BPD patients.

碩士
樹德科技大學
資訊管理系碩士班
107
Smart phones have become an indispensable helper in people''s lives. In the era of a mobile phone, people rely heavily on the convenience brought by mobile phones, but they also suffer from the physical and mental shackles of mobile phones. social problem. Domestic related surveys and education sites have found that the ratio of primary school children using mobile phones has increased year by year, and the phenomenon of younger mobile phones has become more common. Therefore, this study aims to explore the use of smart phones by senior schoolchildren in the Gangshan District of Kaohsiung City, and the influence of parental management methods and physical and mental conditions. In the research method, the questionnaire survey method was adopted, and the content questionnaire of the self-edited "small mobile phone usage behavior of the senior high school students and their parental management methods and physical and mental conditions" was used as a testing tool to take the high school in Kaohsiung City. Grade students are surveyed and surveyed. The sampling method was sampled and a total of 214 valid questionnaires were collected. The questionnaire data were analyzed and sorted by statistical methods such as Descriptive Statistics, Independent sample t test, One-way ANOVA, and Regression Analysis. The results of the study are summarized as follows: 1. The rate of holding mobile phones for senior children in primary schools has increased, and the use of mobile phones has also become younger and the use time has also increased. 2. Mobile phone behavior is particularly important for "entertainment" orientation, and parental management style "requirements" are positive and have little effect on physical and mental conditions. 3. Different background variables have significant differences in the behavior of mobile phones. 4. Different background variables have significant differences in parental discipline. 5. The current state of use of mobile phones is significantly different between the physical and mental conditions. 6. Parental management methods have a significant impact on mobile phone usage and physical and mental conditions. 7. Mobile phone usage has a significant impact on physical and mental conditions. Finally, the results of the comprehensive research and recommendations are made for parents, education authorities, schools, teachers and future researchers.