Melbourne School of Psychological Sciences - Theses
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ItemAssessing the relationship between executive function, coping, stress, depression, anxiety and quality of life in multiple sclerosis( 2014)Background: Compared to healthy controls, people with multiple sclerosis (PwMS) use fewer adaptive and more maladaptive coping strategies when managing stressors and they experience higher rates of depression, anxiety and adjustment disorders. In addition, PwMS experience a high prevalence of cognitive impairment, including executive dysfunction, which has been linked to depression and anxiety. Aims: The current study examined the relationship between executive function, coping strategy use and psychosocial adjustment outcomes including stress, depression, anxiety and quality of life (QoL) in PwMS. The research assessed i) the ability of coping strategies and executive function to predict maladaptive and adaptive adjustment outcomes, and ii) the relationship between executive function and coping and whether there is a moderating and mediating relationship of different coping strategies between executive function and psychosocial adjustment in PwMS. Methods: Participants (N=107) with relapsing remitting or secondary progressive multiple sclerosis were administered tasks of executive function and completed self-report measures of stress, depression, anxiety, QoL and coping. Results: Consistent with expectations, stress, depression, anxiety and QoL were predicted by adaptive and maladaptive coping styles. Similarly, coping strategies, total coping and an adaptive coping index were predicted by tasks of executive function. Lower scores on tasks of executive function best predicted higher use of maladaptive strategies, but also adaptive strategies, while higher scores were limited in their ability to predict adaptive coping strategies. Tasks of executive function that most often predicted coping strategies included tasks of working memory, cognitive flexibility, information processing and attention. However, contrary to expectations, there was limited support for a relationship between tasks of executive function and psychosocial adjustment outcomes. An indirect relationship was found between executive function performance and adjustment through individual maladaptive coping strategies and adaptive coping strategies, as well as for an index of adaptive coping. Higher executive function performance was related to better adjustment via lower venting and behavioral disengagement, as well as higher scores on the adaptive coping index, whereas lower executive function performance was related to better adjustment via higher growth and acceptance. In general, better executive function and psychosocial adjustment was associated with minimal use of adaptive coping strategies, or greater use of maladaptive coping strategies. Conclusion: Executive function and psychosocial adjustment is mediated and moderated by coping strategies used by PwMS. Well-preserved executive function provides relative protection from poorer adjustment in the presence of high maladaptive or low adaptive coping. PwMS who perform poorly on tasks of executive function benefit from using less cognitively demanding coping strategies to enhance adjustment outcomes and this area that would benefit from further research to underpin effective intervention strategies. Findings from this study will assist with development of patient resources and patient management aimed at enhancing adaptive psychosocial adjustment in PwMS.
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ItemOlder parent-child relationships and their associations with older people’s psychological wellbeing: a comparison of Australian-born people and Chinese immigrants( 2014)Parent-child relationships are one of the most fundamental types of family relationships. Against the background of population ageing in Australia and many other Western countries, the present study explored the nature of these relationships in later life and their associations with older people’s psychological wellbeing. Alongside population ageing, Australian populations are becoming culturally diverse. To enhance our understanding of cultural diversity in these issues, the study focused the differences between older Australian-born people and older Chinese immigrants. Older Chinese immigrants were included in the present study because there are some unique features in the nature of parent-child relationships in this group, such as the concept of filial piety. A convenience sample of 122 participants were recruited in the present study, comprising 60 Australian-born people and 62 Chinese immigrants. These participants were interviewed using a standardized interview schedule. Three groups of measures were used, assessing socio-demographic factors, the nature of parent-child relationships, and psychological wellbeing. The solidarity–conflict model and the concept of ambivalence were used to operationalize the nature of parent-child relationships, and four indicators (i.e., depression, anxiety, loneliness, and quality of life) were used to present a broad picture of older people’s psychological wellbeing. Most participants reported relatively high levels of solidarity in their relationships with adult children. Specifically, the majority lived close to, had frequent contact with, and were involved in some kind of exchange relationships with their children. Most participants felt close to their children, believed that their children’s opinions and values were relatively similar to their own, and had some kind of filial expectations. However, conflict and ambivalence were common, albeit, of low intensity, in participants’ relationships with adult children. The study further found that these relationship dimensions were significantly associated with the four wellbeing indicators and that most of these associations persisted when socio-demographic variables were considered. There were both similarities and differences in the nature of older parent-child relationships between Australian-born people and Chinese immigrants. For example, participants from both groups preferred to live independently and to receive help from professional aged care services than from their children. However, older Chinese immigrants were more likely to live with children and reported higher levels of ideal filial expectations. There were also stronger associations between depressive symptoms and the nature of older parent-child relationships among Chinese participants. These findings highlight the complexity of parent-child relationships in contemporary multicultural Australian society and suggest that using a comprehensive model, such as the solidarity-conflict model, helps to present a more complete picture of these relationships. They also provide evidence for the importance of these relationships to older people’s psychological wellbeing. Finally, these findings have important implications for policy development and service planning and provision for older people, in particular, those for older Chinese immigrants.
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ItemAdjustment in life after traumatic brain injury: the impact of cognition, employment, and perceived sense of purpose in life( 2013)Traumatic brain injury (TBI) affects the most wide-ranging domains of survivors’ lives, markedly reducing emotional health and quality of life. The primary objective of this study was to explore the widely proclaimed therapeutic effect of employment on psychological wellbeing (PWB) and quality of life (QoL) relative to perceived sense of purpose in life (PIL). An additional aim was to examine the influence of factors involving cognitive function, injury severity, age at time of injury, gender, and preinjury education, on survivors’ work ability and return to work (RTW). A mixed methods design was used for an in-depth and comprehensive understanding about adjustment in life post-TBI. Method: Participants (N=40; 10-18 months post-TBI) were grouped according to age: 18-39 years (younger group), 40-55 years (older group) and injury severity (Glasgow Coma Scale scores): mild TBI (n=25), moderate-severe TBI (n=15). Quantitative Component: Neuropsychological testing and questionnaire surveys were performed to evaluate participants’ cognitive function, levels of perceived work gainfulness, PIL, PWB, and QoL. Data was analysed using bivariate and multivariate analyses of variance, aided by SPSS computer software. Qualitative Component: 12 participants (6 from each severity group) were randomly selected for digitally recorded semi-structured interviews, predominantly concerning the impact of work and life meaningfulness on adjustment process. Interviews were analysed using grounded theory methodology, aided by NVivo 10 computer package. Results and Discussion: PIL, in comparison to employment, cognitive function, and injury severity, made the strongest unique contribution in explaining PWB and QoL (p < 0.001). Employment potential was largely affected by memory and injury severity, with increased memory deficits (p < 0.01) and injury severity (p < 0.05) respectively associated with deteriorated employment potential. Main Conclusion: Having a strong sense of life as purposeful, notwithstanding employment, cognitive function, and injury severity, encourages survivors to focus on their lives and important life goals and to ultimately, achieve a promising life with healthy wellbeing.
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ItemSpeaking for themselves: how do adolescents define their quality of life after a traumatic brain injury?( 2013)Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in young people (Yeates et al., 2002). The status of quality of life (QoL) in paediatric TBI is mixed. Our recent meta-analysis of paediatric QoL (Di Battista et al., 2012) found that good QoL outcomes are contingent on milder injuries, proxy reporting and early assessment whereas poor outcomes reflect more severe injuries and later assessment. Available paediatric QoL data is largely based on the health-related quality of life (HRQoL) paradigm; where a good outcome is contingent on what one can accomplish or achieve, as assessed by proxies. Information on the subjective well-being (SWB) component of QoL is limited. When estimating the HRQOL in adolescents, the presence of anxiety and depression and the quality of social relationships are important considerations, because adolescents are entrenched in social development during this phase of maturation. The influence of anxiety, depression and loneliness on HRQOL in adolescent survivors of TBI has not been documented. The goal of this study was to explore the adolescent experience of quality of life, anxiety, depression and loneliness after a traumatic brain injury. This study is a mixed-methods assessment of the impact of mood states and loneliness on quality of life (QoL) in adolescents who have survived a traumatic brain injury (TBI). METHOD: mixed method/cohort pilot study (11 adolescents, mild to severe TBI; 9 parents), using self-report (anxiety, depression, HRQoL, loneliness) and proxy-report measures (anxiety, depression and HRQoL) and clinical psychiatric interviews (adolescent only). The adolescent experience of these states is not accurately reflected by parental proxy. Self-reported depression and age at injury were associated with health-related quality of life outcomes, while anxiety was not. Severity of injury was not related to secondary outcomes. Adolescent narratives revealed that having experienced a TBI does not a priori impact upon perceived QoL. The impact of a TBI on QoL could be positive or negative. Post-injury changes in ability were not always attributed to the injury, but rather to a sense of normal age-related changes as identified by the adolescent. Changes as a result of the injury were not always considered important to the adolescent’s view on QoL. Adolescents identified social and inter-personal discrepancies and the emotional consequences of these discrepancies. Ultimately, the individual’s appraisal of their identity from pre to post injury life related to their current sense of well-being. Friendships were very important considerations for post-injury well-being. Processes of post-traumatic growth were identified in the adolescent narrative. The findings of this study are novel and have important implications for both research study design and clinical care settings involving adolescent survivors of a TBI.