Melbourne School of Psychological Sciences - Theses

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    Assessing the relationship between executive function, coping, stress, depression, anxiety and quality of life in multiple sclerosis
    GRECH, LISA ( 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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    Parental psychological distress following very preterm birth: impact on infant social-emotional development and parent-child interaction
    PACE, CARMEN ( 2014)
    It is known that there are high rates of psychological distress in parents of very preterm infants, but previous researchers examining parental mental health after preterm birth have usually assessed mental health at one point in time. As such, little is known about the evolution of parental distress, particularly during the inpatient period in the Neonatal Intensive Care Unit (NICU). Parental distress can negatively impact parent-child relationships, which can then affect longer term child social-emotional development. Furthermore, children born very preterm have higher rates of early social-emotional difficulties, and are more likely to experience suboptimal parent-child interaction. These problems are likely to be compounded by parental mental health difficulties. Understanding these issues in the first year of life is vital to guide appropriate intervention, both for the wellbeing of mothers and fathers during this difficult period, and for the optimal development of their very preterm infants. This study aimed to describe the trajectory of psychological distress (depression, anxiety and post-traumatic stress symptoms) in mothers and fathers of very preterm infants at several key time points from birth to 12 months corrected age. It also investigated how this distress influenced parent-child interaction and the infant’s social-emotional development at 12 months corrected age. Finally, it examined whether parent-child interaction explained the relationship between maternal psychological distress during the first 12 months and infant social-emotional development at 12 months corrected age. Participants included 96 mothers and 86 fathers of 127 infants (99 families including 26 sets of twins and one set of triplets) born prior to 30 weeks gestational age and admitted to the Royal Women’s Hospital NICU in Melbourne, Australia. A subset of families of 55 infants were followed up at 12 months corrected age. Mothers and fathers completed measures assessing depression (The Centre for Epidemiological Studies Depression Scale) and anxiety (The Hospital Anxiety and Depression Scale) fortnightly from birth until the infant reached term equivalent age, and at three, six and 12 months corrected age. In addition, parents completed the Post-traumatic Stress Disorder Checklist Specific Version at term equivalent age and 12 months corrected age to assess post-traumatic stress symptoms. At 12 months corrected age the mothers and infants participated in the Emotional Availability Scales, an observational task assessing parent-child interaction, and mothers completed the Infant-Toddler Social and Emotional Assessment to assess infant social-emotional development. Overall, results showed that symptoms of depression, anxiety and post-traumatic stress were initially high for both mothers and fathers, and reduced in severity over time between the birth of their infant and 12 months corrected age. However, rates of clinically significant symptoms of depression remained above levels that would be expected in the general population at 12 months corrected age. Psychological distress in parents at various time points was predictive of certain infant social-emotional development and parent-child interaction outcomes. When these associations were examined more closely, it was found that the relationships between maternal mental health predictors and infant social-emotional development could not be explained by the influence of parent-child interaction. The findings of this study represent a substantial advance in the understanding of parental mental health following very preterm birth, especially in fathers. Additionally, the results may help identify the optimal timing of assessment and intervention to improve mothers’ and fathers’ wellbeing, and thus their infants’ development.
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    Tuning in to teens: examining the efficacy of an emotion-focused parenting intervention in reducing pre-adolescents’ internalising difficulties
    Kehoe, Christiane Evelyne ( 2014)
    The transition from childhood to adolescence coincides with an increase in anxiety, a peak in somatic complaints, and a post-pubertal rise in depression by mid-adolescence, particularly for girls. For those affected, internalising difficulties result in considerable stress and impairment for the young person even if symptoms do not reach criteria for clinical diagnosis. Up to 50% of all adult psychological disorders have their onset during adolescence, highlighting the importance of identifying methods of prevention that are evidence-based. Emotional competence has been found to be an important protective factor for healthy social, emotional, and behavioural functioning. Both adolescents and adults with internalising difficulties show deficits in aspects of emotional competence. Research in child development suggests that parents’ emotional competence and emotion socialisation practices are related to children’s emotional functioning, including child internalising difficulties. This research has not yet been translated into intervention or prevention programs targeting parents of adolescents. The current study examined the efficacy of the Tuning in to Teens parenting program in improving emotion socialisation practices in parents of pre-adolescents and in measuring the impact on youth internalising difficulties. Grounded in emotion socialisation theory, this program teaches parents skills in responding to emotions in ways that enhance emotional competence in the young person, while also improving parent-youth communication and connectedness. A group-randomised control design was used where participants were recruited from schools and randomised into intervention and control conditions. Data were collected from 225 parents and 224 youth during the young person’s final year of elementary school (6th grade) and again, 10 months later in their first year of secondary school (7th grade). The thesis includes three studies. Study 1 reports the results of multilevel analyses, which showed participation in Tuning in to Teens resulted in significant improvements in parental emotion socialisation and reductions in youth internalising difficulties for the intervention condition. Study 2 examined moderators and mediators of program outcome. Results showed greater program effects for intervention subgroups with high pre-intervention difficulties. Parental education, income, parental internalising difficulties, parental difficulties in emotion awareness and regulation, and attendance rate did not moderate program effects. Mediation analyses supported emotion socialisation theory and showed parents who participated in the Tuning in to Teens parenting program reported improvements in emotion socialisation, which in turn was related to reductions in youth internalising difficulties. Study 3 investigated the relationship between parent emotion socialisation and youth somatic complaints. The study extended the literature on somatic complaints by being the first to consider parents’ emotional competence and emotion socialisation practices as predictors of youth somatic complaints alongside parents’ own somatic complaints. Results indicated that changes in parents’ awareness and regulation of emotion and emotion socialisation practices resulted in reduced youth somatic complaints. These findings have important implications for current aetiological models of somatic complaints and provide support for using an emotion-focused approach to enhance current treatment models of youth somatic complaints. A significant contribution of this thesis is that it presents the first randomised control trial evaluation of a parenting program that utilises research linking parents’ emotion socialisation with young people’s mental health, applying it in practice with a sample of parents of pre-adolescents. The research findings provide support for emotion socialisation theory and for using an emotion focused parenting program to prevent internalising difficulties in early adolescence.
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    Older parent-child relationships and their associations with older people’s psychological wellbeing: a comparison of Australian-born people and Chinese immigrants
    LIN, XIAOPING ( 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.