Melbourne School of Psychological Sciences - Theses

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    An investigation of the holistic processing of faces
    Cheng, Xue Jun ( 2023-11)
    Whether it is due to the specific configuration of faces or our particular expertise with them, faces are seen to be a special class of object and, hence, processed differently compared to most other stimuli in our environment. One influential concept - holistic processing - has been used to describe how we process faces. In general, the concept of holistic processing is based on the idea that the entire face object is perceived and processed as a single unit instead of as individual parts or an aggregate of those parts. However, there is no single clear operationalisation of holistic processing in the literature, and the various experimental paradigms used seem to assess different aspects of processing. In this thesis, I explore the different ways holistic processing has been investigated and provide an in-depth examination of the underlying processing of composite faces. According to theories of information processing, holistic processing can be operationalised as a coactive architecture where all face information is combined into a single channel, which then drives decision-making in specific tasks. Coactive processing can be distinguished from other processing architectures such as serial and parallel processing using systems factorial technology and model-fitting. Overall, our composite faces were best fit by a mixture of serial and parallel processing, indicating little support for the argument that faces are processed holistically. We further investigate this mixture model and discuss how these results can be situated on a continuum which ranges from analytic, independent processing to complete, holistic processing.
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    The role of disgust in moral judgement
    Donner, Michael Ryan ( 2023-10)
    The emotion disgust underlies some of our moral judgments. But it’s not clear whether this relationship is because of disgust’s role in motivating the avoidance of pathogen threats (i.e., pathogen disgust) or reproductive threats (i.e., sexual disgust) (or both). The present thesis systematically examines the respective role of pathogen and sexual disgust in moral judgment across three empirical chapters. Chapter 2 (published in the journal Emotion Review; N = 72,443), was a systematic review and meta-analysis on associations between trait disgust sensitivity and moral judgments (as per Moral Foundations Theory; Graham et al., 2013). The key finding from this investigation was that measures of trait sexual disgust were more strongly related to moral judgments (especially of the sanctity domain) than were measures of trait pathogen disgust. Building on Chapter 2’s findings, Chapter 3 (published in the journal Emotion) aimed to clarify the zero-order effects of the meta-analysis by investigating the unique (semi-partial) contribution of each disgust type on moral judgment. In two studies (N = 2,718), comprised of 10 samples (taken from Australia, the United States, and Brazil), it was found that the unique associations between trait sexual disgust and sanctity/binding moral judgments were strong and significant, whereas the unique associations between trait pathogen disgust and sanctity/binding moral judgments were weak and non-significant. Moreover, the sexual disgust-sanctity/binding association seemed to be explained by motivations to avoid promiscuous sex (a specific kind of reproductive threat that triggers sexual disgust). Together, the findings from Chapters 2 and 3 argue against popular pathogen avoidance explanations of the connection between disgust and sanctity/binding concerns, and instead argue in favor sexual avoidance explanations (e.g., promiscuity avoidance). Chapter 4 moves away from an individual differences approach and adopts an experimental approach to investigate whether inducing state sexual disgust would have a causal impact on moral judgments across two studies (N = 1,290). Although the sexual disgust induction was successful at inducing disgust in both experiments, the induction had no direct causal impact on moral judgments (compared to a control condition) in either experiment. Nevertheless, consistent with the previous two chapters, trait sexual disgust was uniquely and reliably associated with sanctity/binding moral judgments in both experiments. Inconsistencies between trait and state sexual disgust findings might be due to limitations of the experiments or because trait and state approaches test a different underlying process. In summary, the present thesis shows that sexual disgust is an important factor in moral judgments.
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    Improving the Strength and Quality of Research Evidence in Clinical Neuropsychology
    Furey, Rachel Taneya ( 2023-10)
    Evidence replicability directly impacts the quality of care received by neuropsychology patients. While the importance of evidence-based practice has been increasingly recognized in neuropsychology over the past decades, some common practices that lack strong empirical support persist. Many of these practices can be observed in using and interpreting cognitive test scores. Such practices may have originated during a time when questioning expert opinion was uncommon and clinical expertise was relied upon for knowledge. As a result, the need to empirically investigate the assumptions behind some long-standing clinical practices has been overlooked, particularly those practices with high face validity. This thesis aims to evaluate the need and ways to improve the quality of research evidence used to inform clinical neuropsychological practice. Four empirical studies were conducted as part of this PhD project to address this objective. Each study incorporated metascientific practices to demonstrate how these practices can be employed in neuropsychology research to generate strong, high-quality evidence. Study 1 addressed the hypothesis that in the verbal paired-associates (VPA) subtests of the Weschler Memory Scales (WMS), hard items are more sensitive to left hippocampal damage than easy items, based on the assumption that hard items are “semantics-free”. The findings of Study 1 supported a latent semantic structure for the WMS-III VPA, suggesting that performance depends on the semantic features of the target words in each item. Study 2 investigated the latent structure of executive function in the Delis-Kaplan Executive Function System (D-KEFS), addressing the hypothesis that executive function constructs can be integrated with other cognitive ability constructs as defined by the Cattell- Horn-Carroll (CHC) theory. The findings of Study 2 demonstrated the previously published factor models for the D-KEFS, which lacked strong theoretical foundations, were not replicable. In contrast, a factor model consistent with CHC theory was well-fitting for the D-KEFS tests. Study 3 examined the clinical utility of separate recall and recognition testing in identifying memory disorders using a systematic review and meta-analyses. Despite popularity in clinical practice, the results of Study 3 found no evidence to support the hypothesis that recall and recognition tests provide different information. Instead, the findings suggest that recognition tests offer no incremental utility for identifying memory disorders compared to recall tests. Study 4 was a meta-research study that aimed to examine the impact of implementing reporting standards in a single neuropsychology journal, namely, Archives of Clinical Neuropsychology, which introduced mandatory reporting guidelines for submitting authors in 2017. The findings indicate that the quality of reporting in neuropsychology is currently suboptimal, potentially undermining the replicability of research evidence. Furthermore, the findings suggest that requiring authors to adhere to reporting guidelines when submitting their research may not guarantee high-quality methodological and statistical reporting. Overall, the findings of this PhD project demonstrate there is a need to improve evidence replicability in neuropsychology. The current peer review process is not sufficient to guarantee that published research evidence is strong or even valid. Broader adoption of metascientific practices is recommended across all stages of research, including before, during, and after publication. Although improving the peer review process would be a step towards improving evidence quality in neuropsychology, there are currently few incentives for journals to address this issue as a priority. Therefore, if substantial progress is to be made in improving the evidence quality in neuropsychology or other scientific disciplines, addressing the incentive system in academia may be a necessary first step.
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    The Associative Basis of Semantic Processing during Comprehension
    Shabahang, Kiavash ( 2023-08)
    The current thesis presents converging experimental and computational evidence for the centrality of retrieval operations during the comprehension of linguistic material, and develops an associative theory of semantic processing. Chapter 1 outlines the broad theoretical antecedents with a focus on the tension between symbolic and associative representations of meaning, arguing for a structural distinction between associations. Chapter 2 presents an associative network simulation of semantic memory and shows how assuming a spreading activation through a network of direct associations can match the variance in human free word association and word similarity data, traditionally explained by latent-representation semantic memory models. Instead of assuming generalization during encoding as in the latent-representation accounts, the Dynamic-Eigen-Net algorithm is presented as a way to defer generalization until retrieval through spreading activation in the network. Chapter 3 further extends the Dynamic-Eigen-Net to serial-order associations and shows how the Dynamic-Eigen-Net is better able to discriminate consistent and inconsistent novel bi-grams compared to standard spreading activation algorithms. Chapter 4 presents experiments that introduce challenges to the direct-encoding account of paradigmatic formation, where paradigmatic relations are assumed to correspond to directly encoded associations. Over a series of experiments, reliable evidence for the presence of syntagmatic associations is presented, but evidence for paradigmatic associations was inconclusive. Chapter 5 undertakes a comparison of the direct encoding account of paradigmatic relations and alternative theories. The results provide clear evidence in support of the retrieval account of paradigmatic relations, where paradigmatic relations are dynamically formed during retrieval. Chapter 6 revisits the Dynamic-Eigen-Net, presenting one way order-independent and -dependent associations can be integrated in an associative network model of the Syntagmatic-Paradigmatic framework. Chapter 7 concludes with a focus on challenges to overcome to pave the way towards an associative theory of semantic composition.
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    Associations between estradiol, brain structure and function, and extinction recall in adolescents
    Zwaan, Isabel Sterre ( 2023-08)
    Background: Adolescence is a life stage where anxiety and depressive (internalising) disorders emerge. Internalising disorders are twice as prevalent in females as males, a pattern apparent in adolescence. This sex disparity may be explained by pubertal and neurodevelopmental factors, as dramatic hormonal changes and dramatic brain changes occur during adolescence. Individual differences in pubertal hormones may interact with neurodevelopment to impact mental health. The sex steroid hormone estradiol is key in puberty, however few studies have examined associations between estradiol, neurodevelopment, and internalising symptoms, particularly in adolescents. In fact, estradiol may influence neural networks important for emotional processing and regulation, where alterations in these neural networks may underlie emotion dysregulation underlying internalising disorders. Aims: This thesis aims to investigate associations between estradiol variability (secondarily, average estradiol) and brain structure in female adolescents, as well as whether brain structure mediates longitudinal associations between estradiol variability and internalising symptoms. Further, we aim to investigate associations between estradiol variability (secondarily, average estradiol and estradiol level) and brain activation during emotion processing, as well as whether brain function mediates longitudinal associations between estradiol variability and internalising symptoms. Finally, the current thesis aims to explore associations between brain structure, fear extinction recall and trait and state anxiety symptoms, as well as moderating effects of age and sex, in a pilot study of adults and adolescents. Method: Study 1 and Study 2 of this thesis utilised the same sample of 44 female participants measured at age ~12 years (baseline) and age 13 years (follow-up). At baseline adolescents completed self-report questionnaires measuring anxiety (Spence Children’s Anxiety Scale) and depressive (Children’s Depression Inventory 2) symptoms, four saliva samples across one month to measure estradiol, and an MRI scan. In the MRI scan we collected T1-weighted images measuring brain structure for Study 1, and BOLD activation during a passive emotional face viewing task (including angry, fearful, calm faces) for Study 2. At follow-up, participants completed questionnaires measuring internalising symptoms. We utilised average estradiol and estradiol variability for both studies and estradiol on day of scan (the fourth saliva sample) for Study 2, using these to examine associations to brain structure and function during the emotional faces task and to internalising symptoms. In Study 3 we used pilot data from a sample of 18 adults and 20 adolescents who completed a fear conditioning, extinction learning, extinction recall, re-conditioning, and re-extinction fMRI task (a variant of the ‘screaming lady’ paradigm) and examined associations between skin conductance response during extinction recall and brain regions of interest in both groups combined and adolescents only, examining moderating effects of age group and sex. Additionally, we examined correlations between extinction recall, region of interest, and self-reported state and strait anxiety (State-Trait Anxiety Inventory). Results: We found that increased estradiol variability was associated with decreased right medial orbitofrontal cortex (mOFC) thickness, however there was no association between average estradiol and brain structure. Additionally, we found that estradiol on day of scan (but not average estradiol or estradiol variability) was associated with decreased precuneus and precentral gyrus and increased angular gyrus and frontal orbital cortex during processing of negatively valenced vs calm faces. We did not find associations between estradiol and internalising symptoms, or brain structure or function and internalising symptoms. In our pilot study, preliminary findings indicated that lateral OFC thickness was associated with extinction recall response in male, but not female, adolescents, while increased skin conductance response to the threat signal during extinction recall was associated with increased right mOFC thickness in adults. Further, we found a positive correlation between trait anxiety and right mOFC thickness and negative correlation between state anxiety and extinction recall response in adults and adolescents, and a positive correlation between trait anxiety and left medial OFC thickness in adolescents. Significance: To the best of our knowledge, these were the first studies examining associations between estradiol variability and brain structure and function in adolescents. We extended existing literature by demonstrating that increased estradiol variability, and not average estradiol, was associated with decreased vmPFC thickness (a region important for emotion regulation and fear extinction learning and extinction recall) in female adolescents at age 12. Further, we demonstrated that estradiol may module vmPFC activation during emotion processing, potentially facilitating emotion regulation. In our pilot study we (preliminarily) found that sex moderated the association between lateral OFC thickness and extinction recall response in adolescents, thereby extending the limited research on brain structure and extinction recall by indicating that sex differences may be present in these associations. Together, our findings support the notion that female sex steroids have organizational and activational effects on the brain, and that adolescence is a sensitive period of development.
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    Sleep disturbance as a feature of dementia with Lewy bodies
    Salthouse, Olivia Rose ( 2023-07)
    Dementia with Lewy bodies (DLB) is considered the second most common form of dementia after dementia of the Alzheimer’s type. While DLB has been considered its own diagnostic entity for approximately 30-years, several aspects of the clinical presentation remain enigmatic and require further research. Sleep is one such feature. Rapid eye movement (REM) sleep behaviour disorder (RBD) is a prominent feature of DLB and research over the past two decades has shown that it often precedes the onset of other clinical disease features by many years. The striking relationship between RBD and DLB has placed the REM stage of sleep at the forefront of sleep research in this population. Less consideration has been given to other aspects of sleep, yet clinical anecdote and case study evidence strongly suggest that sleep disruption is a pervasive clinical phenomenon, which plays itself out across all stages of sleep, affecting sleep quality, sleep structure, sleep electrophysiology and sleep behaviour. The aims of the current thesis were three-fold: 1) to comprehensively characterise the sleep profile of those in the early stages of probable DLB using actigraphy and PSG recording methods, 2) to characterise the most sensitive areas of cognition in DLB (attentional function and visual processing), and 3) to examine the relationship between sleep disruption and these sensitive areas of cognition in DLB. Participants were nine individuals with early stage DLB and nine age- and education-matched healthy older adults. Actigraphy and PSG sleep recording methods were used to objectively measure sleep quality and architecture. Participants underwent overnight in-home polysomnography (PSG) monitoring on 2 nights and completed 14 days of continuous actigraphy recording. Subjective sleep was measured using self-report questionnaires. Standardised neuropsychological measures assessed visuoperceptual and visuospatial function. Two computerised reaction time paradigms were completed by participants and provided a comprehensive measure of attentional function. This research documents significant disruptions to sleep quality and architecture in individuals with DLB. Actigraphy data revealed reduced sleep quality (reduced sleep efficiency and greater wake after sleep onset) and greater intra-individual variability in sleep quality from night-to-night. Greater variability in daytime sleep/inactivity was also documented. Overnight PSG revealed changes to sleep macrostructure and microstructure. Increased stage 1 sleep (N1), reduced stage 3 sleep (N3), and fewer microstructural features (sleep spindles and K-complexes) were documented. Sleep stage distribution throughout the night was also altered from the typical trajectory; as sleep progressed across the night, the relative distributions of sleep stages remained comparable, particularly for REM sleep. Examination of relationships between sleep and cognition revealed strong and consistent associations in those with DLB. Reduced sleep quality and increased variability in sleep quality were strongly associated with attentional impairment and in particular, attentional variability. Greater variability in daytime sleep/inactivity was also associated with more severe attentional impairment in DLB. Visual processing was largely independent of sleep. Pervasive sleep disruption is a clinical feature of DLB that emerges early in the course of disease. Disruption is represented across all aspects of sleep architecture, and impacts night time sleep and daytime functioning. These disturbances are characterised by prominent intra-individual variability and represent another fluctuating feature of this active and turbulent disease. These findings point to a loss of sleep macro- and micro-structure and suggest loss of structural definition in sleep, and more broadly a breakdown in the boundaries that typically separate the stages of sleep and the states of sleep and wakefulness. Empirical support for associations between sleep disruption and the quintessential cognitive features suggests a common underlying mechanism may underpin both sleep and cognition. This has key implications for understanding the origins of these dynamic features. Broad sleep disturbance is an early and prominent clinical symptom and offers a promising road for better understanding DLB and the neurological mechanisms which underly the enigmatic clinical symptoms of the disease.
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    A Model of Source Memory for Continuous Outcomes: Characterising Retrieval and Decision-Making
    Zhou, Jason ( 2023-09)
    Source memory is the ability to remember the origin of information stored in memory. Source memory has been of growing interest to memory researchers because influential models of episodic memory make opposing predictions about its properties. Particularly contentious is whether source memory retrieval is thresholded (i.e., fails discretely), or continuous (i.e., graded precision). Recent work has shifted away from tasks with discretely coded sources towards ones where both source presentation and responses are continuous. Distributions of source error in continuous-outcome tasks were observed to be highly leptokurtic with heavy tails, interpretable as a mixture of high-precision memory, and uniformly distributed guesses due to retrieval failure. This thesis critically evaluates this interpretation along two main lines of inquiry, the first related to the role of decision-making and the second related to intrusion errors. First, Study 1 applies a formal model of decision-making in the Smith (2016) circular diffusion model to distinguish between properties of decision-making and memory in the continuous-outcome task. Without a model of decision-making, response variability in decision-making can be erroneously attributed to memory processes. Models with decision-making variability and guessing in isolation and in combination were fit to joint distributions of response outcomes and times. Comparison of model fits revealed that guessing was necessary for good fit, suggesting that heavy tails in the distribution of response error is due to memory, rather than decision-making. Study 1 also conditioned participants’ source responding on their confidence in an old/new recognition task, addressing a potential confound by ruling out the possibility that participant guessing was only due to a lack of source memory for unrecognised items. Second, Studies 2 and 3 both concern the role of intrusion errors. Intrusions are responses driven by information retrieved about items other than the target on a trial. Although they represent a form of memory error, the error is in the binding between the items and sources, rather than the retrieval failure implied by guessing. However, when items are randomly distributed on the response domain, intrusions from non-target items mimic errors due to guessing. Across two experiments, Study 2 found evidence of intrusion responses, and showed that when these are explicitly modelled the estimated proportion of guesses decreased. Further elaboration of the intrusion model indicated that items studied in nearby positions in space and time were more likely to intrude. Surprisingly, neither the semantic nor perceptual features of cues had a similar effect. Study 3 manipulated these item features and found that intrusions were more likely when orthographic similarity was high across the list, but not semantics. Overall, these studies demonstrate that some, though not all, apparent guesses can be explained by intrusions, which are related to the similarity of items and contexts. Ultimately, these studies suggest that guessing occurs even when alternative explanations for heavy-tailed distributions of error are considered. Using a model of decision-making and intrusion processes, this thesis connects source memory research to parallel theories in the visual working memory literature. In doing so, it provides the most detailed characterisation of source memory with continuous outcomes to date.
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    Predicting post-concussive symptoms and behaviour outcomes in preschool mild TBI: A prospective study
    Yumul, Joy Noelle Tolentino ( 2023-07)
    Background: Mild traumatic brain injury (mTBI) makes up approximately 90% of all childhood TBIs. Post-concussive symptoms (PCS) and behaviour problems have been documented after mTBI, but their presentation and progression remain poorly understood in preschool children. Of note, the available literature on preschool mTBI is primarily based on parent report, and little is known regarding variables that may impact parents’ report of problems in their child months after the injury. Given the vulnerability of preschool children to mTBI, and the gaps in the current knowledge, the overarching aims of this thesis were to explore PCS and behaviour problems that parents report in preschool children, and to investigate variables, including observed parent-child interaction, which may be associated with parent report. Method: To address these aims, the thesis is composed of three parts. Part I was a cross-sectional study that investigated the proportion of children aged 2-12 years with PCS at three months post-injury and examined potential predictors of parent report. Part II was a systematic review of 11 studies that provided data on post-concussive signs and symptoms in preschool children, where information on PCS and signs of injury (e.g., loss of consciousness) were consolidated and the quality of the evidence was appraised. Part III was a prospective longitudinal study, which documented PCS and behaviour outcomes in children aged 2-5 years up to three months post-mTBI. It also explored variables measured using parent report, child report, and direct observation, which may be associated with parent report of such outcomes. The quality of parent-child interaction and its relationship with the outcomes was also investigated. Results: Part I showed that the proportion of children aged 2-12 years with one or more PCS was significantly higher in the mTBI group compared to the control group with a superficial injury to the head. Within the preschool age group, the proportion of children with PCS was comparable between injury groups. The likelihood of parent report of one or more PCS in children aged 2-12 years decreased if the child was female, and increased with multiple acute PCS, having a mTBI, and higher parental stress. Part II revealed that PCS in preschool children have been mostly assessed at an acute time point. Studies in the systematic review also revealed behaviour difficulties in preschool children even months post-injury. The systematic review highlighted several issues, including the lack of age-appropriate and validated PCS measures for preschoolers and the heavy reliance on parent report. In Part III, comparison of distributions based on mean ranks showed that the number of acute PCS that parents reported in the physical and sleep domains, as well as the mean acute PCS total scores, were significantly higher in preschool children with mTBI than those with limb injury (LI). The number of physical and sleep PCS significantly decreased over time in the mTBI group. The proportion of children with PCS was comparable between injury groups at each time point. Parents’ report of acute PCS was positively associated with pre-injury symptoms and child-rated acute pain. Parents’ report of PCS at one and three months post-injury was negatively associated with the number of acute physical signs of injury. With respect to behaviour outcomes, parent ratings of behaviour at pre- and post-injury were within the normal range and comparable between injury groups, except for sleep problems where the mTBI group received significantly higher ratings than the LI group at three months post-injury. However, this difference may have been pre-existing. Child behaviour at three months post-injury was significantly associated with premorbid child and parent variables: negatively associated with developmental status, and positively associated with parental stress and pre-injury behaviour. The quality of parent-child interaction was deemed suboptimal for most dyads and was significantly associated with several parent-rated variables: positively associated with child developmental status, and negatively associated with acute PCS, pre-/post-injury child behaviour, and parental stress. Conclusions: This thesis provided insight on the recovery of preschool children after mTBI, as well as on the potential benefit of monitoring children and providing additional support and psychoeducation to families post-injury. It also highlighted the need for additional research and demonstrated how future preschool mTBI studies may go beyond parent-rated measures of potential predictors to include novel factors, such as assessment of child’s pain and direct observation of parent-child interaction, which may offer unique information relevant to preschool mTBI outcomes.
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    Where stress presides: Investigating occupational stress within the Australian judiciary
    Schrever, Carly Anne ( 2023-08)
    Background: The thesis presents the first empirical research on the psychological health of the Australian judiciary. Judicial officers have an important and difficult job in democratic societies. They are senior members of the legal profession, the third arm of government, and guardians of the rule of law. They also manage demanding workloads, disturbing case material, and high-stakes decision-making. Several decades of Australian and international empirical research has demonstrated alarmingly high rates of stress and mental ill-health among lawyers and law students. However, judicial wellbeing has not received the same research attention, especially in Australia. The dearth of robust research impinges effective and evidence-based intervention to support judicial officers in their complex and critical work. Aims: The overall aim of this thesis was to empirically investigate the nature, prevalence, severity, sources and impacts of judicial stress in Australia. Across three studies, three broad research questions were addressed: (1) Are judicial officers stressed?; (2) Which judicial officers are most stressed, and why?; and (3) What are judicial officers’ perceptions of the sources and impacts of judicial stress, and their ideas for how judicial stress could be addressed? Method: Five Australian courts, from summary to appellate level, participated in the exploratory, mixed-methods research project. One-hundred and fifty-two (152) judicial officers participated in a survey, incorporating: validated measures for a broad range of stress constructs (non-specific psychological distress, K10; mental ill-health, DASS-21; burnout, MBI-GS; secondary traumatic stress, STSS; and alcohol use and dependence, AUDIT); a validated measure of workplace wellbeing factors (basic psychological needs satisfaction, BPNSFS); and several bespoke questions relating to subjective wellbeing and demographics. Sixty-one (61; 59 available for analysis) participated in in-depth interviews exploring the lived experience of judicial stress and ideas for court responses. Results: Study 1 found that, like lawyers, judicial officers reported elevated levels of psychological distress and problematic alcohol use, and that burnout and secondary trauma were prominent features of the judicial stress experience; however, unlike the broader legal profession, judicial officers’ reported levels of mental ill-health were relatively low. Study 2 found that judicial stress was highest in the high-volume, lower courts and that this was largely due to lower levels of basic psychological needs satisfaction within those jurisdictions. Study 3 found that workload and ‘stressors of injustice’ were emphasised as prominent and increasing sources of judicial stress, while the personal and professional satisfaction judicial officers derive from the work generally compensates for the stress they experience. It also found that increased time and committed leadership were seen as preconditions to the systemic enhancement of judicial wellbeing. Conclusion: The findings across the three studies suggest that: (1) judicial stress is high and increasing, and therefore urgent action is needed to address it – especially in the lower courts; (2) factors extrinsic to the judicial role are causing more stress than those intrinsic to the task of judging, suggesting that systemic stress mitigation is possible in the judicial context; (3) interventions directed to enhancing experiences of autonomy, relatedness, workload manageability, psychosocial safety, and effective leadership are likely to have the greatest impact on judicial wellbeing; and (4) with appropriate, evidence-based intervention to address the identified sources of judicial stress, marked improvements in judicial wellbeing can be expected.
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    Longitudinal prospective study of self-esteem and psycho-social function after childhood traumatic brain injury: delineating the contribution of injury, environmental, and individual factors
    Khan, Noor ( 2023-07)
    Background: Traumatic brain injury (TBI) is a significant public health burden that is a key contributor to lifelong disability. Such injuries can disrupt brain networks undergoing maturation during childhood and derail their ongoing development, contributing to profound changes in functioning. Sustaining a childhood TBI may also influence how individuals perceive themselves i.e., their self-esteem; however, current evidence base is weakened by retrospective, cross-sectional designs, and recruitment of heterogeneous samples. The overall aim of this prospective, longitudinal investigation was to examine the impact of paediatric TBI on self-esteem across childhood/adolescence and into young adulthood, and identify factors that contribute to individual variation in self-esteem. Method: The original study comprised 112 children and adolescents with mild-severe TBI (Anderson et al., 2013). For comparison, 43 typically developing controls matched on age, sex, and socioeconomic status were included. Participating families, both children and their parents, completed assessments at an outpatient clinic or at home at 6- and 12-months post-injury. At the 13-year follow-up time point, 29 young adults with childhood TBI and 10 typically developing controls were recruited from the existing cohort. Consenting participants completed questionnaires online. Results: As documented in three published and one submitted manuscript (chapters 6-9), findings revealed that some aspects of self-esteem may be especially vulnerable to deterioration following TBI. Specifically, perceived competence in both academic and behavioural domains was found to be significantly lower amongst children and adolescents with TBI, relative to typically developing controls. Individual variance in longitudinal self-esteem outcomes was documented in relation to injury factors (TBI severity, injury age, presence of frontal lobe pathology), environmental variables (parent mental health, family function, peer relations), and individual characteristics (social isolation, emotional wellbeing). For young adult survivors of childhood TBI, low self-esteem was endorsed by a sizeable proportion (approximately 20% or 1 in 5 TBI participants). Conclusions: Evidence for links between self-esteem and a multitude of injury, environmental, and individual factors accord with both developmental and brain-injury specific theoretical frameworks, and caution against exclusive reliance on injury-related variables when determining consequences of childhood TBI, especially in the context of self-esteem. While injury severity had some influence, environmental, and individual factors consistently made the largest and most significant contribution to global and domain-specific self-esteem. Collectively, results from the present investigation underscore the importance of routine and ongoing screening of non-injury, potentially modifiable risk factors, which likely represent useful targets for clinical interventions and rehabilitation programs seeking to optimise self-esteem in the short- and long-term following childhood TBI.