Psychiatry - Theses
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ItemWhat are the special characteristics of families who provide long term care for children of parents with mental illness?( 2003)This project investigated characteristics relating to family functioning and attitudes to mental illness, and caregiving, which distinguish families choosing to care for children of parents with mental illness (CPMI) from families who choose not to but do care for other children (NCPMI), and from families not involved in the adoptive care system (COMM). Welfare agencies seeking long term home based care for children of parents with mental illness (among other groups of children) report that potential caregivers are concerned about the child’s genetic risk, and the requirement that they facilitate access visits with the birth parent. Consequently it is more difficult to recruit caregivers to care for children of parents with mental illness. Previous studies found that families who adopt children with special needs had family systems that were flexible and able to adapt to changing needs, and in which family members felt close to one another. It was not known if the functioning of families who care for children of parents with mental illness would differ from other family groups. Nor was it known if these families would differ in motivation to be caregivers and attitudes to mental illness from other family groups. Forty four families completed a questionnaire providing background information, and a family functioning questionnaire which included the FACES II measure (Family Adaptability and Cohesion Evaluation Scale) and questions assessing level of altruism, and tendency to respond in a socially desirable manner. Data from the FACES II measure was used to classify families according to the Circumplex Model of Marital and Family Systems. Q-methodology was used to assess participants’ attitudes to eight issues related to the research question: mental illness, children of parents with mental illness, parents having a mental illness, family environment, motivation to be caregivers, ongoing contact between child in care and parent, approval of others when deciding to be a caregiver, and flexibility in deciding to accept a certain child for placement. The Q-method required participants to rate 42 statements (a Q-set), concerning these issues, according to a fixed distribution, from statements with which they strongly agreed to statements with which they strongly disagreed. Participants could also give open-ended responses to questions addressing the same issues in a semi-structured interview. The CPMI group were found to have a lower level of income and education than the other two groups, and were more likely to be full time caregivers. Both caregiver groups were unlikely to have children of their own. The profiles of the three groups on the cohesion and flexibility sub-scales of FACES II were similar. The classification of the family groups on the Circumplex model showed that the CPMI group were located in the balanced and mid-range levels of the model more so than the other two groups. Responses to the Q-sort and interview questions suggested that the CPMI families were more understanding of mental illness, and of the needs of the children and capacity of their parents. It is suggested that future studies increase the number of participants, and investigate in more detail the factors which motivate families who provide long term care for children of parents with mental illness.
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ItemThe experience of depression: women's perspectives( 2002-12)Reports from epidemiological survey data identify that twice as many women than men suffer with depression over the life cycle. From reviewing the broad research literature, it appears that many studies focus on only one aspect of a bio-psychosocial model and, do not consider how these aspects interact. (For complete abstract open document)
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ItemEvaluation of the Bilingual Case Management Program in community mental health services in Melbourne( 2001-06)This thesis describes the evaluation of a program to employ bilingual staff in case management positions in community mental health services in Melbourne, Australia. A literature review showed that no previous research in Australia had investigated the impact of bilingual staff on clients of mental health services. While research conducted in the USA shows that ethnic matching (matching clients and clinicians on the basis of language or ethnic background) increases service use, its impact on outcome domains such as social functioning remains uncertain. (For complete abstract open document)
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ItemThe relationship between anxiety vulnerability and stress in the cognitive processing of threat-related information( 2000-03)In order to clarify the relationship between anxiety vulnerability and clinical anxiety, information-processing models have been employed to examine the cognitive biases of anxious individuals for threat-related information. At the core of these models are research findings indicating that anxiety-linked attentional biases render high trait anxious individuals disproportionately vulnerable to the effects of stress. The current research, following the model of Williams, Watts, MacLeod, and Matthews (1988), tested the hypothesis that attention to threat-related information is due to the interaction of trait anxiety and state anxiety. Five comparable studies employed emotional Stroop and probe-detection paradigms to assess the attentional biases of high and low trait anxious individuals to threat-related words in response to elevations of stress. Four of the studies assessed the preconscious and conscious attentional biases of adults and one study investigated the attentional biases of children. This focus allowed developmental comparisons that had not been undertaken previously. The studies were comparable to each other and to previous research. The studies sought to clarify the effects of different forms of stress on the anxiety-linked attentional biases and to assess the effects of these stressors on domain-specific stimuli. The hypotheses were that, in response to elevations in state anxiety, high trait anxious individuals show increased attention to threat and low trait anxious individuals show avoidance of threat. It was expected that these threat-related attentional biases are identified at both preconscious and conscious levels of processing, and more when the stimuli are related to the individuals’ domain of concern. Contrary to expectations, only one study found the predicted pattern and this result occurred at a conscious level of processing. In addition to the lack of support for the hypotheses, a counter-intuitive alternative pattern that was the converse of predictions was identified in four of the five studies. In this pattern, in response to elevated stress, there was a trend for high trait anxious individuals to show decreased attention to threat and low trait anxious individuals to show increased attention to threat. The pattern was identified, in various studies, at conscious and preconscious levels of processing, and more in response to domain-specific stimuli. Adults and children showed similar levels and types of attentional biases. The results of the current studies show some convergence with previous research. The findings are discussed in the context of a proposed model that incorporated aspects of Williams et al’s theories (1988; Williams, Watts, MacLeod, & Mathews, 1977) and Mogg and Bradley’s (1988) theory. This model suggests that high and low trait anxious individuals’ patterns of threat-related attentional biases vary according to their different levels of reactivity to stress, which affects their threat threshold. Due to differences in this threat threshold, high and low trait anxious individuals show divergent attentional responses under the same level of external stress. The model incorporates the avoidance effects identified in previous research and theory. This model may explain both the current counter-intuitive findings and past inconsistencies in the literature. It may also clarify how individuals with different levels of anxiety vulnerability show divergent attentional responses to stress elevations. It is suggested that inclusion of the notion of subjective stimulus threat value into the cognitive processing paradigm may clarify some of the unresolved issues raised in this research.
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ItemThe implementation and evaluation of telecounselling as a treatment modality for problem gambling( 2000-07)There is an extensive range of problems and maladaptive behaviours for which people may seek counselling. One of these is problem gambling. The extent of gambling in the community and the incidence of gambling problems have become issues of great concern to many in the Australian community. Counselling in the face-to-face setting may not be available or appropriate for some individuals with gambling difficulties. Potential barriers to the provision of counselling services for problem gamblers means that innovative techniques for counselling service delivery must be developed and evaluated. Provision of counselling services using modern telecommunications technology is one such innovative strategy. (For complete abstract open document)
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ItemA Comparison of an internet-based and face-to-face group intervention to modify body dissatisfaction and disturbed eating in young women( 2003-01)Objective: This study compared the effectiveness of a new manual-based group intervention program, The Body Image and Eating Behaviour Program, for women with sub-clinical body dissatisfaction and disturbed eating behaviours, using two delivery modes: a traditional Face-to-Face group intervention and an Internet-based intervention with interactive on-line group sessions in synchronous time. The program was conducted weekly over an 8-session period. Predictors of a good treatment outcome for the intervention program were examined with both delivery modes combined. Methods: Participants (18-30 year old women) were recruited by advertisements on Melbourne university campuses and at community health agencies. They were randomly assigned to group (Face-to-Face group n=19, Internet-based group n=21). Body dissatisfaction, disturbed eating behaviours, psychological status, and stage of change were assessed using standardized instruments prior to and immediately after the intervention, and at two months follow. Results: A 2 (group) X 3 (testing occasions) within subjects repeated measures analysis of variance was used to examine time and between group differences. Significant improvements on all clinical outcome variables were observed at post-test and maintained at follow-up in both groups. However, there were no significant between group differences. Hierarchical multiple regression analyses were used to examine predictors of treatment outcome at follow-up. Milder depression scores predicted greater improvement in binge eating frequency while a greater improvement in bulimic pathology and self-esteem at follow-up was predicted by more severe body dissatisfaction scores. Stage of change before treatment was not a predictor of outcome. Qualitative research demonstrated that the Internet-based delivery mode was a less confronting way of seeking help and a convenient and supportive medium to disclose personal information. However, participants had more difficulty exploring deeper psychological issues in the Internet-based group and forming close bonds with each other due to the speed and flow of the discussion. Discussion: The treatment program was valuable in both delivery modes and was found to be very acceptable by participants. The Internet, with the potential to over-come obstacles of distance and provide a discrete mode of treatment delivery, showed promising results at improving body satisfaction and disturbed eating behaviours in young women. Findings demonstrated inconclusive evidence for predictors of a good treatment outcome.
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ItemPsychosocial mechanisms underlying cultural differences in depressive and anxiety illness symptom reporting and presentation: comparison of Greek-born immigrants and Anglo-Australians( 2003)The current research included three studies: a survey exploring psychological factors that may underly cultural differences in illness reporting and presentation; and a qualitative and a quantitative study exploring cultural differences in illness schemas. The purpose of the work is to examine the importance of a wide variety of factors that may underly cultural differences in the presentation and reporting of depression and anxiety. The total sample of respondents consisted of 221 Greek-born and 239 Anglo-Australian people (mean age 65 yrs). First, Greek-born people reported higher levels of depression (as measured by the Beck Depression Inventory-2, BD1-2) and anxiety (as measured by the State Trait Anxiety Inventory, STAI) and higher levels of stress, trait negative affectivity, illness concern, impression management, self-focused attention and stigma. Hierarchical regression analyses indicated that all explanatory variables were significant unique predictors of at least one BDI-2 and/or STAI measure when controlling for confounding variables such as socio-economic status, age and gender. Overall, Trait Negative Affectivity (TNA) was the most stable and consistent predictor of the BDI-2 and STAI scores for both birthplace groups. Conceptual similarities appear to exist for the causes and important symptoms components of illness schemas between mental and physical problems for the Greek-born. For the Anglo-Australians, similarities exist for the course and development, consequences and therapy components of illness schemas between mental, physical and social problems. The propensity to report particular types of symptoms to a doctor appeared to also be affected by illness schemas. Findings suggest that different presentation of depression and anxiety across cultures may be better understood by the degree to which processes underlying symptom reporting may be salient in different cultures.
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ItemChinese-Australian families' help-seeking behaviours for mental illness( 2002)This thesis includes two studies: a survey of Melbourne's Chinese community and a family interview study. The survey was based on 418 respondents while twenty-eight caregivers participated in the family interview study. The survey explores how depression and schizophrenia are understood and are dealt with in a migrant Chinese community. The purpose of the family interview study was to examine the pathways to care for mental disorders, the social representation of illness and families' experiences of illness. Social knowledge about mental illness, physical illness and the concepts of normal human experiences of distress influenced the labelling of experienced conditions. Disorders were labelled as ‘a mental illness’, ‘a physical illness’, ‘a normal problem’ or ‘an abnormal problem’. Results indicated that schizophrenia was likely to be labelled as a mental illness and psychiatrists were seen as the main form of help. On the other hand, depressive disorder, anxiety disorder and post traumatic stress disorder were likely to be labelled as a ‘normal problem’, an ‘abnormal problem’ or a ‘physical illness’ and were likely to be treated by family members, friends, a traditional Chinese medicine physician or a Western physician. Labels given determined initial responses to the problem but the work also indicates a dynamic relabelling process developed by exposure to the social and professional systems. Pathways to care are intimately related to illness understandings which in themselves are in some respects relatively dynamic. The present study suggests that health professionals and the health institutions need to take into account patients' and family members’ explanations of illness in order to improve access to their services and in order to improve the quality of the services they deliver to the community.