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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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.