Psychiatry - Theses
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ItemGathering longitudinal outcomes in wellbeing after burns (GLOW) study( 2017)Objective: Burn injuries are common and debilitating traumatic injuries that are associated with a range of post-injury maladjustments. Burn patients experience high rates of psychiatric morbidity, have low rates of return to work and experience reductions in quality of life in the months and years after discharge. Despite this, very limited longitudinal research has evaluated these outcomes in less severe burns, and has examined what early psychosocial risk factors may contribute to these outcomes. Further, common limitations across burns psychological research include variation in sample characteristics, limited reporting of findings, simplistic methodologies and small sample sizes. Aims: In light of the limitations in the burns literature, this research study aimed to investigate what pre-burn, acute and 3-month early psychosocial risk factors contribute to psychopathology, quality of life and return to work outcomes 6-months after burn injury. Method: Consecutive admissions to the burns unit in Melbourne, Victoria with a Total Burned Surface Area of 20% or less were recruited for the study. 109 burn patients provided consent to participate, and 74 completed the 3 and 6-month follow-up assessments. Participants completed structured clinical interviews to measure psychiatric history and post-trauma symptomatology, and a battery of self-report questionnaires assessing factors such as pain, sleep quality, appearance dissatisfaction, anger and social support. Bayesian Structural Equation Modeling was conducted for each outcome (psychopathology, quality of life, return to work) to identify early psychosocial contributors to these outcomes. Results: At 6-months, 28.4% of participants met criteria for an Axis I psychiatric disorder, and while only 3.0% met criteria for PTSD, 7.5% met criteria for subsyndromal PTSD. Quality of life was most affected in relation to taking care of the burn and skin sensitivity. 14% reported not having returned to work at 6-months as a result of the burn, and many participants reported at least moderate difficulty with performing work tasks. Symptoms of PTSD at 6-months were predicted by 3-month mental health symptoms, higher 3-month pain and social support. Symptoms of depression were predicted by higher age and more mental health symptoms at 3-months. Symptoms of anxiety were predicted by 3-month mental health symptoms only. Quality of life, as indicated by the domains of Affect and Relations, Skin Involvement and Functioning, were significantly predicted by various earlier risk factors, but they differed by domain outcome. Specifically, Affect and Relations, meaning problems related to affect, interpersonal relationships and sexuality, was predicted by 3-month mental health symptoms and higher pain. Skin involvement, meaning problems related to skin sensitivity and taking care of the burn, was predicted by burn severity (TBSA) and 3-month mental health symptoms. Functioning at 6-months was only significantly predicted by higher age. Problems returning to work at 6-months was significantly predicted by 3-month greater pain and more mental health symptoms. Conclusions: The findings from this study suggest that even in minor burn injuries, maladjustment is common in the months following the burn. Specifically, these burns experience elevated rates of psychiatric disorders, reduced quality of life and problems returning to work. While these outcomes are related, the findings further demonstrate that different risk factors are important to predicting each of these outcomes. Overall this study highlights the need for early, although not acute, psychosocial screening of even minor burns in order to improve psychosocial services available to minor burns.
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ItemQuality of life in people with cognitive impairment: nursing homes versus home care( 2014)The evaluation of quality of life (QoL) among older adults has become increasingly important in health and social science as it provides evidence which may have influential implications for ageing policies. Although this has been studied in developed countries, there are also issues for emerging countries, which have ageing populations. Living arrangements play a pivotal role in determining the QoL of people with cognitive impairment. Although informal care (home-based) is favoured, transition to formal care (residential care) often becomes necessary, especially in the later stages of cognitive impairment. The primary objective of the thesis was to compare the QoL of people with cognitive impairment in the community and nursing homes. In addition, factors that differentiate the QoL of people with cognitive impairment in these two settings were identified. A cross sectional observational study of people with cognitive impairment from government hospitals (home care) and nursing homes was carried out. This study involved interviews with older adults aged between 60 to 89 years old. Participants completed the QoL measurements (the EUROPE Health Interview Survey-Quality of Life and the Assessment of Quality of Life) as well as other measurements that assess factors contributing to QoL (e.g. the Short Mini Mental State Examination, the Barthel Index, the Cornell Scale for Depression in Dementia, the Camberwell Assessment of Needs for Elderly and the Friendship Scale). All measurements were examined for their psychometric properties (reliability, validity and structure). In a pilot study, 49 older adults with cognitive impairment were recruited and completed the questionnaires. Results showed significant differences in QoL and social connectedness among people with cognitive impairment in home care and those in nursing home. No significant differences were found by socio-demographic factors, cognitive severity and depression between the study cohorts. In a primary study, 219 people with cognitive impairment were recruited. The main study finding on the QoL of people with cognitive impairment demonstrated that those receiving home care experienced significantly better QoL. Other findings were that home care recipients had better cognitive function, were less depressed, had fewer unmet needs and reported higher social connectedness compared to nursing home participants. No significant differences were observed with regards to health condition, co morbidities and physical functions between study cohorts. This suggests that the findings were not due to health differences between the two study cohorts. It was also observed that all scales achieved the reliability and validity criteria set for this study. Thus, suggesting that the scales used in this study were reliable and valid for this study sample. In conclusion, older adults with cognitive impairment living at home experienced higher QoL, had better cognitive function, were less depressed, had fewer unmet needs and reported higher social connectedness compared to those living in institutional care. Therefore, support should be provided enabling home care and empowering caregivers to provide better care for people with cognitive impairment. As this is the first Malaysian study on this topic, this study may provide valuable and useful information for the patients, care givers, government and policy makers with regards to cognitive impairment and dementia care in Malaysia. Strong collaboration between government and NGO’s is needed in promoting ageing in community, by developing infrastructure to facilitate mobility and also encourage social interaction and intergenerational relationships.