Psychiatry - Theses
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ItemReceived social support and well-being among survivors of natural disaster( 2019)The idea that receiving social support in the aftermath of a disaster is beneficial to survivors’ psychological outcomes is widely accepted by both researchers and practitioners. However previous studies assessing the association between received social support and psychological outcomes have produced mixed results. One limitation of these studies is that they only assessed the quantity of support received, but not its quality. However, current evidences suggested that receiving social support is not always beneficial, this can lead to both positive and negative consequences. This research was intended to examine the effects of postdisaster received social support on psychological outcomes, and to explore the determinants of recipients’ perception of social support interactions. In the context of a longitudinal mixed method design, three studies were conducted among survivors of the Lushan earthquake in China: a longitudinal quantitative study examining the impact of post-disaster received social support on posttraumatic stress symptoms and psychological distress; a longitudinal quantitative analysis examining the impact of post-disaster social support on posttraumatic growth; and a qualitative study describing survivors’ experiences of receiving postdisaster social support, and exploring what matters to recipients in their evaluation of these experiences. A convenience sample of Lushan earthquake survivors was invited to complete a questionnaire 7 months after the earthquake (n =199) and was followed up 31 months later (n =161). Face-to-face semi-structured interviews were conducted by the author among a sub-group of participants (n =11) in the follow-up survey. This thesis found that greater quality of social support received 7 months after disaster predicted lower levels of posttraumatic stress symptoms and psychological distress two years later, however quantity of received social support was not significant in predicting these two outcomes. The association between quantity of received social support and PTG was moderated by the quality of received social support. Specifically, for survivors who received high quality of post-disaster social support, greater amounts of support received facilitated their posttraumatic growth. However, for those survivors who received poor quality of post-disaster support, greater quantity of support impeded PTG. Social support recipients cared about features related to outcomes, interaction, provider and management. First, recipients cared about features of the outcomes of social support interactions; that is, whether the support that was received fulfilled their needs, and also whether the distribution of support was equal and fair. Second, they cared about whether the interaction goes smoothly and easily; whether the interaction was initiated by providers; whether the interaction was public and therefore witnessed by others; whether they were treated with dignity in the interaction; and whether they had opportunities to reciprocate. Third, characteristics of help providers, including whether they sincerely wanted to help them, and what they devoted in order to provide assistance, also matter. Lastly, the efficacy and appropriateness regarding the management of disaster relief resources was concerned by recipients.
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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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ItemThe effects of immigration and resettlement on the mental health of South-Asian communities in Melbourne( 2006-02)This research explores the relationship between immigration experiences and psychological well-being within the Indian and Bangladeshi communities in metropolitan Melbourne, Australia. The researcher conducted individual in-depth interviews with thirty-eight adult Australian permanent residents/citizens born in India and Bangladesh with the aim of examining personal post-migration accounts of adjustment, acculturation and coping in a foreign society and the effect on their mental health. Through qualitative analysis, the personal experiences and stories of South-Asian migrants and the psychological consequences of resettlement in Australia are explored. The study investigated coping strategies and psychosocial protective mechanisms and explored factors relevant to both successful and unsuccessful resettlement, and their relationship to psychological well-being. The results indicated that social and emotional disconnection, isolation and alienation, lack of recognition of professional skills, experiences of racism and discrimination, cultural incongruity, feelings of cultural uprooting and inadequate English language competency, all may contribute to psychological distress, difficulties in adjustment to life in Australia and in some cases, repatriation to the country of origin.
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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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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.