Assessment and Promotion of Partner Support: A Prevention-Focused Intervention for Perinatal Depression in Primary Care

Perinatal depression significantly impacts the mother, her partner, the unborn fetus, and the infant/child after delivery. A review of the literature supports the need for preventive intervention methods as research has shown that even with successful treatment, disruptions in attachment, temperament, and cognitive development often remain. Primary care settings are ideal targets for prevention given that they can reach a number of people at low-cost without the stigma associated with seeking help in a mental health facility. This paper purposes a preventive intervention method for perinatal depression that can be implemented in primary care settings in both Western and non-Western countries. The intervention targets two of the primary risk factors for perinatal depression; partner support and relationship quality. The intervention is structured around key target periods in gestational development and during the early weeks after delivery. Suggestions for each target visit are based on prior research that has demonstrated how psychoeducation about the transition to parenthood, as well as increased communication, can positively affect partner support and relationship quality. The ultimate goal of the intervention is not only to prevent perinatal depression but also to improve the mental health and wellbeing of the entire family system.

An Acceptance and Commitment Approach to Issues of Behavioral Health Care in Soldiers

For over a decade, the U.S. military has been engaged in two distinct, yet equally deadly conflicts: Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). There are many physical and psychological effects of war necessitating the activation and interventions of a myriad of behavioral health professionals. The purpose of the paper was to understand how and if contemporary military culture may work to support or hinder application of an Acceptance and Commitment Therapy (ACT) approach to issues of psychological health among Soldiers. While the empirical research on efficacy with Soldiers is limited, a review of military culture revealed the promotion of rigid rule following, although effective in combat, influences the emotional control agenda and stigma while in garrison. However, empirical research demonstrating the clinical benefits and flexibility of ACT is rapidly emerging with civilian and Veteran populations. Suggested as a prevention technique utilized early in Soldier's training to increase psychological flexibility, ACT appears to demonstrate much promise in ameliorating the psychological consequences of war.

Cross-Disciplinary Collaboration Behavior of Practitioners in the Treatment of Anxiety Disorders

Current research on the collaborative behaviors of conventional and alternative health care providers for the treatment of anxiety is lacking. While there are multiple studies looking at alternative health care integration into primary care, none of them look at anxiety specifically. The purpose of this paper is to provide a preliminary exploration of possible barriers to collaboration between conventional and alternative health care providers for the treatment of anxiety. Quantitative data on collaboration behavior patterns were obtained with an anonymous survey. Data from the surveys were analyzed using a chi-square analysis. Along with these numerical data narrative data from the survey and interviews were collected in order to assess beliefs about the barriers to collaboration from different health care providers. The results indicate that conventional providers collaborate the least with alternative providers and alternative providers collaborate the least with conventional providers. The descriptive results regarding the barriers to collaboration from the study illustrated a common theme, specifically, the lack of education of conventional providers on alternative health care practices on anxiety. This is an exploratory study: therefore it would be beneficial for future researchers to look deeper into the beliefs of health care providers on the barriers to collaboration, possibly identifying the specific barriers to collaboration for each type of healthcare provider.

When Wells Run Dry: Water and Tourism Along the Western Coast of Nicaragua

This dissertation uses a political ecology approach to examine the relationship between tourism development and groundwater in southwest Nicaragua. Tourism in Nicaragua is a booming industry bolstered by ‘unspoiled’ natural beauty, low crime rates, and government incentives. This growth has led to increased infrastructure, revenue, and employment opportunities for many local communities along the Pacific coast. Not surprisingly, it has also brought concomitant issues of deeper poverty, widening gaps between rich and poor, and competition over natural resources. Adequate provisions of freshwater are necessary to sustain the production and reproduction of tourism; however, it remains uncertain if groundwater supplies can keep pace with demand. The objective of this research is to assess water supply availability amidst tourism development in the Playa Gigante area. It addresses the questions: 1) are local groundwater supplies sufficient to sustain the demand for freshwater imposed by increased tourism development? and 2) is there a power relationship between tourism development and control over local freshwater that would prove inequitable to local populations? Integrating the findings of groundwater monitoring, geological mapping, and ethnographic and survey research from a representative stretch of Pacific coastline, this dissertation shows that diminishing recharge and increased groundwater consumption is creating conflict between stakeholders with various levels of knowledge, power, and access. Although national laws are structured to protect the environment and ensure equitable access to groundwater, the current scramble to secure water has powerful implications on social relations and power structures associated with tourism development. This dissertation concludes that marginalization due to environmental degradation is attributable to the nexus of a political promotion of tourism, poorly enforced state water policies, insufficient water research, and climate change. Greater technical attention to hydrological dynamics and collaboration amongst stakeholders are necessary for equitable access to groundwater, environmental sustainability, and profitability of tourism.