Adolescent boys’ health : managing emotions, masculinities and subjective social status

The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS). This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted. In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied. The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV). Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions. In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.

Autistic and Schizotypal Traits and Global Functioning in Bipolar I Disorder

Objective: To determine the expression of autistic and positive schizotypal traits in a large sample of adults with bipolar I disorder (BD-I), and the effect of co-occurring autistic and positive schizotypal traits on global functioning in BD-I. Method: Autistic and positive schizotypal traits were self-assessed in 797 individuals with BD-I recruited by the Bipolar Disorder Research Network. Differences in global functioning (rated using the Global Assessment Scale) during lifetime worst depressive and manic episodes (GASD and GASM respectively) were calculated in groups with high/low autistic and positive schizotypal traits. Regression analyses assessed the interactive effect of autistic and positive schizotypal traits on global functioning. Results: 47.2% (CI=43.7-50.7%) showed clinically significant levels of autistic traits, and 23.22% (95% CI=20.29-26.14) showed clinically significant levels of positive schizotypal traits. In the worst episode of mania, the high autistic, high positive schizotypal group had better global functioning compared to the other groups. Individual differences analyses showed that high levels of co-occurring traits were associated with better global functioning in both mood states. Limitations: Autistic and schizotypal traits were assessed using self-rated questionnaires. Conclusions: Expression of autistic and schizotypal traits in adults with BD-I is prevalent, and may be important to predict illness aetiology, prognosis, and diagnostic practices in this population. Future work should focus on replicating these findings in independent samples, and on the biological and/or psychosocial mechanisms underlying better global functioning in those who have high levels of both autistic and positive schizotypal traits.

The Role of Perceived Social Support, Resilience, and Depression on Communicative Participation in Head and Neck Cancer Survivors

Thesis (Master's)--University of Washington, 2016-08

The relationship of early social, mental, and behavioral experiences with adult obesity and Alcohol Use Disorder

Stressful life events early in life, including symptoms of mental disorders or childhood maltreatment, may increase risk for worse mental and physical health outcomes in adulthood. The purpose of this dissertation was to examine the effects of childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms and maltreatment experience on two adult outcomes: obesity and alcohol use disorder (AUD). Mediational effects of adolescent characteristics were explored. This dissertation used Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health. In Paper 1 (Chapter 3), we investigated the association between multiple types of child maltreatment and adult objective (body mass index; BMI) and subjective (self-rated) obesity, as well as mediating effects by adolescent characteristics including depressive symptoms and BMI. Results showed that after adjusting for sex, race/ethnicity, and maternal education, physical maltreatment was moderately associated with adulthood obesity as measured by BMI and self-reported obesity, while sexual maltreatment was more strongly associated with the objective measure but not the subjective measure. The indirect effects of mediation of adolescent BMI and depressive symptoms were statistically significant. In Paper 2 (Chapter 4), the objective was to examine mediation by adolescent depressive symptoms, alcohol consumption, peer alcohol consumption, and delinquency in the relationship between ADHD symptoms and adult AUD. The indirect effects of mediation of adolescent delinquency, alcohol consumption, and peer alcohol consumption were statistically significant in single and multiple mediator models. In Paper 3 (Chapter 5), the objective was to assess the joint effects of maltreatment/neglect on adult AUD. After adjusting for sex, race/ethnicity, child maltreatment, and parental AUD, ADHD symptoms were significantly associated with increased odds of AUD. There was no strong evidence of multiplicative interaction by maltreatment. This association was stronger for males than females, although the interaction term was not statistically significant. This dissertation adds to the literature by examining relationships between several major public health problems: ADHD symptoms, childhood maltreatment, AUD, depressive symptoms, and obesity. This project has implications for understanding how early life stress increases risk for later physical and mental health problems, and identifying potential intervention targets for adolescents.

Examining the Association between Acculturation and Hypertension among Asian Americans in the Washington D.C. Metropolitan Area

Objective: To evaluate the association between Acculturation and hypertension among Asian Americans in the Washington, D.C. metropolitan area. Methods: A cross-sectional study was conducted of 600 Chinese, Korean, and Vietnamese adults. Logistic regression was used to investigate the relationship between acculturation variables (years in the U.S., self-rated acculturation, self-rated English fluency) and hypertension, determined from a mean of 3 blood pressure readings taken on site. Results: Compared to those who resided in the U.S. for 0-5 years, individuals who resided for 6-10 years were about 60% less likely to have hypertension (aOR= 0.36; 95% CI: 0.12, 1.05; p-value=0.06). No significant association was observed between self-rated identity and hypertension. Compared to those with poor English fluency, those who speak “so-so” English have increased odds of hypertension (aOR=1.57; 95%CI: 0.93, 2.64; p-value= 0.09). Disaggregated analysis was conducted for Asian American subgroups, which showed differences in trends of acculturation and hypertension. Conclusion: Findings suggest an association between acculturation and hypertension, guiding future studies to investigate further into these observed effects. Some subgroup differences were observed among Asian American subgroups, potentially suggesting a subgroup-focused intervention.

Predictors of feelings of depression among Asian American college students

The purpose of this study is to explore the relationship between various collegiate experiences including substance use, religiosity, campus climate, academic life, social life, self-concept, satisfaction with college, and perceived feelings of depression among Asian American college students compared to other racial groups. Employing Astin’s (1993) I-E-O model, the study utilized the 2008 Cooperative Institutional Research Program (CIRP) the Freshman Survey (TFS) and the follow up College Senior Survey (CSS) in 2012 with the final sample of 10,710 students including 951 Asian American students. Descriptive analysis, cross-tabulations, blocked hierarchical multiple regression analysis, the equality of the unstandardized beta coefficients from the regression analyses, and a one-way ANOVA were conducted for the data analysis. Asian American students who are female, from low SES backgrounds, academically less achieved, frequent substance users, less religiously involved, and less satisfied with overall college experiences showed higher levels of feeling depressed. For the rate of feeling depressed across racial groups, Asian American college students showed the highest rate of feeling depressed while White students reported the lowest rate of feeling depressed. For Asian American college students, feeling depressed in high school, hours spent per week on studying and homework, and self-confidence in intellectual ability were the most significant predictors of feelings of depression while drinking beer, drinking liquor, spirituality, failing to complete homework on time, hours spent per week on socializing, self rated self-confidence in social ability, and satisfaction with overall college experiences were significant predictors of feelings of depression. Asian American college students spent the longest hours on studying and homework, reported the highest GPA, but showed the lowest self-confidence on intellectual ability. For all four racial groups, feeling depressed in high school and self-confidence in intellectual ability were significant predictors of feelings of depression in common. Implications for practice and directions for future research emphasize the need for better understanding the unique cultural background and impact of academic life associated with feelings of depression among Asian American college students and developing customized psycho-educational and outreach programs to meet unique needs for psychological well-being for each racial group on campus.

National survey of the portuguese elderly nutritional status : study protocol

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Isolamento social e indicadores de depressão em adolescentes: Um estudo longitudinal

Tese submetida como requisito parcial para a obtenção do grau de Mestre em Psicologia Aplicada Especialidade em Psicologia Clínica

Levnadsvanor och självskattad hälsa hos 40-åringar

Självskattad hälsa beskriver personens subjektiva uppfattning av sin hälsa. En lågt självskattad hälsa har samband med ökad framtida dödlighet. Ett starkt välbefinnande är enligt Katie Erikssons dimensioner av hälsa, förutsättningen för att hälsan ska skattas som bra. Syftet med denna studie var att beskriva eventuella skillnader i självskattad hälsa sett till olika levnadsvanor hos 40-åriga kvinnor och män. Metod: Enkätsvar från totalt 1144 40-åriga kvinnor och män har använts. Enkäterna genomfördes under 2014 på 55 vårdcentraler i två regioner i södra Sverige. Levnadsvanor som valdes till denna studie var fysisk aktivitet, grönsaks- och frukostvanor, alkoholintag, rökning, sysselsättning, sömn och stress. Självskattad hälsa kategoriserades som bra (”mycket bra” och ”bra”) och dålig (”någorlunda”, ”dålig” och ”mycket dålig”). För att studera skillnader användes Student T-test på parametrisk data och Chi-två på icke parametrisk data. Resultat: De levnadsvanor som var vanligare förekommande hos de med bra självskattad hälsa var ansträngande/hård motion, låg nivå av stress och att vara i arbete (p<.001). Att inte röka hos män och att äta frukost och grönsaker hos kvinnor var också vanligare förekommande hos de med bra självskattad hälsa. Lågt intag av alkohol visade inte på några skillnader.  Slutsats: För att minska risken för framtida sjuklighet är det viktigt för distriktssköterskor, samt flera andra samhällsinsatser, att försöka påverka och uppmuntra hög fysisk aktivitet och minskad stress.

En jämförelse av upplevd produktivitet samt arbetstillfredsställelse mellan aktivitetsaserade och traditionella kontor.

Purpose: The aim with this study is to compare perceived productivity and job satisfaction between activity based offices and traditional offices. The goal is to investigate, through a quantitative comparison, productivity and job satisfaction between the office types, and if generations perceive this differently. Method: The method used in this study is a quantitative method, in form of a questionnaire. The questionnaire used was taken from a study made by Sahlström and Severin (2015) at the Royal Institute of Technology in Stockholm. The same questionnaire was taken because it had already been quality assured and had good content for the survey. Four IT companies were included in the study. Two of them had activity based offices and two of them had traditional office type. Literature review has also been a method in order to get a deeper understanding of the subject. Findings: The results of the study show that there are differences between the two office types in perceived productivity and job satisfaction. The traditional office type showed the best results. However, this result can be discussed since the two traditional offices differed widely in their responses. The results also show that there are differences between the generations experiencing productivity and job satisfaction of the various offices. The elder generation, Baby boomers, shows better results on the traditional office type and the younger generation, Generation Y, shows better results on the activity based offices. Implications: One conclusion to be drawn from this is that employees at traditional offices are more satisfied with their working place and experience increased productivity than employees on activity based offices. However, these results may be due to other factors than how the office environment affects the employees. Therefore, these results will not be recommended. Another conclusion is that the Baby boomers are experiencing higher productivity and job satisfaction of traditional office and Generation Y experiences higher productivity and job satisfaction on activity based office. These results can be recommended. Limitations: The limitations of this study are to examine only IT companies in Sweden with a maximal amount of employees of 150 persons. The results are, apart from the scattered results in the first issue, generally valid and can be applied to other IT companies. To succeed fully applicable results, a survey with more companies involved had been better. Then, detections of anomaly would easier have been discovered and possible disregards of certain results could have been done. Keywords: Perceived productivity - Self-rated assessment of employees on their own productivity. Traditional offices - In this work traditional offices includes cell offices and shared rooms. Activity based offices - Office where employees have no fixed work place and there are often zones to support different types of working.

El concepto y la práctica de la actividad física y su relación con calidad de vida en los modelos teóricos de la salud

Los estudios acerca del concepto actividad física (AF) son diversos, presentando diferentes concepciones; su relación con calidad de vida suele estar generada dentro del discurso médico, que propende por la ejecución de la Actividad Física desde una mirada netamente biológica. Si bien esta disertación es importante, se debe tener en cuenta que los estudios relacionados con calidad de vida y la AF se basan en la condición de bienestar y percepción frente al estado de salud; dichos estudios no se han realizado desde las condiciones de vida y del contexto social. Si bien es cierto que la mirada médica y lo estudios objetivos son relevantes, ya que arrojan estadísticas que permiten abordar recomendaciones en cuanto a la actividad física, en este documento se elaboró una investigación de tipo cualitativo por medio de la revisión documental del concepto de actividad física, sus prácticas y su relación con calidad de vida, que abordan diferentes autores. Para ello se elige la base de datos PubMed por su énfasis en las publicaciones de salud; se seleccionan artículos publicados del 2004 y 2014, que estudien el concepto de actividad física, sus prácticas y relaciones con calidad de vida, para finalmente hacer un análisis desde los modelos de determinación y determinantes sociales. De esta forma se analiza la posición de los autores con respecto al concepto, sus prácticas y las relaciones que puede llegar a surgir con la calidad de vida. En esta investigación se obtuvo como resultados tendencias biológicas, psicológicas, sociales y culturales, en los cuales los autores dejan clara la posición médica ya que en la mayoría de investigaciones centran sus relaciones en la funcionalidad, y es a través de la visión terapéutica donde buscan el bienestar, la satisfacción de los pacientes que padecen cualquier enfermedad. Además, aparecen categorías emergentes como: cuerpo como medio de publicidad, cibernética que avanza vertiginosamente y el papel del poder en la actividad física que pueden ser contempladas para otros estudios.

Conceptos y prácticas de la actividad física que se reproducen en las clases sociales: aproximación desde el enfoque determinantes/ determinación social de la salud

El concepto de actividad física es concebido de diferentes formas. Mostrando que existen varios factores que afectan de manera directa e indirecta la percepción que los sujetos construyen entorno a él, generando así una aproximación a diferentes definiciones de la actividad física desde varias perspectivas y dimensiones, donde predomina una noción netamente biológica. Este estudio pretende analizar, como desde las clases sociales se concibe la actividad física en sus conceptos y prácticas considerando los modelos de determinantes y determinación social para la salud. Con fin de comprender como los autores de la literatura científica conciben la actividad física y la relación con las clases sociales, desde una perspectiva teórica de los determinantes sociales de la salud y la teoría de la determinación social, se realizó una revisión documental y análisis de contenido de los conceptos y prácticas de la actividad física que se han considerado en los últimos 10 años. Para ello se seleccionaron las bases de datos PubMed y BVS (Biblioteca Virtual de Salud) por sus énfasis en publicaciones de salud mundialmente. Mostrando que la actividad física es concebida dominantemente desde una perspectiva biológica que ejerce una mirada reduccionista. Las relaciones entre actividad física y las clases sociales están claramente establecidas, sin embargo, estas relaciones pueden discrepar teniendo en cuenta el concepto de clase social, el contexto y la orientación de los autores y las poblaciones objetos de estudio. Obteniendo como resultado que los estudios documentados, revisados y analizados muestran una clara tendencia al modelo de determinantes; no obstante, algunos estudios en sus análisis se orientan hacia el modelo de determinación social. En cuanto al concepto de clases sociales los autores consideran una combinación de factores culturales y económicos sin atreverse a adoptar un concepto específico.

Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome

The purpose of this study was to investigate the relationship between self-awareness, emotional distress, motivation, and outcome in adults with severe traumatic brain injury. A sample of 55 patients were selected from 120 consecutive patients with severe traumatic brain injury admitted to the rehabilitation unit of a large metropolitan public hospital. Subjects received multidisciplinary inpatient rehabilitation and different types of outpatient rehabilitation and community-based services according to availability and need, Measures used in the cluster analysis were the Patient Competency Rating Scale, Self-Awareness of Deficits Interview, Head Injury Behavior Scale, Change Assessment Questionnaire, the Beck Depression Inventory, and Beck Anxiety Inventory; outcome measures were the Disability Rating Scale, Community Integration Questionnaire, and Sickness Impact Profile. A three-cluster solution was selected, with groups labeled as high self-awareness (n = 23), low self-awareness (n = 23), and good recovery (n = 8). The high self-awareness cluster had significantly higher levels of self-awareness, motivation, and emotional distress than the low self-awareness cluster but did not differ significantly in outcome. Self-awareness after brain injury is associated with greater motivation to change behavior and higher levels of depression and anxiety; however, it was not clear that this heightened motivation actually led to any improvement in outcome. Rehabilitation timing and approach may need to be tailored to match the individual's level of self-awareness, motivation, and emotional distress.

Self-efficacy for refusal mediated by outcome expectancies in the prediction of alcohol-dependence amongst young adults

The present study examined the relative importance of outcome expectancies and self-efficacy [1] in the prediction of alcohol dependence [2] and alcohol consumption in a sample of young adult drinkers drawn from a milieu previously reported as supportive of risky drinking. In predicting alcohol dependence, outcome expectancies were found to mediate self-efficacy and the same pattern was found for both males and females. This suggests that male and female drinkers may become more similar as they progress along the drinking continuum from risky drinking to dependent drinking. However, in women, in comparison to men, a greater array of expectancies and self-efficacy scales were found to predict heavy drinking, as measured by quantity and frequency. These results suggest that heavy drinking women are particularly at risk of developing drinking related complications and that preventative education needs to take into account gender differences.

Self-narrative reconstruction after dilemma-focused therapy for depression: a comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.