Interveniência da integridade na relação entre idade e ansiedade face à morte em adultos idosos

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Health as a Public Good

The purpose of the article is to present different conceptualizations of health as a public good. Author considers whether analytical tools and conceptual framework developed in the studies on the issue of public goods might be useful in order to analyze health. It was noted that health belongs to the special group of exceptional goods, since it carries the characteristics of both private and public good. It was emphasized that the distribution of public goods is a complex issue that requires an appropriate system of incentives as well as instruments in charge of its proper functioning. In the article it is argued that the widespread social anxiety and growing fear of further integration and globalization to a large extend results from the wrong management and unequal provision of global public goods.

“Dasein” ansiedade perante a morte e imortalidade simbólica em idosos institucionalizados

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

A influência da idade, do género e da sabedoria na ansiedade face à morte dos adultos idosos

Constatado que não havia sido estudada a relação entre a Sabedoria e a Ansiedade Face à Morte (AFM) em adultos idosos, os objectivos deste trabalho consistiram na validação da versão portuguesa da Self Assessed Wisdom Scale (SAWS; Webster, 2003) e no estudo da relação entre essas variáveis e delas com a idade e o género. Usou-se também a versão portuguesa da Revised Death Anxiety Scale (RDAS; Thorson & Powell, 1994) validada para a população idosa por Carvalho, Diniz e Ribeiro (2008). Os 397 participantes (leque etário = 65-97 anos; M = 74) que voluntariamente colaboraram no estudo eram residentes na comunidade. Recorrendo à análise factorial confirmatória (LISREL8.53), a estrutura pentadimensional oblíqua da SAWS apresentou boa validade discriminante em todas as dimensões, e uma boa consistência interna e validade convergente apenas em três delas. No segundo estudo, foi testado o Modelo Preditor da AFM em Adultos Idosos, em que a idade (terceira vs. quarta idade) e o género foram tidos como antecedentes das dimensões Experiência de Vida e Reminiscência e Reflexividade da Sabedoria e também da AFM. Verificou-se que a idade e a Reminiscência e Reflexividade foram as únicas boas preditoras da AFM.

A influência da idade, do género e da saúde funcional subjectiva na ansiedade face à morte em adultos idosos

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Adolescent’s subjective perceptions of chronic disease and related psychosocial factors: Highlights from an outpatient context study

Background: Adolescents with chronic disease (CD) can be more vulnerable to adverse psychosocial outcomes. This study aims: 1) to identify differences in psychosocial variables (health-related quality of life, psychosomatic complaints, resilience, self-regulation and social support) among adolescents who feel that CD affects or does not affect school/peers connectedness (measured by self-reported participation in school and social activities); and 2) to assess the extent to which psychosocial variables are associated with connectedness in school and peer domains. Methods: A cross-sectional study was conducted in 135 adolescents with CD (51.9% boys), average age of 14 ± 1. 5 years old (SD = 1.5). Socio-demographic, clinical, and psychosocial variables were assessed, using a self-reported questionnaire, which included the Chronic Conditions Short Questionnaire, KIDSCREEN-10 Index, Symptoms Check-List, Healthy Kids Resilience Assessment Module Scale, Adolescent Self-Regulatory Inventory, and Satisfaction with Social Support Scale. Descriptive statistics, GLM-Univariate ANCOVA and Logistic Regression were performed using the IBM Statistical Package for Social Sciences (SPSS), version 22.0. The significance level was set at p < 0.05. Results: Thirteen to eighteen percent of the adolescents felt that CD affected participation at school (PSCH) and participation in leisure time with friends (PLTF). These adolescents presented lower results for all psychosocial study variables, when compared with adolescents who did not feel affected in both areas of participation. From the studied psychosocial variables, the most important ones associated with PSCH (after controlling for age, gender, diagnosis, and education level of father/mother) were self-regulation and psychosomatic health. Concerning the PLTF, social support was the sole variable explaining such association. Conclusions: The present study pointed out the association between psychosocial variables; and living with a CD and school/peers connectedness. The need to focus on the assessment of the effects of a CD on adolescents’ lives and contexts is suggested, as well as on the identification of vulnerable adolescents. Such identification could help to facilitate the maximization of social participation of adolescents with CD, and to plan interventions centered on providing support and opportunities for a healthy youth development. For that purpose, a complex and multifactorial approach that includes clinicians, schools, family, and peers may be proposed.

Adherence to therapeuthic regimen and metabolic control of type 1 diabetes

Abstract Objectives: To assess the adherence to therapeutic regimen; to determine the Hemoglobin Glycation Index (HbA1c); to analyse the relationship that exists between the adherence to therapeutic regimen and metabolic control. Design: correlational analytical study, carried out according to a cross-sectional perspective. Participants: A non-probabilistic sample of 266 people with type 1 diabetes aged between 18 and 78 years old (mean M = 51.02 ± SD = 18.710), attending follow-up diabetes consultations. Mostly male individuals (51.88%), with low schooling level (50.75% had only inished elementar school). Measuring Instruments: We used the following data collection tools: a questionnaire on clinical and socio-demographic data, blood analysis of venous blood to determine the glycated hemoglobin level (HbA1c).Three self-report scales were used: Accession to Diabetes Treatment (Matos, 1999), Self-perception Scale (Vaz Serra, 1986) and Social Support Scale (Matos & Rodrigues, 2000). Results: In a sample in which the mean disease duration is 12.75 years, 69.17% of the sample run glycemic control tests between once a day and four times a year and 42.86% of them undergo insulin treatment. In the last 3 weeks, 26.32% of these people have experienced an average of 4.22 to 44.36%, hypoglycemic crises and experienced an average of 6.18 hyperglycemic crises. 57% of the individuals have showed a poor metabolic control (mean HbA1c higher than 7.5% (HbA1c mean M ≥ 7.50%). The mean psychosocial proile revealed individuals who show a decent self-esteem (M = 70.81) and acceptable social support (M = 58.89). Conclusions: The results suggest we should develop a kind of investigation that could be used to monitor the strenght of the mediation effect effect of the psychosocial predictive dimension of the adherence, since it has become essential to support a multidisciplinary approach which center lays in the promotion of a co-responsible self-management from the person who suffers from diabetes. This will enable a better quality of life; fewer years of people’s lives lost prematurely and a better health with less economical costs for citizens and healthcare systems.

What's so funny? An evaluation of the relations among humour use, mirth, and depressive symptomatology

Humour production and showing mirth (i.e., smiling and laughing) confer prosocial advantages. However, there is a paucity of literature evaluating how humour manifests in psychopathology. Humour and mirth may be especially relevant in depression, wherein profound impairments are evident in emotional and social functioning. Chapters 2 and 3 present correlational and predictive relations of depressive, social anxiety, and social anhedonia symptoms with humour styles, and consider the role of motivational systems and expressivity of positive affect as they relate to humour. As expected, symptoms and avoidance-based motivation were positively related to maladaptive humour styles and negatively related to adaptive humour styles. Interestingly, the pattern of relations shifted when considered among individuals in a depressive episode; acutely depressed individuals generally shy away from any humour style rather than gravitating toward specific styles. In a mediation model, the inverse relation between depressive symptoms and affiliative humour was fully mediated by approach-based motivation and expressivity of positive emotions. Chapters 4 and 5 examined subjective and observed mirth responses (facial affect and laughter) demonstrated by depressed and healthy comparison groups. Relative to non-depressed individuals, depressed persons reported less enjoyment, lower ratings of funniness, and fewer instances and shorter durations of positive facial affect and laughter when viewing humourous videos. There was no significant change in retrospective ratings of enjoyment and funniness at a one-week follow-up. The pattern of responsivity by depressed persons shifted when they viewed humourous videos while hearing others laughing. Both groups demonstrated more mirth when hearing others laugh; there were no differences between groups on mirthful behaviours. The one exception was that the total duration of laugher produced by depressed individuals was shorter than that produced by individuals in the healthy comparison group. This research project demonstrates that facets of depressive symptomatology are differentially associated with humour use and depressed individuals show blunted emotional responsivity to humourous stimuli. However, the pattern of reduced affective responsivity is context specific in that it fluctuates in response to hearing others’ laughter. These findings have important implications for the conceptualization of depression and the subsequent avenues for the treatment of individuals with depression.

Moral reasoning in sport: validation of the Portuguese version of the RSBH value-judgement inventory in adolescents

The purpose of this study was to examine the validity and reliability of the Portuguese version of the Rudd Stoll Beller Hahm Value-judgement Inventory (RSBHVI) in a sample of adolescents. The RSBHVI, which measures moral and social reasoning, was translated using a back translation method. A sample of 238 10th to 12th grade high school students (age mean value 16.93 years, s = 1.34) completed the Portuguese versions of RSBH, and the Task and Ego-orientation Questionnaire. Partial support for the original structure of the moral reasoning scale, but not the social reasoning scale, was found. Females, and non-athletes and individual sport athletes scored significantly higher than males and team sport athletes in moral reasoning, respectively. Moral reasoning was negatively correlated with ego-orientation (r = −30; p <. 001) and uncorrelated with task-orientation (r = .10, p > .05). Participants who were low-ego scored higher in moral reasoning than those who were high-ego. It is suggested that decreasing levels of ego-orientation may be necessary to improve athletes’ moral reasoning.

Identidade à organização: relação com a motivação, satisfação e coesão grupal

Esta investigação tem como principal objetivo estudar a relação entre Identidade Organizacional, Motivação, Satisfação no trabalho e Coesão Grupal, numa amostra portuguesa proveniente de uma organização de caracter militar (GNR). Recorrendo a quatro instrumentos; Escala de Identidade Social, Escala de Satisfação no Trabalho, WEIMS e Escala de Coesão Grupal, foi possível recolher os dados. A partir destes dados concluiu-se que a Identidade Organizacional está relacionada positiva e significativamente com a Motivação, Satisfação e a Coesão Grupal. Através da potencialidade das análises estatísticas foi também possível perceber que o elevado estatuto profissional e o tipo de funções exercidas na organização estão positivamente relacionados com a Identidade Social, Motivação, Satisfação no trabalho e Coesão Grupal. Depois de apresentados os resultados desta investigação, serão discutidas as hipóteses confirmadas e infirmadas, apresentando também as limitações práticas e sugestões para investigações futuras; Identity to the Organization: the relation with Motivation, Satisfaction and Group Cohesion Abstract: This investigation has the main aim to study the relation between Organizational Identity, Motivation, Work Satisfaction and Group Cohesion, in a Portuguese sample from a military organization (GNR). We resorting to four instruments, Social Identity Scale, Work Satisfaction Scale, WEIMS and Group Cohesion Scale, with them was possible to do the data collection. From this data concludes that Organizational Identity is related positive and significatively with Motivation, Satisfaction and Group Cohesion. Through the potentiality of statistical analysis was possible to understand too, that high professional statute and the type of practical functions in organization are positively related with Social Identity, Motivation, Work Satisfaction and Group Cohesion. After presented the results of this investigation, will be discussed the hypothesis confirmed and undermined, it presented too the practical limitations and the suggestions for future investigations.

The structure of the Statistics Anxiety Rating Scale: A confirmatory factor analysis using UK psychology students

This study aimed to examine the structure of the statistics anxiety rating scale. Responses from 650 undergraduate psychology students throughout the UK were collected through an on-line study. Based on previous research three different models were specified and estimated using confirmatory factor analysis. Fit indices were used to determine if the model fitted the data and a likelihood ratio difference test was used to determine the best fitting model. The original six factor model was the best explanation of the data. All six subscales were intercorrelated and internally consistent. It was concluded that the statistics anxiety rating scale was found to measure the six subscales it was designed to assess in a UK population.

The parental overprotection scale: associations with child and parental anxiety

Background: Parental overprotection has commonly been implicated in the development and maintenance of childhood anxiety disorders. Overprotection has been assessed using questionnaire and observational methods interchangeably; however, the extent to which these methods access the same construct has received little attention. Edwards, 2008 and Edwards et al., 2010 developed a promising parent-report measure of overprotection (OP) and reported that, with parents of pre-school children, the measure correlated with observational assessments and predicted changes in child anxiety symptoms. We aimed to validate the use of the OP measure with mothers of children in middle childhood, and examine its association with child and parental anxiety. Methods: Mothers of 90 children (60 clinically anxious, 30 non-anxious) aged 7–12 years completed the measure and engaged in a series of mildly stressful tasks with their child. Results: The internal reliability of the measure was good and scores correlated significantly with observations of maternal overprotection in a challenging puzzle task. Contrary to expectations, OP was not significantly associated with child anxiety status or symptoms, but was significantly associated with maternal anxiety symptoms. Limitations: Participants were predominantly from affluent social groups and of non-minority status. Overprotection is a broad construct, the use of specific sub-dimensions of behavioural constructs may be preferable. Conclusions: The findings support the use of the OP measure to assess parental overprotection among 7–12 year-old children; however, they suggest that parental responses may be more closely related to the degree of parental rather than child anxiety.

The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.

Depression, anxiety and body image after treatment for invasive stage one epithelial ovarian cancer

Background: Diagnosis of epithelial ovarian cancer (EOC) in young women has major implications including those to their reproductive potential. We evaluated depression, anxiety and body image in patients with stage I EOC treated with fertility sparing surgery (FSS) or radical surgery (RS). We also investigated fertility outcomes after FSS.----- Methods: A retrospective study was undertaken in which 62 patients completed questionnaires related to anxiety, depression, body image and fertility outcomes. Additional information on adjuvant therapy after FSS and RS and demographic details were abstracted from medical records. Both bi and multivariate regression models were used to assess the relationship between demographic, clinical and pathological results and scores for anxiety, depression and body image.----- Results: Thirty-nine patients underwent RS and the rest, FSS. The percentage of patients reporting elevated anxiety and depression (subscores ≥ 11) were 27 % and 5% respectively. The median (inter quartile range) score for body image scale (BIS) was 6 (3-15). None of the demographic or clinical factors examined showed significant association with anxiety and BIS with the exception of ‘time since diagnosis’. For depression, post-menopausal status was the only independent predictor. Among those 23 patients treated by FSS, 14 patients tried to conceive (7 successful), resulting in 7 live births, one termination of pregnancy and one miscarriage.----- Conclusion: This study shows that psychological issues are common in women treated for stage I EOC. Reproduction after FSS is feasible and lead to the birth of healthy babies in about half of patients who wished to have another child. Further prospective studies with standardised instruments are required.