Stress and coping in families caring for children with severe mental handicap

The thesis presents a longitudinal study of a representative sample from two health districts of 200 children with severe mental handicap and their families. The broad aim of the study was to investigate the impact on family functioning of caring at home for a child with mental handicap. We adopt a life-span perspective. First, the skills, behaviour and abilities of the children were assessed at school or social education centre by trained interviewers who questioned the teacher or care assistant who knew each child best. Secondly, the person responsible for the day-to-day care of the child (usually the mother) was interviewed using a structured questionnaire. Three years later, 178 children were reassessed and their carers reinterviewed. The study examines key points in the child’s and family’s life cycle. We discuss parents’ reactions to and satisfaction with the way the news of the handicapping condition was first given; the child, family and social factors associated with caring for a young handicapped child which make mothers vulnerable to stress; the effects on family functioning; and the impact on the parents’ marriage. We investigate the child, environmental and social correlates of child behaviour problems and present a longitudinal analysis showing the antecedent risk factors for poor outcome. We examine sleep disturbance, a particularly stressful aspect of child behaviour, and show that poor communication skills play a critical role in the development of disturbed sleeping patterns. We present a longitudinal analysis of maternal stress and coping, identifying the child variables and coping resources which predict change in maternal stress over time. Finally, we focus on the transition to adult life of the teenagers in our sample, examining the differences between them and the younger children, the particular concerns of their mothers, and the preparation given at schools and social education centres in the development of skills for independent living. Throughout the thesis we draw attention to both theoretical and practical issues

Workplace bullying in NHS community trust: staff questionnaire survey

Objectives To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes, and to investigate the relation between support at work and bullying. Design Questionnaire survey Setting NHS community trust in the south east of England. Subjects Trust employees. Main outcome measures Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job, satisfaction scale, the support at work scale, and the propensity to leave scale. Results 1100 employees returned questionnaires-a response rare of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the vicitms of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2.7) v 12.2 (2.3), P < 0.001) and higher levels of job induced str-ess (mean 22.5 (SD 6.1) v 16.9 (5.8), P < 0.001), depression (8% (33) v 1% (7), P < 0.001), anxiety (30% (125) v 9% (60), P < 0.001). and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P < 0.001). Support at work seemed to protect people from some of the damaging effects of bullying. Conclusions Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff

Attitude, subjective norm and perceived behavioural control as predictors of women's intentions to take hormone replacement therapy

Objectives. To examine women's attitudes towards the use of hormone replacement therapy (HRT) and to predict intention to take it in a sample of 1200 women using the theory of planned behaviour (Ajzen, 1988) and a measure of similar prior behaviour. Design. The design was cross-sectional. A postal survey was carried out. Methods. Questionnaires were sent to a random sample of 1200 women aged between 38 and 58 generated from the Kent Family Health Services Authority records. Questions based on the theory of planned behaviour were used to predict women's intentions to take HRT. Information was also collected about the women's sources of information on the menopause, their experience of the menopause and the time leading up to it, their general health, and their sociodemographic circumstances. Results. Analysis was carried out on the responses of the 641 women who were not yet taking and had never taken HRT. Hierarchical multiple regression analysis showed that similar prior behaviour made a small independent contribution to the prediction of behavioural intention when entered after the components of the model. Structural equation modelling was carried out to show the paths between the variables. When age was included, similar prior behaviour was shown to influence behaviour through perceived behavioural control and attitude. Conclusions. In predicting women's intention to take HRT, the beliefs of significant others, the women's personal beliefs, their degree of confidence in their ability to carry out the behaviour and the experience of similar prior behaviour are important considerations

Inequalities in pregnancy outcome: A review of psychosocial and behavioural mediators

The purpose of this paper is to review the literature on psychosocial factors in pregnancy outcome and to present a model which attempts to integrate the findings theoretically. There are four sections. The first presents published data on the incidence of early childhood mortality and low birth weight. Changes over time and differences between countries are noted and attention is drawn to the marked inequalities between occupational groups in the British data. The second section reviews the evidence that a variety of psychosocial risk factors influence pregnancy outcome, notably social, emotional, cognitive and behavioural factors. The third section develops the theme of inequalities and examines theories which have been advanced to account for the differences in adult mortality. We argue that material deprivation goes some way towards explaining inequalities in pregnancy outcome, but that any proper account will have to explain the links between inputs and outcome--the processes and mechanisms by which material deprivation is translated into observable mortality and morbidity. In the concluding section, we argue that some of the principal links are the psychosocial risk factors described in the second section, and we present a model which traces the pathways of mediation.social inequalities pregnancy outcome psychosocial and behavioural mediators

First diagnosis of severe mental handicap: Characteristics of unsatisfactory encounters between doctors and parents

This paper presents data from a study of 190 parents and discusses their reactions to being told that their child was likely to be severely mentally handicapped. Dissatisfaction was related to the child's age when the parents were first told about the impairment, which was itself related to the diagnosis of the child's condition. Parents of children with non-specific handicap were often not informed about the impairment until the second or third year of the child's life, while parents of children with Down's Syndrome were usually informed within a week of birth. The paper compares these two groups of parents and discusses the reasons for their dissatisfaction. The study showed that parents valued early acknowledgement of the problem, a sympathetic approach on the part of medical professionals, and the sharing of information and uncertainty. The reasons why parents of mentally handicapped children may continue to feel dissatisfied are discussed in the light of the theoretical literature on doctor-patient communication.diagnosis mental handicap doctors parents

Changing Health Behaviour: Intervention and Research with Social Cognition Models

For many years, social cognition models have been at the forefront of research into predicting and explaining health behaviours. Until recently, there have been few attempts to go beyond prediction and understanding to intervention - but now the position has changed, and a number of excellent interventions have been set up. The purpose of this book is to bring them together in one volume. Following on from the highly successful Predicting Health Behaviour edited by Mark Conner and Paul Norman, this book will be recognised as a ground-breaking text in the psychology of health, for students, researchers and practitioners alike