"Where did I park my car?" : a mixed methods investigation on mild cognitive impairment diagnosis in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of a Doctor of Philosophy in Psychology at Massey University, Wellington, New Zealand

Mild cognitive impairment (MCI) is defined as an objective impairment in cognitive function which spares everyday functional ability. The syndrome is shrouded in controversy regarding definition, cut-off criteria, and clinical utility. Consequently, it is an uncertain label for the client being diagnosed by their healthcare practitioner. To date, minimal research in New Zealand has focused on MCI within specialist assessment services. Reasons for this paucity of literature will be discussed throughout this thesis. The current research aimed to identify how practitioners deliver and perceive cognitive impairment diagnosis, and examine how clients respond to receiving this diagnosis. Client experiences were framed within the common sense model (CSM). This theory originates from health psychology, where coping behaviour is said to be influenced by the cognitive representations that a person has about their condition. Although the framework is previously discussed in relation to chronic illness, international researchers have started to examine the utility of the model in explaining MCI diagnosis response. Given this context, the CSM framework guided the client-focused components of this thesis. In Study One, 57 practitioners who diagnose cognitive impairment completed a questionnaire on labels applied to MCI and beliefs about the value of diagnosis delivery. Responses were analysed using content analysis to gain an impression of professional practice. Cognitive disorder - not otherwise specified (CD-NOS), early dementia, and normal ageing were reported to additionally label the symptoms of MCI in clinical practice. In Study Two, client responses were examined in a small clinical sample (N = 9) diagnosed with MCI and CD-NOS. Participants were interviewed twice within six months of initial diagnosis. Interpretative phenomenological analysis was used to gain insight into how people cope and make sense of their diagnosis over time. Descriptive analyses were also undertaken with a subset of Study Two data to examine changes and differences in coping strategies over time. Findings suggest that participants may not see their diagnosis as an illness or significant health threat in the first six months following diagnosis. This prompts a question on the suitability of an illness model with reference to diagnosis response. Findings from this research add to the literature by highlighting practice associated with an evolving form of clinical diagnosis in NZ

Post-traumatic stress disorder interventions for children and adolescents affected by war in low- and middle-income countries in the Middle East: systematic review

Background Millions of children and adolescents are exposed to wars, affecting their psychological well-being. This review focuses on psychosocial interventions in low and middle-income countries (LMICs) in the Middle East, where mental health services are limited. Aims Our primary aim was to evaluate the effectiveness of trial-assessed psychosocial interventions in reducing post-traumatic stress disorder (PTSD) symptoms in children and adolescents aged ≤18 years who were exposed to war in LMICs in the Middle East. Changes in other psychological conditions and symptoms were evaluated where reported. Method PubMed, Cochrane Library and Ovid were searched without year restriction, in December 2021. Previous review reference lists were also checked. Only studies published in English were included. Each study was evaluated for risk of bias and results are presented as a narrative synthesis. Results Three group-based interventions were identified and evaluated across six studies: ‘Teaching Recovery Techniques’, ‘Writing for Recovery’ and ‘Advancing Adolescents’. Two studies took place in post-war settings, and four in a context of ongoing conflict. Positive experiences and improved social skills were indicated following most interventions, but Teaching Recovery Techniques was the only programme associated with a statistically significant reduction in PTSD score. Differences in follow-up interval limited comparability of outcomes. Conclusions This review highlights a paucity of evidence for effective treatment options for children and adolescents affected by war from LMICs in the Middle East. Promising indications of reductions in PTSD symptoms, specifically from Teaching Recovery Techniques, require further rigorous evaluation and long-term follow-up

A qualitative study of positive psychological experiences and helpful coping behaviours among young people and older adults in the UK during the COVID-19 pandemic

While much research has focused on challenges that younger and older people have faced during the COVID-19 pandemic, little attention has been given to the capacity for resilience among these groups. We therefore explored positive psychological experiences and coping behaviours that protected mental health and well-being. Participants were 40 young people (aged 13–24) and 28 older adults (aged 70+) living in the UK during the COVID-19 pandemic. Interviews were held between May 2020 and January 2021. We generated six themes using qualitative thematic analysis, including: engagement in self-fulfilling activities, increased sense of social cohesion, personal growth, use of problem-focused strategies to manage pandemic-related stressors, giving and receiving social and community support, and utilising strategies to regulate thoughts and emotions. While all six themes were relevant both to younger and older adults, there were nuances in how each was experienced and enacted. For example, many older adults adjusted their routines given worries about virus vulnerability, while some young people experienced greater personal growth amidst increased awareness of mental health as they navigated the various lockdown restrictions

‘You’re just there, alone in your room with your thoughts’: a qualitative study about the psychosocial impact of the COVID-19 pandemic among young people living in the UK

OBJECTIVES: Adolescents and young adults have been greatly affected by quarantine measures during the COVID-19 pandemic, but little is understood about how restrictions have affected their well-being, mental health, and social life. We therefore aimed to learn more about how UK quarantine measures affected the social lives, mental health and well-being of adolescents and young adults. DESIGN: Qualitative interview study. The data were analysed using reflexive thematic analysis, with particular attention paid to contextual factors (such as age, gender, ethnicity and health status) when analysing each individual transcript. SETTING: Data collection took place remotely across the UK via audio or video call, between June 2020 and January 2021. PARTICIPANTS: We conducted semi-structured interviews with 37 participants (aged 13–24 years) to elicit their views. RESULTS: Authors generated four themes during the qualitative analysis: (a) concerns about disruption to education, (b) missing social contact during lockdown, (c) changes to social relationships and (d) improved well-being during lockdown. Many participants said they struggled with a decline in mental health during the pandemic, lack of support and concern about socialising after the pandemic. However, some participants described experiences and changes brought on by the pandemic as helpful, including an increased awareness of mental health and feeling more at ease when talking about it, as well as stronger relationship ties with family members. CONCLUSIONS: Findings suggest that young people may have felt more comfortable when talking about their mental health compared with prepandemic, in part facilitated by initiatives through schools, universities and employers. However, many were worried about how the pandemic has affected their education and social connections, and support for young people should be tailored accordingly around some of these concerns

Psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study

Objectives To explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic.Design This was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding.Participants This study involved 25 participants from a range of frontline professions in health and social care.Setting Interviews were conducted over the phone or video call, depending on participant preference.Results From the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life.Conclusions This study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions

Ethical Subjectivity and Politics in Organizations: A Case of Health Care Tendering.

This paper examines the relationship between ethics and politics in organizations with a specific focus on ethical subjectivity - that is, how people at work constitute themselves as subjects in relation to both their conduct and their sense of ethical responsibility to others. To investigate this we consider those ethics that were politically mobilized when five clinical partners tendered to buy out the medical practice in which they worked. We provide a detailed reading of a letter of complaint written by one of the partners and sent to their employer - a letter we consider to be a deliberate, political, ethically motivated and overt act of resistance. Drawing on the ethical philosophy of Emmanuel Levinas we argue that the practice of ethics is characterized by a tension where ethical commitments and realpolitik come crashing together. The implication we draw from this is that in organizations the ethical subject is always a political subject; the one who takes action in response to the call of the ethical demand. It is answering the call to political action by the ethical subject - a subject prepared to act in response to the experience of injustice while not resting easy on their own ethical righteousness - that provides an affirmative possibility for researching and theorizing ethics within a critical framework.21 page(s