Lisa Kettler

Determinants of adherence in adults with cystic fibrosis

Cystic fibrosis (CF) is now as much a disease of adults as of children and adolescents. An important focus of recent research has been the impact of the complex, expensive, and time consuming routine of self-care and medical treatment that is required by adults with CF to maintain health. A growing concern for medical and allied health teams is the issue of patient adherence to prescribed health management plans. A summary of the particular medical and treatment context of CF is followed by a review of adherence measurement issues and the determinants of adherence to treatment regimens in people with CF, primarily adults. Evidence for factors which influence adherence decisions of people with CF is examined. The medical and psychological aspects of this complex problem have not been adequately addressed because of difficulties with definition and measurement. Only a small proportion of the variance in adherence has been accounted for in the literature. New measurement technologies and new theoretical directions offer promise for a better understanding of this complex and important issue and may result in more effective intervention strategies to improve adherence.

Relationships Between Cognitive Deficits, Symptoms and Quality of Life in Schizophrenia:

Objective: Schizophrenia is a complex disorder characterized by impairment in a number of domains, all of which contribute to disability. The aim of the present study was to investigate the relationships between cognitive function, symptoms and quality of life (QOL) in schizophrenia. Method: This cross-sectional study measured cognition, positive and negative symptom severity, and quality of life (measured with the Quality of Life Scale) in 57 outpatients with schizophrenia. Correlations between the different measures were sought. Multiple regression analyses were used to develop models of the contributions of cognitive deficits and symptomatology to QOL. Results: More severe positive and negative symptoms and cognitive impairment each correlated with poorer QOL. There was a moderate association between negative symptoms and cognition and a small association between positive symptoms and cognition. Age, gender, and drug and alcohol abuse did not significantly predict QOL. In the multiple regression analysis, entering the total cognition and total symptom scores produced a model that accounted for an additional 57% of the variance in QOL. Conclusions: Improving quality of life for people with schizophrenia requires that positive and negative symptoms and cognition are each addressed as separate domains of impairment. But, given that these account for only 57% of the variance in QOL, other factors such as unemployment, poverty, social isolation and stigma may also be important.

Career transitions and identity: a discursive psychological approach to exploring athlete identity in retirement and the transition back into elite sport

Athletes’ career transitions have received widespread research attention and have been identified as potentially distressing for athletes. Yet, the transition back into elite sport following retirement, although rare, has not been a focus of research attention. The concept of athlete identity has been widely researched within sport psychology to give insight into the varied experiences of athletes, especially in relation to the transition out of elite sport. Accordingly, identity may provide additional insight into the transition back into competing at an elite level. Through adopting a discursive psychological approach to the examination of 84 newsprint media representations involving athletes and career transitions, the present study aims to explore dominant social understandings around athlete identity and the choices athletes make to compete (or not) in sport. In doing so, the aim is to add to existing literature around athlete identity and gain insight into the social contexts in which athletes choose to transition back into elite sport, as well as to extend the existing discursive psychological literature of sport and exercise into areas of athlete identity, career transition and the media. Returning to compete in elite sport was routinely depicted in media accounts as something that is not chosen, but as driven by emotion, compulsion and a need to play. Such representations of athletes construct their identity as necessarily motivated by emotion and compulsion.

Social and emotional issues of children in kinship foster care and stressors on kinship carers: A review of the Australian and international literature

The aim of this paper is to review the Australian and international literature on social and emotional issues affecting children in kinship foster care and to examine stresses experienced by kinship foster carers. There is a growing trend of kinship foster care as an alternative form of care for children in Australia and overseas which is attributed to factors such as child abuse, parental incapacity, parental incarceration, and parental substance misuse. The ideology supporting the use of kinship care is that it is in the child’s best interests because it helps them to maintain ties with their family of origin. A comprehensive search of the literature on kinship care was undertaken and articles addressing social and emotional issues of children in kinship care or their carers were selected for critical review. The literature suggests that children placed with kinship foster carers suffer from a range of social and emotional issues and these may impact on outcomes in adulthood. The existing literature does not, however, adequately differentiate the impacts of kinship care itself from the children’s pre-existing difficulties and there is a paucity of literature comparing kinship care outcomes with outcomes for children who have experienced other forms of out-of-home care. Common factors experienced by kinship foster carers that can make it challenging for them to deal with children’s issues are economic disadvantage, stress, health issues and lack of resources. In conclusion, this review supports the arguments for assessment and interventions for children in kinship foster care; and support, parent training and interventions for kinship carers. Longitudinal studies are needed in this area.

Re-thinking rapport through the lens of progressivity in investigative interviews into child sexual abuse

Building rapport is considered important in investigative interviewing of children about alleged sexual abuse, but theoretical understanding of the nature of rapport and how to judge its presence remains sketchy. This article argues that the conversation analytic concept of progressivity may provide empirical tractability to the concept of rapport and indeed may be partially what people are detecting when they judge the presence of rapport. A single case is analysed, drawn from a corpus of 11 video-taped interviews with children conducted by police in an Australian sexual crime unit. Analysis focuses on how the interviewer responds when progressivity breaks down, and how restoration is collaboratively achieved. Findings are discussed in terms of implications for future work that might investigate a more thoroughly social interactional account of rapport, and in terms of new ideas about what might constitute skilful interviewing practices amongst investigative interviewers.

Do people with schizophrenia lack emotional intelligence

Social cognition is a domain of cognitive function that includes the ability to understand and manage social interactions. Emotional intelligence (EI) has been identified as a component of social cognition and is defined as the ability to identify, use, understand, and manage emotions. Neurocognitive impairments are known to be associated with poorer social function in people with schizophrenia, but less is known about the relationships between EI, neurocognition, and social function. The current study assessed EI using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) in 20 people with schizophrenia and 20 controls. The schizophrenia group had significantly lower scores on all measures of EI and demonstrated poorer neurocognition and social functioning than controls. The difference between schizophrenia and control groups was greatest for the Understanding Emotions Branch of the MSCEIT. The neurocognition score and total EI score accounted for 18.3% of the variance in social function in the control group and 9.1% of the variance in social function in the schizophrenia group. Our results suggest that a total EI score is not a useful predictor of overall social function and it may be more clinically useful to develop an individual profile of social cognitive abilities, including EI, to form a remediation program.

The effectiveness of cognitive-behavioural therapy with hopeful elements to prevent the development of depression in young people: a systematic review

Background  The onset of depression during adolescence can adversely impact future functioning. Cognitive-Behavioural Therapy (CBT) has been suggested to prevent depression in adolescence by providing an individual with the ability to interpret and the tools to deal with the impact of negative life events. Objective  Examine the best available evidence to determine the effectiveness of CBT to prevent the onset of depression in young people, and assess whether the incorporation of hopeful elements makes CBT more effective. Search strategy  A comprehensive three-step search strategy was developed to find both published and unpublished studies in English from 1987 to March 2007. Papers selected for retrieval were then assessed for methodological validity by two independent reviewers. Selection criteria  Papers that used a randomised controlled design and investigated the efficacy of CBT to prevent the onset of depression in young people between the age of 10 years and 16 years were included. Papers were included if the CBT involved between four and 15 sessions, a follow-up period of between 3 and 24 months and included typical strategies, such as the identification of negative and irrational beliefs, the establishment of links between thoughts, feelings and behaviours, and provided tools so participants could self-monitor these. Data analysis  Data were extracted using the standard tool from the Joanna Briggs Institute, pooled in a meta-analysis, and then grouped and analysed according to the amount of hopeful elements the CBT was judged to contain. Results and conclusion  Limited evidence was found to indicate that CBT, regardless of its content (i.e. with or without hopeful elements), is effective at preventing the onset of clinical levels of depression in young people on a sustained basis. Nonetheless, given the devastating impact that depression can have on young peoples future functioning, further research is needed to develop effective interventions to equip young people with the cognitive skills to buffer its onset on a more sustained basis and to enable them to reach and sustain mental health.

Accountability, monitoring and surveillance: Body regulation in elite sport

Regulation of athletes’ bodies is commonplace in sporting environments, despite evidence that athletes have a higher risk of developing disordered eating than non-athletes. This article explores how athletes’ bodies are regulated in practice, building on examinations of body surveillance in other contexts. Over 40 interactions occurring during body monitoring are analysed. Athletes, pre-emptively or following an explicit request, accounted for their body regulatory behaviours, also working to produce positive athlete identities. Failing to produce an account of improvement was interactionally problematic, making visible athletes’ accountability to the institute to regulate their bodies. Implications of body regulatory practices are discussed.

Is Hope or Mental Illness a Stronger Predictor of Mental Health

Health promotion strategies often focus on the prevention or alleviation of mental illness in an attempt to indirectly promote mental health. But, while the absence of mental illness may be a consequence of mental health, it does not necessarily signal or lead to mental health (Keyes & Lopez, 2002), suggesting that a focus on mental illness may not be the optimal way to promote mental health. The current study adopted a positive psychological approach and tested whether hope was a stronger predictor of mental health in young people than was mental illness. Confirmatory factor analysis was used to test the proposed model, and data were drawn from a sample of young South Australians (N = 3913; 1317 years). The results indicated that hope was a significantly stronger predictor of mental health than was mental illness. These results have implications for the content of strategies to promote mental health in young people.

Australian Parents' Needs and Expectations Regarding out of School Hours Care: A Pilot Study.

An increasing number of working parents are making use of out of school hours care (OSHC) for their young primary-school aged children, but in Australia very little is known about how effectively these services meet parent needs. The present pilot study aimed to gather information non-directively from employed parents, first, about how OSHC use affects their workforce participation and ability to resolve the competing demands of work and family responsibilities. The second goal was to gain some idea of what parents look for in OSHC and how satisfied they feel with the service they use. Thirteen mothers answered open-ended but structured questions in a telephone interview. They expressed how vital OSHC services are in enabling them to work, but usually did not spontaneously evaluate the quality of the service. Results suggest a need for more systematic research on OSHC quality, and how it does or might contribute to parent and child well-being.