PhD students
Glòria Durà-Vilà
Medicalisation of sadness, depression and spiritual distress
Supervisors: Prof Gerard Leavey and Prof Roland Littlewood
Start & end dates: June 2010 – June 2013
PhD outline:
Background: Critiques of the validity of the current diagnostic criteria for depressive disorder argue that it fails to differentiate between dysfunctional sadness and normal sadness as they do not take into account the phenomenological and existential context in which the depressive symptoms occurred. My previous ethnographic field work conducted in a community of contemplative nuns revealed that symptoms that otherwise might have been described as pathological and likely to meet diagnostic criteria for a depressive disorder, were considered by the nuns a normal and valued experience and understood within the framework of the so-called Dark Night of the Soul narrative: an active process of transforming emotional distress into a process of self-reflection, attribution of religious meaning and spiritual growth (Durà-Vilà et al., 2010).
Aims & objectives: I aim to examine emotional distress and its corresponding explanatory models amongst a highly religious sample. I intend to test and deepen the findings of my initial fieldwork considerably expanding the number of participants as well as significantly increasing the diversity of the religious sample including monastic and secular contexts. A detailed depiction of the Dark Night of the Soul narrative will be obtained from those who conceptualise suffering using this idiom. Furthermore, notions of what constitutes spiritual pathology and the understanding and expression of depressive disorder in a fervent Catholic sample will be sought in an attempt to explore universal concepts of disordered sadness transcending this particular context. Finally, an in-depth exploration of the management of suffering among the participants will be sought, paying particular attention to the role that the clergy play in helping their parishioners and other religious people to cope with times of intense emotional suffering.
Methods: The following four samples were interviewed (semi-structured interviews) giving a total of 60 interviews: 10 contemplative nuns (these nuns were different from those interviewed in the initial research), 10 contemplative monks, 20 lay adults with religious beliefs attending a Catholic theological college, 20 priests.
Progress to date: all the interviews have been done. I have just upgrade fromMPhil to PhD.
Tjasa Velikonja
Association between childhood and adulthood adversity in relation to schizotypy’
Supervisors: Dr. Sonia Johnson, Dr. Oliver Mason, Dr. Helen Fisher (external)
Start & end dates: Mar 2011 – Mar 2014
PhD Outline
Background: There is increasing evidence that there is an association between childhood adversity and schizotypy traits. These schizotypal traits are also believed to be a frequently cited factor for transition to clinical psychosis and are present throughout the normal population, also suggesting psychosis may be a continuous/dimensional phenotype. Evidence for this continuum approach to psychosis is gained from many experimental studies in which high scoring individuals perform in similar ways to individuals with clinically diagnosed psychosis. Multiple studies suggest that increased child adversity is experienced by a greater number of schizotypal individuals in comparison with controls.
Aims & objectives: The aim of this project is to explore the relationship between childhood and adulthood adversity in relation to schizotypy. I am including all aspects of childhood adversity (sexual, physical, psychological abuse, household discord and peer bullying) and taking into account the perpetrator, duration of abuse, age of occurrence, frequency, severity and positive and/or negative support received as possible co-variables. The research will also look at the following mediators of this relationship: - Social: (adult adversity: life events and/or ongoing difficulties, socio-demographics); - Psychological: (cognitive and affective processes)
- Genetic (family history). Methods: We will recruit a sample of 300 community controls aged 18-64 from the same geographical area.The sample collected will be a part of the EU-GEI study (European study of Gene-Environment Interactions in Schizophrenia). Besides the socio-demographic data the following data will be collected: 1. Schizotypy ratings
2. Childhood adversity
3. Adult adversity
4. Cognitive processes and affective states
5. Genetic/Family Psychiatric History
6. Other: Premorbid Adjustment Scale Progress to date * PhD Introduction courses completed * Completion of all trainings on measurements used in the study * Started with data collection and continue literature review
Francesca Zanatta
Patterns of Parenting in African-Caribbean communities in London, and the clash with British child development theories
Supervisors: Prof Roland Littlewood and Dr Simon Dein
Start & end dates September 2008- September 2012
PhD outline: Interpretative fieldwork based study designed in order to provide an insight on the dynamics and the interactions of Caribbean families living in London, and also to outline common misconceptions held by practitioners and their consequences and impacts on the studied population.
Background: The African-Caribbean community is definitely a good example of how misconceptions, having become labels hard to remove, can jeopardise a whole population. A study conducted in the mid-90s emphasizes that black children under 5 are more likely than their white peers to enter social care. “Typical” West Indian family patterns are considered mostly pathological and negatively affecting the child’s development. Western psychological studies classify West Indian families as negatively constructed: “the problems of West Indian children are seen by white professionals not as in the transition from one culture to another but as located within the family they are born into” (Littlewood, 1982).
Aims & objectives: The aim is to increase the awareness and stimulate the will to know and to avoid relying on false beliefs/misconceptions in practitioners. On the same time this investigations aims to give voice to Caribbean families and provide a space for them to analyze and become aware of their perspective but also of the perspective of the “others”.
Methods: The research has been developed on two different levels: the community level, ethnographic fieldwork aiming to gain an understanding of the family life from the inside; and the professional level, a series of semi-structured interviews with professionals from various backgrounds, aiming to delineate the actual situation of Caribbean families from the practitioners’ perspective.
Progress to date: Several common themes emerged by the analysis of the data collected: unbalanced family structure, in which the figure of the mother dominates and the figure of the father is frequently absent, male/female interaction, expression of emotions, and patterns of communication. The comparison of fieldwork data with existing patterns of attachment has evinced gaps in the theory and the need for a new attachment pattern, fluctuant, specific to the studied population.
Tatiana Salisbury
Improving Care in Longer Term Mental Health Facilities: International differences in quality and service user experience of care
Supervisors: Helen Killaspy; Michael King
Start & end dates: June 2009 – May 2012 (fingers crossed)
PhD outline
Background: Over the past decade, the World Health Organization has actively lobbied for an increase in national mental health budgets and deinstitutionalisation of care (the degree to which mental health care is provided in community settings and integrated into general health). Although several studies have found a link between unit expenditure and aspects of care related to better quality (e.g. staffing, built environment, participation in activities), research into the relationship between national expenditure and quality is non-existent. Recently an international measure called, the Quality Indicator for Rehabilitative Care (QuIRC) was developed to assess quality of care in longer term mental health facilities. This tool has allowed for the evaluation of the relationship between quality and expenditure and deinstitutionalisation.
Aims & objectives: To examine international differences in quality of care and service user experience when compared to national levels of mental health expenditure and deinstitutionalisation.
Hypotheses:
A – The quality of institutional care will increase with increased national expenditure.
B – The quality of institutional care will increase with increased national deinstitutionalisation.
C – Service user experiences of care will decrease with increased national expenditure.
D – Service user experiences of care will increase with increased national deinstitutionalisation.
Methods: Hypotheses will be tested using multilevel models. Individual models will be developed, based on fit, using the predictor variables cited along with country and unit variables.
Progress to date: Literature review, Aims and Methodology written up. A quantitative measure of deinstitutionalisation has been developed. Currently testing deinstitutionalisation measure and building models.
Rachel McCrea
Investigating latent structure in the symptoms of common mental disorders: an analysis of data from the national surveys of psychiatric morbidity.
Supervisors: Professor Michael King and Dr Rumana Omar (Statistical Science)
Start & end dates: October 2009 – September 2012
PhD Outline:
Background: Three national psychiatric morbidity surveys of adults living in Great Britain have investigated the prevalence and correlates of common mental disorders (and other conditions) in the population. These were carried out in 1993-2007 and used the same standardised interview to screen participants for key symptoms of common mental disorders (CMDs), regardless of whether or not participants appeared likely to meet criteria for any particular condition. The pooled surveys dataset (>20,000 individuals) provides a wealth of information not only on the prevalence of CMDs themselves, but also on the prevalence and co-occurrence of individual symptoms associated with these disorders. A key area of concern in the study of CMDs is the comorbidity between anxiety and depressive disorders: in the 2007 psychiatric morbidity survey, 61% of the respondents who met the criteria for an ICD-10 depressive episode also met the full criteria for a concurrent anxiety disorder. Similarly high levels of comorbidity in US surveys have lead researchers to question whether the diagnostic boundaries between anxiety and depression may have been drawn in the wrong place. A number of attempts have been made to investigate whether latent variable models can aid with the derivation of a revised classification that better accounts for such symptom co-occurrence. However, these have generally been limited by the lack of availability of symptom-level data for large sections of the population and the use of statistical methods that impose a particular structure on the data.
Aims: The aim of this project is to use a range of different latent variable models to explore what they can tell us about structure in the symptoms of CMDs.
Methods: I am focussing on three main families of latent variable models to investigate latent structure in the symptoms ofCMDs: factor analysis models for ordinal categorical data (also known as item response theory models), latent class analysis models, and several different variants of hybrid “factor mixture” models that allow for a dimensional factor structure within each of a number of latent classes.
Progress: Learning how to fit all of these models has been a real challenge, as has learning how to interpret and compare the reams of statistical output that they produce. Nonetheless, I have managed to fit a wide range of models, and my latent variable modelling is almost complete. What is proving to be an even bigger challenge is trying to summarise and explain the results of my analyses in a way that is accessible to those with little experience of latent variable techniques!
Bridget Candy
Can qualitative evidence inform effectiveness of complex interventions.
Supervisors: Professor Michael King, Professor Sandy Oliver (Professor of public policy at Institute of Education).
PhD outline:
Aim:
To explore whether combining qualitative evidence from a systematic review on patients views can inform a systematic review of trials on the effectiveness of a complex intervention.
Objectives.
· To use and develop approaches/techniques that have previously been used only in a limited extent in health care research.
· To explore how these approaches may be most productive (that is in selection of topic selection and research design)
· To assess the value and limitations of using qualitative evidence in this way.
· To seek to establish whether this research activity can meaningfully inform the development of interventions.
Progress:
· MPhil upgrade, including a 8,000 report on thesis
· Paper on first experiment published in peer-review methodology journal
· Close to completion of ‘experiments’
· Consideration of potential of one or two further papers to be submitted for peer review publication consideration.
· Updated chapter plan for write-up.
· Supervisors agree to start write-up around end of year (2011).
Lauren Yates
The development and evaluation of individual Cognitive Stimulation Therapy (individual CST) for dementia.
Supervisors: Professor Martin Orrell & Dr. Vasiliki Orgeta
Start date: June 2011
Background
Aims & objectives
To investigate whether individual CST benefits cognition and quality of life in people with dementia over 6 months compared to a control (treatment as usual, TAU) group
To assess the cost effectiveness of individual CST vs. TAU
To produce and disseminate a standardised therapy package for individual CST
Methods
This is a multi centre, pragmatic, single blind randomised 2 treatment arm (individual CST vs TAU) controlled clinical trial over 26 weeks. The intervention consists of iCST sessions delivered by a carer for 30 minutes, 3 times a week over 25 weeks. The primary outcome measures include quality of life of people with dementia assessed by QoL-AD, and cognition assessed by the ADAS-Cog. For carers, quality of life is the primary outcome measure. The trial includes a cost-effectiveness analysis from a public sector perspective.
Progress to date
We are currently in the development phase of the project. We have produced the first draft of the individual CST manual and are running a series of focus groups, interviews and having participants field test the materials to inform the final draft of the package ready for the main RCT.
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