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Title: The social, social-psychological and psychiatric correlates of outcome : the relationships between psychiatric history, life events, social support, powerful emotion, and cognitive appraisals among routinely-discharged patients of an acute, short-stay admission ward of a psychiatric hospital
Author: Morrison, David Michie
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1992
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Abstract:
Recent reviews of the research literature whose concern is the association between 'life events', health and 'social support' have found the evidence to be strongest for mental health (e.g., Ganster and Victor, 1988). Several studies of the relationship between various forms of social support and mental health have revealed evidence for two kinds of effect. Research whose concern has been the influence of social, social-psychological and psychiatric factors on the 'community adjustment' of psychiatric patients discharged from psychiatric hospitals following short periods of stay has found the most consistently significant factor, after 'previous psychiatric history', to be a 'social' one. Recent reviews of these factors (e.g., Avison and Speechley, 1987; Rushton, 1990) call attention to the need to monitor and examine the processes - rather than the structural components - by which patients, recently discharged from hospital, 'revolve back through the doors' of the wards of those hospitals within six months to two years of discharge. The current investigation was designed to marry these two highly-related research domains: i.e., research into the factors that associate with successful 'community adjustment' was considered most fruitfully advanced through its integration with research concerned with the relationships between life events, social support and mental health. Good reasons for this 'integration' are summarized in the first chapter. Using a 'life events' model, with special emphasis on the global construct 'social support', the thesis of the current investigation - an exploratory one given the considered uniqueness of the enterprise - can be summarized thus: "What forms of stress and/or social support combine to precipitate or to postpone the return to the hospital ward of the routinely-discharged psychiatric patient?". The subjects of the investigation were all patients on the short-term assessment ward of the psychiatric hospital who were about to be routinely discharged from record, who had no evidence of organic brain damage, and who were willing to participate. Using a longitudinal, repeated-measures design, 52 patients were interviewed on the ward immediately prior to their respective discharge and then once again six months thence. Each patient was interviewed using reliable and valid formal questionnaires as part of a semi-structured interview that assessed the various factors in the hypothesized 'model' of the 'revolving door' process. These factors were: a) each patient's experience of life events prior to current hospital stay, b) 'social support', conceptualized as six distinct components: i) close and ii) general attachment ('social integration') availability; iii) perceived interpersonal support; iv) actual received support; v) pleasurable social contact; vi) satisfaction with close and general attachments; c) psychiatric history prior to current hospital slay; d) experience of the 'powerful emotions' (Brewin el al., 1989) shame and guilt in respect of the patient status, and e) each patient's 'cognitive appraisals' of their patient status - the degree of self-blame, consensus and isolation from others. An informal description and analysis of the non-structured information relating to patients' experiences of life events both prior to and during the six months after hospital discharge follows, which reveals support for previous findings (e.g. Brown et al., 1988; and Oatley and Perring, 1991). Thus, patients whose symptoms of distress significantly deteriorated a) were less likely than those patients who 'improved' to have experienced any kind of 'fresh start', and, b) were more likely to have experienced continuation of their already chronically distressing life conditions, with no improvement of any kind. Considerable attention is given to the paper by Brewin, MacCarthy and Furnham (1989) in drawing together in a meaningful way the various findings relating to patients' experiences of shame and guilt about their patient status and to their cognitive appraisals thereof. Finally, some attention is given to the perceived difficulties associated with the design of a study such as this. Each criticism is countered in a reasoned way with suggestions put forward for possible improvements. Further research concerned with the central thesis of this investigation is considered best advanced by incorporating measures of patients' own constructs of themselves - of their patient status, their problems (their causes, impact and likely solution), and of others - how they view 'normal' people in their communities, their family and friends, their selves in relation to these informal carers; and their selves in relation of formal helping agents such as consultants, doctors, nurses, occupational therapists and psychologists. Such research will likely provide fruitful insight into support-eliciting and support-seeking processes. Further, given the importance of shameful experiences in relation to their patient status, suggestions are made about the efficacy of incorporating more reliable and valid measures of such experiences in any intended research enterprise.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.796719  DOI: Not available
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