Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
<p><strong>Systematic Review of Research Literature (SRL)</strong></p> <p><em>Background:</em> Recent studies reveal non-heterosexual (hereafter ‘queer’) men are at greater risk of dying by suicide than heterosexual men. This finding makes it important to u...
| Main Author: | |
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
2024
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| _version_ | 1811140541273866240 |
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| author | Townsend, E |
| author2 | Knight, M |
| author_facet | Knight, M Townsend, E |
| author_sort | Townsend, E |
| collection | OXFORD |
| description | <p><strong>Systematic Review of Research Literature (SRL)</strong></p>
<p><em>Background:</em> Recent studies reveal non-heterosexual (hereafter ‘queer’) men are at greater risk of dying by suicide than heterosexual men. This finding makes it important to understand this demographic’s experiences in order to design better means of support and reducing risk. This review synthesises qualitative papers to (1) identify themes of factors associated with suicidal thoughts and behaviours in queer men and (2) explore how queer men make sense of these experiences.</p>
<p><em>Method:</em> Six databases were searched (PsychINFO, Embase, Scopus, Medline, CINAHL, and Web of Science) in October 2023, repeated in May 2024. The studies included were published since 2003, used qualitative methodologies, and aimed to explore suicidal thoughts and behaviours in queer men. The QualSyst quality assessment tool was used to explore study quality. Sixteen papers were synthesised in line with Thomas and Harden’s (2008) thematic approach.</p>
<p><em>Results:</em> Sixteen papers from fourteen datasets were included. All papers were of good to strong quality. Thematic synthesis identified 6 themes: the process of identity development; experience of rejection and isolation; multifaceted experience of stigma; mental health and barriers to support; sociocultural contexts; and belongingness and reasons for living. These themes are discussed in relation to existing literature and in terms of theoretical frameworks.</p>
<p><em>Conclusions:</em> Risk factors associated with suicidal ideation and action included: experiences of rejection and isolation, stigma and harassment, mental health challenges, and facing barriers to help. Risk factors were experienced within the context of an evolving identity development and in sociocultural contexts in which religion, culture, and societal attitudes to queerness influenced men’s experiences. Men identified reasons for living and factors that halted ideation becoming action.</p></br>
<p><strong>Service Improvement Project (SIP)</strong></p>
<p>In spinal cord injury inpatient services, the ideal pathway from admission to psychology would be to screen each new patient to determine psychological need. However, the implementation of ‘gold standard’ guidelines are often not possible due to limited resources, such as understaffing or poor funding. This study examined how best to use resources to increase access to the psychology team where universal screening is not possible.</p>
<p>This mixed methods study had 4 stages. An audit examined 161 inpatients admitted to the National Spinal Injuries Centre (NSIC) over one year; a questionnaire evaluated staff understanding of psychology; focus groups were used to develop a more in depth understanding and recommendations were made.</p>
<p>Results suggested that the psychology team’s role was unclear to staff, and they were viewed as separate to other disciplines. Recommendations were made to improve staff and patient access to the team. A need to improve the psychology team’s communication was identified, alongside clarifying and simplifying the referral process.</p></br>
<p><strong>Theory Driven Research Project (TDRP)</strong></p>
<p><em>Objective:</em> This study aimed to explore the differences in internalised stigma level in people with a functional seizure diagnosis (Non-Epileptic Attack Disorder (NEAD)) compared to people with an organic seizure diagnosis (epilepsy). It also investigated whether there is a difference in disclosure of diagnosis between these two groups. Finally, it explored the relationship between internalised stigma and the factors of self-esteem and self-efficacy.</p>
<p><em>Design and participants:</em> This study used a cross-sectional survey design to address these questions. Anxiety and depression were measured and controlled for where appropriate. 51 people with functional seizure diagnoses took part, alongside 47 people with epilepsy and 14 with both epilepsy and functional seizures. The comorbid group was too small to include as an independent group in analysis and were therefore excluded from analysis.</p>
<p><em>Results:</em> People with NEAD reported higher levels of internalised stigma than people with epilepsy (PwE). People with NEAD also reported significantly lower levels of disclosure than PwE. This remained significant after controlling for anxiety and depression. A hierarchical multiple regression analysis indicated that internalised stigma was a significant predictor of both self-esteem and self-efficacy, over and above the amount of variance accounted for by anxiety and depression.</p>
<p><em>Conclusions and implementation for practice:</em> This research provides context regarding internalised stigma and disclosure of their condition in people with NEAD compared to PwE. Clinicians should be aware of high levels of anxiety and depression in both groups. Self-esteem and selfefficacy could be important targets of intervention. Limitations are discussed. Further research should explore the relationships between these factors, including potential moderators.</p> |
| first_indexed | 2024-09-25T04:23:37Z |
| format | Thesis |
| id | oxford-uuid:73bd6d44-9379-4e6f-a031-54e851b443e4 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:23:37Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | oxford-uuid:73bd6d44-9379-4e6f-a031-54e851b443e42024-08-20T15:21:10ZEmily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)Thesishttp://purl.org/coar/resource_type/c_db06uuid:73bd6d44-9379-4e6f-a031-54e851b443e4EnglishHyrax Deposit2024Townsend, EKnight, MHogg, LKing, NPounds-Cornish, LBarnado, LMoore, C<p><strong>Systematic Review of Research Literature (SRL)</strong></p> <p><em>Background:</em> Recent studies reveal non-heterosexual (hereafter ‘queer’) men are at greater risk of dying by suicide than heterosexual men. This finding makes it important to understand this demographic’s experiences in order to design better means of support and reducing risk. This review synthesises qualitative papers to (1) identify themes of factors associated with suicidal thoughts and behaviours in queer men and (2) explore how queer men make sense of these experiences.</p> <p><em>Method:</em> Six databases were searched (PsychINFO, Embase, Scopus, Medline, CINAHL, and Web of Science) in October 2023, repeated in May 2024. The studies included were published since 2003, used qualitative methodologies, and aimed to explore suicidal thoughts and behaviours in queer men. The QualSyst quality assessment tool was used to explore study quality. Sixteen papers were synthesised in line with Thomas and Harden’s (2008) thematic approach.</p> <p><em>Results:</em> Sixteen papers from fourteen datasets were included. All papers were of good to strong quality. Thematic synthesis identified 6 themes: the process of identity development; experience of rejection and isolation; multifaceted experience of stigma; mental health and barriers to support; sociocultural contexts; and belongingness and reasons for living. These themes are discussed in relation to existing literature and in terms of theoretical frameworks.</p> <p><em>Conclusions:</em> Risk factors associated with suicidal ideation and action included: experiences of rejection and isolation, stigma and harassment, mental health challenges, and facing barriers to help. Risk factors were experienced within the context of an evolving identity development and in sociocultural contexts in which religion, culture, and societal attitudes to queerness influenced men’s experiences. Men identified reasons for living and factors that halted ideation becoming action.</p></br> <p><strong>Service Improvement Project (SIP)</strong></p> <p>In spinal cord injury inpatient services, the ideal pathway from admission to psychology would be to screen each new patient to determine psychological need. However, the implementation of ‘gold standard’ guidelines are often not possible due to limited resources, such as understaffing or poor funding. This study examined how best to use resources to increase access to the psychology team where universal screening is not possible.</p> <p>This mixed methods study had 4 stages. An audit examined 161 inpatients admitted to the National Spinal Injuries Centre (NSIC) over one year; a questionnaire evaluated staff understanding of psychology; focus groups were used to develop a more in depth understanding and recommendations were made.</p> <p>Results suggested that the psychology team’s role was unclear to staff, and they were viewed as separate to other disciplines. Recommendations were made to improve staff and patient access to the team. A need to improve the psychology team’s communication was identified, alongside clarifying and simplifying the referral process.</p></br> <p><strong>Theory Driven Research Project (TDRP)</strong></p> <p><em>Objective:</em> This study aimed to explore the differences in internalised stigma level in people with a functional seizure diagnosis (Non-Epileptic Attack Disorder (NEAD)) compared to people with an organic seizure diagnosis (epilepsy). It also investigated whether there is a difference in disclosure of diagnosis between these two groups. Finally, it explored the relationship between internalised stigma and the factors of self-esteem and self-efficacy.</p> <p><em>Design and participants:</em> This study used a cross-sectional survey design to address these questions. Anxiety and depression were measured and controlled for where appropriate. 51 people with functional seizure diagnoses took part, alongside 47 people with epilepsy and 14 with both epilepsy and functional seizures. The comorbid group was too small to include as an independent group in analysis and were therefore excluded from analysis.</p> <p><em>Results:</em> People with NEAD reported higher levels of internalised stigma than people with epilepsy (PwE). People with NEAD also reported significantly lower levels of disclosure than PwE. This remained significant after controlling for anxiety and depression. A hierarchical multiple regression analysis indicated that internalised stigma was a significant predictor of both self-esteem and self-efficacy, over and above the amount of variance accounted for by anxiety and depression.</p> <p><em>Conclusions and implementation for practice:</em> This research provides context regarding internalised stigma and disclosure of their condition in people with NEAD compared to PwE. Clinicians should be aware of high levels of anxiety and depression in both groups. Self-esteem and selfefficacy could be important targets of intervention. Limitations are discussed. Further research should explore the relationships between these factors, including potential moderators.</p> |
| spellingShingle | Townsend, E Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title | Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_full | Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_fullStr | Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_full_unstemmed | Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_short | Emily Townsend - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_sort | emily townsend thesis submitted in partial fulfilment of the degree of doctor of clinical psychology dclinpsych |
| work_keys_str_mv | AT townsende emilytownsendthesissubmittedinpartialfulfilmentofthedegreeofdoctorofclinicalpsychologydclinpsych |