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The Role Of A Psychologist aqa unit 5 biology synoptic essay helpWeek 5 PSY623
Using a minimum of 4 recent scholarly peered reviewed article less than 5yrs old for DQ 1 and 3 scholarly peer-reviewed article for DQ 2 must be cited using APA format 750 words for each topic DQ 1 and DQ2 It should be written separately include the http or DOI for all references used please Note: Please see reading references below:
DQ 1
Are female psychologists better suited to treat female offenders? Explain why based on the role a psychologist should play.
DQ 2
Should female offenders receive the same program and service opportunities that male offenders receive, or are there any significant, substantive differences between men and women that warrant the provision of different services? If different services were provided, would this violate the equal protection clause of the 5th or 14th Amendment?
Reading Assignment
1. (UN)Equal Protection: Why Gender Equality Depends on Discrimination
Read (UN)Equal Protection: Why Gender Equality Depends on Discrimination, by Cunningham-Parmeter, from Northwestern Uni
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2. Correctional Mental Health: From Theory to Best Practice
Read Chapter 10 in Correctional Mental Health: From Theory to Best Practice.
View Resource
 
3. Not Susceptible to the Logic of Turner: Johnson v. California and the Future of Gender Equal Protection Claims From Prisons
Read Not Susceptible to the Logic of Turner: Johnson v. California and the Future of Gender Equal Protection
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4. Gender Differences in Jail Populations: Factors to Consider in Reentry Strategies
Read “Gender Differences in Jail Populations: Factors to Consider in Reentry Strategies,” by Spjeldnes, Jung, & Yamatani, fro
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5. The Career Counseling Needs of Mothers in the Criminal Justice System
Read “The Career Counseling Needs of Mothers in the Criminal Justice System,” by Laux et al. from Journal of Offender Re
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Significance of Technology to the Society essay help writer: essay help writera 10- to 15-slide Microsoft PowerPoint presentation with speaker notes in which you: Analyze three significant points in history when rapid technological advances have occurred that you believe had the greatest impact on society, different cultures, and individuals. For each technological advancement, discuss the following:
Why was the technology significant for society?What happened in society as a result of the technology? What were the unintended consequences?What were the effects of the technology on sociocultural development, including the benefits and harms?What were the benefits and harms of the technology on the privacy and values of individuals?How has the technology shaped how people define and present themselves in society and their digital identities? Will it continue to do so?Has the technology created greater, lesser, or divided social equity over time?

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Qualitative research design essay help for free1)Identify the specific qualitative research design used in the qualitative study attached
2)Summarize the main points of the study including information on the research question, sampling strategy, research design, data analysis method(s), findings, and conclusion(s).
3)Evaluate the published qualitative research study focusing on and identifying the researchers paradigm or worldview and any evidence of reflexivity described in the report.
4)Explain whether or not potential biases were adequately addressed by the researchers. 5)Describe how the researchers applied ethical principles in the research study.
HERE IS THE CITATION FOR THE QUALITATIVE STUDY ATTACHED
References
Harrod, M., Miller, E. M., Henry, J., & Zivin, K. (2017). Ive never been able to stay in a job: A qualitative study of Veterans experiences of maintaining employment. Work, 57(2), 259268.
 

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Diversity in Groups Article Analysis aqa unit 5 biology synoptic essay help: aqa unit 5 biology synoptic essay helpDiversity in Groups Article AnalysisSelect one published article from any of the online databases listed in the Library that presents research on any type of diversity issue discussed in Chapter 6 of the required text. Some examples are racial, ethnic, gender, sexual orientation, or generational diversity in groups.
Your assignment for this week is to summarize and evaluate the main points or theses of the article. Specifically:
Summarize the article and its main point(s) or argument(s).Identify the methodology and design (example: qualitative and phenomenological) of the research undertaken or put forth.State and discuss the implications and meaning of the results.Provide your evaluation of the study, critiquing its findings and, if relevant, stating and defending your position on the issue.Explain how the research study could be improved or what you might have done differently and why.Explain how this research expands the knowledge base on diversity and groups.Explain how this research relates to what we are learning in class.

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Steps of a Functional Behavioral Assessment college application essay help: college application essay helpSteps of a Functional Behavioral Assessment (no more than 75 words)Conducting an FBA allows you to determine the purpose or function of a specific behavior for a particular person. You can then use that information to design intervention strategies to decrease that behavior. For this discussion, complete the following:
Explain how each step of an FBA is conducted and how each of these steps helps the behavior analyst come to a conclusion on the function of the behavior.Identify the step you would choose to conduct in the FBA, if you had to choose just one step. Explain why.
Reply to your friend’s discussion:
1 day agoRaven Grier Unit 6 discussion 1COLLAPSE
Conducting an FBA includes 4 steps: first step involves gathering information which includes using indirect methods such as interviews, checklist, rating scales etc., also direct methods such observing the behavior and collecting data and presenting the data in the form of graphs and charts. The second step is interpreting the information that was gathered to formulate hypotheses about the function of the problem behavior. This step is important because the information that was gathered is analyzed for patterns in behavior and the environmental events that are present when the behaviors occur. The third step is testing the hypotheses with a functional analysis. During a functional analysis the environment is manipulated this is done by incorporating a control (neutral) condition and a test condition in which the behavior is said to occur. The last step in the FBA process is developing interventions based on the function of the problem behavior. Once the prior steps are completed, intervention procedures can be created and implemented. These interventions need to be functionally equivalent to the problem behavior and must be adjusted and/or the above steps can be repeated if interventions are proven ineffective or functions of behavior has changed, but ruling out medical problems maybe suggested and required (Cooper et al.,2020).
I would choose to create and design interventions because seeing your work be the reason a problem behavior has decreased or cease to exist is very rewarding in this field.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2020). Applied behavior analysis 3rd edition. Pearson

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The Collaborative Documentation PowerPoint college essay helpAfter reviewing the collaborative documentation PowerPoint, identify the essential elements needed to document a service the same day it occurred.
In 750-1,000 words, What is collaborative documentation standards and the benefits of using this approach in a community mental health and wellness center.
Review at least three scholarly resources on the benefits and limitations of collaborative documentation and write a comparative analysis between the positions for or against it.
Describe the basic outcome measures used in healthcare and how using collaborative documentation will assist with better outcomes.
 

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Depression and anxiety nursing essay help: nursing essay helpDEBATE Open Access
Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority Claire L. Niedzwiedz1* , Lee Knifton2,3, Kathryn A. Robb1, Srinivasa Vittal Katikireddi4 and Daniel J. Smith1
Abstract
Background: A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety. We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high- quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited.
Conclusion: Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.
Keywords: Mental health, Psychiatry, Cancer, Multimorbidity, Depression, Anxiety, Oncology, Survivorship
Background A cancer diagnosis can have a wide-ranging impact on mental health and the prevalence of depression and anx- iety among people with cancer is high [1, 2]. Among those with no previous psychiatric history, a diagnosis of cancer is associated with heightened risk of common mental disorders, which may adversely affect cancer treatment and recovery, as well as quality of life and sur- vival [3]. People who have previously used psychiatric services may be particularly vulnerable and at greater
risk of mortality following a cancer diagnosis [4]. How- ever, the mental health needs of people with cancer, with or without a prior psychiatric history, are often given lit- tle attention during and after cancer treatment, which is primarily focused on monitoring physical health symp- toms and side effects. Advances in the earlier detection of cancer and improved cancer treatments means that people are now living longer with cancer, presenting a significant global challenge. The total number of people who are alive within 5 years of a cancer diagnosis was estimated to be 43.8 million in 2018 for 36 cancers across 185 countries [5], and in the United States alone, the number of cancer survivors is projected to rise
The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence: [email protected] 1Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK Full list of author information is available at the end of the article
Niedzwiedz et al. BMC Cancer (2019) 19:943 https://doi.org/10.1186/s12885-019-6181-4
exponentially from 15.5 million in 2016 to 26.1 million in 2040 [6]. The main objective of this article is to argue that more
research is needed into the prevention, care and treat- ment of co-morbid depression and anxiety among people with cancer and highlight it as a growing clinical and policy priority. For background and to support our argument, we provide a current evidence review of sys- tematic reviews relating to common mental disorders amongst people living with and beyond cancer. We cover the factors that may increase the risk of experien- cing co-morbid depression and anxiety, epidemiology, and potential care and treatment options. We searched three key electronic databases: Medline,
PsycINFO and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for relevant reviews (favour- ing those using systematic methods) using the following search terms: (neoplasm OR carcinoma OR tumo*r OR
cancer) AND (depression OR anxiety) AND review. Only English language articles were considered and searches were limited to the years 2012 to 2017 and updated during February 2019. These years were considered adequate to capture the main themes relating to cancer and common mental disorders in the current literature. The references of highly relevant articles were scrutinised for additional papers and a Google search for important grey literature was also conducted. A minority of significant research ar- ticles known to the authors were also consulted.
Main text Factors influencing the development of depression and anxiety among people with cancer A variety of factors are likely to interact to influence the development of depression and anxiety among people with cancer (summarised in Fig. 1), but these are not well understood [1], and require further research. Individual
Fig. 1 Factors that may contribute to depression and anxiety among people living with and beyond cancer
Niedzwiedz et al. BMC Cancer (2019) 19:943 Page 2 of 8
risk factors that may increase the risk of depression, simi- lar to the general population, include demographic factors, such as age and gender, and social and economic factors such as unemployment, fewer educational qualifications and a lack of social support [7]. The development of de- pression and anxiety among people with cancer is also likely to depend on factors at the structural level, includ- ing healthcare costs and access, as well as access to welfare support, such as disability benefits, as cancer can have a significant financial impact [8, 9]. Several psychological factors are also important. A key factor is the presence of pre-existing mental health problems and their severity. Research has demonstrated that individuals who have previously accessed mental health services before a cancer diagnosis experience excess mortality due to certain cancers, which may reflect late diagnosis, inadequate treatment and a higher rate of adverse health behaviours [4, 10]. Personality factors, such as neuroticism, and exist- ing coping skills may also contribute [11]. The risk of suicide among people with cancer is higher than the gen- eral population for certain diagnoses that tend to have poorer prognoses, such as mesothelioma and lung cancer, especially in the first 6 months after diagnosis [12, 13]. Individuals who have previously engaged in suicidal be- haviour are likely to be particularly vulnerable. The individual psychological response to a cancer
diagnosis is also likely to be an important component. The experience of being diagnosed, particularly if the diagnosis has been delayed, can be a significant source of distress and can impact on illness acceptance [14]. Feelings of hopelessness, loss of control and uncertainty around survival and death can also have a detrimental impact, particularly in patients with a poor prognosis. Anxiety around a cancer diagnosis can also lead to sleep disturbance, which may increase the risk of depression [15]. The stigma surrounding both mental illness and certain types of cancer, such as lung cancer, can lead to feelings of guilt and shame, which could contribute to the onset of depression. For example, the link between smoking and lung cancer can lead to some patients blaming themselves for their illness and experiencing stigma if they have engaged in smoking [14]. A variety of factors related to the cancer and its treatment
are likely to impact on the development of depression and anxiety, including the type of cancer, stage and prognosis. Cancer treatments including immunotherapy and chemo- therapy may induce depression through particular biological mechanisms, such as inflammatory pathways, and some medications used to treat chemotherapy-induced nausea can reduce dopaminergic transmission, which is implicated in the development of depressive symptoms [16]. The use of steroids in cancer treatment can induce depression [17], and androgen deprivation therapy in the treatment of prostate cancer is also associated with increased risk [18]. The
physical symptoms of specific cancers can also contribute to depression (e.g. incontinence and sexual dysfunction associ- ated with prostate cancer) [19]. Iatrogenic distress is also commonly reported amongst patients, which could increase the risk of experiencing later problems with depression and anxiety, including post-traumatic stress disorder [20]. This is often related to a combination of poor communication, a lack of consideration of psychological concerns and dis- jointed care [14, 20].
Prevalence of depression and anxiety among people with cancer The prevalence of common mental disorders among people with cancer varies widely in the published litera- ture. The mean prevalence of depression using diagnos- tic interviews is around 13% and using all assessment methods it varies from approximately 4 to 49% [2, 21]. This wide variation is due to several factors including the treatment setting, type of cancer included and method used to screen for symptoms (e.g. interview by trained psychiatrist or self-report instrument). The esti- mated prevalence of depression was found to be 3% in patients with lung cancer, compared to 31% in patients with cancer of the digestive tract, when diagnostic inter- views were used [21]. A meta-analyses of 15 studies meeting a number of quality criteria, including the use of diagnostic interviews, found that the estimated preva- lence of depression varied across treatment settings (5 to 16% in outpatients, 4 to 14% in inpatients, 4 to 11% in mixed outpatient and inpatient samples, and 7 to 49% in palliative care) [2]. There is no universal standardised tool which is recommended for depression screening in patients with cancer and the method used is likely to differ depend- ing on the treatment setting. A meta-analysis of screening and case finding tools for depression in cancer settings iden- tified 63 studies that used 19 different screening tools for depression [22]. Common screening methods for depression include semi-structured diagnostic interviews, the Hospital Anxiety and Depression Scale – depression subscale (HADS- D) and Center for Epidemiologic Studies Depression Scale (CESD), which are designed to measure the severity of depressive symptoms. An important aspect that needs to be considered is the
timing of increased psychiatric risk. Studies demonstrate that depression tends to be highest during the acute phase and decreases following treatment, but again this likely differs depending on the type of cancer and prog- nosis [21]. Using diagnostic interviews, the prevalence of depression during treatment was found to be 14%, 9% in the first year after diagnosis and 8% a year or more after treatment in a meta-analysis of 211 studies [21]. Of the 238 cohorts included, around 30% included only breast cancer patients and there is a need for research includ- ing rarer types of cancer.
Niedzwiedz et al. BMC Cancer (2019) 19:943 Page 3 of 8
As well as the type of cancer, the type of mental health outcome considered is also important and fewer studies have examined anxiety. A systematic review and meta- analysis study focusing on patients with ovarian cancer found that anxiety tended to be higher following treatment (27%) and during treatment (26%), and was lowest pre- treatment (19%) [23]. The heightened anxiety observed post-treatment may be due to reduced clinical consultations and support following treatment, potential transfer to a pal- liative setting, and fear of recurrence. Fear of recurrence is one of the most commonly reported issues and an import- ant area of unmet need for cancer survivors [24]. A lack of outward physical symptoms in ovarian cancer also means that self-monitoring is difficult [23]. In the same study of ovarian cancer patients, depression was highest before treat- ment (25%) and during treatment (23%), and reduced fol- lowing treatment (13%). This is in the context of a lifetime prevalence for clinical depression and anxiety of around 10 and 8%, respectively, amongst women in the UK [23, 25]. A similar systematic review of depression and anxiety
among patients with prostate cancer found that anxiety tended to be highest pre-treatment (27%) and lowered during treatment (15%) and post-treatment (18%) [26]. Rates of depression were relatively similar following treatment (18%), during treatment (15%) and pre- treatment (17%), with the 95% confidence intervals for these estimates largely overlapping. For reference, the prevalence of clinical depression and anxiety in men aged over 65 years is less than 9 and 6%, respectively [26]. A systematic review on the prevalence of psycho- logical distress among testicular cancer survivors dem- onstrated that around one in five experienced clinically significant anxiety, compared to one in eight among general population controls, with fear of recurrence again being one of the key issues reported [27]. How- ever, depression was no more prevalent amongst those surviving testicular cancer compared to the general population. In Scotland, the prevalence of depression was found to be highest in patients with lung cancer (13%), followed by gynaecological cancer (11%), breast cancer (9%), colorectal cancer (7%), and genitourinary cancer (6%) [28]. The authors found depression to be more likely among younger and more socially disadvan- taged individuals. In addition, 73% of the patients with depression were not receiving treatment for their men- tal health. Further research is needed to ascertain the factors which contribute to the uptake and efficacy of treatment for depression. This study also only consid- ered people with cancer who had attended specialist cancer clinics within a defined time period, which likely excluded people who were diagnosed many years ago. The longer-term psychological impact of cancer has
received comparatively little research. The few studies in this area have mainly focused on women with breast
cancer and demonstrate that depressive symptoms can persist for over 5 years after diagnosis, though the preva- lence of anxiety was not elevated compared to the general population [29]. A systematic review of the prevalence of depression and anxiety among long-term cancer survivors, including all types, found that anxiety was more prevalent among cancer survivors, compared to healthy controls [30]. Few studies have focused specif- ically on younger cancer survivors and more research is needed in this area. A representative study of young adult cancer survivors aged 15 to 39 years in the United States demonstrated that moderate (23% vs 17%) and se- vere (8% vs 3%) mental distress were significantly higher in those living with cancer for at least 5 years after diag- nosis, compared to controls [31]. 75 and 52% of people with cancer with moderate and severe distress, respect- ively, had not talked to a mental health professional, with the cost of treatment a potential barrier. Limita- tions of this study included the focus on self-reported mental distress and not clinical depression or anxiety, as well as the relatively small sample size. Many studies in this area have a poor response rate,
lack representativeness, are based on a small sample of patients (often with the most common types of cancer), which often exclude those with cognitive impairment and patients who are too physically or mentally unwell to take part [32]. Future studies would benefit from using administrative health data [33], for example, link- ing together cancer registries, inpatient and outpatient records and prescribing data. There are also a lack of studies covering populations from low- and middle- income countries [34]. The estimated prevalence of co- morbid common mental disorders is likely to vary de- pending on the country studied, due to factors such as the health and welfare system. These factors may influ- ence mental health inequalities among people with can- cer, which has received little research focus. In a Scottish study, depression was found to be higher in the least advantaged groups (19%), compared to the most advantaged (10%) [35]. Cancer and comorbid anxiety was also unequally distributed; in the least advantaged groups around 12% had both conditions, compared to 7% among the most advantaged [35]. Further research is needed in this area to quantify, monitor and prevent in- equalities among people with cancer. It should also be highlighted that the psychological im-
pact of cancer may not always be negative and many people will not experience problems with depression and anxiety. Experiencing temporary distress related to a can- cer diagnosis may lead to positive psychological changes in the long-term whereby individuals feel a greater appre- ciation of life and are able to re-evaluate their priorities [36]. The factors that protect against the development of common mental disorders and contribute to positive
Niedzwiedz et al. BMC Cancer (2019) 19:943 Page 4 of 8
mental health among people living with and beyond can- cer merits further research.
Treatment and management of depression and anxiety among people with cancer To effectively manage and treat depression and anxiety among people with cancer, symptoms must first be identi- fied. However, several social and clinical barriers have been reported. A key issue is the lack of physician time for assessing symptoms. There can also be a normalisation of distress and attribution of the somatic symptoms of depression and anxiety to the cancer. Patients may not disclose psychiatric symptoms because of the stigma sur- rounding mental health conditions [37]. Screening for de- pression and anxiety among patients with cancer is also only of value if it leads to effective treatment and support that is able to improve patient outcomes. Patients may be more reluctant to discuss their mental health needs if they perceive a lack of effective treatment options. The existing evidence for treating anxiety and depression
among patients with cancer is limited and of varying quality [38]. Studies with small sample sizes are common; this miti- gates against the detection of meaningful changes in patient outcomes and these studies often suffer from a high rate of attrition, which likely reflects the high symptom burden and reduced survival in this patient population [39]. Sys- tematic reviews demonstrate there is a preponderance of studies from the United States, which include a high num- ber of studies focusing on female patients with breast cancer [40]. However, these studies demonstrate that psy- chotherapy, psychoeducation and relaxation training may have small to medium short-term effects on relieving emo- tional distress and reducing symptoms of anxiety and depression, as well as improving health-related quality of life. The evidence for pharmacological treatment of depres- sion with antidepressants is mixed – there are very few studies in this area and those that exist are of low quality [41]. There is also concern around potential side effects of antidepressants and drug interactions that may affect the efficacy of cancer treatments [42]. A systematic review and meta-analysis focusing on
cognitive behavioural therapy (CBT) found that it may be effective in reducing depression and anxiety and im- proving quality of life in patients with cancer in the short-term, but potential long-term effects were only sustained for quality of life [43]. However, in this meta- analysis the included participants were primarily women with breast cancer and there are a lack of studies cover- ing other cancer types. It is likely that collaborative care interventions which involve partnership between psych- iatry, clinical psychology and primary care, overseen by a care manager are likely to be most effective in the man- agement and treatment of depression amongst people with cancer [44]. Treatment should be based on patient
preference and also take into account potential adverse side effects [44]. In a UK-based study it was found that only a third of patients with cancer and related psycho- logical or emotional distress were willing to be referred for support [45]. Qualitative studies also demonstrate that patients often do not want to discuss their feelings with nurses during cancer treatment [46]. However, pa- tients valued having the option to talk about their emo- tions, but they preferred to choose with whom and when. There is therefore a need for further research into some of the barriers to obtaining mental health support among those affected by cancer and experiencing dis- tress to prevent future problems. The self-management of psychological distress among
people with cancer may be beneficial and could help pre- vent distress becoming clinical depression or anxiety. Self- management can be defined as: The individuals ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses the ability to monitor ones condition and to affect the cogni- tive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Thus, a dynamic and continuous process of self-regulation is established. [47]. Studies on self-management, cancer and psychological dis- tress have focused on the treatment phase, with fewer investigating interventions following treatment or at the end of life [48]. There is evidence to suggest that self- management of psychological distress in cancer can help to empower patients and families to care for themselves in a way which is preferable for them. Self-management inter- ventions that have shown promise include education, moni- toring, teaching and counselling to help patients manage the short- and long-term physical and psychosocial effects of cancer [48]. However, a recent systematic review exam- ining the impact of self-management interventions on outcomes including quality of life, self-efficacy and symp- tom management (such as psychological distress) amongst cancer survivors demonstrated a lack of evidence to sup- port any specific intervention and found that the six included interventions lacked sustainability, bringing into question their long-term effectiveness and value for money [49]. Again, the included studies were dominated by women with breast cancer, with only two covering other cancers. Effective treatment and management strategies may
also differ according to the demographic group affected. In a report by CLIC (Cancer and Leukaemia in Child- hood) Sargent which surveyed 146 young people with cancer, keeping in touch with friends and family, talking to others with similar experiences and access to the internet in hospital were reported to help maintain men- tal health during cancer treatment [50]. Of the young people who mentioned they would find it helpful to talk
Niedzwiedz et al. BMC Cancer (2019) 19:943 Page 5 of 8
to other people with similar experiences, 60% said they would prefer to do this online. Young people also reported that the available services were not tailored to deal with those aged under 18 or the emotional impact of cancer. In addition, those who accessed services men- tioned that there is a lack of suitable long-term emo- tional support. Just over 40% of the young people who took part did not access support for their mental health needs. It is clear that a more personalised approach to support-
ing the psychological health of people with cancer is needed [51]. Some people may not want or require sup- port or treatment, others will be able to self-manage, and some may have more complex needs that require more intensive follow-up and support. At diagnosis, the psycho- logical health of patients should be considered alongside their physical health and sources of support offered. Needs and symptoms may also change over time. Evaluation of more recent personalised approaches to follow-up care that have been adopted in several areas including England and Northern Ireland [51] are needed to understand the role they may have in preventing longer term depression and anxiety amongst cancer survivors. A key barrier affecting research progress in this area is
funding [52]. In the UK, money spent on research into the biology of cancer was more than five times than that spent on Cancer Control, Survivorship and Outcomes during 2017/18 [53]. Research into the mental health and wellbeing of people living with and beyond cancer is likely to only be a small part of this. Research is ur- gently needed in this area as more people survive cancer and for some cancers, such as multiple myeloma and colorectal cancer, risk is increasing in younger cohorts [54]. The long-term (those that begin during treatment and continue afterwards) and late effects of cancer treat- ment (those that begin after treatment is completed), such as secondary cancers, infertility, chronic pain and insomnia, are likely to affect the mental wellbeing of cancer survivors, potentially contributing to depression and anxiety [6]. The National Cancer Research Institute (NCRI) in the UK have also recently highlighted re- search into the short-term and long-term psychological impacts of cancer and its treatment as a key priority, fol- lowing surveys of over 3500 patients, carers, and health and social care professionals [55].
Conclusion The mental health of people living with and beyond cancer in its various types and stages is an important and growing research and clinical priority. Compared to the general population, the prevalence of anxiety and depression is often higher among people with cancer, but estimates vary due to a number of factors, such as the type and stage of cancer. Patients often do not obtain psychological support or
treatment. This is likely due to several factors, including lack of awareness and identification of psychiatric symptoms, an absence of support available or offered, lack of evidence around effective treatments, stigma, and patient preference. In particular, we highlight the lack of high-quality research into the mental health of long-term cancer survivors, the po- tential impact of long-term and late effects of cancer treat- ment, and the few studies focused on prevention. Further research that includes the less common types of cancer is required, as well as the inclusion of younger people and populations from low- and middle-income countries. Given the increasing numbers of people living with and beyond cancer, this research is of timely importance.
Abbreviations CBT: Cognitive behavioural therapy; CESD: Center for Epidemiologic Studies Depression Scale; CINAHL: Cumulative Index to Nursing and Allied Health Literature; CLIC: Cancer and Leukaemia in Childhood; HADS-D: Hospital Anxiety and Depression Scale – depression subscale; NCRI: National Cancer Research Institute
Acknowledgements This article is built on a literature review conducted by CLN and LK for a project on Supporting the mental and emotional health of people with cancer funded by the Big Lottery Fund when CLN was an employee of the Mental Health Foundation in Scotland during 2017.
Authors contributions CLN and LK conceived the article. CLN conducted the searches and drafted the manuscript. CLN, LK, SVK, KAR and DJS interpreted the findings. All authors critically revised the manuscript, read and approved the final version.
Funding CLN is currently supported by the Medical Research Council (grant number MR/R024774/1). SVK is funded by a NHS Research Scotland (NRS) Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15) and Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15). The funders had no role in the study design; collection, analysis and interpretation of data; the writing of the article; and in the decision to submit it for publication.
Availability of data and materials All data generated or analysed during this study are included in this published article.
Ethics approval and consent to participate Not applicable
Consent for publication Not applicable
Competing interests The authors declare that they have no competing interests except for the funding acknowledged.
Author details 1Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK. 2University of Strathclyde, Centre for Health Policy, Glasgow, Scotland, UK. 3Mental Health Foundation, Glasgow, Scotland, UK. 4MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK.
Received: 19 March 2019 Accepted: 20 September 2019
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DEBATE Open Access
Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority Claire L. Niedzwiedz1* , Lee Knifton2,3, Kathryn A. Robb1, Srinivasa Vittal Katikireddi4 and Daniel J. Smith1
Abstract
Background: A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety. We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high- quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited.
Conclusion: Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.
Keywords: Mental health, Psychiatry, Cancer, Multimorbidity, Depression, Anxiety, Oncology, Survivorship
Background A cancer diagnosis can have a wide-ranging impact on mental health and the prevalence of depression and anx- iety among people with cancer is high [1, 2]. Among those with no previous psychiatric history, a diagnosis of cancer is associated with heightened risk of common mental disorders, which may adversely affect cancer treatment and recovery, as well as quality of life and sur- vival [3]. People who have previously used psychiatric services may be particularly vulnerable and at greater
risk of mortality following a cancer diagnosis [4]. How- ever, the mental health needs of people with cancer, with or without a prior psychiatric history, are often given lit- tle attention during and after cancer treatment, which is primarily focused on monitoring physical health symp- toms and side effects. Advances in the earlier detection of cancer and improved cancer treatments means that people are now living longer with cancer, presenting a significant global challenge. The total number of people who are alive within 5 years of a cancer diagnosis was estimated to be 43.8 million in 2018 for 36 cancers across 185 countries [5], and in the United States alone, the number of cancer survivors is projected to rise
The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence: [email protected] 1Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK Full list of author information is available at the end of the article
Niedzwiedz et al. BMC Cancer (2019) 19:943 https://doi.org/10.1186/s12885-019-6181-4
exponentially from 15.5 million in 2016 to 26.1 million in 2040 [6]. The main objective of this article is to argue that more
research is needed into the prevention, care and treat- ment of co-morbid depression and anxiety among people with cancer and highlight it as a growing clinical and policy priority. For background and to support our argument, we provide a current evidence review of sys- tematic reviews relating to common mental disorders amongst people living with and beyond cancer. We cover the factors that may increase the risk of experien- cing co-morbid depression and anxiety, epidemiology, and potential care and treatment options. We searched three key electronic databases: Medline,
PsycINFO and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for relevant reviews (favour- ing those using systematic methods) using the following search terms: (neoplasm OR carcinoma OR tumo*r OR
cancer) AND (depression OR anxiety) AND review. Only English language articles were considered and searches were limited to the years 2012 to 2017 and updated during February 2019. These years were considered adequate to capture the main themes relating to cancer and common mental disorders in the current literature. The references of highly relevant articles were scrutinised for additional papers and a Google search for important grey literature was also conducted. A minority of significant research ar- ticles known to the authors were also consulted.
Main text Factors influencing the development of depression and anxiety among people with cancer A variety of factors are likely to interact to influence the development of depression and anxiety among people with cancer (summarised in Fig. 1), but these are not well understood [1], and require further research. Individual
Fig. 1 Factors that may contribute to depression and anxiety among people living with and beyond cancer
Niedzwiedz et al. BMC Cancer (2019) 19:943 Page 2 of 8
risk factors that may increase the risk of depression, simi- lar to the general population, include demographic factors, such as age and gender, and social and economic factors such as unemployment, fewer educational qualifications and a lack of social support [7]. The development of de- pression and anxiety among people with cancer is also likely to depend on factors at the structural level, includ- ing healthcare costs and access, as well as access to welfare support, such as disability benefits, as cancer can have a significant financial impact [8, 9]. Several psychological factors are also important. A key factor is the presence of pre-existing mental health problems and their severity. Research has demonstrated that individuals who have previously accessed mental health services before a cancer diagnosis experience excess mortality due to certain cancers, which may reflect late diagnosis, inadequate treatment and a higher rate of adverse health behaviours [4, 10]. Personality factors, such as neuroticism, and exist- ing coping skills may also contribute [11]. The risk of suicide among people with cancer is higher than the gen- eral population for certain diagnoses that tend to have poorer prognoses, such as mesothelioma and lung cancer, especially in the first 6 months after diagnosis [12, 13]. Individuals who have previously engaged in suicidal be- haviour are likely to be particularly vulnerable. The individual psychological response to a cancer
diagnosis is also likely to be an important component. The experience of being diagnosed, particularly if the diagnosis has been delayed, can be a significant source of distress and can impact on illness acceptance [14]. Feelings of hopelessness, loss of control and uncertainty around survival and death can also have a detrimental impact, particularly in patients with a poor prognosis. Anxiety around a cancer diagnosis can also lead to sleep disturbance, which may increase the risk of depression [15]. The stigma surrounding both mental illness and certain types of cancer, such as lung cancer, can lead to feelings of guilt and shame, which could contribute to the onset of depression. For example, the link between smoking and lung cancer can lead to some patients blaming themselves for their illness and experiencing stigma if they have engaged in smoking [14]. A variety of factors related to the cancer and its treatment
are likely to impact on the development of depression and anxiety, including the type of cancer, stage and prognosis. Cancer treatments including immunotherapy and chemo- therapy may induce depression through particular biological mechanisms, such as inflammatory pathways, and some medications used to treat chemotherapy-induced nausea can reduce dopaminergic transmission, which is implicated in the development of depressive symptoms [16]. The use of steroids in cancer treatment can induce depression [17], and androgen deprivation therapy in the treatment of prostate cancer is also associated with increased risk [18]. The
physical symptoms of specific cancers can also contribute to depression (e.g. incontinence and sexual dysfunction associ- ated with prostate cancer) [19]. Iatrogenic distress is also commonly reported amongst patients, which could increase the risk of experiencing later problems with depression and anxiety, including post-traumatic stress disorder [20]. This is often related to a combination of poor communication, a lack of consideration of psychological concerns and dis- jointed care [14, 20].
Prevalence of depression and anxiety among people with cancer The prevalence of common mental disorders among people with cancer varies widely in the published litera- ture. The mean prevalence of depression using diagnos- tic interviews is around 13% and using all assessment methods it varies from approximately 4 to 49% [2, 21]. This wide variation is due to several factors including the treatment setting, type of cancer included and method used to screen for symptoms (e.g. interview by trained psychiatrist or self-report instrument). The esti- mated prevalence of depression was found to be 3% in patients with lung cancer, compared to 31% in patients with cancer of the digestive tract, when diagnostic inter- views were used [21]. A meta-analyses of 15 studies meeting a number of quality criteria, including the use of diagnostic interviews, found that the estimated preva- lence of depression varied across treatment settings (5 to 16% in outpatients, 4 to 14% in inpatients, 4 to 11% in mixed outpatient and inpatient samples, and 7 to 49% in palliative care) [2]. There is no universal standardised tool which is recommended for depression screening in patients with cancer and the method used is likely to differ depend- ing on the treatment setting. A meta-analysis of screening and case finding tools for depression in cancer settings iden- tified 63 studies that used 19 different screening tools for depression [22]. Common screening methods for depression include semi-structured diagnostic interviews, the Hospital Anxiety and Depression Scale – depression subscale (HADS- D) and Center for Epidemiologic Studies Depression Scale (CESD), which are designed to measure the severity of depressive symptoms. An important aspect that needs to be considered is the
timing of increased psychiatric risk. Studies demonstrate that depression tends to be highest during the acute phase and decreases following treatment, but again this likely differs depending on the type of cancer and prog- nosis [21]. Using diagnostic interviews, the prevalence of depression during treatment was found to be 14%, 9% in the first year after diagnosis and 8% a year or more after treatment in a meta-analysis of 211 studies [21]. Of the 238 cohorts included, around 30% included only breast cancer patients and there is a need for research includ- ing rarer types of cancer.
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As well as the type of cancer, the type of mental health outcome considered is also important and fewer studies have examined anxiety. A systematic review and meta- analysis study focusing on patients with ovarian cancer found that anxiety tended to be higher following treatment (27%) and during treatment (26%), and was lowest pre- treatment (19%) [23]. The heightened anxiety observed post-treatment may be due to reduced clinical consultations and support following treatment, potential transfer to a pal- liative setting, and fear of recurrence. Fear of recurrence is one of the most commonly reported issues and an import- ant area of unmet need for cancer survivors [24]. A lack of outward physical symptoms in ovarian cancer also means that self-monitoring is difficult [23]. In the same study of ovarian cancer patients, depression was highest before treat- ment (25%) and during treatment (23%), and reduced fol- lowing treatment (13%). This is in the context of a lifetime prevalence for clinical depression and anxiety of around 10 and 8%, respectively, amongst women in the UK [23, 25]. A similar systematic review of depression and anxiety
among patients with prostate cancer found that anxiety tended to be highest pre-treatment (27%) and lowered during treatment (15%) and post-treatment (18%) [26]. Rates of depression were relatively similar following treatment (18%), during treatment (15%) and pre- treatment (17%), with the 95% confidence intervals for these estimates largely overlapping. For reference, the prevalence of clinical depression and anxiety in men aged over 65 years is less than 9 and 6%, respectively [26]. A systematic review on the prevalence of psycho- logical distress among testicular cancer survivors dem- onstrated that around one in five experienced clinically significant anxiety, compared to one in eight among general population controls, with fear of recurrence again being one of the key issues reported [27]. How- ever, depression was no more prevalent amongst those surviving testicular cancer compared to the general population. In Scotland, the prevalence of depression was found to be highest in patients with lung cancer (13%), followed by gynaecological cancer (11%), breast cancer (9%), colorectal cancer (7%), and genitourinary cancer (6%) [28]. The authors found depression to be more likely among younger and more socially disadvan- taged individuals. In addition, 73% of the patients with depression were not receiving treatment for their men- tal health. Further research is needed to ascertain the factors which contribute to the uptake and efficacy of treatment for depression. This study also only consid- ered people with cancer who had attended specialist cancer clinics within a defined time period, which likely excluded people who were diagnosed many years ago. The longer-term psychological impact of cancer has
received comparatively little research. The few studies in this area have mainly focused on women with breast
cancer and demonstrate that depressive symptoms can persist for over 5 years after diagnosis, though the preva- lence of anxiety was not elevated compared to the general population [29]. A systematic review of the prevalence of depression and anxiety among long-term cancer survivors, including all types, found that anxiety was more prevalent among cancer survivors, compared to healthy controls [30]. Few studies have focused specif- ically on younger cancer survivors and more research is needed in this area. A representative study of young adult cancer survivors aged 15 to 39 years in the United States demonstrated that moderate (23% vs 17%) and se- vere (8% vs 3%) mental distress were significantly higher in those living with cancer for at least 5 years after diag- nosis, compared to controls [31]. 75 and 52% of people with cancer with moderate and severe distress, respect- ively, had not talked to a mental health professional, with the cost of treatment a potential barrier. Limita- tions of this study included the focus on self-reported mental distress and not clinical depression or anxiety, as well as the relatively small sample size. Many studies in this area have a poor response rate,
lack representativeness, are based on a small sample of patients (often with the most common types of cancer), which often exclude those with cognitive impairment and patients who are too physically or mentally unwell to take part [32]. Future studies would benefit from using administrative health data [33], for example, link- ing together cancer registries, inpatient and outpatient records and prescribing data. There are also a lack of studies covering populations from low- and middle- income countries [34]. The estimated prevalence of co- morbid common mental disorders is likely to vary de- pending on the country studied, due to factors such as the health and welfare system. These factors may influ- ence mental health inequalities among people with can- cer, which has received little research focus. In a Scottish study, depression was found to be higher in the least advantaged groups (19%), compared to the most advantaged (10%) [35]. Cancer and comorbid anxiety was also unequally distributed; in the least advantaged groups around 12% had both conditions, compared to 7% among the most advantaged [35]. Further research is needed in this area to quantify, monitor and prevent in- equalities among people with cancer. It should also be highlighted that the psychological im-
pact of cancer may not always be negative and many people will not experience problems with depression and anxiety. Experiencing temporary distress related to a can- cer diagnosis may lead to positive psychological changes in the long-term whereby individuals feel a greater appre- ciation of life and are able to re-evaluate their priorities [36]. The factors that protect against the development of common mental disorders and contribute to positive
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mental health among people living with and beyond can- cer merits further research.
Treatment and management of depression and anxiety among people with cancer To effectively manage and treat depression and anxiety among people with cancer, symptoms must first be identi- fied. However, several social and clinical barriers have been reported. A key issue is the lack of physician time for assessing symptoms. There can also be a normalisation of distress and attribution of the somatic symptoms of depression and anxiety to the cancer. Patients may not disclose psychiatric symptoms because of the stigma sur- rounding mental health conditions [37]. Screening for de- pression and anxiety among patients with cancer is also only of value if it leads to effective treatment and support that is able to improve patient outcomes. Patients may be more reluctant to discuss their mental health needs if they perceive a lack of effective treatment options. The existing evidence for treating anxiety and depression
among patients with cancer is limited and of varying quality [38]. Studies with small sample sizes are common; this miti- gates against the detection of meaningful changes in patient outcomes and these studies often suffer from a high rate of attrition, which likely reflects the high symptom burden and reduced survival in this patient population [39]. Sys- tematic reviews demonstrate there is a preponderance of studies from the United States, which include a high num- ber of studies focusing on female patients with breast cancer [40]. However, these studies demonstrate that psy- chotherapy, psychoeducation and relaxation training may have small to medium short-term effects on relieving emo- tional distress and reducing symptoms of anxiety and depression, as well as improving health-related quality of life. The evidence for pharmacological treatment of depres- sion with antidepressants is mixed – there are very few studies in this area and those that exist are of low quality [41]. There is also concern around potential side effects of antidepressants and drug interactions that may affect the efficacy of cancer treatments [42]. A systematic review and meta-analysis focusing on
cognitive behavioural therapy (CBT) found that it may be effective in reducing depression and anxiety and im- proving quality of life in patients with cancer in the short-term, but potential long-term effects were only sustained for quality of life [43]. However, in this meta- analysis the included participants were primarily women with breast cancer and there are a lack of studies cover- ing other cancer types. It is likely that collaborative care interventions which involve partnership between psych- iatry, clinical psychology and primary care, overseen by a care manager are likely to be most effective in the man- agement and treatment of depression amongst people with cancer [44]. Treatment should be based on patient
preference and also take into account potential adverse side effects [44]. In a UK-based study it was found that only a third of patients with cancer and related psycho- logical or emotional distress were willing to be referred for support [45]. Qualitative studies also demonstrate that patients often do not want to discuss their feelings with nurses during cancer treatment [46]. However, pa- tients valued having the option to talk about their emo- tions, but they preferred to choose with whom and when. There is therefore a need for further research into some of the barriers to obtaining mental health support among those affected by cancer and experiencing dis- tress to prevent future problems. The self-management of psychological distress among
people with cancer may be beneficial and could help pre- vent distress becoming clinical depression or anxiety. Self- management can be defined as: The individuals ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition. Efficacious self-management encompasses the ability to monitor ones condition and to affect the cogni- tive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Thus, a dynamic and continuous process of self-regulation is established. [47]. Studies on self-management, cancer and psychological dis- tress have focused on the treatment phase, with fewer investigating interventions following treatment or at the end of life [48]. There is evidence to suggest that self- management of psychological distress in cancer can help to empower patients and families to care for themselves in a way which is preferable for them. Self-management inter- ventions that have shown promise include education, moni- toring, teaching and counselling to help patients manage the short- and long-term physical and psychosocial effects of cancer [48]. However, a recent systematic review exam- ining the impact of self-management interventions on outcomes including quality of life, self-efficacy and symp- tom management (such as psychological distress) amongst cancer survivors demonstrated a lack of evidence to sup- port any specific intervention and found that the six included interventions lacked sustainability, bringing into question their long-term effectiveness and value for money [49]. Again, the included studies were dominated by women with breast cancer, with only two covering other cancers. Effective treatment and management strategies may
also differ according to the demographic group affected. In a report by CLIC (Cancer and Leukaemia in Child- hood) Sargent which surveyed 146 young people with cancer, keeping in touch with friends and family, talking to others with similar experiences and access to the internet in hospital were reported to help maintain men- tal health during cancer treatment [50]. Of the young people who mentioned they would find it helpful to talk
Niedzwiedz et al. BMC Cancer (2019) 19:943 Page 5 of 8
to other people with similar experiences, 60% said they would prefer to do this online. Young people also reported that the available services were not tailored to deal with those aged under 18 or the emotional impact of cancer. In addition, those who accessed services men- tioned that there is a lack of suitable long-term emo- tional support. Just over 40% of the young people who took part did not access support for their mental health needs. It is clear that a more personalised approach to support-
ing the psychological health of people with cancer is needed [51]. Some people may not want or require sup- port or treatment, others will be able to self-manage, and some may have more complex needs that require more intensive follow-up and support. At diagnosis, the psycho- logical health of patients should be considered alongside their physical health and sources of support offered. Needs and symptoms may also change over time. Evaluation of more recent personalised approaches to follow-up care that have been adopted in several areas including England and Northern Ireland [51] are needed to understand the role they may have in preventing longer term depression and anxiety amongst cancer survivors. A key barrier affecting research progress in this area is
funding [52]. In the UK, money spent on research into the biology of cancer was more than five times than that spent on Cancer Control, Survivorship and Outcomes during 2017/18 [53]. Research into the mental health and wellbeing of people living with and beyond cancer is likely to only be a small part of this. Research is ur- gently needed in this area as more people survive cancer and for some cancers, such as multiple myeloma and colorectal cancer, risk is increasing in younger cohorts [54]. The long-term (those that begin during treatment and continue afterwards) and late effects of cancer treat- ment (those that begin after treatment is completed), such as secondary cancers, infertility, chronic pain and insomnia, are likely to affect the mental wellbeing of cancer survivors, potentially contributing to depression and anxiety [6]. The National Cancer Research Institute (NCRI) in the UK have also recently highlighted re- search into the short-term and long-term psychological impacts of cancer and its treatment as a key priority, fol- lowing surveys of over 3500 patients, carers, and health and social care professionals [55].
Conclusion The mental health of people living with and beyond cancer in its various types and stages is an important and growing research and clinical priority. Compared to the general population, the prevalence of anxiety and depression is often higher among people with cancer, but estimates vary due to a number of factors, such as the type and stage of cancer. Patients often do not obtain psychological support or
treatment. This is likely due to several factors, including lack of awareness and identification of psychiatric symptoms, an absence of support available or offered, lack of evidence around effective treatments, stigma, and patient preference. In particular, we highlight the lack of high-quality research into the mental health of long-term cancer survivors, the po- tential impact of long-term and late effects of cancer treat- ment, and the few studies focused on prevention. Further research that includes the less common types of cancer is required, as well as the inclusion of younger people and populations from low- and middle-income countries. Given the increasing numbers of people living with and beyond cancer, this research is of timely importance.
Abbreviations CBT: Cognitive behavioural therapy; CESD: Center for Epidemiologic Studies Depression Scale; CINAHL: Cumulative Index to Nursing and Allied Health Literature; CLIC: Cancer and Leukaemia in Childhood; HADS-D: Hospital Anxiety and Depression Scale – depression subscale; NCRI: National Cancer Research Institute
Acknowledgements This article is built on a literature review conducted by CLN and LK for a project on Supporting the mental and emotional health of people with cancer funded by the Big Lottery Fund when CLN was an employee of the Mental Health Foundation in Scotland during 2017.
Authors contributions CLN and LK conceived the article. CLN conducted the searches and drafted the manuscript. CLN, LK, SVK, KAR and DJS interpreted the findings. All authors critically revised the manuscript, read and approved the final version.
Funding CLN is currently supported by the Medical Research Council (grant number MR/R024774/1). SVK is funded by a NHS Research Scotland (NRS) Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15) and Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15). The funders had no role in the study design; collection, analysis and interpretation of data; the writing of the article; and in the decision to submit it for publication.
Availability of data and materials All data generated or analysed during this study are included in this published article.
Ethics approval and consent to participate Not applicable
Consent for publication Not applicable
Competing interests The authors declare that they have no competing interests except for the funding acknowledged.
Author details 1Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland, UK. 2University of Strathclyde, Centre for Health Policy, Glasgow, Scotland, UK. 3Mental Health Foundation, Glasgow, Scotland, UK. 4MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK.
Received: 19 March 2019 Accepted: 20 September 2019
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Reflection Part II: Community Connection aqa unit 5 biology synoptic essay helpReflection Part I: Purpose
In 200-300 words, describe why you are studying in the field of Mental Health and Wellness. How do you hope to apply the skills you have acquired upon completion of this program?
Reflection Part II: Community Connection
In 150-200 words, name an organization in your community that treats a mental health disorder and two evidence-based practices (EBPs) they utilize for this particular mental health disorder. Include the name, location, and website (if available) of the organization. How did you find out about this organization? What would an individual need to do to be able to receive services at this organization? Include appointment, referral, and insurance criteria
 

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Legal and Ethical Issues melbourne essay helpChapter Fifteen: Legal and Ethical Issues
2017 Cengage Learning
Introduction
Crisis intervention presents intriguing ethical dilemmas and challenges for mental health workers
Ethical guidelines should be honored
Crisis situations create impossible situations to follow ethical guidelines
Ethical codes do not specifically address crisis intervention services
Workers are left to make decisions based on reflection and consultation
Nuances matter
The legal and ethical questions of a crisis situation can change quickly
2017 Cengage Learning
Ethical and Legal Interface with Crisis Intervention
Misconceptions regarding ethical decision making
Decision-making models are practical
Time to consult
One correct answer
The role of the mental health professional
Safety
Calming
Self and collective efficacy
Connectedness
Hope
2017 Cengage Learning
The Confluence of Beliefs, Emotion, Morality, and Values
Vulnerability and resiliency are dynamic
Crisis workers need to understand their reasons for doing crisis work
Understand personal values, beliefs, and background
Reflection
Supervision
Nonrational factors influence ethical decision-making
Context
Perceptions
Relationships
Emotions
Learning processes
2017 Cengage Learning
Laws and Ethical Codes Are Living Documents
Laws are mandatory
Ethical codes are aspirational
A good bedside manner is the best risk management strategy
Legal requirements and ethical codes can conflict
Often no single right answer
Consult an attorney
Choose the least harmful option
Consider the effect on the community over the individual
2017 Cengage Learning
Confidentiality and Privacy
Confidentialitythe legal duty to protect clients private communication
Privacyclients righto to choose what to say and when to say it
Privileged Communication
Legally prevents disclosure of confidential information
Laws differ by location
Limited in certain circumstances
When a reasonable practitioner has the duty to protect clients or others from serious and foreseeable harm
2017 Cengage Learning
Duty to Warn, Protect, and Report (1 of 2)
Duty to warn rules are location specific
Tarasoff v. Regents of the University of California
Duty to warn holds across counseling modality and venue
Tarasoff mandated conditions for warning
Must be a special relationship (e.g., client-therapist)
Must be a reasonable prediction of dangerous conduct
Must be a foreseeable victim
2017 Cengage Learning
Duty to Warn, Protect, and Report (2 of 2)
Guidelines for action when a clear threat of violence is made
Clearly state the limits of confidentiality
Special rules may apply for minors
Consult and document
Warn identified potential victims
Warn despite threats of reprisal
2017 Cengage Learning
Negligence and Liability
Negligencethe unintentional breach of duty one person owes another
Practitioner has a duty
Duty has been breached through an unprofessional act or omission
Client sustained physical or emotional harm
Practitioners behavior caused the harm
What is the professional standard of practice?
Areas of vulnerability
Practicing outside ones scope
Incompetence
Failure to use most beneficial techniques
Failure to obtain informed consent
Failure to protect from harm
2017 Cengage Learning
Clinical Supervision of Crisis Workers
Vicarious Liability–Supervisors may be liable for supervisees actions
Supervisors have the authority to direct supervisees work
Extent of vicarious liability affected by various factors
Presence of an employment relationship
Extent of authority supervisor holds
Number of supervision levels present
Which supervisor has the most direct contact with supervisee
2017 Cengage Learning
Moral Principles of Ethical Decision-Making
Autonomy
Clients right to self-determination
Beneficence
Working for the good of the client and society
Fidelity
Keeping ones promises and commitments
Justice
Fostering fairness, equality, and equitable access to care
Nonmaleficience
Avoiding actions that cause harm
2017 Cengage Learning
Using Ethical Decision-Making Models
Benefits
Allow crisis workers time to consider legal and ethical facets of a situation and make the best decision
Limits
Time is often short in a crisis situation
Cultural aspects often left out of models
Not always a right answer available
Discernment
Workers ability to perceive a course of action amid the chaos
Affect Heuristic
Decision-making primarily based on personal biases, relationships, and context
2017 Cengage Learning
Becoming a More Effective Crisis Worker
Reflective Practice– Process of thinking about:
Being a crisis responder
Ones clinical interventions
How to improve your clinical skills
Self-care
Respect for ones dignity and self-worth
Recognition that self-care is how individual workers prepare to provide care for others during crisis situations
2017 Cengage Learning
Chapter Fifteen: Legal and Ethical Issues
2017 Cengage Learning
Introduction
Crisis intervention presents intriguing ethical dilemmas and challenges for mental health workers
Ethical guidelines should be honored
Crisis situations create impossible situations to follow ethical guidelines
Ethical codes do not specifically address crisis intervention services
Workers are left to make decisions based on reflection and consultation
Nuances matter
The legal and ethical questions of a crisis situation can change quickly
2017 Cengage Learning
Ethical and Legal Interface with Crisis Intervention
Misconceptions regarding ethical decision making
Decision-making models are practical
Time to consult
One correct answer
The role of the mental health professional
Safety
Calming
Self and collective efficacy
Connectedness
Hope
2017 Cengage Learning
The Confluence of Beliefs, Emotion, Morality, and Values
Vulnerability and resiliency are dynamic
Crisis workers need to understand their reasons for doing crisis work
Understand personal values, beliefs, and background
Reflection
Supervision
Nonrational factors influence ethical decision-making
Context
Perceptions
Relationships
Emotions
Learning processes
2017 Cengage Learning
Laws and Ethical Codes Are Living Documents
Laws are mandatory
Ethical codes are aspirational
A good bedside manner is the best risk management strategy
Legal requirements and ethical codes can conflict
Often no single right answer
Consult an attorney
Choose the least harmful option
Consider the effect on the community over the individual
2017 Cengage Learning
Confidentiality and Privacy
Confidentialitythe legal duty to protect clients private communication
Privacyclients righto to choose what to say and when to say it
Privileged Communication
Legally prevents disclosure of confidential information
Laws differ by location
Limited in certain circumstances
When a reasonable practitioner has the duty to protect clients or others from serious and foreseeable harm
2017 Cengage Learning
Duty to Warn, Protect, and Report (1 of 2)
Duty to warn rules are location specific
Tarasoff v. Regents of the University of California
Duty to warn holds across counseling modality and venue
Tarasoff mandated conditions for warning
Must be a special relationship (e.g., client-therapist)
Must be a reasonable prediction of dangerous conduct
Must be a foreseeable victim
2017 Cengage Learning
Duty to Warn, Protect, and Report (2 of 2)
Guidelines for action when a clear threat of violence is made
Clearly state the limits of confidentiality
Special rules may apply for minors
Consult and document
Warn identified potential victims
Warn despite threats of reprisal
2017 Cengage Learning
Negligence and Liability
Negligencethe unintentional breach of duty one person owes another
Practitioner has a duty
Duty has been breached through an unprofessional act or omission
Client sustained physical or emotional harm
Practitioners behavior caused the harm
What is the professional standard of practice?
Areas of vulnerability
Practicing outside ones scope
Incompetence
Failure to use most beneficial techniques
Failure to obtain informed consent
Failure to protect from harm
2017 Cengage Learning
Clinical Supervision of Crisis Workers
Vicarious Liability–Supervisors may be liable for supervisees actions
Supervisors have the authority to direct supervisees work
Extent of vicarious liability affected by various factors
Presence of an employment relationship
Extent of authority supervisor holds
Number of supervision levels present
Which supervisor has the most direct contact with supervisee
2017 Cengage Learning
Moral Principles of Ethical Decision-Making
Autonomy
Clients right to self-determination
Beneficence
Working for the good of the client and society
Fidelity
Keeping ones promises and commitments
Justice
Fostering fairness, equality, and equitable access to care
Nonmaleficience
Avoiding actions that cause harm
2017 Cengage Learning
Using Ethical Decision-Making Models
Benefits
Allow crisis workers time to consider legal and ethical facets of a situation and make the best decision
Limits
Time is often short in a crisis situation
Cultural aspects often left out of models
Not always a right answer available
Discernment
Workers ability to perceive a course of action amid the chaos
Affect Heuristic
Decision-making primarily based on personal biases, relationships, and context
2017 Cengage Learning
Becoming a More Effective Crisis Worker
Reflective Practice– Process of thinking about:
Being a crisis responder
Ones clinical interventions
How to improve your clinical skills
Self-care
Respect for ones dignity and self-worth
Recognition that self-care is how individual workers prepare to provide care for others during crisis situations
2017 Cengage Learning
Chapter Fifteen: Legal and Ethical Issues
2017 Cengage Learning
Introduction
Crisis intervention presents intriguing ethical dilemmas and challenges for mental health workers
Ethical guidelines should be honored
Crisis situations create impossible situations to follow ethical guidelines
Ethical codes do not specifically address crisis intervention services
Workers are left to make decisions based on reflection and consultation
Nuances matter
The legal and ethical questions of a crisis situation can change quickly
2017 Cengage Learning
Ethical and Legal Interface with Crisis Intervention
Misconceptions regarding ethical decision making
Decision-making models are practical
Time to consult
One correct answer
The role of the mental health professional
Safety
Calming
Self and collective efficacy
Connectedness
Hope
2017 Cengage Learning
The Confluence of Beliefs, Emotion, Morality, and Values
Vulnerability and resiliency are dynamic
Crisis workers need to understand their reasons for doing crisis work
Understand personal values, beliefs, and background
Reflection
Supervision
Nonrational factors influence ethical decision-making
Context
Perceptions
Relationships
Emotions
Learning processes
2017 Cengage Learning
Laws and Ethical Codes Are Living Documents
Laws are mandatory
Ethical codes are aspirational
A good bedside manner is the best risk management strategy
Legal requirements and ethical codes can conflict
Often no single right answer
Consult an attorney
Choose the least harmful option
Consider the effect on the community over the individual
2017 Cengage Learning
Confidentiality and Privacy
Confidentialitythe legal duty to protect clients private communication
Privacyclients righto to choose what to say and when to say it
Privileged Communication
Legally prevents disclosure of confidential information
Laws differ by location
Limited in certain circumstances
When a reasonable practitioner has the duty to protect clients or others from serious and foreseeable harm
2017 Cengage Learning
Duty to Warn, Protect, and Report (1 of 2)
Duty to warn rules are location specific
Tarasoff v. Regents of the University of California
Duty to warn holds across counseling modality and venue
Tarasoff mandated conditions for warning
Must be a special relationship (e.g., client-therapist)
Must be a reasonable prediction of dangerous conduct
Must be a foreseeable victim
2017 Cengage Learning
Duty to Warn, Protect, and Report (2 of 2)
Guidelines for action when a clear threat of violence is made
Clearly state the limits of confidentiality
Special rules may apply for minors
Consult and document
Warn identified potential victims
Warn despite threats of reprisal
2017 Cengage Learning
Negligence and Liability
Negligencethe unintentional breach of duty one person owes another
Practitioner has a duty
Duty has been breached through an unprofessional act or omission
Client sustained physical or emotional harm
Practitioners behavior caused the harm
What is the professional standard of practice?
Areas of vulnerability
Practicing outside ones scope
Incompetence
Failure to use most beneficial techniques
Failure to obtain informed consent
Failure to protect from harm
2017 Cengage Learning
Clinical Supervision of Crisis Workers
Vicarious Liability–Supervisors may be liable for supervisees actions
Supervisors have the authority to direct supervisees work
Extent of vicarious liability affected by various factors
Presence of an employment relationship
Extent of authority supervisor holds
Number of supervision levels present
Which supervisor has the most direct contact with supervisee
2017 Cengage Learning
Moral Principles of Ethical Decision-Making
Autonomy
Clients right to self-determination
Beneficence
Working for the good of the client and society
Fidelity
Keeping ones promises and commitments
Justice
Fostering fairness, equality, and equitable access to care
Nonmaleficience
Avoiding actions that cause harm
2017 Cengage Learning
Using Ethical Decision-Making Models
Benefits
Allow crisis workers time to consider legal and ethical facets of a situation and make the best decision
Limits
Time is often short in a crisis situation
Cultural aspects often left out of models
Not always a right answer available
Discernment
Workers ability to perceive a course of action amid the chaos
Affect Heuristic
Decision-making primarily based on personal biases, relationships, and context
2017 Cengage Learning
Becoming a More Effective Crisis Worker
Reflective Practice– Process of thinking about:
Being a crisis responder
Ones clinical interventions
How to improve your clinical skills
Self-care
Respect for ones dignity and self-worth
Recognition that self-care is how individual workers prepare to provide care for others during crisis situations
2017 Cengage Learning
Chapter Fifteen: Legal and Ethical Issues
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Introduction
Crisis intervention presents intriguing ethical dilemmas and challenges for mental health workers
Ethical guidelines should be honored
Crisis situations create impossible situations to follow ethical guidelines
Ethical codes do not specifically address crisis intervention services
Workers are left to make decisions based on reflection and consultation
Nuances matter
The legal and ethical questions of a crisis situation can change quickly
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Ethical and Legal Interface with Crisis Intervention
Misconceptions regarding ethical decision making
Decision-making models are practical
Time to consult
One correct answer
The role of the mental health professional
Safety
Calming
Self and collective efficacy
Connectedness
Hope
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The Confluence of Beliefs, Emotion, Morality, and Values
Vulnerability and resiliency are dynamic
Crisis workers need to understand their reasons for doing crisis work
Understand personal values, beliefs, and background
Reflection
Supervision
Nonrational factors influence ethical decision-making
Context
Perceptions
Relationships
Emotions
Learning processes
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Laws and Ethical Codes Are Living Documents
Laws are mandatory
Ethical codes are aspirational
A good bedside manner is the best risk management strategy
Legal requirements and ethical codes can conflict
Often no single right answer
Consult an attorney
Choose the least harmful option
Consider the effect on the community over the individual
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Confidentiality and Privacy
Confidentialitythe legal duty to protect clients private communication
Privacyclients righto to choose what to say and when to say it
Privileged Communication
Legally prevents disclosure of confidential information
Laws differ by location
Limited in certain circumstances
When a reasonable practitioner has the duty to protect clients or others from serious and foreseeable harm
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Duty to Warn, Protect, and Report (1 of 2)
Duty to warn rules are location specific
Tarasoff v. Regents of the University of California
Duty to warn holds across counseling modality and venue
Tarasoff mandated conditions for warning
Must be a special relationship (e.g., client-therapist)
Must be a reasonable prediction of dangerous conduct
Must be a foreseeable victim
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Duty to Warn, Protect, and Report (2 of 2)
Guidelines for action when a clear threat of violence is made
Clearly state the limits of confidentiality
Special rules may apply for minors
Consult and document
Warn identified potential victims
Warn despite threats of reprisal
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Negligence and Liability
Negligencethe unintentional breach of duty one person owes another
Practitioner has a duty
Duty has been breached through an unprofessional act or omission
Client sustained physical or emotional harm
Practitioners behavior caused the harm
What is the professional standard of practice?
Areas of vulnerability
Practicing outside ones scope
Incompetence
Failure to use most beneficial techniques
Failure to obtain informed consent
Failure to protect from harm
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Clinical Supervision of Crisis Workers
Vicarious Liability–Supervisors may be liable for supervisees actions
Supervisors have the authority to direct supervisees work
Extent of vicarious liability affected by various factors
Presence of an employment relationship
Extent of authority supervisor holds
Number of supervision levels present
Which supervisor has the most direct contact with supervisee
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Moral Principles of Ethical Decision-Making
Autonomy
Clients right to self-determination
Beneficence
Working for the good of the client and society
Fidelity
Keeping ones promises and commitments
Justice
Fostering fairness, equality, and equitable access to care
Nonmaleficience
Avoiding actions that cause harm
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Using Ethical Decision-Making Models
Benefits
Allow crisis workers time to consider legal and ethical facets of a situation and make the best decision
Limits
Time is often short in a crisis situation
Cultural aspects often left out of models
Not always a right answer available
Discernment
Workers ability to perceive a course of action amid the chaos
Affect Heuristic
Decision-making primarily based on personal biases, relationships, and context
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Becoming a More Effective Crisis Worker
Reflective Practice– Process of thinking about:
Being a crisis responder
Ones clinical interventions
How to improve your clinical skills
Self-care
Respect for ones dignity and self-worth
Recognition that self-care is how individual workers prepare to provide care for others during crisis situations
2017 Cengage Learning

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Strengths and challenges of Beck’s Depression Scale cheap mba definition essay help: cheap mba definition essay helpWhat are some strengths and challenges of Beck’s Depression Scale for assessing emotional status? Do you feel that this scale is a good method to assess emotional status? Why or why not? Provide specific examples to support your position.
 

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What is the MMPI-2-RF? research essay helpCreate a PowerPoint presentation of 16 slides for the Minnesota Multiphasic Personality Inventory (MMPI-2-RF).
Address and include the following in your PowerPoint:
A title, introduction, and conclusion slide.What is the MMPI-2-RF and what does it measure?What are the legal and ethical requirements for a professional to administer, interpret, and/or report the results of an MMPI-2-RF?How would information gathered from the MMPI-2-RF assist in the intake and treatment planning process?Describe potential treatment strategies that would likely be incorporated into a treatment plan based on results from an MMPI-2-RF.Include speaker notes below each content-related slide that represent what would be said if giving the presentation in person. Expand upon the information included in the slide and do not simply restate it. Please ensure the speaker notes include a minimum of 50 words.A reference slide with a minimum of four scholarly references in addition to the textbook.

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Explain theories of etiology my assignment essay help: my assignment essay helpOption B
Complete the following:
Evaluate one of the sleep disorders covered this week.Explain theories of etiology (causation), including the neuroanatomical structures, neurotransmitter/receptor systems, and the functional nervous system (neural) pathways involved.Include an analysis of the contribution of genetics, environment, and lifestyle to the development and natural history of the condition.Provide information regarding diagnostic criteria and evaluate options for care interventions (both pharmacological and nonpharmacological).Be sure to identify the neuroanatomical structures and any neurotransmitter/receptor systems involved.Also in your discussion, imagine you are in a career position that utilizes a degree in psychology, including but not limited to that of a social worker, teacher or teachers aide, child care worker, psychiatric technician or other behavioral health staff, peer support specialist, social service specialist, probation or parole officer, case manager, or counselor.How would your knowledge of the neurobiology of sleep disorders or disorders of consciousness help you in your professional life?Would you be able to better assist your clients, students, or patients with this knowledge?You must use a minimum of one peer-reviewed and/or scholarly source that was published within the last five years, documented in APA style, as outlined in the Ashford Writing Center. Your post should be a minimum of 250 words. You may cite and reference your textbook, required or recommended reading, or multimedia, but these will not fulfill the source requirement.
Make sure to use terminology from the DSM-5 for psychological/behavioral health conditions and current terminology from professional sources for neurological conditions. Please be sure to access the DSM-5 directly in our library. For further information view The DSM-5: Accessing and Using the DSM-5 in the University of Arizona Global Campus Library (Links to an external site.) screencast on how to access and use this resource, and how to cite and reference the DSM-5.
 

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Examples of Qualitative Designs write my essay help: write my essay helpExamples of Qualitative Designs to choose ONE from. Follow all instructions carefully
-Grounded Theory Approaches
-Interpretative Phenomenological Analysis
-Discourse Analysis Approaches
-Narrative Analysis Approaches
Take on the role of a clinical psychologist treating clients for depression. You are interested in doing research on effective treatments for a chronic form of depression called dysthymia. In the DSM-5, it is referred to as persistent depressive disorder. Details regarding the disorder can be found in section 300.4(F34.1) of the DSM-5. In your review of the current materials attached, you find that most of the previous research on this disorder has been done using quantitative methods. Identify an aspect of this topic you feel should be studied using qualitative methods. Apply the scientific method to this research issue and develop a specific research question. Compare the characteristics and appropriate uses of various qualitative research designs and choose an appropriate qualitative design for this research question. Create a feasible research design that includes plans for the sample selection, data collection, and data analysis. Apply ethical principles to your design by explaining how this type of qualitative design may affect the participants in your study and how you will deal with sociocultural issues.
REFERENCES TO BE USED
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Frost, N. (2011). Qualitative research methods in psychology. New York, NY: McGraw-Hill. (This is the textbook references for the four attachments attached. Chapter 2: Grounded Theory Approaches,Chapter 3: Interpretative Phenomenological Analysis, Chapter 4: Discourse Analysis Approaches, Chapter 5: Narrative Analysis Approaches) please use one of these Qualitative design.

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Discuss an evidence-based practice computer science essay helpChoose one of the diagnoses listed below. Discuss an evidence-based practice (EBP) for the diagnosis. Discuss any disparities in treatment (racial, gender, socioeconomic status, sexual orientation, geographical location, social conditions, etc.). Use a scholarly source to cite your description of the EBP and the disparity.
AnxietyBipolar disordersOppositional defiance disorderDepressionSchizoaffective disorde

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Discuss the concept of resilience. compare and contrast essay help: compare and contrast essay helpPrepare a 10- to 12-slide Microsoft PowerPoint presentation that illustrates how people create growth and find meaning out of trauma and suffering.
Create a mock case study of a client who is a survivor of a traumatic event, who has overcome the experience, and who is now demonstrating resilience and overall well-being.
Include and discuss the following concepts:
Introduce the concept of resilience.Describe the event the client experienced.Discuss how the client interpreted and overcame the event by use of meaning-making, sense-making and benefit-findingDiscuss the post-traumatic growth the client experienced.Explain the role of resilience in protecting well-being.

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Tracking Discussion medical school essay helpI need help addressing the following Did you experience more positive or negative emotions during the tracking period? What did you notice about the range of emotions you experienced during the 4 days? What type of experiences generated the strongest emotional responses? Explain the psychological benefits of positive emotions as discussed in this week’s readings. What are some strategies to help cultivate positive emotions in your life?
Include the chart created

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