Download JSS COLLEGE OF NURSING 1st MAIN, SARASWATHIPURAM

JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM, MYSORE -570 009
SYNOPSIS SUBMISSION
BY:
Mr. PARAMESHA
1st YEAR M. Sc NURSING
PSYCHIATRIC NURSING DEPARTMENT
JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM
MYSORE- 570 009
GUIDE:
Ms. BUVANESWARI. R
ASST. PROFESSOR
PSYCHIATRIC NURSING DEPARTMENT
JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM
MYSORE- 570 009
BATCH: 2011-2013
1
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE CANDIDATE
Mr. PARAMESHA
AND ADDRESS
1st YEAR M.Sc NURSING
(IN BLOCK LETTERS)
JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM
MYSORE-570 009
2
NAME OF THE INSTITUTE
JSS COLLEGE OF NURSING
MYSORE
3
4
COURSE OF THE STUDY
1st YEAR M.Sc NURSING
AND SUBJECT
PSYCHIATRIC NURSING
DATE OF ADMISSION OF THE
30.07.2011
COURSE
5
TITLE OF THE TOPIC
A CORRELATIONAL STUDY ON LIFE EVENTS
AND
DEPRESSIVE
SYMPTOMS
AMONG
ADOLESCENTS STUDYING AT SELECTED
SCHOOLS IN MYSORE.
2
6. BRIEF RESUME OF THE INTENDED WORK
Childhood is measured out by sounds and smells and sights, before the dark hour of
reason grows.... - John Betjeman, Summoned by Bells.
6.0 INTRODUCTION:
Adolescence is characterized by positive gains in cognitive maturity, better interpersonal
skills, new experiences, increased autonomy, and hormonal changes. Although these normative
transitions can provide opportunities for further growth in cognitive, physical, psychological, and
social domains, exposure to adverse experiences (e.g., peer pressure, difficulties in school
performance, loss of a romantic relationship) can place the adolescent at increased risk for the onset of
a wide range of emotional and behavioural problems, including the development of depressive
symptoms1.
The period of adolescence is the one of rapid growth, change, relocation and self-discovery,
which is defining qualities of stressful experience. Most prevailing models of development
psychopathology recognize the potential importance of psychosocial stress in the etiology and
maintenance of both internalizing and externalizing disorders in youth. Both long standing and recent
social adversities precede and increase the risk for emotional and behavioural psychopathology during
the school -age years2.
Adolescents also tend to take everything to their heart and they can't tolerate insult or being
pointed at or even failure. They even end up losing their life for issues like failure in examinations,
insult in school by teachers or classmates. They feel the pressure to conform to the standards set by
their peers and if they feel left out or inadequate or deprived in any way, it could lead to depression
and other complications in behaviour. Teen Depression is hard to spot in teenagers because the
occasional tantrums, irritability, anti-social behaviour are all part of getting through the teenage years3.
Depression is a disorder of major public health importance, in terms of its prevalence and the
suffering, dysfunction, morbidity, and economic burden. It is estimated that by the year 2020, if
current trends for demographic and epidemiological transition continue, the burden of depression will
increase to 5.7% of the total burden of disease and it would be the second leading cause of disabilityadjusted life years (DALYs). In view of the morbidity, depression as a disorder has always been a
focus of attention of researchers in the world4.
Studies have also reported that parental loss before the age of 18 years; parental disharmony and
eldest birth order tend to be more common in subjects with depression. With respect to life events in
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children and adolescents, depressed adolescent girls report life events in the form of death of a family
member, change in residence, failure in examination, end of a relationship and serious illness. Other
risk factors identified to be associated with depression in children include stress at school and family as
well as family history of mental illness. However, one of the older studies failed to find a link between
childhood bereavement and depression5.
Depression doesn't have any age bar, but teens are the most affected group, as they do not know
how to tackle their fear of being in the state of depression. Teens face lots of pressure and they even
tend to take extreme decisions even if it’s a silly situation6.
Depression has a significant impact on adolescent development and well being. Adolescent
depression can adversely affect school and work performance, impair peer and family relationships, and
exacerbate the severity of other health conditions such as asthma and obesity. Depressive episodes often
persist, recur, or continue into adulthood. Youth who have had a Major Depressive Episode (MDE) in
the past year are at greater risk for suicide and are more likely than other youth to initiate alcohol and
other drug use, experience concurrent substance use disorders, and smoke daily7.
Negative patterns of thinking and maladaptive information processing, termed cognitive
vulnerabilities, have been shown to contribute to the development of depressive symptoms in
adolescents who activate these vulnerabilities in response to negative life events. Life events are best
conceptualized along a continuum with some negative events being more important than others (e.g.,
parental divorce, poor academic performance). Researchers from diverse theoretical orientations have
proposed that certain personal factors (i.e., age, gender, and ethnicity) serve as vulnerability factors to
the development of depressive symptoms1.
6.1 NEED FOR THE STUDY:
I am so mixed up and lonely. Can’t even make friends with my brain, I’m too young to be where
I’m going. But I’m too old to go back again.... John Prine.
Adolescence can be a stressful time for children, parents and adults. Children are dealing with
the challenges of going through puberty, meeting changing expectations and coping with new feelings.
Many also worry about moving from an elementary to a middle or junior high school and some kids
may have to deal with things that their peers don't have to face such as the death of a family member or
moving to a new town. Most children meet these challenges successfully and grow into healthy adults
while others have a harder time coping with their problems2.
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During adolescence, the onset of psychological disorders may be fast (days or weeks) or slow
(months or years) depending in part on the nature of social adversities. What the exact negative
psychological effects are and why the time of onset varies following exposure to negative
circumstances, remain almost entirely unknown. An important assumption is that events and difficulties
carry a latent and undesirable psychological construct (such as personal threat or negative impact to the
self) that can be inferred from a detailed recall of the social characteristics of the experience. Early
childhood adversities and recent negative life events have been shown to be robust predictors of major
depression in adolescents and adults2.
Major Depressive Disorder (MDD) is one of the top three causes of global health burden along
with ischemic heart disease and cerebro-vascular diseases. Studies have shown that depressive disorders,
previously thought to be a disorder of adulthood, often develop during childhood and adolescence8, 9.
According to the National Institute of Child Health and Human Development, approximately one in six
youths in the US report depressive symptoms and the prevalence of depressive symptoms increases with
age across adolescence10. Studies have shown that, when compared with asymptomatic adolescents,
adolescents reporting more depressive symptoms had an elevated risk for later major depressive
disorders, psychosocial dysfunction, and suicidal ideation and attempts11.
Depressed patients have significantly greater number of life events prior (6-12 months) to the
onset of their illness. In terms of type of life events, it is seen that depressed patients experience
significantly higher proportion of life events related to death of a family member, personal health
related events, bereavement, interpersonal and social events .Studies have also reported that parental
loss before the age of 18 years; parental disharmony and eldest birth order tend to be more common in
subjects with depression. With respect to life events in children and adolescents, depressed adolescent
girls report life events in the form of death of a family member, change in residence, failure in
examination, end of a relationship and serious illness. Other risk factors identified to be associated with
depression in children include stress at school and family as well as family history of mental illness.
However, one of the older studies failed to find a link between childhood bereavement and depression5.
Longitudinal study’s (21 years) findings further supported that young adults who had recurrent
depressive symptoms during mid-adolescence aged between 14 to 16 years were at increased risk for
major depressive episodes later in adolescence and adulthood, anxiety disorders, nicotine or alcohol
dependence, educational underachievement, unemployment, early parenthood, and suicide attempts. In
response to this significant public health concern, the United States Preventative Services Task Force
(2009) currently recommends screening all adolescents (12-18 years of age) for depressive symptoms
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when adequate systems are in place for appropriate follow-up. It is clear that depressive symptoms during
adolescence represent a large burden to the individual, the healthcare system and society6.
Nurses work in a wide range of settings that provide care for the adolescent population. In the
area of adolescent depression, nurses are uniquely positioned to implement primary prevention strategies
that encourage positive cognitions and resiliency in schools, communities, and clinical settings. As
opposed to other disciplines serving the adolescent population, the discipline of nursing has a holistic
approach that encompasses health promotion and disease prevention. Nurses working with adolescents
are in a position to identify adolescents who are at risk for the development of depressive symptoms by
understanding the mechanisms through which depressive symptoms develop. Hence, the investigator
interested to find the relationship between the life events and depressive symptoms among adolescents.
6.2 REVIEW OF THE LITERATURE:
Literature is categorized under the following headings:

Prevalence of Depression among adolescents.

Life events and depression among adolescents.
 Prevalence of Depression among adolescents.
A study was conducted to assess the prevalence of depression among a 4,020 High School and
Pre-university adolescents at Rasht, Northern Iran. Beck’s self-administered standard questionnaire and a
predetermined form containing some demographic variables were applied to measure variables. Among
4,020 subjects, 299 subjects (due to incomplete responses) and 40 subjects (evening-school students)
were excluded from the study. Results revealed that 1250 (34%: CI 95%, 32.4 – 35.4%) out of 3,681
subjects suffered from depression. There were significant differences between the prevalence of
depression and type of school (P < 0.001), educational field (P < 0.0005), socioeconomic class (P =
0.0002), and gender (P < 0.001). There was no significant difference between the prevalence of
depression and city district, school grade, and age of participants12.
A descriptive study on psychosocial correlates of depressive symptoms among Norwegian
adolescents representative was done. The samples of 2,465 aged between 12 to 14 years adolescents
were selected. The results revealed that depressive symptoms were measured by the Mood and Feelings
Questionnaire (MFQ). The results Depressive symptoms were more strongly correlated with schoolrelated stress among boys than girls, whereas the correlation between daily hassles and depressive
symptoms was higher for girls than boys. The results of univariate analyses showed significantly higher
mean total MFQ scores among adolescents not living with both natural parents, those who had moved
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more than twice and those with more than 3 siblings or having fewer than 2 close friends. Further,
adolescents from Third World societies and adopted adolescents, those from lower socio economic
society groups, having unemployed parents or living in coastal areas had higher mean depressive
symptom scores. The results of multiple regression analyses yielded the following six significant
predictors of total MFQ scores in order of importance: Sum of daily hassles and sum of stressful life
events, gender, and number of friends, ethnicity and mother's employment status. 13.
A cross-sectional study on prevalence & associated factors of depression among adolescents,
aged 13 to 19 years, attending secondary schools conducted in Trinidad. 1290 students participated, a
response rate of 79.6%; 43% were aged 13–15 years; 53.6 % were Indo-Trinidadians; 82.5% were
attending co-educational schools and 70.6% lived with both parents. The prevalence of depression was
25.3% ± 2.37%. Chi-square analysis revealed statistically significant associations between depression
and the categories of age, gender, living arrangements and school type. Respondents reporting that they
were afraid of parents or of being injured by parents were three times as likely to be depressed as
respondents who had not had those experiences. One out of every four secondary school students in
Trinidad was found to have significant depression. There were strong associations between depression
and age, gender, school type and family structure. This study identifies that many adolescents
experience violence in the home and those who did were more likely to be depressed14.
 Life events and depression among adolescents
A study was done to adapt and test the validity of a scale, explore the casual relationships
between stressful events and behavioural problems in an Indian adolescents and to compare the degree of
overlap in stress-causing events between Indian adolescents and their parents. An adolescent life event
stress scale (ALESS) containing 41 items was administered to 156 adolescents for formulation and 102
adolescents for validation. A third set of 112 adolescents was used to compare ALESS scores with child
behaviour checklist (CBCL) scores and parental stress scores due to life events. The comparison showed
a strong positive correlation with CBCL scores with a model fit (r
2
= 0.32) and a weak positive
correlation with parental stress (Pearson's coefficient=0.011) due to life events2.
A cross-sectional, descriptive Correlational design was used to investigate cognitive
vulnerabilities, negative life events, and depressive symptoms in a sample of young adolescents. The
study was conducted within two middle schools in a single county in rural Tennessee. A total of 1,565
students attend the two middle schools in this county were involved in the study. Results of the study
reveals that depressive symptoms were highly correlate with negative life events. To gain a deeper
understanding of the relationship between the development of depressive symptoms and negative life
events, each domain (i.e., family, romantic relationships, school, and friends) was examined individually.
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Each of the domains was significantly associated with depressive symptoms, but the strongest association
was found for the total number of negative life events reported by the participants 1.
A Correlational study was done on life events and depressive symptoms in black and white
adolescent girls. The study samples consisted of 1300 black and white female adolescents, in which five
domains of life events were assessed at age 16 years and depressive symptoms were measured at age 18
and again at age 21 years. The results suggest that life events and some specific type of stressors
increase the likelihood of the onset of depression symptoms in future years, for both black and white
girls. 15.
A longitudinal study on self-perceived competence and the relation between life events and
depressive symptoms in adolescence conducted on 9th grade students. The samples (N
= 468)
completed self-report measures of stressful life events, depressive symptoms and 5 domains of selfperceived competence (i.e., academic competence, social acceptance, physical appearance, behavioural
conduct, and athletic competence). Results suggested that self-perceived competence served as a
mediator (but not a moderator) of this relation. Negative events predicted changes in self-perceived
competence. Self-perceived competence predicted changes in depressive symptoms. Also, the direct
effect of negative events on depressive symptoms diminished after controlling for self-perceived
competence 16.
A study was conducted to find association between adverse life events and depressive
symptoms in African American youth, also it examined the past year violent and nonviolent life events.
The study was done to assess 6th grade life events as predictors of 7th grade depressive symptoms among
a community epidemiologically defined sample of 447 (47% girls) urban African American adolescents.
Depressive symptoms were assessed twice, at a one year interval, and initial depressive symptoms were
controlled in the analyses. Results from the study suggest that urban, African American youth may
benefit from learning ways to identify which areas of their lives they in fact do have control over, as well
as learning various coping strategies to manage situations in which they have little control (e.g.,
neighbourhood violence)17.
A prospective study on Life events and psychological distress among 233 young adolescents
between 7th and 8th graders, they were administered measures of negative and positive life experiences
and psychological distress on 2 occasions approximately. The Junior High Life Experiences Survey, the
State-Trait Anxiety Inventory, and a child development inventory at Time 1. 79 of the 233 Study
samples were completed the 3 measures at Time 2. Cross-sectional regression analyses revealed a
8
significant positive relationship between negative events and distress but generally failed to support th
stress-buffering effects of positive events18.
A study on negative life events, perceived social support and emotional problems among
1053 adolescents in eighth grade was shown that thirty-one percent of the adolescents reported that they
had experienced at least one negative life event during the last year. Serious illness or injury among
close relatives or friends was reported as the most prevalent negative life event. Negative life events
were significantly associated with emotional problems among both female and male adolescents.
Moreover, support from parents, friends and teachers was directly, negatively associated with emotional
problems in both sexes. Finally, results indicate that support from parents moderate the relationship
between negative life events and emotional problems among adolescent girls19.
A longitudinal study of stressful life events and daily stressors among adolescents at high risk
for psychotic disorders was shown that psychosocial stress preceding the onset or recurrence of
psychotic symptoms has been identified in patients with schizophrenia; yet there is limited
understanding of the effects of stress in typically developing adolescents or those who show behavioral
signs of risk for schizophrenia spectrum disorders. This study examined the developmental course of
symptom progression as a function of stressful life events and daily hassles in adolescents with
Schizotypal Personality disorder (SPD), other personality disorders. In this prospective longitudinal
study, life events and daily stressors were assessed in adolescents aged 12 to 18 years. Results revealed
that adolescents with Schizotypal Personality disorder (SPD) and other personality disorders reported
significantly greater total, independent, and undesirable life events than individuals with no Axis II
disorders. Youth with Schizotypal Personality disorder (SPD) report daily hassles to cause more distress
compared to peers. Across diagnostic groups, the incidence of independent and undesirable life events
were associated with current prodromal symptoms, while the frequency of daily stressors predicted a
significant increment in positive, but not negative, prodromal symptoms over time. Therefore,
adolescents who report greater daily stressors exhibit an increase in prodromal symptoms over a 1 year
period. Psychosocial stress has been implicated in the etiology of schizophrenia, and these findings
suggest the importance of life events and daily hassles as potential risk factors in the onset of psychotic
symptoms during adolescence20.
6.3 STATEMENT OF THE PROBLEM:
A Correlational study on life events and depressive symptoms among adolescents studying at
selected schools in Mysore.
6.4 OBJECTIVES
9
The objectives of the study are:
1. To assess the life events experienced by the adolescents studying in selected schools.
2. To assess the depressive symptoms among the adolescents.
3. To determine the relationships between life events and depressive symptoms among adolescents.
4. To find the association of life events and depressive symptoms among adolescents with their
selected personal variables.
6.4.1 CONCEPTUAL / THEORETICAL FRAMEWORK:
Conceptual framework is based on Sr. Callista Roy’s Adaptation Model.
6.4.2 OPERATIONAL DEFINITIONS:
 Life Events:
In this study it refers to events or changes that are happened/happening in the adolescents’
life and is perceived either positive or negative by the adolescents and it includes events related to
family & parents, school & classes, friends & social activities, which is assessed by Modified
Adolescents Life Events Questionnaire.
 Depressive symptoms:
It refers to the symptoms of sadness, self worthlessness, irritability, loss of concentration and
insomnia, which may be experienced by the adolescents and it is assessed by Modified Center for
Epidemiologic Studies Depression Scale for children and expressed in terms of depressive
symptoms.
 Adolescents:
It refers to both boys and girls in the age group of 13-16 years and those who are studying in
selected schools.
 Selected Personal Variables:
In this study it includes age, gender, religion, family income, type of family, parental
occupation, birth order, number of siblings and class of study.
6.5 HYPOTHESES:
The following hypotheses are formulated for the study, and will be testes at 0.05 level of
significance.
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H1 :
There will be a significant relationship between life events and depressive symptoms
among adolescents.
H2 :
There will be significant association between life events and depressive symptoms
among adolescents with their selected personal variables.
6.6 ASSUMPTIONS:
Assumptions of the study are.
1. Adolescents may experience many life events and these life events may have impact on their
mental health.
6.7 DELIMITATIONS:
The study is delimited to adolescents studying at selected schools in Mysore.
7.0 MATERIAL AND METHODS:

RESEARCH DESIGNS AND APPROACH:
Survey design.

VARIABLES OF THE STUDY
a) Study Variables: Life events and depressive symptoms.
b) Selected personal variables: Age, gender, religion, family income, type of family, parental
occupation, birth order, number of siblings and class of study.
7.1 SOURCE OF DATA

SETTING: Selected schools in Mysore.

POPULATION: Adolescents studying at schools in Mysore.
7.2 METHOD OF COLLECTION OF DATA
(Including sampling procedure, if any):
SAMPLE: Adolescents aged between 13-16 years of selected schools.
SAMPLING CRITERIA
11
The study samples will be selected keeping in view of the following predetermined
criteria.
Inclusion criteria:
1. Both boys and girls in the age group of 13-16 years, who are studying at selected schools
in Mysore.
2. Adolescents who are willing to participate in the study.
Exclusion criteria:
1. Adolescents who are absent during the period of data collection.
2. Adolescents who are already receiving treatment for any type of mental illness.
SAMPLING TECHNIQUE: Convenience sampling technique will be used.
SAMPLE SIZE: 120 Adolescents.
DATA COLLECTION TECHNIQUES:
1.
Modified Adolescent Life Events Questionnaire to assess the life events among adolescents.
2.
Modified Center for Epidemiologic studies Depression Scale for children to assess the
depressive symptoms among adolescents.
METHOD OF DATA COLLECTION:
1. Approval from school authority
2. Obtain informed consent from both parents and adolescents.
3. Select sample and collect data as per criteria.
4. Administer modified Life Events Questionnaire and Modified Center for Epidemiologic
studies Depression Scale for children to assess the life events and depressive symptoms
among adolescents.
DATA ANALYSIS PLAN:
 Descriptive Statistics.
 Frequency & percentage will be used for describing the personal variables.
 Mean, median, range and standard deviation to compute scores of negative life events and
depressive symptoms among adolescents.
 Inferential statistics
12
 Correlation coefficient will be used to determine the relationship between life events and
depressive symptoms among adolescents.

Chi square test will be used to determine the association between life events and depressive
symptoms with selected personal variables.
7.3 Does the study require any investigation or intervention to be conducted on
patients or human animals? If so please describe briefly.
No
7.4 Has ethical clearance been obtained from your institution in case of 7. 3
Yes
13
8 BIBLIOGRAPHY:
1.
Cara Suzanne Calloway. Cognitive Vulnerabilities, Negative life events, and Depressive
Symptoms in young adolescents. [Homepage on the internet]. May, 2010 [cited 2011 Dec
11].
available
from:
graduate
school
of
Vanderbilt
university,
web
site:
http://etd.library.vanderbilt.edu/available/etd-03312010-151456/unrestricted/dissertation.pdf.
2.
Shilpa Aggarwal. Stressful life events among adolescents: The development of a new
measure, Indian Journal of Psychiatry [serial on the Internet]. 2007 ; 49(2) Available from:,
Department of Psychiatry, Base Hospital, Delhi Cantt, New Delhi - 110 010, India Web site:
http://www.indianjpsychiatry.org/article.asp?issn=0019
5545;year=2007;volume=49;issue=2;spage=96;epage=102;aulast=Aggarwal.
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Sandeep Grover, Alakananda Dutt, Ajit Avasthi. An overview of Indian research in
depression Department of Psychiatry, India, Year 2010: 52(7): 178-88.
4.
Grover S, Dutt A, Avasthi A. An overview of Indian research in depression. Indian Journal of
Psychiatry 2010: 52:178-88.
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Costello, E. J., Mustillo. S, Erkanli, A., Keeler, G., & Angold, A. Prevalence and
development of psychiatric disorders in childhood and adolescence. Archives of General
Psychiatry 2003:60, 837-44.
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National Indicators of Well-Being, 2011
Available from:
http://www.childstats.gov/americaschildren/health4.asp.
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Lewinsohn, P., Joiner, T., & Rohde. P; Evaluation of cognitive diathesis-stress models in
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Cuijpers, P, Graaf, R, & van Dorsselaer. S. (2004). Minor depression: Risk profiles,
functional disability, health care use and risk of developing major depression. Journal of
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Lewinsohn, P, Rohde, P, & Seely. J. (1994). Psychosocial risk factors for future adolescent
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Fergusson, D., Horwood, J , Ridder. E., & Beautrais. A. Sub threshold depression in
adolescence and mental health outcomes in adulthood. Archives of General Psychiatry 2005
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Mohammad-Jafar Modabber-Nia MD•*, Hossein Shodjai-Tehrani PhD*, Seyed-Roknoddin
Moosavi MD*, Nakisa Jahanbakhsh-Asli MD*, Mahnaz Fallahi MSc*; the Prevalence of
Depression among High School and Pre-university Adolescents: Rasht, Northern Iran; Arch
Iranian Med 2007: 10 (2): 141 – 46.
13.
Anne Mari Sund et.al; Psychosocial correlates of depressive symptoms among 12–14-year-old
Norwegian adolescents; Journal of Child Psychology and Psychiatry May 2003: 44(4):588–97.
14.
Maharaj RG, Alli F, Cumberbatch F. Depression among adolescents, aged 13–19 years,
attending secondary schools in Trinidad prevalence and associated factors. West Indian
Medical Journal [homepage on the Internet]. Sep 2008 [cited 2011 Dec 11].;57(4) Available
from: Unit of Public Health and Primary Care, Faculty of Medical Sciences Web site:
http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S004331442008000400008&lng=en&nrm=.pf.
15.
Franko DI. Expanding our understanding of the relationship between negative life events and
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Applied Educational Psychology Web site: http://www.ncbi.nlm.nih.gov/pubmed/15697058#.
16.
Taram JM, Cole DA. Self-perceived competence and the relation between life events and
depressive symptoms in adolescence: mediator or moderator? Abnormal Psychol [homepage
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Yadira M, Sanchez, Sharon F. Adverse Life Events and Depressive Symptoms in African
American Youth: The Role of Control-Related Beliefs. Depression Research and Treatment
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[serial on the Internet]. 2011 Available from: George Washington University, Department of
Psychology Web site: http://www.hindawi.com/journals/drt/2011/871843/ref/.
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Swearingen, Elizabeth M.; Cohen, Lawrence H; Life events and psychological distress: A
prospective study of young adolescents. Developmental Psychology: Nov 1985: 21(6):104554.
19.
Terje Murberg A. Social Support, Negative Life Events and Emotional Problems Among
Norwegian Adolescents. School Psychology InternationalNov,2004;25(4) Available from:
Stavanger University College, Faculty Health and Social work education Web site:
http://spi.sagepub.com/content/25/4/387.abstract.
20.
Kevin D. Tessner, Vijay Mittal. Longitudinal Study of Stressful Life Events and Daily
Stressors among Adolescents at High Risk for Psychotic Disorders. Schizophrenia Bulletin
[serial on the Internet]. 2011;37(2) Available from: Stavanger University College, Faculty
Health and Social work education Web site
http://schizophreniabulletin.oxfordjournals.org/content/37/2/432.abstract.
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9.0
SIGNATURE OF THE CANDIATE:
10.0 REMARKS OF THE GUIDE:
RECOMMENDED AND FORWARDED
11. 1 NAME AND DESIGNATION OF GUIDE (in block letters)
Ms. BUVANESWARI.R
ASST. PROFESSOR
PSYCHIATRIC NURSING DEPARTMENT
JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM
MYSORE- 570009
11.2 SIGNATURE:
11.3 HEAD OF THE PSYCHIATRIC NURSING DEPARTMENT
Ms. BUVANESWARI.R
ASST. PROFESSOR
PSYCHIATRIC NURSING DEPARTMENT
JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM
MYSORE- 570009
11.4
SIGNATURE:
12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL:
RECOMMENDED AND FORWARDED
PROF.SHEELA WILLIAMS
PROFESSOR AND PRINCIPAL
JSS COLLEGE OF NURSING
1st MAIN, SARASWATHIPURAM
MYSORE- 570009
12.2 SIGNATURE:
17