Individual Factors and Patient Appraisal of Betrayal in the Medical System

Date
2019-08
Authors
Tamaian, Andreea
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Publisher
Faculty of Graduate Studies and Research, University of Regina
Abstract

When an institution (e.g., medical system) fails to prevent or respond supportively to a traumatic event (i.e., betrays one’s trust), the institution itself exacerbates the individual’s psychological distress (Smith & Freyd, 2013). In the case of childbirth, dissatisfaction with medical interactions during labour and delivery is linked to postnatal posttraumatic (Grekin & O’Hara, 2014). The current study employed a longitudinal design (N = 171) to investigate the impact of institutional betrayal on women’s postpartum mental health, and to better understand the role of individual factors (i.e., attachment and personality factors) in explaining this link. Results showed that individuals with an anxious attachment style may be especially vulnerable to experiencing instances of betrayal in the medical system. After controlling for demographics, trauma, individual and interpersonal factors, institutional betrayal predicted posttraumatic (PTSD) symptoms across time. An avoidant attachment style, higher levels of neuroticism and lower levels of social support also significantly predicted PTSD symptoms, depression and anxiety. Individuals who perceived a lack of support from their medical team during childbirth reported higher levels of dissociation. In the qualitative portion of this study, women commented on the following themes as impacting whether they perceived their childbirth experience as positive or negative: personal factors (i.e., taking control, using alternative care), factors related to the medical team (i.e., perceived competency, emotional support, informed consent), and systemic factors (i.e., impact of organizational/ facility issues, continuity of care, systemic response to medical errors). The findings from the current study provide clarity about factors that predict postpartum mental health. Institutional betrayal appears to predict mental health during pregnancy, childbirth and beyond. While medical errors may be common, education and training should be provided for medical staff in how to deal with these issues when they occur, prioritizing accountability and sensitivity in addressing patient complaints. Ultimately, understanding and addressing the factors that affect how individuals view healthcare experiences could be beneficial for both patients and the medical system, since these interventions may lower the financial costs and psychological effects of patient complaints in the medical system.

Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Clinical Psychology, University of Regina. x, 196 p.
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