Search

The current researchers carried out a large online survey on 18 March 2020 and unintentionally provided a 'snap shot' of how the British population was responding in the early stages of the Covid‐19 pandemic. This paper aims to investigate the relationship between loneliness and mental health at the early stages of the global crisis. This cross‐sectional study was carried out using Prolific, an online participant recruitment platform that allowed 1608 responses in just 2 hr. Participants completed measures of Personal Well‐being, Psychological Distress, Flourishing and Loneliness. Numerous associations between loneliness and mental health were found. A multiple regression found that 43% of the variance in loneliness can be accounted for by age, psychological distress and flourishing. Responses were also categorised into three groups: the non‐lonely (n = 311), averagely lonely (n = 1054) and the severely lonely (n = 243), with analysis indicating that poorer well‐being was associated with increased loneliness. Due to the cross sectional nature of this research, determining the direction of causality is not possible. It remains uncertain whether increased loneliness negatively impacted on mental health, whether poor mental health lead to increased loneliness, or both in fact. Current findings suggest that severely lonely individuals may be particularly vulnerable to psychological distress and that individuals with poor mental health may be especially prone to loneliness. Individuals experiencing loneliness and/or poor mental health will almost certainly need additional support during and beyond the pandemic. [ABSTRACT FROM AUTHOR]

Personal health budgets (PHBs) are being promoted in England as expanding the benefits of choice and control to individuals with healthcare needs. National Health Service (NHS) money is provided to eligible people to use as set out in approved care plans, including direct employment of personal assistants (PAs). The government plans to increase NHS‐funded PHBs and to further introduce integrated personal budgets (IPBs). This potentially creates more demand for directly employed or self‐employed PAs with health‐related skills. The objective of this paper is to report findings from interviews with PAs (n = 105) and key informants (n = 26) from across England, undertaken between October 2016 and August 2017, about the potential for the PA workforce to undertake 'health‐related' tasks as facilitated by the introduction of PHBs. PAs were purposefully recruited to ensure the sample included participants from different geographical locations. Key informants were purposefully selected based on their knowledge of policy and community services. Data were analysed quantitatively and qualitatively. This paper focuses on reporting qualitative findings, which are set within the theoretical framework of normalisation process theory to explore implementation challenges of PHBs. The majority (64%) of PAs confirmed that they saw their current roles as congruent with PHBs, were willing to engage with PHBs and undertake health‐related tasks. However, 74% of PAs said they would need additional training if enacting such roles. Key informant interviews appraised the development of PHBs as complex, noting incongruences arising from NHS and social care‐funded PAs carrying out similar roles within different organisational systems. We conclude the current PA workforce is willing to take on PHB work and is likely to interweave this with work funded by PBs and self‐funding care users. Implications include the need for careful consideration of training requirements and delivery for PHB‐funded PAs. [ABSTRACT FROM AUTHOR]

Summary: The social care assessment is a 'key interaction' between a person and the local authority with 'critical' importance for determining a person's needs for care and support. In order to achieve this, the guidance requires that assessments must be 'person-centred throughout'. The concept of person-centred practice is now routinely invoked, but there remains little empirical evidence on how it gets put into practice. Findings: This paper draws on interview data from 30 practitioners about their experiences of conducting social care assessments in England. While there was widespread support for the principles of a person-centred approach, tensions emerged for practitioners in three ways: the way in which 'chat' was used to build a relationship or conduct the assessment, whether to conduct the assessment via a conversation or by following the sections on the agency form and the extent to which the assessor should involve and negotiate the contributions of family members. Applications: We argue that each of these dilemmas represents an occasion when a commitment to person-centred practice is negotiated between professionals and service users and sometimes compromised as a result. We consider the possibilities for and constraints on achieving person-centred assessments in a post-Care Act environment and discuss the implications for social work practice and research. [ABSTRACT FROM AUTHOR]

cook c. (2012) Email interviewing: generating data with a vulnerable population. Journal of Advanced Nursing 68(6), 1330-1339. Abstract Aims. This paper describes online recruitment and the email interviewing data collection method with women diagnosed with a viral sexually transmitted infection. The paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult. Background. Online recruitment and in-depth email interviewing have been used by only a small number of nurses internationally. The method enables inclusion of people who might otherwise be excluded from research, for reasons such as geographical distance, incompatible time frames, clinicians''gate-keeping' and participants' desire for anonymity for physical or emotional reasons. Methods. In-depth email interviews were conducted with 26 women in New Zealand, United States of America, Canada and England who had a diagnosis of either human papilloma virus or genital herpes simplex virus. Data were collected during 2007-2008 and analysed using a poststructuralist, feminist thematic analysis. Results. Participant retention was high. Women emphasized satisfaction with the process. Asynchronous interviews allowed for additional reflexivity in the researcher's responses and rich data generation. Conclusion. This method has the potential to enable nurses to include vulnerable and relatively inaccessible participants in 'sensitive' research. In-depth email interviews may generate rich data through a process participants deem to be of personal value. [ABSTRACT FROM AUTHOR]

Introduction: In the United Kingdom, fractures of the cervical dens process in older and/or frail patients are usually managed nonsurgically in a hard collar. However, hard collars can lead to complications and this management approach is now being questioned, with growing interest in maximising patients' short‐term quality‐of‐life. It is vital that patients' perspectives are considered; yet, there is a dearth of literature examining the aspect. To help inform wider decision‐making about use of collar/no collar management of dens fractures in older/frail people, we explored older/frail people's experience of the two management approaches and how they affected their perceived quality‐of‐life. Methods: We interviewed older and/or frail adults with a recent dens fracture (aged ≥65 years or with a clinical frailty score of ≥5) or their caregiver. Participants were recruited from both arms of a clinical trial comparing management using a hard collar for 12 weeks (SM) with early removal of the collar (ERC) and were interviewed following randomisation and again, 12–16 weeks later. Data were analysed using a framework approach. Results: Both participant groups (SM/ERC) reported substantial, negative quality‐of‐life (QoL) experiences, with the fall itself and lack of access to care services and information being frequent major contributory factors. Many negative experiences cut across both participant groups, including pain, fatigue, diminished autonomy and reduced involvement in personally meaningful activities. However, we identified some subtle, yet discernible, ways in which using SM/ERC reinforced or alleviated (negative) QoL impacts, with the perceived benefits/burdens to using SM/ERC varying between different individuals. Conclusion: Study findings can be used to support informed decision‐making about SM/ERC management of dens fractures in older/frail patients. Patient or Public Contribution: Public and patient involvement contributors were involved in the study design, development of interview topic guides and interpretation of study findings. [ABSTRACT FROM AUTHOR]

Background: There is a lack of research about the experiences and impact of having a sibling with a life-limiting condition. Studies focus on the sibling experience during childhood but the experience and impact during adulthood is unknown despite the increased life-expectancy of children with life-limiting conditions. Aim: To explore adult siblings' perspectives on the experience of having a sister/brother with a childhood life-limiting condition and to identify their perceived needs and preferences for support. Design: A qualitative exploratory study design with data generated by semi-structured interviews and analysed using reflexive thematic analysis, underpinned by interpretivism. Setting/participants: Twenty-two siblings (17–42 years old) were recruited via a children's hospice in England. Results: The experience of having a sibling with a life-limiting condition changes over time in response to how understandings of the meaning of a life-limiting condition develop and changing roles/relationships with parents and siblings. These experiences have an enduring impact on adult sibling's mental health which is compounded by their unmet (and sometimes unrecognised) support needs in adolescence and adulthood. Siblings described the importance of support continuing into adulthood with a focus on the provision of psychotherapy and peer support. Conclusions: Having a sister/brother with a childhood life-limiting condition appeared to have a significant and ongoing impact on adult siblings but their support needs, particularly for psychotherapy and peer support, are overlooked. The findings highlight the importance of ensuring siblings are included in family assessments and that family-based interventions are developed to promote sibling-parent relationships. [ABSTRACT FROM AUTHOR]

Widespread among adolescents in England, dating and relationship violence (DRV) is associated with subsequent injuries and serious mental health problems. While DRV prevention interventions often aim to shift harmful social norms, no established measures exist to assess relevant norms and their role in mediating DRV outcomes. We conducted cognitive interviews exploring the understandability and answerability of candidate measures of social norms relating to DRV and gender roles, informing measure refinement. In all, 11 participants aged 13 to 15 from one school in England participated. Cognitive interviews tested two items assessing descriptive norms (beliefs about what behaviors are typical), three assessing injunctive norms (beliefs about what is socially acceptable), and (for comparison) one assessing personal attitudes. Findings were summarized by drawing on interview notes. Summaries and interview notes were subjected to thematic analysis. For some participants, injunctive norms items required further explanation to clarify that items asked about others' views, not their own. Lack of certainty about, and perceived heterogeneity of, behaviors and views among a broad reference group detracted from answerability. Participants were better able to answer items for which they could draw on concrete experiences of observing or discussing relevant behaviors or social sanctions. Data suggest that a narrowed reference group could improve answerability for items assessing salient norms. Findings informed refinements to social norms measures. It is possible to develop social norms measures that are understandable and answerable for adolescents in England. Measures should assess norms that are salient and publicly manifest among a cohesive and influential reference group. [ABSTRACT FROM AUTHOR]

There is a dearth of studies exploring how younger children engage in civic life, what may be expected of them given their age, and what instruments may be used to capture their levels of civic engagement. Addressing these questions, this article presents key findings from a pilot study that aimed to create a validated instrument designed to measure the civic engagement of primary school children. Based on a survey administered to 655 primary school children aged 9–11 across England, this article focuses on the new measure that was specifically designed, and then tested and validated through both exploratory and confirmatory analyses. The findings validate a tripartite measure of civic engagement that assesses the civic attitudes, actions and awareness of 9–11-year-olds. This measure was found to be both practical and efficient in its administration, and it has been shown to be easily comprehensible by this age group. This new measure addresses an important gap in the literature on civic engagement in children, providing researchers with a validated tool to effectively measure civic engagement in 9–11-year-olds. The findings have implications for both researchers and educators interested in designing and evaluating interventions aimed at promoting civic engagement among younger children. [ABSTRACT FROM AUTHOR]

kennedy f., harcourt d. & rumsey n. (2011) The shifting nature of women's experiences and perceptions of ductal carcinoma in situ. Journal of Advanced Nursing 68(4), 856-867. Abstract Aim. This paper is a report of a descriptive qualitative study of the evolution of women's perceptions and experiences of ductal carcinoma in situ from the period near to diagnosis to 1 year later. Background. Ductal carcinoma in situ is a non-invasive breast condition where cancer cells are detected but confined to the ducts of the breast. With treatment, the condition has a positive prognosis but ironically patients undergo treatment similar to that for invasive breast cancer. There is a lack of longitudinal qualitative research studying women's experiences of ductal carcinoma in situ, especially among newly diagnosed patients, and how experiences change over time. Methods. Forty-five women took part in an initial interview following a diagnosis of ductal carcinoma in situ and 27 took part in a follow-up interview 9-13 months later. Data were collected between January 2007 and October 2008. Transcripts were analysed using a hybrid approach to thematic analysis. Findings. Women's early perceptions of ductal carcinoma in situ merged and sometimes conflicted with their lay beliefs of breast cancer. Perceptions and experiences of the condition shifted over time. These overriding aspects were evident in four themes identified across the interviews: (i) perceptions of ductal carcinoma in situ vs. breast cancer, (ii) from paradox to acceptance, (iii) personal impact, and (iv) support and interactions with others. Conclusion. This study represents one of the few longitudinal qualitative studies with newly diagnosed patients, capturing women's initial and shifting experiences and perceptions of the condition. The issues identified need to be recognized in clinical practice and supported appropriately. [ABSTRACT FROM AUTHOR]

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic. People with dementia and their carers completed assessments before (July 2019–March 2020; 206 dyads) and after (July–October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline. In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness. Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The social and economic consequences of COVID‐19 have the potential to affect individuals and populations through different pathways (e.g., bereavement, loss of social interaction). Objective: This study adopted a solicited diary method to understand how mental health was affected during England's first lockdown. We also considered the experiences of diary keeping during a pandemic from the perspective of public participants. Methods: Fifteen adults older than 18 years of age were recruited from northwest England. Diarists completed semistructured online diaries for 8 weeks, which was combined with weekly calls. A focus group captured participants' experiences of diary keeping. Findings: Four key factors influenced mental health, which fluctuated over time and in relation to diarists' situations. These concerned navigating virus risk, loss of social connections and control and constrictions of the domestic space. Diarists also enacted a range of strategies to cope with the pandemic. This included support from social networks, engagement with natural environments, establishing normality, finding meaning and taking affirmative action. Conclusion: Use of diary methods provided insights into the lived experiences of the early months of a global pandemic. As well as contributing evidence on its mental health effects, diarists' accounts illuminated considerable resourcefulness and strategies of coping with positive effects for well‐being. While diary keeping can also have therapeutic benefits during adversity, ethical and practical issues need to be considered, which include the emotional nature of diary keeping. Public Contribution: Members of the public were involved in interpretation of data as well as critiquing the overall diary method used in the study. [ABSTRACT FROM AUTHOR]

Online abuse, facilitated via social media and mobile technologies, has recently attracted considerable academic attention. The nonconsensual sharing of intimate images—revenge pornography—can have a devastating effect on victims, is a global problem, and constitutes interpersonal violence. The national helpline in the United Kingdom has now received over 7,000 calls. In the United Kingdom, new legislation making revenge pornography a crime was introduced in 2014, yet the police do not always respond appropriately to victims. This article presents the findings of a national online survey of police understanding of revenge pornography, undertaken in the United Kingdom in March 2017. The study set out to investigate police knowledge of revenge pornography legislation, their confidence in responding to cases of revenge pornography, and what level of training they had received. A total of 783 members of the police force responded to the survey and, to the authors' knowledge, this the first study to seek to quantify the understanding of revenge pornography by police officers and staff in England and Wales. The findings suggest that the police in the United Kingdom have a limited understanding of revenge pornography legislation and lack confidence both in investigating cases and in effectively responding to victims. The implications of the study demonstrate that there is an urgent need for training across police forces to ensure that cases of revenge pornography are appropriately responded to, victims are safeguarded, and offenders brought to justice. [ABSTRACT FROM AUTHOR]

Adolescent dating and relationship violence is associated with health harms and is an important topic for sex education. School-based interventions addressing this have been effective in the USA, but schools in England confront pressures that might hinder implementation. We assessed the feasibility of, and contextual enablers/barriers to implementing Project Respect, a whole-school intervention. We conducted a pilot trial with process evaluation in six English secondary schools. Intervention comprised: training; policy-review; mapping and patrolling 'hotspots'; parent information; help-seeking app; and a curriculum (including student-led campaigns) targeting dating violence. Process evaluation included assessments of fidelity and interviews with the trainer and school staff. Schools delivered training and lessons partially or completely and made parent and app information available. Two schools conducted policy reviews; none patrolled hotspots or implemented campaigns. Implementation was strengthened where staff saw dating violence as a priority. Delivery was undermined where staff were insufficiently involved, lacked time for planning or struggled to timetable lessons, and where new school challenges undermined engagement. School-based health interventions must work to build staff buy-in and ensure they do not overburden schools. Dating and relationship violence might best be addressed in this context as a broader aspect of sex education. [ABSTRACT FROM AUTHOR]

Ecological approaches to health promotion have been increasingly adopted to address the complexities of increasing population level physical activity. These approaches understand individual behaviour in terms of the outcome of interactions between multiple biological, psycho-sociological and environmental factors which require complex and multilevel interventions. However, the health promotion field has been hampered by a lack of evaluation frameworks that provide sufficient flexibility to accommodate the complexity of 'real world' settings which lie at the heart of ecological approaches. In order to evaluate a small grants community health promotion programme this study deployed a social-ecological evaluation framework operationalised through a Social Return on Investment (SROI) methodology. This sought to understand and assess the broader social outcomes relating to the implementation of range of local physical activity and sport projects, and to maintain stakeholder engagement throughout. The formative and summative components of the evaluation are described before results are presented, which include qualitative findings and outcome indicator values. Findings highlight a diverse range of societal outcomes at the individual level for example, improved physical and mental health, and community level for example, community connectedness, which reflect a range of social, personal and interpersonal, and economic benefits. The SROI methodology not only provides social enterprises with a framework for measuring performance and impact, but is also shown to be a valuable management and stakeholder engagement tool for those commissioning local physical activity and sport programmes of this type. [ABSTRACT FROM AUTHOR]

Children and young people in public care have long been recognised as a particularly vulnerable group in our society. Many have complex personal, inter-personal and educational needs as a result of pre-care maltreatment. Despite a number of initiatives to change the often negative outcomes for these children, results have remained stubbornly disappointing. The model of professional childcare, rooted in psychological research and theory, was designed to enable and empower foster and adoptive parents and residential carers to acquire a deeper understanding of their children's needs and to provide these young people with the informed support required to help them to lead more fulfilling lives. In this study, we examined the impact of the model in a three-year project involving fifty-three children and young people and their carers in local-authority children's homes on two UK areas (Northern and Southern England). Significant improvements in both behavioural and affective measures were observed following implementation of the model with these young people (Z(N=53) = 3.978, p < 0.001). These results demonstrate that this model of professional childcare can achieve positive outcomes for previously maltreated young people in children's homes. Methodological constraints on implementation of the model are discussed. [ABSTRACT FROM AUTHOR]

Background: Reciprocal relationships between researchers and patient and public involvement (PPI) contributors can enable successful PPI in research. However, research and anecdotal evidence suggest that researchers do not commonly provide feedback to PPI contributors thus preventing them from knowing whether, how or where their contributions were useful to researchers and research overall. Aims: The aim of this study was to explore the variation, types, importance of, and satisfaction with feedback given by researchers to PPI contributors in six PPI groups in England, and identify the barriers to the process of feedback. Methods: An explanatory mixed methods sequential study design with a questionnaire survey followed by semi‐structured interviews with researchers and PPI contributors in six PPI groups. PPI contributors were involved in all stages of the research process. Results: Researchers do not routinely give feedback to PPI contributors. Feedback was found to have different meanings: an acknowledgement, impact and study success and progress. PPI contributors who receive feedback are motivated for further involvement; it supports their learning and development and prompts researchers to reflect on PPI impact. The importance of the role of a PPI lead or coordinator to facilitate the process of providing feedback was also highlighted. Conclusion: This study found no generic way to give feedback indicating that mutual feedback expectations should be discussed at the outset. PPI feedback needs to become integral to the research process with appropriate time and resources allocated. PPI feedback can be seen as a key indicator of mature, embedded PPI in research. [ABSTRACT FROM AUTHOR]

Loneliness in later life is a common problem with poor health outcomes. However, interventions to prevent or ameliorate loneliness have a weak evidence base. The views of older people experiencing or at risk of loneliness in the community are important in identifying features of potential support, but have been little studied. Twenty-eight community dwelling people, aged 65 and over who reported being 'lonely much of the time' or identified as lonely from the de Jong Gierveld six-item loneliness scale in a larger study, participated in in-depth interviews, between June 2013 and May 2014. Views and experiences on seeking support from primary care and community based one-to-one and group based activities, including social and shared interest groups, were explored. Interviews were recorded and transcribed. Thematic analysis was conducted by a multidisciplinary team, including older people. Using two different measures of loneliness enabled a spectrum of loneliness experience to be explored. Two-thirds of the participants were the 'younger old' and all were able to leave their homes independently. Older people with characteristics of loneliness were generally knowledgeable about local social and community resources but, for the majority, community and primary care based services for their loneliness were not considered desirable or helpful at this point in their lives. However, group based activities with a shared interest were thought preferable to one-to-one support (befriending) or groups with a social focus. Descriptions of support as being for loneliness and specific to older people discouraged engagement. Older people experiencing or at risk of loneliness did not consider that primary care has a role in alleviating loneliness because it is not an illness. They thought primary care practitioners lack understanding of non-physical problems and that a good relationship was necessary to discuss sensitive issues like loneliness. For many, loneliness was a complex and private matter that they wished to manage without external support. [ABSTRACT FROM AUTHOR]

Aim To explore caregivers' perspectives on ethics in older people's residential and domiciliary social care. Method Seventeen staff working in domiciliary and residential care were divided into four focus groups and invited to share their perspectives on 'ethical' or 'good' care, the ethical issues that arise in their care practice, and barriers and enablers for ethical care. Findings A thematic analysis identified four themes: negotiating relationships, boundaries and the management of emotions, the effects of negative portrayals of care, and becoming a good carer. Conclusion Providing ethical social care is complex, and involves managing emotional boundaries and relational issues. The authors suggest that caregivers provide skilled companionship to those in their care. [ABSTRACT FROM AUTHOR]

Ten people with dementia (PWD) and their family carers participated in a Singing Together Group for 10 weeks and measures of mood, quality of life, PWD's behavioural and psychological problems, activities of daily living and cognitive status were measured at pre, post and 10-week follow-up. Engagement levels were monitored during the sessions and care partners asked to rate each session. Additional qualitative information was obtained through interview pre-post and at follow-up and subjected to thematic analysis. The results showed that PWD were deteriorating slowly over the course of the study on all measures but that they and their carers’ quality of life remained relatively stable. Engagement levels during the group were very high and attendance excellent. Qualitative data gave strong support to the group having promoted wellbeing of all participants and Nolan's ‘Senses Framework’ was used to explore this further. Future research directions are suggested. [ABSTRACT FROM PUBLISHER]

This study investigates whether the level of language ability and presence of autistic symptomatology in adolescents with a history of SLI is associated with differences in the pattern of difficulties across a number of areas of later functioning. Fifty-two adolescents with a history of SLI participated. At age 14, 26 participants had a history of SLI but no autistic symptomatology and 26 had a history of SLI and autistic symptomatology. At age 16, outcomes were assessed in the areas of friendships, independence, academic achievement, emotional health and early work experience for both subgroups and for 85 typically developing peers. Autistic symptomatology was a strong predictor of outcomes in friendships, independence and early work experience whilst language was a strong predictor of academic achievement. No significant associations were found for later emotional health. [ABSTRACT FROM AUTHOR]

Cross-sectional research has shown that frequency of self-disclosure to outgroup members mediates the positive relationship between intergroup friendship and outgroup attitudes. The current research investigated the relationship between self-disclosure and attitudes in more depth. New undergraduate students were asked to nominate an ingroup or outgroup friend and then report the intimacy of their disclosures to them, their anxiety and attitudes towards a series of social groups, in the first week of the semester and 6 weeks later. Intimacy of disclosure predicted more positive attitudes towards outgroups over time, but this association was only found among participants who nominated an outgroup friend. In the ingroup friend condition, a negative association was found. These associations were mediated by general intergroup anxiety. These relationships highlight the importance of integrating theories of interpersonal and intergroup relations when investigating intergroup contact. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women ( N == 58) aged 25-36. Study 2 consisted of a psychiatric sample ( N == 138) aged 21-60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction. [ABSTRACT FROM AUTHOR]