C. Van Audenhove

The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature

Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe-primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.

Evaluating a decision aid for patients with localized prostate cancer in clinical practice.

Aim: The aim of the study was to evaluate the usefulness of a decision aid regarding treatment options for patients with early-stage localized prostate cancer. Methods: 50 patients with newly diagnosed localized prostate cancer received the decision aid and were interviewed twice: before the decision-making consultation with the physicians and before treatment or, in case of watchful waiting, before the follow-up consultation. The physicians (radiation oncologists and urologists) were interviewed after the consultation. Results: The patients became more active partners in the decision-making process: They were better prepared for the consultation, asked more direct information, and were able to make a more deliberative choice. Generally, the use of the decision aid improved the quality of the consultation and resulted in a treatment decision agreed upon by both parties. Sometimes the consultation turned out to be more time-consuming. The decision aid did not only improve the patient-physician interaction but also helped patients to discuss the disease with their partner and family members. Conclusion: The use of the decision aid has a positive impact on the consultation and the decision-making process. The policy of involving patients more actively in the decision process should be further implemented in daily practice.

The determinants of informal caregivers' burden in the care of frail older persons: a dynamic and role-related perspective

ABSTRACT Research into informal caregivers’ burden does not distinguish between different stages of impairment. This study explored the determinants of burden from an in-depth perspective in order to identify which determinants apply to which phases of impairment. Methods: This was a cross-sectional study including frail older persons aged 65 and above. Instruments used were the interRAI Home Care, the Zarit-12 interview and an ad hoc economic questionnaire. A combination of variables from the Stress Process Model and Role Theory and a sub-group analysis enabled refined multivariate logistic analyses. Results: The study population consisted of 4175 older persons (average age: 81.4 ± 6.8, 67.8% female) and their informal caregivers. About 57% of them perceived burden. Depressive symptoms, behavioral problems, IADL impairment, previous admissions to nursing homes and risk of falls yielded significant odds ratios in relation to informal caregivers’ burden for the whole sample. These determinants were taken from the Stress Process Model. When the population was stratified according to impairment, some factors were only significant for the population with severe impairment (behavioral problems OR:2.50; previous admissions to nursing homes OR:2.02) and not for the population with mild or moderate impairment. The informal caregiver being an adult child, which is a determinant from Role Theory, and cohabitation showed significant associations with burden in all strata. Conclusion: Determinants of informal caregivers’ burden varied according to stages of impairment. The results of this study can help professional caregivers gain a greater insight into which informal caregivers are most susceptible to perceive burden. Abbreviations: NIHDI: National Institute for Health and Disability Insurance; ZBI12: Zarit Burden Interview - 12 items; InterRAI HC: interRAI Home Care instrument; ADL: Activities of Daily Living; ADLH: interRAI Activities of Daily Living Hierarchy scale; IADL: Instrumental Activities of Daily Living; IADLP: InterRAI Instrumental Activities of Daily Living Performance scale; CPS2: InterRAI Cognitive Performance scale 2; DRS: InterRAI Depression Rating scale

Hospital Reality from a Lying Perspective:Exploring a Sensory Research Approach

Despite many efforts by healthcare providers, for most people a hospital stay is rarely a pleasant experience. The hospital building as such is part of this perception. Moreover, the specific situation of a hospital stay is largely determined by the material reality of the organisation. Studies on hospital environments tend to single out one particular aspect, e.g. the view through the window, or presence of green (Ulrich 1984a, 1984b) and try to prove its clinical outcome. Yet they fail to translate their results to the design of real-life settings (Rubin et al., 1998, Cbz 2008). Moreover, the influence of patients’ peculiar perspective, i.e. lying in a hospital bed, on the way they experience the reality of the hospital is largely under researched.

Mental health, burnout and job satisfaction among professionals in sheltered living in Flanders. A pilot study.

Abstract.Background:Interest has been growing over the last few years in the working conditions of professionals who deal with clients with severe and chronic mental illnesses. In this study, the relationship between the affective climate, as measured by the construct of expressed emotion, and professionals’ feelings of well-being and burnout was investigated. It was hypothesised that high expressed emotion (EE) (= a high amount of criticism, hostility or emotional overinvolvement) would be related to high burnout scores.Methods:Fifty-six professionals were interviewed about their schizophrenic clients who resided in sheltered-living houses in Flanders. EE was measured with two instruments, the Camberwell Family Interview (CFI) and the Perceived Criticism Scale (PCS). The professionals’ characteristics were mental health (Symptom Checklist, SCL-90), job satisfaction (VEVAK), and burnout (a Dutch version of the Maslach Burnout Inventory, UBOS-C).Results:Little indication was found for an association between EE and working conditions as measured with the CFI. For the PCS, a significant relationship was found between the resident version of the PCS and burnout. The professionals who were perceived by the residents as being very critical were less depersonalised and less emotionally exhausted than those who were not so perceived.Conclusions:High EE relationships can exist without feelings of stress and burnout.

Discrimination in the workplace, reported by people with major depressive disorder: A cross-sectional study in 35 countries

Objective Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). Method Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. Results Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. Conclusions Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Spatial Clues for Orientation: Architectural Design Meets People with Dementia

The physical environment holds great potential to improve the well-being of people with dementia (Calkins et al., 2001; Van Audenhove et al., 2003; ternberg, 2009; Van Audenhove et al., 2009). However, when designing environments for them, architects are faced with a lack of adequate design knowledge. On the hypothesis that the perspectives of people with dementia have the potential to expand architects’ design expertise (Zeisel, 2001), our research ims to gain a better understanding of their spatial experiences in order to achieve this end. This paper outlines how this overall objective has become more articulated into more specific research questions through preliminary research:

Problematisch alcoholgebruik in de praktijk

SamenvattingDe huisarts vormt een belangrijke sleutelfiguur in de zorg voor mensen met problematisch alcoholgebruik. Dit onderzoek gaat na hoe huisartsen met dit problematisch alcoholgebruik omgaan, met name de aspecten die gerelateerd zijn aan de diagnose, de behandeling, de doorverwijzing, hun attitudes en kennis en kunde over problematisch alcoholgebruik.Uit deze bevraging blijkt dat een substantieel aantal huisartsen moeilijkheden ervaart met de diverse aspecten van de omgang met patiënten met een problematisch alcoholgebruik. Vormingen die hierop inspelen, kunnen hieraan tegemoetkomen.

Suicide registration procedures and practices in Europe

Suicide is an important primary outcome measure for evaluating the effectiveness of intervention programmes. The aim of the current study was to describe and compare suicide-registration procedures in eight European countries, pinpoint potential deficiencies and provide recommendations on how best to improve the quality of suicide registration in the EU. Qualitative data on suicide registration were collected within the OSPI-Europe project from country experts using a structured questionnaire. Suicide registration was based on the medico-legal system in six countries and the coronial system in two. Differences not only between, but also within these two systems emerged. In every country, the process starts after the fact of death has been ascertained by a physician and any suspicion of injury death has arisen. It ends with registration of the death in the national mortality statistics. Between these stages, several elements that are crucial to the consistency of suicide registration were identified: the professional background and co-operation among the authorities involved, performance of the legal inquiry and forensic autopsy, certification and final decision-making, and the coding and registry system. A model for recording suicides with maximum accuracy should include: (1) a comprehensive, accurate and time-limited legal inquiry; (2) obligatory forensic autopsy in all cases of injury death; (3) reciprocal and accurate communication among the authorities involved; (4) electronic data transmission; (5) final decision-makers access to comprehensive information and (6) specially trained coders entitled to obtain additional information from the legal authorities and the certifiers.

Public attitudes toward depression and seeking professional help: baseline survey prior to the OSPI intervention in four European countries

Public attitudes with regard to mental illness strongly impact upon whether and how professional help is sought by people affected and are important to understand stigmatisation. Several studies indicate rather negative attitudes among the general population, which, however, may be amenable to change. We undertook a general population survey in four European countries participating in the OSPI project, prior to the intervention. This survey was conducted by means of telephone interviews in a representative sample of 4000 members of the adult general population in both intervention and control regions. The survey comprised the Depression Stigma Scale, the Attitudes toward Seeking Professional Psychological Help, self-reported help seeking, socio-demographic variables and several measures of mental health of subjects and their relatives. We report on baseline attitudes in intervention compared to control regions, the relation between attitudes toward depression and attitudes toward help seeking, the relation between attitudes toward and actual help seeking, and the relation between attitudes, socio-demographic factors, subjects history of depression or suicidal ideation and subjects experience with mental ill-health in relatives.