Håkan Nunstedt

Experiences of Major Depression: Individuals’ Perspectives on the Ability to Understand and Handle the Illness

In all social groups, major depression is an increasingly serious problem in modern society. Important aspects of a persons capacity for recovery are the persons own understanding of the illness and the ability to use this understanding to manage the illness. The aim of this study is to describe how individuals with major depression understand their illness and use their understanding to handle it. Twenty participants treated in community care for major depression as determined by the Diagnostic and Statistical Manual of Mental Disorders were interviewed between February and June, 2008. Content analysis of the interviews revealed three major themes: (1) awakening insight, (2) strategies for understanding and managing, and (3) making use of understanding, each with additional subthemes. Individual understandings of the illness varied and led to differences in the ways participants were able to handle their depression. In clinical care it is essential to support an individuals understanding of depression and his or her use of that understanding to handle the illness.

The portfolio method as management support for patients with major depression.

AIMS AND OBJECTIVES To describe how patients with major depression in psychiatric outpatient care use the portfolio method and whether the method helps the patients to understand their depression. BACKGROUND Major depressive disorder is an increasing problem in society. Learning about ones depression has been demonstrated to be important for recovery. If the goal is better understanding and management of depression, learning must proceed on the patients own terms, based on the patients previous understanding of their depression. Learning must be aligned with patient needs if it is to result in meaningful and useful understanding. DESIGN Each patients portfolio consisted of a binder. Inside the binder, there was a register with predetermined flaps and questions. The patients were asked to work with the questions in the sections that built the content in the portfolio. METHODS Individual interviews with patients (n = 5) suffering from major depression according to Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) (American Psychiatric Association 1994) were repeatedly conducted between April 2008 and August 2009 in two psychiatric outpatient clinics in western Sweden. Data were analysed using latent content analysis. RESULTS The results showed that the portfolio was used by patients as a management strategy for processing and analysis of their situation and that a portfolios structure affects its usability. The patients use the portfolio for reflection on and confirmation of their progress, to create structure in their situation, as a management strategy for remembering situations and providing reminders of upcoming activities. CONCLUSIONS Using a clearly structured care portfolio can enable participation and patient learning and help patients understand their depression. RELEVANCE TO CLINICAL PRACTICE The portfolio method could provide a tool in psychiatric nursing that may facilitate patient understanding and increase self-efficacy.

Problematization of perspectives on health promotion and empowerment in mental health nursing –within the research network “MeHNuRse” and the Horatio conference, 2012

Mental illness is increasing worldwide, while societys response seems to be a trend toward narrower and more specialized mental health care. This development is creating great demands on mental health nurses to include a health promotion perspective in care and support of persons with mental illness. A health promotion perspective emphasizes cooperation and communication with people who suffer from long-term mental illness, focusing on their independence and health. From a health perspective, every human being is an actor in his/her own life, with an inherent ability to make his/her own choices. However, persons who suffer from long-term mental illness are at risk of losing power and control over areas of their lives and their health. Mental health nurses are in a position to support these individuals in promoting health and in maintaining or regaining control over their lives. The emphasis of this paper is to problematize mental health nurses’ responsibility to provide health-promoting nursing care in relation to empowerment by means of emancipation, self-efficacy, and self-management. We argue that mental health nurses can work from a health-promoting perspective by using these concepts and that this challenges some of the traditional ideas of health promotion in mental health nursing. The theoretical background discussions in this paper have their origin in the research network “Mental Health Nursing Research in Scandinavia” (MeHNuRse) and from the professional discussions developed during a 2012 workshop that included mental health nurses and researchers at the European Horatio Festival in Stockholm.