Karina Dencker

A salutogenetic perspective on how men cope with major depression in daily life, with the help of professional and lay support

Worldwide, major depression is one of the main causes of premature death and lowered functional capacity, and its importance will increase in the coming years. At the same time, there is a gap in service provision, and the needs of depressed patients are often not met. Therefore, the aim of this study was to describe how men (N=12) with major depression (DSM-IV) cope with daily life with the help of professional and lay support. The men were selected by strategic sampling and analysed with an approach inspired by phenomenography. Four descriptive categories emerged: being unburdened, restoring ones health, feeling involved, and finding a meaning. A man receives help and support from health care in restoring his health but his own path to getting well is to resume his place in the public domain. To help him do so, lay support is vital, and an important task for the nurse is, therefore, to support him in maintaining his existing social network or in building a new one.

Women's conceptions of coping with major depression in daily life: a qualitative, salutogenic approach.

The experience of having a severe disease such as major depression affects all aspects of the individuals life, including family, work, and social functioning. Therefore, the aim of this study was to describe, from a salutogenic approach, womens conceptions of coping with major depression in daily life with the help of professional and lay support. Thirteen women, previously hospitalized for major depression, were included in the study. The women were selected by strategic sampling, and data were analyzed by application of a phenomenographic approach. Four descriptive categories emerged: Self-Healing, Managing, Receiving Social Support, and Finding Meaning. While working their way out of the depression, the women needed to undergo a process of transition, involving both a cognitive and an emotional understanding, which they subsequently translated into health-related actions. The task of psychiatric mental health nurses is to provide care that empowers patients. Future nursing research should explore the circumstances that empower these women to start the transition process, as this process appears to be vital for recovery from major depression.

The closure of a major psychiatric hospital: reactions of the psychogeriatric nursing staff

SummaryA political decision to decentralize psychiatric care in a province in Sweden was arrived at in October 1984, leading to the closing down of the only psychiatric hospital in the area (290,000 inh.). The hospital is of the traditional type with 490 beds and 1,294 staff. It has units for long-term care, short-term care and rehabilitation, as well as a unit for research and education. The psychogeriatric patients are to be transferred to their home districts. All of the psychogeriatric staff have been guaranteed new jobs under the auspices of the County Councils medical services. This study is concerned with the nursing staffs reactions to the decentralization and the kind of problems they were faced with. A questionnaire was sent to all nursing staff, and for the psychogeriatric unit (199 patients) the personnel turnover was also registered. The results show that the greatest problems for the nursing staff were the splitting up of their working teams and having to establish relations with new colleagues. They were also worried about longer and more expensive journeys to new places of work. Most of the nursing staff considered the information given about the consequences of the political decision very poor. More than half of the nursing staff (54%) thought the patients would be provided with better care by decentralized psychiatric health services. Many stated that the decision had affected them so that their interest in further education (37%) and in working in a new type of psychiatric care (43%) had increased. It was also found that a great many of the nursing staff, the well-educated staff especially, fled the hospital for new jobs elsewhere, and this brought about great recruitment problems.

The experience of social support in patients suffering from treatment-refractory depression—A pilot study

The purpose of this study was (1) to ascertain to what extent a group of patients with treatment-refractory depression perceive that they have received sufficient social support, and (2) to define clinical variables that differentiate such patients from those who perceive that they have not received sufficient social support. Twenty-seven treatment-refractory patients with major depression were included in the study. The result showed that only 37% had what was judged as insufficient social support. Those with insufficient and sufficient social support had equally severe depressions, the same number of stressful life events, and the same number of persons in their social network. Patients with insufficient social support were characterized by (1) a subjective conviction that the number of persons in their network was insufficient, and (2) female gender. Emotional support was valued higher than any other kind of support.

The closure of a mental hospital in Sweden: characteristics of patients in long-term care facing relocation into the community.

SummaryA political decision to decentralize psychiatric care in a county of Sweden was made in October 1984, leading to the closure of the only large mental hospital in the area (290,000 inhabitants). The hospital is of the traditional type, with 490 beds and 1,294 staff members. It has units for long-term care, short-term care and rehabilitation and a unit for research and education. The long-term care is to cease completely and be replaced by community based alternative types of care. In this study, the long-term population (n=199) was characterized and their levels of functioning were measured. The results showed that 91% of the patients were 65 years old or more and that more than half of them were organically demented. Only 20% were chronic schizophrenics. All patients were cognitively impaired and 80% were also impaired in ADL functioning. A correlation between length of stay in hospital and ADL functioning was found in the organically demented group, but not in the group of chronic psychiatrically ill patients. Thirty-nine per cent of the population were severely impaired in ADL functioning and needed nursing care around the clock; 34% were moderately impaired and needed help and support that could be given in alternative types of care; 27% were not impaired at all to midly impaired and could be relocated to some type of service apartment. Thus, all patients needed sheltered living arrangements and care provided by staff with adequate training.

The closure of a major psychiatric hospital

SummaryA political decision to decentralize psychiatric care in a county in Sweden was arrived at in October 1984. This will lead to the closure of the only large psychiatric hospital in the area, which will be replaced by three smaller units. The long-term care in the hospital will cease completely and be replaced by district-based psychiatric services. All patients in the hospitals long-term unit were studied over one year at an early stage of deinstitutionalization. The results showed that 12% of patients were discharged during that year, mostly to other institutions, only 2 patients to their homes. Twenty-five per cent died, and one-year mortality was 40% for patients with severely impaired ADL functioning. The demented patients deteriorated significantly in ADL functioning.

Short-term nursing staff reactions to the closure of a major psychiatric hospital

A political decision to decentralize psychiatric care in a province in Sweden was arrived at in October 1984, leading to the closing down of the only psychiatric hospital in the area (290,000 inhabitants). The hospital is of the traditional type with 490 beds and 1294 staff. It has units for long-term care, short-term care, and rehabilitation and a unit for research and education. The short-term psychiatric care will be transferred to psychiatric units at hospitals in the catchment area. All staff have been guaranteed new jobs under the auspices of the County Councils medical services. This study is concerned with the nursing staffs reactions to the decentralization and the kind of problems they were faced with. A questionnaire was sent to all nursing staff, and for the short-term unit the personnel turnover was also registered. The results show that the greatest problems for the nursing staff were the splitting up of their working teams and having to establish relations with new colleagues. They were al...

The closure of a mental hospital in Sweden. 5 years of transition to district-based long-term care.

SummaryA political decision to decentralize psychiatric care in a county of Sweden was made in October 1984. This will lead to the closure of the countys only large psychiatric hospital. Short-term psychiatric care will be provided by three smaller hospitals in the county, while long-term care in hospital will cease completely and be replaced by district-based psychiatric services. All patients (n=199) in the large hospitals long-term unit were studied over 5 years of the transition period. The results showed that 42% of patients were discharged during the period, mainly to other institutions. Only 8 patients were provided with alternative types of care, such as group homes. Sixty-eight per cent of all patients died, most of them before being discharged (80% of the organically demented patients and 51% of the others). The mortality rate for patients with severely impaired activities of daily living (ADL functioning) was 92% for those who were also organically demented and 84% for the others. The patients who survived the 5-year period were mainly (80%) nondemented patients with relatively well-preserved ADL functioning, but with behavioural disturbances.