Mona Eklund

The importance of work as compared to other forms of daily occupations for wellbeing and functioning among persons with long-term mental illness

This study investigated the importance of competitive work as compared to participating in community-based activities and having no regular daily activity for people with long-term mental illness. One hundred and three persons visiting an outpatient unit and representing the three targeted occupational conditions were randomized to the study and assessed on satisfaction with daily occupations, health, and wellbeing. Persons with work were more satisfied with their daily occupations and were interviewer-rated as better functioning than the other groups, but the groups did not differ on self-ratings of health and wellbeing. Unexpectedly, people participating in community-based activities did not show better satisfaction or functioning than those without regular daily activity. It was concluded that competitive work should be an urgent end goal for services designed for occupational or vocational support.

Relationships between satisfaction with occupational factors and health-related variables in schizophrenia outpatients

Abstract  Background: The purpose of this study was to explore relationships between satisfaction with occupational factors, operationalized as occupational status and the total daily occupational situation, and health-related variables among people with schizophrenia. The health-related variables included quality of life, perceived control, sense of coherence, and psychopathology. Gender differences in these relationships were explored as well. Methods: A sample of 74 individuals, aged 20–55 years, from outpatient psychiatric services were recruited to the study. A variety of interviews and self-rating scales were used in the data collection. Results: When controlling for depressive symptoms, the results showed that satisfaction with employment status was of significance for health among patients with schizophrenia, but satisfaction with the total daily occupational situation seemed to be even more important to quality of life and other health-related aspects. In particular, satisfaction with daily occupations constituted an important dimension for self-rated quality of life. Some minor sex differences could be discerned in the pattern of associations. Conclusions: The strong association between satisfaction with daily occupations and self-rated quality of life adds a new dimension to the understanding of quality of life for this group of subjects, and suggests that helping to organise an individuals daily occupations ought to be a significant task in planning for psychiatric services.

Relationships between Occupational Factors and Health and Well-Being in Individuals with Persistent Mental Illness Living in the Community

Purpose. This study identified relationships between occupational factors and health and well-being among individuals with persistent mental illness. Methods. There were 103 subjects assessed in regards to time spent in different occupations, activity level, satisfaction with daily occupations, and experienced occupational value. The health-related variables were self-rated health, quality of life, self-esteem, sense of coherence, self-mastery, psychosocial functioning, and psychiatric symptoms. Results. Subjective perceptions of occupational performance were consistently related to both self-rated and interviewer-rated aspects of health and functioning. While variables pertaining to actual doing showed weak or no associations with self-rated health-related variables, they exhibited moderate relationships to interviewer-rated health and functioning. Implications. The health-promoting ingredients in occupations were determined by the way occupations were perceived, rather than the doing per se. The findings indicate that perceived meaning and satisfaction ought to be prioritized when setting goals in occupational therapy practice, and, besides, that existing occupational therapy theory needs to be updated.

Daily activities and hand function in women with scleroderma.

Objective: To give a detailed description of hand function and the ability to perform daily activities among patients with systemic sclerosis. Methods: Thirty patients with scleroderma answered a self‐administered activities of daily living (ADL) questionnaire. Hand function was estimated with respect to hand mobility, dexterity, and grip force. Perceived symptoms were reported on a visual analogue scale (VAS), and skin thickness was assessed by means of the modified Rodnan skin score. Results: Finger flexion and extension were the most impaired aspects of hand mobility. Dexterity was on average reduced to 68–80%, and grip force to 46–65% compared with values for healthy persons. The predominant self‐perceived problem was Raynauds phenomenon, whereas pitting scars/ulcers were perceived as the least problem. Activities building on hand and arm function were harder to perform than activities depending on lower limb function. Raynauds phenomenon, stiffness, grip force, and dexterity were factors with the strongest associations with ADL difficulties. Assistive devices and alternative working methods improved ADL ability. Conclusion: Impaired hand function was related to ADL difficulties and the use of assistive devices improved ADL. This emphasizes the importance of treatments that improve hand function and of testing ergonomic tools.

Meaningfulness in work – Experiences among employed individuals with persistent mental illness

The aim of the present study was to investigate how people with persistent mental illness, with various types of work and employment conditions, experience and describe the meaningfulness of work. The study had a qualitative approach and twelve informants living in the community were purposefully selected and interviewed according to overarching themes. The interviews were analysed using qualitative content analysis, and all of the authors were involved in the analysis process. The findings resulted in four main themes: 1) work per se has certain characteristics, 2) participation in different contexts gives a feeling of normality, acceptance, belonging and fulfilment of norms and values, 3) work affords structure, energy and a balanced daily life, and 4) work increases well-being and strengthens ones identity. A tentative model is described concerning perceived meaningfulness in work among individuals with persistent mental illness, in which the first three aspects of meaning are a prerequisite for meaning in terms of increased well-being and strengthened identity. Furthermore, it seems important that work has to bring the just right challenge to the individual in order for him or her to perceive the identified aspects of meaningfulness.

Satisfaction with Daily Occupations: A Tool for Client Evaluation in Mental Health Care

Research findings suggest that in order to clarify the relationship between occupation and health, occupation needs to be framed in several different ways. One facet of occupation is satisfaction with daily occupations, assessed using the Satisfaction with Daily Occupations (SDO) instrument. The purpose was to investigate some of the SDOs psychometric properties when applied on people with persistent mental illness. Discriminant validity against occupational value and quality of life was investigated, as was internal consistency and ability to discriminate between people with different types of daily occupation. A total of 103 patients from a psychiatric outpatient unit were selected, representing people in work or studying, people visiting activity centres, and people with no organized daily occupation. The SDO showed no or weak relationships with occupational value and quality of life, and the internal consistency was alpha=0.80. Factor analysis revealed loadings between 0.44 and 0.79. Five out of 9 items discriminated between the occupational groups. In conclusion, the SDO showed discriminant validity against occupational value and quality of life, had acceptable internal consistency, and formed one single construct. The SDO can be improved by means of further revision and psychometric testing, but the present version should be valid and reliable enough to use in occupational therapy practice and research.

Occupational value among individuals with long-term mental illness.

Purpose. The study compared the perceived value of occupation among a sample of individuals with long-term mental illness to a sample of people not diagnosed with mental illness. As well, it investigated whether diagnostic and demographic factors were related to perceived occupational value among the individuals with mental illness. Finally, the study examined the relationship between occupational value and ratings of health and well-being. Method. One hundred and three individuals with mental illness and 28 healthy individuals were recruited for the study. Results. Overall occupational value among the individuals diagnosed with mental illness differed only marginally from the healthy group, indicating that perceived occupational value was by and large not related to mental illness. Among the individuals with mental illness, having children living at home was related to occupational value. There were moderate to strong associations between occupational value and measures of health and well-being. Practice Implications. This study provides important insights into occupational value among individuals with persistent mental health problems and provides some preliminary evidence in support of the Value, Meaning and Occupation Model.

Meaningfulness in daily occupations among individuals with persistent mental illness

This study investigated how people with persistent mental illness who work or study, attend a community‐based activity centre or have no regular activities, experience and describe the meaningfulness of their daily occupations. Data were gathered from 102 randomly selected individuals who were interviewed regarding their daily occupations and perceived meaningfulness using a ‘yesterday activity diary’. Content analysis revealed five main themes of meaningfulness: 1) Connection with others and the world around them, 2) Enjoyment and fun in life, 3) Being productive and having a sense of achievement, 4) Being occupied and having routines and projects in the stream of time and 5) Taking care of oneself to maintain health. Their connections, enjoyment and fun, and taking care of oneself were the aspects of meaningfulness that occurred most frequently. Participants who worked or studied more frequently identified connections, and made fewer statements about taking care of their health. The findings contribute to the knowledge of perceived meaningfulness in daily occupation, showing that despite different occupational structures and settings, all themes of meaningfulness were represented in the three groups. Thus, people with persistent mental illness create and find meaning within their daily occupations, although the occupations that generate these aspects of meaningfulness may differ.

Time use among people with psychiatric disabilities: implications for practice.

TOPIC This paper reviewed the current literature regarding time use among people with psychiatric disabilities. PURPOSE The purpose was to investigate what characterizes time use, occupational balance and occupational patterns among people with psychiatric disabilities, how time use relates to health in this group, and how time use can be used in research designs and addressed in assessments and interventions. SOURCES The databases CINAHL and PubMed were searched, by combinations of terms such as: time use, time geography, occupational balance, occupational pattern, assessment, intervention, occupational therapy, lifestyle redesign, well-being, and mental health. CONCLUSIONS Time use for people with psychiatric disabilities is often restricted to sleeping, eating, caring for oneself, and performing quiet activities. The target group is at risk of being both over- and under-occupied, and occupational imbalance may be regarded as an expression of the disability, thus shaped by a misfit between the persons capacities and environmental opportunities and demands. Several time-use methods exist for the study of daily occupations in people with psychiatric disabilities, but no intervention based on time use was found. Principles for a time-use based intervention are discussed. However, such an intervention needs to be investigated for relevance and effectiveness in future research.

Value dimensions, Meaning and Complexity in Human Occupation: A tentative structure for analysis

In occupational therapy and occupational science, it is important to clarify the perspective from which the analysis of occupation is addressed. The purpose of this paper is to present a tentative structure for describing occupation, allowing for analysis in a lifelong panorama as well as for the immediate experience a person acquires from performing a single occupation. The concept of occupational value is introduced as a prerequisite for meaning, defining three different dimensions: concrete, symbolic, and self-reward value. A dynamic categorisation of single occupations is presented, considering each unique occupational performance viewed from a macro, meso, and a micro perspective, inspired by dynamic systems theory. It is proposed that all occupations are meaningful if they are integrated parts of a persons occupational continuity, and that it is the interaction between the mentioned three perspectives that determines their meaningfulness. With an explicit focus on value and meaning as perceived by the unique person, occupational therapists will become more skilled in designing meaningful occupational therapy interventions. This paper is a contribution to the development of occupational science as well as to occupational therapy, but the theoretical framework presented must be empirically tested in order to demonstrate its validity.In occupational therapy and occupational science, it is important to clarify the perspective from which the analysis of occupation is addressed. The purpose of this paper is to present a tentative structure for describing occupation, allowing for analysis in a lifelong panorama as well as for the immediate experience a person acquires from performing a single occupation. The concept of occupational value is introduced as a prerequisite for meaning, defining three different dimensions: concrete, symbolic, and self-reward value. A dynamic categorisation of single occupations is presented, considering each unique occupational performance viewed from a macro, meso, and a micro perspective, inspired by dynamic systems theory. It is proposed that all occupations are meaningful if they are integrated parts of a persons occupational continuity, and that it is the interaction between the mentioned three perspectives that determines their meaningfulness. With an explicit focus on value and meaning as perceived by the unique person, occupational therapists will become more skilled in designing meaningful occupational therapy interventions. This paper is a contribution to the development of occupational science as well as to occupational therapy, but the theoretical framework presented must be empirically tested in order to demonstrate its validity.