Sigrid Stjernswärd

Perceived and anticipated discrimination in people with mental illness-An interview study.

Abstract Background. Studies on perceived discrimination of people with mental illness are largely lacking. The purpose of the study was to investigate perceived discrimination in a sample of users in contact with mental health services in Sweden. Methods. Interviews were conducted with 156 users, asking for perceived and anticipated discrimination during the last 2 years. Background characteristics were also collected. Results. Perceived discrimination was common. Highest frequencies were reported regarding family (54%), avoidance by people who knew about the mental illness (53%) and in making or keeping friends (50%). A majority of those anticipating discrimination regarding job or education seeking, or starting a close relationship did not report having been discriminated in these areas. Previous hospitalizations were associated with discrimination, and age with anticipated discrimination. Conclusions. Public stigma and self-stigma have been reported to have a number of negative consequences for people with mental illness. Discrimination is part of this complex situation and this study showed that this largely affects a number of individual life areas posing an obstacle for social integration. Anticipated discrimination or self-stigma was also prevalent and it is pointed out that this to a great extent is an obstacle on its own without being promoted by actual experiences of discrimination.

Illuminating User Experience of a Website for the Relatives of Persons With Depression

Background: The aim of the study was to illuminate users’ experiences of a website aimed at helping relatives of persons with depression. Material: Data was collected through forum posts, a usability scale and focus groups, and was analyzed using content analysis. Discussion: The diary and forum seemed to fill different and valuable functions (i.e. think tank, exchange of stories), allowing communication with the self and others. Conclusions: The website www.sommarregn.se has the potential to work as an empowering self-help instrument online, representing a viable medium to help relatives cope. Its usability can be enhanced through further development.

Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009-2014: an evaluation of a national antistigma programme.

Public stigma of mental illness is still a major problem where numerous population studies during the last decade have mainly shown no improvements. A Swedish national antistigma campaign has been running 2010–2014. The aim of this study was to investigate changes in public stigma during this period as compared to baseline in 2009.

A Web-Based Supportive Intervention for Families Living With Depression: Content Analysis and Formative Evaluation

Background Relatives of people with a mental illness who live together can experience additional burdens that may require support. A Web-based tool including a psychoeducation module, a diary, and a password-protected forum was developed to support relatives of a person with depression. Objective The objective of our study was to explore participants’ use of the Web-based tool, with focus on the forum, and to assess its potential health and psychosocial benefits. Methods Twenty-five people participated in this explorative open trial. Self-rating instruments assessing caregiver burden, stigma, and the tool’s usability were analyzed with Carer QoL7-D, DISC-12, and a system usability scale. A summary measure of subjective burden was assessed with CarerQoL-VAS. The forum posts were studied using content analysis. Results The majority reported fulfillment from their caregiving tasks (84%, 21/25), and had relational problems (76%, 19/25), their own mental health problems (72%, 18/25), support (72%, 18/25), and difficulties coordinating daily activities with caregiving (56%, 14/25). Most (72%, 18/25) reported having been able to use their inner strength to cope with stigma and discrimination, 64% (16/25) had concealed or hidden the person’s condition, and 40% (10/25) reported having been avoided or shunned by people who knew about the illness. Forty-eight percent (12/25) reported unfair treatment from family; 40% (10/25) in marriage or divorce and 36% (9/25) from mental health staff. Almost one-third (28%, 7/25) reported having stopped themselves from having a close personal relationship. Participants’ subjective assessment of the tool’s usability resulted in a mean of 61.5 (range, 22.5-90; possible total value 0-100; >70=good). Ten people participated in the forum; content analysis resulted in five categories describing relatives’ situations: balancing the caregiver’s role and relationship to the patient; their own lives and need for support; resources and patient advocacy; a looming shadow on leisure, social, and professional life; and interaction and social support. Conclusions Further studies are needed to explore optimal ways of using Web-based tools to address support for relatives of a person with mental illness. Professional feedback may enhance the use and value of online communities.

Depression, e-health and family support. What the Internet offers the relatives of depressed persons.

Depression affects the depressed person and her/his closest network, giving rise to needs of support and information. The aim of this study was to examine the presence of information or other useful material for the relatives and significant others of depressed individuals on health-related Web sites and to see whether the possibly found material was addressing relatives’ as of today known needs of information and support. A total of 22 Web sites granted with the Health on the Net Foundations quality logo were examined and analysed according to Grounded Theory methodology. The study showed that a number of studied Web sites contained valuable information and material, thereby partly addressing relatives’ known needs, whereas others offered no or little useful material. The study also resulted in a model in part showing the interaction between the depressed individual, the relatives and society. Conclusively, more can be done to help the relatives of depressed individuals cope with a daily life marked by the presence of depression by means of the Internet.

A modified Drug Attitude Inventory used in long-term patients in sheltered housing

The self-report Drug Attitude Inventory (DAI), in 30- and 10-item versions, provides unique information of clinical relevance for monitoring treatment adherence among people diagnosed with schizophrenia. The primary purpose of this paper was to evaluate the 10-item version among patients living in sheltered housing. Data were collected among 68 persons living in sheltered housing, most of them (82%) diagnosed with schizophrenia, 6% with non-organic psychoses, and 12% with other diagnoses. The dichotomic response format of the original DAI-10 was replaced by a 4-point Likert scale, in order to improve the resolution of the scale. Over 90% of the participants produced meaningful scores. A factor analysis suggested a 2-factor orthogonal structure: one highly homogenous factor (5 items) reflected wanted effects of the drug and displayed a bimodal distribution; one factor (3 items) reflected side effects. One item concerned the perceived control over ones drug treatment, which is a key clinical issue. One item was conceptually ambiguous and displayed no correlations with the other items. On the basis of the results we suggest cut-off scores which indicate the need for three kinds of adherence-improving interventions. Summing up, by dropping one item and using a Likert scale response format, the resulting instrument, DAI-9, appears to be an easy-to-use self-report instrument for monitoring drug attitudes and to identify needs for treatment adherence interventions among seriously ill patients.

Outcome of a web-based mindfulness intervention for families living with mental illness – A feasibility study

ABSTRACT Background: Families living with a person with mental illness can experience distress requiring therapeutic interventions. Web-based mindfulness interventions have shown beneficial health outcomes for both clinical and healthy populations, and may help families cope and overcome barriers that can otherwise hinder a help-seeking process. Aims: To develop and assess outcomes of a web-based mindfulness intervention for families living with a person with mental illness. Methods: A pilot study investigating an 8-week web-based mindfulness intervention with a pre–post design and follow-up after 3 months, with mindfulness as the primary outcome and perceived stress, caregiver burden and self-compassion as secondary outcomes. The study included a sample of 97 persons approached by advertisement in newspapers, newsletters, and online. Results: The study showed significant improvements in levels of mindfulness post-intervention and at follow-up as well as significant improvements in levels of perceived stress, caregiver burden, and self-compassion both post-intervention and at follow-up. Discussion: Acceptability and feasibility of the intervention were high, outcomes were relevant, and the intervention showed positive and significant results supporting the hypothesis that the intervention may help families cope with a stressful situation. Conclusion: Further randomized controlled studies of the intervention are needed to investigate the intervention’s effectiveness, including dose-effect studies.

Effectiveness and Usability of a Web-Based Mindfulness Intervention for Families Living with Mental Illness

Families living with mental illness express needs of support and experiences of burden that may affect their own health detrimentally and hence also their ability to support the patient. Mindfulness-based interventions have shown beneficial health effects in both clinical and healthy populations. The aim of the current study was to explore the effectiveness and usability of a web-based mindfulness program for families living with mental illness, which was first tested in a feasibility study. The study was designed as a randomized controlled trial with an experiment group and a wait-list control group with assessments on primary and secondary outcomes at baseline, post-intervention, and at a 3-month follow-up. Significant positive improvements in mindfulness and self-compassion, and significant decreases in perceived stress and in certain dimensions of caregiver burden were found, with good program usability. Easily accessible mindfulness-based interventions may be useful in addressing caregivers’ needs of support and in preventing further ill health in caregivers. Further studies are needed, among others, to further customize interventions and to investigate the cost-effectiveness of such programs.

Young Women: The Meaning of a Collaborative Program Supporting Young Women's Rehabilitation and Reintegration into the Labor Market.

Women are at a higher risk for long-term sick leaves and mental ill health. The aim of this study was to explore a supportive programs meaning for women with anxiety/stress/depression problems that are unemployed and/or on a sick leave, and for the personnel involved. Seven women and the personnel (n = 5) were interviewed individually pre- and post-intervention. Data was analyzed using content analysis. The program appeared to provide participants with tools to handle their physical and mental health, and occupational support, improving their social situation. Collaboration between organizations appears to be beneficial for all parties involved.

Relatives and friends queries on a psychologists "question and answer" forum online - authorship and contents.

Background: Families living with mental illness can experience added burden and eventually own ill health. National and international guidelines support the development of web based solutions to cost-effectively address health care needs. Mapping patterns of internet use may help tailor interventions to effectively address users’ needs. Aim: The study’s aim was to explore the contents of relatives’ and friends’ queries on a psychologists’ website with professional feedback. Methods: All visible questions [n = 59] classified under the website’s “helping a relative/friend” category between 20 090 615–20 130 927 were printed out and analyzed using content analysis. Results: The analysis resulted in four categories and subcategories illuminating families’/friends’ areas of concern: support to help; concerns with health care; young children’s welfare; and repercussions on own health. Conclusions: “Question & Answer” [Q&A] forums can shed light onto health seekers’ online behavior and may be a way of addressing families’ needs of support and information. Further studies are needed to assess the replies’ therapeutic value for their recipients.