Silvia Krumm

Needs and quality of life among patients with schizophrenia in five European centres: what is the impact of global functioning scores?

BackgroundGlobal assessment of functioning, quality of life (QOL) and patient needs have been discussed as inter-related domains important for care planning and outcome assessment in care for the severely mentally ill. The study was conducted to investigate relationships of functioning level, subjective QOL and unmet needs in a cross-sectional study of 404 patients with schizophrenia spectrum disorders in five European centres with a focus on the patient group with low function scores.MethodsPatient groups with low, medium and high function scores were compared with regard to subjective QOL and unmet needs. QOL variability was assessed in subgroups according to function scores. Regression analyses were used to examine the impact of illness-related and other unmet patient needs on QOL. The influence of individual needs in the low and medium/high function score subgroup was compared.ResultsQOL increased and unmet needs decreased from the low to high function score subgroup. There was greater QOL variability in patients with low function scores compared to those with medium and high function scores, with some low-function score patients having relatively high QOL. In the low function score subgroup, both illness-related and other needs had an impact on QOL, whereas non-illness needs influenced QOL in medium and high function score patients.ConclusionScores of functioning level, in people with schizophrenia spectrum disorders, are related to QOL in a complex way, and types of unmet need impinge on the relationship. In order to improve QOL in people with low function scores, both illness-related and other needs should be met.

Mental health services for parents affected by mental illness.

Purpose of review Despite an increasing awareness of support needs of families affected by parental mental illness, there is a lack of adequate mental healthcare provision for parents. As contemporary mental health services are both user-focused and evidence based, the present review focuses on knowledge regarding the subjective perspective on parenting issues among affected parents and the evidence base for parenting programs. Recent findings There has been a shift in the research focus from adverse effects of parental mental illness on children toward inclusion and the subjective perspective in affected mothers and, more recently, fathers with mental health problems. Parents report on role conflicts, parenting difficulties, and stigma. Despite a broad spectrum of parental needs, many parents are reluctant to use services. There is an increasing evidence base for intervention programs. Summary Adequate care for parents affected by mental illness requires sensitivity for parents’ subjective perspective, interagency collaboration, standard intake practice, high level of professional knowledge and skills, provision of family-friendly environments, evidence-based parenting programs comprising both individual and group approaches and peer support. There is a lack of research on other parenting needs such as desire for children, coping with custody loss, and childlessness related to mental illness.

Subjective views of motherhood in women with mental illness – a sociological perspective

Background: Women with mental disorder perceive decisions on reproductive issues as a central domain of personal autonomy. Family planning issues in women with mental disorders are often neglected in psychiatric practice and research. Aims: Developing a comprehensive understanding of family planning in women with mental disorders. Method: Some factors are introduced which impact on family planning among women with mental disorders. A sociological perspective is used; structural and individual factors are considered. Results: Following factors are likely to influence womens decisions in the field of reproduction: stigma of mentally ill mothers, increase in self-responsibility for reproductive behaviour, growing impact of genetic counselling for future mental health care, knowledge about adverse effects of pregnancy, consequences of childbearing and motherhood on the course of maternal illness, and the risks for children. Conclusions: While many women may feel empowered to take autonomous reproductive decisions, they may feel overwhelmed at times by decisions on a complex matter without adequate support. Professionals should bear in mind that reproductive behaviour and motherhood are central aspects in female biographies. They should be aware that family planning aspects are not restricted to adequate birth control. In research, the inclusion of sociological concepts and methods is a promising approach.

Elternschaft als (neue) Herausforderung für die Psychiatrie

Seit geraumer Zeit erfährt das Thema Elternschaft auf gesellschaftlicher Ebene zunehmende Beachtung. Neben einer schier unüberschaubaren Ratgeberliteratur zu Familie und Erziehung lassen sich beinahe täglich Debatten um Reproduktionsziffern, Elterngeld und -zeit oder um die Frage des gesellschaftlichen Werts von Kindern verfolgen. Dieser Diskurs bleibt sicherlich nicht ohne Einfluss auf den individuellen Umgang mit der eigenen (potenziellen) Elternschaft. Kinder zu haben, so die Botschaft an Frauen und Männer, ist eine überaus verantwortungsvolle Aufgabe, die mit hohen Anforderungen an die eigenen Fähigkeiten und Ressourcen für eine optimal ablaufende Elternschaft verknüpft ist. Menschen, die zeitweilig oder dauerhaft von einer psychischen Erkrankung betroffen sind, stehen aber darüber hinaus aufgrund spezifischer reproduktiver Risiken vor besonderen Herausforderungen. Diese Risiken treten bereits beim Umgang mit einem Kinderwunsch hervor. So bergen einige Psychopharmaka teratogene Risiken für den Embryo. Problematisch ist dabei, dass Schädigungen bereits in einer sehr frühen Phase der embryonalen Entwicklung erfolgen können – in einer Phase also, in der die Frauen häufig noch gar nicht wissen, dass sie schwanger sind. Erschwerend kommt hinzu, dass hier eine z.T. eingeschränkte Befundlage besteht [1,2]. Das letztlich immer verbleibende Restrisiko bei Weiterführung, Wechsel oder Abbruch der medikamentösen Therapie ist – selbst nach eingehender Beratung durch behandelnde Ärzte – von den betroffenen Frauen selbst zu tragen. Weitere, damit verbundene Risiken betreffen den Krankheitsverlauf der betroffenen Frau: Gerade das abrupte Absetzen eines Medikaments kann ein beträchtliches Rezidivrisiko mit sich bringen. Aber auch im Hinblick auf den weiteren Schwangerschaftsverlauf bestehen Risiken, denn nur ein kleiner Teil der psychiatrisch vorbelasteten Frauen erfährt durch ihre Schwangerschaft eine Stabilisierung ihres psychischen Gesundheitszustandes. Tatsächlich ist die Annahme eines generell protektiven Effekts einer Schwangerschaft als ein weitverbreiteter „Mythos“ einzuordnen [3]. Auch die Zeit des Wochenbetts geht mit einem erheblichen Rückfallrisiko einher [1]. Schließlich kommen im weiteren Verlauf Risiken für die Entwicklung der Kinder hinzu. Langzeitstudien haben belegt, dass Kinder psychisch kranker Eltern ein erhöhtes Risiko haben, psychopathologische Auffälligkeiten im kognitiven, emotionalen und sozialen Bereich zu entwickeln bzw. selbst an einer psychischen Störung zu erkranken [4,5]. Das erhöhte Risiko für die Kinder geht neben genetischen auch auf Umweltfaktoren zurück, insbesondere in Form einer reduzierten mütterlichen Empathie und Reaktion auf kindliche Signale im Frühkindalter sowie eines unangemessenen Erziehungsstils in späteren Entwicklungsphasen [6]. Schon dieser nur kurz skizzierte Hintergrund macht deutlich, dass Elternschaft für Menschen mit einer psychischen Erkrankung ein kontinuierliches Abwägen zwischen der Berücksichtigung eigener, krankheitsrelevanter Bedürfnisse und den (prospektiven) Bedürfnissen des (ungeborenen) Kindes erfordert. Neben der Problematik im Zusammenhang mit der Medikation während einer Schwangerschaft umfasst dies auch die Einschränkungen in der Erziehungsfähigkeit, die viele Mütter als eine Folge der Medikamenteneinnahmewahrnehmen. Die Befürchtung, entweder die Gesundheit des (ungeborenen) Kindes bzw. dessen psychosoziale Entwicklung oder aber die eigene psychische Stabilität zu gefährden, wird von betroffenen Frauen als belastend erlebt [7–10]. Jenseits aller individuellen Risiken für Mutter und Kind existieren aber auch gesellschaftliche Repräsentationen, die den Umgang mit dem Thema Elternschaft bei Menschen mit einer psychischen Erkrankung moderieren können. Ein weitverbreitetes Stereotyp umfasst die Unfähigkeit psychisch kranker Menschen, ein Kind angemessen zu be-

„Ein Kind wäre schon ein Wunsch …”– Psychische Erkrankung und Kinderwunsch aus der subjektiven Sicht betroffener Frauen – Eine qualitative Untersuchung

OBJECTIVE The desire for children among women with mental disorders may be influenced by the perception of reproductive risks for the person herself as well as for the potential child. There is a lack of research regarding the desire for children among this group. METHODS 15 narrative-biographical interviews with women with mental illness aged 26-42 years. Verbatim transcripts were analyzed using a reconstructive approach. RESULTS/CONCLUSIONS Desire for children is considered problematic by the women interviewed. Taking psychotropic drugs during pregnancy and limitations in parenting capabilities are described as dilemmata. Transmission of the mental disorder to the potential child and the limitations of planning motherhood are reported as further problems. However, individual experiences with mental disorder are also considered a parenting resource. Three different forms of coping were extracted: exclusion of motherhood, postponing motherhood, and neglecting reproductive risks.

Men's Views on Depression: A Systematic Review and Metasynthesis of Qualitative Research

Background: According to the concept of “male depression,” depression among men might be underdiagnosed and undertreated because of gender differences in symptoms and coping. There is evidence that men experience atypical depressive symptoms including irritability, aggression, substance abuse, and increased risk behavior. To date, a substantial number of qualitative studies on mens views on depression has been conducted in the last few decades. Methods: Based on a systematic review and metasynthesis of qualitative studies on mens subjective perspectives on depression, we aim at a comprehensive understanding of mens subjective views on depression with a specific focus on masculinity constructions. Results: Based on 34 studies assessed as appropriate for the study, 2 overarching subthemes could be identified: normative expectations regarding masculinity ideals and mens subjective perspectives of depression as “weakness.” Mens strategies include denial of “weakness” and “closing up.” Further themes include suicide, masculinity ideals as a healthy resource, and alternative masculinities. Discussion/Conclusions: Traditional masculinity values might serve as barriers but also as facilitators to adaptive coping strategies in depressed men. More research is needed to study the dimensions and role of alternative masculinities in the context of depression.

Barriers and facilitators of help-seeking among unemployed persons with mental health problems: a qualitative study

BackgroundUnemployed people with mental health problems often do not use mental health services and therefore do not benefit from available therapies. As unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to and facilitators of mental health service use are poorly understood. The purpose of this study was to identify barriers to and facilitators of help-seeking and service use based on experiences of unemployed people with mental health problems.MethodsFifteen qualitative semi-structured individual interviews were conducted with unemployed persons who reported mental health problems. Interview topics included individual experience with help-seeking and mental health service use with a focus on barriers and facilitators. Transcripts were analysed using qualitative content analysis and major themes were identified.ResultsParticipants reported being treated as “different” within their social environment as well as by health care professionals because of their mental health problems, which resulted in a lack of self-esteem and avoidance of help-seeking. Interviewees associated negative attributes with help-seeking such as helplessness and weakness. They equated psychiatric medication with illegal drugs and worried about the risk of addiction. However, social support and a desire for change on the other hand increased the motivation to search for help. Employment agency staff were mostly perceived as supportive by individuals seeking mental health services.ConclusionsUnemployed individuals with mental health problems faced barriers and facilitators when seeking help on three different levels: (1) mental health literacy; (2) stigma and discrimination; and (3) structures and conditions of health care. Awareness and attitudes of health care professionals concerning mental health issues should be improved. Stigmatisation of people with mental illnesses should be reduced in health care settings. Training for employment agency staff concerning mental health problems and services is recommended.

Präsentismus vermeiden – Arbeitsbereitschaft fördern. Ein Zielkonflikt der Pandemieplanung?

ZusammenfassungHintergrund und FragestellungBeschäftigten wird empfohlen, im Fall einer akuten Atemwegserkrankung nicht zur Arbeit zu gehen. Doch andererseits wird während einer Influenzapandemie eine möglichst hohe Arbeitsbereitschaft der Beschäftigten erfordert. Für die betriebliche Pandemieplanung ergibt sich daraus die Frage, ob zwischen diesen beiden Zielen ein Konflikt besteht.Studiendesign und UntersuchungsmethodenBefragung der Beschäftigten der Stadtverwaltung Dortmund über Präsentismus bei akuter Atemwegserkrankung sowie zur Arbeitsbereitschaft im Fall einer Influenzapandemie.ErgebnisseIm Modell linearer multivariater Regression zeigte sich: Die untersuchten Aussagen zur Arbeitsbereitschaft im Fall einer Influenzapandemie erklären nur 2,4 % der Abweichungen bei der Neigung zum Präsentismus bei akuter Atemwegserkrankung.SchlussfolgerungDie Geringfügigkeit der Zusammenhänge insgesamt spricht gegen das Vorliegen eines Konflikts zwischen einer hohen Arbeitsbereitschaft im Pandemiefall und der gleichzeitigen Vermeidung von Präsentismus bei akuter Atemwegserkrankung. Zur weiteren Unterstützung der Pandemieplanung sollte zukünftige Forschung die Eignung von Interventionen untersuchen, beiden Zielsetzungen zu entsprechen.AbstractIntroductionEmployees are recommended to stay at home when they show symptoms of an acute respiratory infection. Yet, in case of an influenza pandemic another challenge is to promote the employees’ high willingness to report to work. For pandemic planning this raises the question, whether there is a conflict between these two goals.MethodEmployee survey at the urban administration of Dortmund, Germany, about presenteeism with symptoms of an acute respiratory infection and the willingness to report to work during an influenza pandemic.ResultsResults of multivariate linear regression indicated: There is only little association between propensity for presenteeism with symptoms of an acute respiratory infection and willingness to report to work during an influenza pandemic (R2 = 0,024).ConclusionResults did not support the aforementioned conflict of goals between reducing presenteeism with symptoms of an acute respiratory infection and promoting willingness to report to work during an influenza pandemic. Further research should investigate interventions, which will support both goals alike, in order to support pandemic planning.

Research on family planning issues in women with mental disorders

Motherhood and reproductive life are key biographic themes for people with mental disorders with a strong impact on quality of life. Too narrow a focus on motherhood, a lack of focus on the individual perspective and on professional views towards reproductive life are among shortcomings of current research. A broad perspective on family planning is proposed with research issues ranging from the desire for children to the subjective meaning of motherhood and loss of parental rights. Sociological concepts and methods are pertinent.

Stigma and suicidality among suicide attempt survivors: A qualitative study

Abstract Among people with mental illness, stigma experiences can increase suicidality, and suicidality itself is associated with negative stereotypes. Suicide attempt survivors experience both mental illness stigma and suicide stigma, which could contribute to their increased risk for completed suicide. We interviewed 13 suicide attempt survivors regarding experiences and consequences of stigma and identified five stigma-related themes. Stigma led to substantial emotional strain, including loneliness and hopelessness, which are important precursors of suicidality. Our findings suggest that both mental illness stigma and suicide stigma can contribute to suicidality among people with mental illness in general, and in suicide attempt survivors specifically.