Tommy Björkman

Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care

Stigma and discrimination have been identified as important obstacles to the integration of people with mental illness in society. In efforts to reduce stigma and discrimination, health professionals play an important role as they have frequent contact with and responsibility for treatment and rehabilitation of consumers. The aim of the present study was to investigate attitudes towards mental illness and people with mental illness among nursing staff working in psychiatric or somatic care. The sample consisted of 120 registered or assistant nurses who were interviewed about intimacy with mental illness and attitudes about seven different mental illnesses. The results showed that nursing staff in somatic care, to a higher degree than nursing staff in mental health, reported more negative attitudes with regard to people with schizophrenia as being more dangerous and unpredictable. In contrast, professional experience, intimacy with mental illness and type of care organization were found to be more associated with attitudes to specific mental illnesses concerning the prospect of improvement with treatment and the prospect of recovery. In conclusion, attitudes among nursing staff are in several respects comparable with public opinions about mental illness and mentally ill persons. In order to elucidate if negative attitudes about dangerousness and unpredictability of persons with specific mental illnesses are associated with realistic experiences or with prejudices further studies with a qualitative design are suggested.

Quality of life in people with severe mental illness. Reliability and validity of the Manchester Short Assessment of Quality of Life (MANSA)

The Manchester Short Assessment of Quality of Life (MANSA) is a short interview, which has received a recent interest in research investigating quality of life in people with mental illness. In the present study, the Swedish version of MANSA is examined with regard to reliability, in terms of internal consistency and construct validity. Ninety-two persons with severe mental illness were interviewed regarding quality of life, social network, psychosocial functioning, psychiatric symptoms, needs for care, empowerment and experiences of stigma. Internal consistency was adequate (alpha = 0.81). Positive correlations were found between MANSA and social network, empowerment and psychosocial functioning, and negative correlations with psychopathology, number of needs for care, perceived devaluation and discrimination, and rejection experiences. Social network, psychosocial functioning and beliefs of devaluation and discrimination altogether explained 67% of the variance in quality of life. The Swedish version of MANSA showed a satisfactory reliability in terms of internal consistency. The construct of validity of the scale was satisfactory insofar as associations with validation measures were of considerable magnitude and in expected directions.

The assessment of needs in psychiatric patients. Interrater reliability of the Swedish version of the Camberwell Assessment of Needs instrument and results from a cross-sectional study

The assessment of needs has been put forth as an important dimension in both the planning, development and evaluation of psychiatric services. A needs assessment tool for routine use should ideally be brief, not require additional staff, be valid and reliable with respect to setting, gender and culture, and also be sensitive to changes in needs and differences in needs between subgroups of patients. In this study, the interrater reliability of the Swedish version of the Camberwell Assessment of Needs instruments (CAN), measuring needs in 22 areas, was investigated in a cross‐sectional sample consisting of 119 psychiatric inpatients and outpatients. The prevalence and severity of needs, prevalence of unmet needs, as well as current help received was also investigated. The interrater reliability of the instrument was found to be good both measured as total percentages of agreement in ratings, where an agreement of 80 % or above was found in 90% of the comparisons, and as measured by Cohens kappa. Predominant needs in the sample were in addition to clinical needs concerning psychological distress and psychotic symptoms, social needs such as the need for company, daytime activities and information concerning condition and treatment. The CAN seems to be a instrument with a high interrater reliability also when used under routine conditions as in this study. It also seems to have a high degree of feasibility with regard to different types of patients and settings and a sensitivity concerning differences in needs in subgroups of patients.

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.

Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence

AIMS AND OBJECTIVES The aim of this study was to investigate how a lifestyle intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities. BACKGROUND Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at lifestyle interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities. DESIGN A cluster randomised controlled trail. METHODS Forty-one persons with a DSM-IV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12-month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance. RESULTS A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up. CONCLUSIONS Structured activities in the form of lifestyle intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence. RELEVANCE TO CLINICAL PRACTICE Improving physical health with lifestyle programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

Physical health—a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff

The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities, and their caregivers. Their satisfaction with the intervention was also assessed. Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known. Few randomized controlled trials have been aimed specifically at lifestyle issues among persons with a psychiatric disability. This trial includes clients with psychiatric disabilities living in supported housing and their staff. Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005–2006 in Sweden. The supported housing facilities with residents and staff were randomly assigned to either a health intervention programme or a control programme with an aesthetic content. The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c, P-glucose, P-insulin, lipids, blood pressure, physical working capacity, body mass index, Heart Score were investigated and participants’ satisfaction assessed. There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up. The participants expressed satisfaction with the programme. The results indicate that health interventions on lifestyle issues when involving carers are appreciated, feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities.

Stigma, discrimination, empowerment and social networks: a preliminary investigation of their influence on subjective quality of life in a Swedish sample.

Background: Studies investigating the importance of social network, empowerment and experiences of stigma on subjective quality of life among persons with mental illness are rare. Aim: This study aimed to investigate beliefs of devaluation/discrimination, actual rejection experiences, empowerment, social network and the relationship of these factors to subjective quality of life among subjects with mental illness. Methods: A cross-sectional study assessing beliefs of devaluation/discrimination, actual rejection experiences, empowerment, social network and subjective quality of life was performed on 150 subjects with mental illness. Results: The factors most prominently related to subjective quality of life were overall empowerment and overall social network. For a subgroup of subjects suffering from psychotic disorders there was a significant negative relationship between subjective quality of life and rejection experiences. This group also reported more frequent rejection experiences. Conclusion: The findings indicate that persons with mental illness are a heterogeneous group with regard to the influence of social network, stigma and empowerment on subjective quality of life. The negative impact of actual rejection experiences might express that, in order to increase subjective quality of life, stigma must be addressed as a separate and important factor in its own right.

Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial

Background The outcome of less intensive case management services, such as the strengths model, is still inconclusive, which suggests a need for more controlled studies. The aim of the present study was to investigate the outcome of a strengths model of case management service (SCM) compared to standard care. Methods Seventy-seven clients with a mental illness and a serious impairment in functioning in social contacts, housing or work situation were randomly allocated to SCM or standard care. Outcome was assessed with regard to use of psychiatric services, changes in symptomatology, psychosocial functioning, social network, needs for care, quality of life and client satisfaction with care. The follow-up period was 36 months. Results The results showed a greater reduction in needs for care in clients receiving SCM. No differences in clinical or social outcome were shown. Clients receiving SCM also used significantly less days in psychiatric inpatient services and were generally more satisfied with the psychiatric services offered. Conclusions SCM failed to improve clinical and social outcome compared to standard care, but was more successful in reducing days spent in hospital, and the clients were also more satisfied with the service compared to standard care.

Empowerment in supported employment research and practice: Is it relevant?:

Background: This cross-sectional study is aimed at describing and investigating empowerment and its relationships with level of engagement in daily activities and community life, experienced stigma, psychopathology, and quality of life among people with mental illness entering supported employment. Method: The following scales were administered to 120 persons: Empowerment Scale, Profiles of Occupational Engagement Scale, Manchester Short Assessment of Quality of Life Scale, Rejection Experience Scale and Brief Psychiatric and Rating Scale. Results: Higher scores of empowerment were associated with fewer symptoms and experienced stigma, a higher level of engagement in daily activities and community life, better quality of life and having work rehabilitation. Self-efficacy and self-esteem were in particular significantly correlated to depressive symptoms. Descriptive statistics enveloped the group of participants that said ‘Yes I want to work’ with a somewhat high mean score for empowerment, level of engagement and quality of life, but a low mean score with regard to both symptoms and experienced stigma. Conclusions: This study advocates the importance of evaluating empowerment in supported employment research and practice. The findings suggest the importance of taking into account not only monetary aspects of having a job but also social and psychological aspects such as empowerment, reduction in experienced stigma and community integration.

Quality of life of the mentally ill. Reliability of the Swedish version of the Lancashire Quality of life profile

There has been a growing interest in the quality of life (QoL) of the mentally ill, subsequently a number of instruments to measure QoL have been developed. One of the measures of QoL which has received considerable attention is the Lancashire QoL Profile (LQOLP). The present study investigated test-retest reliability and internal consistency in the Swedish translation of the LQOLP using a cross-sectional sample of 29 inpatients. The results showed that test-retest reliability of subjective life satisfaction in the nine life domains covered by the LQOLP was satisfactory in seven of the domains, and acceptable in two (social relations and religion). Test-retest reliability for total subjective satisfaction score, global well-being, and an interviewer rated QoL were all on a satisfactory level (r > 0.80). The internal consistency and homogeneity of the total subjective QoL scale and the nine life domain subscales was satisfactory except for the social relations scale, where it was somewhat low.