BACKGROUNDS. A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on health and wellbeing, there is a lack of research regarding the model called the Psychiatric Rehabilitation Approach from Boston University (BPR).
The aim was to investigate the outcome of the BPR intervention regarding changes in life situation, use of healthcare services, quality of life, health, psychosocial functioning and empowerment.
The study has a prospective longitudinal design and the setting was seven mental health services who worked with the BPR in the county of Halland in Sweden. In total, 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments.
The most significant finding was an improved psychosocial functioning at the follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up. There were significant differences with regard to health, empowerment, quality of life and psychosocial functioning for those who reported that they had mainly/completely had achieved their self-formulated rehabilitation goals compared to those who reported that they only had to a small extent or not at all reached their goals.
Our results indicate that the BPR approach has impact on clients' health, empowerment, quality of life and in particular concerning psychosocial functioning.
Mental disorders are a key cause of sickness absence (SA) and challenge prolonging working careers. Thus, evidence on the development of SA trends is needed. In this study, educational differences in long SAs due to mental disorders were examined in two age groups among employees of the City of Helsinki from 2004 to 2013.
All permanently and temporarily employed staff aged 18-34 and 35-49 were included in the analyses (n=~27800 per year). SA spells of =14 days due to mental disorders were examined annually. Education was classified to higher and lower levels. Joinpoint regression was used to identify major turning points in SA trends.
Joinpoint regression models showed that lower educated groups had more long SAs spells due to mental disorders than those groups with higher education. SA trends decreased during the study period in all studied age and educational groups. Lower educated age groups had similar SA trends. Younger employees with higher education had the fewest SAs.
A clear educational gradient was found in long SAs due to mental disorders during the study period. SA trends decreased from 2004 to 2013.
The growth curves of all nonimmigrant school-age children living in one district of Malmö, Sweden and treated at the Department of Child and Youth Psychiatry during 1983 were investigated. The study group consisted of 40 children. Twenty-five of these children (63%) showed abnormal growth compared to 6 children (15%) with abnormal growth in an age-and sex-matched nonpsychiatric control population (p less than 0.001). A majority of the children with abnormal growth exhibited deviant growth within the first 4 years of life, usually several years before showing any psychiatric symptoms. These results, if borne out by additional studies, may have important clinical applications in the fields of developmental medicine and child psychiatry.
In this article, the author presents the main results of an exploratory clinical study aimed at identifying the adaptation mechanisms used by chronic psychiatric patients. These patients had been treated and followed by an external clinic located in an underprivileged urban environment. Upon the analysis of social worker's observations, the author was able to pinpoint 39 adaptation mechanisms within five areas of daily life: economical, residential, temporal, interpersonal and therapeutic. In conclusion, the author emphasizes on the six operating parameters of these adaptation mechanisms.
The care and treatment of adolescents on an adult acute psychiatric unit in a general hospital can pose serious problems for unit staff. Adolescents with behavior or character problems who prove violent or manipulative can disrupt treatment of both the adolescent and adult patients on the unit. Yet the demand for immediate treatment for many adolescents and the accessibility of general hospital psychiatric units often mean that adolescents may placed there inappropriately. This paper describes how an adult acute unit in a general hospital solved the problems caused by acting-out, manipulative adolescents on the unit. A committee found problems in inappropriate admissions, unworkable treatment plans, management of acting-out behaviors, case disposition, and staff attitudes. Remedies came in the form of more specific admission and discharge guidelines, strict enforcement of those guidelines, staff discussion of treatment plans, an inservice education program, and improved liaison with community facilities for adolescents.
Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13-18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6%). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.
Cites: J Epidemiol Community Health. 2009 Dec;63(12):1043-819666637
Despite a growing literature on social support processes across the life-span, few studies have examined support perceptions in societies undergoing rapid social transition. This study reports data on age, support and mental health from 2672 participants in four former Soviet nations. Results suggest a small but significant decline in overall support across age (r = -.12), with this slope significantly influenced by nationality and gender. Mental health also declines with age (r = -.15), with tangible support having the greatest mediational effect on the age-mental health relationship. These findings are discussed in the light of the continuing economic and social strains influencing the inhabitants of this region.
To explore parents' involvement in the informal and professional care of their young adult child with mental illness. A further aim was to examine concepts in the caring theory of 'Involvement in the light-Involvement in the dark' in the context of mental health care.
Mental illness has increased among young people in high-income countries, and suicide is now the leading cause of death for this group. Because of their disease, these young people may have difficulty in carrying out daily, taken-for-granted, tasks. Consequently, they often become dependent on their parents, and their parents shoulder a considerable responsibility.
A secondary descriptive design with a deductive content analysis was used.
Ten parents who have a son or daughter with long-term mental illness (aged 18-25 years) were interviewed. The deductive analysis was based on the caring theory of 'Involvement in the light-Involvement in the dark'.
The results are described using the following concepts in the theory: 'Knowing', 'Doing', 'Being' and 'Attitude of the health professionals'. The result are to a great extent consistent with the 'Involvement in the dark' metaphor, which describes an isolated involvement in which the parents were not informed, seen or acknowledged by the health professionals. Continuous support by professionals with a positive attitude was described as being of decisive importance for meaningful involvement. The theory's transferability is strengthened to the mental health care context.
Parents have a considerable need for knowledge that can enable them to choose how they should act (be) and what they should do, in order to help and support their child.
Since the patient, the family members and the professionals are mutually dependent, it is important to make use of each other's knowledge in a partnership to achieve a common caring strategy.
As established in several studies, therapists differ in effectiveness. A vital research task now is to understand what characterizes more or less effective therapists, and investigate whether this differential effectiveness systematically depends on client factors, such as the type of mental health problem. The purpose of the current study was to examine whether therapists are universally effective across patient outcome domains reflecting different areas of mental health functioning. Data were obtained from 2 sites: the Research Consortium of Counseling and Psychological Services in Higher Education (N = 5,828) in the United States and from primary and secondary care units (N = 616) in Sweden. Outcome domains were assessed via the Outcome Questionnaire-45 (Lambert et al., 2004) and the CORE-OM (Evans et al., 2002). Multilevel models with observations nested within patients were used to derive a reliable estimate for each patient's change (which we call a multilevel growth d) based on all reported assessment points. Next, 2 multilevel confirmatory factor analytic models were fit in which these effect sizes (multilevel ds) for the 3 subscales of the OQ-45 (Study 1) and 6 subscales of CORE-OM (Study 2) were indicators of 1 common latent factor at the therapist level. In both data sets, such a model, reflecting a global therapist effectiveness factor, yielded large factor loadings and excellent model fit. Results suggest that therapists effective (or ineffective) within one outcome domain are also effective within another outcome domain. Tentatively, therapist effectiveness can thus be conceived of as a global construct. (PsycINFO Database Record