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

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.

Bark consumption by voles in relation to mineral contents

Recent field experiments with impregnated wooden sticks have demonstrated a pronounced use by small rodents of mineral supplies, especially sodium, and such findings seemed related to vole damage to forestry seedlings. Consumption of the bark of experimentally introduced aspen twigs and of sodium-impregnated sticks by voles (mainly or onlyMicrotus agrestis) correlated significantly on clear-cuts but not on unmanipulated abandoned fields. Such a correlation appeared when abandoned fields were cut continuously in summer. At vole peak densities, bark of pine seedlings experimentally fertilized with sodium was consumed but not bark of seedlings fertilized with calcium or control seedlings. Field pine seedlings attacked by voles had significantly higher levels of calcium, sodium, and phosphorus than the nearest untouched seedling. However, sodium and phosphorus contents correlated strongly. Sodium and calcium supply to voles in laboratory feeding trials did not diminish the moderate interest in pine bark. Such conditions are, however, assumed to mimic a situation of bark sampling in low-density populations. Sodium, and possibly also calcium, requirements are concluded to be partial determinants of the destructive bark consumption by voles at the peaks of their multiannual population cycles.

The influence of physical environmental qualities on the social climate of supported housing facilities for people with severe mental illness

The study investigates the extent to which the perceived physical environmental quality of housing facilities for people with severe mental illness accounts for perceived social environmental quality. Twenty facilities were assessed by people with psychiatric disabilities (residents), staff, and experts with regard to the physical environmental aspects of visual pleasantness, indirect environmental effects, overall physical quality, and the social environmental indicator of social relationship. The results suggest that residents' and staff's physical environmental quality perception accounts for social relationship quality perception, whereas experts' environmental assessment does not. Moreover, the staff reported a more positive social relationship perception than the residents.

Mental health professionals' attitudes towards people with mental illness: do they differ from attitudes held by people with mental illness?

AIMS

Studies investigating mental health professionals' attitudes towards people with mental illness are scarce and there is a lack of comparative studies including both patients' and mental health professionals' attitudes. The aim of the present study was to investigate mental health staff's attitudes towards people with mental illness and compare these with the attitudes of patients in contact with mental health services. A further aim was to relate staff attitudes to demographic and work characteristics.

METHODS

A cross-sectional study was performed including 140 staff and 141 patients. The study included a random sample of outpatients in contact with mental health services in the southern part of Sweden and staff working in these services. Attitudes were investigated using a questionnaire covering beliefs of devaluation and discrimination of people with a mental illness.

RESULTS

Negative attitudes were prevalent among staff. Most negative attitudes concerned whether an employer would accept an application for work, willingness to date a person who had been hospitalized, and hiring a patient to take care of children. Staff treating patients with a psychosis or working in inpatient settings had the most negative attitudes. Patient attitudes were overall similar to staff attitudes and there were significant differences in only three out of 12 dimensions. Patients' most negative attitudes were in the same area as the staff's.

CONCLUSIONS

This study points to the suggestion that mental health care staff may hold negative attitudes and beliefs about people with mental illness with tentative implications for treatment of the patient and development and implementation of evidence-based services. Since patients and staff in most respects share these beliefs, it is essential to develop interventions that have an impact on both patients and staff, enabling a more recovery-oriented staff-patient relationship.

Friends and symptom dimensions in patients with psychosis: a pooled analysis

BACKGROUND

Having friends is associated with more favourable clinical outcomes and a higher quality of life in mental disorders. Patients with schizophrenia have fewer friends than other mentally ill patients. No large scale studies have evaluated so far what symptom dimensions of schizophrenia are associated with the lack of friendships.

METHODS

Data from four multi-centre studies on outpatients with schizophrenia and related disorders (ICD F20-29) were included in a pooled analysis (N = 1396). We established whether patients had close friends and contact with friends by using the equivalent items on friendships of the Manchester Short Assessment of Quality of Life or of the Lancashire Quality of Life Profile. Symptoms were measured by the Brief Psychiatric Rating Scale or by the identical items included in the Positive and Negative Syndrome Scale.

RESULTS

Seven hundred and sixty-nine patients (55.1%) had seen a friend in the previous week and 917 (65.7%) had someone they regarded as a close friend. Low levels of negative symptoms and hostility were significantly associated with having a close friend and contact with a friend. Overall, almost twice as many patients with absent or mild negative symptoms had met a friend in the last week, compared with those with moderate negative symptoms.

CONCLUSIONS

Higher levels of negative symptoms and hostility are specifically associated with the lack of friendships in patients with psychotic disorders. These findings suggest the importance of developing effective treatments for negative symptoms and hostility in order to improve the probability of patients with schizophrenia to have friends.

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.

The therapeutic relationship and adherence to antipsychotic medication in schizophrenia

Objective

Previous research has shown that a better therapeutic relationship (TR) predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia.

Methods

134 clinicians and 507 of their patients with schizophrenia or a related psychotic disorder participated in a European multi-centre study. A logistic regression model examined how the TR as rated by patients and by clinicians is associated with medication adherence, adjusting for clinician clustering and symptom severity.

Results

Patient and clinician ratings of the TR were weakly inter-correlated (r_s = 0.13, p = 0.004), but each was independently linked with better adherence. After adjusting for patient rated TR and symptom severity, each unit increase in clinician rated TR was associated with an increase of the odds ratio of good compliance by 65.9% (95% CI: 34.6% to 104.5%). After adjusting for clinician rated TR and symptom severity, for each unit increase in patient rated TR the odds ratio of good compliance was increased by 20.8% (95% CI: 4.4% to 39.8%).

Conclusions

A better TR is associated with better adherence to medication among patients with schizophrenia. Patients' and clinicians' perspectives of the TR are both important, but may reflect distinct aspects.

Improving insight in patients diagnosed with schizophrenia and understanding insight from a patient perspective - a mixed methods study

The method Guided Self-Determination (GSD), originally developed and proven effective in difficult diabetes care, has been adjusted to patients with schizophrenia. Currently a randomised controlled study investigates if the method GSD has effect on the outcomes insight, self-esteem, recovery, psychopathology and social functioning when applied in psychiatric care in 3 Assertive Outreach Teams and 3 Psychosis Teams.

As an extension from the RCT we just started a qualitative study using Classic Grounded Theory. The overall approach is a Mixed Methods Approach with a Sequential Explanatory Strategy.

The RCT hypothesize that the method GSD improves both clinical and cognitive insight in patients, measured by Birchwood Insight Scale and Beck Cognitive Insight Scale that both are self-rating scales. Lack of insight into illness is often associated with patients diagnosed with schizophrenia. Also poorer treatment compliance, clinical outcome, social functioning and response to vocational rehabilitation are linked to lack of insight.

In the literature lack of insight is a complex and multi dimensional phenomenon with disagreement on etiology but always described and investigated from health professionals’ perspective. Both insight self-rating scales are also developed by and represent health professionals’ perspective on insight. Apparently it appears that the patients’ perspective and understanding of insight is missing in the literature.

The qualitative study will both aim on identifying patients’ perspective on insight, emerging in a grounded theory and the grounded theory elaborating on the results on clinical and cognitive insight from the RCT.

The poster will illustrate the two designs in a Mixed Methods Approach.

Test-retest reliability of two instruments for measuring public attitudes towards persons with mental illness

BACKGROUND

Research has identified stigmatization as a major threat to successful treatment of individuals with mental illness. As a consequence several anti-stigma campaigns have been carried out. The results have been discouraging and the field suffers from lack of evidence about interventions that work. There are few reports on psychometric data for instruments used to assess stigma, which thus complicates research efforts. The aim of the present study was to investigate test-retest reliability of the Swedish versions of the questionnaires: FABI and "Changing Minds" and to examine the internal consistency of the two instruments.

METHOD

Two instruments, fear and behavioural intentions (FABI) and "Changing Minds", used in earlier studies on public attitudes towards persons with mental illness were translated into Swedish and completed by 51 nursing students on two occasions, with an interval of three weeks. Test-retest reliability was calculated by using weighted kappa coefficient and internal consistency using the Cronbach's alpha coefficient.

RESULTS

Both instruments attain at best moderate test-retest reliability. For the Changing Minds questionnaire almost one fifth (17.9%) of the items present poor test-retest reliability and the alpha coefficient for the subscales ranges between 0.19 - 0.46. All of the items in the FABI reach a fair or a moderate agreement between the test and retest, and the questionnaire displays a high internal consistency, alpha 0.80.

CONCLUSIONS

There is a need for development of psychometrically tested instruments within this field of research.

Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer--occurrence and risk factors

OBJECTIVE

The aim of the study was to assess recto-vaginal fistula (RVF) after anterior resection of the rectum for cancer with regard to occurrence and risk factors.

METHOD

All female patients [median age 69.5 years, Union Internationale centre le Cancer (UICC) cancer stage IV in 10%] who developed a symptomatic RVF (n = 20) after anterior resection of the rectum for cancer from three separate cohorts of patients were identified and compared with those who developed conventional symptomatic leakage (n = 32), and those who did not leak (n = 338). Patient demography and perioperative data were compared between these three groups. Fourteen patient-related and surgery-related variables thought to be possible risk factors for RVF (anastomotic-vaginal fistula) were analysed.

RESULTS

Symptomatic anastomotic leakage occurred in 52 (13.3%) of 390 patients. Twenty (5.1%) had an anastomotic-vaginal fistula (AVF) and 32 (8.2%) conventional leakage (CL). Patients with AVF required unscheduled re-operation and defunctioning stoma as often as those with CL. AVF was diagnosed later and more often after discharge from hospital compared with CL. Patients with AVF had lower anastomoses and decreased BMI compared with those with CL. Risk factors for AVF in multivariate analysis were anastomosis < 5 cm above the anal verge (P = 0.001), preoperative radiotherapy (P = 0.004), and UICC cancer stage IV (P = 0.005). Previous hysterectomy was a risk factor neither for AVF nor for CL.

CONCLUSION

Anastomotic-vaginal fistula forms a significant part of all symptomatic leakages after low anterior resection for cancer in women. Although diagnosed later, the need for abdominal re-operation and defunctioning stoma was not different from patients with CL. Risk factors for AVF included low anastomosis, preoperative radiotherapy and UICC cancer stage IV.

Attitudes towards mental illness among health care students at Swedish universities--a follow-up study after completed clinical placement

The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.

Are stigma experiences among persons with mental illness, related to perceptions of self-esteem, empowerment and sense of coherence?

The aim of the study was to explore the relationship between stigmatizing rejection experiences and self-related variables. Our hypothesis was that rejection experiences would be negatively associated with perceptions of self-esteem, empowerment and sense of coherence. A cross-sectional study assessing rejection experiences, empowerment, sense of coherence and self-esteem was performed, including 200 persons in current or earlier contact with mental health services. The results showed that experiences of rejection were negatively associated with sense of coherence, empowerment and self-esteem. This exploratory investigation suggests that experiences of rejection might be a target for coping interventions. Mental health nurses are in a key position to identify patients' experiences of stigma and by that to understand what consequences of devaluation/discrimination can have for the afflicted.