The symptoms, resourcefulness and quality of life in community‐based patients with schizophrenia

Mediating Role of Resourcefulness in the Relationship Between Illness Uncertainty and Poststroke Depression

Objectives

To examine the association between illness uncertainty, resourcefulness, and poststroke depression (PSD) and identifies whether stroke patients' resourcefulness plays a mediating role in the relationship between illness uncertainty and PSD.

Methods

A cross-sectional study was conducted from September 2020 to April 2021. A convenience sample of 355 stroke patients was recruited. A general characteristic questionnaire, the Mishel Uncertainty in Illness Scale, the Resourcefulness Scale (RS), and the Patient Health Questionnaire-9 (PHQ-9) were used to obtain data. Descriptive analysis, Student's t-test, Mann-Whitney U-test, chi-squared test, hierarchical regression analyses, Pearson correlation analysis, and mediation analysis with the PROCESS macro were used to analyze the data.

Results

Illness uncertainty, resourcefulness, and PSD were significantly related to each other. Resourcefulness partially mediated the relationship between illness uncertainty and PSD.

Conclusion

Illness uncertainty and resourcefulness were significantly associated with PSD, and resourcefulness played a mediating role between illness uncertainty and PSD. Interventions designed to reduce illness uncertainty and enhance resourcefulness may contribute to the prevention and improvement of PSD.

Pilot test of a learned resourcefulness program for older family caregivers in Taiwan

Learned resourcefulness, a theory-based education intervention, can be applied to provide strategies to improve the health status and reduce caregiver burden for older family caregivers. We developed a culturally relevant SOURCE program and designed a pilot study to its effect and feasibility for older family caregivers living in Taiwan. Using a quasi-experimental study with one-group, pre-test and post-test design, we recruited a convenience sample of 30 older family caregivers who received home-care services from a regional hospital in southern Taiwan. The older family caregivers participated in and completed the four-week SOURCE program. Effectiveness and feasibility data were collected after the completion of the program. Results indicated that the SOURCE program significantly improved caregiving burden (t = 3.05, p = .005) and revealed that the program was helpful and useful to older family caregivers. The next step will be to use the SOURCE program with more older family caregivers.

Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model

AIMS

To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases.

DESIGN

Descriptive, cross-sectional study design.

METHODS

In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables.

RESULTS

Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life.

CONCLUSION

The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population.

IMPACT

Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.

Feeling safe with patient-controlled admissions: A grounded theory study of the mental health patients' experiences

AIM

To develop a grounded theory of the patients' experiences with patient-controlled admission.

BACKGROUND

Research indicates a potential for involving patients in mental health care, but there is a need to develop and investigate new approaches in health services. Patient-controlled admission is an option for patients with severe mental disorders to refer themselves for a brief hospital admission when needed and thus avoid the usual admission procedure.

DESIGN

Classic grounded theory with generation of a theory based on the constant comparative method for data collection and analysis.

METHODS

Field observations and interviews with 26 mental health patients. The COREQ checklist was followed.

RESULTS

We found that patient-controlled admission induced safety by providing faster access to help and thus preventing further deterioration of symptoms. Being self-determined, achieving calmness and receiving care with support and guidance from professionals during admission contributed to the sense of safety. The familiarity with the mental health professionals in their related units supported the patients in managing their situation. On the other hand, feelings of being overlooked by the professionals and experiencing uncertainty could undermine patients' feeling of safety.

CONCLUSIONS

We demonstrate that safety is a focal point for patients when receiving help and support in mental health care. Patient-controlled admission can induce a feeling of safety both at the hospital and at home. Patients' self-determination is strengthened, and brief admissions give them an opportunity to handle what they are currently struggling with. Professionals can support patients in this, but their actions can also reduce patients' feeling of safety.

RELEVANCE TO CLINICAL PRACTICE

Patient involvement can be introduced in psychiatry, and even severely ill patients seem to be able to assess their own condition. Feasibility may, however, be associated with the attitude and behaviour of the professionals in clinical practice.