Sense of mastery in first-episode psychosis-a one-year follow-up study

Introduction

A sense of mastery refers to beliefs about having control over one's life and has been found to protect health and buffer the effect of stressful experiences.

Methods

We investigated sense of mastery in first-episode psychosis (FEP) patients and population controls at baseline and at one-year follow-up. Pearlin and Schooler's Sense of Mastery scale was completed by 322 participants at baseline and by 184 participants at follow-up.

Results

People having experienced FEP reported lower mastery than controls at both time points, but a modest increase was seen in patients at follow-up. The strongest correlates of high baseline mastery in FEP were lower depressive symptoms and higher perceived social support, whereas positive or negative psychotic symptoms did not associate with mastery. Current depressive symptoms also correlated with mastery at the follow-up point, and change in depressive symptoms correlated with change in mastery. Higher mastery at treatment entry predicted remission of psychotic symptoms one year later. Sense of mastery was also found to mediate the association of perceived social support with depressive symptoms.

Discussion

The usefulness of mastery measures should be further tested for estimations of patient prognosis in early psychosis.

One-year follow-up after the time management group intervention Let's Get Organized

BACKGROUND

Time management skills are essential to maintain occupations in everyday life. People with neurodevelopmental or mental disorders often experience persistent difficulties with managing time and organizing daily life, consequently, there is a need to establish interventions with sustainable results.

AIM

The aim was to perform a one-year post-intervention follow-up after the intervention Let's Get Organized (LGO-S) for people with neurodevelopmental or mental disorders.

METHODS

The study is a one-year follow-up of a single group pre-test-post-test design. Thirty-eight persons with difficulties in time management due to neurodevelopmental or mental disorders participated. Instruments to collect data were Assessment of Time Management Skills; Weekly Calendar Planning Activity and the Satisfaction with Daily Occupations instrument. Wilcoxons's signed-rank test was used to compare data over time.

RESULTS

There were no significant differences in the participants' outcomes between post-intervention and one-year follow-up in time management skills and regulation of emotions, satisfaction with daily occupations, and global satisfaction. A significant improvement could be seen in the subscale organization and planning at the one-year follow-up compared to post-intervention.

CONCLUSIONS

Improvements in time management skills, organization, and planning, regulation of emotions, and satisfaction with daily occupations after the LGO-S can be maintained in the long term.

Cross-Cultural Adaptation, Validation and Reliability of the Spanish Satisfaction with Daily Occupations-Occupational Balance (SDO-OB): An Evaluation Tool for People with Mental Disorders

Occupation can be defined as all activities that occupy a person's time. The Satisfaction with Daily Occupations and Occupational Balance instrument evaluates the perceived satisfaction with performance and the balance in time dedicated to different occupations. The main aim was to translate the original instrument to Spanish and examine and establish the psychometric properties. This is a quantitative, cross-sectional study conducted in two stages: translation and cultural adaptation (forward translation, expert panel, back-translation, second expert panel and pre-testing and cognitive interviewing) and collecting data to evaluate psychometric properties (homogeneity, construct validity, known-groups validity, and floor/ceiling effects). One hundred participants took part in the study, adults with a diagnosis of a mental health disorder and adults without any known health problems. The Spanish version showed known-groups validity, acceptable internal consistency, and construct validity, although the relationships with some of the indicators of discriminant validity were somewhat higher than expected. The instrument shows promise as a useful screening tool for assessing activity level and satisfaction with daily occupations among a Spanish speaking population.

An exploration of occupational choices in adolescence: A constructivist grounded theory study

BACKGROUND

Adolescence is a critical period within the life course, for developing adult occupational competencies and health behaviours. Few studies have considered how 16-17 year olds choose activities and behaviours from an occupational perspective.

AIM AND OBJECTIVES

To explore how adolescents aged 16-17 years old make choices about their daily occupations to inform a theoretical model of occupational choice.

MATERIALS AND METHODS

About 27 secondary school students aged 16-17 years attended one of six focus groups. Transcripts were analyzed using constructivist grounded theory, informing the iterative development of a theoretical model of occupational choice.

RESULTS

Adolescent occupational choice occurred in response to experiencing needs, and was characterized by 'weighing up' and 'juggling' the following four key domains: 'Appraising values and priorities', 'Interacting with the situational context', 'Exploring skills and occupational repertoire' and 'Considering time factors'. A developing sense of responsibility and autonomy for occupational choices was described, leading to the development of the future occupational self.

CONCLUSIONS AND SIGNIFICANCE

A theory illuminating how adolescents make choices was developed. The theory aligns with existing developmental literature and provides unique insights, from an occupational science perspective, on the conscious process by which adolescents make, develop and adapt choices about the occupations they do considering contextual and individual opportunities and constraints.

Navigating in a Misty Landscape - Perceptions of Supporting a Relative Residing in Supported Housing for People with a Psychiatric Disability

The aim was to explore informal carers' perceptions of supporting the everyday life of a relative who has a psychiatric disability and resides in supported housing (SH). A qualitative study based on interviews with 12 informal carers was performed, and the data was analyzed with qualitative content analysis. The theme "Navigating in a misty landscape when striving to support a relative with a psychiatric disability" was identified, encompassing four categories pertaining to residents' needs, collaboration, environmental issues and the carer's situation. SH services can be enhanced by addressing informal carers' experiences and developing greater collaboration involving informal carers, residents and staff.

Mental health consumers’ perspectives on using an occupation-focused assessment to initiate change in everyday activities

Introduction

Engagement in meaningful activities is central to recovery for people with mental health conditions. The aim of this study was to examine the utility of an occupation-focused assessment, the Daily Experiences of Pleasure, Productivity, and Restoration Profile, as a means to guide engagement in meaningful activity.

Methods

Eight consumers who were receiving services from a community-based behavioural health centre utilized the Profile to set and work towards self-identified goals. Data derived from audiotaped sessions, notes, and a focus group were analysed using an iterative content analysis process.

Results

Three themes emerged: completion of the Profile was ‘burdensome, but right on’, moving from insights gained to choosing and working towards a goal required guidance from the therapist, and insights gained from the Profile supported some changes in actions and perspectives.

Conclusion

The findings support preliminary utility of the Daily Experiences of Pleasure, Productivity, and Restoration Profile to guide engagement in meaningful activity among people living with mental health conditions. Moreover, the support and guidance of the occupational therapist is critical. Continued examination of the use of the Profile is warranted to help support occupational therapy’s role in promoting recovery for people with mental health conditions through meaningful activities.

Nonmedical Interventions for Schizophrenia: A Review of Diet, Exercise, and Social Roles

Schizophrenia is a major mental illness with a disease course that is influenced by lifestyle. The risk-benefit ratio for alternative interventions is more favorable than for antipsychotics in long-term treatment. Dietary interventions may target autoimmune features, vitamin or mineral deficiencies, abnormal lipid metabolism, gluten sensitivity, or others. Examples of interventions involving diet, physical activity, or physical processes or social interventions including talk therapy exist in the literature. Notwithstanding, the general utility of these types of interventions remains inconclusive, awaiting long-term randomized trials. A perspective that separates the cause of the disease from its symptoms may be helpful in treatment planning and is warranted to distinguish between short-term and long-term recovery goals.

Perceived occupational value in people with acquired brain injury

BACKGROUND

It is well known that engagement in occupations becomes restricted after acquired brain injury (ABI), but little is known about how this influences occupational values and occupational balance.

AIM

To describe the extent to which persons with ABI perceived occupational value; to explore whether occupational value and occupational balance were associated with life satisfaction, and to explore how occupational value, occupational balance, the severity of disability, fatigue and sociodemographic characteristics influenced life satisfaction.

MATERIALS AND METHODS

A cross-sectional study was undertaken with 75 participants of working age with ABI who responded to questionnaires on occupational value, occupational balance, and life satisfaction. Additionally, instruments covering fatigue and severity of disability were administered. Data were analyzed by means of comparisons, correlations and logistic regression.

RESULTS

A high perceived occupational value and a high perceived occupational balance were significantly associated with satisfaction with life as a whole, psychological health and somatic health. The logistic regression showed that occupational value, occupational balance and severity of disability significantly impacted satisfaction with life as a whole.Conclusions and significance: Occupational value and occupational balance together with severity of disability, are important areas of focus in the later phase of rehabilitation after ABI to promote satisfaction with life as a whole.

Construct Validity and Reliability of the Comprehensive Occupational Therapy Evaluation Scale (COTES) in People With Schizophrenia

OBJECTIVE

We evaluated the construct validity (i.e., unidimensionality and convergent validity) and Rasch reliability of the 20-item Comprehensive Occupational Therapy Evaluation Scale (COTES) in people with schizophrenia.

METHOD

Retrospective chart review was used to collect COTES data from 505 inpatients with schizophrenia. For construct validity, we first examined unidimensionality of each of the three COTES subscales using Rasch analysis. After unidimensionality was supported, we examined convergent validity using Pearson's r and Rasch reliability of the individual subscales.

RESULTS

After deleting two misfitting items, the remaining items (i.e., the COTES-18) showed unidimensionality. Infit and outfit mean squares were 0.73-1.25. Moderate correlations were found among the three COTES-18 subscales (rs = .57-.71). The Rasch reliabilities of the three subscales were .83-.92.

CONCLUSION

The COTES-18 has sufficient construct validity and reliability to assess three specific dimensions of behavior affecting occupational performance in people with schizophrenia.

Associations Between Meaning of Everyday Activities and Participation Among Children

IMPORTANCE

The subjective meaning that people attach to their occupations may explain the association among participation, health, and well-being. To date, the subjective meaning of occupation among children has mostly been studied through qualitative studies. No study has yet quantitatively assessed the perceived meaning of everyday activities among children. Moreover, no study has assessed the associations between perceived meaning and actual participation.

OBJECTIVE

To explore the perceived meaning-value, challenge, felt time, and autonomy-that typically developing children attribute to their everyday activities and to assess the correlations between children's perceived meaning and their participation as assessed by parents.

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

A convenience sample of 60 Israeli children (ages 6-12 yr) and their parents.

OUTCOMES AND MEASURES

Parents completed the Children Participation Questionnaire-School, and children completed the Perceived Meaning of Occupation Questionnaire (PMOQ).

RESULTS

Children valued their activities, they perceived the challenge as low, they felt that the time was almost equally distributed between time passing quickly and passing slowly, and they felt autonomous. The subjective perceived meanings were moderately correlated with the children's actual participation.

CONCLUSIONS AND RELEVANCE

Children are capable of reflecting on the meaning of their everyday activities. The PMOQ may assist occupational therapy practitioners in eliciting their young clients' perspectives regarding their everyday occupations. The results contribute to the occupational science literature in the context of child development.

WHAT THIS ARTICLE ADDS

The PMOQ enables children to reflect on their subjective perceived meanings of occupations. The subjective perceived meanings of occupations are moderately correlated with the children's actual participation. The PMOQ may broaden the potential pathways to facilitating children's meaningful participation in everyday occupations.

Predictors of clinically important improvements in occupational and quality of life outcomes among mental health service users after completion and follow-up of a lifestyle intervention: multiple regression modelling based on longitudinal data

BACKGROUND

Balancing Everyday Life (BEL) is a new activity-based lifestyle intervention for mental health service users. An earlier study found BEL to be effective in increasing occupational engagement, occupational balance, activity level, and quality of life scores when compared with a care-as-usual group. However, it is unclear whether care context and socio-demographic, clinical and self-related factors at baseline also influence the results. Thus, the aim of the current study was to explore whether such factors could predict clinically important improvements in occupational and quality of life aspects.

METHODS

Participants were interviewed and filled out self-report questionnaires before starting the 16-week intervention (n = 133), upon completion (n = 100), and 6 months following (n = 89). Bi-variate and multi-variate statistical analyses were performed.

RESULTS

Several baseline factors were associated with clinically important improvements, but few predictors were found in the multivariate analyses. Having children was found to be a predictor of improvement in occupational engagement at BEL completion, but reduced the chance of belonging to the group with clinically important improvement in activity level at follow-up. Regarding occupational balance, having a close friend predicted belonging to the group with clinically important improvement in the leisure domain. At BEL completion, other predictors for improvements were female gender for the self-care domain, and self-esteem for the home chores domain. At follow-up, psychosocial functioning and lower education level predicted general balance. None of the factors explored in this study were found to be predictors for improvements in quality of life.

CONCLUSIONS

Few of the studied care context, socio-demographic, clinical and self-related factors were found to predict clinically important improvements in occupational engagement, activity level, occupational balance, or QOL. This study, together with previous studies showing positive results, suggests that BEL can be an appropriate intervention in both community and clinical settings, and can support improvement in occupational aspects and QOL for participants with diverse socio-demographic, clinical, and self-related characteristics.

TRIAL REGISTRATION

This study is part of a larger research project that is registered at ClinicalTrials.gov. Reg. No. NCT02619318.

Everyday Occupations and Other Factors in Relation to Mental Well-Being among Persons with Advanced Parkinson's Disease

This cross-sectional study investigated performed activities and the level of satisfaction with everyday occupations among people (n = 67) with advanced Parkinson's disease (PD), and how these factors and experiences of social relationships were related to mental well-being. Managing one's hygiene and physical exercises were activities that the majority still performed, whereas few were engaged in work or other productive occupations. Perceived health problems and satisfaction with everyday occupations were important factors for mental well-being since satisfaction with everyday occupations may be an important focus for occupational therapists and other health professionals when supporting mental well-being among persons with advanced PD.

The effects of clinical illness severity and physical activity on health-related quality of life in schizophrenia

BACKGROUND

Quality of life is an important clinical outcome in individuals with schizophrenia. Illness severity and physical activity (PA) were independently reported to influence health-related quality of life (HRQoL) in people with schizophrenia. This study attempts to examine the intensity and types of PA and their impact on HRQoL, as well as the relative contributions of illness severity, PA, and sedentary behavior (SB) to HRQoL in people with schizophrenia.

METHODS

Demographic information was collected from 297 community-dwelling individuals with schizophrenia. Severity of illness was assessed on the Clinical Global Impression-Severity (CGI-S); PA and SB were assessed on the Global Physical Activity Questionnaire (GPAQ); HRQoL was assessed on the RAND-36. Regression analyses were conducted to examine the impact of different types and intensities of PA on HRQoL, and the relative impact of CGI-S, GPAQ-PA, and GPAQ-SB on HRQoL.

RESULTS

Most participants had low PA level, and travel is the main type of PA adopted. Leisure time, travel-related, work-related, moderate-, and vigorous-intensity PA were all not associated with HRQoL. Lower severity of illness was significantly associated with better physical (PHC), mental (MHC) and global (GHC) health composites of the RAND-36 (GHC: t = - 5.628, p < 0.001, PHC: t = - 4.026, p < 0.001, MHC: t = - 5.534, p < 0.001). Both PA and SB were not significantly associated with PHC, MHC, and GHC.

CONCLUSION

Severity of illness has a significant impact on HRQoL in people with schizophrenia. However, we found no evidence to support the association between physical activity and sedentary behavior with HRQoL.

The Daily Experiences of Pleasure, Productivity, and Restoration Profile: A case study: Étude de cas sur l'utilité du Daily Experiences of Pleasure, Productivity, and Restoration Profile

BACKGROUND

Occupational therapy enables clients to self-manage their health through the use of occupation; however, additional occupation-focused assessments are needed to capture people's subjective experiences associated with everyday activities as awareness of one's experiences can help promote change.

PURPOSE

This qualitative case study explored the utility of one such assessment, the Daily Experiences of Pleasure, Productivity, and Restoration Profile (PPR Profile).

METHOD

Five spousal caregivers completed and discussed the PPR Profile with an occupational therapist. Interviews with the caregivers and therapist occurred during and following use. Content analysis revealed several themes.

FINDINGS

Both caregivers and the occupational therapist reported that use of the PPR Profile provided benefits but not without challenges.

IMPLICATIONS

The findings support preliminary utility of the PPR Profile; however, additional research is needed and occupational therapists need to be aware of the challenges when deciding to use the tool.

Satisfaction with Daily Occupations for Elderly People (SDO-E)-Adaptation and Psychometric Testing

Satisfaction with everyday occupations has been shown to be important for health and well-being in various populations. Research into satisfaction with everyday occupations among elderly persons is, however, lacking. The aim was to investigate the psychometric properties of an adapted test version of the Satisfaction with Daily Occupations instrument (SDO) for elderly people, called SDO-E. Five hospital-based occupational therapists working with elderly people evaluated the content validity and usability of the SDO-E. The elderly participants consisted of 50 people from outside of the health services and 42 inpatients at an internal medicine clinic. They completed the SDO-E and rated their perceived health, activity level, and general satisfaction with daily occupations. The SDO-E showed fair content validity and utility, acceptable internal consistency, good preliminary construct validity and relevant known-groups validity. The SDO-E thus appears to be a useful screening tool for assessing activity level and satisfaction with daily occupations among elderly people, and a complement to other self-report instruments concerning factors connected with health and well-being. Future research should further explore the content validity of the SDO-E, particularly the views of the elderly themselves, and investigate the SDO-E in terms of sensitivity to change.

Well-being and perceptions of everyday activities among those who attend community-based day centres for people with mental illness in Sweden - Does an immigrant background make a difference?

BACKGROUND

Community-based day centres (CBDCs) for people with mental illness are a common service for both people with an immigrant background and native Swedes.

AIM

The aim was to compare CBDC attendees with an immigrant background with attendees who were native Swedes in terms of well-being and perceptions of everyday activities and investigate whether ethnic background could predict these factors.

METHODS

Attendees at nine CBDCs were invited to participate. In all, 56 with an immigrant background and 69 native Swedes completed self-report questionnaires that addressed various aspects of well-being and everyday activities.

RESULTS

Attendees with an immigrant background had a worse situation regarding perceived self-esteem, empowerment and satisfaction with everyday activities. In multivariate logistic regression analyses, ethnic background only became a significant predictor in regard to empowerment. Quality of life and activity level were of importance for satisfaction with everyday activities. Empowerment and self-esteem mutually influenced each other.

CONCLUSION

Having a mental illness and an immigrant background may infer a particular risk for low empowerment. The mental health services and society at large should consider measures for adjusting the support to this group, including an analysis of how environments and contexts may act as barriers to activity enrichment and culturally congruent support.

Staff ratings of occupational engagement among people with severe mental illness - psychometric properties of a screening tool in the day center context

Background

Staff who plan and organize day center activities may need to observe the attendees’ performance and progression. This led us to develop a tool for that purpose, termed General Occupational Engagement in people with Severe mental illness (GOES). The aim was to investigate its psychometric properties in terms of factor structure, internal consistency, corrected item-total correlations (CITC), convergent and discriminant validity, and test-retest stability.

Methods

Ninety-three day center attendees were assessed by the GOES and instruments addressing constructs hypothesized to be either similar to (activity level, motivation for day center attendance, perceptions of the worker role, hours spent in the day center) or divergent from the GOES (attendees’ ratings of engagement in specified occupations, self-rated health, psychosocial functioning, psychiatric symptoms). A second sample of 41 attendees were included for the test-retest analysis. Exploratory factor analysis, Cronbach’s alpha analysis, Pearson correlations and paired-samples t-tests were performed.

Results

Exploratory factor analysis indicated one factor, which was in line with the intentions of the scale. The alpha value was 0.85 and all CITC were above 0.30. The tests for convergent validity resulted in correlations ranging between 0.23 and 0.47, most of which were moderately strong and mainly confirmed the hypotheses. Discriminant validity was clearly indicated, since all correlations with the selected constructs were <0.20. GOES also showed preliminary test-retest stability (r = 0.32).

Conclusions

The GOES is ready for use in rehabilitation services and research where productive and other types of activities are of interest. It may serve as an important supplement to attendees’ self-reported occupational engagement.

Occupational balance in health professionals in Sweden

BACKGROUND

Health care employees are often women, a group that has high degrees of sick leave and perhaps problems attaining occupational balance. However, people think differently about their everyday activities and it is therefore important to take their perceptions into account but occupational balance has not yet been measured in health professionals. The aim was to describe occupational balance in three different samples of health professionals in Sweden. A further aim was to investigate whether occupational therapists (OTs) rate their occupational balance differently from other health professionals.

MATERIAL AND METHOD

Four hundred and eighty-two health professionals, employees in public dentistry, mental health care and OTs, aged 21-70 years participated. The participants' occupational balance was measured using the occupational balance questionnaire (OBQ).

RESULTS

The ratings of occupational balance were similar to earlier studies and did not differ significantly between the samples. The OTs' occupational balance was also similar to that of the other health professionals.

CONCLUSION

The similarities in occupational balance indicate the same difficulties in attaining it.

SIGNIFICANCE

The result highlights the possibility that working people face similar difficulties in achieving occupational balance. Further research is warranted about how to attain it.

Programme characteristics and everyday occupations in day centres and clubhouses in Sweden

BACKGROUND

Meaningful everyday occupations are important for mental health and recovery and are provided by both community-based day centres (DCs) and clubhouses. It is unknown, however, if any of the two has more recovery-promoting features.

OBJECTIVE

This nine-month longitudinal study compared DC and clubhouses, concerning the users' perceptions of unit and programme characteristics, and aspects of everyday occupations in terms of engagement and satisfaction. Stability over time in these respects, as well as motivation for participation and relationships with occupational engagement and satisfaction, were explored.

METHODS

Participants from 10 DCs (n = 128) and 5 clubhouses (n = 57) completed self-report instruments.

RESULTS

DC attendees rated lower levels on two organizational factors; choice and ability to influence decisions, and the unit's social network. Motivation showed to be an important factor for perceived occupational engagement, which did not differ between the two groups. DC attendees were more satisfied with their everyday occupations at baseline, but that factor increased more in the clubhouse group and there was no group difference at follow-up. The unit and programme characteristics and occupational engagement showed stability over time.

DISCUSSION

Clubhouses seemed more advantageous and DC services may consider developing users' opportunities for choice and decision-making, and peer support.

An exploratory study into the application of psychological theories and therapies in Australian mental health occupational therapy practice: Challenges to occupation-based practice

BACKGROUND

While legitimate practice tools have been the subject of debate within the profession, little attention has been paid to psychological frames of reference (PFsOR). Hence, this article explores the ways psychological theories and therapies shape occupation-based practice in mental health settings.

METHODOLOGY

Narrative inquiry methods and thematic analysis were used to explore the career stories of nine occupational therapists who had worked in mental health practice for more than five years.

FINDINGS

Respondents found it difficult to hold onto their occupational focus in the psychology-dominated world of mental health practice. The main themes to emerge were (i) tension between occupation and psychology; (ii) overwhelming pressures to adopt PFsOR; (iii) resistance to PFsOR; and (iv) using PFsOR to enhance professional repertoires. Findings pointed to the need to ensure PFsOR include occupational considerations for occupation-based practice in mental health.

CONCLUSION

A occupation-based perspective means balancing PFsOR with occupation-based considerations, so service-user issues are holistically addressed. There is a need to critically review occupational therapists' use of PFsOR lest their most visible practical actions appear psychologically based rather than occupation based.

Young people with psychiatric disabilities and their views of day centres

Young people with psychiatric disabilities may require support in structuring their everyday life. To learn more about the relevance of day centres in this respect, this study aimed to examine the experiences of young people with psychiatric disabilities. A particular focus was on the perceptions of meaningful occupation when visiting day centres, their reasons for not choosing this option when given it and what they desired instead. A qualitative design based on individual interviews was used. Twelve women and eight men between 18 and 35 years, with a need for organized daily occupations, participated as informants. Qualitative content analysis revealed three categories: 'Being in a context', 'Balancing between developing and stagnating', and 'Longing for something more'. The findings indicated that the occupations were inherently age neutral, as were the possibilities for socializing. There was a desire for more activities in the community and more support for engaging in occupations that other young people did. A major issue in the accomplishment of this was the need to earn money, and the lack of opportunities for doing that in the day centre context was a considerable drawback. The findings highlight the importance of identifying young people's views when designing day centres.

Occupations, perceived stress, and stress-related disorders among women and men in the public sector in Sweden

BACKGROUND

Stress-related disorders are a public health problem and represent a significant burden to individuals and society. It is, therefore, of importance to regard stress in a wider context and identify risk factors not only at work but in all occupations in everyday life, to prevent ill health.

AIM/OBJECTIVE

The aim of this study was to examine potential associations between everyday occupations, perceived stress, and stress-related disorders as well as potential gender differences.

MATERIAL AND METHODS

A survey was mailed to a random selection of 3481 employees in the public sector in Western Sweden. Cox regressions with constant time at risk were used, in order to calculate prevalence ratios (PR) and their 95% confidence intervals (CI).

RESULTS

The results showed a clear association between reporting imbalance between different everyday occupations and both perceived stress and stress-related disorders among men and women.

CONCLUSION

Imbalance between different everyday occupations seems to be an important risk factor for perceived stress and stress-related disorder among both women and men.

SIGNIFICANCE

To enable people to achieve balance between different everyday occupations may be a useful way to prevent stress, stress-related disorders, and sick leave, and to promote better health and well-being.

Perception of occupational balance by people with mental illness: A new methodology

Aims The aims were to (i) investigate initial construct validity of a tool for assessment of time allocation in occupational balance, and (ii) describe perceived occupational balance and its relationship with socio-demographics, well-being, and personal recovery among people with mental illness. Methods Satisfaction with Daily Occupations and Occupational Balance (SDO-OB) was administered to 226 persons. SDO-OB reflects balance in five occupational domains: work, leisure, home chores, self-care, and overall occupational balance. Indicators for assessing construct validity were: satisfaction with everyday occupations, occupational value, symptom severity, and psychosocial functioning. For the second aim, the data collection included socio-demographics, life quality, self-esteem, self-mastery, and personal recovery. Results Occupational balance ratings indicated the participants were either under-occupied or in balance. Few were over-occupied. Feeling in balance was related to greater well-being and recovery compared with being under-occupied. Risk factors for under-occupation were younger age (in relation to work), and higher education (in relation to overall balance). Conclusions Associations with the indicators suggest initial construct validity. The SDO-OB is promising for assessment of occupational balance among people with mental illness. Being under-occupied was detrimental to well-being and recovery, and this indicates the importance of offering more occupational opportunities for people with mental illness.

Interdisciplinary residential treatment of posttraumatic stress disorder and traumatic brain injury: effects on symptom severity and occupational performance and satisfaction

OBJECTIVE. This study examined outcomes of an 8-wk residential treatment program for veterans with posttraumatic stress disorder (PTSD) and a history of traumatic brain injury (TBI). METHOD. Twenty-six veterans completed the Canadian Occupational Performance Measure, Clinician-Administered PTSD Scale, Beck Depression Inventory-2nd Edition, and PTSD Checklist before and after treatment. RESULTS. Veterans demonstrated significant improvements in occupational performance and satisfaction with their performance, as well as in PTSD and depression symptom severity after residential PTSD/TBI treatment. Additionally, improvements in occupational performance and satisfaction were associated with decreases in depression symptom severity. CONCLUSION. Although preliminary, results suggest that veterans with PTSD and a history of TBI experienced significant decreases in PTSD and depression symptom severity and improvement in self-perception of performance and satisfaction in problematic occupational areas. Changes in occupational areas and depression symptom severity were related, highlighting the importance of interdisciplinary treatment.

Work experiences among attendees of day centres for people with psychiatric disabilities

BACKGROUND

It is possible that people with psychiatric disabilities who visit day centres have previous work experiences that may be seen as resources for their current engagement in day centre activities. Research in this respect seems to lack, however.

OBJECTIVE

To investigate work experiences among attendees at day centres for people with psychiatric disabilities and relationships with current type of day centre (work-oriented, meeting place-oriented or mixed), engagement in day centre activities, motivation and socio-demographic and health-related factors.

METHODS

Seventy-seven attendees responded to questionnaires. Global Assessment of Functioning, GAF, was also used. Work was categorised into Group I (professionals, semi-professionals), Group II (clerical support, services workers) and Group III (e.g. craft workers, elementary occupations).

RESULTS

Almost everyone had previously had open-market employment; more than half for ≥ 10 years. Group I was more common in mixed centres, Group II in meeting place-oriented ones and Group III in work-oriented ones. Group I more frequently had college degree and was rated high on GAF functioning. Women were over-represented in Group II, and men in Group III and in meeting place-oriented centres. Attending mixed centres was more likely when having a college degree, scoring high on GAF functioning and being highly engaged in activities. Attendees at work-oriented day centres were characterised by being motivated for spending time alone and reporting a diagnosis of psychosis.

CONCLUSIONS

The participants had unused working capacity. No clear-cut relationships were found between work experiences and the investigated correlates.

User-perceived utility of the Daily Experiences of Pleasure, Productivity, and Restoration Profile

BACKGROUND

Awareness of the relationship between everyday occupations and subjective experience could help clients make changes that promote health.

PURPOSE

This study evaluated user-perceived utility of the Daily Experiences of Pleasure, Productivity, and Restoration Profile (PPR Profile), a time-use survey designed to uncover users' experiences of pleasure, productivity, and restoration and to promote awareness of how these experiences are related to daily occupations.

METHOD

Eighteen participants completed the PPR Profile on 2 days within I week and were subsequently interviewed. Content analysis was used to uncover themes.

FINDINGS

Analysis revealed that completion of the PPR Profile requires time and energy, completion more than once is useful, and the PPR Profile contributes to awareness. Four subthemes of awareness were identified: awareness of the here and now, insights into one's occupations, context matters, and what is and what might be.

IMPLICATIONS

Results support the utility of the PPR Profile to promote users' awareness of their occupations and related subjective experiences. This awareness may encourage positive change. Further research is recommended to continue to evaluate the PPR Profile's clinical utility.

Adding quality to day centre activities for people with psychiatric disabilities: Staff perceptions of an intervention

AIM

To evaluate an intervention aimed at enriching day centres for people with psychiatric disabilities by exploring staff experiences from developing and implementing the intervention.

METHOD

Each staff group developed a tailor-made intervention plan, following a manual, for how to enrich the day centre. They received supervision and support from the research team. The study was based on focus-group interviews with a total of 13 staff members at four day centres. Narrative analysis with a thematic approach was used. A first round resulted in one narrative per centre. These centre-specific narratives were then integrated into a common narrative that covered all the data.

RESULTS

A core theme emerged: User involvement permeated the implementation process and created empowerment. It embraced four themes forming a timeline: "Mix of excitement, worries and hope", "Confirmation and development through dialogue, feedback and guidance", "The art of integrating new activities and strategies with the old", and "Empowerment-engendered future aspirations".

CONCLUSION

The users' involvement and empowerment were central for the staff in accomplishing the desired changes in services, as were their own reflections and learning. A possible factor that may have contributed to the positive outcomes was that those who were central in developing the plan were the same as those who implemented it.

The Satisfaction with Daily Occupations (SDO-13) Scale: Psychometric Properties among Clients in Primary Care in Sweden

This article describes the results to expand and develop the use of the Satisfaction with Daily Occupations (SDO-13) Scale. Data were collected in primary care before (I) and after intervention (II) among clients with stress-related disorders and musculoskeletal pain. The Cronbach's alpha values of the SDO-13 Scale were 0.80 and 0.88. Convergent validity was assessed against global occupational satisfaction and general health, resulting in rs = -0.65 (p < 0.001) and rs = -0.46 (p < 0.001). The SDO-13 Scale could not discriminate between the primary care sample and a psychiatric sample (p = 0.15), whereas number of current occupations could (p < 0.001). The SDO-13 was not sensitive to change (p = 0.92). Future studies need to explore criterion and construct validity based on more dissimilar samples and more standardized interventions. Applications of these results to practice are discussed.

Sources of meaning derived from occupational engagement for people recovering from mental illness

Introduction

Engagement in meaningful occupations is of central importance in mental health recovery. The purpose of this study was to gain a richer understanding of the relationships between occupations, sources of meaning and recovery for people living with mental illness.

Method

People living with mental illness ( n = 78) attending an Australian Clubhouse completed the recovery assessment scale and socially valued role classification scale. Qualitative and quantitative data were analysed using mixed methods.

Findings

The most meaningful occupations were those most likely to provide opportunities for social connection and being valued by others. The frequency with which these socially derived sources of meaning were identified far outweighed other sources: positive sense of self; skills/personal development; time use/routine; financial gain and fun/pleasure. Neither the occupations identified as most meaningful nor the source of meaning differed depending on level of recovery.

Conclusion

Irrespective of stage of recovery, socially derived aspects of meaning are most frequently prioritized by people living with mental illness. In facilitating engagement in personally meaningful occupations, occupational therapists need to understand that, for many, meaningfulness centres around inter-dependence: being with others, belonging, giving or contributing and being valued by others.

Satisfaction with daily occupations amongst asylum seekers in Denmark

AIM

The aim of this study was to describe asylum seekers' satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related to their satisfaction with daily occupations and activity level.

METHODS

A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social information were used as well as Assessment of Motor and Process Skills.

RESULTS

The results showed a low level of satisfaction with daily occupations at both baseline and follow-up. There was no statistically significant change in satisfaction or activity level between baseline and the follow-up. Associations between AMPS process skills--education, worst pain and activity level--were present at baseline, as was a relationship between AMPS process skills and satisfaction. At follow-up, associations between WHO-5 and satisfaction and activity level and between MDI scores and activity level were found.

CONCLUSION

Asylum seekers experience a low level of satisfaction with daily occupations, both at arrival and after 10 months in an asylum centre. There is a need for further research and development of occupation-focused rehabilitation methods for the asylum seeker population.

Factors influencing occupational engagement in day centers for people with psychiatric disabilities

Occupational engagement is a vital factor in people's lives since it has been shown to be important for health and well-being. Community-based day centers (DCs), both meeting place-oriented and work-oriented ones, are common service alternatives in many western countries for enabling engagement in productive and leisure occupations among people with psychiatric disabilities. Little is, however, known about factors influencing occupational engagement in such settings. We aimed to investigate how factors pertaining to day center attendance, socio-demographics, motivation, clinical and self-related characteristics were related to how day center attendees rated their occupational engagement in productive occupations. These variables were assessed among day center attendees in meeting place-oriented (n = 39) and work-oriented (n = 54) DCs in Sweden through questionnaires and interviews. Logistic regression models showed that (1) less general psychopathology and more time spent on day center occupations were indicators of belonging to the group with a high level of occupational engagement according to a median cut; (2) higher perceived self-mastery was the only important factor with respect to ratings of occupational engagement above the third quartile. The models may be seen as creating a stepwise indication on which factors are important for reaching a medium level of occupational engagement (less severe general psychopathology and time spent at the day center) and for reaching a still higher level (a high level self-mastery), respectively, of occupational engagement. The findings may also be discussed in relation to different levels of engagement in a recovery process.

Psychometric properties and factor structure of the 13-item satisfaction with daily occupations scale when used with people with mental health problems

Background

In mental health care practice and research it is increasingly recognized that clients’ subjective perceptions of everyday occupations, such as satisfaction, are important in recovery from mental illness. Instruments thus need to be developed to assess satisfaction with everyday occupations. The aim of the present study was to assess psychometric properties of the 13-item Satisfaction with Daily Occupation (SDO-13) when used with people with mental health problems, including its internal consistency, factor structure, construct validity and whether the scale produced ceiling or floor effects. An additional question concerned if the factor structure varied whether the participants were, or were not, presently engaged in the activity they rated.

Methods

The interview-based SDO-13 includes items pertaining to work/studies, leisure, home maintenance, and self-care occupations. Whether the person currently performs an occupation or not, he/she is asked to indicate his/her satisfaction with that occupation. The SDO-13 was completed with 184 persons with mental illness. Residual variables were created to remove the variation linked with currently performing the targeted occupation or not and to assess the factor structure of the SDO-13. The indicators of general satisfaction with daily occupations, self-esteem and global functioning were used to assess construct validity. The statistical methods included tests of homogeneity, confirmatory factor analysis and Pearson correlations.

Results

The internal consistency was satisfactory at 0.79. A three-factor solution indicated that the construct behind the SDO-13 was composed of three facets; Taking care of oneself and the home, Work and studies, and Leisure and relaxation. The same factor structure was valid for both original scores and the residuals. An expected pattern of correlations with the indicators was mainly found, suggesting basic construct validity. No ceiling or floor effects were found.

Conclusions

Taken together, the findings suggest the SDO-13 is a reliable and robust instrument that may be used to get an overview of the satisfaction people living with mental illness derive from their daily occupations.

A scoping review of time-use research in occupational therapy and occupational science

BACKGROUND

Time use is a defining interest within occupational therapy and occupational science. This is evident through the range of contributions to the disciplinary knowledge base. Indeed it has been suggested that time-use methods are amongst the most established research techniques used to explore aspects of human occupation. However, the extent and nature of such activity in occupational therapy and occupational science has not been examined to date.

AIM

This study sought to map the extent and nature of time-use research in occupational therapy and occupational science journals and the extent to which studies explored the relationship between time-use and health.

METHOD

A scoping review method was used.

RESULTS

Sixty-one studies were included. Scandinavian countries contributed the largest number of studies (n = 16, 26%). While time-use diaries were used most frequently (n = 30, 49%) occupational therapists and occupational scientists have developed a range of data-collection instruments. Forty-nine studies (80%) focused on time-use in clinical or defined population sub-groups. Ten studies (16%) included an empirical examination of the relationship between time-use and health.

CONCLUSION

Future research should examine time-use and health amongst well populations across the lifespan and in different parts of the world.

Women's perceptions of everyday occupations: outcomes of the Redesigning Daily Occupations (ReDO) programme

AIMS

The aim was to (i) assess the outcomes of the 16-week Redesigning Daily Occupations (ReDO) programme for women on sick leave due to stress-related disorders, in terms of occupational value, satisfaction with everyday occupations, and participation level; (ii) investigate the relationships between those outcomes and return-to-work rate.

METHODS

A total of 42 women receiving ReDO and 42 receiving care as usual (CAU) were included in a matched-control study with measurements before and after the rehabilitation. Seventy-eight participated on both occasions. They completed self-report questionnaires regarding the aforementioned outcomes. Return-to-work data were obtained from the registers of the Social Insurance Offices.

RESULTS

Increases in concrete, symbolic, and self-reward values were found in both groups, but no statistically significant difference between the groups was demonstrated. The ReDO group improved more than the CAU group, however, on satisfaction with everyday occupations and participation level. Occupational value, but not satisfaction with everyday occupations, was related to return to work.

CONCLUSIONS

Everyday occupations were shown to be relevant outcomes after work rehabilitation. They could play an important role in future development of profession-specific evidence of occupational therapy. Further support was obtained for viewing occupational value and satisfaction with everyday occupations as theoretically distinct phenomena.

Effectiveness of an intervention to improve day centre services for people with psychiatric disabilities

Background/aim

Day centres for people with psychiatric disabilities need to be evaluated for effectiveness in order to provide the best possible support. This study aimed at investigating the effectiveness of a tailor-made intervention to improve day centre services for people with psychiatric disabilities.

Methods

The intervention was devised to bridge identified gaps in the services and lasted for 14 months. Eight centres were allotted to the intervention (55 attendees) or comparison condition (51 attendees). Fidelity to the intervention and major events in the day centres were assessed. The outcomes were degree of meaningfulness found in the day centre occupations, satisfaction with the rehabilitation received, satisfaction with everyday occupations and quality of life.

Results

The fidelity to the intervention was good, but more positive events, such as new occupational opportunities, had taken place in the comparison units. No differences were identified between the intervention and the comparison group regarding changes from baseline to the 14-month follow-up in perceived meaningfulness among day centre occupations, satisfaction with everyday occupations or quality of life.

Conclusions

The intervention seemed ineffective, but the positive events in the comparison group resembled the measures included in the tailor-made interventions. This first intervention study in the day centre context has hopefully helped to generate hypotheses and methods for future research.

A prospective longitudinal study testing relationships between meaningful activities, basic psychological needs fulfillment, and meaning in life

The current study used a prospective longitudinal design to determine whether change in meaningful activity over an 11-month period could help explain change in meaning in life in a sample of 174 undergraduate and graduate students. The Engagement in Meaningful Activities Survey, Basic Psychological Needs Scales (i.e., autonomy, competence, relatedness), and the Meaning in Life Questionnaire were used as indicators of the constructs of meaningful activity, basic psychological needs fulfillment, and meaning and purpose in life. The findings were in support of the study hypotheses and indicated that change in meaningful activity explained both change in basic psychological needs fulfillment (i.e., autonomy, competence, relatedness) and change in meaning in life. Further, this study reports findings consistent with results from cross-sectional studies in support of the hypothesis that change in meaningful activity may influence change in meaning in life through two pathways: a direct path of influence from meaningful activity to meaning in life and an indirect path through change in basic psychological needs fulfillment. The current study contributes to a growing literature implicating subjective evaluations of day-to-day action (or meaningful activity) as a fruitful means for exploring relationships between occupation and well-being.

Psychometric evaluation of the Danish version of Satisfaction with Daily Occupations (SDO)

AIMS

The Satisfaction with Daily Occupations (SDO) scale assesses satisfaction within the domains of work, leisure, domestic tasks, and self-care. The aim was to investigate the psychometric properties of the Danish version of the SDO when used with asylum seekers.

METHODS

The participants were 93 Danes without known ill health and 43 asylum seekers. They completed the SDO and rated their perceived health, activity level, and general satisfaction with daily occupations. Translation into Danish and back-translation into Swedish was made by professional interpreters.

RESULTS

Internal consistency was α = 0.75 for the Danish sample and α = 0.79 for the asylum seekers. The SDO distinguished between asylum seekers and the Danish sample, suggesting criterion validity. Concurrent validity, analysed against general satisfaction with daily occupations, was indicated for both samples. Discriminant validity was indicated against self-rated health for both samples and against activity level for the Danish sample. There was, however, a correlation of 0.65 between the SDO satisfaction score and activity level for the asylum seekers.

CONCLUSION

The SDO exhibited satisfactory internal consistency and criterion and concurrent validity. The findings regarding discriminant validity were somewhat inconclusive. The Danish SDO may be regarded as psychometrically sound but further psychometric testing is needed.

Predictors of valued everyday occupations, empowerment and satisfaction in day centres: implications for services for persons with psychiatric disabilities

This study addresses predictors of occupational value, empowerment and satisfaction with the rehabilitation received in day centres for people with psychiatric disabilities. These outcomes represent varying aspects of relevance for the day centre context and together create a manifold outcome picture. This was a longitudinal study with approval from the regional research vetting board. Self-report instruments were used, and the investigated predictors motivation for going to the day centre, occupational engagement, socio-demographic factors and self-reported diagnosis. Attendees (N = 108) at 8 day centres participated and filled in self-report questionnaires regarding the predictor and outcome variables. A baseline measurement and a 14-month follow-up composed the data. Occupational engagement at baseline could predict all three outcomes at the follow-up. Motivation for the day centre activities and not preferring work before attending the day centre were positive for satisfaction with the day centre. A low participation rate, although comparable with previous studies on the target group, was a limitation of this study. To conclude, both occupational engagement and motivation are factors that can be stimulated by the staff in day centres. Actions for how to accomplish that, and thereby also more positive outcomes of the day centre services, are proposed, such as a system of freedom of choice among day centres, and between day centres and supported employment.

The Gutenberg Health Study: measuring psychosocial factors at work and predicting health and work-related outcomes with the ERI and the COPSOQ questionnaire

Background

Several instruments have been developed to assess psychosocial workload. We compared two of these instruments, the Effort-Reward Imbalance (ERI) model and the Copenhagen Psychosocial Questionnaire (COPSOQ) with regard to congruent validity and internal validity.

Methods

This analysis is based on a population-based sample of the baseline examination of 2,783 employees from the Gutenberg Health Study (GHS). About half of the participants completed the ERI questionnaire (n = 1,342), the other half completed the COPSOQ (n = 1,441). First, the two samples were compared and descriptive analyses were carried out calculating mean values for both instruments in general, then separately for age, gender and main occupational groups. Second, we analyzed the relationship between ERI and COPSOQ scales on the workplace situation and on the workplace outcomes: job satisfaction, general health, burnout, satisfaction with life, by applying stepwise logistic regression analysis.

Results and discussion

For the majority of occupations, high effort as reflected by the ERI corresponded with high demands as reflected by the COPSOQ. Comparably, high reward (according to ERI) yielded a good agreement with high “influence and development” (according to COPSOQ). However, we could also find differences between ERI and COPSOQ concerning the intensity of psychosocial workload in some occupations (e.g., physicians/pharmacists or warehouse managers/warehousemen/transport workers). These differences point to differing theoretical concepts of ERI and COPSOQ. When the ability of ERI and COPSOQ was examined to determine the associations with health and work outcomes, burnout could be better predicted by the COPSOQ; this might be due to the fact that COPSOQ comprises the constructs “work-privacy conflict” and “emotional demand”, which are closely related to burnout. However, methodological differences between these instruments limit their direct comparability.

Conclusions

The ERI and COPSOQ instrument yielded similar results for most occupational groups. The slightly stronger association between psychosocial workload as assessed by COPSOQ and burnout might be explained by its broader approach. The ability of the ERI and COPSOQ instrument to reflect relevant risk factors for clinically manifest disorders (e.g., coronary heart disease) will be derived from subsequent prospective analyses of the GHS with the follow-up data.

Client-centred practice in occupational therapy: critical reflections

AIMS

The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices.

MAJOR FINDINGS

Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power.

PRACTICE CONCLUSION

Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.

Associations between women's subjective perceptions of daily occupations and life satisfaction, and the role of perceived control

BACKGROUND/AIM

More knowledge is needed about the role of perceived control in the associations between different perceptions of daily occupations and positive health outcomes. The aim was to explore the associations between different subjective perceptions of daily occupations, in terms of occupational balance, occupational meaning, occupational value and satisfaction with occupations, and life satisfaction, and the role of perceived control in those associations.

METHODS

A questionnaire including questions about perceptions of daily occupations, perceived control and life satisfaction were answered by a random sample of 488 middle-aged Swedish women. Multiple logistic regression analysis was used to test the associations between perceptions of daily occupations and life satisfaction, and the role of perceived control.

RESULTS

After adjustments for perceived control women who perceived a high level of satisfaction with work and leisure, occupational balance, occupational meaning and occupational value perceived greater life satisfaction than the other women. Perceived control was not significant in the model.

CONCLUSIONS

It seems that occupational balance and occupational meaning were pivotal for the women's life satisfaction, but satisfaction with work and leisure, as well as perceived occupational value, was also of importance. The assumption that perceived control would have a role in the association between perceptions of occupations and life satisfaction was not confirmed.

SIGNIFICANCE OF THE STUDY

The results indicate that occupational therapists need to focus on occupational balance, occupational meaning, occupational value and satisfaction with work and leisure to promote positive health outcomes, in terms of life satisfaction, when working with middle-aged female clients.

Loss of activities and its effect on the well-being of substance abusers

AIMS

Participation in everyday activities positively influences well-being, but few have studied how participation in activities influences well-being among patients with substance use disorders. The authors examined the number of past, recent, and desired future activities of patients being admitted to five units for inpatient substance abuse treatment at a Norwegian university hospital.

MAJOR FINDINGS

The total number of activities had dropped significantly compared with before the respondents started abusing substances, and the respondents desired an increase in activities in the future. A lower level of well-being as measured by the WHO-5 was predicted by a more pronounced drop in number of activities from past to recent and by more severe use of alcohol and other substances. Principal conclusion. Substance abuse is associated with a change in number of activities. Losing activities may contribute to a decrease in well-being. Helping substance abuse patients regain positive activities could improve well-being.

[Revisiting the therapeutic experience in a psychiatric day hospital six months after discharge: path and perceptions of people with mental disorders]

This article presents a qualitative study on the therapeutic experience in a psychiatric day hospital six months after discharge. The study explores the impact of this experience on the lives of people with mental disorders. A qualitative design using semi-structured individual interviews was completed with 18 participants six months after their discharge of a day hospital. Results showed that the day hospital experience was particularly helpful to improve symptoms and relationship with self. It activated a self-transformational process that continued afterwards. Termination created for many, an abrupt void. Issues at stake during the first six months were continuity of care, social support and maintaining skills and knowledge acquired.