1
|
Jackson K, Kaner E, Hanratty B, Gilvarry E, Yardley L, O'Donnell A. Understanding people's experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study. Addiction 2024; 119:268-280. [PMID: 37778755 DOI: 10.1111/add.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/23/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND AIMS Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice. DESIGN Semi-structured qualitative interviews underpinned by the methodology of interpretive description. SETTING North East and North Cumbria, UK. PARTICIPANTS Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score). MEASUREMENTS Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression. FINDINGS Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) 'lack of recognition' of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having 'nowhere to go' to access relevant treatment and care and (3) 'supporting relational autonomy' as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals' differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation. CONCLUSIONS Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship between alcohol use and depression and formal care provision that does not acknowledge people's social and economic context, including their intrinsic need for relational support, may contribute to distress and limit their capacity to get well.
Collapse
Affiliation(s)
- Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Faulkner A, Kelly K, Gibson S, Gillard S, Samuels L, Sweeney A. Respect for the journey: a survivor-led investigation of undergoing psychotherapy assessment. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1803-1811. [PMID: 33517488 PMCID: PMC10628034 DOI: 10.1007/s00127-020-02017-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Psychotherapy assessments are key decision points for both clients and services, carrying considerable weight on both sides. Limited research indicates that assessments have immediate and long-term impacts on clients, particularly where trauma has been experienced, affecting engagement with therapy. Understanding assessments from clients' perspectives can inform service development and improve client experience. METHODS This is a survivor-led exploration of clients' experiences of undergoing assessment for talking therapies. Interviews were conducted with seven people who had undergone assessment for psychological therapies in third sector and NHS services. Interviews were recorded, transcribed and analysed thematically. RESULTS The core theme was 'respect for the journey' reflecting the need expressed by participants for their life experiences prior to the assessment to be given full respect and consideration. Six sub-themes were identified: trauma and desperation, fear of judgement, search for trust and safety, sharing and withholding (a balancing act), feeling deconstructed, and finding hope. CONCLUSIONS The findings highlight the heightened emotional power surrounding psychotherapy assessments, reflecting the journey participants had undertaken to reach this point. The dilemma facing clients at the heart of an assessment-how much to share and how much to withhold-demonstrates the importance for services and assessors of treating the journey a client has made to the assessment with care and respect. Findings indicate the value of services and practitioners undertaking a trauma-informed approach to assessment encounters.
Collapse
Affiliation(s)
| | - Katie Kelly
- Tower Hamlets Early Intervention for Psychosis Service (THEIS), East London NHS Foundation Trust, London, E2 6BF, UK
| | | | - Steve Gillard
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Lana Samuels
- PEER, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Angela Sweeney
- Service User Research Enterprise, King's College London, London, SE5 8AF, UK.
| |
Collapse
|
3
|
Flett GL, Casale S, Stoakes A, Nepon T, Su C. Mattering, substance use, and addictive behaviors: review, analysis, and implications for treatment and prevention. J Ethn Subst Abuse 2023:1-34. [PMID: 37733489 DOI: 10.1080/15332640.2023.2218283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
In the current article, we examine mattering to others as a relational resource and discuss how feelings of not mattering are uniquely implicated in addiction and substance use. We describe the mattering construct and how it is conceptualized, and we comprehensively review existing evidence based primarily on research with adolescents that links feelings of not mattering with addictive tendencies in general, and specific tendencies (e.g., excessive drinking and drug use and excessive social media use). A central premise of this article is the need to take race and ethnicity into account when considering the potential link between feelings of not mattering and substance use among young people with minority status and various ethnicities who may be especially prone to feeling marginalized and insignificant as a result of adverse experiences reflecting being ostracized and not socially accepted. Potential models of drinking and addictive tendencies that can easily incorporate the mattering construct are also outlined to underscore the conceptual relevance of feelings of not mattering to others. Mattering is also considered in terms of how internalization (i.e., not mattering to oneself) potentiates impulsive and risky behavior. Our article concludes with discussion of the implications for treatment and prevention in addiction and substance use and directions for future research that should further illuminate the role of feelings of not mattering to others and not mattering to oneself.
Collapse
Affiliation(s)
| | | | | | | | - Chang Su
- York University, Toronto, Canada
- Brandon University, Brandon, Canada
| |
Collapse
|
4
|
Fox S. […] you feel there’s nowhere left to go: the barriers to support among women who experience substance use and domestic abuse in the UK. ADVANCES IN DUAL DIAGNOSIS 2020. [DOI: 10.1108/add-09-2019-0010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Domestic abuse victimisation is a common experience among women with problematic substance use, but support provision for both issues is siloed within the UK. Research on the topic focuses on practitioner responses, dominating women’s voices within research, policy and practice. As such, knowledge about women’s experiences of help-seeking is missing. This study therefore aims to fill a gap in knowledge by exploring the lived experiences of supporting seeking among women impacted by domestic abuse and substance use.
Design/methodology/approach
Semi-structured interviews were conducted with 12 women who had a history of co-occurring problematic substance use and domestic abuse. Influenced by interpretive phenomenological analysis and feminist research praxis, the study explored how women with dual needs navigated support and help seeking and the barriers they faced.
Findings
The women reported the biggest barrier was the disconnect between substance use and domestic abuse support, including a gap in the communication of information. This resulted in them having to choose which of their needs to seek support for. None of the women received support for their combined experiences, and most of the women never received support for their domestic abuse experiences alone.
Originality/value
This is the first piece of research from the UK to explore, in-depth, women’s journey through support for their co-occurring substance use and domestic abuse victimisation. Previous research has not consulted with women to understand how they navigate the complex support systems available. This paper is, therefore, important, because it demonstrates the journeys to services these women take and the barriers they have to overcome.
Collapse
|
5
|
Peña-Salazar C, Simó Algado S, Pons i Baños J, Arrufat FX, Valdés-Stauber J. Life Trajectories of Suicide Attempt Survivors. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819847100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Judit Pons i Baños
- University of Vic–Central University of Catalonia, Vic, Spain
- Osona Salut Mental, Vic, Spain
| | | | | |
Collapse
|
6
|
F. Carreno D, Pérez-Escobar JA. Addiction in existential positive psychology (EPP, PP2.0): from a critique of the brain disease model towards a meaning-centered approach. COUNSELLING PSYCHOLOGY QUARTERLY 2019. [DOI: 10.1080/09515070.2019.1604494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - José Antonio Pérez-Escobar
- Chair of History and Philosophy of Mathematics, Department of Humanities, Social and Political Sciences, ETH Zürich, Zurich, Switzerland
| |
Collapse
|
7
|
Abstract
PURPOSE To illuminate long-term experiences of mental illness from both research and autobiographical accounts. DESIGN A literature review of English-language papers, 1950-2014, relating to the experience of long-term mental illness indexed in AgeInfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, PsycEXTRA, and PsychINFO. FINDINGS Twenty-five research papers and nine autobiographic accounts met the review criteria. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research Implications: There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length-of-time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the Western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples' perspectives. PRACTICAL IMPLICATIONS Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence-based services cannot be provided if we do not have an holistic understanding of long-term mental illness. Social Implications: This review questions our ability to provide effective support for those experiencing long-term mental illness, in particular older people and different cultural perspectives. ORIGINALITY/VALUE There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.
Collapse
Affiliation(s)
- Elizabeth Collier
- a University of Salford , School of Health & Society , Salford , United Kingdom
| | - Maria J Grant
- a University of Salford , School of Health & Society , Salford , United Kingdom
| |
Collapse
|
8
|
When structural violences create a context that facilitates sexual assault and intimate partner violence against street-involved young women. WOMENS STUDIES INTERNATIONAL FORUM 2018. [DOI: 10.1016/j.wsif.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Sorsa MA, Kiikkala I, Åstedt-Kurki P. Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities. ADVANCES IN DUAL DIAGNOSIS 2018. [DOI: 10.1108/add-11-2017-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose
Mothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis.
Design/methodology/approach
This is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps.
Findings
Engagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed.
Originality/value
Engagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.
Collapse
|
10
|
Sigurdardottir S, Halldorsdottir S, Bender SS, Agnarsdottir G. Personal resurrection: female childhood sexual abuse survivors’ experience of theWellness-Program. Scand J Caring Sci 2015; 30:175-86. [DOI: 10.1111/scs.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 03/17/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | - Sigridur Halldorsdottir
- Faculty of Graduate Studies; School of Health Sciences; University of Akureyri; Akureyri Iceland
| | - Soley S. Bender
- Research and Development regarding Sexual and Reproductive Health; School of Health Sciences; University Hospital; University of Iceland; Reykjavik Iceland
| | | |
Collapse
|
11
|
Sorsa MA, Åstedt-Kurki P. Lived experiences in help-seeking from the perspective of a mother with a dual diagnosis. Int J Qual Stud Health Well-being 2013; 8:20316. [PMID: 23965985 PMCID: PMC3749368 DOI: 10.3402/qhw.v8i0.20316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 11/14/2022] Open
Abstract
Mothers with a co-occurring mental illness and substance abuse (dual diagnosis) use numerous different services. Help-seeking and engagement are complex processes which have not yet been sufficiently conceptualized. A descriptive phenomenological approach was used to explore these experiences from different service contexts and to describe the decisions in and structure of help-seeking over a 13-year period. Four in-depth interviews were conducted and data were analysed with a descriptive phenomenological method developed by Giorgi. The essential meaning structure is an inner conflict within the client, including a realization that change starts from within. The essential meaning structure combines the other meaning structures: disbelief of receiving help and admitting the need for help, keeping up the perfect façade and the risk of total collapse, being given and making own choices regarding care and being forced to use services and inner emptiness and search for contentment in life. It is possible that clients in the help-seeking process do not always recognize they have a need for care. If the client experiences inner powerlessness as emptiness and resistance to being helped, it is probably not possible to create relationships with care providers. Clients may have several ambiguous inner processes which prevent them from accepting the need for care. Theoretically and empirically a long-term approach is crucial, since the inner transformative processes take time. The services can contribute new experiences to the personal level of understanding and decision-making, if they consider the experiential level of their clients.
Collapse
Affiliation(s)
- Minna A Sorsa
- School of Health Sciences, Nursing Science, University of Tampere and Finnish Doctoral Programme in Nursing Science, Tampere, Finland.
| | | |
Collapse
|
12
|
The relationship between forgiveness, spirituality, traumatic guilt and posttraumatic stress disorder (PTSD) among people with addiction. Psychiatr Q 2013; 84:11-26. [PMID: 22585109 DOI: 10.1007/s11126-012-9223-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes.
Collapse
|
13
|
Sigurdardottir S, Halldorsdottir S. Repressed and silent suffering: consequences of childhood sexual abuse for women’s health and well-being. Scand J Caring Sci 2012; 27:422-32. [DOI: 10.1111/j.1471-6712.2012.01049.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Langman L, Chung MC. The relationship between forgiveness, spirituality, traumatic guilt and posttraumatic stress disorder (PTSD) among people with addiction. THE PSYCHIATRIC QUARTERLY 2012. [PMID: 22585109 DOI: 10.1007/s11126–012-9223–5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes.
Collapse
Affiliation(s)
- Louise Langman
- Faculty of Health, Education and Society, School of Social Science and Social Work, University of Plymouth, Plymouth, UK
| | | |
Collapse
|
15
|
Marchetti CA. Regret and police reporting among individuals who have experienced sexual assault. J Am Psychiatr Nurses Assoc 2012; 18:32-9. [PMID: 22262496 DOI: 10.1177/1078390311431889] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sexual assault (SA) and the underreporting of SA are highly prevalent in the United States. Since regret is a complex, negative emotion linked to decision making, studying regret within the context of reporting SA is important. OBJECTIVE To describe decisional regret regarding SA reporting. DESIGN A cross-sectional, descriptive study design was used. The sample included 78 individuals, aged 18 to 25 years, who experienced SA during the past 5 years and completed an electronic questionnaire. A multiple regression model was generated to describe how selected independent variables explain variation in levels of regret. RESULTS In the final model, four independent variables accounted for 33.3% (adjusted R (2)) of the variation in regret: weight change, stranger assailant, professional treatment, and police reporting. CONCLUSIONS The findings inform clinical practice by describing post-decisional regret about the reporting of SA, and they provide a foundation to develop strategies (e.g., decision aids) that can assist clinicians to help patients as they struggle to make difficult health care decisions.
Collapse
|
16
|
Villena ALD, Chesla CA. Challenges and struggles: lived experiences of individuals with co-occurring disorders. Arch Psychiatr Nurs 2010; 24:76-88. [PMID: 20303448 DOI: 10.1016/j.apnu.2009.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 03/09/2009] [Accepted: 04/15/2009] [Indexed: 11/27/2022]
Abstract
Approximately 20 million people have substance abuse disorder in a given year, and approximately 7-10 million of them will have co-occurring disorders (CODs) of both mental illness and substance abuse. Individuals with COD have higher rates of other chronic health problems (i.e., diabetes) and multiple rehospitalizations and overutilize emergent services. Despite their elevated risk for physical morbidities, there is a dearth of literature that focuses on the impact for those with COD of having multiple physical health disorders. The purpose of this interpretive study was to understand, describe, and illustrate the social and structural barriers that individuals with COD of mental illness, substance abuse, and general medical conditions encounter in regard to their health care. A purposive sampling of 20 individuals with COD (11 men and 9 women; 65% African American) were recruited from community treatment centers and supportive housing sites. Social and structural barriers to managing medical health conditions while living with COD were identified in three realms: (a) in having interpersonal relationships with health care providers, (b) in negotiating an arduous health care "system," and (c) in trying to manage health conditions while living in unstable shelter.
Collapse
|
17
|
Vandermause R, Wood M. See my suffering: women with alcohol use disorders and their primary care experiences. Issues Ment Health Nurs 2009; 30:728-35. [PMID: 19916806 DOI: 10.3109/01612840903230081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite global initiatives to improve the primary care of 2.5 million US women meeting criteria for alcohol use disorders (AUD), many women with serious problems are unseen, misunderstood, misdiagnosed, or ignored. This interpretive phenomenological study explored the meaning of the primary care experience for a small group of women with self-identified AUD. Interviews uncovered suffering. Subsuming themes of Presenting My Damaged Self and Being Silenced/Being Heard revealed potential interventions for primary care practitioners. Analyzed alongside extant literature on suffering, these findings complement and enhance recent important research in the area of diagnosis of and intervention for AUD in primary care.
Collapse
Affiliation(s)
- Roxanne Vandermause
- Washington State University, College of Nursing, P. O. Box 1495, Spokane, WA 99210-1495, USA.
| | | |
Collapse
|
18
|
Abstract
Violence remains highly problematic for women. Women diagnosed with schizophrenia are at particularly high risk for numerous types of violence. Many of these women receive services in the community through mental health case managers. These case managers have developed ongoing and close relationships with women, and are often the front-line service providers to assist them in negotiating with physical, mental, and social service agencies. This interpretive phenomenological study examined the perspective of mental health case managers to better understand how they cope with the intersection of violence with a diagnosis of schizophrenia among their clientele. Accepting and forsaking was a theme developed to describe how case managers gradually accepted violence in the lives of women with schizophrenia, and how this acceptance was eventually coupled with forsaking hope for a reduction or elimination of violence in women's lives.
Collapse
Affiliation(s)
- Elizabeth Rice
- University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
19
|
|
20
|
Abstract
A theoretical framework that explains how survivors of childhood sexual abuse tell others about their abuse experiences is presented. Data are drawn from open-ended interviews conducted with 74 individuals who experienced ongoing childhood sexual abuse by a family member or close acquaintance. Grounded theory methods were used to develop the framework. The psychosocial problem shared by the participants is that childhood sexual abuse both demands and defies explanation. The core psychosocial process used in response to this problem is storying childhood sexual abuse. The framework includes five processes, and the stories associated with each process vary in their nature and function. The processes and associated stories are (a) starting the story: the story-not-yet-told, (b) coming out with the story: the story-first-told, (c) shielding the story: the story-as-secret, (d) revising the story: the story-as-account, and (e) sharing the story: the story-as-message. Clinical applications of the framework are discussed.
Collapse
|
21
|
The invisibility of violence against women diagnosed with schizophrenia: a synthesis of perspectives. ANS Adv Nurs Sci 2008; 31:E9-21. [PMID: 18497583 DOI: 10.1097/01.ans.0000319568.91631.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Women diagnosed with severe mental illness experience twice the rates of violence compared with women without mental illness. Despite awareness of violence, mental healthcare providers feel powerless to combat the problem. This article synthesizes 2 previous interpretive studies that examined violence perpetrated against women diagnosed with schizophrenia. This synthesis critically examines the perspectives of women who experience violence and schizophrenia and case managers who care for them. Stigma was an overarching theme in participants' stories but each group differed in its understanding of how stigma impacted women's lives. This disconnection perpetuates stigma and allows violence to remain invisible.
Collapse
|
22
|
Erdmans MP, Black T. What they tell you to forget: from child sexual abuse to adolescent motherhood. QUALITATIVE HEALTH RESEARCH 2008; 18:77-89. [PMID: 18174537 DOI: 10.1177/1049732307309004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study explores the relationship between child sexual abuse and adolescent motherhood, using a life story interview method. The sample consists of 27 mothers participating in a home-visitation parenting program for mothers at risk of child maltreatment. The failure to articulate the violation of child sexual abuse and to appropriately construct blame resulted in a range of self-destructive behaviors, some of which placed mothers at greater risk of teen pregnancy. Repressed feelings associated with the trauma often resurfaced with motherhood as victims re-experienced their innocence and vulnerability as children.
Collapse
|
23
|
Haldenby AM, Berman H, Forchuk C. Homelessness and health in adolescents. QUALITATIVE HEALTH RESEARCH 2007; 17:1232-1244. [PMID: 17968040 DOI: 10.1177/1049732307307550] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite an abundance of resources, many of the world's wealthiest nations have a large homeless population. People at all stages of development are affected by this problem, but adolescents who are homeless face a unique set of challenges. In this critical narrative study the authors examined the experiences of homeless adolescents with particular attention to the role of gender and public policy, health experiences and perceptions, and barriers to health care services. Six girls and 7 boys participated in semistructured dialogic interviews. Their stories revealed that living without a home had a substantial impact on their health and wellness. The findings from this study support the need for health care professionals to work in collaboration with homeless youth so that more effective care that is sensitive to their unique health needs can be provided.
Collapse
Affiliation(s)
- Amy M Haldenby
- The University of Western Ontario, School of Nursing, London, Canada
| | | | | |
Collapse
|
24
|
Min M, Farkas K, Minnes S, Singer LT. Impact of childhood abuse and neglect on substance abuse and psychological distress in adulthood. J Trauma Stress 2007; 20:833-44. [PMID: 17955535 DOI: 10.1002/jts.20250] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Structural equation modeling was used to examine the relationship of childhood trauma, educational level, and the use of avoidant coping on substance abuse and psychological distress in a community sample of 285 women. Results indicated that self-reported childhood trauma was significantly related to greater substance abuse and psychological distress, through educational attainment and avoidant coping strategies. Lower level of education affected substance abuse through greater use of avoidant coping, but had no significant relationship with psychological distress. Greater use of avoidant coping was related to increased substance abuse and greater psychological distress. Findings indicate the need for supportive educational strategies and interventions to teach coping skills in preventing substance abuse and longer-term psychological distress in children exposed to trauma.
Collapse
Affiliation(s)
- Meeyoung Min
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-7164, USA.
| | | | | | | |
Collapse
|
25
|
Abstract
Violence against women is a major public health problem. Women with a diagnosis of schizophrenia suffer higher rates of violence compared with women without mental illnesses. Little research has focused on what it means for women to live with schizophrenia and a history of violence. This interpretive phenomenological study identified three themes of schizophrenia and violence: Being Stigmatized, Foreclosing a Future of Possibilities, and Finding Meaning in Symptoms. The results suggest mental health professionals should assess women with diagnoses of schizophrenia for violence and provide opportunities for trauma stories to be heard. These listening types of patient-centered interventions may promote recovery.
Collapse
Affiliation(s)
- Elizabeth Rice
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201-0413, USA. ricee@uwm,edu
| |
Collapse
|
26
|
Brewer KM. The Contextual Factors that Foster and Hinder the Process of Recovery for Alcohol Dependent Women. J Addict Nurs 2006. [DOI: 10.1080/10884600600862194] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|