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

Contributions of a time use perspective in community mental health practice: a scoping review

Introduction

Time use is an important indicator of health and well-being. Exploration of time use can provide in-depth information about individuals' activity patterns including routines and structure, the experience of activities, personal priorities and challenges. People experiencing severe mental illness may be at particular risk for time use patterns associated with poor health and wellbeing.

Methods

This scoping review aimed to identify and map the evidence about how a time use perspective informs assessment and intervention in community mental health practice. Electronic databases and hand-searches were used to identify relevant studies involving people with severe mental illness, and focused on time use applications in practice. Twenty-nine studies were included in this review, data-extracted and synthesized with reference to the review question.

Results

Of the twenty-nine identified studies, seven described development and psychometric testing of time use assessments; twelve used time use tools to measure outcomes; and ten described or evaluated time use intervention approaches. The identified time use assessments typically involved retrospective diaries completed before or during structured interviews, and an Experience Sampling Method using smart technology to gather activity data in real time. Both psychosocial and occupational interventions used time use to measure outcomes relevant to activity engagement, social functioning, and personal recovery. The identified time use interventions originated in occupational therapy; included structured manuals and workbooks to enable reflection on daily time use; individual or group sessions to collaborate in identifying priorities, goal planning and supporting desired changes to activity patterns. These interventions were viewed favorably overall, with improved activity engagement, quality of life, and personal recovery reported.

Discussion

Time use assessments evaluate outcomes of importance to personal recovery and community inclusion. Time use interventions address activity patterns associated with poor health and wellbeing, using collaborative and supported activity engagement approaches, and contribute to emerging evidence on interventions that support personal recovery. Furthering peer involvement in developing and delivering these interventions will bring important insights to time use practice and research, while the social forces that marginalize or constrain activity participation for people with severe mental illness also need to be addressed to advance time use and other approaches that aim to support community inclusion.

Occupational value outcomes among people with mental health issues participating in activity-based interventions - The importance of internal and external factors

BACKGROUND

Perceived occupational value is an important treatment outcome but is still relatively unexplored as a phenomenon.

AIM

To evaluate whether the Balancing Everyday Life (BEL) intervention for people with mental health issues was effective compared to Standard Occupational Therapy (SOT) regarding improvement on three dimensions of occupational value (concrete, socio-symbolic and self-reward), and how internal factors (self-esteem and self-mastery) and external factors (sociodemographics) were related to occupational value.

METHODS

The study was a cluster RCT (n = 226) and used self-report questionnaires on three occasions (baseline = T1, completed intervention = T2, six-month follow-up = T3).

RESULTS

No differences between the groups were seen in occupational value change scores. Within-group analyses (T1-T3) indicated a change in the BEL group on concrete value and self-reward value. No change was indicated in the SOT group. Associations showed that self-esteem and self-mastery were correlated with all three aspects of occupational value. Having children was negative for experiencing occupational value, whereas having a friend was positive. None of the correlates could predict changes in occupational value.

CONCLUSION

Self-related factors appeared to be integral in occupational value.

SIGNIFICANCE

Since occupational value is essential for a meaningful life, therapists should consider such factors and peer support when supporting people with mental health issues.

Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL)

BACKGROUND

The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context.

AIM

The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned.

METHODS

This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers.

RESULTS

Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation.

CONCLUSIONS

Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.

Worker role perceptions and work participation among people with mental health issues taking part in interventions focusing on everyday life

BACKGROUND

Knowing whether interventions addressing everyday life as a whole can affect work readiness for people with severe mental health issues would be important for how to develop support.

OBJECTIVE

To compare two groups of people with mental health problems, receiving either of two types of 16-week activity-based interventions, Balancing Everyday Life (BEL) or Care as Usual (CAU), regarding work readiness in terms of perceived worker role and satisfaction with recent work experience. Changes from baseline (T1) to completed intervention (T2) and a six-month follow-up (T3) and variables of potential importance to changes were also explored.

METHODS

This cluster RCT recruited participants for BEL (n = 133) and CAU (n = 93) from specialized and community-based psychiatry. Questionnaires addressing work readiness and potentially influencing variables (sociodemographic, clinical, type of intervention, work experience, non-work activity factors, social interaction and self-esteem) were used. Mixed model regression analyses were employed.

RESULTS

Positive changes occurred for both groups in one worker role aspect (resources for a future worker role) and in satisfaction with recent work participation. Satisfaction with non-work everyday activities, having valued activities, and self-esteem were important for change in the work readiness variables, whereas intervention type, age, sex or general activity level were not.

CONCLUSION

Both interventions yielded equally positive work readiness outcomes. Support that emphasizes engagement in satisfying and valued everyday activities and boosts self-esteem would be a potential way to help people with mental health issues develop work readiness in terms of the worker role and satisfaction with work participation.

Do childhood adversity and sensory processing sensitivity interact to predict meaningful activity engagement in adulthood?

Introduction

A core tenet of occupational therapy is that engagement in meaningful activities is integral for a person’s health and wellbeing. Childhood adversity can have lifelong impacts on physical and mental health; however, the effects of childhood experiences are dependent on the presence of susceptibility factors, including sensory processing sensitivity. To date, the effects of childhood adversity and sensory processing sensitivity have not been investigated for meaningful activity engagement. This study seeks to determine whether childhood adversity is related to engagement in meaningful activities in adulthood and whether this relationship is moderated by sensory processing sensitivity.

Method

Using convenience snowball sampling, a cross-sectional online survey was conducted with 328 adults. Participants completed a battery of questionnaires, including the Risky Families Questionnaire, Highly Sensitive Person Scale and Engagement in Meaningful Activities Scale.

Results

Correlational analyses found that childhood adversity was related to significantly less meaningful activity engagement in adulthood, but this relationship was not moderated by sensory processing sensitivity.

Conclusion

This study showed, for the first time, that a history of childhood adversity is linked to less engagement in meaningful activities in adulthood. While further research is needed, supporting meaningful activity engagement may be necessary for adults who experienced childhood adversity.

Relationship of Forced Social Distancing and Home Confinement Derived from the COVID-19 Pandemic with the Occupational Balance of the Spanish Population

Abrupt interruption in the performance of everyday occupations as a consequence of forced social distancing and home confinement, coupled with a lack of regulatory capacities and skills, can trigger harmful effects on people's health and well-being. This study aimed to determine the factors related to the occupational balance in the Spanish population during home confinement as a consequence of the coronavirus disease 19 (COVID-19) pandemic. A total of 3261 subjects completed an online survey, which was disseminated through the mainstream social media platforms in Spain and included the Occupational Balance Questionnaire (OBQ), sociodemographic variables, and factors related to COVID-19 infection. The mean age of the participants (81.69% women) was 40.53 years (SD ± 14.05). Sociodemographic variables were related to a greater occupational balance, and the multivariate analysis showed that age (β = 0.071; p = 0.001), the perception of having received enough information (β = 0.071; p ≤ 0.001), not telecommuting (β = -0.047; p = 0.022), and not being infected by COVID-19 (β = 0.055; p = 0.007) contributed to a better occupational balance. There were profiles of people less likely to suffer disturbances in occupational balance during home confinement, but more studies are needed to help understand and analyze the effects of the COVID-19 pandemic on people's occupational and mental health.