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Ekbäck E, Rådmark L, Molin J, Strömbäck M, Midgley N, Henje E. The Power Threat Meaning Framework: a qualitative study of depression in adolescents and young adults. Front Psychiatry 2024; 15:1393066. [PMID: 38757135 PMCID: PMC11097657 DOI: 10.3389/fpsyt.2024.1393066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Depression constitutes one of our largest global health concerns and current treatment strategies lack convincing evidence of effectiveness in youth. We suggest that this is partly due to inherent limitations of the present diagnostic paradigm that may group fundamentally different conditions together without sufficient consideration of etiology, developmental aspects, or context. Alternatives that complement the diagnostic system are available yet understudied. The Power Threat and Meaning Framework (PTMF) is one option, developed for explanatory and practical purposes. While based on scientific evidence, empirical research on the framework itself is still lacking. This qualitative study was performed to explore the experiences of adolescents and young adults with depression from the perspective of the PTMF. Methods We conducted semi-structured interviews with 11 Swedish individuals aged 15- 22 years, mainly female, currently enrolled in a clinical trial for major depressive disorder. Interviews were transcribed verbatim and analyzed with framework analysis informed by the PTMF. Results A complex multitude of adversities preceding the onset of depression was described, with a rich variety of effects, interpretations, and reactions. In total, 17 themes were identified in the four dimensions of the PTMF, highlighting the explanatory power of the framework in this context. Not all participants were able to formulate coherent narratives. Discussion The PTMF provides a framework for understanding the complexities, common themes, and lived experiences of young individuals with depression. This may be essential for the development of new interventions with increased precision and effectiveness in the young.
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Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Lina Rådmark
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Jenny Molin
- Department of Clinical Science, Umeå University, Umeå, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Maria Strömbäck
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Nick Midgley
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
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Dussault JM, Akiba C, Zimba C, Malava J, Akello H, Stockton M, Mbota M, Matewere M, Masiye J, Udedi M, Gaynes BN, Go VF, Hosseinipour MC, Pence BW. Evaluating the validity of depression-related stigma measurement among diabetes and hypertension patients receiving depression care in Malawi: A mixed-methods analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001374. [PMID: 37195929 PMCID: PMC10191271 DOI: 10.1371/journal.pgph.0001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/16/2023] [Indexed: 05/19/2023]
Abstract
Mental illness stigma research is sparse in Malawi. Our team previously analyzed the reliability and statistical validity of a quantitative tool to measure depression-related stigma among participants with depressive symptoms using quantitative psychometric methods. This analysis aims to further evaluate the content validity of the stigma tool by comparing participants' quantitative responses with qualitative data. The SHARP project conducted depression screening and treatment at 10 noncommunicable disease clinics across Malawi from April 2019 through December 2021. Eligible participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at each study timepoint included a vignette-based quantitative stigma instrument with three thematic domains: disclosure carryover (i.e., concerns about disclosure), treatment carryover (i.e., concerns about external stigma because of receiving depression treatment), and negative affect (i.e., negative attitudes about people having depression). Sub-scores were aggregated for each domain, with higher scores indicating greater stigma. To better understand participants' interpretation of this quantitative stigma questionnaire, we asked a subset of six participants a parallel set of questions in semi-structured qualitative interviews in a method similar to cognitive interviewing. Qualitative responses were linked with participants' most recent quantitative follow-up interviews using Stata 16 and NVivo software. Participants with lower quantitative stigma disclosure sub-scores had qualitative responses that indicated less stigma around disclosure, while participants with higher quantitative stigma sub-scores had qualitative responses indicating greater stigma. Similarly, in the negative affect and treatment carryover domains, participants had parallel quantitative and qualitative responses. Further, participants identified with the vignette character in their qualitative interviews, and participants spoke about the character's projected feelings and experiences based on their own lived experiences. The stigma tool was interpreted appropriately by participants, providing strong evidence for the content validity of the quantitative tool to measure these stigma domains.
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Affiliation(s)
- Josée M. Dussault
- Dept of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Christopher Akiba
- RTI International, Research Triangle Park, NC, United States of America
| | | | - Jullita Malava
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | | | - Melissa Stockton
- Dept of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
- New York State Psychiatric Institute, New York, NY, United States of America
| | | | | | - Jones Masiye
- Ministry of Health Malawi, NCDs & Mental Health Unit, Lilongwe, Malawi
| | - Michael Udedi
- Ministry of Health Malawi, NCDs & Mental Health Unit, Lilongwe, Malawi
| | - Bradley N. Gaynes
- Dept of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Dept of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States of America
| | - Vivian F. Go
- Dept of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Mina C. Hosseinipour
- UNC Project - Malawi, Lilongwe, Malawi
- Division of Infectious Disease, UNC School of Medicine, Chapel Hill, NC, United States of America
| | - Brian W. Pence
- Dept of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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3
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Fernández O, Altimir C, Reinel M, Duarte J, Krause M. “I am strong and I can get on with my life”: The subjective experience of recovery of patients treated for depression. Psychother Res 2022; 33:625-639. [DOI: 10.1080/10503307.2022.2147035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Olga Fernández
- Instituto Milenio para la Investigación de la Depresión y la Personalidad (MIDAP), Universidad de Chile, Santiago de Chile, Chile
| | - Carolina Altimir
- Instituto Milenio para la Investigación de la Depresión y la Personalidad (MIDAP), Universidad Alberto Hurtado, Santiago, Chile
| | - Mahaira Reinel
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Doctorado en Psicoterapia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Duarte
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Center of Studies in Clinical Psychology and Psychotherapy, Universidad Diego Portales (CEPPS-UDP), Santiago, Chile
| | - Mariane Krause
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Pontificia Universidad Católica de Chile, Santiago, Chile
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Bear HA, Krause KR, Edbrooke-Childs J, Wolpert M. Understanding the illness representations of young people with anxiety and depression: A qualitative study. Psychol Psychother 2021; 94:1036-1058. [PMID: 33960606 DOI: 10.1111/papt.12345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many young people with anxiety or depression drop out of treatment early, and/or leave treatment without showing measurably improved symptom levels. To enhance treatment engagement and effectiveness, it is critical to better understand how young people's perceptions of the symptoms, causes, consequences, treatability, and course of their anxiety and depression influence engagement. AIM This study aimed to provide a qualitative account of illness perceptions among youth with anxiety and depression by applying the Common Sense Model of Self-Regulation (CSM), which was developed in physical health contexts. METHODS Semi-structured interviews were conducted with 26 young people (aged 16-24, 73% female) with a history of anxiety and/or depression. Interviews were analysed using a combination of theory- and data-driven analysis techniques, consisting primarily of deductive thematic analysis. RESULTS The five themes broadly mapped onto the dimensions of the CSM, suggesting parallels in how mental and physical health problems are perceived. Anxiety and depression were viewed as non-linear, relapsing and remitting, but lifelong conditions, with a fluctuating and complex path to recovery and coping. Youth described pervasive negative impacts on their lives, but also described some positive aspects. IMPLICATIONS Better understanding of young people's illness beliefs has the potential to open a range of intervention possibilities by prioritizing young people's illness perceptions over the clinician's understanding and the supposed objective condition severity and trajectory. Although this study supported a common structure of illness beliefs, the content of these beliefs was idiosyncratic and specific to anxiety and depression, suggesting the need to develop a valid tool to measure illness perceptions in this group. PRACTITIONER POINTS Our findings suggest that illness perceptions are complex, highly idiosyncratic, and specific to youth anxiety and depression. Given the complexity of these beliefs and the known association with important treatment- and health-related outcomes, it is important that clinical formulation incorporates young people's illness belief models, including their perceptions of symptoms, cause, timeline to recovery, consequences, and personal and treatment control. To increase help-seeking, treatment engagement and adaptive coping strategies, therapy should work to a shared understanding of illness beliefs. Increasing congruence between the belief models of young people, families, and clinicians may serve to improve treatment benefits and address the unmet mental health needs of young people.
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Affiliation(s)
- Holly Alice Bear
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK.,Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Karolin Rose Krause
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Julian Edbrooke-Childs
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK
| | - Miranda Wolpert
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK.,Wellcome Trust, London, UK
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O'Neill A, Stapley E, Stock S, Merrick H, Humphrey N. Adolescents' Understanding of What Causes Emotional Distress: A Qualitative Exploration in a Non-clinical Sample Using Ideal-Type Analysis. Front Public Health 2021; 9:673321. [PMID: 34109149 PMCID: PMC8181134 DOI: 10.3389/fpubh.2021.673321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background: There is increased interest in early intervention and prevention of mental health difficulties during adolescence; thus, we are seeing increased efforts to optimize well-being during this epoch. Positive emotional experiences are a central component of overall well-being. However, research exploring what adolescents perceive to be the cause(s) of their emotional difficulties is lacking. Improving understanding of this issue within non-clinical adolescent groups may provide useful insight into how to develop strategies to support young people as they navigate emotional difficulties. Objectives: The aim of this research was to explore if meaningful categories of perceived cause(s) for emotional distress exist for non-clinical adolescent groups. Methods: The data for this study were drawn from interviews across 6 sites in England conducted as part of the 5-year national evaluation of the HeadStart Learning Programme. The sample comprised of 32 young people aged 11–12 years from the first annual wave of qualitative data collection in 2017. Ideal type analysis—a qualitative form of person-centered analysis—was used to construct a typology of adolescents perceived cause(s) for emotional distress. Findings: We identified five distinct categories of perceived cause: (1) perceived lack of control; (2) unfair treatment; (3) others, their actions and judgements as the catalyst; (4) concerns for self and others; and, (5) self as cause. Conclusions: Our findings illustrate that distinct categories for perceived cause of emotional distress exist among adolescents considered to be “at risk” of developing mental health difficulties, which provides a foundation for future necessary work seeking to investigate the possible link between perceived cause for emotional distress and help-seeking behavior among sub-clinical groups.
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Affiliation(s)
- Alisha O'Neill
- Department of Education, The University of Manchester, Manchester, United Kingdom
| | - Emily Stapley
- Evidence Based Practice Unit (Anna Freud National Centre for Children and Families and University College London), London, United Kingdom
| | - Sarah Stock
- Evidence Based Practice Unit (Anna Freud National Centre for Children and Families and University College London), London, United Kingdom
| | - Hannah Merrick
- Evidence Based Practice Unit (Anna Freud National Centre for Children and Families and University College London), London, United Kingdom
| | - Neil Humphrey
- Department of Education, The University of Manchester, Manchester, United Kingdom
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6
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Yuan G, Elhai JD, Hall BJ. The influence of depressive symptoms and fear of missing out on severity of problematic smartphone use and Internet gaming disorder among Chinese young adults: A three-wave mediation model. Addict Behav 2021; 112:106648. [PMID: 32977268 DOI: 10.1016/j.addbeh.2020.106648] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/05/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
Internet gaming disorder (IGD) and problematic smartphone use (PSU) symptoms are associated with increased depression symptom severity across studies. The current study aimed to examine the fear of missing out (FoMO) as a possible mediator in this relationship. We employed a three-wave longitudinal design among 341 Chinese university students. Results indicated that depression severity was significantly related to increased symptoms of PSU and IGD symptoms. FoMO significantly mediated the linkage between depression and PSU severity. IGD symptoms also partially mediated the relation between FoMO and PSU severity. This longitudinal study demonstrates the key role of FoMO in the linkage between psychopathology symptoms and Internet-related overuse.
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‘I am Still Able to Contribute to Someone Less Fortunate’: A Phenomenological Analysis of Young Adults’ Process of Personal Healing from Major Depression. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2020. [DOI: 10.1007/s10447-019-09387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sun KS, Lam TP, Lam KF, Lo TL, Chao DVK, Lam EWW, Chan HY. Views of Hong Kong Chinese primary care attenders on psychological distress: causes, management and recovery. Fam Pract 2019; 36:84-90. [PMID: 30351425 DOI: 10.1093/fampra/cmy102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Most of the previous studies of help seeking for psychological distress were conducted in Western countries. Chinese studies have had a stronger emphasis on psychosis. OBJECTIVE This study aims to understand how Hong Kong Chinese primary care attenders see psychological distress, including its causes, management approaches and recovery, and whether their views are different from Western views. METHOD Nine focus groups and six individual interviews were conducted in Hong Kong among Chinese primary care attenders with/without known distress, patients' significant others and the general public, and a questionnaire survey was conducted with 1626 primary care attenders recruited from 13 private clinics and 6 public clinics. RESULTS More survey respondents agreed with psychological counselling (95.3%) than drugs (69.0%) to relieve psychological distress. Despite the belief in self-resilience (77.7%), only 34.8% respondents agreed that psychological distress could get better without professional help. Respondents with younger ages, better education and higher incomes tended to have stronger trust in counselling and self-resilience than drugs. Qualitative interviews revealed that although participants regarded psychological distress as a common problem in modern societies, distressed patients might be seen as being weak and troublesome. Some distressed patients found their recovery process painful because of discouragement from family and personnel at their workplace. CONCLUSIONS Hong Kong Chinese patients' views of the causes and management approaches of psychological distress are similar to Western findings. However, help seeking and recovery are of greater concern in a Chinese context where patients may receive limited empathy for their conditions of psychological distress.
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Affiliation(s)
- Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Tak Lam Lo
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.,Kwai Chung Hospital, Hong Kong, China
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.,Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - Edmund Wing Wo Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Hoi Yan Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
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9
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Rönngren Y, Björk A, Kristiansen L, Haage D, Enmarker I, Audulv Å. Meeting the needs? Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting. Int J Ment Health Nurs 2018; 27:390-399. [PMID: 28374967 DOI: 10.1111/inm.12333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 11/28/2022]
Abstract
Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle-related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse-led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16-25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse-led programme provides health information-management strategies that could easily be integrated in a primary health-care setting.
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Affiliation(s)
- Ylva Rönngren
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Annette Björk
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | | | - David Haage
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Ingela Enmarker
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.,Department of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Center for Care Research, Mid-Norway, Steinkjer, Norway
| | - Åsa Audulv
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden
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10
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Nunstedt H, Rudolfsson G, Alsén P, Pennbrant S. Strategies for healthcare professionals to facilitate patient illness understanding. J Clin Nurs 2017; 26:4696-4706. [PMID: 28334458 DOI: 10.1111/jocn.13820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Håkan Nunstedt
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Gudrun Rudolfsson
- NORD university; Faculty of Nursing and Health Sciences; Bodø Norway
| | - Pia Alsén
- Department of Health Sciences; University West; Trollhättan Sweden
| | - Sandra Pennbrant
- Department of Health Sciences; University West; Trollhättan Sweden
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Nunstedt H, Rudolfsson G, Alsen P, Pennbrant S. Patients´ Variations of Reflection About and Understanding of Long-Term Illness- Impact of Illness Perception on Trust in Oneself or Others. Open Nurs J 2017; 11:43-53. [PMID: 28567169 PMCID: PMC5420171 DOI: 10.2174/1874434601711010043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Patients' understanding of their illness is of great importance for recovery. Lacking understanding of the illness is linked with the patients' level of reflection about and interest in understanding their illness. Objective: To describe patients’ variations of reflection about and understanding of their illness and how this understanding affects their trust in themselves or others. Method: The study is based on the “Illness perception” model. Latent content analysis was used for the data analysis. Individual, semi-structured, open-ended and face-to-face interviews were conducted with patients (n=11) suffering from a long-term illness diagnosed at least six months prior to the interview. Data collection took place in the three primary healthcare centres treating the participants. Results: The results show variations in the degree of reflection about illness. Patients search for deeper understanding of the illness for causal explanations, compare different perspectives for preventing complication of their illness, trust healthcare providers, and develop own strategies to manage life. Conclusion: Whereas some patients search for deeper understanding of their illness, other patients are less reflective and feel they can manage the illness without further understanding. Patients' understanding of their illness is related to their degree of trust in themselves or others. Patients whose illness poses an existential threat are more likely to reflect more about their illness and what treatment methods are available.
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Midgley N, Parkinson S, Holmes J, Stapley E, Eatough V, Target M. "Did I bring it on myself?" An exploratory study of the beliefs that adolescents referred to mental health services have about the causes of their depression. Eur Child Adolesc Psychiatry 2017; 26:25-34. [PMID: 27207089 PMCID: PMC5233729 DOI: 10.1007/s00787-016-0868-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
Abstract
The causal beliefs which adults have regarding their mental health difficulties have been linked to help-seeking behaviour, treatment preferences, and the outcome of therapy; yet, the topic remains a relatively unexplored one in the adolescent literature. This exploratory study aims to explore the causal beliefs regarding depression among a sample of clinically referred adolescents. Seventy seven adolescents, aged between 11 and 17, all diagnosed with moderate to severe depression, were interviewed using a semi-structured interview schedule, at the beginning of their participation in a randomised controlled trial. Data were analysed qualitatively using framework analysis. The study identified three themes related to causal beliefs: (1) bewilderment about why they were depressed; (2) depression as a result of rejection, victimisation, and stress; and (3) something inside is to blame. Although some adolescents struggled to identify the causes of their depression, many identified stressful life experiences as the cause of their current depression. They also tended to emphasise their own negative ways of interpreting those events, and some believed that their depression was caused by something inside them. Adolescents' causal beliefs are likely to have implications for the way they seek help and engage in treatment, making it important to understand how adolescents understand their difficulties.
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Affiliation(s)
- Nick Midgley
- Anna Freud Centre, 12 Maresfield Gardens, London, NW3 5SU, UK. .,Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Sally Parkinson
- Anna Freud Centre, 12 Maresfield Gardens, London, NW3 5SU UK ,Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Joshua Holmes
- Anna Freud Centre, 12 Maresfield Gardens, London, NW3 5SU UK
| | - Emily Stapley
- Anna Freud Centre, 12 Maresfield Gardens, London, NW3 5SU UK ,Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Virginia Eatough
- Department of Psychological Sciences, Birkbeck College, University of London, Malet Street, London, WC1E 7HX UK
| | - Mary Target
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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Abstract
ABSTRACTThis study investigated whether five positive psychological constructs (self-efficacy, gratitude, grit, hope and optimism) had a combined effect on levels of depression. The co-occurrence of these psychological factors, defined as an example of covitality, was examined in relation to predicting lower levels of depression. Participants were 278 retirees living in Brisbane, Australia. Each participant completed either an online or hard-copy self-report, related to positive psychological functioning. A standard multiple regression found that self-efficacy, grit, optimism and hope were individually all significant predictors of depression (small effect sizes); however, the combinatorial relation of all these four factors with depression was substantial (R2 = 0.34; large effect size). Gratitude was not a significant predictor. While no causality can be inferred from this cross-sectional study, having a combination of positive psychological factors might have an effect on levels of depression in retirement.
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Abstract
In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning-referred to as anosognosia-has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.
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Bjørkløf GH, Kirkevold M, Engedal K, Selbæk G, Helvik AS. Being stuck in a vice: The process of coping with severe depression in late life. Int J Qual Stud Health Well-being 2015; 10:27187. [PMID: 26119368 PMCID: PMC4483368 DOI: 10.3402/qhw.v10.27187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2015] [Indexed: 11/14/2022] Open
Abstract
Articles describing older persons’ experiences of coping with severe depression are, to our knowledge, lacking. This article is methodologically grounded in phenomenological hermeneutics, inspired by Paul Ricoeur, and applies a descriptive design with in-depth interviews for producing the data. We included 18 older persons, 13 women and 5 men, with a mean age of 77.9 years, depressed to a severe or moderate degree, 1–2 weeks after admission to a hospital for treatment of depression. We found the metaphor “being in a vice” to capture the essence of meaning from the participants’ stories, and can be understood as being stuck in an immensely painful existence entirely dominated by depression in late life. This is the first article where coping in older men and women experiencing the most severe phase of depression is explored.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department for Mental Health Research and Development, Division for Mental health and addiction, Vestre Viken Hospital Trust, Lier, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway;
| | | | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre of Old Age Psychiatry, Innlandet Hospital Trust, Ottestad, Norway
| | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,St Olav's University Hospital, Trondheim, Norway
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Östman M, Ung EJ, Falk K. Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure-A grounded theory study. Int J Qual Stud Health Well-being 2015; 10:27775. [PMID: 28229746 PMCID: PMC4490805 DOI: 10.3402/qhw.v10.27775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 12/18/2022] Open
Abstract
Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: "Experiencing a subordinate approach," "Objectifying during the encounter" and "Expected to be compliant." This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: "Experiencing an empowering approach," "Person-centredness during the encounter" and "Expected to be capable." It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals' attitudes and communication in encounters with patients. Health care must be designed to support and promote patients' own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a paradigm shift in the health-care organisation and culture in order to support the patients in their efforts to live a meaningful, rich life, in spite of the chronic illness CHF.
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Affiliation(s)
- Malin Östman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Källstorp Health Centre, Trollhättan, Sweden
| | - Eva Jakobsson Ung
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Jönsson PD, Nunstedt H, Berglund IJ, Ahlström BH, Hedelin B, Skärsäter I, Jormfeldt H. Problematization of perspectives on health promotion and empowerment in mental health nursing--within the research network "MeHNuRse" and the Horatio conference, 2012. Int J Qual Stud Health Well-being 2014; 9:22945. [PMID: 24717267 PMCID: PMC3982111 DOI: 10.3402/qhw.v9.22945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mental illness is increasing worldwide, while society's response seems to be a trend toward narrower and more specialized mental health care. This development is creating great demands on mental health nurses to include a health promotion perspective in care and support of persons with mental illness. A health promotion perspective emphasizes cooperation and communication with people who suffer from long-term mental illness, focusing on their independence and health. From a health perspective, every human being is an actor in his/her own life, with an inherent ability to make his/her own choices. However, persons who suffer from long-term mental illness are at risk of losing power and control over areas of their lives and their health. Mental health nurses are in a position to support these individuals in promoting health and in maintaining or regaining control over their lives. The emphasis of this paper is to problematize mental health nurses’ responsibility to provide health-promoting nursing care in relation to empowerment by means of emancipation, self-efficacy, and self-management. We argue that mental health nurses can work from a health-promoting perspective by using these concepts and that this challenges some of the traditional ideas of health promotion in mental health nursing. The theoretical background discussions in this paper have their origin in the research network “Mental Health Nursing Research in Scandinavia” (MeHNuRse) and from the professional discussions developed during a 2012 workshop that included mental health nurses and researchers at the European Horatio Festival in Stockholm.
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Affiliation(s)
- Patrik D Jönsson
- Department of Research, Development and Education (FoUU), Region of Halland, Halmstad, Sweden; School of Social and Health Sciences, Halmstad University, Halmstad, Sweden;
| | - Håkan Nunstedt
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | | | - Britt H Ahlström
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | - Birgitta Hedelin
- Department of Nursing, Gjøvik University College, Gjøvik, Norway
| | - Ingela Skärsäter
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
| | - Henrika Jormfeldt
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
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Schön UK, Rosenberg D. Transplanting recovery: research and practice in the Nordic countries. J Ment Health 2013; 22:563-9. [PMID: 24205790 DOI: 10.3109/09638237.2013.815337] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The conceptual framework which describes recovery from mental illness is based primarily on studies conducted in English-speaking countries. Knowledge and development of recovery orientation within other cultures and mental health systems is still limited. AIM The aim of this study was to compile, describe and discuss the research on personal recovery and recovery-oriented practice within the psychiatric and social fields in the Nordic countries. METHOD A systematic literature review of Nordic research on recovery from mental illness. RESULTS The research literature is limited, and primarily replicates designs and confirms findings first presented in studies conducted in the USA and Great Britain. The majority of the studies are qualitative, and point to the importance of social relations, environmental factors and peer support. CONCLUSIONS There is a need to identify and describe factors in Nordic mental health systems that may influence the recovery process. A corresponding challenge will be to translate and further develop outcome indicators that can promote a recovery-oriented health system.
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Affiliation(s)
- Ulla-Karlin Schön
- School of Health and Social Studies , Dalarna University , Falun , Sweden
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Nunstedt H, Nilsson K, Skärsäter I. The portfolio method as management support for patients with major depression. J Clin Nurs 2013; 23:1639-47. [PMID: 24127874 DOI: 10.1111/jocn.12284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe how patients with major depression in psychiatric outpatient care use the portfolio method and whether the method helps the patients to understand their depression. BACKGROUND Major depressive disorder is an increasing problem in society. Learning about one's depression has been demonstrated to be important for recovery. If the goal is better understanding and management of depression, learning must proceed on the patient's own terms, based on the patient's previous understanding of their depression. Learning must be aligned with patient needs if it is to result in meaningful and useful understanding. DESIGN Each patient's portfolio consisted of a binder. Inside the binder, there was a register with predetermined flaps and questions. The patients were asked to work with the questions in the sections that built the content in the portfolio. METHODS Individual interviews with patients (n = 5) suffering from major depression according to Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) (American Psychiatric Association 1994) were repeatedly conducted between April 2008 and August 2009 in two psychiatric outpatient clinics in western Sweden. Data were analysed using latent content analysis. RESULTS The results showed that the portfolio was used by patients as a management strategy for processing and analysis of their situation and that a portfolio's structure affects its usability. The patients use the portfolio for reflection on and confirmation of their progress, to create structure in their situation, as a management strategy for remembering situations and providing reminders of upcoming activities. CONCLUSIONS Using a clearly structured care portfolio can enable participation and patient learning and help patients understand their depression. RELEVANCE TO CLINICAL PRACTICE The portfolio method could provide a tool in psychiatric nursing that may facilitate patient understanding and increase self-efficacy.
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Affiliation(s)
- Håkan Nunstedt
- The Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
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