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The Missing Measure of Loneliness: A Case for Including Neededness in Loneliness Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010429. [PMID: 35010687 PMCID: PMC8744771 DOI: 10.3390/ijerph19010429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022]
Abstract
Prominent tools used to measure loneliness such as the UCLA Scale and DJGS include no items related to being needed, i.e., neededness. More recent scales such as the DLS and SELSA do include items on neededness, but only within their romantic loneliness subscales. This paper proposes that new iterations of loneliness scales should include in all subscales two items on neededness: (a) whether a person feels important to someone else and (b) whether that person has good ways to serve others’ well-being. The paper surveys cognate studies that do not rely on loneliness scales but establish a link between neededness and feelings of social connection. It then highlights ways in which neededness items would improve the ability of loneliness scales to specify the risk profile, to delineate variations in the emotional tone and quality of loneliness, and to propose suitable interventions. The paper outlines a theoretical argument—drawing on moral philosophy—that prosociality and being needed are non-contingent, morally urgent human needs, postulating that the protective benefits of neededness vary according to at least four factors: the significance, persistence, non-instrumentality, and non-fungibility of the ways in which a person is needed. Finally, the paper considers implications for the design of appropriate remedies for loneliness.
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Makin P, Allen R, Carson J, Bush S, Merrifield B. Light at the end of the bottle: flourishing in people recovering from alcohol problems. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1905092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Paul Makin
- Department of Psychology, University of Bolton, Bolton, UK
| | - Rosie Allen
- Department of Psychology, University of Bolton, Bolton, UK
| | - Jerome Carson
- Department of Psychology, University of Bolton, Bolton, UK
| | - Stacey Bush
- Department of Psychology, University of Bolton, Bolton, UK
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Beentjes TAA, van Gaal BGI, van Achterberg T, Goossens PJJ. Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research. J Am Psychiatr Nurses Assoc 2020; 26:464-482. [PMID: 31578904 DOI: 10.1177/1078390319877953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: The development of de-hospitalization policies in mental health has resulted in a growing emphasis on self-management. In the chronic care model, self-management support is an essential element. Because of the episodic nature of severe mental illness (SMI) and its high relapse rates, we assume that the extent of self-management support needs of individuals with an SMI is considerable. However, a clear overview of the nature of the self-management support needs of persons with SMI is missing. AIMS: This study aimed to identify self-management support needs from the perspective of individuals with SMI. METHOD: A systematic review was conducted using the method of thematic synthesis of qualitative studies. After searching the databases MEDLINE, PsycINFO, CINAHL, and EMBASE, we screened the papers for the eligibility criteria: individuals with an SMI, adequately representing the voice of persons with SMI and describing their self-management support needs. Thirty-one papers were included. RESULTS: The main findings showed that participants in the studies described the need for informational support, emotional support, acknowledgment, encouragement, and guidance to make sense of their illness experiences, ease suffering, obtain validation and recognition, execute self-management tasks, and be led through unfamiliar territory. CONCLUSION: The perspectives of persons with SMI can provide a road map for constructing a self-management support intervention for persons with SMI. Important others have an essential role in fulfilling support needs. Independently managing an SMI is difficult. Therefore, it is preferable to let important others participate in self-management interventions and to introduce peer support.
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Affiliation(s)
- Titus A A Beentjes
- Titus A. A. Beentjes, MScN, APRN, RN, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; Dimence Group Mental Health Care Centre, Deventer, the Netherlands; Centre for Nursing Research, Saxion University of Applied Science, Deventer, the Netherlands
| | - Betsie G I van Gaal
- Betsie G. I. van Gaal, PhD, FEANS, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, FEANS, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Group Mental Health Care Centre, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Salehi A, Ehrlich C, Kendall E, Sav A. Bonding and bridging social capital in the recovery of severe mental illness: a synthesis of qualitative research. J Ment Health 2018; 28:331-339. [DOI: 10.1080/09638237.2018.1466033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Asiyeh Salehi
- School of Health and Human Sciences, Southern Cross University, Gold Coast, Australia,
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, and
| | - Carolyn Ehrlich
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, and
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia, and
| | - Adem Sav
- Faculty of Health Sciences, School of Allied Health, Australian Catholic University, Brisbane, Australia
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Björk Brämberg E, Torgerson J, Norman Kjellström A, Welin P, Rusner M. Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care. BMC FAMILY PRACTICE 2018; 19:12. [PMID: 29316894 PMCID: PMC5759233 DOI: 10.1186/s12875-017-0687-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. METHODS Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. RESULTS The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). CONCLUSIONS Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.
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Affiliation(s)
- Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska institutet, 171 77, Stockholm, Sweden. .,Närhälsan Eriksberg Primary Health Care Centre, Sjöporten 4, 417 64, Göteborg, Sweden.
| | - Jarl Torgerson
- Department of Psychosis, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
| | - Anna Norman Kjellström
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, 541 80, Skövde, Sweden
| | - Peder Welin
- Centre for Equity in Health, Region Västra Götaland, Regionens Hus, 405 44, Göteborg, Sweden
| | - Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Brämhultsvägen 52, 501 82, Borås, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
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Abstract
A hermeneutic phenomenological analysis reveals the complexity of bipolar disorder. Operating at biological, psychological, and social levels this phenomenon creates dilemmas and people must account for their choices in a moral order. Two participants suffer from the condition, whereas a third is employed to deliver mental health treatment. Three themes are identified showing that all the participants struggle to feel they are competent and consistent decision makers. They feel exposed, fearing that others will impose interpretations on their behavior. They resist the imposition of a medical model, wanting to believe that choices are personal and related to life experiences. This person-centered interpretation is favored because it offers the potential for learning, for achieving autonomy, and growth. By attending to the interpersonal aspects of emotion and subjectivity, this analysis challenges the idea that autonomy can be undermined by a disease process in a simple manner. It is suggested that mental health care systems need to deliver services in which the personal and interpersonal aspects of recovery are adequately managed.
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Cutcliffe JR, Hummelvoll JK, Granerud A, Eriksson BG. Mental health nurses responding to suffering in the 21st century occidental world: accompanying people in their search for meaning. Arch Psychiatr Nurs 2015; 29:19-25. [PMID: 25634870 DOI: 10.1016/j.apnu.2014.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/30/2014] [Indexed: 11/19/2022]
Abstract
Much of contemporary health and mental health practice pays little attention to suffering, and when it does, invariably suffering is conflated with pain. Within such views, the health care practitioner ought to be concerned with removing or stopping the suffering as, for many parts of the occidental world at least, suffering is regarded as antagonistic to the pursuit of happiness. However, it has been recognized since ancient times that the experience of suffering can give rise to growth. This view sees suffering as an inevitable aspect of the human condition and experience; as something that might need to be endured, minimized, relieved, explored for meaning and maybe even learned from. The former conceptualization of suffering leaves little, if any, room for the sufferer to be to be proud of his suffering and to consider it ennobling rather than degrading, and such views are highly congruent with the increased pathologizing of 'everyday life' and with that, the inexorable proliferation of pharmacological 'treatment'. Accordingly, we assert that there is a clear need for Psychiatric/Mental Health nurses to re-think their views of suffering and consider how they might help the person discover meaning in the experience; how they might accompany the individual on his/her suffering journey. We therefore identify a range of approaches and interventions that Psychiatric/Mental Health nurses can use when attempting to help those experiencing mental health-related suffering.
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Affiliation(s)
- John R Cutcliffe
- University of Ottawa, Canada; University of Coimbra, Portugal; University of Malta, Malta.
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Rusner M, Carlsson G, Brunt D, Nyström M. Towards a more liveable life for close relatives of individuals diagnosed with bipolar disorder. Int J Ment Health Nurs 2013; 22:162-9. [PMID: 22712875 DOI: 10.1111/j.1447-0349.2012.00852.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The life of close relatives of persons with bipolar disorder (BD) is associated with emotional distress, depression, and a high level of use of mental health care. Illness-related changes of their life situation endanger relationships, social life, finances, and occupational functioning. Understanding of facilitating conditions for close relatives is still a neglected research area. The aim of the present study thus was to explore what makes the life of close relatives of persons with BD more liveable. A lifeworld phenomenological approach was used. The findings reveal that keeping distance, having stability in everyday life, and strengthening equality through transparent communication are conditions that enable close relatives to influence the unpredictable and its consequences and thus make life more liveable. This implies contributions from close relatives, the person with BD, and the caring services. We propose that health-care support should not be divided in support for the patient and/or the close relatives but instead be designed as support for the 'patient and close relatives' as a unit. Professional caregivers need to take responsibility for creating intersubjective settings for the person with BD and their close relatives to share their needs and make joint plans for how to influence the illness-related life issues.
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Affiliation(s)
- Marie Rusner
- School of Health Sciences, University of Borås, Borås, Sweden.
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Connell J, Brazier J, O’Cathain A, Lloyd-Jones M, Paisley S. Quality of life of people with mental health problems: a synthesis of qualitative research. Health Qual Life Outcomes 2012; 10:138. [PMID: 23173689 PMCID: PMC3563466 DOI: 10.1186/1477-7525-10-138] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 11/07/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To identify the domains of quality of life important to people with mental health problems. METHOD A systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis. RESULTS We identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or 'ill-being' were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization. CONCLUSIONS Generic measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems.
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Affiliation(s)
- Janice Connell
- Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Brazier
- Health Economics, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alicia O’Cathain
- Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Myfanwy Lloyd-Jones
- Health Economics, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Suzy Paisley
- Information Resources, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Rusner M, Carlsson G, Brunt DA, Nyström M. The paradox of being both needed and rejected: the existential meaning of being closely related to a person with bipolar disorder. Issues Ment Health Nurs 2012; 33:200-8. [PMID: 22468585 DOI: 10.3109/01612840.2011.653037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to elucidate the existential meaning of being closely related to a person with bipolar disorder. A qualitative, descriptive, and explorative design with a phenomenological meaning-oriented analysis was used. The findings reveal a paradoxical, existential exposure of close relatives to a person with bipolar disorder, being both needed and rejected whilst being overshadowed by the specific changeable nature of bipolar disorder. Psychiatric health care services are recommended to consider changes in attitudes and structures that may facilitate close relatives' participation in the care and treatment of persons with bipolar disorder.
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Affiliation(s)
- Marie Rusner
- School of Health Sciences, University of Borås, Borås, Sweden.
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