| 1. |
- Björkman, Tommy, et al.
(författare)
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Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial.
- 2002
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 37:4, s. 147-152
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The outcome of less intensive case management services, such as the strengths model, is still inconclusive, which suggests a need for more controlled studies. The aim of the present study was to investigate the outcome of a strengths model of case management service (SCM) compared to standard care. METHODS: Seventy-seven clients with a mental illness and a serious impairment in functioning in social contacts, housing or work situation were randomly allocated to SCM or standard care. Outcome was assessed with regard to use of psychiatric services, changes in symptomatology, psychosocial functioning, social network, needs for care, quality of life and client satisfaction with care. The follow-up period was 36 months. RESULTS: The results showed a greater reduction in needs for care in clients receiving SCM. No differences in clinical or social outcome were shown. Clients receiving SCM also used significantly less days in psychiatric inpatient services and were generally more satisfied with the psychiatric services offered. CONCLUSIONS: SCM failed to improve clinical and social outcome compared to standard care, but was more successful in reducing days spent in hospital, and the clients were also more satisfied with the service compared to standard care.
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| 2. |
- Hansson, Lars, et al.
(författare)
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The effectiveness of narrative enhancement and cognitive therapy : a randomized controlled study of a self-stigma intervention
- 2017
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 52:11, s. 1415-1423
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Stigma has been proposed to be one of the most serious obstacles to successful treatment, rehabilitation and inclusion in society of people with severe mental illness. An aspect of stigma which has been increasingly discussed is self-stigma, which refers to the internalization of negative stereotypes among people with severe mental illness. The aim of the present study was to investigate the effectiveness of a group-based anti self-stigma intervention, narrative enhancement and cognitive therapy (NECT) as an add-on to treatment as usual, with regard to changes in self-stigma, self-esteem, and subjective quality of life. Method: After screening for eligibility 106 participants were included in a randomized controlled trial using a wait-list control group, of which 87 completed the study. Assessments were made at baseline, at termination of the intervention, and at a 6-month follow-up (intervention group only). Results: The results showed that NECT was effective in reducing self-stigma and improving self-esteem compared to treatment as usual only. No differences were shown regarding subjective quality of life. Changes shown in the intervention group at termination of intervention were stable at the 6-month follow-up. A regression analysis showed that there was a positive relationship between exposure to the intervention and reduction of self-stigma. Conclusions: The conclusion of the present study is that, using a sample size with adequate power, NECT seems to be an effective intervention with regard to diminishing self-stigma and improving self-esteem, and that these improvements were stable at a 6-month follow-up. There was a distinct relationship between number of sessions attended and improvements in self-stigma and self-esteem controlling for confounding factors. This puts attention to the importance of creating a group climate which facilitate and encourage participation through the various phases of the intervention.
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| 3. |
- Jarbin, H, et al.
(författare)
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Adult quality of life and associated factors in adolescent onset schizophrenia and affective psychotic disorders
- 2004
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 39:9, s. 725-729
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Tidskriftsartikel (refereegranskat)abstract
- Background Subjects in treatment for affective disorders are usually less satisfied with life compared to subjects with schizophrenia. Aims The aims of this study were to compare subjective quality of life (QoL) at adult age of adolescent onset psychotic disorders and analyse associated factors. Method Fifty-three patients with adolescent onset psychotic disorders were followed up at age 25, diagnostically re-evaluated according to the DSM-IV and assessed with the Positive and Negative Symptoms Scale, the Strauss-Carpenter Scale and the Lancashire Quality of Life Profile. Results Subjects diagnosed with schizophrenia or schizoaffective disorder (n = 27) experienced significantly lower overall QoL than subjects with psychotic mood disorders (n = 26). Overall QoL was strongly associated to depressed mood (R-2 = 0.49) in the schizophrenia group and to degree of employment (R-2 = 0.39) in the mood disordered group. Conclusion Depression is a major concern in the evaluation and treatment of patients with schizophrenia, while vocational support seems particularly important after an episode of psychotic mood disorder.
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| 4. |
- Korkeila, J, et al.
(författare)
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Structure of needs among persons with schizophrenia
- 2005
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 40:3, s. 233-239
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Tidskriftsartikel (refereegranskat)abstract
- Background The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs. Methods The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed. Results The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms. Conclusions It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.
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| 5. |
- Lundberg, Bertil, et al.
(författare)
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Sociodemographic and clinical factors related to devaluation/discrimination and rejection experiences among users of mental health services.
- 2007
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Ingår i: Social psychiatry and psychiatric epidemiology. - : Springer Science and Business Media LLC. - 1433-9285 .- 0933-7954. ; 42:4, s. 295-300
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A major goal in mental health research and policy is to identify ways to reduce stigma among persons with mental illness. AIMS: The aims of the present study were to (1) investigate the prevalence of rejection and devaluation/discrimination in a cross-sectional sample of 200 individuals with experiences of mental illness and (2) investigate the relationship between sociodemographic and clinical, client characteristics and perceived devaluation/discrimination and experiences of rejection. METHODS: A total of 200 subjects in current contact with mental health services or with earlier experiences of this were interviewed regarding beliefs about devaluation/discrimination and rejection experiences. RESULTS: The results showed that subjects with a higher degree of global functioning perceived less devaluation/discrimination. With regard to rejections experiences associations were found between rejection experiences and global functioning, number of admissions to inpatient psychiatric care and current contact with social services. CONCLUSION: Further research should investigate the causal relationship between stigma experiences and psychosocial functioning. To understand what consequences perceived devaluation/discrimination has for the afflicted, a psychological and social approach in the research must be taken into consideration.
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| 6. |
- Mattsson, M, et al.
(författare)
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Background factors as determinants of satisfaction with care among first-episode psychosis patients
- 2005
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 40:9, s. 749-754
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate the impact of demographic and psychosocial background factors and psychiatric and functional status before and at admission on the patients' satisfaction with care (PSC) among first-episode psychosis (FEP) patients. Method One year after entering the Parachute Project, 134 FEP patients completed a patient satisfaction questionnaire. The association with demographic and psychosocial background factors, together with psychiatric and functional status before and after admission, was analysed. Results Twenty-nine per cent of the variance of PSC was explained by factors such as educational level, social network, duration of untreated psychosis (DUP) and Global Assessment of Functioning (GAF) the year prior to onset. Negative symptoms and lack of hope at admission were also predictors of PSC. The strongest predictor was DUP. Conclusion Affecting the public knowledge in psychiatric problems and psychiatric treatment, together with early intervention strategies aiming to decrease the prodromal and DUP period among FEP patients, can positively influence the patients' experience of given care. By increasing the knowledge of available psychiatric treatment, the sense of powerlessness might decrease among the affected persons, and the possibility of early help seeking might increase.
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| 7. |
- van den Brink, Rob, et al.
(författare)
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Non-uniform effectiveness of structured patient-clinician communication in community mental healthcare: an international comparison
- 2011
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 46:8, s. 685-693
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Tidskriftsartikel (refereegranskat)abstract
- The effectiveness of psychosocial interventions in community mental healthcare has been shown to depend on the setting in which they are implemented. Recently structured patient-clinician communication was found to be effective in a multi-centre trial in six European countries, the DIALOG trial. In the overall study, differences between centres were controlled for, not studied. Here, we test whether the effectiveness of structured patient-clinician communication varies between services in different countries, and explore setting characteristics associated with outcome. The study is part of the DIALOG trial, which included 507 patients with schizophrenia or related disorder, treated by 134 keyworkers. The keyworkers were allocated to intervention or treatment as usual. Positive effects were found on quality of life (effect size 0.20: 95% CI 0.01-0.39) and treatment satisfaction (0.27: 0.06-0.47) in all centres, but reductions in unmet needs for care were only seen in two centres (-0.83 and -0.60), and in positive, negative and general symptoms in one (-0.87, -0.78, -0.87). The intervention was most effective in settings with patient populations with many unmet needs for care and high symptom levels. Psychosocial interventions in community mental healthcare may not be assumed to have uniform effectiveness across settings. Differences in patient population served and mental healthcare provided, should be studied for their influence on the effectiveness of the intervention. Structured patient-clinician communication has a uniform effect on quality of life and treatment satisfaction, but on unmet needs for care and symptom levels its effect differs between mental healthcare settings.
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| 8. |
- Wiersma, Durk, et al.
(författare)
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Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?
- 2009
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 44:4, s. 317-324
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Tidskriftsartikel (refereegranskat)abstract
- Background Mental health interventions should demonstrate an effect on patients' functioning as well as his/her needs, in particular on unmet needs whose assessment depends on the perspective of either the patient or the clinician. However, individual met and unmet needs appear to change over time, qualitatively and quantitatively, raising questions about their sensitivity to change and about the association between level of needs and treatment. Methods Data on baseline and follow-up need assessment in community mental health services in four European countries in the context of a cluster randomised trial on a novel mental health service intervention were used, which involved 102 clinicians with key worker roles and 320 patients with schizophrenia or related psychotic disorders. Need assessment was performed with the Camberwell assessment of needs short appraisal schedule (CANSAS) among patients as well as clinicians. Focus is the sensitivity to change in unmet needs over time as well as the concordance between patient and clinician ratings and their relationship with treatment condition. Results At follow-up 294 patients (92%) had a full need assessment, while clinician rated needs were available for 302 patients (94%). Generally, the total number of met needs remained quite stable, but unmet needs decreased significantly over time, according to patients as well as to clinicians. Sensitivity to change of unmet needs is quite high: about two third of all unmet needs made a transition to no or met need, and more than half of all unmet needs at follow-up were new. Agreement between patient and clinician on unmet needs at baseline as well as follow-up was rather low, without any indication of a specific treatment effect. Conclusions Individual unmet needs appear to be quite sensitive to change over time but as yet less suitable as outcome criterion of treatment or specific interventions.
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| 9. |
- Östman, Margareta, et al.
(författare)
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Children in families with a severely mentally ill member Prevalence and needs for support.
- 2002
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 37:5, s. 243-248
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Tidskriftsartikel (refereegranskat)abstract
- Background The prevalence of minor children in families with a severely mentally ill member, these children's needs for support and the situation of the spouses were investigated as part of a multi-centre study of the quality of the mental health services in Sweden performed in 1986, 1991 and 1997. Methods The sample was drawn from relatives of compulsorily and voluntarily admitted inpatients to acute psychiatric wards. The instrument used was a semi-structured questionnaire, interviewing relatives about the burden of relatives, their needs for support and participation in care and items concerning the situation of the under-aged children in these families. Results The results over the years investigated showed the same proportion of patients admitted to hospital who were also parents to minor children and a decreasing proportion of patients who had the custody of their children. Female patients were more often a parent and also more often had the custody of the children. The majority of the children had needs for support caused by their parent's illness and these needs were met in half of the cases. The healthy spouses in families with minor children more often had to give up their own occupation and to a higher extent experienced own needs for care and support from psychiatric services compared to spouses without minor children. Conclusions The study supports that there is an urgent need for the psychiatric services to initiate parental issues in programmes for treatment and rehabilitation to ensure that the specific needs of minor children are met.
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