| 1. |
- Bäärnhielm, Sofie
(författare)
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Clinical encounters with different illness realities : qualitative studies of illness and restructuring of illness meaning among two cultural groups of female patients in a multicultural area of Stockholm
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Mental health care in Sweden encounters a multicultural population. Meaning given to illness may differ between patient, family and caregiver and this affects the clinical encounter and outcome of treatment. The general aim of this thesis is to explore, understand, and describe how a group of Swedish and a group of Turkish-born women, assessed as somatizing by their caregivers, and in contact with local health care in Western Stockholm, gave meaning to their illness. Additional aims are to explore participants' restructuring of illness meaning, caregivers' experiences and meanings of encountering patients using a bodily idiom for emotional distress, in a multicultural milieu, and how caregivers imparted their professional agenda of illness meaning. Methods and results: The thesis consists of five explorative qualitative studies and one paper discussing methodology. Data were collected 1997-2001. Study I explores structures of illness meaning among 8 Swedish-born women. Data were collected via 25 interviews. Some data were collected to reflect the caregivers' professional opinions. Study II explores structures of illness meaning among 10 Turkish-born women. Data were collected via 29 interviews. Some data were collected to reflect the caregivers' professional opinions. Results of Studies I and II describe illness expressions, healing strategies, meanings, and initial differences in illness meaning between participants and caregivers, caregivers' introduction of a "psychological language" of distress, and participants' efforts to grasp their caregivers' meaning. Study III explores restructuring of illness meaning among the 10 Turkish-born women from Study II. Data were collected by a secondary analysis of data from Study II and 8 new interviews. Results describe restructuring to include loss of meanings, shifts in expressions and healing strategies, and a push towards restructuring illness into a psychological or psychiatric framework. Restructuring was in many ways a disruptive experience and participants tried to bridge gaps between perspectives. In this, they perceived poor support from their social context. Study IV explores restructuring of illness meaning among the 8 Swedish-born women from Study I. Data were collected by a secondary analysis of data from Study I and 7 new interviews. Results describe restructuring to include two trends, firstly an acceptance of a psychological language of distress and secondly paying attention to stress and demanding work conditions. Restructuring was not uncomplicated and participants tried to bridge gaps between perspectives. In this, the social context was important. Study V explores caregivers' experiences and meanings of encountering patients using a bodily idiom for emotional distress in a multicultural milieu and how caregivers; imparted their professional agenda of illness meaning. Data were collected via 7 focus group interviews. Results describe caregivers' experiences and meanings and that, in imparting their professional agenda, caregivers lacked support from organisational structures and clinical models for adapting work to the multicultural population and for treating mental ill health in primary care. Paper VI highlights the experiences, and reviews the literature, of using focus groups as a qualitative method in transcultural psychiatric research. Discussion and conclusion: From the results of Studies III & IV, I suggest that Antonovsky's Sense of Coherence Concept may be relevant when considering the restructuring of illness meaning, and that constructing coherence between experience, expression, and past and new illness meanings, may be significant for patients' recovery. From the results of Studies I-V, from a patients perspective, I wish to formulate the following hypotheses for the clinical encounter of emotional distress and mental illness in multicultural milieus: 1) Constructing a sense of coherence between experience, expression, past and new meanings given to illness, may be significant for patients' recovery. 2) Regarding clinical transaction of meanings, for the disruptive experience of illness, restructuring patients' illness meaning needs to be carried out in such a way as to facilitate for the patient to construct a sense of coherence between her/his illness meaning and the caregivers' medical framework. 3) The individual illness reality of the patient needs to be given an integral and important role as a collaborative resource alongside the medical framework. Implications: For the clinical encounter, results stress the significance of becoming acquainted with patients' meanings associated with illness experiences. For caregivers, in multicultural milieus, results argue for the importance of support from organisational structures and shared formulated models for adapting their work to the diversity of the population and for treating mental ill health in primary health care. For research, results point to the significance of further studies on interaction between health care and individuals and different social/cultural groups as well as on how people make sense of, use, and cope with the clinical encounter for recovery. This is of special importance for patients in an immigration situation as immigration involves being uprooted, dislocated and relocated.
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| 2. |
- Bäärnhielm, Sofie, et al.
(författare)
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Gott professionellt bemötande kan stärka den utsatta patienten
- 2020
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 117:1-3, s. 35-38
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- The Swedish word, 'bemötande', has no direct equivalent in English but refers to contact, treatment and the relationship with a patient. 'Bemötande', in the context of care, concerns amongst other things how the session is conducted and takes place. The experience of a positive 'bemötande' is important for the patient and relatives to be able to feel trust and confidence, as well as to create a well-functioning working alliance. A respectful 'bemötande' is made more difficult by people's need to classify and see individuals as 'us' and 'them'. A positive 'bemötande' can reinforce patients' self-esteem and have an empowering effect. In this article, we discuss positive 'bemötande' in a transcultural psychiatric care context and focus, in particular, upon the vulnerable patient. We also give examples of how an organisation can contribute to good contact with the local community and facilitate the encounter with individual patients.
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| 3. |
- Bäärnhielm, Sofie, et al.
(författare)
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Introducing a psychological agenda for understanding somatic symptoms--an area of conflict for clinicians in relation to patients in a multicultural community.
- 2008
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Ingår i: Cult Med Psychiatry. - : Springer Science and Business Media LLC. - 0165-005X .- 1573-076X. ; 32:3, s. 386-405
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Tidskriftsartikel (refereegranskat)abstract
- ntroducing a psychological agenda for understanding somatic symptoms--an area of conflict for clinicians in relation to patients in a multicultural community.Bäärnhielm S, Ekblad S.Transcultural Center, Stockholm County Council, St Göran's Hospital, Floor 13, 112 81 Stockholm, Sweden. sofie.baarnhielm@sll.seCulturally capable care requires that clinicians possess insights into patients' reasoning about illness. It is universally common for emotional distress to be expressed in terms of somatic symptoms. Converting meanings of illness from a somatic to a psychological agenda for understanding distress may be complicated for patients. Objectives of this study were to explore (a) professionals' experiences of encountering patients who use a bodily idiom for emotional distress in a multicultural milieu and their ascriptions of meaning and (b) how professionals impart their agenda of illness meaning to patients. Data were collected by seven focus-group interviews with professionals working in a multicultural suburban area of Stockholm, Sweden, and analyzed in two steps. The first step was content analysis. The second step was an inductive analysis with a revised grounded theory approach. Results showed that the caregivers stressed the importance of constructing a working alliance with the patient. With few exceptions, this did not include a patient-centered approach by the staff for exploring patients' perspectives and understandings of illness. Current knowledge about the importance of gaining insights into patients' perspectives was not implemented. Results of this study point to the importance of implementing new knowledge and according priority to research on the outcomes of that implementation.
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| 4. |
- Bäärnhielm, Sofie, et al.
(författare)
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[Transcultural encounter empowering the vulnerable patient]. : Gott professionellt bemötande kan stärka den utsatta patienten - Kunskap, självreflektion och vårdenhetens arbetssätt kan skapa förutsättningar för ett bra möte.
- 2020
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Ingår i: Lakartidningen. - 1652-7518. ; 117:1-3, s. 39-42
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish word, 'bemötande', has no direct equivalent in English but refers to contact, treatment and the relationship with a patient. 'Bemötande', in the context of care, concerns amongst other things how the session is conducted and takes place. The experience of a positive 'bemötande' is important for the patient and relatives to be able to feel trust and confidence, as well as to create a well-functioning working alliance. A respectful 'bemötande' is made more difficult by people's need to classify and see individuals as 'us' and 'them'. A positive 'bemötande' can reinforce patients' self-esteem and have an empowering effect. In this article, we discuss positive 'bemötande' in a transcultural psychiatric care context and focus, in particular, upon the vulnerable patient. We also give examples of how an organisation can contribute to good contact with the local community and facilitate the encounter with individual patients.
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| 5. |
- Leiler, Anna
(författare)
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Mental Health and Quality of Life Among Individuals in Asylum Accommodations : Screening and Intervention
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Refugees have often experienced traumatic events that could be classified as disasters before leaving their home countries. They are further distressed by difficult experiences while in flight and after reaching the new country. Since the experience of traumatic events is associated with an increased risk of subsequent mental health problems, recommendations regarding psychosocial support after disasters have been established. Two examples are the screen and treat approach, and active monitoring. According to these recommendations, individuals who have experienced a disaster ought to be screened for mental health problems one month after the disaster, and those with persisting symptoms of distress should be offered treatment. The general aim of this thesis is to assess the possibility and appropriateness of applying a screen and treat approach to the mental health of refugees.Four studies are included in the thesis. The first study assessed the mental health and quality of life among individuals living in refugee housing facilities in Sweden. The results showed that the prevalence of symptoms of anxiety, depression and PTSD was high, and that the included participants rated their quality of life as low. Individuals without residence permits generally had worse outcomes than those who had received a residence permit. In the second study, the ability of the Refugee Health Screener (RHS, an instrument developed for assessment of emotional distress among newly arrived refugees) to distinguish between different levels of symptom severity was assessed. By comparing the scores on the RHS with scores on other established scales with cutoffs indicating symptom severity, we identified cutoff values for mild, moderate, and severe distress. In the third study, these cutoffs were further assessed by an investigation of the association between suicidal ideation and symptom severity. The odds of an individual having suicidal ideation increased notably at each severity level. More than half of the individuals with severe distress had suicidal ideation, indicating that they needed support. The fourth study is a pilot study assessing potential effectiveness, acceptability and feasibility of a group psychoeducational intervention delivered at asylum accommodations. The results showed that the intervention was promising in alleviating symptoms of distress and insomnia. It also seemed to be acceptable to both participants and staff, even though some sessions require further elaboration. To deliver the intervention in the midst of the asylum process was demanding, but feasible. This was an early evaluation but shows that the transition to an RCT is reasonable. Taken together, the results of the four studies indicate that the mental health needs among newly arrived refugees are considerable, that the RHS can be used to identify individuals with differing needs of mental health care, and that high levels of distress are associated with suicidal ideation. The results also indicate that it is possible and meaningful to provide psychosocial interventions to individuals at asylum accommodations. This indicates that it could be possible to implement a screen and treat approach to the mental health of refugees. However, if access to treatment cannot be assured, only implementing the screening would neither be ethical nor appropriate.
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| 6. |
- Puthoopparambil, Soorej Jose, 1985-
(författare)
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Life in Immigration Detention Centers : An exploration of health of immigrant detainees in Sweden and three other EU member states
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Governments around the world use immigration detention to detain and deport irregular immigrants, which negatively affects their health. The aim of this thesis was to explore, describe and identify factors that could mitigate the effect of immigration detention on the health of detainees. This was a mixed method study using qualitative methods (Papers I and II), quantitative methods (Paper III) and descriptive case comparison (Paper IV) comparing the Swedish system to the system in the Benelux countries (Belgium, the Netherlands and Luxembourg). The study design was strengthened by triangulation of methods and data sources.Detainees experienced lack of control over their own lives due to lack of information in a language they can understand, inadequate responses from detention staff and restrictions within detention centers further limiting their liberty. Duration of detention was negatively associated with satisfaction of services provided in detention and the detainees’ Quality of Life (QOL). Detainees had low QOL domain scores with the psychological domain having the lowest score (41.9/100). The most significant factor positively associated with the QOL of detainees was the support received from detention staff. A sense of fear was present among detainees and staff. Detainees’ fear was due to their inadequate interaction with authorities, perceiving it as threatening, and due to their worry of facing repercussions of being involved in incidents caused by others. The potential for physical threat from detainees created a sense of fear among the staff. The detention staff expressed the need for more support to manage their emotional dilemma and role conflict of being a civil servant, simultaneously enabling the deportation process while providing humane care to detainees as fellow human beings. Detention centers in the Benelux countries had more categories of staff providing different services to detainees. Compared to the Benelux countries, healthcare services at the Swedish detention centers were limited. Detainees were offered no medical screening on arrival and no regular access to mental healthcare professionals.Detaining authorities have the obligation to safeguard the health of detainees. Challenges faced by the detention staff and detainees must be addressed to create a supportive environment and fulfill that obligation.
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| 7. |
- Strand, Mattias, et al.
(författare)
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Migration background, eating disorder symptoms and healthcare service utilisation : findings from the Stockholm Public Health Cohort
- 2023
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Ingår i: BJPsych Open. - : Cambridge University Press. - 2056-4724. ; 9:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: From a global perspective, eating disorders are increasingly common, probably because of societal transformation and improved detection. However, research on the impact of migration on the development of eating disorders is scarce, and previously reported results are conflicting.Aims: To explore if eating disorder symptom prevalence varies according to birth region, parents' birth region and neighbourhood characteristics, and analyse if the observed patterns match the likelihood of being in specialist treatment.Method: This study uses data from a large population-based health survey (N = 47 662) among adults in Stockholm, Sweden. A general linear model for complex samples, including adjustment for gender and age, was used to explore self-reported eating disorder symptoms. Odds ratios were calculated for individual symptoms.Results: Eating disorder symptoms are substantially more common in individuals born abroad, especially for migrants from a non-European country. This holds true for all surveyed symptoms, including restrictive eating (odds ratio 5.5, 95% CI 4.5-6.7), compensatory vomiting (odds ratio 6.1, 95% CI 4.6-8.0), loss-of-control eating (odds ratio 2.6, 95% CI 2.3-3.1) and preoccupation with food (odds ratio 2.3, 95% CI 1.9-2.8). Likewise, symptoms are more common in individuals with both parents born abroad and individuals living in districts with a high percentage of migrant residents. A gap exists between district-level symptom scores and the likelihood of being in specialist eating disorder treatment.Conclusions: These findings call for oversight of current outreach strategies, and highlight the need for efforts to reduce stigma and increase eating disorder symptom recognition in broader groups.
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| 8. |
- Strand, Mattias, et al.
(författare)
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The Cultural Formulation Interview as a clinical tool in the assessment of eating disorders : a pilot study
- 2024
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Cultural Formulation Interview (CFI) in the DSM-5 is a person-centered instrument for systematically appraising the impact of sociocultural factors in psychiatric assessment. The CFI has been shown to be feasible, acceptable, and useful in various clinical contexts. However, to this date there is only one published report describing the use of the CFI with patients with eating disorders.Aims: To explore the potential benefits and challenges of utilizing the CFI in the assessment of eating disorders.Methods: As an addendum to an ongoing qualitative study about barriers to treatment for eating disorders for individuals with a migration background in Sweden, we utilized the CFI in the assessment of adult patients (n=8) in specialist eating disorder treatment. Interview data were analyzed employing a thematic analysis framework. Participants provided feedback using a standard form for evaluation of the CFI.Results: Certain CFI questions proved especially meaningful in this context. In response to the CFI question about patient explanatory models, previously unrecognized ideas about causation emerged. These included perfectionism—a known risk factor for eating disorders—based on immigrant parents’ career expectations and experiences of strict family control over life choices. In response to the CFI questions on cultural identity and its impact, the participants provided rich descriptions including important themes such as religion, racism, and ambiguities associated with being a second-generation immigrant. The final CFI question, eliciting concern about the patient-clinician relationship, revealed numerous examples of prejudice and unfamiliarity with migrant groups among healthcare providers.Implications: The CFI can be useful in the assessment of patients with eating disorders and should be further explored as a standard tool in specialist eating disorder services.
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| 9. |
- Uhlin, Karin, et al.
(författare)
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Interdisciplinary pain rehabilitation for immigrants with chronic pain who need language interpretation
- 2024
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden. - 1650-1977 .- 1651-2081. ; 56
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate outcomes in patients with chronic pain after participation in an interdisciplinary pain rehabilitation programme with language interpreters, and to investigate the outcomes in women and men separately.Design: Prospective multi-centre cohort study. Patients: Ninety-five patients in Sweden with chronic pain who have insufficient knowledge of the Swedish language.Methods: Duration and intensity of pain, anxiety and depression, health-related quality of life and fear of movement were evaluated before and after the pro-gramme. Patients were compared with a reference group comprising Swedish-speaking patients participating in an ordinary interdisciplinary pain rehabilitation programme.Results: Before the interdisciplinary pain rehabilitation programme with language interpreters, all variables except pain duration differed significantly to the detriment of the studied group. The studied group showed significant improvements after the interdisciplinary pain rehabilitation programme with language interpreters, with regards to pain inten-sity, depression and fear of movement. The reference group improved significantly for all variables. The women in the studied group showed significant improvements for the same variables as the whole group, while the men in the studied group did not improve in any of the variables.Conclusion: This study indicates that patients with chronic pain, and especially women, who have insufficient knowledge of Swedish seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result may be of value for the further development of rehabilitation programmes with language interpreters.
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| 10. |
- Wallin, Malin Idar, et al.
(författare)
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A qualitative analysis of the documentation of DSM-5 Cultural Formulation Interviews with non-native speaking patients in a Swedish mental health care setting
- 2024
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients.Materials and methods: The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients.Results: We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms.Discussion: Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians’ identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.
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