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Oral health problems and support as experienced by people with severe mental illness living in community-based subsidised housing: a qualitative study
Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV). Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0001-6008-091X
Malmö högskola, Faculty of Health and Society (HS), Department of Health and Welfare Studies (HV). Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).
2010 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 18, no 5, p. 529-536Article in journal (Refereed)
Abstract [en]

The purpose of this study was to explore how persons with severe mental illness (SMI) experience oral health problems (especially dry mouth), and weigh the support they received in this regard from professionals and staff at community-based congregate housing through a controlled intervention programme. Oral health problems and dry mouth are found in association with apathy and indifference, cognitive deficits, and long-term medication with psycho-pharmacological drugs. The present study describes the results from one part of a longitudinal intervention programme, which sought effective ways of mitigating dry mouth through increased support with oral health problems. This part consists of 67 informal interviews with ten participants in two community-based urban housing projects between November 2006 and June 2007, with a follow-up session in December 2007. Content analysis of the results yielded five categories: The shame of having poor dental health, history of dental care, experiences of self-care, handling of oral health problems, and experiences of staff support. Poor oral health caused shame and limited participation in social activities. Participants avoided oral health issues by such circumventions as denial of a tooth ache or dental infections, or postponing oral problems with the hope that they would die away. Offers of support were frequently resisted because of unsatisfactory prior encounters with dental professionals and staff. Our findings suggest that self-care needs to be facilitated in an unobtrusive manner with minimal staff involvement, and clients should be referred to dental care providers experienced in treating people with SMI.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2010. Vol. 18, no 5, p. 529-536
Keywords [en]
community-based housing, perceived support, oral health, severe mental illness, qualitative study, xerostomia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-14594DOI: 10.1111/j.1365-2524.2010.00931.xISI: 000280635600010PubMedID: 20561079Scopus ID: 2-s2.0-77955369003Local ID: 12903OAI: oai:DiVA.org:mau-14594DiVA, id: diva2:1418115
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-09-18Bibliographically approved
In thesis
1. Oral health in an outpatient psychiatric population: oral status, life satisfaction, and support
Open this publication in new window or tab >>Oral health in an outpatient psychiatric population: oral status, life satisfaction, and support
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Oral health has generally improved in Sweden over the past 30 years. Investigations of living conditions have indicated that people with chronic mental health problems requiring psychiatric services diverge from that pattern. Research into oral health-related quality of life in this group might enhance our knowledge of the relationship between oral health, health perceptions, life satisfaction, and oral status, and its impact on quality of life in people with mental health problems. It could contribute to the description and broaden the understanding of the concept quality of life. The overall aims of this thesis were to describe oral health and oral health-related quality of life in persons attending psychiatric outpatient services; and to investigate oral health in relation to its biological aspects and perceived quality of life, including self-related variables and social aspects. Additional aims were to describe how persons with severe mental illness perceive oral health problems and to analyze the support they receive in counteracting dry mouth. The population studied consisted of 113 persons attending outpatient psychiatric services who voluntarily underwent a visual oral examination and a structured interview monitoring different aspects of life. Ten persons took part in a longitudinal investigation of how people with severe mental illness perceive oral health problems and support by means of regular visits aimed to evaluate the increase of such support. The findings showed that people in the total cohort were missing an average of 2.4 teeth. Poor oral hygiene was found in 41% of the group and 44% had objective signs of dry mouth. Seventy percent were assessed to be in need of some kind of dental treatment: 50% were overdue for scaling and polishing, 13% required more extensive dental treatment, and in 7% the need was acute. Routine dental visits were not uncommon: 75% had visited the dentist during the last year. Use of psychopharmceuticals was prevalent: 65% reported taking two or more prescribed 10 drugs. The investigation improved the understanding of psychological aspects associated with oral health among those studied, and showed measurably lower scores on life satisfaction items than is found in the general population. Analyses of the relationships between perceived oral health-related quality of life and biological and psychological factors demonstrated a correlation with numbers of teeth, type of psychiatric diagnosis, and gender. In the study population, number of teeth, life satisfaction, perceived physical health, and gender were found important. In relation to the psychiatric diagnoses, number of teeth was a significant factor in participants diagnosed with mood disorders and within the schizophrenia spectra. In participants diagnosed with anxiety and other psychiatric diagnoses, life satisfaction and reliance on chance were significant. The perception of health explained the variance in males. To females, number of teeth, life satisfaction, dental fear, and reliance on chance were also significant factors. In the study describing experience of oral health and perceived support, the result was illustrated by five categories: feelings and experiences related to poor oral health, experiences of dental care, experience of self-care, strategies for handling poor oral health, and experience of support. Oral health was important to the informants’ ability to relate to their social environment. A compromised dental status caused feelings of shame and stigma. Dental care revealed positive as well as negative experiences associated with the provider’s ability to meet the informant’s special needs. Strategies for dealing with poor oral health were mostly circumventions and were at best given ad-hoc solutions. Receiving support in oral health matters from staff was almost perceived as offensive; oral care reminders were often disregarded in an apparent assertion of the autonomy of informants, even though such behaviour could have negative consequences for their health. In conclusion, the findings showed that dental status, expressed as numbers of missing teeth, was higher for those attending psychiatric outpatient services than in a general population. The need for prophylactic dental treatment was considerable, suggesting that oral health issues need to receive increased attention during the course of psychiatric care in order to treat the whole patient. Experiences of oral health-related quality of life are of importance to the total appreciation of quality of life in an individual. This study might also contribute to the understanding of health problems in an outpatient psychiatric population since the perception of oral health-related quality of life was found to be dependent on the particular psychiatric diagnosis and gender. Questions regarding oral health in people with severe mental illness need to receive increased interest from dental, psychiatric, and social services in order to encourage self-care and enhance the autonomy of individuals.

Place, publisher, year, edition, pages
Malmö University, Faculty of Health and Society, 2009. p. 144
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383
Keywords
Oral Health, Psychiatric Outpatients, Life Satisfaction, Oral health Related Quality of Life, Quality of Life, Oral Status, Social Services, Qualitative study, Cross-Sectional Study, Multiple Linear Regression
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7367 (URN)8596 (Local ID)978-91-7104-229-3 (ISBN)8596 (Archive number)8596 (OAI)
Note

Note: The papers are not included in the fulltext online.

Paper II and III in dissertation as accepted manuscripts, paper II with title "Low perceived quality of life among psychiatric out-patients related to oral health."

Paper IV in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-09-18Bibliographically approved

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Persson, KarinÖstman, Margareta

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