The aim of this study is to describe the experiences of children’s social workers in Sweden who work with families in which a parent suffers from serious mental illness, and how a child in such a family receives support. Data were collected through individual interviews and focus groups discussions with 13 professionals in 2 minor municipalities in southern Sweden. Interviewees stated that parental serious mental illness was not a main focus for children’s social workers. When parental serious mental illness became a barrier to caring for their children, the children’s social workers sought to collaborate with psychiatric services, but in many cases it did not turn out well. Providing support to the parent was one way of aiding the family, although at the price of setting the child’s perspective aside. Being faced with responsibility for the parent and the child left children’s social workers feeling they were the last outpost for the families. Children’s social workers require greater knowledge of how to handle parental serious mental illness, and more interagency collaboration with psychiatric services is needed to adequately support children of parents with a serious mental illness. Keywords: children of parents with serious mental illness; parental serious mental illness; children’s social workers; psychiatric services

Introduction: Although research has shown that evidence-based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim: This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method: Five families with children aged 10–12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results: In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child-rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice: Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners.

Abstract Background: Children of parents with a mental illness need support from adult psychiatric services. Efforts have been made to enhance the knowledge of practitioners in this field so that they may work in a more family- oriented manner and to include children in the therapeutic services they provide. Aim: This study investigates how adult psychiatry services works with families and children when a parent has a mental illness. Method: Twenty-four Swedish professional care providers were interviewed individually or in focus groups. Data was analyzed using an inductive content method. Results: Although the professionals knew that their patients had minor children, they still prioritized the individual relationship they had with the parent. Few efforts were made to include both children and families in the treatment offered, and when this happened it was done at the professional’s own discretion. Conclusion: Despite the mandatory Swedish obligation to pay attention to a patient’s children, our study showed that professionals tend to fall short in this regard. Adult psychiatry services needs to strengthen family -oriented work in order to provide support to such children. Keywords: Minor children; Parents with mental illness; Adult psychiatric services; Family therapy

Background: A parental mental illness affects all family members and should warrant a need for support.Aim: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration.Methods: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients' main diagnoses, comorbidity, children below the age of 18, and child-focused interventions.Results: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care.Conclusions: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

Rationale and aims: This study focuses on the development of an instrument for the evaluation of clinical practice guidelines and is one part of a research project about the implementation and use of such guidelines among hospitals in the southern region of Sweden. The aim of the present paper was to investigate the test-retest reliability of a questionnaire. Method: A questionnaire was designed to gather data about guidelines that have been implemented as well as information about factors, which, according to the Promoting Action on Research Implementation in Health Service (PARIHS)-model, influence the success of implementation. Thirty-nine professionals at one of the hospitals included in the survey completed the questionnaire on two occations within a mean time of 5.5 weeks. The test-retest reliability was analyzed by means of Cohen's Kapps and percentage concordance. Results: Eight items had good agreement in terms of strength and high percentage concordance. With regard to the Kappa values 13 items show moderate and two fair agreement. Conclusions: The test-retest reliability scores show mainly acceptable results indicating a reasonable stability, thus suggesting the possibility of further developing the instrument. The factors described in the PARIHS-model seem relevant for use in evaluating implementation and use of guidelines. The instrument could benefit from a revision of the language in order to enhance clarity and make it less abstract.

The implementation of clinical practice guidelines (CPGs) has become an increasingly common element of clinical care, but little qualitative research has been conducted in real-life clinical settings. The aim was to elucidate experiences and factors of importance for the implementation of CPGs in hospital care. Twenty interviews were conducted, audio-taped and transcribed verbatim. A manifest and latent content analysis was performed to interpret the text. A system of subcategories related to five categories and one overall theme were developed. The data reveal that the implementation of CPGs is continuous processes of creating reliable and tenable routines that involve all staff members and expect to lead to better and safer patient care as well as to increased knowledge and confidence among staff. The process is initiated by internal or external demands and represents a way to keep abreast of knowledge development. Several factors facilitate the implementation and have an influence on the use and compliance with CPGs. To increase support for and willingness to use the CPG, it appears important to involve all staffs in the implementation process as well as to follow up and give feedback continuously to staff and management. It seems necessary to evaluate the process to supervise compliance with CPGs and to balance priorities and costs. Evaluation can also demonstrate importance of the application.

The purpose of this study was to examine the life experiences of nineteen Thai women of low socioeconomic status who were living with type 2 diabetes. A qualitative research design was conducted, and the women were identified by the snowball technique. The study find that despite the vulnerable situations caused by diabetes and low socioeconomic status, the women remained calm, with a consciousness to continue their lives with the disease. The Buddhist views on life, specifically natural law, assisted them to consider life with diabetes as simply a natural course. Buddhism served as a spiritual refuge and helped the women to cope with their psychological burden from diabetes.

Illness perception and self-management might be of importance in proactive care for patients with type 2 diabetes.

Objective: The aim of the study was to examine the influences of socioeconomic status on the illness perception and self-management of Thai people with diabetes.

Methods: A cross-sectional descriptive method was used to study 220 people with type 2 diabetes in a suburban area in Thailand. The participants were selected using a multistage sampling method. Data were collected through the structured interviews using the revised versions of the Diabetes Illness Perception scale and Diabetes Self-Management scale. Independent sample t test or Mann-Whitney U test was used for income and education subgroups comparisons as well as multiple logistic regression was analyzed the predictors of illness perception and self-management.

Results: The results indicated that socioeconomic status, defined by income and educational level, showed the effects on some aspects of illness perception and self-management strategies in a type 2 diabetes population. Educational level demonstrated more effects on many subscales of illness perception and self-management than on income and was also shown to be a predictor of self-management (OR 2.047, 95% CI 1.014-4.131, p-value 0.046). 

Conclusion: The study found that socioeconomic status had an impact on the illness perception and self-management of people with type 2 diabetes. Educational level demonstrated a significant influence on the perceptions and management of Thai people with diabetes, which was also true concerning income level, although to a lesser extent. Illuminating socioeconomic status in the context of religious beliefs may increase health care professionals’ understanding of patients’ experiences and management of their diabetes. This is especially important when designing appropriate interventions for patients of low education.

The objective of this study was to explore how Thai woman of low socioeconomic status handle their type 2 diabetes. The finding showed that becoming adeptr at handling diabetes required significant Changes in woman's behaviours and required taking advantagrs of influences from social environment.

BACKGROUND: It is increasingly acknowledged that satisfaction with sexual relations forms an important aspect of people's lives, but little is known of factors associated with this phenomenon among people with mental illness. AIM: This study aimed to investigate how demographic, social, clinical, and health-related factors were related to satisfaction with sexual relations. METHODS: Patients with persistent mental illness (N = 103), recruited from an outpatient unit, were assessed regarding the target variables. RESULTS: No clinical variable, and only one demographic factor, namely being a cohabitant, was found to be important to satisfaction with sexual relations. Several social factors, pertaining to how everyday occupations were valued and how the social network was perceived, were shown to be of importance. General quality of life, but not self-rated health or interviewer-assessed psychopathology, was also important for satisfaction with sexual relations. A multivariate analysis showed that the most significant factor for satisfaction with sexual relations was how everyday activities were valued, and being a cohabitant explained some additional variation. CONCLUSION: Previous research indicates that the mental health care services largely neglect sexual problems among people with mental illness, and the findings may provide additional knowledge that may be used in the support of this target group.

Purpose – This study aims to illuminate self-perceived health-related quality of life (HRQoL) among newly-arrived Arabic-speaking refugees in Malmo¨ , Sweden participating in a specific group Health Promotion activity. Design/methodology/approach – Data consist of questionnaires, observations and oral evaluations in groups. Questions about HRQoL was measured by EQ-5D self-assessment containing five dimensions and three response options of severity, including a visual analog health rating scale. Participants’ sleep patterns were measured by a sleep and recovery questionnaire with questions about sleep quality and sleep quantity. Findings – The results show that disturbed sleep relates to EQ-5D variables and to health rating scores. Moreover, there are changes over time and participants’ perceptions of their health and quality of life in most EQ-5D variables have significantly increased after the end of activity. In the variables pain and depression an improvement remains even at second follow up and health rating scores are higher at both follow ups relative to what it was originally. Sleep and recovery problems were perceived as less difficult at the course completion and second follow up. Research limitations/implications – Because of practical and ethical reasons there is an absence of a control group in this study. Practical implications – The paper includes implications for education in medicine, health care and social work, for the design of the refugee reception programs and for the inter-professional collaborations. Originality/value – The paper shows that health promotion interventions in group setting in the first stage of resettlement turn out to be useful according to HRQoL and knowledge of the health care system. Keywords Health promotion, Refugees, Arabic-speaking, Health-related quality of life, Sweden, Immigration, Health care

Background: Supporting families where one person suffers from long-term severe mental illness (SMI) is essential, but seems hard to reach. The aim of this study was to examine professionals’ views of supporting relatives of persons with SMI. Material: Individual interviews mirroring personal narratives and group interviews reflecting group-processed answers were conducted among 23 professionals and analyzed thematically. Results: Three themes emerged: (a) information and group interaction reduces stigma and increases well-being, (b) professionals need to feel secure and confident about how the support structure works and (c) collaboration is difficult but required on several levels. Conclusion: Trusting relationships with families were considered important, although seldom achieved; professionals wished to feel secure in their role toward relatives of a person with SMI; and professionals wanted to feel confident when working together with other services to support families.

BACKGROUND: : The literature concerning interpretation in research primarily concentrates on rigorous techniques to eliminate bias. This article analyses other significant issues that arise when interpreters participate in research. MATERIAL: : Empirical examples are drawn from a research project concerning mental ill health in a multicultural neighbourhood. DISCUSSION: : Interpreters influence interview data in ways commonly unnoticed by researchers. One often-overlooked factor is that languages are dynamic and interpreters are not instruments. CONCLUSION: : Research conducted with an interpreter is a complex undertaking. Solely relying on checklists to improve methodological rigour can result in a false sense of the material's validity.

According to a 2005 survey, the people of Rosengård, a culturally heterogeneous borough of Malmö, Sweden, utilise considerably less mental health services in relation to their estimated needs than the rest of the city’s population. A study based on interviews with people living or working in the area revealed several possible reasons. Most important was their perception of what constitutes mental illness. If the cause of one’s disturbed mental state is viewed as a normal life crises rather than an illness, one does not seek medical treatment. The aim of this article is to illustrate how under-utilisation of mental health services by an immigrant population can be explained by their different perceptions of what constitutes mental illness. Interventions should add concerns regarding a client’s socio-economic and psychosocial needs, rather than solely follow a medical model.

Severe mental illness causes suffering for the patient as well as the patientâ s immediate family. The Swedish National Board of Health and Welfare has recommended the implementation of multifamily psychoeducation in order to assist patient and family in the recovery process. The aim of this study was to determine how introducing multifamily psychoeducation in Sweden has been viewed by professionals. Semi-structured interviews were conducted with 11 service providers, who were involved in evaluating multifamily psychoeducation. Our main findings fell under the headings of defensive culture and unsuitable model. Resistance to introducing the new intervention was found on multiple levels. The model proposed was considered too rigid for both the target group and the organizations because it could not be adjusted to the needs of patients, families, or facilitators. Despite good evidence for the effectiveness of the intervention, there were difficulties introducing the multifamily psychoeducation model in clinical practice. The feasibility of an intervention needs to be evaluated before adopting it as a national guideline.

Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach. Two categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses' work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses' personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation. Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.

Abstract Background: Registered Sick Children’s Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. Method: A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Results: Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent’s lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. Conclusion: CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse’s conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse’s, as well as the parent’s efforts to influence the children’s weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight. Keywords: Child, Conceptions, Nurses, Overweight, Perceptions, Primary health care, Qualitative research

In this paper, we discuss traditional Somali concepts of mental ill health.Qualitative interviews were conducted with some 20 Swedish Somali interviewees about factors causing mental ill health, traditional classification, strategies to deal with mental ill health, and attitudes to the mental health care services in Sweden. Social mobilisation and religious healing are cornerstones of traditional Somali measures to deal with mental suffering. Traditional Somali views of mental ill health stand in stark contrast to classification of mental ill health in the western biomedical model. These views deserve attention since they may have an impact on health-seeking behaviour among Somali immigrants in western countries. Yet a too strong focus on cultural aspects may over-shadow the fact that much mental suffering among Somali migrants must be understood within social, economic, and political contexts.

Objectives: Relatives of people with mental illnesses are affected in many different areas of life, and are often concerned that their ill family members might be of danger to themselves or others. The aim of this presentation is to report some results from Swedish studies of relatives focusing on stigma, family burden, participation in care, and attitudes towards coercive treatment. Methods: In three different data collection periods in a longitudinal project, in all 455 relatives of committed and voluntarily admitted patients were interviewed, using a semi-structured questionnaire. Results: A majority of relatives experienced psychological factors of stigma by association. Relatives‘ burden and participation in care were not found to be associated to violent behaviour by the patients or to the patients‘ diagnoses, but relatives of patients with suicide attempts scored higher on some of the burden and participation items than other relatives. Relatives reported stronger support for coercion in order to protect the patient than for easing family burden and protecting others. Conclusion: The results indicate that relatives of psychiatric patients experience stigma by association and low participation in care, but in general support the need for compulsory psychiatric care in specific situations. However, despite a heavy burden due to the patients‘ mental illnesses, relatives do not primarily call for coercion in order to ease the family burden. There is a need for the psychiatric services to involve and support relatives of patients with suicidal behaviour.

As in many other countries, the Swedish legislation on compulsory psychiatric care has been revised several times during the last four decades. Great regional differences within the country in the use of compulsory psychiatric care have been reported. The aims of this study were to describe the development of compulsory psychiatric care in Sweden 1979–2002, and to analyse differences between two groups of counties, one group with high and one with low civil commitment rates, in terms of psychiatric care structure, resources and processes. Data on civil commitments and forensic psychiatric care in Sweden 1979–2002 were collected from public statistics. At least one responsible person in leading position (administrative manager or chief psychiatrist) in each of the included counties was interviewed. The total number of involuntarily hospitalised patients decreased about 80% between censuses in 1979 and 2002, but the rates of forensic patients were unchanged. No clear-cut differences were found in the analyses of structure, resources and processes of psychiatric services between counties with high and counties with low levels of compulsory care. The equality before the law may be questioned. The importance of leadership is emphasised for future analyses.

Radiotherapy to the head and neck region leads to severe side effects in the oral cavity but knowledge about severity and onset is scarce among oncology nurses in a radiotherapy department. The aim was to test the Oral Assessment Guide for reliability and validity for patients receiving radiotherapy to the head and neck region. A prospective design with repeated assessments was selected. Thirty-six outpatients admitted to the department for radiotherapy to the head and neck region were included. In connection with the treatment session, the oral cavity was examined every second day by a nurse and once a week by an oncologist. The results were documented on separate forms. All patients showed alterations in the oral cavity and side effects started early during the first week of treatment. The result from inter-rater reliability showed a high concordance in all categories (>71%). Cohen's kappa (k) showed good agreement for voice, swallow and saliva and moderate for lips, tongue, mucous membranes, gums and teeth/dentures. The association, the sensitivity, between dose of radiation and side effects was weak or moderate and the acceptability with patients and staff was generally good.

Purpose: The aim of the present study was to illuminate a theoretical framework about autonomy as a capacity, which takes into consideration both the cognitive functioning of the individual as well as access to social networks. Design and Method: In order to illuminate a theoretical framework about autonomy as a capacity, a quantitative study comprising a dataset of involuntarily and voluntarily admitted patients at acute general psychiatric wards was used. Findings: Respondents who reported meeting friends, family, relatives or acquaintances often had a significant higher functioning in terms of total GAF score compared to respondents who reported meeting friends, family, relatives or acquaintances as seldom or never. Practice Implications: The efforts of nursing care practices to care for and treat severe mental illness may benefit from greater awareness about research on functioning and access to social networks. Such research is a valuable contribution to further develop a theoretical framework about autonomy within the nursing profession.

Introduction This paper describes the process of implementing a family focused model, The Family Model, in child and adolescent and adult mental health services in Sweden. Additionally, it describes a service development project carried out in both services within a defined geographical area of Region Stockholm. The Family Model is a communication tool designed to assist clinicians in both services to have family focused conversations with their patients and relatives. Internationally, the needs of individuals experiencing mental health challenges (parents, children and young people) and their close relatives are now well recognized, but barriers to family focused practice nevertheless persist. The aim of this study was to better understand clinicians` experiences in implementing The Family Model in both services.Methods Three preplanned focus group interviews were carried out with 14 clinicians and managers across both services and the data were analyzed in accordance with methods of Naturalistic inquiry.Result Findings suggest that The Family Model has utility in both services. The Naturalistic inquiry analyses revealed three main themes: individual, relational and organizational aspects with a total of 10 sub-themes of how the models influence the participants. Furthermore, analyses on a meta understanding level explored that participants underwent a developmental journey in learning about and using The Family Model in practice which was expressed through three themes: "Useful for burdened families", "Influencing prevention", and "To integrate this would be fantastic".Conclusions The Family Model, when adapted for the Swedish context, is a useful tool for assisting experienced clinicians to engage in family focused practice in both child and adolescent and adult mental health services. The Family Model highlights different aspects in everyday clinical services that were of special interest for clinicians, families, and the system. Future research could explore families' perspectives of the utility of the model.

Purpose: The aim of the study was to investigate the effects of naturalistic educational interventions on attitudes towards persons with mental illness. Methods: In a pre-post test design, 456 students in vocational University programmes to become nurses, social workers, occupational therapists, physiotherapists, psychologists, and public health workers were studied after a course in mental illness, using questionnaires focusing on familiarity with mental illness and attitudes towards the mentally ill in general and towards schizophrenia in particular. Results: The results revealed a significant improvement for the total group in their being afraid of people with mental illness in general and being more positive towards having mentally ill people kiving in their neighbourhood.Differences between the students groups were found. Some educational features positively influencing stigmatizing attitudes were identified. Conclusion: Education has some effect on attitudes towards patients with mental illness, mostly on fear. To understand the effective educational ingredients for change, further research is needed.

The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.

OBJECTIVES: The relationship between oral health and various aspects of quality of life has gone uninvestigated in psychiatric populations. The aim of this study was to investigate the correlation between the Oral Health Impact Profile-14 and subjective quality of life, perceptions about general health, and self-related variables. METHODS: A structured interview constructed from validated instruments was administered to 113 consumers attending outpatient psychiatric care. RESULTS: A lower perceived oral health-related quality of life had a correlation with decreased ratings of subjective quality of life, general health disabilities, and chance and internal locus of control. CONCLUSIONS: Correlations between subjective and general health-related quality of life and oral health-related quality of life had not been detected in this group before. In order to improve mental health consumers' total perceived quality of life, oral health problems should be regularly addressed in the course of psychiatric care.

Impaired mental health has been associated with an increased need for dental care. Population surveys have indicated that people with enduring mental health problems make less frequent planned visits to the dentist and report a greater number of missing teeth than the general population. The study aims to examine oral health status, attendance to dental care, and medication in an outpatient psychiatric sample. A descriptive study combining a structured interview with a visual oral examination carried out in 113 outpatients under psychiatric care. Dental health was described in terms of sound, missing and/or filled teeth, and showed a relation between these categories and types of psychiatric diagnosis, age and numbers of antidepressant and neuroleptic drugs. Oral hygiene was found to be more neglected among men and in patients with the diagnosis of schizophrenia. The need of dental treatment was widespread, although regular dental visits were commonly reported. In order to maintain good oral health, regular dental check-ups should be encouraged for patients under psychiatric care. Further studies are required to reveal contributory causes for/to decreased oral health. The difficulty such individuals have in maintaining additional self-efficacy raises questions about the necessity for oral health interventions in outpatient psychiatric services.

Research related to oral health in people with mental health problems may deepen our understanding of the quality of life of such individuals. This study aimed to investigate the relationship between oral status, health perceptions and life satisfaction, and their impacts on oral health-related quality of life (OHQoL). Data were collected from 113 patients in outpatient psychiatric care using a structured interview and an oral examination. Six multivariate models (one comprising the total population, three separate diagnostic groups, and two sex groups) investigated the variance in OHQoL. In the total population, the number of teeth, subjective life satisfaction, perception of physical health, sex, and relying on chance accounted for 40% of the variance. In the group consisting of patients diagnosed with schizophrenia 41% of the variance was explained by the variables 'number of teeth' and 'perception of physical health'. In the group diagnosed with mood disorders, the variable 'number of teeth' accounted for 58% of the variance. The variance in the remaining group of diagnoses was explained, up to 38%, by life satisfaction and reliance on chance. The sex models revealed significant differences: men considered the responsibility of caring for their oral health as a health matter, while women saw oral health as a more subjective issue. The perception of OHQoL was found to be dependent on the particular psychiatric diagnosis and sex. Such findings can be of use in the development of rehabilitation, as well as preventive strategies that could be individually tailored to maintain OHQoL and oral health.

Treatment and support of people diagnosed with severe mental illness in Sweden takes place in out-patient psychiatric services or municipality services. Most of the responsibility for support in daily life are provided by the close family. One crucial matter is how to support these families. This research project aimed to investigate the Swedish construction with shared responsibility between county psychiatric care and municipality social care for consumers with severe mental illness affects actions in municipalities in relation to family support. Ten representatives from five municipality settings were interviewed. Five semi-structured interviews were analysed using a thematic analysis. The following themes emerged; One overarching theme, "a mismatch of paradigms", and sub-themes: (a) "accentuating differences", (b) "doubts about including the entire family in the same session" and (c) "lack of a uniform family support policy". We conclude that a shared mandate needs a dialogue between psychiatric and municipality services concerning this mismatch.

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.

Persons with a Middle Eastern background represent a minority in Sweden which has significantly increased in size over recent years. The purpose of the present study was to explore the elements that shape the experiences and perceptions of clients with a Middle Eastern background living by Muslim norms who received occupational therapy in mental health care at the time of participating in the study. The study included interviews with 11 clients who received occupational therapy in mental health care. Data collection and analysis were carried out in accordance with the grounded theory approach. One core category, desiring a union, described the clients’ desire for an alliance with the therapists that encompassed the realities and truths embedded in their values, preferences, world-views, and belief systems, as well as a wish to reconstruct their abilities to function and perform daily life tasks within their cultural contexts. The core category included sub-categories: desiring relationship, desiring affiliation, and desiring affirmation as well as some related components. The overall findings showed a tentative model in which the notion of mahram affinity was embedded. The results demonstrated that the clients’ views regarding desiring a union had their support in collectivistic world-views that often clash with those of the therapists.

Occupational well-being is a central issue underpinning factors that constitute a good life. This study aimed to explore occupational well-being among Middle Eastern immigrants to Sweden, as reflected in the occupations performed in the context of psychosocial health care. Ten participants experiencing mental health issues, who received occupation-based rehabilitation, were inter- viewed. Grounded theory methods for data collection and analysis were employed. The core category, being empowered by getting support - a paradoxical pathway to occupational well-being, described the participants’ experiences of striving for empowerment and at the same time desiring support. The core category comprised the categories: striving for control, grasping the meaning in occupation, and striving for self-respect. The participants’ ambivalence in relation to empowerment and support reflected the realities and truths embedded in both collective and individualist cultural views, which influenced the ways they viewed themselves in relation to their occupational needs and occupational well-being. Moreover, findings indicated that oscillat- ing between different cultural views related to occupational needs might amplify or diminish the participants’ experiences of occupational well-being, depending on the type of support received.

Young immigrants who suffer from psychosis perceive their illness from the outlook of at least two cultures, which is often a source of confusion and misunderstanding for clients, their families, and clinicians. This article presents a case study with a narrative approach, aiming to illustrate how an occupational therapy intervention can highlight the role of culture and address bicultural identification in a young adult immigrant woman with mental health problems. The results show how a culturally adapted intervention model can be used to help the client go through a transition from an interdependent to a more independent self. During the course of occupational therapy, the client gained greater insight into her problems and could view herself as integrating numerous facets related to two different social and cultural contexts. Moreover, the client achieved better skills in dealing with discrepancies and cultural contradictions and became capable of relying on either or both of the cultures in different situations.

Background Early hospital arrival and rapid intervention for acute myocardial infarction is essential for a successful outcome. Several studies have been unable to identify explanatory factors that slowed decision time. The present study examines whether personality, psychosocial factors, and coping strategies might explain differences in time delay from onset of symptoms of acute myocardial infarction to arrival at a hospital emergency room. Methods Questionnaires on coping strategies, personality dimensions, and depression were completed by 323 patients ages 26 to 70 who had suffered an acute myocardial infarction. Tests measuring stress adaptation were completed by 180 of them. The patients were then categorised into three groups, based on time from onset of symptoms until arrival at hospital, and compared using logistic regression analysis and general linear models. Results No correlation could be established between personality factors (i.e., extraversion, neuroticism, openness, agreeableness, conscientiousness) or depressive symptoms and time between onset of symptoms and arrival at hospital. Nor was there any significant relationship between self-reported patient coping strategies and time delay. Conclusions We found no significant relationship between personality factors, coping strategies, or depression and time delays in seeking hospital after an acute myocardial infraction.

Smoking is an important cardiovascular risk factor and smoking cessation should be a primary target in secondary prevention after a myocardial infarction (MI). The purpose of this study was to examine whether personality, coping and depression were related to smoking cessation after an MI MI patients a parts per thousand currency sign 70 years (n = 323, 73 % men, 58.7 +/- 8.3 years), participating in the Secondary Prevention and Compliance following Acute Myocardial Infarction study in Malmö, Sweden, between 2002 and 2005, were interviewed by a psychologist to assess coping strategies and completed Beck Depression and NEO Personality Inventories, in close proximity to the acute event. Correlation between smoking status (current, former and never), personality factors, coping and depression was assessed at baseline and 24 months after the MI using logistic regression and in a multivariate analysis, adjusting for age and sex Of the participating patients, 46 % were current smokers. Two years after the event, 44 % of these were still smoking. At baseline, current smokers scored higher on the depression and neuroticism scales and had lower agreeableness scores. Patients who continued to smoke after 2 years had higher scores on being confrontational (i.e. confrontative coping style) compared to those who had managed to quit. Patients who continued to smoke had significantly lower agreeableness and were more often living alone Personality, coping strategies and psychosocial circumstances are associated with smoking cessation rates in patients with MI. Considering personality factors and coping strategies to better individualise smoking cessation programs in MI patients might be of importance.

Background: Whether personality factors and depressive traits affect patients’ utilization of health care following an acute myocardial infarction is relatively unknown. The aim of this study was to examine whether hospital-based health care utilization after a myocardial infarction was correlated with patients’ personality factors and depressive symptoms. Methods: We studied 366 myocardial infarction patients admitted to Malmö University Hospital between 2002 and 2005 who subsequently participated in a cardiac rehabilitation programme. The patients were followed for two years after their index event. We investigated whether personality factors and depressive traits were correlated with the participants’ health care utilization, defined as a) out-patient Cardiology visits and phone calls to a physician, nurse or a social worker, and b) acute visits or admissions to the Emergency or Cardiology Departments, using negative binominal regression analysis. Results: In unadjusted comparisons neuroticism predicted more out-patient contacts. This significance remained after adjusting for age, sex, smoking, alcohol consumption and size of the myocardial infarction (measured as max level on troponin-I and left ventricular ejection fraction). There were no significant correlations between other personality factors or depression and out-patient contacts. None of the personality factors or depression predicted acute admissions. Conclusion: Apart from neuroticism, personality factors did not explain utilization of health care in terms of Cardiology out-patient contacts or acute admissions in myocardial infarction patients participating in a cardiac rehabilitation programme. Neither did depressive symptoms predict more health care utilization. This might indicate a robust cardiac rehabilitation programme offered to the study subjects, minimizing the need for additional health care contacts.

Women are at a higher risk for long-term sick leaves and mental ill health. The aim of this study was to explore a supportive program's meaning for women with anxiety/stress/depression problems that are unemployed and/or on a sick leave, and for the personnel involved. Seven women and the personnel (n = 5) were interviewed individually pre- and post-intervention. Data was analyzed using content analysis. The program appeared to provide participants with tools to handle their physical and mental health, and occupational support, improving their social situation. Collaboration between organizations appears to be beneficial for all parties involved.

Depression affects the depressed person and her/his closest network, giving rise to needs of support and information. The aim of this study was to examine the presence of information or other useful material for the relatives and significant others of depressed individuals on health-related Web sites and to see whether the possibly found material was addressing relatives' as of today known needs of information and support. A total of 22 Web sites granted with the Health on the Net Foundation's quality logo were examined and analysed according to Grounded Theory methodology. The study showed that a number of studied Web sites contained valuable information and material, thereby partly addressing relatives' known needs, whereas others offered no or little useful material. The study also resulted in a model in part showing the interaction between the depressed individual, the relatives and society. Conclusively, more can be done to help the relatives of depressed individuals cope with a daily life marked by the presence of depression by means of the Internet.

BACKGROUND: The aim of the study was to illuminate users' experiences of a website aimed at helping relatives of persons with depression. MATERIAL: Data was collected through forum posts, a usability scale and focus groups, and was analyzed using content analysis. DISCUSSION: The diary and forum seemed to fill different and valuable functions (i.e. think tank, exchange of stories), allowing communication with the self and others. CONCLUSIONS: The website www.sommarregn.se has the potential to work as an empowering self-help instrument online, representing a viable medium to help relatives cope. Its usability can be enhanced through further development.

E-health is developing at a high rate and represents an opportunity for the development and spreading of information and communication channels to interested parties. The aim of this study was to get an overview and comprehension of the e-health field, with special focus on depression. A survey of initiatives and studies regarding e-health and depression was carried out. Relevant articles were found through searches on databases, search engines and reference lists. This paper shows that many different initiators with differing goals and motives are active within the e-health field. In the field of e-health and depression, the following areas of interest show interesting results: studies mapping users profile and habits, the quality of health related information and the effectiveness of online therapies and supportive communities. Numerous initiators have launched different kinds of e-health initiatives. The potential of the Internet to be used constructively by health care professionals and health care consumers for health enhancing purposes still needs to be mapped, evaluated and developed.

Background: Families living with mental illness experience added burden and need information and support. Aim: This aim of this study was to explore the experiences of families living close to a depressed individual. Methods: Eighteen persons were interviewed individually or in focus groups. Data was analysed using a grounded theory-inspired methodology. Results: Most participants expressed a feeling of not living their own life, struggling to balance relationships, adapting to and re-evaluating their life circumstances, and struggling to voice their ill relatives’ and their own needs. Conclusions: More can be done to help and sustain hope in the relatives of persons with depression. Key words: depression, family burden, support, grounded theory, interviews, focus groups

Background:  The Internet’s potential as health care tool should be explored. Aim:  One objective was to determine the feasibility of constructing a digitally based tool through an iterative design process in cooperation with potential users. The tool’s purpose is to alleviate hardships in daily life of relatives of persons with depression. An additional aim was to explore motivation and hindrances to using the tool as a basis for design decisions. Method:  An iterative design approach, including data collection through focus groups and with paper and web-based prototypes, was used. Results:  Cooperation with potential users, using an iterative design process, was valuable in developing the digitally based tool. Motivations (i.e. to create understanding and rehabilitate oneself) and hindrances (i.e. lack of time or energy) to using the tool were illuminated. Design decisions were based on consideration towards participants’ privacy concerns, needs of support and the depression’s influence on the relatives’ daily life. Conclusion:  Prototypes and cooperation with potential users were essential and valuable for the iterative development of the website.

Background: Discrimination and stigmatization of people with mental illness are a global and complex phenomenon and there is evidence that negative attitudes and discrimination are also prevalent among health care staff and health care students. Methods: Attitudes towards people with schizophrenia among 1101 students in eight different university programs providing train- ing for work in the health care and social sectors were explored, using a cross-sectional design. Results: In five of the eight training programs the majority of the students’ perceived people with schizophrenia as a danger to others. In several aspects police students were found to hold more negative attitudes than students from other programs. Students with previous experiences of work in mental health services and students knowing a person with schizophrenia showed more positive attitudes. Discussion: In order to decrease negative attitudes and prejudices towards people with schizophrenia among students, it is essential that the training includes personal con-tact with people with experience of being mental illness.

Background Research has identified stigmatization as a major threat to successful treatment of individuals with mental illness. As a consequence several anti-stigma campaigns have been carried out. The results have been discouraging and the field suffers from lack of evidence about interventions that work. There are few reports on psychometric data for instruments used to assess stigma, which thus complicates research efforts. The aim of the present study was to investigate test-retest reliability of the Swedish versions of the questionnaires: FABI and "Changing Minds" and to examine the internal consistency of the two instruments. Method Two instruments, fear and behavioural intentions (FABI) and "Changing Minds", used in earlier studies on public attitudes towards persons with mental illness were translated into Swedish and completed by 51 nursing students on two occasions, with an interval of three weeks. Test-retest reliability was calculated by using weighted kappa coefficient and internal consistency using the Cronbach's alpha coefficient. Results Both instruments attain at best moderate test-retest reliability. For the Changing Minds questionnaire almost one fifth (17.9%) of the items present poor test-retest reliability and the alpha coefficient for the subscales ranges between 0.19 - 0.46. All of the items in the FABI reach a fair or a moderate agreement between the test and retest, and the questionnaire displays a high internal consistency, alpha 0.80. Conclusions There is a need for development of psychometrically tested instruments within this field of research.

The introduction of a new Civil Commitment Act in Sweden in 1992 involved a shift of emphasis from medical to judicial authority. Little is known about general patient attitudes to compulsory care. The aim of the study was to study possible differences in attitudes, before and after the mental health law reform, among involuntarily and voluntarily admitted patients and their nextof- kins towards involuntary psychiatric admission. Samples of 84 committed and 84 voluntarily admitted patients in 1991 and 118 committed and 117 voluntarily admitted patients in 1997-99 were interviewed within 5 days from admission and at discharge, or after 3 weeks of care. Samples of 64 next-of-kins to the committed patients and 69 next-of-kins to the voluntarily admitted patients in 1991, and 73 and 89 next-of-kins, respectively, in 1997-99 were interviewed approximately 1 month after the admission. Few changes in attitudes were found between the two study occasions. A majority of all patients stated that it should be possible to compulsorily admit patients, and a great majority of the patients and the next-of kins stated that decisions regarding compulsory admission should be taken by doctors. Most patients and next-of-kins regarded decisions about involuntary psychiatric care mainly as a medical matter. Strong support for coercion in order to protect the patient and others was found among next-of-kins. The law reform was not reflected in attitudinal differences.

This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996–2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n = 333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and ‘suicide attempt’ (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p < 0.001, respectively), had more markers of mental ill-health in pregnancy records (p ≤ 0.001), compared to women without such previous care, and fewer were nulliparous (p < 0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman’s mental health status in pregnancy may predict and prevent emergency cesarean section.