Background: Alopecia areata (AA) is an autoimmune hair loss disease, considered a psychosomatic disease with comorbid symptoms of depression and anxiety. Alexithymia, defined as difficulties in recognizing and describing feelings, has been found to be a vulnerability factor for developing anxiety and depression and somatic disease. The psychological burden of AA needs to be further investigated in larger studies by using standardized instruments developed to identify alexithymia, and clinical depression and anxiety. The outcome is important when treating patients with AA as well as for decisions on treatment.

Objectives: To explore the prevalence of alexithymia and its subtypes and how they relate to depressive and anxiety symptoms in patients with AA.

Methods: In this cohort study 100 patients with AA were interviewed about sociodemographic data, AA disease variables, and previous and present mental health. The Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Toronto Alexithymia Scale-20 (TAS-20) were used to identify alexithymia, depression and anxiety. Associations between alexithymia and subtype scores – difficulties identifying feelings (DIF), difficulties describing feelings (DDF) and externally oriented thinking (EOT) – were analysed in relation to depression and anxiety scores. Relations between alexithymia, depressive and anxiety scores, and AA and sociodemographic variables were examined.

Results: Prevalences of depression, anxiety and alexithymia in patients with AA were 16% (n = 16/100), 22% (n = 22/100) and 32% (n = 32/100), respectively. There was a statistically significant relation between DIF and anxiety and between DIF, DDF and depression. Lower levels of education were related to alexithymia, depression and anxiety symptoms. Alexithymia was statistically significantly more frequent among those who were younger at AA onset, in the relapsing form of AA and with nonfamilial AA. Previous mental affective illness was reported in 77% (n = 77/100) of patients with AA during the life course.

Conclusions: Patients with AA had a higher prevalence of depression, anxiety and alexithymia compared with normative data. Alexithymia was found among those with earlier AA onset, younger age at interview and lower educational levels. Higher EOT scores were found among those with anxiety and lower education.

Background: Patients often relate preceding life events to the onset of alopecia areata (AA). This cohort study systematically examined number and type of life events together with experienced strain during two years before AA onset.

Methods: The study involved 100 patients with AA who reported life events through the Social Readjustment Rating Scale (SRRS). Life event strain was examined using the Streiner model, a stress-based model in which strain is defined as undesirable, unanticipated and uncontrollable. SRRS readjustment rating and the rated strain for each life event were obtained. Percentages of strainful life events for each SRRS category were calculated. Associations between AA disease-variables, sociodemographic-variables, Beck Depression Inventory-scores and Beck Anxiety Inventory-scores were examined in relation to the number of SRRS events and the number of strainful events.

Results: Total life events reported were median (range) 7.0 (0– 22), almost two times higher than lifetime population studies on life events. The most experienced life events were loss of health and separation. At least one strainful life event prior to the AA onset was reported by 82% of patients. The highest strainful ratings were found in the Family and Personal categories of SRRS, such as Major change in health of a family member and Major personal injury or illness. A comparison between SRRS life events and strain ratings showed that 60% of the life events were rated higher and 35% were rated lower than the standard SRRS readjustment weight order.

Conclusion: This study provides support for an inquiry into any strainful life event preceding AA onset in newly diagnosed patients with AA. Categories of highly strainful events and the importance of subjective strain are identified in patients with AA. This implies the need to address strain, which seems to be important for strain reduction thereby decreasing the burden among patients with AA.

The aim of this study was to describe the extent to which men in psychiatric care have experienced emotional, physical, and sexual abuse during the life course and the association between this experience and being a perpetrator oneself. The aim was also to identify who exposed them to abuse and whether there was an association between the category of abuser and being a perpetrator oneself. A cross-sectional study was performed using the self-administered NorVold Abuse Questionnaire for men. The study included 210 men and showed that there was a significant association between physical abuse both as a child and as an adult and being a perpetrator oneself. There was, furthermore, a significant correlation between having been subjected to physical and emotional family member abuse and being oneself a perpetrator of abuse. This study concludes that experiences of abuse among men in a Swedish psychiatric context can be associated with perpetration of abuse.

PURPOSE: This study explores women's experiences of a novel prehabilitation intervention, integrating early vaginal dilator therapy before and during pelvic radiotherapy.

METHODS: This qualitative study included sixteen women scheduled for pelvic radiotherapy. All participants received a pre-treatment intervention with individualized information and support to start vaginal dilator therapy prior to radiotherapy. Semi-structured interviews were conducted with all sixteen women before or during treatment. Of these, ten also participated in follow-up interviews after radiotherapy. Data were analyzed using reflexive thematic analysis.

RESULTS: Four themes were constructed reflecting women's experiences of the new prehabilitation intervention: (1) Regaining control while facing the unknown, (2) Navigating identity, (3) Conceptualizing vaginal and sexual health, and (4) Building trust. Women found that vaginal dilator therapy during prehabilitation enabled a sense of control and readiness for upcoming sexual and vaginal health concerns. The early support was perceived as timely, acceptable, and empowering, regardless of women's initial motivation to engage. None of the women preferred to only receive the information after treatment, reflecting the value of proactive care.

CONCLUSION: Integrating vaginal dilator therapy into prehabilitation may enhance preparedness, promote self-care, and reduce distress during pelvic radiotherapy. Further research is needed to confirm benefits and tailor support to individual needs.

Experience of abuse as a life event is common among men in a psychiatric care context. Systematically charting life events and abuse plays a central role within psychiatric and mental health nursing and could improve the understanding of the patient's life situation. The aim of the study was to explore the life course of male psychiatric patients who had experienced domestic abuse as victims and as perpetrators. An interview study was performed with nine informants using a time-geographic method followed by a qualitative analysis approach. The analysis of life events resulted in four categories-living the everyday life, adverse life experiences, the lived experience of abuse exposure and perpetration, and systems of support. The categories were then synthesized and presented through a constructed case. The study reveals that the men faced severe domestic abuse, difficult home conditions, and a lack of support during childhood. Further, they encountered stressful events and mental health issues in adulthood. These findings offer deeper insights into the lives of men with abuse experiences. The knowledge obtained provides valuable information about important life events, including abuse and perpetration, of male psychiatric patients, which may encourage a patient narrative suitable for good psychiatric and mental health nursing practice.

The aim of this qualitative study is to present the experiences of family members bereaved by intimate partner homicide (IPH). The focus is on immediate and long-term consequences of the killing, and on the participants' experiences of subsequently offered information and support. This includes interactions with healthcare, social services, the criminal justice system, and the media. Twenty-two interviews with parents, siblings, and adult children of IPH victims underwent thematical analysis. The bereaved mainly described the social support following the IPH as lacking or inadequate, and recounted that they had been left alone with handling practical and emotionally difficult tasks, such as cleaning up after the killing. More specifically, they felt that institutional responses had been lacking with regard to information, understanding, coordination between professionals, continuity, professionalism, and redress. These results indicate that a coordinated response to people bereaved by IPH is necessary and, if lacking, must be developed. Using thematic analysis, this interview study explores the experiences of family members who have been bereaved by intimate partner homicide. The focus is on the social support they were offered, which they found lacking or inadequate. In hindsight, they would have wanted some professional to reach out to the family and offer emotional and practical support, as well as information.

Psychiatric Day Hospitals offer time-limited active treatment programmes that are therapeutically intensive, coordinated, and with structured clinical services within a stable environment. No previous studies have described patients' experiences of recovery-oriented care at a Psychiatric Day Hospital in a Swedish or Nordic healthcare context. The aim of the study was to explore patients' experiences of a Psychiatric Day Hospital with focus on patient recovery. A qualitative method was used; 12 in-depth interviews were performed with patients all analysed with content analysis. The theme that emerged was "A safe haven." To do something routinely and meaningful during the days, feelings of security, and to gain increased knowledge about mental ill health were concepts which felt important and contributed to recovery. Feelings of belonging and prevention of loneliness were also highlighted.

Defining psychiatric and mental health nursing has been a challenge for decades, and it is still difficult to find a comprehensive definition. We have identified a possibility to clarify psychiatric and mental health nursing based on humanistic philosophy in a general psychiatric care context. The aim was therefore to identify and synthesize the theoretical frameworks from which psychiatric and mental health nursing models are developed. We systematically collected and evaluated articles based on Grounded Theory (GT) methodology regarding psychiatric or mental health nursing. The PRISMA statement for systematic reviews was used and the formal process of synthesis, as a three-step process of identifying first -, second - and third-order themes following the examples of Howell Major and Savin-Baden. The synthesis resulted in a model describing five core elements of psychiatric and mental health nursing: 'professional nursing', 'therapeutic relationships' and 'honest engagement', with time as the all-encompassing theme, including the patients' 'lifetime perspective'. Psychiatric and mental health nursing is a caring support towards recovery, where the patient's lifetime perspective must be in focus during the caring process with a relationship built on an honest engagement. Time is therefore essential for psychiatric and mental health nursing.

BACKGROUND: Previous research indicates that routine inquiry or screening conducted by healthcare providers may significantly increase the identification of interpersonal violence. There is a lack of comprehensive instruments to routinely assess patients about interpersonal violence and violence against children in the household. The purpose of this study was to assess the content validity, face validity and reliability of the Questions on Violence (FOV) tool, an instrument specifically designed for routine inquiries about interpersonal violence in healthcare settings within the Swedish context.

METHODS: The content validity, face validity and reliability of the FOV instrument was assessed through (1) a content validity index with six experts in the field of intimate partner violence, (2) cognitive interviews with nine patients recruited from a primary healthcare facility, and (3) an evaluation of the test-retest reliability based on responses from 37(50.0%) university students. The intraclass correlation coefficient, model 2.1, was calculated to assess the degree of correlation and agreement between the two measurements.

RESULTS: Calculations based on the content validity index indicated that five out of seven items had excellent content validity (≥ 0.78). The average content validity index of included items was 0.88, which is slightly below the recommended threshold for excellent content validity. The results based on the cognitive interviews revealed that participants found the seven items to be relevant and easy to understand. Overall, the participants agreed that the concept of 'close relationships' primarily encompassed intimate partners, family members, and close friends. The value of the intraclass correlation coefficient was 0.85 (0.77-0.91; CI 95%), indicating good reliability with an interval of good to excellent test-retest reliability.

CONCLUSIONS: The results demonstrate that the seven-item FOV instrument has good content and face validity as well as good to excellent test-retest reliability. The current study provides healthcare professionals with a short yet comprehensive instrument for identifying patients who have experienced or perpetrated different forms of interpersonal violence.

BACKGROUND: Workplace violence is a global threat to healthcare professionals' occupational health and safety and the situation has worsened during the COVID-19 pandemic. This study aimed to explore workplace violence directed against assistant and registered nurses working on surgical wards in Sweden.

METHODS: This cross-sectional study was conducted in April 2022. Using a convenience sampling procedure, 198 assistant and registered nurses responded to an online questionnaire developed for this specific study. The questionnaire comprised 52 items and included, among other items, subscales from validated and previously used instruments. Data analysis included descriptive statistics, the chi-square test, and independent-samples t-test.

RESULTS: The most frequently reported type of workplace violence was humiliation (28.8%), followed by physical violence (24.2%), threats (17.7%), and unwanted sexual attention (12.1%). Patients and patients' visitors were reported as the main perpetrators of all kinds of exposure. Additionally, one third of the respondents had experienced humiliation from colleagues. Both threats and humiliation showed negative associations with work motivation and health (p < 0.05). Respondents classified as working in a high- or moderate-risk environment were more frequently exposed to threats (p = 0.025) and humiliation (p = 0.003). Meanwhile, half of the respondents were unaware of any action plans or training regarding workplace violence. However, of those who indicated that they had been exposed to workplace violence, the majority had received quite a lot or a lot of support, mainly from colleagues (range 70.8-80.8%).

CONCLUSION: Despite a high prevalence of workplace violence, and especially of humiliating acts, there appeared to be low preparedness within the hospital organizations to prevent and/or handle such incidents. To improve these conditions, hospital organizations should place more emphasis on preventive measures as part of their systematic work environment management. To help inform such initiatives, it is suggested that future research should focus on the identification of suitable measures regarding different types of incidents, perpetrators, and settings.