Objective: The de-institutionalizing process came to an end before the millennium shift by closing mental hospitals. After that some of the most ill patients are cared for in sheltered housing (SH). There is no in-house psychiatric competence and the staff on the floor usually lacks such knowledge and training. Observation instruments may improve this by making it possible to assess and monitor patients. Method: FAST-O is a simple twelve-item observation scale. Staff at eight SH units were trained in using the instrument and then assessed a total of 67 patients once, twice or three times at monthly intervals. Results: Ten items formed two highly homogenous subscales reflecting Social skills (Soc) and Excitation/Aggression (E/A). Depression and Clinical Global Impression (CGI) items were considered separately. The correlation pattern suggested that the ratings had construct validity. A cluster analysis identified three patient subgroups, of which one had very high E/A scores. Comparisons with reference data suggested that the average symptom level was on par with acutely admitted in-patients for this subgroup. In all groups, E/A symptoms varied considerably over time, the other symptoms were more stable. There were marked differences among the eight SH units with respect to the level of patient problems. Conclusions: The SH staff was able to produce valid FAST-O assessments. There are reference data which makes it possible to characterize individual patients as well as SH units with respect to treatment needs and safety aspects (for instance risk of violence).

The self-report Drug Attitude Inventory (DAI), in 30- and 10-item versions, provides unique information of clinical relevance for monitoring treatment adherence among people diagnosed with schizophrenia. The primary purpose of this paper was to evaluate the 10-item version among patients living in sheltered housing. Data were collected among 68 persons living in sheltered housing, most of them (82%) diagnosed with schizophrenia, 6% with non-organic psychoses, and 12% with other diagnoses. The dichotomic response format of the original DAI-10 was replaced by a 4-point Likert scale, in order to improve the resolution of the scale. Over 90% of the participants produced meaningful scores. A factor analysis suggested a 2-factor orthogonal structure: one highly homogenous factor (5 items) reflected wanted effects of the drug and displayed a bimodal distribution; one factor (3 items) reflected side effects. One item concerned the perceived control over one's drug treatment, which is a key clinical issue. One item was conceptually ambiguous and displayed no correlations with the other items. On the basis of the results we suggest cut-off scores which indicate the need for three kinds of adherence-improving interventions. Summing up, by dropping one item and using a Likert scale response format, the resulting instrument, DAI-9, appears to be an easy-to-use self-report instrument for monitoring drug attitudes and to identify needs for treatment adherence interventions among seriously ill patients.

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.

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: 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.

Families living with mental illness experience an added burden and may experience such psychological distress that they require therapeutic intervention. The Internet is used as a daily tool by a growing share of the population worldwide, including for health related matters. Its potential as a health care tool, including advantages and drawbacks, should be explored. The overall aim of the present thesis was to explore the relatives’ experiences of living close to a person with depression and the Internet’s potential to address their needs. Explorative qualitative research has been used to map the e-health field in relation to depression, to explore what the Internet offers the families living with depression, as well as the relatives’ experiences of living with a person with depression. An iterative design process was used in the development of a digitally based tool aimed at supporting the relatives in their daily life with depression. Users’ experiences of the tool were explored using qualitative explorative research. A vast array of different organizations and initiatives are represented within the e-health field. However, initiatives that are targeted and tailor-made for families living with depression are scarce. Research in the e-health field with focus on depression illuminates health seekers’ and online community users’ profiles, effects of online cognitive behavioral therapy (CBT), and a number of strengths (i.e. accessibility) and weaknesses (i.e. reliability) related to the Internet as a health care tool. Living close to a person with depression can strongly affect the private, social and professional areas of the relatives’ daily life. A growing feeling of not living one’s own life may arise, due to the difficulties of balancing relationships, a process of adaptation and re-evaluation of life circumstances, and a struggle to act as advocate and voice for the person with depression within the health care system and society. Relatives often come in contact with health professionals on 12 behalf of their ill kin and need information and support; needs that are rarely addressed by the health care system. A digitally based tool aimed at supporting the relatives in their daily life with depression was developed using an iterative design process. The tool’s development was carried out in close cooperation with users with the help of focus groups and prototypes. Motivations and obstacles to using online self-help tools were illuminated. Privacy stood out as an important factor when developing online tools. The study resulted in a website, www.sommarregn.se, entailing an online diary (private and encrypted), including scales, and a forum (members only access), including an e-mail function. Users’ experiences of the website over a 10 weeks test period were illuminated. The diary and forum appeared to fill a number of valuable functions, although a further development of the tool may enhance its usability, which was good. The tool promoted communication with the self and others. The Internet as a technology offered a number of advantages, such as convenience of use and perceived anonymity, and disadvantages, such as qualitative issues. The relatives’ needs ought to be addressed in order to support them in a daily life with depression. Empowered relatives are in a better position to help their ill kin and support may prevent ill health in the relatives themselves, and subsequently additional costs to society. Health care professionals meet patients that are also online health seekers. Professionals must be aware of the advantages and drawbacks of e-health when meeting patients. In an economically pressured society, alternative support options have to be explored in order to address the needs of target groups at risk.

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

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.

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.