Landlords' experiences of housing tenants suffering from severe mental illness: a Swedish empirical study.

The aim of this Swedish study was to describe landlords' experiences of having tenants suffering from severe mental illness. Sixteen landlords working in private and public housing agencies participated in open in-depth interviews. Data were subjected to a thematic latent content analysis. The results showed that having tenants with severe mental illness entails being confronted with various difficult circumstances, ranging from mismanagement of apartments to sensitivity among neighbours as well as issues regarding provocative behaviour. It involved providing assistance that was far beyond their professional obligations and to be neglected by the community-based psychiatric service system when in need of help. In order to support landlords and to prevent evictions of individuals with severe mental illness, community-based psychiatric services need to be more pro-active in their attempts to achieve collaboration with the parties at hand.

Victimization in individuals suffering from psychosis: a Swedish cross-sectional study.

The aims of the study were to investigate: (1) self-reported adulthood and last-year victimization in male and female outpatients suffering from psychosis; (2) relationships to perpetrators; (3) whether drugs or alcohol were involved in victimization situations; (4) places where victimization occurred. Patients were randomly selected from five outpatient units geared to patients with psychosis; 174 patients participated in a structured face-to-face interview. Experiences of victimization in adulthood were reported by 67%, 33% in the previous year. During adulthood 51% had been physically and 32% sexually victimized and 39% threatened. In the previous year 21% reported threats, 20% physical and 15% sexual victimization. Women reported greater exposure to physical and sexual victimization than men during adulthood and in the previous year. Strangers and acquaintances were mainly reported as perpetrators and half (55%) of those victimized in the previous year stated no involvement of alcohol or drugs. Victimization mainly occurred in the patients' own home (59%), outside downtown (34%), or in others homes (38%). The results of this study give reason to highlight the importance for research and clinical practices to adopt a broad frame of interpretation concerning victimization in patients, covering both individual and environmental factors.

Mental health users' experiences of being interviewed by another user in a research project. A qualitative study.

BACKGROUND: Although user involvement in research is an area of high priority there is a lack of knowledge about how users of the mental health system perceive participation in studies carried out by other users. AIM: The aim of the study was to describe how users experience participation in research interviews performed by other users. METHOD: A varied sample of 17 mental health users with experience of being interviewed in a research project by another user was thematically interviewed in this qualitative study. Data was subject to content analysis. RESULTS: Being interviewed by another user was a special experience including both negative and positive aspects, and took place in an atmosphere of comradeship. However, being interviewed by another user could generate feelings of insecurity. This finding indicates requirements from the informants how to perform user-involved research in the future. CONCLUSIONS: In planning for user-involved research education, it is necessary to consider training and issues related to secure ethical principals concerning the informants.

Staff experience and understanding of working with abused women suffering from mental illness.

The phenomenon of abused women with mental illness is often unrecognised by staff working within welfare services. This may be explained by staff members' attitudes, insecurity or lack of awareness. Today, there are shortcomings in the knowledge of staff members' experiences and interpretations of abuse against women suffering from mental illness. The aim of this qualitative study was to describe how staff members experience and understand their work with abused women suffering from mental illness. Thematic interviews were conducted with 13 staff members from various welfare services. Data were subject to content analysis. The findings showed that working with abused women was experienced as ambiguous and painful and made the staff act pragmatically. Feelings of ambiguity were mainly related to the lack of theoretical frameworks for interpreting why women with mental illness are exposed to abuse. Painful experiences involved intertwined feelings of distress, frustration, worthlessness, ambivalence and powerlessness. These were all feelings that emerged in the direct encounters with the abused women. In response to the abused women's comprehensive needs, staff members acted pragmatically, implying networking without any sanction from the leaders of the organisation, compliance with routines and taking action in here-and-now situations. By acting pragmatically, staff members could achieve concrete results through their interventions. It is concluded that staff members, working with abused women with mental illness, are in a vulnerable situation and in need of formally accepted and implemented support and legitimacy as well as theoretical knowledge regarding causes and consequences of abuse in this particular group of women.

The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occurred.

The aims of the study were to investigate self-reported physical, sexual, emotional and economical abuse in Swedish female users of psychiatric services, who the perpetrators were and in which places abuse occurred. An anonymous self-administrated questionnaire was answered in the waiting room of the services. The drop-out rate was 21% and n=1382 women completed the questionnaire. Fifty-three per cent of the women had been abused during childhood, 63% during adulthood and 31% during past year. Seventy-four per cent of those exposed during childhood were also exposed later in life. Women subjected to abuse reported longer contact with psychiatric care. Regardless of life period, the majority reported multiple and frequent abuse. Emotional abuse was most frequent reported in both childhood and adulthood followed by physical and sexual abuse. The reported perpetrators were mainly male persons to whom the woman had an intimate relationship. Mostly the abuse occurred in the women's own home. However, other women, strangers, acquaintances and relatives were also stated as perpetrator and abusive acts also took place in other homes, outdoors or down town. The high prevalence of abuse and its multiplicity point to the necessity for the care and support system to prioritize abuse against women with psychiatric illness.

Childhood abuse in Swedish female users of psychiatric services.

INTRODUCTION: The aims of this study were to investigate: (1) the prevalence of childhood abuse in women admitted to psychiatric services in a county in the south of Sweden; (2) who the perpetrators were; and (3) the women's self-reported consequences of childhood abuse. METHOD: The study had a cross-sectional design and was a part of a more comprehensive study. An anonymous self-reported questionnaire was used which included both closed and open-ended questions. The data material were analysed by means of descriptive statistics, Mann-Whitney U-test and manifest content analysis. RESULTS: The total number of women who participated in the study was 259, 51% of whom reported experiences of abuse during childhood, with 53% of these having been exposed to more than one type of abuse. The most frequent perpetrator was the woman's parents; mainly the fathers but also the mothers turned out to be frequent perpetrators of abuse. Some 75% of the women reported current psychological problems in adulthood related to abuse in childhood. According to a manifest content analysis, five themes of self-reported psychological problems emerged: psychiatric problems, shortcomings in social relations, poor self-confidence, fears and bad memories.

Mastery in patients with schizophrenia living in the community: relationship to sociodemographic and clinical characteristics, needs for care and support, and social network.

In line with user involvement and empowerment in individuals who suffer from a severe mental illness, the sense of mastery is important. Few studies have investigated factors that contribute to mastery in individuals with schizophrenia. The aims of the present 18-month follow-up study were to investigate associations between mastery and clinical and sociodemographic factors, needs for care and support and social network, and to investigate whether changes in mastery were related to changes with regard to these aspects in a group of patients (n = 120) with schizophrenia living in the community. Structural interviews were performed at baseline and after 18 months. Pearlin's mastery scale, the Camberwell Assessment of Needs (CAN), the Interview Schedule for Social Interaction (ISSI), and the Brief Psychiatric Rating Scale (BPRS) were used on both interview occasions. A stepwise regression analysis showed a negative relationship between psychopathology, especially affective and negative symptoms, and mastery. Stronger mastery was associated with younger age and less severe basic needs. In total psychopathology, age and basic needs explained 50.7% of the variance in mastery. Changes in mastery were positively correlated to changes in access to social contact but negatively correlated to changes in affective symptoms. In order to target mastery in individuals with schizophrenia, the community-based nursing services need to develop, implement, and evaluate interventions that are effective for psychiatric symptoms, social skills performance, and needs for care and support in areas of living, nutrition, and daytime activities.

Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings.

OBJECTIVE: To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community-based individuals with schizophrenia. METHOD: A total of 418 individuals with schizophrenia from 10 sites were interviewed with regard to quality of life, psychopathology, social network and needs for care. Characteristics of the living situation investigated were: living alone or not, living with family or not, and having an independent or a sheltered housing situation. RESULTS: An independent housing situation was related to a better quality of life concerning living situation and living with the family to a better quality of life concerning family relations. An independent housing situation was associated with a better social network regarding availability and adequacy of emotional relations. CONCLUSION: People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not.

Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life.

Quantitative and qualitative aspects of the social network were investigated in a sample of 120 schizophrenic out-patients. Sociodemographic and clinical factors as well as subjective quality of life were investigated as to their relationship to the social network. The Interview Schedule for Social Integration (ISSI) was used to assess social network and Lancashire Quality of Life Profile was used to assess subjective quality of life. Psychopathology was measured by BPRS and psychosocial functioning by GAF. The patients reported a significantly worse social network compared to a normal sample both regarding quantitative and qualitative aspects of the network. Almost half of the patients wanted access to more social contacts. Relatives and friends turned out to be the patient's main source of supportive contacts. More severe negative and positive symptoms were related to a worse social network. Support was found for an association between characteristics of the social network, such as satisfaction with social contacts, and quality of life. The results give reason to suggest that the care system should consider the informal caregivers' situation and focus on interventions, which enhance the patient's satisfaction with social contacts.

The relationship of personality dimensions as measured by the temperament and character inventory and quality of life in individuals with schizophrenia or schizoaffective disorder living in the community.

The influence of personality factors on the appraisal of subjective quality of life in individuals with schizophrenia or schizoaffective disorder is not much investigated. The present study examined this relationship in a sample of 104 patients living in the community. The temperament and character inventory was used to assess personality and the Lancashire quality of life profile was used to assess quality of life. The results showed that lower levels of harm avoidance and higher levels of self-directedness were significantly correlated to a better subjective quality of life. Regression analyses controlling for psychopathology revealed that a higher level of self-directedness was significantly associated with a better subjective quality in all aspects measured and explained the variance in the latter in the range of 4-12%. It is concluded that personality factors are involved in severely mentally ill individuals' assessment of their quality of life and should be accounted for in evaluations of quality of life assessments. The strength and directions of this influence require further studies.

The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help.

In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% ('telephone') to 84.0% ('psychotic symptoms'). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% ('telephone') and 80.6% ('food'). The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs. In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received. In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs. It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.

Predictors of social relations in persons with schizophrenia living in the community: a Nordic multicentre study.

BACKGROUND: Deinstitutionalisation has led to persons with serious mental illness spending most of their time outside psychiatric institutions. Not much is known about their social life. The paper presents the results of structured interviews with non-institutionalised persons with schizophrenia about treatment, care and social network. The network data are analysed from three perspectives: finding predictors of the number and of the quality of social contacts, and establishing the respective variables that characterise persons with high, and those with low, scores on both the quantity and quality dimensions of social integration. METHODS: Random samples of persons with schizophrenia receiving outpatient services in ten psychiatric centres in the four Nordic countries were interviewed. The following instruments were used: Interview Schedule for Social Interaction (ISSI), Camberwell Assessment of Needs, Lancashire Quality of Life Profile, General Assessment of Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS), in addition to a checklist covering the utilisation of different services. The ISSI provided the main data for this paper. A restricted number of possible predictors were used in General Linear Model (GLM) factorial analysis and discriminant analysis. RESULTS: A total of 418 persons took part in the study. The overall participation rate was 55%. Social integration in terms of number of contacts was related to a high GAF score, few BPRS negative and hostility symptoms, having contact with user organisations and living in urban (in contrast to rural) areas. Availability of emotional relations was predicted by female sex, low scores on the BPRS hostility dimension, high GAF score, having contact with one's family more than once a month, and living in urban areas. Work, adequate leisure activities and GAF score discriminated between the best and worst integrated groups. CONCLUSIONS: Living in urban areas, being female, having a high GAF score and low scores on hostility predicted better integration in terms of number of contacts and emotional relations.

The validity of Antonovsky's Sense of Coherence measure in a sample of schizophrenic patients living in the community.

AIM OF THE STUDY: To examine the construct and predictive validity of Antonovsky's Sense of Coherence (SOC) concept in a sample of schizophrenic persons living in the community. BACKGROUND: The salutogenic model of Antonovsky proposes that the individual's sense of coherence, which is a personal orientation towards life, determines the health experience. The salutogenic perspective might in several advantageous aspects contribute to the care and support for patients with a long and persistent mental illness like schizophrenia. DESIGN: The study is a 18-month follow-up study. Structured interviews were used to interview 120 patients with a diagnosis of schizophrenia or a schizoaffective disorder. Pearlin's mastery scale, Rosenberg's self-esteem scale, the Interview Schedule for Social Interactions (ISSI) and the Brief Psychiatric Rating Scale (BPRS) were used as construct validity measures of the SOC scale. Health related measures such as quality of life, global well-being, satisfaction with health assessed by the Lancashire Quality of Life Profile (LQOLP) and global psychosocial functioning (GAF) were used in calculations of the predictive validity of SOC. RESULTS: The SOC was positively related to mastery, self-esteem and social support but negatively associated to psychopathology. In total, mastery, self-esteem and adequacy of social integration explained 61.1% of the variance in SOC, and mastery contributed with the greatest part of the variance, 46.3% SOC was positively associated to all health related measures and changes in SOC during an 18-month follow-up was positively correlated to changes in overall subjective quality of life, general health, global well-being and global psychosocial functioning. CONCLUSION: The results gave support to the construct and predictive validity of the SOC measure in individuals suffering from a diagnosis of schizophrenia.

Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.

OBJECTIVE: The present study is part of a Nordic multicentre study investigating the life and care situation of community samples of schizophrenic patients. The specific aim of the present part of the study was to examine the agreement between patients and their key worker concerning the presence of met and unmet needs in a number of life domains, and help or support given in these domains. METHOD: The comparisons were based on 300 matched pairs of assessments of need using the Camberwell Assessment of Need interview. RESULTS: The results showed that key workers identified slightly more needs, 6.17 vs. 5.76, a significant difference. There was a moderate or better agreement on the presence of a need in 17 of 22 life domains investigated, but in only 11 life domains concerning the presence of an unmet need. Disagreement concerning whether the patient was given the right kind of help or support was even more substantial. CONCLUSION: It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

Clinical and social needs of schizophrenic outpatients living in the community: the relationship between needs and subjective quality of life.

BACKGROUND: The aims of this study were to assess self-perceived clinical and social needs among 120 schizophrenic outpatients, and the relationship between needs and subjective quality of life. METHOD: The Camberwell Assessment of Need instrument (CAN) was used to assess needs and the Lancashire Quality of Life Profile was employed to assess subjective quality of life. RESULTS: More than half of the patients expressed needs in areas concerning psychotic symptoms, daytime activity, company, physical health and information about their condition or treatment. The areas with the highest proportion of unmet needs were information, company, intimate relationship, physical health, daytime activity and psychological distress. A more severe need of care and support in the areas of company, psychological distress, daytime activity and sexual expression was associated with a worse subjective quality of life, controlling for the influence of symptomatology. CONCLUSIONS: The results point to a need to further emphasise interventions towards the treatment of psychotic symptoms and psychological distress as well as to focus on interventions concerning the social relations and occupational situation of long-term mentally ill patients.

Subjective quality of life in schizophrenic patients living in the community. Relationship to clinical and social characteristics.

The aims of this study were to assess the quality of life among 120 schizophrenic patients who were attending a psychiatric outpatient department and to investigate which socio-demographic and clinical factors influenced their subjective quality of life. Quality of life was assessed by the Lanchashire quality of life profile, social functioning was judged according to the Global Assessment of Functioning (GAF) scale, and psychopathology was rated by means of the Brief Psychiatric Rating Scale (BPRS). Both objective and subjective life conditions indicated an impaired quality of life for the patients. The areas of finance and work had the largest proportion of dissatisfied patients. Socio-demographic indicators showed to have a weak influence on the patient's self-assessed quality of life while clinical factors, such as psychopathology, strongly influenced the patient's life satisfaction. It is concluded that there is a need for further emphasise on the clinical, financial, and social interventions for this group of patients.

Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study.

As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.