Norwegian general practitioners' perceptions of their depression care - a national survey.

BACKGROUND: The General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs' workload. OBJECTIVE: To assess how GPs experience their patients' expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics. METHODS: A cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021. RESULTS: Of the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40-54 years. CONCLUSIONS: Talking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.

An Internet-Based Intervention to Increase the Ability of Lesbian, Gay, and Bisexual People to Cope With Adverse Events: Single-Group Feasibility Study.

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at higher risk of mental health problems due to widespread hetero- and cisnormativity, including negative public attitudes toward the LGBTQ+ community. In addition to combating social exclusion at the societal level, strengthening the coping abilities of young LGBTQ+ people is an important goal. OBJECTIVE: In this transdiagnostic feasibility study, we tested a 6-week internet intervention program designed to increase the ability of nonclinical LGBTQ+ participants to cope with adverse events in their daily lives. The program was based on acceptance and commitment therapy principles. METHODS: The program consists of 6 web-based modules and low-intensity assistance for homework provided by a single care provider asynchronously. The design was a single-group assignment of 15 self-identified LGB community members who agreed to participate in an open trial with a single group (pre- and postintervention design). RESULTS: Before starting the program, participants found the intervention credible and expressed high satisfaction at the end of the intervention. Treatment adherence, operationalized by the percentage of completed homework assignments (32/36, 88%) was also high. When we compared participants' pre- and postintervention scores, we found a significant decrease in clinical symptoms of depression (Cohen d=0.44, 90% CI 0.09-0.80), social phobia (d=0.39, 90% CI 0.07-0.72), and posttraumatic stress disorder (d=0.30, 90% CI 0.04-0.55). There was also a significant improvement in the level of self-acceptance and behavioral effectiveness (d=0.64, 90% CI 0.28-0.99) and a significant decrease in the tendency to avoid negative internal experiences (d=0.38, 90% CI 0.09-0.66). The level of general anxiety disorder (P=.11; d=0.29, 90% CI -0.10 to 0.68) and alcohol consumption (P=.35; d=-0.06, 90% CI -0.31 to 0.19) were the only 2 outcomes for which the results were not statistically significant. CONCLUSIONS: The proposed web-based acceptance and commitment therapy program, designed to help LGBTQ+ participants better manage emotional difficulties and become more resilient, represents a promising therapeutic tool. The program could be further tested with more participants to ensure its efficacy and effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT05514964; https://clinicaltrials.gov/study/NCT05514964.

Stakeholder views on work participation for workers with depression and intersectoral collaboration in depression care: a focus group study with a salutogenic perspective.

OBJECTIVE: To explore how stakeholders in depression care view intersectoral collaboration and work participation for workers with depression. DESIGN: Focus group study applying reflexive thematic analysis using a salutogenic perspective. SETTING AND SUBJECTS: We conducted seven focus group interviews in six different regions in Norway with 39 participants (28 women); three groups consisted of general practitioners (GPs), two of psychologists and psychiatrists and two of social welfare workers and employers (of which one group also included GPs). RESULTS: Stakeholders considered work participation salutary for most workers with depression, given the right conditions (e.g. manageable work accommodations and accepting and inclusive workplaces). They also highlighted work as an integral source of meaningfulness to many workers with depression. Early collaborative efforts and encouraging sick-listed workers to stay connected to the workplace were considered important to avoid long and passive sickness absences. Furthermore, stakeholders' views illuminated why intersectoral collaboration matters in depression care; individual stakeholders have limited information about a worker's situation, but through collaboration and shared insight, especially in in-person collaborative meetings, they (and the worker) can gain a shared understanding of the situation, thereby enabling more optimal support. Ensuring adequate information flow for optimal and timely follow-up of workers was also emphasized. CONCLUSIONS: Stakeholders highlighted the salutary properties of work participation for workers with depression under the right conditions. Intersectoral collaboration could support these conditions by sharing insight and knowledge, building a shared understanding of the worker's situation, assuring proper information flow, and ensuring early and timely follow-up of the worker.

Patient experiences with depression care in general practice: a qualitative questionnaire study.

OBJECTIVE: To investigate patient experiences and preferences regarding depression care in general practice. DESIGN AND SETTING: A qualitative study based on free-text responses in a web-based survey in 2017. Participants were recruited by open invitation on the web page of a Norwegian patient organization for mental health. The survey consisted of four open-ended questions concerning depression care provided by general practitioners (GPs), including positive and negative experiences, and suggestions for improvement. The responses were analysed by Template Analysis. SUBJECTS: 250 persons completed the web-based survey, 86% were women. RESULTS: The analysis revealed five themes: The informants appreciated help from their GP; they wanted to be met by the GP with a listening, accepting, understanding and respectful attitude; they wanted to be involved in decisions regarding their treatment, including antidepressants which they thought should not be prescribed without follow-up; when referred to secondary mental care they found it wrong to have to find and contact a caregiver themselves; and they thought sickness certification should be individualised to be helpful. CONCLUSIONS: Patients in Norway appreciate the depression care they receive from their GP. It is important for patients to be involved in decision-making regarding their treatment.KEY POINTSDepression is common, and GPs are often patients' first point of contact when they seek help. • Patients who feel depressed appreciate help from their GP. • Patients prefer an empathetic GP who listens attentively and acknowledges their problems. • Individualised follow-up is essential when prescribing antidepressants, making a referral, or issuing a sickness absence certificate.

Life satisfaction and mental health among transgender students in Norway.

BACKGROUND: Social attitudes to transgender persons and other gender minorities vary around the world, and in many cultures, prejudices and social stigma are common. Consequently, transgender persons face challenges related to discrimination and negative attitudes among the public. The purpose of this study was to compare life satisfaction, loneliness, mental health, and suicidal behavior among transgender students with cisgender students' experiences in a nationwide sample of Norwegian students pursuing higher education. METHODS: In total,50,054 full-time Norwegian students completed an online questionnaire (response rate 30.8%), of whom 15,399 were cisgender males, 34,437 cisgender females, 28 individuals who reported being binary transgender (12 transwomen and 16 transmen), and 69 individuals non-binary transgender persons. The measures included questions concerning gender identity, life satisfaction (Satisfaction With Life Scale), loneliness (The Three-Item Loneliness Scale), mental health problems (Hopkins Symptoms Check List), mental disorders, and suicidal ideation, suicidal behavior, and self-harm. Chi-square tests, Independent-Samples Kruskal-Wallis tests, and logistic regression analyses were used to examine differences between gender identities. RESULTS: Transgender students reported significantly more psychosocial burdens on all measures. There were no significant differences in any of the measures between the binary and non-binary transgender students. CONCLUSION: The findings call for increased awareness about welfare and health for transgender students in Norway. Higher education institutions need to consider measures at various levels to establish a learning environment that is more inclusive for gender minorities.

Not talking about illness at meeting places in Norwegian community mental health care: A discourse analysis of silence concerning illness-talk.

Research on the topic of not talking about psychosocial hardships describes the presence of 'house rules' against illness-talk in common areas in 'meeting places' ('day centres') in community mental health care. The aim of this article was to explore the complexity of not talking about psychosocial hardships ('silence') in meeting places in Norwegian community mental health care. The research team consisted of first-hand and academic knowers of community mental health care (participatory research team). We performed two series of focus group discussions with service users and staff of meeting places. The focus group interviews were analysed within a discourse analytic framework, and five discursive constructions were identified: (1) biomedical colonization of illness-talk, (2) restricted access for biomedical psychiatry and problem-talk in the common spaces of meeting places, (3) censorship of service users' civil and human rights to freedom of speech, (4) protection from exploitation and burdens and (5) silent knowledge of the peer community. Based on the analysis, we suggest that not talking about illness (silence) entails a complexity ranging from under-privileging implications to promoting the interests of people who 'use' meeting places. For instance, restricting biomedical psychiatry may imply the unintended implication of further silencing service users, while silently shared understandings of hardships among peers may imply resistance against demands to speak to legitimize one's situation. The discussion illuminates dilemmas related to silence that require critical reflexive discussions and continuous negotiations among service users, staff and policymakers in community mental health care.

Burdened parents sharing their concerns for their children with the doctor. The impact of trust in general practice: a qualitative study.

Objective: The aim of this study was to recognise the preconditions experienced by general practitioners (GPs) in addressing the children's needs when ill and substance abusing parents consult for their own health problems. Design: Qualitative analysis of 38 case stories told by GPs in focus group interviews. Setting: Focus group interviews of four continuing medical education groups for GPs in western Norway. Subjects: 27 GPs (nine females) with at least 5 years' experiences in general practice. Results: Different aspects of the GPs' perceived mandate of trust from the parents was a precondition for the children's situation to be addressed. In some case stories the participants took an open mandate from the parent for granted, while in others they assumed that the parent did not want to discuss their family situation. Sometimes the participants had faith that by continuing with their ordinary GP tasks, they might obtain a more open mandate of trust. Their evaluation of the mandate of trust seemed to impact on how the GP could adopt a mediating role between the parents and various support agencies, thus supporting children who were at risk. Discussion/conclusion: The children most at risk may remain invisible in GPs' encounters with their parents, possibly because their parent's health problems and overall situation overshadow the children's situation. The mandate of trust from burdened parents to GPs can be a fruitful concept in understanding the interaction regarding the welfare of the parent's children. Negotiating the mandate of trust with parents by explicitly addressing trust and having an ongoing discussion about the mandate and its limits might be an option to secure the children support if necessary. KEY POINTS Offering children of burdened parents information and support can be crucial for health promotion and illness prevention. A general practitioner's (GP's) evaluation of the trust parents have in them can determine the extent of support children receive. Depending on the parents' level of trust, GPs may take a mediating role between support services and parents for the benefit of the children. A negotiation concerning the trust parents have in the GP may open up possibilities for GPs to offer children necessary support.

Overcoming Clinician and Parent Ambivalence: General Practitioners' Support of Children of Parents With Physical or Mental Illness and/or Substance Abuse.

Children who are next of kin to parents with physical or mental illness and/or substance abuse need access to mental health support and several cost-effective interventions are available. Because most parents in the target group often consult general practitioners (GPs), GPs may have a crucial role in identifying burdened children and ensuring their follow-up. However, this important topic has received little attention in clinical discussions and research. In response to the knowledge gap, we conducted the research project Burdened Children as Next of Kin and the General Practitioner. Four sub-studies have been completed and published: a sub-study with qualitative analysis of focus group interviews with GPs (paper 1), a qualitative analysis of focus group interviews with adolescents as next of kin (paper 2), and a qualitative analysis of individual interviews with parents with illness and/or substance abuse (paper 3). The results from these sub-studies were incorporated in a survey sent to members of a nationwide GP organization (paper 4). The aim of the present sub-study was to gain further knowledge about conditions for the encounters between GPs and parents with impairments to be supportive for the children as next of kin. The material of the present sub-study derived from the project's four previous sub-studies and comprised a secondary analysis of the four prior sub-studies. We conducted an overarching thematic analysis of these sub-studies' results sections. We searched for statements from the GPs, the adolescents, and the parents on their experiences and evaluations of the needs of the children and their families, and the possible ways of accommodating these needs in general practice. The analysis shows that both GPs and parents were ambivalent about addressing the topic of the patients' children during consultations. This was the case although the GPs were in a good position to identify these vulnerable children, and the parents were worried about their children's situations. Possible strategies for GPs to overcome this ambivalence can be to (1) strengthen their competence in the topic, (2) gradually build trusting relationships with parents, and (3) gradually gain contextual knowledge about the families' situations. GPs can do this by performing ordinary GP tasks and acknowledging the parents' efforts to give their children good daily lives.

Oversampling as a methodological strategy for the study of self-reported health among lesbian, gay and bisexual populations.

AIMS: Epidemiological research on lesbian, gay and bisexual populations raises concerns regarding self-selection and group sizes. The aim of this research was to present strategies used to overcome these challenges in a national population-based web survey of self-reported sexual orientation and living conditions-exemplified with a case of daily tobacco smoking. METHODS: The sample was extracted from pre-established national web panels. Utilizing an oversampling strategy, we established a sample including 315 gay men, 217 bisexual men, 789 heterosexual men, 197 lesbian women, 405 bisexual women and 979 heterosexual women. We compared daily smoking, representing three levels of differentiation of sexual orientation for each gender. RESULTS: The aggregation of all non-heterosexuals into one group yielded a higher odds ratio (OR) for non-heterosexuals being a daily smoker. The aggregation of lesbian and bisexual women indicated higher OR between this group and heterosexual women. The full differentiation yielded no differences between groups except for bisexual compared with heterosexual women. CONCLUSIONS: The analyses demonstrated the advantage of differentiation of sexual orientation and gender, in this case bisexual women were the main source of group differences. We recommend an oversampling procedure, making it possible to avoid self-recruitment and to increase the transferability of findings.

Is restlessness best understood as a process? Reflecting on four boys' restlessness during music therapy in kindergarten.

ADHD can be considered an internationally recognized framework for understanding children's restlessness. In this context, children's restlessness is understood as a symptom of neurodevelopmental disorder. However, there are other possible understandings of children's restlessness. In this article, we explore four boys' collaborative and creative process as it is described and understood by three adults. The process is framed by a community music therapy project in a Norwegian kindergarten, and we describe four interrelated phases of this process: Exploring musical vitality and cooperation, Consolidating positions, Performing together, and Discovering ripple effects. We discuss these results in relation to seven qualities central to a community music therapy approach: participation, resource orientation, ecology, performance, activism, reflexivity and ethics. We argue that in contrast to a diagnostic approach that entails a focus on individual problems, a community music therapy approach can shed light on adult and systemic contributions to children's restlessness.

Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study.

BACKGROUND: Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. METHOD: A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. RESULTS: It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. CONCLUSION: Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.

Gay-related name-calling among Norwegian adolescents--harmful and harmless.

Being called names such as "gay," "faggot," "lezzie" may be experienced as both harmful or harmless by adolescents, depending on the situation in which the name-calling occurs. The aim of this study was to explore how being called gay-related names by agents with whom the relationship is differentiated by friendship, acquaintance status and perceived likeability is associated with depressive symptoms, and to explore associations between gay-related name-calling, bullying and depressive symptoms. The participants were 921 ninth grade pupils (450 boys) with an age range from 14 to 15 years from 15 schools. The study reveals that the participants' depressive symptoms were more associated with being called gay-related names by someone who did not like them or someone they did not know, than with being called gay-related names by a friend. Being called gay-related names was associated with higher levels of depressive symptoms, even when controlling for bullying. Boys who were bullied and called gay-related names had even higher levels of depressive symptoms, as indicated by an interaction effect found between being called gay-related names and bullying. Because of the potential harmfulness of gay-related name-calling, anti-bullying programmes should address this topic as a part of their regular anti-bullying strategy.

To give the invisible child priority: children as next of kin in general practice.

OBJECTIVE: To explore general practitioners' (GPs') experiences in helping children as next of kin of drug-addicted, mentally ill, or severely somatic ill adults. These children are at risk of long-term mental and somatic health problems. DESIGN: Qualitative focus-group study. SETTING: Focus-group interviews were conducted in western Norway with a total of 27 GPs. Participants were encouraged to share stories from clinical encounters with parents who had one of the above-mentioned problems and to discuss the GP's role in relation to helping the patients' children. RESULTS: The GPs brought up many examples of how they could aid children as next of kin, including identifying children at risk, counselling the parents, and taking part in collaboration with other healthcare professionals and social workers. They also experienced some barriers in fulfilling their potential. There were time constraints, the GPs had their main focus on the patient present in a consultation, and the child was often outside the attention of the doctors, or the GPs could be afraid of hurting or losing their vulnerable patients, thus avoiding bringing up the patients' children as a subject for discussion. CONCLUSIONS: Norwegian GPs are in a good position to help children as next of kin and doctors make a great effort to support many of them. Still, support of these children by GPs often seems to depend not on careful consideration of what is best for the patient and the child in the long run, but more on short-term convenience reasons.

Vulnerable discipline: experiences of male competitive bodybuilders.

The aim was to understand experiences of male competitive bodybuilders from a non-pathologizing perspective. Six male Norwegian competitive bodybuilders were interviewed. The interviews were analysed using a meaning condensation procedure resulting in five themes: being proud of capacity for discipline, seeing a perfectionist attitude as a necessary evil, experiencing recognition within the bodybuilding community, being stigmatized outside the bodybuilding community and going on stage to display a capacity for willpower and discipline. We suggest that bodybuilders may be stigmatized for breaking social norms: by their distinctive appearance, by the way they handle suspected drug use and by challenging gender norms.

Struggling for a normal life: work as an individual self-care management strategy among persons living with non-malignant chronic pain.

BACKGROUND: A significant part of the population suffers from non-malignant chronic pain that is not treated by pain specialists. No successful long-term treatment exists. The patients have to deal with their condition in collaboration with health personnel establishing treatment programmes under uncertain circumstances with few guidelines. Thus, there is a strong need for knowledge on how patients with chronic non-malignant pain manage their condition. OBJECTIVES: The aim of the study was to explore how patients with chronic non-malignant pain deal with their condition. METHODS: Twenty patients with chronic non-malignant pain (aged 26-63 in year 2006) told in an open-ended interview situation, how they lived with and dealt with their condition. The interviews were analysed within a phenomenological meaning condensation framework. RESULTS: For all patients the pain was as an integrated part of their life that required huge efforts to cope with. Typically, the patients experienced loneliness, fear of stigmatization and despair because of their unpredictable condition, and they wanted to come back to a normalized daily life, first and foremost by getting back to paid work. CONCLUSIONS: In general, the patients developed individual strategies that were influenced by their local contexts and life situation as well as the pain itself. This may be interpreted in line with Bourdieu's notions of habitus, strategies and social capital.

Treatment regimes in a psychiatric hospital and apparent contradictions: report from field work in a lock-up ward illustrated with a constructed case.

The medical approach dominates in Norwegian psychiatry, but mental health nurses and other ward staff hold that milieu therapy constitutes an additional and important treatment approach for psychiatric patients. In this study, we wanted to explore these approaches as they are implemented in inpatient treatment. We conducted a 9-month ethnographic study in two lock-up psychiatric wards in a Norwegian psychiatric hospital. In this article, we present a constructed case, Mary, to illustrate the voices, experiences, and perspectives of patients and staff as observed primarily in the patients' smoking room, the corridor, and the staffroom. From the perspective of staff, we identified at least two professional perspectives concerning patients' daily life: a strong medical-psychiatric view and a weaker therapeutic milieu, which seemed difficult to implement. When considering the view of people in care, we observed that patients' experiences and points of view occurred and remained to a large degree in their smoking room, and patients seemed to have little impact on their own treatment programmes. This stands in sharp contrast to patients' legal rights to participate in any important decisions regarding their treatment and to the espoused person-centred orientation in health care today.

User participation when using milieu therapy in a psychiatric hospital in Norway: a mission impossible?

In the past decade, the Norwegian government has emphasized user participation as an important goal in the care of mentally ill patients, through governmental strategic plans. At the same time, the governmental documents request normalization of psychiatric patients, including the re-socialization of psychiatric patients back into society outside the psychiatric hospital. Milieu therapy is a therapeutic tool to ensure user participation and re-socialization. Based on an ethnographic study in a long-term psychiatric ward in a psychiatric hospital, we identified how staff tried to implement user participation in their milieu-oriented therapy work. We have identified three major tensions and challenges in implementing user participation in milieu-therapeutic work. First, it is difficult to implement individual-based user participation and at the same time take collective house rules and codes of conduct into consideration. Second, user participation proved a difficulty when patients' viewpoints challenged staff judgements on proper conduct and goals for which patients might aim. Third, user participation becomes a challenge when trying to establish relationships based on equality when using milieu therapy in a biomedical hierarchical hospital structure. These tensions and challenges are seen in light of paradoxical political frames and demands on one side, and milieu therapy as a complex tradition anchored in different ideologies on the other.

Raising adults as children? A report on milieu therapy in a psychiatric ward in Norway.

Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.

Heteronormative consensus in the Norwegian same-sex adoption debate?

This article investigates the Norwegian newspaper debate (1998-2002) on the right of homosexual couples to adopt children. It identifies two patterns of meaning within which both anti-adoption and pro-adoption sides of the debate were located: 1) the nuclear family as reference point; and 2) a focus on innate qualities. Parallell to a continuous liberalization of sexualities in Norway we seem to witness a consensus on heteronormativity in Norway on both sides of the debate as the basic axiom in public discussions on homosexuality and adoption. In this article, we explore the nature of the heteronormative arguments and the reason for their appearance in this particular debate. The two patterns of meaning reproduce a perception of lesbians and gays as either a worthy or unworthy minority. These findings may be seen as reflecting fundamental positions regarding the Norwegian modernization project, where both sides of the debate see homosexuality as a central symbol. State feminism may also have played the role of reinforcing gender categories and thereby served as an important condition of possibility for contemporary heteronormativity.