Student nurses and the general population in Sweden: trends in attitudes towards mental illness.

OBJECTIVE: To evaluate attitudes towards mental illness displayed by student nurses' with previous contact with mentally disordered persons prior to education in psychiatric nursing and to evaluate trends in attitudes towards mental illness exhibited by student nurses and the public in Sweden. METHODS: Altogether 246 student nurses enrolled in three universities in Sweden (mean age = 27.9 ± 7.5 years) out of which 210 were females and 36 males, completed prior to their obligatory course in psychiatric nursing a shortened version of 11 internally reliable (Cronbach's alpha 0.84) items from the Swedish version of the Community Attitudes towards Mental Illness questionnarie. The selected items were named the Student Nurse Attitude Index (SNAI) and formed the basis for an evaluation of trends exhibited by student nurses and the attitudes of the general population towards mental illness by means of Jonkheere's trend test. By linear regression analysis, the impact of previous contact with mental illness on student nurses' attitudes towards mental illness prior to education in psychiatric nursing was assessed. RESULTS: Student nurses did not demonstrate, in contrast to the public in Sweden, a trend of positive attitudes toward persons with mental illness. Even so, it was revealed that student nurses who had experienced some type of contact with mental illness prior to education in psychiatric nursing exhibited a positive attitude, more so than those lacking contact, toward mental illness. CONCLUSIONS: The findings corroborated the "contact hypothesis", implying that direct contact with persons with mental illness will encourage acceptance and enhance a positive attitude towards mental illness in general.

Impact of gender and age on attitudes towards mental illness in Sweden.

BACKGROUND: Factors such as respondent's sex, age, experience of mental illness and marital status have been found to impact public prejudices toward persons with mental illness. AIMS: The impact of respondents' sex, age, real-life experience and marital status on their attitudes towards mental illness was the focus of this study. METHODS: Altogether, 2391 respondents completed the Swedish version of Community Attitudes toward the Mentally Ill, CAMI-S. Their answers were reduced by principal component analysis into four factors: Open-minded and Pro-integration, Fear and Avoidance, Community Mental Health Ideology and Intention to Interact with Persons with Mental Illness. By Structural Equation Modeling (SEM), the relations between public's sex and age on their attitudes toward mental illness on these four factors were assessed. Impact of experience and marital status on attitudes towards mental illness was assessed by analysis of variance (ANOVA). RESULTS: Females were found to hold a greater open-mindedness and were positive to pro-integration, but they were also fearful and avoidant, more so than males, relative to persons with mental illness. With regard to getting older, as age increased, so did open-mindedness and a pro-integration attitude relative to persons with mental illness; on the other hand as age increased, community mental health ideology decreased. As attitudes of open-mindedness and pro-integration improved, so did attitudes representing community mental health ideology. Furthermore, as fear and avoidance increased, attitudes of open-mindedness and pro-integration increased but also the intention to interact with persons subject to mental illness was improved.

Swedish attitudes towards persons with mental illness.

BACKGROUND: Negative and stigmatizing attitudes towards persons with mental illness must be dealt with to facilitate the sufferers' social acceptance. AIM: The present study aimed at survey Swedish attitudes towards persons with mental illness related to factors impacting these attitudes. MATERIAL AND METHODS: New CAMI-S based on the questionnaire "Community Attitudes to Mental Illness in Sweden" ([CAMI] Taylor & Dear, 1981) was developed with nine behavioral-intention items and thus comprised a total of 29 items. Of 5000 Swedish people, 2391 agreed to complete the questionnaire. Principal component analysis rendered four factors reflecting attitudes towards the mentally ill: Intention to Interact, Fearful and Avoidant, Open-minded and Pro-Integration, as well as Community Mental Health Ideology. The factors were analyzed for trends in attitudes. By MANOVA, the experience of mental illness effects on mind-set towards the sufferers was assessed. By means of logistic regression, demographic factors contributing to positive attitudes towards persons with mental illness residing in the neighborhood were assessed. RESULTS: By New CAMI-S, the Swedish attitudes towards the mentally ill were surveyed and trends in agreement with living next to a person with mental illness were revealed in three out of four factors derived by principal component analysis. Aspects impacting the Swedish attitudes towards persons with mental illness and willingness to have him/her residing in the neighborhood comprised experience of mental illness, female gender, age (31-50 years), born in Scandinavia or outside Europe, only 9 years of compulsory school and accommodation in flat. CONCLUSION: The New CAMI-S came out as a useful tool to screen Swedish attitudes towards persons with mental illness. Most Swedes were prepared to live next to the mentally ill.

Attitudes towards mental illness in Sweden: adaptation and development of the Community Attitudes towards Mental Illness questionnaire.

The main purpose for the expansion of supported community care for persons with serious mental illness in Sweden was to ensure the right for these persons to live as citizens in the community. However, earlier research shows that negative attitudes towards mental illness present an obstacle for social integration of persons with serious mental illness. The aim of this study, conducted in Sweden, was to evaluate an existing instrument's (Community Attitudes towards Mental Illness, CAMI), validity and reliability. An additional aim was to adapt and develop the questionnaire to Swedish circumstances. After translation and modification of the original CAMI, the Swedish version of the questionnaire (CAMI-S) was distributed to all student nurses at three different universities in Sweden. The overall Cronbach's alpha coefficient was 0.90 of the original CAMI-S. A corrected inter-item total correlation excluded 20 items because they showed loading <0.43. The overall Cronbach's alpha coefficient on the 20 items (new CAMI-S) that showed loading, >0.43, was 0.903. A factor analysis of these items revealed that the data could be extracted in three factors labelled as: open-minded and pro-integration, fear and avoidance and community mental health ideology. Finally, in order to reach reliable results in attitude research, it is important to measure the respondent's attitude towards the object in common as well as the respondent's attitude to interact with the object. Accordingly, it is important to add behavioural intention items to the 'new CAMI-S'. Statements exemplifying how something 'ought to be' in an impersonal way have a good degree of stability over time and place.

To be a nurse or a neighbour? A moral concern for psychiatric nurses living next door to individuals with a mental illness.

Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses' experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory was used for data collection and analysis. The process of 'behaving as a nurse or not' was identified as a core category. Four subcategories were identified: 'receiving involuntary information', 'to take action or not', 'behaving as a mediator in the neighbourhood' and 'the freedom of choice'. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time.

Swedish mental health nurses' responsibility in supervised community care of persons with long-term mental illness.

The aim of the present study was to describe psychiatric nurses' experience of how the changing focus of mental health care in Sweden, from in-patient treatment to community-based care, has influenced their professional autonomy. Eleven psychiatric nurses were interviewed and a qualitative content analysis was used to identify major themes in the data. Three main themes were found: pattern of responsibility, pattern of clinical judgement, and pattern of control through support and supervision. All themes were related to the nurse's identity, moral responsibility and the feelings of loneliness and independence in his/her daily work. Together, the three themes were found to constitute a process. This study shows the complexity involved in nursing care provided in the patient's home. Achieving control over the patient's everyday life through support and supervision does not imply taking over the patient's autonomy, but rather reducing the stigma attached to mental illness and facilitating the process of rehabilitation.