This study seeks to explore the challenges and difficulties faced by children raised by a parent with bipolar disorder, with a specific focus on the experiences and memories of daughters of these individuals. Bipolar disorder, previously known as manic-depressive illness, is characteristically referred to as an episodic, yet lifelong and clinically severe affective (mood) disorder. Bipolar disorder is a severe mental illness, which is stressful not only for patients, but also for family members. Very little work has been done to define more precisely the family burden associated with the illness. Studies that do focus on the impact of bipolar disorder on caregivers or families of the patient have looked at the family as a whole. There seems to be a scarcity of research looking at the experiences of children of parents with bipolar disorder. The children of individuals with bipolar disorder are at high risk for developing a range of mental disorders. Overall, parents with bipolar disorder tend to create a familial environment that is unstable and lacking in structure. Therefore in addition to being at genetic risk for the development of mental disorders, are exposed to a stressful familial environment that increases the risk of psychopathology and difficulties. Despite the importance of assessing the impact parental bipolar disorder can have on children, there is a lack of relevant literature. A non-probability sample of eight female individuals raised by a parent with bipolar disorder was selected from the student population at Wits University. Semi-structured face-to-face interviews were used to gain in depth information regarding the memories and experiences of these individuals. One interview was conducted per participant. Once the data was collected, thematic content analysis was used in order to analyse and draw conclusions from the data. From this method of analysis ten main themes were found, as well as six sub themes. The findings of this study suggest that bipolar disorder has a profound effect, not only on the individual suffering from the illness, but on their children as well. Manic episodes appear to be a particularly stressful time, featuring with great prominence in the memories of respondents. Participants felt strongly that their family environment was affected by their parent’s illness. In general it seemed as if participants with ill mothers described a far more chaotic family environment as compared to those participants with ill fathers. This study also found that knowledge and understanding help these individuals make sense of their parent’s illness, seemingly providing a sense of power and control. A number of participants mentioned the negative effects that stigma associated with mental illness has on the families concerned, often leading to adverse outcomes. In contrast to this, support and understanding by both healthcare professionals as well as the broader community is considered indispensable. The children of patients with bipolar disorder, in addition to being at genetic risk for the development of mental disorders, are exposed to a stressful environment that increases the risk of psychopathology and other difficulties. It is therefore imperative that further research be conducted in this area, as relatively little is known about the long term effects of the parent’s illness on their child.

OBJECTIVE: Anxiety disorders are among the most common comorbid conditions in youth with bipolar disorder (BP). We aimed to examine the prevalence, correlates, persistence (>50% of the follow-up time), and the onset of new anxiety disorders in youth with comorbid anxiety disorders and BP. METHODS: As part of the Course and Outcome of Bipolar Youth study (COBY), 446 youth ages 7 to 17, who met DSM-IV criteria for BP-I (n=260), BP-II (n=32) or operationalized criteria for BP not otherwise specified (BP-NOS; n=154) were included. Subjects were evaluated for current and lifetime Axis-I psychiatric disorders at intake using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children–Present and Lifetime version (K-SADS-PL), and standardized instruments to assess functioning and family history. Subjects were followed on average 5 years using the Longitudinal Interval Follow-up Evaluation. RESULTS: Forty-four percent (n=194) of the sample met DSM-IV criteria for at least one lifetime anxiety disorder, most commonly separation anxiety (24%) and generalized anxiety disorders (16%). Nearly 20% met criteria for two or more anxiety disorders. Overall, anxiety disorders predated the onset of BP. BP-II subjects were more likely than BP-I or BP-NOS subjects to have a comorbid anxiety disorder. After adjusting for confounding factors, BP youth with anxiety were more likely to have BP-II, longer duration of mood symptoms, more severe ratings of depression, and family history of depression, hopelessness and somatic complaints during their worst lifetime depressive episode than those without anxiety. Of the 170 youth who had anxiety at intake, 80.6% had an anxiety disorder at any time during the follow-up. Most of the anxiety disorders during the follow-up were of the same type as those present at intake. About 50% of the youth had persistent anxiety, particularly Generalized Anxiety Disorder (GAD). Persistence was associated with multiple anxiety disorders, less follow-up time in euthymia, less conduct disorder, and less treatment with antimanic and antidepressant medications (all p-values≤0.05). Twenty-five percent of the sample who did not have an anxiety disorder at intake developed new anxiety disorders during follow-up, most commonly GAD. New onsets were significantly associated with being female, lower socioeconomic status, presence of attention-deficit/hyperactivity disorder and substance use disorder and more follow-up time with manic or hypomanic symptoms (all p-values≤0.05) CONCLUSIONS: Comorbid anxiety disorders are common in youth with BP, and most often predate BP onset. BP-II, a family history of depression, and more severe lifetime depressive episodes distinguish BP youth with comorbid anxiety disorders from those without. In addition, anxiety disorders in youth with BP tend to persist and new anxiety disorders onset in a substantial proportion of the sample. Careful consideration should be given to the assessment of comorbid anxiety in BP youth. Furthermore, early identification of factors associated with the persistence and onset of new anxiety disorders may enable the development of strategies for treatment and prevention. / OBJECTIUS: Els trastorns d'ansietat són les condicions comòrbides més comuns en nens i adolescents amb trastorn bipolar (TB), però fins on sabem, cap estudi ha examinat l'evolució dels trastorns d'ansietat en joves i adults amb TB. L'objectiu de l'estudi va ser examinar els factors associats amb la persistència (>50% del temps de seguiment) i l'aparició de nous trastorns d'ansietat en nens i adolescents amb TB. MÈTODE: Com a part de l’estudi Course and Outcome of Bipolar Youth (COBY), 413 nens i adolescents entre 7 i 17 anys que complien els criteris per el Manual Diagnòstic i Estadístic IV (DSM-IV) pel TB-I (n=244), TB-II (n=28) o el criteri operacionalitzat pel TB no especificat (TB-NOS; n=154) van ser reclutats principalment de consultoris d'atenció ambulatòria. Els subjectes van ser seguits de mitjana durant 5 anys utilitzant el Longitudinal Interval Follow-up Evaluation. RESULTATS: Dels 170 nens i adolescents que presentaven ansietat a l'inici de l’estudi, el 80.6% tenia un trastorn d'ansietat en qualsevol moment durant el seguiment. La majoria dels trastorns d'ansietat durant el seguiment van ser del mateix tipus que els presents a l'inici de l'estudi. Al voltant del 50% dels joves tenien persistència d'ansietat, sobretot trastorn d'ansietat generalitzada (TAG). La persistència es va associar amb trastorns d'ansietat múltiple, menys temps de seguiment en eutimia, menys trastorn de conducta i menor tractament amb medicaments antidepressius i antimaníacs. Vint-cinc per cent de la mostra que no tenien un trastorn d'ansietat a l'inici, va desenvolupar nous trastorns d'ansietat durant el seguiment, en general TAG. L'inici de nous trastorns d'ansietat es va associar significativament amb ser dona, baix nivell socioeconòmic, presència del trastorn per dèficit d'atenció i hiperactivitat, trastorn per consum de substàncies i més temps de seguiment amb símptomes maníacs o hipomaníacs. CONCLUSIONS: Els trastorns d'ansietat en nens i adolescents amb TB tendeixen a persistir i l'ansietat de nou inici apareix en una proporció substancial de la mostra. S'ha de prestar atenció a l'avaluació de l'ansietat comòrbida en nens i adolescents amb TB i la identificació precoç dels factors associats amb la persistència i l'aparició de nous trastorns d'ansietat poden permetre el desenvolupament d'estratègies pel tractament i la seva prevenció.

La aparición de los antipsicóticos atípicos o de segunda generación ha supuesto un gran cambio en el manejo de los pacientes con trastorno bipolar. Los ensayos controlados han demostrado la eficacia de prácticamente todos los antipsicóticos atípicos en la manía aguda. Además, la mayor parte de ellos disponen de datos positivos para el tratamiento de mantenimiento del trastorno bipolar, lo que sugiere propiedades normotímicas. E incluso algunos de ellos han mostrado datos positivos en la depresión bipolar. Sin embargo, apenas existen estudios independientes comparando la acción de los atípicos con la de los clásicos, mas allá del uso de haloperidol como comparador activo en algunos estudios de manía aguda. En este contexto, esta tesis tiene como objetivo evaluar el comportamiento de los antipsicóticos atípicos en las fases de manía aguda y depresión, en comparación con el de los antipsicóticos clásicos (haloperidol) y placebo respectivamente, para testar las posibles propiedades normoreguladoras en los episodios agudos. Se utilizaron para ello las técnicas de metanálisis, estructurándose la tesis en dos metanálisis separados. El primero en manía aguda, comparando antipsicóticos atípicos con antipsicóticos clásicos. Dentro de este metanálisis se escogieron dos variables principales: la velocidad de inicio de acción, operativizada como la disminución en la puntuación en la escala de manía a la primera semana, y el viraje depresivo. En los dos casos, se trata de variables de interés clínico, escasamente estudiadas hasta la actualidad, y que señalan el perfil de acción de los fármacos. En segundo lugar, se llevó a cabo un segundo metanálisis comparando la acción de los antipsicóticos atípicos con la del placebo (no existían estudios comparativos con antipsicóticos clásicos) en depresión bipolar. Los resultados de la primera variable del metanálisis en manía aguda, que dan lugar al primer artículo de esta tesis, confirman que el haloperidol muestra un inicio de acción más rápido que los antipsicóticos atípicos. El tamaño del efecto fue pequeño (SMD = 0,17 [0,01 - 0,32] tal como cabria esperar entre dos grupos de eficacia demostrada. Sin embargo, este resultado sugiere que el haloperidol puede seguir siendo un tratamiento de primera línea en la manía aguda en casos graves en los que se requiere una mejoría sintomática urgente, siempre y cuando el riesgo de efectos adversos extrapiramidales y de viraje depresivo sea bajo. El segundo artículo de la tesis analiza las diferencias en el riesgo de viraje depresivo tras el tratamiento de la manía aguda con antipsicóticos atípicos en comparación con haloperidol. El resultado del metanálisis es que los atípicos conllevan un 42% menos de riesgo de viraje que el haloperidol. No obstante, se observa heterogeneidad en este análisis y las diferencias entre grupos son atribuibles especialmente a la acción de tres de los atípicos: olanzapina, quetiapina, y ziprasidona. El segundo metanalisis, que da lugar al tercer lugar de la tesis, observa que existe un efecto positivo en la depresión bipolar, en comparacion con placebo, pero que solo es atribuible a algunos de los antipsicóticos atípicos, concretamente, a la olanzapina y la quetiapina. De modo que se concluye que no se trata de un efecto de clase de la familia. Analizando los resultados de los dos metanálisis en conjunto se observa que se puede establecerse un gradiente en función de la afinidad por el receptor dopaminergico D2, modulado por la acción sobre otros receptores, en el que la mayor afinidad y selectividad antiD2 supondría mayor potencia antimaníaca, inicio de acción antimaníaca más rápido, mayor riesgo de viraje depresivo, e ineficacia y/o agravamiento de la depresión bipolar. Haloperidol se situaría en el extremo izquierdo del gradiente y se propone la siguiente ubicación para los antipsicóticos atípicos: Risperidona – Aripiprazol – Ziprasidona – Olanzapina – Quetiapina. Además, este gradiente coincide con el de los valores del Índice de Polaridad obtenidos en los estudios de prevención de recurrencias con los antipsicóticos atípicos, de lo que se desprende que los efectos en los episodios agudos tiende a perdurar durante el tratamiento de mantenimiento. / Introduction of atypical antipsychotics has involved a great change in the management of bipolar disorder during last decade. Not only they show efficacy in mania, but also for recurrence prevention, and some of them have also been shown to work in bipolar depression. However, comparisons with classical neuroleptics to assess advantages and disadvantages are scarce. In this context, the goal of this thesis was to assess the behavior of atypical antipsichotics in the acute phases of mania and depression, compared to classical antipsychotics in the former and with placebo in the latter, and study their possible normothymic properties. Metanalysis techniques were used. The thesis was structured in two different metanalysis. The first one in acute mania, comparing atypical and classical antipyschotics. Two different outcomes were assessed: speed of onset of action and switch to depression. The second metanalysis studied the efficacy of atypical antipsychotics in bipolar depression versus placebo. The first article of the thesis shows that haloperidol has a faster onset of action than atypical antipsychotics in acute mania. The size of the effect was small (SMD = 0,17 [0,01 - 0,32] but could still be clinically significant in the subset of severe manic patients who require an urgent relief of symtpoms. On the other hand, as it is shown in the second paper of the thesis, treatment with atypicals involves a 42% reduction in the risk of switch to depression compared to haloperidol. However, heterogeneity was present which could be due to differences in the group of atypicals, as three of them (olanzapine, quetiapine, and ziprasidone) could explain the effect. The third article, corresponding to the second metanálisis, shows only some atypicals, namely olanzapine and quetiapine, are efficacious in bipolar depression. Therefore, there is no class effect. A global view of both metanalysis shows that dopaminergic D2 affinity is likely to be the most important factor over the different profile of antipsychotics, with lower affinity involving more clear normothymic actions.

Objective: The aim of the current study was to investigate the differences in baseline characteristics and three-year outcomes between two diagnostic categories with presentation of first-episode psychosis: bipolar affective disorder (mania with psychotic features) and schizophrenia. The comparison was based on pre-treatment characteristics, clinical presentation, symptomatic and functional outcomes, and engagement in risk behaviours. Methods:461 schizophrenic patients and 54 bipolar affective disorder (BAD) patients between the ages of 15 to 25 years from a local first-episode psychosis treatment program within the years2001 to 2003 were studied. Researchers collected detailed data on baseline and three-year follow up variables from systematic medical file review for statistical analyses. Results: At service entry, compared to schizophrenic patients, bipolar affective disorder(BAD)patients exhibited more prominent positive symptoms (p = 0.01), were younger at first presentation and had a higher unemployment rate (p < 0.01), were more likely to have acute onset of psychosis, shorter duration of untreated psychosis (DUP), a higher rate of hospital admission within first month after initial contact, and lower pre-treatment functioning (Social and Occupational Functioning Assessment Scale (SOFAS), p < 0.001). There was no significant difference in gender, education level, age of onset and pre-treatment risk taking behaviours. After applying univariate analysis of variance (ANCOVA)by controlling baseline variables that showed significant differences, the three year follow up reveals that schizophrenic patients displayed fewer numbers of hospitalization (p <0.01)with no difference in the total length (days) of hospitalization, more prominent positive symptoms(p < 0.01), poorer functioning at year 3 (p <0.05), and consistently significant lower employment rate at 12 month (p < 0.001), 24 month (p < 0.001) and 36 month (p < 0.01). Finally, more schizophrenic patients received social benefits (p < 0.05). Conclusion: The outstanding baseline poorer functioning level of bipolar affective disorder patients have progressively made a modest improvement in functional outcomes at the end of three-year follow up. BAD patients also displayed a marked improvement with fewer positive symptoms in the follow up. The results suggest a differentiation in symptomatology and the course of illness between bipolar affective disorder and schizophrenia with first-episode psychosis. In coherence with other scholastic literature, duration of untreated psychosis (DUP) associates with remission(Crumlish et al., 2009;Chang et al., 2012a), positive symptoms(Barnes et.al., 2008; Chang et.al., 2012b; Clarke et al., 2006; Crumlish et.al., 2009;), and functional outcomes(Barnes et al., 2008; Chang et al., 2012b; Clarke et.al., 2006; Crumlish et.al, 2009; Fusar-Poli et al., 2009). Moreover, further exploration about the diagnostic-specific therapeutic window for early intervention, symptoms management, and rehabilitation strategies in occupational training are in demand. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model. / Psychology / D. Litt. et Phil. (Psychology)

Text in Afrikaans / Binne die tradisionele christelike westerse samelewing waarin ons leef is daar diskoerse en meta-narratiewe wat dikteer wat van ons as huweliksmaats verwag word. Ons is dikwels onbewus van hoe hierdie verwagtinge, rolle en eise wat aan ons gestel word, deur verskillende diskoerse en stories tot stand gekom het. Die spesifieke lewenstorie en omstandlghede van die indiwidu(e) word meestal in die proses geignoreer, byvoorbeeld die saamleef met 'n huweliksmaat wat "gediagnoseer" is as iemand met 'n "bipolêre gemoedsversteuring", bring noodwendig omstandighede mee wat vir die meeste mense onuithoudbaar mag wees. Hierdie studie vertel die storie van 'n persoon wie daarin kon slaag om ten spyte van hierdie "omstandighede", sy storie so te kon herskryf dat hy steeds met hierdie persoon suksesvol binne die huwelik kan saamleef. Die studie fokus op 'n persoon, wie se lewe op grond van die christelike narratief leef, se belewing van die saamleef met 'n persoon met 'n "bipolere gemoedsversteuring". Die algemene doel van die studie was om aan die deelnemer 'n geleentheid te skep om sy belewinge in die saamleef van 'n persoon met 'n "bipolêre gemoedsversteuring" te kon deel. 'n Spesifieke fokus is geplaas om die rol wat christelike spiritualiteit speel in die verwerking en hantering daarvan, te beskryf. Daar is ook aan die persoon geleentheid gegee om op grond van sy belewlnge en verstaan van christenskap, aanbevelings te maak aan die professlone!e gemeenskap, die geloofsgemeenskap en aan huweliksmaats wat met soortgelyke omstandighede meet saamleef. Die navorslng is vanuit 'n postmoderne diskoers-oogpunt aangepak en op 'n kwalitatiewe wyse uitgevoer by wyse van 'n gevallestudle. Die deelnemer se storie is deur middel van sosiale konstruksieteorie en 'n narratiewe terapeutiese benadering, gedekonstrueer. Dit was duidelik vanuit die studie dat die funksie wat mense se spirituele oortuiginge en hul belewing daarvan in hul lewens verrig, in berekening gebring moet word in die terapeutiese proses. Wanneer kliënte belangrike besluite moet neem, moet die invloed van geloofsoortuiginge in die besluitnemingsproses in berekening gebring word. / Philosophy, Practical and Systematic Theology / M. Th. - (Pastoral Theology)

Bipolar disorder is a serious illness affecting approximately 2-4% of the population and is one of the world’s leading causes of disability. In individuals with bipolar disorder, medical comorbidity associated with cardiovascular, respiratory and endocrine disorders is related to increased rates of mortality. Recent updates to multi-system inflammatory related conceptualizations of bipolar disorder focus on the unique power that medical illness and biological processes may play as factors associated with course and outcome in bipolar disorder. The current study examined medical comorbidity and its associations with various demographic and psychological variables in individuals with bipolar disorder, schizophrenia, and major depressive disorder with psychotic features followed for 10 years from their first hospital admission. When compared to an age, gender and race-matched control sample from the population, those with bipolar disorder had significantly higher medical comorbidity across a range of medical diagnoses both at 6 months and 10 years after first hospital admission. Ten years following initial hospitalization, individuals in all three diagnostic groups reported increased rates of diabetes (OR: 2.0 – 3.7), stroke (OR: 4.6 – 7.0) and asthma (OR: 1.9 - 3.1), and individuals with bipolar disorder reported increased rates of cancer (OR = 2.1). A number of psychological and demographic symptoms were examined for their ability to predict the development of medical illness across the assessment interval. Overall rates of medical illness were elevated both early in illness course and 10 years after diagnosis, suggesting that broad sequelae of multi-system inflammation are present early and progress over time.

The aims of the current research program were to examine the social-cognitive and sociological models of stigma in relation to student attitudes towards an individual experiencing a mood disorder. Two experiments (Studies 1 and 2) sought to empirically distinguish between controllability and responsibility, both constructs of the attribution model which is subsidiary to the social-cognitive model of stigma. Despite manipulating controllability, participants were reluctant to attribute controllability of cause to individuals experiencing depression or bipolar disorder. The stability of beliefs about the controllability of cause for condition onset was consistent with research suggesting that the Australian public increasingly conceptualise mental disorders in terms of biochemical and genetic causal factors. These findings, in combination with past research linking biogenetic beliefs to negative attitudes, resulted in a change in focus of investigation in Studies 3, 4, 5 and 6 to explain why, contrary to the prediction of the attribution model, biogenetic explanations of mental disorders are associated with the proliferation of stigma. To measure causal beliefs, the Causal Belief Inventory (CBI) was developed in Study 3 and refined in Study 4. The correlational results examined in Studies 4, 5 and 6 found that genetic and biochemical causal beliefs were associated with a number of positive attitudes towards individuals experiencing a mood disorder and that genetic cause was associated with a reduced implicit bias against major depression. Furthermore, each study pointed to the centrality of judgments of differentness in determining affective responses and direct and proxy measures of behaviour. In contrast, manipulation of genetic and psychosocial cause in Study 5 found that causal condition largely failed to impact upon student attitudes. Mediator analysis did, however, find that beliefs about the stability of the vignette actor's condition fully mediated the relationship between the negative influence of genetic cause on proxy helping behaviour. Manipulation of psychosocial, genetic and biochemical cause with the inclusion of a non-depressed control in Study 6 resulted in more ambiguous findings. The combination of findings from Studies 1 to 6 suggest that focusing on the impact of the controllability of cause of depression onset on student attitudes is unwarranted. Instead researchers and public health educators should be examining models which facilitate the examination of the cognitive factors that mediate these relationships. Two such models, namely the social-cognitive and sociological models of stigma, were found to adequately fit the data. Recommendations for integrating these two models of stigma are discussed.

Positive Clinical Psychology (PCP) argues that positive and negative psychological constructs are jointly important for explaining psychological problems. “Positive” constructs have been explicitly focused on by positive psychology researchers and “negative” constructs have been explicitly focused on by mental health researchers. This thesis examines the relationship between positive and negative constructs in relation to four psychological problems: depressive symptoms (Chapter 2), anxiety-problems (Chapter 3), suicide attempts (SAs) (Chapter 4 and 5), and nonsuicidal self-injury (NSSI) (Chapter 4 and 5). Clarifying how psychological problems are most appropriately conceptualised has implications for definitions, diagnostic criteria, measurement, and clinical interventions. This thesis provides evidence that some constructs form bipolar continua, having a positive pole and a negative pole, whilst other constructs do not. Chapters 2 and 3 demonstrate that well-being and calmness respectively form continua with depressive and anxiety symptoms. In contrast, Chapters 4 and 5 demonstrate that SA and NSSI cognitions do not form a continuum with another construct. Results indicate that positive and negative constructs appear to have different relationships to one-another depending on the construct under investigation. Constructs that are common in the general population – such as depressive symptoms, anxiety symptoms, well-being symptoms, and calmness symptoms – appear to be bipolar, having a positive and a negative pole. Psychological constructs that are rare in the general population and which specifically characterise psychological problems (rather than being an extreme manifestation of a common psychological experience) – such as SA and NSSI cognitions – appear to be unipolar. The replication of scientific findings also features strongly throughout this thesis. Each chapter may therefore have a timely bearing on the emerging “replication crisis” literature.

Sammanfattning Titel: I mötet med depressiv ohälsa på äldreboenden Handledare: Anna Siverskog Examinator: Klas Borell Forskning pekar på en betydande omfattning av depressiv ohälsa bland äldre på äldreboende, något som medför mänskligt lidande och hög belastning på samhället. Mot den bakgrunden ämnar följande studie undersöka förekomst och symtombild av denna ohälsa utifrån vård-och omsorgspersonals erfarenheter. Studien syftar även till att utforska de bemötande- och arbetsstrategier som medarbetarna använder i sina yrkesroller samt om olika yrkesbakgrund förefaller utgöra grund för skillnader i arbetet med depressiva äldre på äldreboenden. I syfte att besvara frågeställningarna har semistrukturerade intervjuer gjorts med elva yrkesverksamma personer. Bearbetning av empirin har skett utifrån en tematisk ansats och med stöd av teorierna kring ålderism och livslopp.  Den upplevda förekomsten av depressiv ohälsa varierar utifrån intervjupersonernas erfarenheter, men flertalet upplever att problematiken är omfattande bland de äldre på boenden. Symtomen för depressiv ohälsa skiftar, men det råder samstämmighet bland de intervjuade att symtomen ofta är diffusa och sällan uttrycks med konkreta ord. Personalen beskriver att de utifrån sin kompetens och i nära samarbete inom arbetsgruppen använder sig av olika övergripande bemötandestrategier som anpassas utifrån de individuella behoven och förutsättningarna med ambitionen att bedriva en god vård. Mindre skillnader mellan yrkesgrupperna har iakttagits i det att sjuksköterskorna förefaller ge uttryck för en starkare tilltro till kliniskt medicinsk vård medan omvårdnadspersonalen i större utsträckning lyfter dess risker och i stället framhåller vikten av nära relationer för att skapa god vård och omsorg.  Begränsade förutsättningar i tid och kompetens utgör dock hinder och belyser behovet av att förhålla sig till ålderistiska föreställningar och tillskapa resurser för att leva upp till samhällets ambitioner för en äldreomsorg som möter allt fler äldre med komplex problematik. Det är av vikt att rikta forskning mot hur vård-och omsorgspersonalens uttryckta behov av ökad individuell kompetens avseende depressiv ohälsa bland äldre kan understödjas på ett optimalt sätt. / Abstract Title: Dealing with depressive illness in nursing homes Tutor: Anna Siverskog Examinator: Klas Borell Research indicates a significant extent of depressive illness among the elderly in nursing homes, something that causes human suffering and a high burden on society. The following study intends to investigate the prevalence and symptoms based on the experiences of health and care professionals. The study also aims to explore the treatment and work strategies that employees use in their professional roles and whether different professional backgrounds seem to form differences in working with depressed elderly people in nursing homes. Eleven semi-structured interviews were conducted with professionals in the specified field of work in order to answer the questions. The empirical data was processed using a thematic approach supported by theories of ageism and life course.   The perceived incidence of depressive illness varies based on the interviewees' experiences, but the majority experience this to be extensive among the elderly in nursing homes. The symptoms of depressive illness vary, but there is a consensus among the interviewees that the symptoms are often diffuse and rarely expressed in specific words. Care and nursing staff describe that, based on their competence and in close collaboration within the team, they use various overall treatment strategies based on the individual needs and conditions with the ambition of conducting good care. Minor differences between professional groups have been observed, nurses seem to express a stronger reliance on clinical medical care, while other nursing staff are more likely to highlight its risks and instead emphasize the importance of close relationships in providing good care and support. However, the study points towards that limited time and individual skills obstruct as well as highlight the need to address ageist notions and provide resources to meet society's ambitions for elderly care, which is facing an increasing number of older people with complex problems. It is important to focus research on how to optimally support the expressed needs of health and social care professionals, for increased individual competence in relation to depressive illness in older people.