The experience of mental disorders while part of humanity, reveal inequities that are inhumane due to a lack of quality clinical service provisions globally. In Haiti, a formalized mental healthcare infrastructure developed after the 2010 earthquake where emerging dissemination and implementation studies demonstrated the potential for treatment utilization within recently established primary care. Partners in Health (PIH) and Zanmi Lasante (ZL) the frontline healthcare team have coordinated with the Haitian Ministry of Health to lead this initiative. A community-based mental healthcare system has proven to be sustainable through a task-sharing model, which delivers mental healthcare for common mental disorders (CMDs), severe mental disorders (SMDs), and neurological conditions (NCs)–with specific care pathways for major depression, psychotic disorders, and epilepsy. The extent to which patient mental healthcare are evaluated in lower-middle income countries (LMICs) like Haiti, however, have been limited. The primary aim of this study was to therefore evaluate patterns of mental disorders and to assess current patient care priorities in Haiti. The present study, builds upon previous literature by examining the continuum of mental disorders. A latent class analysis provides a data-driven approach to examine features of mental disorders to inform clinical treatment and best practices. EHR data from PIH and ZL were obtained from patients (N=914) who met criterion for a primary diagnosis and had completed mental health evaluations that were assessed at 13 sites in Haiti from 2016-2018. Known characteristics of mental disorders include the patient’s primary diagnosis, mood symptoms such as depression and suicidality, and the level of functional impairment. Accordingly, each were included as an LCA model indicator. Post-hoc multinomial logistic regression (MLR) models predicted mental health class selection and correlates based on the descriptive and clinical symptom variables. Results suggested there are six distinct mental health subgroups, that were distinguished by functional impairment: class 1a “common mental disorders– none to low functional impairment” (11.5%), class 2a “severe mental disorders–none to low functional impairment” (4.9%), class 3a “neurological conditions–none to low functional impairment” (11.1%), class 4b “common mental disorders–high functional impairment” (38.62%), class 5b “severe mental disorders–high functional impairment” (13.02%), and class 6b “neurological conditions–high functional impairment” (20.9%). MLR model 1 revealed CMDs were 2–3 times more likely female and received psychosocial interventions more often, and by comparison SMDs and NCs typically received psychiatric medication. MLR model 2 included patient’s clinical symptoms, that suggested severe CMDs with high functional impairment were somewhat more likely depressed when compared to other LCA subgroups. Although, in all likelihood this finding was probably attributed to CMDs including mild to severe forms of major depression, whereas SMDs were mostly psychotic disorder and bipolar disorder. Taken together, the most frequent primary diagnosis included: 1) major depressive disorder (60.3%) and generalized anxiety disorder (27.2%) for CMDs, 2) psychotic spectrum disorders (47.6%) and bipolar disorder (23.7%) for SMDs, and 3) epilepsy (88.8%) for NCs. Patients were infrequently diagnosed with co-occurring psychological disorders. The varied mental health disorder subgroups that participated in psychotherapy and psychiatric medication management, demonstrate such mental health treatments for Haitian’s are feasible and acceptable. While the present analysis was exploratory, LCA provides potential tools for treatment specification and best practices. The WHODAS, a measure of functional impairment, may be useful as a screening tool for triage, and primary outcome to determine patient improvement. Mental healthcare pathways based on results should expand to include women’s mental health and bipolar disorder. These findings are generalizable due to the data being from a community sample and directly from EHRs with inclusion criterion that was not limited by diagnostic specification, symptom severity, or co–occurring disorders. Overall, there is a vast need for mental health services that are broadly accessible for CMDs, SMDs, and NCs. This study highlights, specific clinical training and supervision needs, and the necessity for increased nursing, psychiatry, and neurology collaboration in Haiti. There is hope that healthcare expansion will strengthen and continue to empower communities in Haiti.

Bakgrund: Varje år begår cirka 1200 individer suicid i Sverige på grund av psykisk ohälsa. Många patienter beskriver en frustration över att leva med psykisk ohälsa samt beskriver att de har en begränsad tillit till vården. De upplever sig missförstådda och stigmatiserande i bemötandet av hälso– och sjukvårdvårdspersonal. Det resulterar till att många patienter upplever att de behöver dölja sin psykiska ohälsa genom att censurera sina ordval och handlingar.Syfte: Syftet med denna litteraturöversikt var att belysa sjuksköterskors attityder till att vårda patienter med psykisk ohälsa inom somatisk vård.Metod: Metoden genomfördes som en litteraturöversikt. Datainsamling utfördes systematiskt i databaserna CINAHL, PubMed och PsycINFO. 18 vetenskapliga artiklar inkluderades från 2011–2021 från databaserna som besvarade litteraturöversiktens syfte. 12 artiklar var kvantitativa studier och 6 artiklar var kvalitativa studier.Resultat: Resultatet består av 5 kategorier som belyser sjuksköterskors attityder till att vårda patienter med psykisk ohälsa inom somatisk vård. Resultat visar att kunskap och utbildning inom psykisk ohälsa är av stor betydelse för sjuksköterskors positiva attityder. Sjuksköterskors negativa attityder var en central faktor som påverkade omvårdnaden av patienter med psykisk ohälsa. Detta kan anses bero på bristande kompetens samt kulturella värderingar hos sjuksköterskor.Slutsats: Psykisk ohälsa är ett globalt växande problem. Patienter som lider av psykisk ohälsa förekommer i alla delar av vården. Resultatet visar att en ökad kunskap och utbildning inom psykisk ohälsa är av en stor betydelse i omvårdanden av dessa patienter. Det är av ett stort värde att sjuksköterskor inom den somatiska vården får en god kunskap kring psykisk ohälsa för att kunna möjliggöra en god personcentrerad vård. / Background: Every year, approximately 1200 individuals commit suicide in Sweden due to mental illness. Many patients describe a frustration over living with mental illness and describe that they have limited trust in care. They feel misunderstood and stigmatized in the treatment of health care professionals. As a result, many patients feel the need to hide their mental illness by censoring their words and actions.Aim: To Illuninate nurses' attitudes to caring for patients with mental illness in somatic care.Method: The literature review data collections were performed systematically in the databases CINAHL, PubMed and PsycINFO. 18 articles were included from 2011–2021 from the databases that answered the purpose of the literature review. 12 articles were quantitative studies and 6 articles were qualitative studies.Results: The results consist of 5 categories that shed light on nurses' attitudes to caring for patients with mental illness in somatic care. Results show that knowledge and education in mental illness is of great importance for nurses' positive attitudes. Nurses' negative attitudes were a key factor influencing the care of patients with mental illness. This can be considered due to lack of competence and cultural values among nurses.Conclusion: Mental illness is a global growing problem. Patients suffering from mental illness occur in various care facilities. The results show that increased knowledge and education in mental illness is of great importance in the care of these patients. It is of great value that nurses in somatic care gain a good knowledge of mental illness in order to enable good person-centered care.

Bakgrund: Fysisk vårdmiljö på psykiatriska slutenvårdsavdelningar erfars positivt och negativt. Dock undersöks sällan huruvida miljön erfars främja eller hämma återhämtning. Syfte: Beskriva hur personer som vårdas inom psykiatrisk slutenvård erfar den fysiska vårdmiljöns betydelse för återhämtning. Metod: Semistrukturerade intervjuer med tio deltagare som nyligen varit inlagda på psykiatrisk slutenvårdsvårdsavdelning. Kvalitativ innehållsanalys med induktiv ansats användes. Resultat: Det erfars främjande för återhämtningen att få uppleva ljus när det känns mörkt, att uppleva avdelningens miljö inbjudande, att få hjälp att komma till ro samt att få känna liv med hjälp av växter i den fysiska vårdmiljön. Det erfars hämmande för återhämtningen att känna sig begränsad av att dela rum med andra, att inte få möjlighet till en god sömn, att känna frustration när inget stimulerar samt att uppleva miljön som fängelselik. Slutsatser: Det är inte stora renoveringar eller interiör som är centralt i resultatet. Snarare handlar det om tanke bakom utformningen, som kan främja gemenskap, social interaktion och valmöjligheter. Utformningen kan skapa trygghet och underlätta återhämtningsprocessen. Sjuksköterskan behöver tänka steget längre och väga in den fysiska vårdmiljön som betydelsefull för återhämtningen och med de medel som finns skapa en återhämtningsfrämjande miljö för varje enskild person. / Background: Physical care environment in psychiaric wards experienced positively and negatively. However, it is rarely investigated whether the environment is experienced to promote or inhibit recovery. Purpose: Describe how people who are cared for in psychiatric inpatient care experience the importance of the physical care environment for recovery. Method: Semi-structured interviews with ten participants who have recently been admitted to a psychiatric inpatient ward. Qualitative content analysis with an inductive approach was used. Results: It is experienced to promote recovery to experience light when it feels dark, to experience the ward's environment inviting, to get help to calm down and to feel life with the help of plants in the physical care environment. It is experienced as inhibiting the recovery to feel limited by sharing a room with others, not to have the opportunity for a good sleep, to feel frustration when nothing stimulates and to experience the environment as prison-like. Conclusion: It is not major renovations or interiors that are central to the result. Rather, it is about thought behind the design, which can promote community, social interaction and choices. The design can create security and facilitate the recovery process. The nurse needs to think one step further and consider the physical care environment as important for recovery and with the means available to create a recovery-promoting environment for each individual person.

Bakgrund: Den psykiska ohälsan ökar bland befolkningen. När en person drabbas av psykisk ohälsa kan det komma att påverka hela familjen. Sjuksköterskor behöver få en ökad kunskap i närståendes upplevelser av att leva nära en person med psykisk ohälsa för att kunna möta den närståendes behov. Syfte: Belysa närståendes upplevelser av att leva nära en person med psykisk ohälsa. Metod: En litteraturöversikt med tio kvalitativa artiklar. Resultat: Av analysen framträdde fyra kategorier, att hamna utanför samhället, att inte få sätta sig själv i första rummet, att vilja ses som en resurs inom sjukvården och en känsla av tillhörighet. Konklusion: Examensarbetet belyser att det är många närstående till personer med psykisk ohälsa som upplever stigmatisering. Som sjuksköterska ska man bemöta varje patient och närstående med respekt och ett öppet sinne. Sjuksköterskor kan genom detta arbete få en ökad förståelse för hur närstående upplever hur det är att leva nära en person med psykisk ohälsa och därigenom ge ett bättre stöd till den närstående. / Background: Mental illness is increasing among the population. When a person suffers from mental illness, it can affect the whole family. Nurses need to gain an increased knowledge of relatives‘ experiences of living close to a person with mental illness to meet the needs of the relatives. Aim: Illuminate relatives‘ experiences of living close to a person with mental illness. Method: A literature overview with ten qualitative articles. Result: Of the analysis, four categories emerged, to end up outside society, not put oneself first, to want to be a resource in healthcare and to want to feel a sense of belonging. Conclusion: The study highlights that there are many relatives of people with mental illness who experience stigma. As a nurse, you must treat every patient and relative with respect and an open mind. Through this work, nurses can gain an increased understanding of how close relatives experience what it is like to live close to a person with mental illness and thereby provide better support to the close relative.

SAMMANFATTNING Bakgrund: Bristande bemötande och brist på förståelse mot personer med psykisk sjukdom är vanligt förekommande, även inom vården. Sjukhusmiljön ska vara en plats där patienter ska få hjälp men faktorer som exempelvis fördomar kan påverka bemötande. Bristande förståelse och bemötande kan bidra till att patientens behov av vård inte tas på allvar. Syfte: Syftet med denna studie var att beskriva hur patienter med psykisk sjukdom uppfattade bemötandet av sjuksköterskor inom hälso- och sjukvården.Metod: Syftet har besvarats med hjälp av en deskriptiv litteraturöversikt. Inkluderade artiklar har varit av kvalitativ ansats samt har genomgått en kvalitetsanalys och erhållit hög eller medel kvalitet. Resultat: I resultatet beskrev patienter både positiva och negativa uppfattningar av bemötandet från sjuksköterskor i hälso- och sjukvården. Positiva aspekter beskrevs bland annat som att bli bemött med medmänsklighet, respekt och som en individ. Även upplevelsen av att känna sig förstådd hade också en stor betydelse. De negativa aspekterna som bristande förståelse, kontinuitet, misstro och fördomar beskrevs av patienter. Detta förklarades påverka patientens självförtroende och psykiska mående, såsom känslor av hopplöshet, rädsla och hjälplöshet. Slutsats: Patienterna beskrev empati, förmågan att lyssna, medmänsklighet, kontinuitet och respekt som positiva delar i bemötandet med sjuksköterskor. De negativa delarna som patienterna beskrev i bemötandet med sjuksköterskor var i motsatsförhållande till de positiva, brist på empati, sympati, ointresse för patienterna, brist på kontinuitet och respekt men även misstro och rädsla. Nyckelord: psykisk sjukdom, sjuksköterskor, patientens perspektiv, stigmatisering, bemötande / ABSTRACT Background: Lack of treatment and lack of understanding towards people with mental illness is common, even in healthcare settings. The hospital environment should be a place where patients should receive help, but factors such as prejudice can affect treatment. Lack of understanding and treatment can contribute to the patient’s need for care not being taken seriously.  Aim: The purpose of this study was to describe how patients with mental illness perceived the treatment by nurses in healthcare settings.Method: The purpose has been answered with the help of a descriptive literature review. Included articles have been of qualitative approach and have undergone a quality analysis and obtained high or medium quality. Results: In the results, patients described both positive and negative perceptions of how the treatment of nurses in the healthcare setting is. Positive aspects were described, among other things, as being treated with compassion, respect and as an individual. Even the experience of being understood was of great importance. The negative aspects such as lack of understanding, continuity, mistrust and prejudice were described by patients. This was explained to affect the patient's self confidence and mental state, such as feelings of hopelessness, fear and helplessness. Conclusion: Patients’ described empathy, the ability to listen, compassion, continuity and respect as positive components in treatment by nurses’. The negative components that patients’ described in treatment by nurses’ were in a opposite relationship to the positive ones, lack of empathy, unconcern for patients’, lack of continuity and respect, but also mistrust and fear. Keywords: mental illness, nurses, patients’ perspective, stigmatization, treatment

Bakgrund: Psykisk ohälsa ökar bland barn och ungdomar i Sverige och världen över. Oupptäckt psykisk ohälsa kan leda till både kort- och långsiktiga negativa konsekvenser. Psykisk ohälsa under barndomen ökar risken för sämre livskvalitet, fysiska hälsoproblem och psykisk ohälsa i vuxenålder. Skolsköterskan har möjlighet att arbeta hälsofrämjande och förebyggande mot psykisk ohälsa. Skolsköterskor träffar eleverna regelbundet vid hälsobesök och andra hälsoundersökningar i olika årskurser och har därför möjlighet att identifiera psykisk ohälsa hos eleverna. Syfte: Syftet med denna metasyntes var att beskriva skolsköterskans erfarenhet av arbete med psykisk ohälsa hos elever. Metod: Studien är en systematisk litteraturöversikt med kvalitativ ansats med metasyntes som forskningsmetod. Resultat: Analysen resulterade i tre övergripande teman organisatoriska omständigheter har betydelse, skolsköterskans arbetssätt påverkar och kompetens krävs. Dessa teman resulterade i följande syntes: Arbete med psykisk ohälsa hos elever påverkas av organisatoriska omständigheter där hög arbetsbelastning och bristfällig resursfördelning har en negativ inverkan medan samarbete med och stöd från olika parter inom och utanför skolan är viktigt och underlättar. Samtidigt har rektorn en avgörande roll i hur välfungerande samarbetet inom elevhälsoteamet blir. Olika arbets- och bedömningsverktyg behövs och används i både identifiering av och i arbete med psykisk ohälsa dock efterfrågar skolsköterskor olika utvecklingsmöjligheter som kan stödja arbetet. Det krävs professionell kunskap för arbete med psykisk ohälsa men även grundläggande kompetens, såsom kommunikationsfärdigheter, är nödvändigt. Konklusion: Skolsköterskor behöver mer tid, resurser och utbildning samt ett gott samarbete med andra professioner inom och utanför skolan för att kunna arbeta hälsofrämjande och förebyggande mot psykisk ohälsa hos eleverna / Background: Mental illness is increasing among children and young people, both in Sweden and worldwide. Undetected mental illness can have short- and long-term negative consequences. Mental illness during childhood reduces quality of life as well as increases the risk of physical health problems and mental illness in adulthood. The school nurse can work to promote health and prevent mental illness. School nurses meet students regularly during health dialogues and other health examinations from all grade levels which gives them the opportunity to identify mental illness early on. Aim: The aim of this study was to describe school nurses´ experiences of working with mental illness in students. Method: The study is a systematic literature review with a qualitative approach, with metasynthesis as the analysis method. Results: The analysis resulted in three overarching themes, organizational circumstances matter, the school nurse´s working methods have an impactand competence is required. The themes resulted in the following synthesis: Working with mental illness in students is affected by organizational circumstances, a high workload and inadequate resource allocation have a negative impact while collaboration with and support from different parties inside and outside the school is important and facilitates. At the same time, the principal has a decisive role in how well-functioning the collaboration within the school health service will be. Different work and assessment tools are needed and are in use both in identification of and in working with mental illness, however different development opportunities that can support the work, are requested by the school nurses. Professional competence is required for working with mental illness but basic skills, such as communication skills, are also necessary. Conclusion: School nurses need more time, more resources, and more education as well as the ability to collaborate with other professions inside and outside the school setting, to be able to promote health and take preventative measures against mental illness in students.

Heterogeneous treatment responses are commonly observed in patients with mental disorders. Thus, a universal treatment strategy may not be adequate, and tailored treatments adapted to individual characteristics could improve treatment responses. The theme of the dissertation is to develop statistical and machine learning methods to address patients heterogeneity and derive robust and generalizable individualized treatment strategies by integrating evidence from multi-domain data and multiple studies to achieve precision medicine. Unique challenges arising from the research of mental disorders need to be addressed in order to facilitate personalized medical decision-making in clinical practice. This dissertation contains four projects to achieve these goals while addressing the challenges: (i) a statistical method to learn dynamic treatment regimes (DTRs) by synthesizing independent trials over different stages when sequential randomization data is not available; (ii) a statistical method to learn optimal individualized treatment rules (ITRs) for mental disorders by modeling patients' latent mental states using probabilistic generative models; (iii) an integrative learning algorithm to incorporate multi-domain and multi-treatment-phase measures for optimizing individualized treatments; (iv) a statistical machine learning method to optimize ITRs that can benefit subjects in a target population for mental disorders with improved learning efficiency and generalizability. DTRs adaptively prescribe treatments based on patients' intermediate responses and evolving health status over multiple treatment stages. Data from sequential multiple assignment randomization trials (SMARTs) are recommended to be used for learning DTRs. However, due to the re-randomization of the same patients over multiple treatment stages and a prolonged follow-up period, SMARTs are often difficult to implement and costly to manage, and patient adherence is always a concern in practice. To lessen such practical challenges, in the first part of the dissertation, we propose an alternative approach to learn optimal DTRs by synthesizing independent trials over different stages without using data from SMARTs. Specifically, at each stage, data from a single randomized trial along with patients' natural medical history and health status in previous stages are used. We use a backward learning method to estimate optimal treatment decisions at a particular stage, where patients' future optimal outcome increment is estimated using data observed from independent trials with future stages' information. Under some conditions, we show that the proposed method yields consistent estimation of the optimal DTRs, and we obtain the same learning rates as those from SMARTs. We conduct simulation studies to demonstrate the advantage of the proposed method. Finally, we learn DTRs for treating major depressive disorder (MDD) by stage-wise synthesis of two randomized trials. We perform a validation study on independent subjects and show that the synthesized DTRs lead to the greatest MDD symptom reduction compared to alternative methods. The second part of the dissertation focuses on optimizing individualized treatments for mental disorders. Due to disease complexity, substantial diversity in patients' symptomatology within the same diagnostic category is widely observed. Leveraging the measurement model theory in psychiatry and psychology, we learn patient's intrinsic latent mental status from psychological or clinical symptoms under a probabilistic generative model, restricted Boltzmann machine (RBM), through which patients' heterogeneous symptoms are represented using an economic number of latent variables and yet remains flexible. These latent mental states serve as a better characterization of the underlying disorder status than a simple summary score of the symptoms. They also serve as more reliable and representative features to differentiate treatment responses. We then optimize a value function defined by the latent states after treatment by exploiting a transformation of the observed symptoms based on the RBM without modeling the relationship between the latent mental states before and after treatment. The optimal treatment rules are derived using a weighted large margin classifier. We derive the convergence rate of the proposed estimator under the latent models. Simulation studies are conducted to test the performance of the proposed method. Finally, we apply the developed method to real-world studies. We demonstrate the utility and advantage of our method in tailoring treatments for patients with major depression and identify patient subgroups informative for treatment recommendations. In the third part of the dissertation, based on the general framework introduced in the previous part, we propose an integrated learning algorithm that can simultaneously learn patients' underlying mental states and recommend optimal treatments for each individual with improved learning efficiency. It allows incorporation of both the pre- and post-treatment outcomes in learning the invariant latent structure and allows integration of outcome measures from different domains to characterize patients' mental health more comprehensively. A multi-layer neural network is used to allow complex treatment effect heterogeneity. Optimal treatment policy can be inferred for future patients by comparing their potential mental states under different treatments given the observed multi-domain pre-treatment measurements. Experiments on simulated data and real-world clinical trial data show that the learned treatment polices compare favorably to alternative methods on heterogeneous treatment effects and have broad utilities which lead to better patient outcomes on multiple domains. The fourth part of the dissertation aims to infer optimal treatments of mental disorders for a target population considering the potential distribution disparities between the patient data in a study we collect and the target population of interest. To achieve that, we propose a learning approach that connects measurement theory, efficient weighting procedure, and flexible neural network architecture through latent variables. In our method, patients' underlying mental states are represented by a reduced number of latent state variables allowing for incorporating domain knowledge, and the invariant latent structure is preserved for interpretability and validity. Subject-specific weights to balance population differences are constructed using these compact latent variables, which capture the major variations and facilitate the weighting procedure due to the reduced dimensionality. Data from multiple studies can be integrated to learn the latent structure to improve learning efficiency and generalizability. Extensive simulation studies demonstrate consistent superiority of the proposed method and the weighting scheme to alternative methods when applying to the target population. Application of our method to real-world studies is conducted to recommend treatments to patients with major depressive disorder and has shown a broader utility of the ITRs learned from the proposed method in improving the mental states of patients in the target population.

1 Abstract Published researches show that loneliness negatively affects mental and physical health and occurs across all age groups. However, the area of loneliness has not been sufficiently explored in the Czech context, and there are still not enough studies on a global scale focusing on loneliness in people with mental illness. This work therefore contributes to the opening of this issue from the perspective of social work, which can respond well to the challenges that loneliness brings to the lives of people with mental illness. In the theoretical part I deal with the definition of a group of diagnoses called "serious mental illnesses". A common feature of diagnoses from this group is a serious disruption of normal and social functioning of the individual. Subsequently, I define loneliness, its types and theoretical framework, which provides an insight into the issue. Furthermore, I present the basic researched areas, which are followed by abstracts of studies with focus on loneliness in people with mental illness. The aim of the thesis was to answer the main research question: "How do people with serious mental illness experience loneliness?" It was answered using interpretive phenomenological analysis, which offers a flexible approach to research and gives space for respondent's interpretation. The...

Existentiell hälsa: ett naturligt inslag i arbetsterapi – Arbetsterapeuters uppfattningar om hur de integrerar existentiell hälsa i sitt arbete. Som arbetsterapeut kan man möta personer med psykisk ohälsa som bär på existentiella funderingar. Psykisk ohälsa benämns som ett folkhälsoproblem och utgör en stor del av pågående sjukfall i Sverige. Att bemöta och involvera existentiell hälsa i arbetsterapi är därför viktigt för att stödja dessa individer till ökad hälsa och delaktighet. Studiens syfte var att beskriva arbetsterapeuters uppfattningar av hur de integrerar existentiell hälsa för personer med psykisk ohälsa. En kvalitativ metod valdes där data samlades in genom semistrukturerade intervjuer. Deltagarna rekryterades via snöbollsurval och var arbetsterapeuter inom olika verksamhetsområden runt om i Sverige. En kvalitativ innehållsanalys resulterade i en huvudkategori: Existentiell hälsa är ett naturligt inslag i arbetsterapi och tre kategorier: Miljön utgör ett verktyg för att beröra aspekterna i existentiell hälsa, Använda aktiviteter för att väcka tankar och inre känslor samt I samtal medvetandegörs och stärks den existentiella hälsan. Samtliga kategorier har tillhörande underkategorier. Slutsatsen var att existentiell hälsa uppfattades av arbetsterapeuterna som ett naturligt inslag i arbetsterapi och integrerades mer eller mindre avsiktligt gentemot målgruppen med psykisk ohälsa. Den existentiella dimensionen integrerades på olika sätt, genom miljön, aktivitet och samtal. / Existential health: A natural element in occupational therapy - Occupational therapists’ perceptions of how they integrate existential health into their work.Occupational therapists can meet people with mental illness who carry existential thoughts. Mental illness is described as a public health problem in Sweden. Involving existential health in occupational therapy is therefore necessary to increase health and participation. The purpose of the study was to describe Occupational Therapists’ perceptions of how they integrate existential health for people with mental illness.  A qualitative method was chosen where data were collected through semi-structured interviews. The participants were recruited through snowball sampling and were occupational therapist in different institutions around Sweden. A qualitative content analysis resulted in a main category: Existential health is a natural element in occupational therapy and three categories: The environment is used as tool for touching the aspects of existential health, Activities is used to awaken thoughts and feelings and In conversation the existential health is made conscious and strengthened. The conclusion was that existential health was perceived by Occupational Therapists’ as a natural element in occupational therapy and was more or less intentionally integrated towards the target group with mental illness. The existential dimension was integrated through the environment, activities and conversation.

Bakgrund: En god mental hälsa är en förutsättning för att människan ska kunna hantera svårigheter i livet. Fysisk aktivitet har flertalet positiva hälsoeffekter vilket bland annat innefattar minskad risk att drabbas av hjärtkärlsjukdomar, cancer samt psykisk ohälsa. Fysisk aktivitet visar sig även kunna ha positiv effekt och kunna dämpa symtom vid bland annat depression och ångest. Psykisk ohälsa är ofta förknippat med dålig fysisk hälsa och för tidig död där det i tidigare forskning finns flertalet barriärer som gör att personer med psykisk ohälsa inte utför fysisk aktivitet.Syfte: Att beskriva sjuksköterskans erfarenhet av att använda fysisk aktivitet som hälsofrämjande åtgärd vid psykisk ohälsaMetod: Studien genomfördes genom en litteraturöversikt baserat på 15 vetenskapliga artiklar vilka var publicerade under tidsperioden 2010–2020. Databaserna PubMed, CINAHL, PsycINFO samt Web of Science användes för att hitta relevanta artiklar.Resultat: Resultatet visar att det förekom bristande kunskap hos sjuksköterskor, otydlighet i ansvarsfördelningen för den fysiska vården samt att det var ett tidskrävande arbete. Sjuksköterskorna ansåg fysisk aktivitet som en viktig del av behandling vid psykisk ohälsa men det fanns ett flertal barriärer hos personer med psykisk ohälsa vilket försvårade utförandet, bland annat läkemedelsbiverkningar och dålig psykisk status.Slutsats: Hög arbetsbelastning, bristande kunskap och att det är ett tidskrävande arbete gör det problematiskt för sjuksköterskan att ge råd till patienter med psykisk ohälsa i att utöva fysisk hälsovård. / Background: Good mental health is a prerequisite for people to be able to handle difficulties in life. Physical activity has many positive health effects which includes a reduced risk of suffering from cardiovascular disease, cancer and mental illness. Physical activity also proves to have a positive effect and can alleviate symptoms of depression and anxiety. Mental illness is often associated with poor physical health and premature death, where in previous research there are several barriers that prevent people with mental illness from performing physical activity.Aim: The aim was to describe nurses experience of using physical activity as a health-promoting measure in mental illness.Method: This study was conducted through a literature review on 15 scientific articles which were published during the period 2010-2020. The databases PubMed, CINAHL, PsycINFO and Web of Science were used to find relevant articles.Result: The result show that there was a lack of knowledge among nurses, ambiguity in who was responsible for physical care and that it was a time-consuming job. The nurses considered physical activity to be an important part of treatment for mental illness, but there were several barriers in people with mental illness that made it difficult to perform, including drug side effects and poor mental status.Conclusion: High workload, lack of knowledge and the fact that it is a time-consuming job makes it problematic for the nurse to give advice to patients with mental illness to perform exercise.