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Abstract Authors: Mikael Gustafsson & Kristofer von Wachenfeldt Title: With help from people and cattle; to recover from mental illness in a rural environment [translated title] Supervisor: Kent-Inge Perseius Purpose: The aim of this study was to examine feelings of recovery from mental illness in the perspective of individuals participating in Nymålen; a rural- situated facility focusing on recreation- and work- related interventions. The study took place outside of Oskarshamn, Sweden. The study focused on if, and in that case how, Nymålen contributes to recovery from mental illness. We were also interested in which factors affecting the recovery-process, as expressed by the participants themselves. Method: Eight individuals from Nymålen participated in individually performed semi- structured interviews. The collected data was then coded and categorized to enable further analysis by using Qualitative content analysis inspired by Graneheim & Lundman (2003). Latent themes that described the underlying meaning of the material were then extracted, using an analysis inspired by Robert K. Merton’s (1967) thesis on manifest and latent functions. Results: The findings of this study suggest that Nymålen in some ways contributes to feelings of recovery from mental illness. Nymålens environment including animals, a feeling of non- demanding chores, perceptive personnel and a positive interaction between the participants were the expressed main factors contributing to recovery from mental illness. Factors interrupting the recovery process were also detected, mainly an unhealthy feeling of competition between the participants, the lack of personnel and feelings of neglect from other psychiatric institutions. Keywords: Recovery, Mental illness, Animals, Rural, Rehabilitation, Qualitative content analysis

Barn till psykisk sjuka kan ha ökad risk för psykisk ohälsa men detta kan uppvägas av tillgängliga skyddsfaktorer. Barn har blivit mer uppmärksammade inom vuxenpsykiatrin på senare år. Beardslees familjeintervention implementeras sedan 2008 i Sverige. Studien undersökte hur vuxenpsykiatrin stödjer barn till psykisk sjuka, speciellt angående interventionen. Tio anställda, utbildade i interventionen, från sju psykiatriska kliniker i Stockholm intervjuades. Materialet analyserades abduktivt. Barns reaktioner och behov visade sig påverkas av föräldrafunktionen och risk- och skyddsfaktorer hos barnet, i omgivningen och situationen. Interventionen upplevdes bli ett sätt att uppmärksamma barn och skapa dialog inom familjen. Samtidigt upplevde deltagarna bristande kunskap om hur man kommunicerar med barn. För att stödja barn som mår dåligt skulle ett samarbete med BUP behövas. Ingen barnpolicy på avdelningsnivå finns och barns delaktighet ansågs låg. Preventivt arbete kan minska riskfaktorerna, men fokus måste också vara att öka barns möjlighet att hantera vardagssituationen, vilken kan förändras av omständigheterna och över tid. / Children of mentally ill parents have a higher risk to develop psychiatric problems but this risk can be reduced by protective factors. In recent years children of mentally ill have received more attention within adult psychiatry. The Beardslee family intervention has been implemented in Sweden since 2008. This study examines how adult psychiatry supports children of mentally ill, with focusing specifically on this intervention.  Ten professionals, educated in the intervention, from seven psychiatric hospitals in Stockholm, were interviewed and data analyzed abductive. Children's reactions and needs was shown to be influenced by the parenting skills and factors of risk and protection within the child, the environment and the situation. The intervention was perceived as a way of paying attention to the child and to create a dialogue within the family. At the same time the participants experienced a lack of knowledge about how to communicate with children. In order to support children cooperation with child psychiatry is required. No policy of how to handle children was available at the hospital units and the participation of children is considered to be low. Prevention may decrease the risk factors but there must also be a focus on increasing the possibility for the child to cope with the everyday situation. This situation may also change depending on circumstances and over time.

Background: During the last decades patient satisfaction has become an important measurement of quality in psychiatric care. However the patients are seldom asked to evaluate the treatments. Objectives: The aim is to determine which factors the outpatients regard as beneficial in their psychiatric treatment. The purpose is explorative. During the study another purpose developed; to present research on the importance of the relationship between the caretaker and the caregiver for the outcome. Method: 30 persons were interviewed about what they found helpful in psychiatric treatment. The interviews were open using Grounded Theory as methodological input. Result: The most prominent topic was the quality of the relationship between the caregiver and the caretaker. The characteristics of a helping relationship seem to be when the patient: - is being listened to and understood by a caregiver who is interested and concerned. - is not only seen as a caretaker with problems but also as a complete person, someone more than an equation of symptoms, diagnoses and shortcomings - is seen as a person worth listening to with unique knowledge which matters to the caregiver - is seen as a unique person not possible to minimize to just another case

Syftet med denna beskrivande litteraturstudie var att beskriva vårdpersonals attityder till personer med psykisk sjukdom. Litteratursökning genomfördes i databaserna Medline och PsycINFO och totalt valdes 15 vetenskapliga artiklar ut. Resultatet delades in i två huvudkategorier: attityder till psykisk sjukdom samt skillnader i attityder. Resultatet visade att vårdpersonal generellt sett hade en negativ syn på personer med psykisk sjukdom och ansåg att de var farliga, oförutsägbara och mer benägna att ta till våld. Detta ledde till att personalen försökte undvika konflikter med dem och de tyckte även att det var svårt att kommunicera med dem. Attityderna varierade beroende på vilken sjukdom personen led av. Exempelvis ansågs en person med schizofreni vara långt mer farlig än en person med depression och den senare ansågs ha större chans till tillfrisknande. Sjuksköterskor och läkare var positiva till psykiatriska vårdinrättningar i bostadsområden men de ville inte ha sådana där de själva bor. Sjuksköterskor tycktes ha en mer positiv attityd än läkare till personer med psykisk sjukdom och de som jobbade inom psykiatrin hade en mer positiv attityd än de inom somatisk vård. Några större, entydiga skillnader mellan män och kvinnor har inte funnits, men yngre personal tycktes vara mer negativa än äldre. / The aim of this descriptive literature review was to describe the attitudes of health personnel towards people with mental illness. The literature was gathered through the databases Medline and PsycINFO and a total of 15 scientific articles were chosen. The result was divided into two main categories: attitudes to mental illness and differences in attitudes. The result showed that health personnel in general had a negative view of people with mental illness and they regarded them as dangerous, unpredictable and violent. The personnel tried to avoid unnecessary conflicts with them and thought of them to be hard to communicate with. The attitudes varied depending on what psychiatric illness the person suffered from. A person with schizophrenia was believed to be more dangerous than a person with depression and the latter was believed to have a higher chance to recover. Nurses and doctors were positive to mental health services in residential neighbourhoods but didn't want to live next door to a person with a mental illness. Nurses seemed to have a more positive attitude than doctors to people with mental illness and personnel working in psychiatric care had a more positive view than personnel working in somatic care. Any unequivocal differences between men and women have not been found, but young health personnel seemed to be more negative than elder.

Den psykiska ohälsans utbredning är omfattande och är idag ett folkhälsoproblem i Sverige. Många människor söker vård för psykisk ohälsa genom telefonrådgivning. Syftet med denna studie har varit att undersöka och beskriva sjuksköterskors erfarenheter av att bemöta patienter med psykisk ohälsa i arbetet med sjukvårdsrådgivning. För att genomföra denna studie valdes en kvalitativ metod. Sju sjuksköterskor som arbetar med telefonrådgivning intervjuades. I resultatet framkom fem olika teman som benämndes: ”att känna att man betyder något för en annan människa”, ”att känna obehag inför samtal”, ”att inte kunna göra något och att känna sig otillräcklig”, ”att inte ha tid och resurser” samt ”att inte kunna se varandra”. Studien visar att det är viktigt för sjuksköterskan att betyda något för patienten. Den visar också att samtal om psykisk ohälsa kan innebära känslor som stress och obehag hos sjuksköterskorna. I studien framkommer för- och nackdelar med att inte ha en visuell kontakt mellan sjuksköterskan och patienten. / Mental illness is today an extensive problem, which affect the public health in Sweden. Many people with mental illness, try to get help through healthcare call centres. The aim of the study was to examine in what way nurses in healthcare call centres experience receiving patients, suffering from mental illness. To implement this study, a qualitative method was chosen. Seven nurses who work with counselling by phone were interviewed. Five themes appeared in the result: “to feel that you mean something to another human being”, “to feel discomfort with some calls”, “feeling insufficient and feelings of dejection”, “lack of time and resources” and “being unable see each other”. This study emphasizes that it is important for the nurses to mean something to the person who calls the healthcare call centre. Its also shows that calls about mental illness could create stress and discomfort feelings among the nurses. This study also shows advantages and disadvantages about the disability of not seeing the patient.

Background: Women and men in Sweden are in paid work to almost the same extent, but are found in different occupations and positions in the labour market. Still, women perform the bulk of the unpaid domestic work at home. Gendered inequalities in these respects leave women and men exposed to different work environments and responsibilities, which in turn can have gendered health consequences. In public health research there is a lack of studies on domestic work that include women and men, as well as a lack of qualitative studies exploring individuals’ experiences of domestic work and mental health. At the workplace level, few attempts have been made to analyse how several dimensions of gender equality at workplaces are related to health status and there is a lack of studies with a contextual approach combining many different variables that are at play simultaneously. Because of the cross-sectional design of previous studies on paid and domestic work there is a lack of analyses taking possible health-related selection into account, which makes it difficult to ascertain whether gender equality leads to better health or if good health is a prerequisite for gender equality. Aim: The aim of this thesis was to analyse gender relations of work (at workplaces and at home) in relation to mental illness among women and men. Methods: The thesis was based on data from the Northern Swedish Cohort. The baseline survey was conducted in 1981 when the participants were 16 years old (n= 1080, 574 boys and 506 girls), with follow-up at age 18, 21, 30 and 42. The response rate was 94 % throughout the last follow-up in 2007. Data from the Northern Swedish Cohort were supplemented with register data about the employees at the participants’ workplaces. The analysis methods for the questionnaire and register data were logistic regression analysis and cluster analysis. Interviews were performed with four women and four men in the Northern Swedish Cohort and were analysed with a Grounded Theory approach. Results: Women had overall greater responsibility for domestic work. Gender inequality in responsibility for domestic work and perceptions of gender inequality in the couple relationship (after adjustments for background variables and previous psychological distress) were associated with psychological distress among women and men. However, among men the relation between domestic work inequalities and psychological distress was affected by socioeconomic position relative to the partner. Having less responsibility for domestic work and a partner with higher socioeconomic position was associated with psychological distress among men. The qualitative analysis showed that gender relations were an important part of how the domestic work was unequally organised and related to experiences of mental illness among women and men. Among women the high burden of domestic work was experienced as an obstacle to experiencing good health. Among men the experience of being trapped in an outmoded masculinity was related to feelings of stress. At the workplace level, patterns of gender inequality were associated with psychological distress among women, but not among men. However, the most gender-equal pattern was related to lower as well as more similar levels of mental illness among women and men, which supports a convergence in health when women’s and men’s work conditions become more similar. Conclusion: Gender equality at home and at work is central for reducing mental illness among both women and men, but also for achieving a good average health status in the population, which is a central public health target. When investigating social inequalities in health, gender perspectives are of great importance for deepening the understanding of how and why gender inequalities in paid and domestic work are related to mental illness. Integrating gender perspectives into public health policy could be a way to acknowledge power relations that hinder good public health. / Bakgrund: Kvinnor och män i Sverige yrkesarbetar i nästan samma sträckning, men återfinns i olika yrken och positioner på arbetsmarknaden. Samtidigt utför kvinnor merparten av det obetalda arbetet i hemmet. Könade orättvisor i dessa avseenden innebär att kvinnor och män utsätts för olika arbetsmiljöer och ansvarsområden, vilket kan medföra könade hälsokonsekvenser. Dock är det få folkhälsovetenskapliga studier om obetalt arbete i hemmet och hälsa som inkluderar både kvinnor och män. Det är också en brist på kvalitativa studier som undersöker individers upplevelser av det obetalda arbetet i hemmet och psykisk hälsa. På arbetsplatsnivå har det gjorts få försök att analysera hur olika dimensioner av jämställdhet på arbetsplatser är relaterade till hälsostatus, och det är en brist på studier med en kontextuell metod som tar hänsyn till hur flera olika variabler samspelar. Tidigare folkhälsovetenskapliga studier som undersökt förvärvsarbete och hemarbete har framförallt använt sig av en tvärsnittsdesign, vilket gjort det svårt att utreda riktningen av samband mellan jämställdhet och psykisk hälsa, det vill säga om jämställdhet leder till bättre hälsa eller om god hälsa är en förutsättning för jämställdhet. Syfte: Syftet med denna avhandling var att analysera genusrelationer i arbete (på arbetsplatser och i hemmet) i förhållande till självskattad psykisk ohälsa bland kvinnor och män. Metod: Avhandlingen bygger på data från Luleåkohorten. Baslinjeundersökningen genomfördes år 1981 då deltagarna var 16 år (n=1080, 574 pojkar och 506 flickor). Uppföljningar har genomförts vid 18, 21, 30 och 42 års ålder och svarsfrekvensen var 94% under det senaste uppföljningen år 2007. Data från Luleåkohorten kompletterades med registerdata om anställda på deltagarnas arbetsplatser. Analysmetoder för enkät- och registerdata var logistisk regressionsanalys och klusteranalys. Intervjuer har genomförts med fyra kvinnor och fyra män i kohorten och analyserats med grundad teori. Resultat: Kvinnor hade totalt sett ett större och män ett mindre ansvar för det obetalda arbetet i hemmet. Upplevelse av bristande jämställdhet i ansvar för obetalt arbete i hemmet och i parrelationen hade ett samband med psykisk ohälsa bland kvinnor och män (även efter justering för bakgrundsvariabler och tidigare psykisk ohälsa). Att ha mindre ansvar för det obetalda arbetet i hemmet och en partner med högre socioekonomisk klass hade även ett samband med psykisk ohälsa bland män. Den kvalitativa analysen visade att genusrelationer var en viktig del i en ojämställd organisering av hemarbete och relaterade till upplevelser av psykisk ohälsa bland kvinnor och män. En hög belastning av hemarbete var ett hinder för kvinnor att uppleva en god hälsa. Upplevelser av att vara instängd i en omodern maskulinitet innebar en stressfull situation bland män. Mönster av ojämställdhet på arbetsplatser hade ett samband med psykisk ohälsa för kvinnor, men inte för män. Däremot visade sig de mest jämställda arbetsplats-mönstern vara relaterade till lägre och mer liknande nivåer av psykisk ohälsa bland kvinnor och män, vilket stödjer en konvergens i hälsa när kvinnor och mäns arbetsplats förhållanden är likvärdiga. Slutsats: Jämställdhet på arbetsplatser och i hemmet är viktigt för att minska psykisk ohälsa både bland kvinnor och män, men också för att uppnå en god genomsnittlig hälsa i befolkningen, något som är ett centralt folkhälsomål. Vid analyser av social ojämlikhet i hälsa är genusperspektiv av stor betydelse för att fördjupa förståelsen om hur och varför ojämställdhet i på arbetsplatser och i hemmet är relaterat till psykisk ohälsa. Att integrera genusperspektiv i folkhälsopolicy kan vara ett sätt att ta hänsyn till de maktrelationer som förhindrar en god folkhälsa.

This is a qualitative research centred on factors related to depressing and mental health among elderly Chinese immigrant women living in Ontario, Canada. The purpose of this qualitative research study was to examine those social factors that affect or contribute to depression or other forms of mental illness among elderly Chinese immigrant women. Qualitative content analysis was used. Reports of organisations concerned with elderly Chinese immigrants, qualitative research articles on elderly Chinese immigrant women, and government reports and publications were analysed based on their content. From the data, three main categories were developed. These are pre-migration, settlement experiences and health promotion. Some of the themes or sub –categories under these three main categories include the following: separation, isolation and loneliness, family and economic dependence, communication barriers, physical and psychological illness, transportation and food challenges, and empowerment. These themes or sub-categories were presented alongside the general conditions affecting elderly immigrant women as reported by other literature. From these findings several recommendations with regards to feminist health promotion were discussed. These include empowerment, making health social support accessible, family connectedness and others.

The experience of having a sibling with a mental illness affects well siblings in a myriad of ways (Marsh, 1998). In the present paper the term well siblings refers to those individuals who have a sibling with a mental illness but who do not have a mental illness themselves. They face unique stressors due to disruptions in the sibling relationship and in the family (Corrigan & Miller, 2004). The stressors commonly experienced by well siblings include stigma, objective and subjective burden, intense and conflicting emotions, disruptions in family of origin, interpersonal and intrapersonal difficulties, difficulties with the mental health system, and over reliance on maladaptive stress coping resources (Greenberg, Kim, & Greenley, 1997; Lukens, Thorning, & Lohrer, 2004; Marsh, 1998; Marsh & Dickens, 1997b; Riebschleger, 1991). Research describing disruptions in family of origin suggests that well siblings also are experiencing emotional neglect (Lukens et al.; Marsh; Marsh & Dickens). This paper presents a synthesis of literature on the stressors well siblings experience and their attempts at coping with stress. For this study, 133 participants completed 3 instruments: (a) demographics questionnaire, (b) the Coping Resources Inventory for Stress (Matheny, Curlette, Aycock, Pugh, & Taylor, 1987), a measure of perceived stress coping resources, and (c), the Childhood Trauma Questionnaire (Bernstein & Fink, 1998), which includes an emotional neglect scale. Participants with siblings with a mental illness were compared with participants whose siblings do not have a mental illness. Results indicate significant relationships between well siblings and emotional neglect and between emotional neglect and effective stress coping. However no significant relationship was observed between well siblings and effective stress coping. Therefore, having a sibling with a mental illness seems a risk factor for emotional neglect, but is not itself a risk factor for poor stress coping. The present study suggests that it is emotional neglect which is a risk factor for poor stress coping. The clinical implications of these results are discussed as well as the research implications and limitations of the study.