Background: Mental health issues are a growing global problem and there is a big gap between the need for mental health care and the financial resources allocated to this health care sector. Nurses work closely to patients and play an important role in alleviating suffering and in the recovery of the patient. Highlighting the nurses’ role and experiences of working with persons with mental health problems can give information of how to address the different challenges they meet.  Aim: The aim of this study was to describe nurses’ experiences of caring for persons with mental health problems in a psychiatric care setting in the Kurdistan region of Iraq. Method: Seven semi-structured interviews were conducted with a total of eight nurses working at two psychiatric hospitals. Qualitative content analysis was used to analyze the data. Findings: Four main themes were found: Between possibilities and challenges, Holistic view, Striving for equality and Caring relations. Nurses in psychiatric settings in Kurdistan region of Iraq face different challenges related to organization, prejudice and inequality. They have a lot of knowledge about nursing and aim to meet patients and families with a person-centered approach. Conclusion: The findings show that nurses need the work environment to be open to nurses’ thoughts and concerns. Management should involve nurses in the development of the hospital, encourage collaboration and provide on the job training. This would increase the job satisfaction and contribute to a person-centered atmosphere.

Background: Research points in different directions when looking at possible increases in mental health problems among adolescents. Findings in favor of an increase are questioned due to methodological problems. Aim: Investigating whether mental health problems among young adolescents are increasing over time in Europe and North America. If so, does the trend apply both to mean levels of symptoms and to the proportion of adolescents with substantial problems? Are the time-trends similar over sex and age-categories?                                                                                                    Method: A total of 401 089 adolescents from a total of 38 countries are included in the analysis. Based on the eight health variables on self-rated health provided by the HBSC study, a measurement of mental health problems was created using factor analysis in SPSS. Results: Increases of mental health problems were found in Europe and North America. Increases were found both in terms of mean levels of symptoms and to the proportion of adolescents with substantial problems. Increases were seen in all age groups and among both girls and boys. Conclusion: Reasons behind the discovered increases are not known and should be further investigated as extensive research point to severe consequences of mental health problems in adolescence for later life.       Key words   Adolescents, mental health problems, trends, self-reported health (SRH), psychological health complaints (PHC)

Regeringen vill lägga mer vikt på att stärka möjligheten till kultur och social delaktighet. De belyser vikten av att skapa trygghet och att minska isolering inom grupper som till exempel långtidssjukskrivna och långtidsarbetslösa. Kulturaktiviteter som konst, film, musik och teater har bevisats ha en positiv effekt på hälsan genom bland annat ökad social funktion, ökad livskraft och ökad fysisk hälsa. Det avser både att delta i samt att uppleva utan att delta i kulturen. Syftet med denna studie var att undersöka om kulturaktiviteter kan påvisa en skillnad i återgång till arbete och psykisk ohälsa hos långtidssjukskrivna personer med psykisk ohälsa, samt undersöka vilken påverkan egna förväntningar har på återgång till arbete. Det insamlade materialet kom från enkätdata ur projektet Kultur och hälsa, genomförd av landstingets enhet Kompetenscentrum för hälsa i Västerås stad. Resultatet visade att andelen som åter var i arbete efter deltagande i kulturaktiviteter hade ökat och den psykiska hälsan hade förbättrats, men inga statistiska samband kan fastställas i denna studie. Mer forskning behövs inom området kultur som hjälp för återgång till arbete efter långtidssjukskrivning. / The government wants to put more emphasis on strengthening the ability to culture and social participation. They highlight the need to provide security and to reduce the isolation of groups such as long-term sickness and unemployed. Cultural activities such as art, film, music and theater have proven to have a positive effect on health by, improved social functioning, increased vitality and physical health. It refers both to participation in and to experience without participating in culture. The aim of this study was to investigate whether cultural activities may effect in a difference in the return to work and mental illness among long-term sick people with mental health problems, and investigate the impact of their own expectations on return to work. The collected material was taken from the project Culture and Health, made ​​by Department of public health, Västmanland County council in Västerås. The results showed that the proportion of who was back in work after participating in cultural activities had increased and mental health had improved, but no statistical link could be established in this study. More research is needed in the area about if culture help people to return to work after long term sickness.

Aim: The overall aim of this thesis was to study mental distress, health and lifestyle habits, social factors and psychotropic drug use by young people, and how PHNs conceive their roles in relation to this. Methods: Quantitative and qualitative methods were used. Study I included data  from the Norwegian Youth Health Study (NYHS, 11 620 participants, aged 15-16 years) (2000–2003) linked to the Norwegian Prescription Database (NorPD) (2004–2009). Study II included prescription data on psychotropic drugs among 15-16 year olds from the NorPD (2006–2010). Eight young people were interviewed and qualitative content analysis was used to analyse the data (III). Study IV included interviews with 20 Public Health Nurses (PHN), and was analysed using a phenomenographic approach. Main results: Mental distress was reported among 15.5% of the adolescents non-users of psychotropic drugs, 75% of whom were girls. In both genders reporting mental distress, incident psychotropic use was higher one to nine years, up to 27.7% among girls, as compared with the rest of the participants. In addition, health, lifestyle habits and social factors were associated with incident use (I). Psychotropic drug use increased during 2006–2010, hypnotics and melatonin accounted for most of the increase. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010 (II). Young people experience both beneficial and undesired effects from psychotropic drugs. Access to professional support and follow-up was experienced as insufficient. Life with family, friends, school and work was influenced by psychotropic drug use, and they were afraid of being lonely and stigmatized (III). The PHNs conceived their roles in relation to young people as; the discovering PHNs who became aware of psychotropic drug use in the health dialogues and chose either to act or not to act in relation to this. Those PHNs who took action continued to be the cooperating PHNs who cooperated with the young people, their families, schools, and others. If cooperation was established, the supporting PHNs teach and support the young people in relation to psychotropic drug use (IV). Conclusions: Attention must be paid to poor mental health and increasing psychotropic drug use by young people. Advances in knowledge, treatment and follow-up are needed. The prevalence of mental distress among young people, with differences between the genders, as well as between socioeconomic groups, should have consequences for health promotion strategies. PHNs in Norway, working in health centres and schools, have responsibility and opportunity to identify and follow-up young people with mental health problems. / Baksidestext International studies indicate an increase in mental distress and psychotropic drug use among young people. In this thesis mental distress is reported among 15.5 % of the young people. Of those reporting mental distress 75 % were girls. One quarter of the girls reporting mental distress at 15-16 years of age was incident users of psychotropic drugs one to nine years later. Psychotropic drug use, increase among young people, particularly hypnotic drugs. The young people experience beneficial and undesired effects of the psychotropic drugs. They miss out on professional availability and follow-up, and experience negative reactions related to their psychotropic drug use by their significant others. The public health nurse who discovers psychotropic drug use among young people chooses either to act or not to act in relation to this. Those who choose to act continue to cooperate with the young people and others. An established cooperation was followed by a public health nurse who supports and teaches the young people. The prevalence of mental distress, with a high frequency of initiation of psychotropic drug use among young people should have consequences for health promotion in the school health service. Public health nurses, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the responsibility and opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others.

Children's mental health problems are a significant public health concern. They are costly to society in both human and financial terms. This thesis contributes to the 'science of prevention' by examining issues related to the identification of children at risk of mental health problems. In particular, it was of interest to determine whether 'at-risk' children could be identified before the development of significant behavioural or emotional problems. Three areas were explored: family risk factors that predict the development of children's mental health problems, teachers' ability to identify family risk factors, and parent- and teacher-report screening methods. Data were collected from the parents and teachers of over 1000 children in preschool to Year 3 as part of the Promoting Adjustment in Schools (PROMAS) Project. Parents and teachers each completed two questionnaires at two time points, one year apart. Parents completed the Family Risk Factor Checklist - Parent (FRFCP) and the Child Behaviour Checklist (CBCL) and the equivalent instruments for teachers were, respectively, the Family Risk Factor Checklist - Teacher (FRFC-T) and the Teacher Report Form (TRF). The FRFC-P and FRFC-T were original to the current research and were designed to assess children's exposure to multiple family risk factors across five domains: adverse life events and instability (ALI), family structure and socioeconomic status (SES), parenting practices (PAR), parental verbal conflict and mood problems (VCM), and parental antisocial and psychotic behaviour (APB). Paper 1 investigated the psychometric properties of the FRFC-P and the potential for its use at a population-level to establish community risk factor profiles that subsequently inform intervention planning. The FRFC-P had satisfactory test-retest reliability and construct validity, but modest internal consistency. Risk assessed by the PAR domain was the most important determinant of mental health problem onset, while the PAR, VCM, and APB domains were the strongest predictors of mental health problem persistence. This risk factor profile suggests that, for the studied population, the largest preventive effects may be achieved through addressing parenting practices. Paper 2 examined teachers' knowledge of children's exposure to family risk factors using the FRFC-T. While teachers had accurate knowledge of children's exposure to risk factors within the ALI and SES domains, they had poor knowledge of children's exposure to risk factors within the PAR, VCM, or APB domains - the types of risk factors found in Paper 1 to be the most strongly related to children's mental health problems. Nevertheless, teachers' knowledge of children's exposure to risk factors within the ALI and SES domains predicted children's mental health problems at one year follow-up even after accounting for children's behaviour at the first assessment. Paper 3 investigated the potential of both the FRFC-P and FRFC-T for identifying individual, at-risk children. The accuracy of the FRFC in predicting internalising versus externalising disorders was compared against behavioural and simple nomination screening methods. For both parents and teachers, the behavioural screening methods were superior, however, the simple nomination method also showed promise for teachers. Both parents and teachers were more accurate at identifying children at risk of externalising mental health problems than children at risk of internalising problems. The performance of the FRFC and simple nomination methods in identifying children for selective interventions, before the development of significant behavioural or emotional problems, was also tested. Both the FRFC and simple nomination methods showed only modest predictive accuracy for these children. Combined, the results suggest that while on the one hand, the FRFC is useful for population level screening to inform intervention planning, on the other hand, it falls short of achieving good predictive accuracy for individual children. Future research should investigate ways to optimise predictive accuracy for individual children, particularly those at risk of developing internalising disorders. One option may be to use the FRFC in conjunction with behavioural screening methods. The challenge is to develop accurate screening methods that remain practical to complete at a population level. Finally, this body of research provides insight into the feasibility of offering selective preventive interventions within the school setting. While significant obstacles remain, there were several promising indications that using screening methods such as FRFC-T or simple nomination, teachers may be able to identify children earlier on the developmental pathway, before significant behavioural or emotional symptoms have developed.

Background: Since athletes are often perceived as unbreakable, their mental health problems might be bypassed or denigrated by their coach, peers or even by the media. However, athletes are as, if not more, susceptible to mental health problems as anyone else. As the media continues to be the primary source of information, the way in which the media portrays mental health problems can affect how people perceive and regard them. In this research, I examined how Finnish elite athletes with mental health problems are portrayed in the Finnish news websites by qualitatively analyzing eight articles of four Finnish athletes, two former and two current. Furthermore, I compared the articles with one another in order to study the eventual differences between each article’s portrayal of the athletes’ mental health problems. Method: This analysis was conducted by applying a narrative discourse schema to the selected eight articles, which enabled me to examine both the structures of the articles as well as the underlying discourses and social context. Results: Nearly all of the articles are framed from the athlete’s point of view in terms of including more citations from the athlete than comments from the journalist. Furthermore, none of the articles regarded mental health problems among athletes in general, but rather portrayed each case as a single incident. Male athletes with a depressive disorder were complimented far more compared to female athletes. Moreover, female athletes eating disorder and anxiety were often associated with appearance and pressure regarding their sports career. Conclusion: The way in which athletes with mental health problems are portrayed in the Finnish news websites can be interpreted in two ways. Firstly, they can be perceived as hopeful recovery stories from the athletes perspective, as they portray how successful athletes can also develop mental health problems and still continue their career. Secondly, by not addressing the problem as a whole nor including any factual information in any of the articles indicates the journalists lack knowledge and/or apathy about the issue, and that it is a difficult subject to portray acceptably.

Bakgrund: Personer med psykisk ohälsa har ofta även en somatisk samsjuklighet. Forskning har visat att patienter med psykisk ohälsa ofta upplever sig orättvist behandlade och missförstådda när de söker somatisk vård. Ett bra bemötande är en förutsättning för skapandet av en vårdande relation vilket utgör grunden för en god omvårdnad. Bemötandet har även betydelse för patientens hälsa, följsamhet för behandling och upplevelse av vården. Syfte: Syftet var att belysa faktorer av betydelse för bemötandet av patienter med psykisk ohälsa inom somatisk vård ur sjuksköterskans perspektiv. Metod: En litteraturstudie som baserades på 15 vetenskapliga artiklar. Såväl kvantitativa som kvalitativa artiklar inkluderades. Sökningar gjordes i databaserna PubMed och Cinahl. Resultat: I resultatet framkom att faktorer som hade betydelse för bemötandet kunde delas in i tre teman: attityder, faktorer kopplade till patientmötet och faktorer kopplade till organisation. Såväl positiva som negativa attityder till patienter med psykisk ohälsa framkom. Faktorer som kunde kopplas till patientmötet var oro och rädsla, komplex kommunikation, samt otillräcklig kompetens. Faktorer som koppades till organisationen var miljö, tid och resurser, stöd samt prioritering av somatisk vård. Slutsats: Slutsatser som kan dras av studien är att det finns ett antal olika faktorer som kan ha betydelse för bemötandet, samt att det finns utrymme för förbättringar. Viktiga förbättringsområden som framkom är sjuksköterskors attityder och kompetens. Resultatet tyder även på att organisationen inom den somatiska vården inte är anpassad för vård och bemötande av patienter med psykisk ohälsa. / Background: People with mental health problems often have a somatic comorbidity. Research shows that patients with mental health problems often experience that they are treated unfairly and being misunderstood when seeking somatic care. Good encountering is a prerequisite for the creation of a caring relationship which forms the foundation for good care. Encountering also affect the patient's health, compliance, and experience of care. Aim: The aim was to illuminate factors of significance for the encountering of patients with mental health problems in somatic care from nurse’s perspective. Method: A literature review based on 15 articles with both quantitative and qualitative design. Searches were made in the databases PubMed and Cinahl. Result: Factors of significance for encountering could be divided into three themes: attitudes, factors related to the patient meeting and factors related to organization. Both positive and negative attitudes to patients with mental health emerged. Factors related to the patient meeting were anxiety and fear, complex communication, and insufficient skills. Factors related to organization were environment, time and resources, support and prioritization of somatic care. Conclusion: Conclusions that may be drawn from this study are that several different factors may be relevant to encountering, and that there is room for improvement. Important areas of improvement that emerged are nurse´s attitudes and competence. The result also indicates that the organization within somatic care is not adapted to the care and encountering of patients with mental health problems.

Stepped care is designed to provide mental health treatment in the most effective and efficient way. It aims to provide patients with low intensity interventions in the first instance and only move onto high intensity treatments if outcome is not 'successful'. However, there is a paucity of research about how health professionals make decisions about treatment and the experiences of patients within this decision-making process. Using a multi-method approach, this study aimed to explore health professional and patient decision-making in stepped care for anxiety and depression. 24 health professional interviews from three stepped care sites were conducted, which included the completion of an active information search (AIS) think-aloud task. In addition, 14 patients were interviewed about their experiences of decision-making whilst being managed within stepped care model. Qualitative interview data was analysed using the principles of Framework analysis, while some of the data collected in the AIS think-aloud task lent itself to quantitative analysis.This study revealed that three core tensions exist when making decisions within the stepped care model. These are 1. The notion of standardisation of outcomes versus the individual needs of patients; 2. The public health orientation of stepped care versus the therapeutic orientation of health professionals and; 3. The rhetoric about patient choices versus the realities of shared decision-making in a resource-limited system.The complexity of decision-making within the stepped care model was highlighted. The success of stepped care relies on ensuring that there is an adequate workforce to deliver the intended interventions, where this is not present health professionals are faced with difficult decisions and it is clear that those most affected are the less-experienced frontline workers. Scarcity of resources impacts heavily upon the decisions that are made. This can have a substantial impact upon variability in treatment decisions and on the ability to allow for patient choice to be incorporated. Decisions that are made for a patient are influenced by the need to provide them with the treatment that they want (which may not be regarded as what they need within the stepped care model nor necessarily by the health professional) and the capacity of the service. The problem that exists with primary care mental health is that the current demands exceed capacity. Optimal patient care is, in part, traded off by the need to meet the demands of the service. Improving the flexibility of the service may be one solution to the problem and adopting a stratified/stepped care approach might help to resolve some of the tensions and help to relieve some of the capacity issues.

No description available.

No / This paper reports on the evaluation of the Enriched Opportunities Programme in improving well-being, diversity of activity, health, and staff practice in for people with dementia. Participants were 127 residents with a diagnosis of dementia or enduring mental health problems in three specialist nursing homes in the UK. A repeated measures within-subjects design was employed, collecting quantitative and qualitative data at three points over a twelve-month period in each facility with follow-up 7 to 14 months later. Two-way ANOVAs revealed a statistically significant increase in levels of observed well-being and in diversity of activity following the intervention. There was a statistically significant increase in the number of positive staff interventions but no change in the number of negative staff interventions overall. There was a significant reduction in levels of depression. No significant changes in anxiety, health status, hospitalisations, or psychotropic medication usage were observed. The Enriched Opportunities Programme demonstrated a positive impact on the lives of people with dementia in nursing homes already offering a relatively good standard of care, in a short period of time. The refined programme requires further evaluation to establish its portability.