<p>Flera studier har pekat på viktiga faktorer för att hälsa och återgång till yrkeslivet ska vara möjliga men hur detta i praktiken ska ske och vilka rehabiliteringsåtgärder som är mest effektiva är otillräckligt belagt. Studien har genom intervjuer med sju kvinnor med stressrelaterade störningar granskat hur en tillfriskningsprocess kan upplevas och vad som upplevs som meningsfull hjälp i samband med den. Deras tillfriskning har inneburit en kamp och ett starkt personligt engagemang. Beslutsamhet och målinriktning var förutsättningar för att få ta del av rehabiliteringsåtgärder. Kvinnorna i studien har upplevt ett stort personligt ansvarstagande för sin tillfriskning men de har också betonat vikten av bekräftelse från en förstående omgivning. En stor besvikelse har uttryckts gentemot Försäkringskassan och i vissa fall arbetsgivare för bristande förståelse, stöd och hjälp. Genom bland annat kampandan har kvinnorna utvecklat sin självkännedom och sin livssituation.</p> / <p>Several studies have identified factors associated with the promotion of health and return to work. But knowledge is insufficient of how this is practically done and which rehabilitation methods are most effective. This study aimed to shed light on women’s experiences of their rehabilitation process and also experiences of meaningful support associated with the process. Interviews were done with seven women with stress-related disorders whose recovery involved great efforts and a great deal of personal responsibility. The respondents’ determination was a condition for receiving the needed rehabilitation measures. They also emphasized the importance of social support and an empathetic attitude from others. Respondents expressed disappointment with the way The Swedish Social Insurance Agency and employers have handled and treated them. Through the struggles women in this study have endured, they’ve achieved personal growth and the awareness needed to change their situation of life.</p>

Flera studier har pekat på viktiga faktorer för att hälsa och återgång till yrkeslivet ska vara möjliga men hur detta i praktiken ska ske och vilka rehabiliteringsåtgärder som är mest effektiva är otillräckligt belagt. Studien har genom intervjuer med sju kvinnor med stressrelaterade störningar granskat hur en tillfriskningsprocess kan upplevas och vad som upplevs som meningsfull hjälp i samband med den. Deras tillfriskning har inneburit en kamp och ett starkt personligt engagemang. Beslutsamhet och målinriktning var förutsättningar för att få ta del av rehabiliteringsåtgärder. Kvinnorna i studien har upplevt ett stort personligt ansvarstagande för sin tillfriskning men de har också betonat vikten av bekräftelse från en förstående omgivning. En stor besvikelse har uttryckts gentemot Försäkringskassan och i vissa fall arbetsgivare för bristande förståelse, stöd och hjälp. Genom bland annat kampandan har kvinnorna utvecklat sin självkännedom och sin livssituation. / Several studies have identified factors associated with the promotion of health and return to work. But knowledge is insufficient of how this is practically done and which rehabilitation methods are most effective. This study aimed to shed light on women’s experiences of their rehabilitation process and also experiences of meaningful support associated with the process. Interviews were done with seven women with stress-related disorders whose recovery involved great efforts and a great deal of personal responsibility. The respondents’ determination was a condition for receiving the needed rehabilitation measures. They also emphasized the importance of social support and an empathetic attitude from others. Respondents expressed disappointment with the way The Swedish Social Insurance Agency and employers have handled and treated them. Through the struggles women in this study have endured, they’ve achieved personal growth and the awareness needed to change their situation of life.

It is documented that stress activates the locus coeruleus-norepinephrine system. However, there are far few reports regarding effects of stress on the expression of dopamine β-hydroxylase, a hallmark enzyme of the noradrenergic neuron. In the present study, adult Fischer 344 rats were subjected to chronic social defeat for 4 weeks. Dopamine β-hydroxylase expressional levels in the locus coeruleus and its terminal regions were measured by in situ hybridization and western blotting. The results showed that immediately following chronic social defeat there are significantly increased mRNA and protein levels of dopamine β-hydroxylase in the locus coeruleus, and dopamine β-hydroxylase protein levels in the hippocampus, frontal cortex and amygdala, compared with those in the control. This chronic social defeat-induced upregulation of dopamine β-hydroxylase was completely abolished by adrenalectomy, and/or by treatment with corticosteroid receptor antagonists, mifepristone and spironolactone, either alone or in combination. Furthermore, treatment with desipramine, an antidepressant with specific inhibitory effects on norepinephrine transport, prevented an increased dopamine β-hydroxylase expression by chronic social defeat in the locus coeruleus and its main terminal regions such as the hippocampus, frontal cortex and amygdala. However, treatment with fluoxetine, an antidepressant with specific inhibition for serotonin transport, only selectively blocked increased dopamine β-hydroxylase protein levels in the hippocampus caused by CSD. The present findings indicate that chronic social defeat activates the locus coeruleus-norepinephrine system by upregulating the expression of dopamine β-hydroxylase, which may increase norepinephrine synthesis. This chronic social defeat induced upregulation of DBH expression was mediated through corticosterone and corticosteroid receptors, with possible interference from antidepressants.

It is documented that stress activates the locus coeruleus-norepinephrine system. However, there are far few reports regarding effects of stress on the expression of dopamine β-hydroxylase, a hallmark enzyme of the noradrenergic neuron. In the present study, adult Fischer 344 rats were subjected to chronic social defeat for 4 weeks. Dopamine β-hydroxylase expressional levels in the locus coeruleus and its terminal regions were measured by in situ hybridization and western blotting. The results showed that immediately following chronic social defeat there are significantly increased mRNA and protein levels of dopamine β-hydroxylase in the locus coeruleus, and dopamine β-hydroxylase protein levels in the hippocampus, frontal cortex and amygdala, compared with those in the control. This chronic social defeat-induced upregulation of dopamine β-hydroxylase was completely abolished by adrenalectomy, and/or by treatment with corticosteroid receptor antagonists, mifepristone and spironolactone, either alone or in combination. Furthermore, treatment with desipramine, an antidepressant with specific inhibitory effects on norepinephrine transport, prevented an increased dopamine β-hydroxylase expression by chronic social defeat in the locus coeruleus and its main terminal regions such as the hippocampus, frontal cortex and amygdala. However, treatment with fluoxetine, an antidepressant with specific inhibition for serotonin transport, only selectively blocked increased dopamine β-hydroxylase protein levels in the hippocampus caused by CSD. The present findings indicate that chronic social defeat activates the locus coeruleus-norepinephrine system by upregulating the expression of dopamine β-hydroxylase, which may increase norepinephrine synthesis. This chronic social defeat induced upregulation of DBH expression was mediated through corticosterone and corticosteroid receptors, with possible interference from antidepressants.

Syftet med studien var att beskriva hur arbetsterapeuter i primärvården upplever att arbeta med unga vuxna med stressproblematik. Studien utgick ifrån kvalitativ forskningsansats bestående av semistrukturerade intervjuer. Deltagarna rekryterades med avsiktligt urval och snöbollsurval. Totalt deltog tio respondenter, samtliga befann sig på olika vårdcentraler runt om i Sverige. Materialet analyserades och tolkades av författarna och resulterade i tre huvudkategorier: Att ge patienter professionellt och känslomässigt stöd, Att skapa förståelse för aktivitetens betydelse och Att skapa förändring. Resultatet visade att arbetsterapeuter upplever att det ofta finns en obalans i aktiviteterna bland unga vuxna. Unga vuxna uppmuntras av samhällsnormer att ha många bollar i luften och har därför svårt att få återhämtande aktiviteter i sin vardag. Det resulterade i ökad stress och till slut total utmattning. Arbetsterapeuterna upplever att stressen hos unga vuxna växer på grund av obalansen i vardagen, attityder och att de har otillräckligt med strategier för att hantera stressfyllda situationer. Gruppbehandling upplevs som ett bra verktyg att skapa diskussioner kring stress och lyfta bort stigmat från stressproblematiken. Arbetsterapeuterna upplevde svårigheter vid målformuleringen då patienterna formulerade prestationsinriktade mål. Störst förändring upplevdes vara de små förändringarna i vardagen. Detta gjorde skillnad för rehabiliteringen. Slutsatsen var att känslomässigt och professionellt stöd upplevdes som viktigt. Erfarenhet visar att förståelse för aktivitetens betydelse behövs för att skapa förändring. / The aim of this study was to investigate occupational therapists, working in primary health care center, experience and perception of working with young adults with stress related disorders. The study progressed emanated from a qualitative method consisting of semi structured interviews. Participants were recruited from different health care centers, with a purposive sampling and a snowball sampling, totally ten participants participated. The material was analyzed and interpreted and resulted in three main categories: To give the patient professional and emotional support, To create understanding for the significance of activities and To create change. The results show that occupational therapists perceived that the cause of stress was imbalance in the activities of young adults. They are encouraged by societal norms to multitask and to keep busy and they have difficulties to implement recovering activities. This contributed to increased stress and finally led to exhaustion. Group treatment was perceived as a good tool to create discussions about stress and to remove the stigma from stress related disorders. The occupational therapists experienced difficulties in formulating prestige driven goals. The biggest change was perceived to be the small changes in everyday life, this made a difference for the rehabilitation. The conclusion was that emotional and professional support is important. Experience also shows that creating understanding for the significance of activities is needed to make a change.

Stressrelaterad psykisk ohälsa ökar mest och står för den längsta varaktigheten bland sjukskrivningarna. Förändringar i sjukförsäkringssystemet och beslut om att minska sjuktalen har gett konsekvenser som ökat antal avslag om sjukpenning. Syftet med studien var att undersöka erfarenheter av avslag om sjukpenning från Försäkringskassan hos personer med stressrelaterad psykisk ohälsa för att beskriva och förstå vad det får för betydelse för deras sjukdomsbild och återhämtning. Studien är kvalitativ och har genomförts genom semistrukturerade intervjuer med fem personer som drabbats av stressrelaterad psykisk ohälsa och fått avslag om sjukpenning från Försäkringskassan. Materialet som samlats genom intervjuerna har analyserats med Ulrich Becks teorin om risksamhället och Randall Collins teori om symboliska interaktionskedjor samt tidigare forskning. Resultatet i studien indikerar att avslag om sjukpenning påverkar sjukdomsbilden och möjligheten till återhämtning negativt för personer som drabbats av stressrelaterad psykisk ohälsa. Respondenterna upplevde att avslaget förlängt sjukdomstiden, genom minskad möjlighet till återhämtning och förvärrad sjukdomsbild. Resultatet visar även på en samlad bild av upplevelsen av avslaget om sjukpenning från Försäkringskassan. Personerna upplever inte att handläggare på Försäkringskassan tror dem och därmed känner de sig kränkta. / Stress-related disorders have increased and accounts for the longest duration of sick leave. Changes in the health insurance system and decisions to reduce the sick-leave have had consequences such as an increased number of rejection of sickness benefits. The aim of this study was to investigate the experience for people having a stress-related disorder and being rejected sickness benefits from the Social Insurance Fund, to describe and understand the importance for their disease image and recovery. The study is qualitative and has been conducted through semistructured interviews with five participants who suffered from stress-related disorders and received a refusal of sickness benefits from the Social Insurance Fund. The material gathered through the interviews has been analyzed with Ulrich Beck’s theory of risk society and Randall Collin’s theory of symbolic interaction-chains and previous research. The result of this study indicates that the refusal of sickness benefits affects the recovery rate negatively for the participants in the study. The participants felt that the refusal extended the disease time, and they experienced reduced opportunities to recover and a worse diseases image. The result also shows a consistent picture of the experience of receiving a refusal of sickness benefits from the Swedish Social Insurance Agency. The participants do not feel that the case officers at the Social Security Fund believe them and thus they feel offended.

The aim of this study has been to explore how social workers in a Swedish context, who have been on sick leave due to burnout or other stress-related disorders, perceive their occupational role compared to the time before the disorder. The primary focus has been how the social workers view their occupational role after the experience of being on sick leave due to the disorder and if the experience have taught the social workers things they find valuable in their occupational role. This study is based on six interviews with social workers who have the requested experience and have been back to work for at least six months. The theoretical framework used to analyse the results consists of Sense of Coherence (Antonovsky, 2005) and concepts of coping (Lazarus and Folkman, 1984). This study concludes that the social workers differentiates the view and approach towards the occupational role. The social workers do not perceive that they have a changed view of the occupational role, but their approach to the occupational role seems to be different. The experience have also taught them useful things that they practice in their occupational role and advise other social workers to also practice these wisdoms.

Le chien de service (CS) émerge comme modalité d’assistance à la gestion des symptômes reliés au trouble de stress post-traumatique (TSPT) auprès des vétérans. Les tâches qu’il accomplit et les changements qu’il induit sur l’activité physique et le sommeil, deux des habitudes de vie perturbées par le TSPT, demeurent peu étudiés à ce jour. Les objectifs spécifiques de cette thèse étaient de : 1) spécifier les rôles et les tâches accomplis par le CSTSPT, les avantages et les obstacles reliés à son utilisation ainsi que les recommandations souhaitables pour améliorer l’efficacité du CSTSPT, 2) décrire la sédentarité, l’activité physique, et le sommeil avant et après l’acquisition d’un CSTSPT à l’aide de l’actigraphie et de questionnaires standardisés et examiner si les changements post-acquisition s’accompagnaient d’un élargissement des aires de déplacement et d’une diminution de l’intensité des symptômes reliés au TSPT et ceux dépressifs, et 3) explorer s’il y a des associations entre la sédentarité, l’activité physique, et l’intensité des symptômes reliés au TSPT et ceux dépressifs avant l’acquisition d’un CSTSPT, ainsi qu’entre les changements de la sédentarité, l’activité physique, et le sommeil, avant et après l’acquisition d’un CSTSPT auprès de vétérans vivant avec un TSPT chronique. Ces objectifs ont été poursuivis à l’aide : d’une étude de cas exploratoire transversale réalisée auprès de 10 vétérans experts utilisant leur CSTSPT depuis deux à quatre ans (objectif/étude 1), une étude exploratoire prépost intervention sans groupe contrôle complétée par 18 vétérans vivant avec un TSPT chronique (objectif/étude 2), et d’une étude corrélationnelle réalisée auprès 27 vétérans vivant un TSPT chronique (objectif/étude 3). Les résultats de l’étude 1 soutiennent que le CSTSPT accomplit plusieurs rôles (p. ex., détecter les symptômes intrusifs) et tâches (p. ex., réveiller le vétéran lors d’un cauchemar), et qu’il procure plusieurs avantages (p. ex. faciliter la gestion des symptômes), malgré la présence d’obstacles (p. ex. coûts reliés à son utilisation). Les constats rapportés supportent l’émission de recommandations (p. ex. création d’un programme national de CSTSPT) afin d’améliorer son utilisation. Les résultats de l’étude 2 indiquent que l’acquisition d’un CSTSPT améliore le pourcentage de temps quotidien d’éveil dédié à réaliser de l’activité physique d’intensité modérée, le nombre de pas réalisés par jour, l’étendue des aires de déplacement (c.-à-d., voisinage et extérieur de la ville), et l’intensité des symptômes reliés au TSPT et ceux dépressifs. Aucune amélioration significative n’a été observée pour le sommeil mesuré par actigraphie, alors que les résultats Pittsburgh Sleep Quality Index indiquent une amélioration de la qualité du sommeil et de l’efficacité du sommeil, ainsi qu’une diminution des perturbations du sommeil. Les résultats de l’étude 3 révèlent des associations faibles et modérées qui suggèrent la présence d’effets synergiques entre l’activité physique, le sommeil et les symptômes associés au TSPT et ceux dépressifs. En conclusion, les résultats confirment que le CSTSPT représente une modalité d’assistance prometteuse pour la gestion des symptômes reliés au trouble de stress post-traumatique (TSPT). / The psychiatric service dog (SDPTSD) is emerging as an assistive modality for the management of symptoms associated with post-traumatic stress disorder (PTSD) among veterans. The scientific evidence pertaining to the tasks the SDPTSD accomplishes and the changes brought about its acquiring on physical activity and sleep, two of the life habits perturbed by PTSD, remain limited. The specific objectives of this thesis were thus to: 1) specify the roles and tasks accomplished by the SDPTSD, the advantages and obstacles associated to its use, and recommendations to increase its efficacy, 2) describe sedentariness, physical activity, and sleep before and after the acquiring of a SDPTSD using actigraphy and standardized questionnaires and examining if the changes reported following its acquiring were accompanied by an expansion of mobility areas and a diminution of the intensity of PTSD-related and depressive symptoms, and 3) explore the associations between 1) sedentariness, physical activity, and the intensity of PTSD-related and depressive symptoms, and 2) sedentariness, physical activity, and sleep three months before and nine months after the acquiring of a SDPTSD among veterans living with chronic PTSD. These specific objectives were carried out with an exploratory cross-sectional case study realized among 10 expert veterans who had been using their SDPTSD for two to four years (objective/study 1), a prepost intervention exploratory study without a control group realized among 18 veterans living with chronic PTSD (objective/study 2), and a correlational study realized among 27 veterans living with chronic PTSD (objective/study 3). In brief, the results of study 1 showed that the SDPTSD accomplishes several roles (e.g., detecting intrusive symptoms), and tasks (e.g., awakening the veteran during a nightmare), and that it brings several advantages (e.g., facilitating symptom management), despite obstacles (e.g., cost related to its use). Observations gathered in this study support issuance of recommendations (e.g., creating a national SDPTSD program) to improve its use. The results of study 2 suggest that the acquiring of a SDPTSD improves the percentage of daily awake time dedicated to practising physical activity of moderate intensity, the number of steps per day, mobility areas (neighborhood and outside of town), and the intensity of PTSD-related and depressive symptoms. No significative improvements emerged when considering actigraphic sleep results, although results at the Pittsburgh Sleep Quality Index revealed an improved sleep quality and efficiency and a diminution of sleep perturbations. The results of study 3 uncovered weak and moderate correlations suggesting the presence of synergic effects between physical activity, sleep and the intensity of PTSD-related and depressive symptoms. In conclusion, these encouraging results confirm that the SDPTSD is a promising assistive aid in the management of PTSD-related symptoms.