Sense of Belonging and Hope in the Lives of Persons with Schizophrenia

The experience of loneliness among people with psychosis: Qualitative meta-synthesis

BACKGROUND

Loneliness can be a significant challenge for people living with psychosis. We currently lack evidence about how to help with this. Understanding the origins, experience, and impact of loneliness in this group is helpful in developing strategies to reduce it. We therefore aimed to conduct a meta-synthesis of the qualitative literature exploring the nature of loneliness, and the factors contributing to the development and maintenance of loneliness, among people living with psychosis.

METHODS

We searched four electronic databases (MEDLINE, Embase, PsycINFO and Web of Science) for studies meeting pre-defined eligibility criteria. We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, and appraised the quality of each eligible study using the Critical Appraisal Skills Programme (CASP) checklist. We conducted thematic synthesis to combine the included qualitative findings to generate key overarching themes.

RESULTS

We included 41 articles and our analysis generated six meta-themes: (1) loneliness in the form of disconnection, (2) a rejecting and stigmatising external world, (3) loneliness and acute psychotic episodes and symptoms, (4) thwarted longing for connection, (5) paradoxes of loneliness and psychosis, and (6) well-being embedded in the social world. Our findings suggest a vicious cycle in which loneliness, psychosis and social withdrawal can be mutually reinforcing. Reciprocity of and continuity in relationships were valued by those with psychosis, while self-stigma and experiences of rejection appeared to exacerbate loneliness and impede recovery.

CONCLUSION

Our meta-synthesis offers insights into how people living with psychosis are affected by loneliness. Tailored interventions are needed, which should focus on supporting people in overcoming internal barriers to connection and low self-esteem, challenging stigma and self-stigma, and linking people to social support according to needs and preferences.

Sex differences in loneliness, social isolation, and their impact on psychiatric symptoms and cognitive functioning in schizophrenia

BACKGROUND

Social isolation and loneliness, objective and subjective features of dysfunctional social relationships, are more prevalent in patients with schizophrenia (SCZ) than in the general population. This study aimed to explore sex differences in loneliness and social isolation among Chinese chronic SCZ patients, and to investigate their relationships with psychiatric symptoms and cognitive functioning.

METHODS

A total of 323 SCZ patients, comprising 136 males and 187 females, were recruited. Psychopathology, cognitive functioning, loneliness, social isolation were assessed using the Positive and Negative Syndrome Scale (PANSS), the Repeated Battery for Assessment of Neuropsychological Status (RBANS), the UCLA (University of California, Los Angeles) Loneliness Scale (Version 3) and the Social Isolation Index (ISI). Multiple linear regression models were conducted to test the independent, relative, and synergistic efects of loneliness and social isolation on psychiatric symptoms and cognitive performance for male and female patients separately.

RESULTS

Male patients exhibited higher UCLA loneliness scale scores and social isolation scores compared to female patients (ps < 0.05). In male patients, both loneliness and social isolation significantly predicted PANSS total scores (ps< 0.01), negative subscale scores (ps < 0.05) and general psychopathology subscale scores (ps < 0.05). For female patients, loneliness (not social isolation) significantly predicted immediate memory (p < 0.001), language (p = 0.013), delayed memory (p = 0.017), and RBANS total scores (p = 0.002). Further examination of loneliness components in female patients revealed that personal feelings of isolation were negatively associated with language (r = -0.21, p = 0.001) and a negative correlation exists between lack of collective connectedness and delayed memory (r = -0.19, p = 0.048).

CONCLUSION

Loneliness and social isolation are more pronounced in male SCZ patients than in female patients. Both loneliness and social isolation are positively related to psychiatric symptoms in male patients, while loneliness is negatively associated with cognitive functioning in female patients.

How individuals with psychosis develop and maintain resilience to suicidal experiences through psychological therapy: a qualitative study

BACKGROUND

Almost half of people with psychosis have suicidal experiences. There is limited understanding of the processes underpinning psychological resilience to psychotic and suicidal experiences especially in people who have engaged with psychological talking therapies. Hence, the current study aimed to redress this gap by examining the perspectives of clients who had recent lived-experiences of psychosis, suicidality, and psychological therapy.

METHODS

Semi-structured interviews were conducted with 35 participants who had psychosis and suicidal experiences in the three months prior to recruitment. Data were analysed using reflexive thematic analysis.

RESULTS

There were four key psychological processes that contributed to resilience: (1) gaining a sense of control by nullifying perceptions of being controlled by overwhelming emotional and psychotic experiences, and instead, acquiring confident autonomy; (2) gaining a sense of hope facilitated by experiencing mental health problems on a fluctuating continuum, translating immersive positive memories into future possibilities, and embracing meaningful personal values; (3) developing genuine self-worth based on compassionate self-understanding, and affirmation of personal qualities; and (4) finding acceptance by being able to live alongside psychotic and suicidal experiences. Specific resilience components that participants developed through psychological therapy, together with their own knowledge and observations, were identified.

CONCLUSIONS

People who live with psychotic and suicidal experiences can, and do, experience psychological change and psychological resilience in response to psychological therapy. To promote resilience, practitioners should pursue a person-based, client-directed approach; embrace acceptance; and be open to exploring different ways of working with clients' experiences of overwhelming thoughts and emotions.

An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: An integrative review

WHAT IS KNOWN ON THE SUBJECT?: There is evidence that social isolation and loneliness is more prevalent in people living with mental illness than in the general population. People living with mental illness frequently experience stigma, discrimination, rejection, repeated psychiatric admissions, low self-esteem, low self-efficacy, and increased symptoms of paranoia, depression, and anxiety. There is evidence of common interventions that can be used to improve loneliness and social isolation such as psychosocial skills training and cognitive group therapy. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper offers a comprehensive assessment of the evidence between mental illness, loneliness, and recovery. The results suggest that people living with mental illness experience elevated levels of social isolation and loneliness leading to poor recovery and quality of life. Social deprivation, social integration and romantic loneliness are related to loneliness, poor recovery, and reduced quality of life. A sense of belonging, ability to trust and hope are important aspects of improved loneliness, quality of life and recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The existing culture in mental health nursing practice needs to be examined to address loneliness in people living with mental illness and its impact on recovery. Existing tools to research loneliness do not consider dimensions in loneliness experience as reflected in the literature. Practice needs to demonstrate an integrated approach to recovery, optimal service delivery and augmentation of evidence-based clinical practice to improve individual's loneliness, social circumstances, and relationships. Practice needs to demonstrate nursing knowledge in caring for people living with mental illness experiencing loneliness. Further longitudinal research is required to clearly understand the relationship between loneliness, mental illness, and recovery.

ABSTRACT

INTRODUCTION: To our knowledge, there are no previous reviews on the impact of loneliness experienced by people aged 18-65, who are living with mental illness and their recovery experience.

AIM/QUESTION

To explore the experience and impact of loneliness in people living with mental illness during recovery.

METHOD

An integrative review.

RESULTS

A total of 17 papers met the inclusion criteria. The search was conducted using four electronic databases: MEDLINE, CINAHL, Scopus and PsycINFO. Across these 17 papers, participants were most commonly, diagnosed with schizophrenia or psychotic disorders and recruited from community mental health services.

DISCUSSION

The review revealed loneliness to be substantial in people living with mental illness and that loneliness affected their recovery, and their quality of life. The review identified many factors that contribute to loneliness including unemployment, financial strain, social deprivation, group housing, internalized stigma and mental illness symptoms. Individual factors such as social/community integration and social network size as well as an inability to trust, a sense of not belonging, hopelessness and lack of romance were also evident. Interventions targeting social functioning skills and social connectedness were found to improve social isolation and loneliness.

IMPLICATIONS FOR PRACTICE

It is vital for mental health nursing practice to employ an approach integrating physical health as well as social recovery needs, optimal service delivery and augmentation of evidence-based clinical practice to improve loneliness, recovery, and quality of life.

Validity and Reliability of Turkish version of the Schizophrenia Hope Scale

This study aimed to evaluate the validity and reliability of the Turkish version of the Schizophrenia Hope Scale (SHS). This methodological study was carried out with 214 participants diagnosed with schizophrenia who were followed up in the psychiatry outpatient clinics of a university hospital between August 2021 and August 2022. Data were collected using an Information Form and the Schizophrenia Hope Scale (SHS). Language and content validity, exploratory and confirmatory factor analyses, item-total correlation, Cronbach alpha coefficient, and test-retest reliability methods were used in the validity and reliability analysis of the scale. As a result of the exploratory factor analysis, no item was excluded from the scale and it was determined that the scale has nine items and a single-factor structure. The single-factor structure of the scale was confirmed with the confirmatory factor analysis. The Cronbach Alpha coefficient of the scale was 0.901 and the factor loads ranged between 0.70 and 1.0. The test-retest correlation coefficient was r=0.959. The Turkish version of the scale was found to be valid and reliable. SCH is important since it represents the subjective meaning of hope from schizophrenic patients’ perspective and allows an easier measurement of the level of hope in this population. Mental health professionals can use SHS to determine or increase the level of hope of schizophrenia patients in their studies.

Depression Mediates the Relationships between Hallucinations, Delusions, and Social Isolation in First-Episode Psychosis

Social isolation is common among individuals with schizophrenia spectrum and other psychotic disorders. Research indicates that social isolation relates to poorer mental health outcomes, depression, and negative symptoms, with less known about its relationship with positive symptoms. This study examined depression as a mediator in the relationships between positive symptoms (i.e., hallucinations and delusions) and social isolation among an early treatment phase sample in the United States. Data were obtained from the Recovery After an Initial Schizophrenia Episode project of the National Institute of Mental Health's Early Treatment Program. Participants (N = 404) included adults between ages 15 and 40 in a first episode of psychosis. Data were analyzed using structural equation modeling in Mplus (Version 8). The study showed that delusions (b = .095, SE = 0.04, p < .05) and hallucinations (b = .076, SE = 0.03, p < .01) were directly related to depression, and that both delusions (b = .129, SE = 0.06, p < .05) and depression (b = .254, SE = 0.09, p < .05) were directly related to social isolation. Findings of this study determined that depression functioned as a mediator in the relationships between positive symptoms and social isolation. Targeting psychosis symptomatology and depression in treatment, improving social skills and social support networks, and considering the role of stigma in social isolation are of great importance in the prevention of poorer mental health outcomes.

Relatives' experiences of an equine-assisted intervention for people with psychotic disorders

PURPOSE

The aim of this study was to describe relatives' experiences of an equine-assisted intervention for people with psychotic disorders.

METHODS

The study has a qualitative and descriptive design. Ten semi-structured interviews were performed with relatives of people with a psychotic disorder who had participated in an equine-assisted intervention. A conventional content analysis was used to analyse the data.

RESULT

The overall category "Being with the horses strengthens health capabilities" summarizes the four identified subcategories "The horses contribute to a context with a common focus", "Interaction with the horses enhances self-confidence and motivation", "The interplay with the horses nurtures positive emotions" and "Being with the horses encourages physical activity".

CONCLUSIONS

The result of this study contributes to the growing body of research about the potential outcomes of equine-assisted interventions. The result also indicates that equine-assisted interventions may improve health capabilities among people with psychotic disorders. The generated knowledge may be useful in mental health services when developing equine-assisted interventions.

Experiences of digital exclusion and the impact on health in people living with severe mental illness

Background

The covid-19 pandemic has accelerated the use of digital tools within health and social care services. However, for a range of different reasons, across the UK there continue to be people who are digitally excluded. People living with a disability have been identified as being more likely to be digitally excluded and many of these people, including people with severe mental illness (SMI) already experience health inequalities. Therefore, understanding the perceived impact digital exclusion has on health and potential facilitators of increased inclusion is an important area for research. This study had two aims: 1. To understand experiences of digital exclusion and the impact on health in people with SMI. 2. To explore the influences and mechanisms which would increase engagement with digital health tools.

Methods

This was an observational qualitative study, conducting focus groups (with the option of a 1:1 interview for those uncomfortable in groups) with nine people with severe mental illness.

Results

Participant’s responses were themed in to four key areas in relation to digital exclusion and impact on health: 1. Reduced social connectedness, 2. The impact on wider determinants of health 3. Negative perception of self, 4. Disempowerment. Key facilitators for increased engagement with digital tools included, local digital skills support with mental health lived experience involvement in the delivery, digitally engaged social referents, access to digital tools and data, personalised and straightforward digital tools. In addition, increasing health and social care staff’s awareness of digital exclusion was also viewed as important in promoting inclusion.

Conclusion

The research findings suggest that digital inclusion should be viewed as a wider determinant of health. Many of the identified consequences of exclusion are particularly important in relation to mental health and mental health recovery. This research suggests that identifying and addressing digital exclusion should be viewed as a priority for mental health services.

Investigation of the relationship between the negative automatic thoughts of patients with schizophrenia and their levels of social functionality

AIM

This study was carried out to investigate the relationship between the negative automatic thoughts of patients with schizophrenia and their levels of social functionality.

DESIGN AND METHODS

This cross-sectional study was conducted 142 patients with schizophrenia. The data were collected using the Personal Information Form, Negative Automatic Thoughts Questionnaire (NATQ) and Social Functioning Assessment Scale (SFAS).

FINDINGS

There was a strong negative correlation between the mean scores obtained from the overall NATQ and SFAS. In addition, negative automatic thoughts of the patients with schizophrenia had a negative effect of 47.2% on their social functionality.

PRACTICE IMPLICATIONS

It was found that the patients had moderate levels negative automatic thoughts and social functionality; and that their negative automatic thoughts affected their social functionality negatively.

"Why I stay in community psychiatric rehabilitation": a semi-structured survey in persons with schizophrenia

AIMS

Although community psychiatric rehabilitation plays an important role in returning persons with schizophrenia to the society, many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study is aimed to explore the underlying causes of this trend and identify possible solutions.

METHODS

This study used a qualitative descriptive design to examine the persons with schizophrenia who stay in rehabilitation centers for longer periods of time. The researchers conducted semi-structured telephone interviews with the patients recruited through purposeful sampling. The audio-recorded interviews were transcribed in transcripts in Chinese. Thematic analysis was performed using Colaizzi's 7-step method.

RESULTS

Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.

CONCLUSIONS

Persons with schizophrenia with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

The experience of psychosis and recovery from consumers' perspectives: An integrative literature review

WHAT IS KNOWN ON THE SUBJECT?: Since the first decade of this century, few qualitative studies and literature reviews have reported consumers' experiences of psychosis and recovery. The findings from these studies need further exploration. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: New insights into consumers' experiences of psychosis were generated. Additionally, understanding of consumers' conceptions and experiences of recovery were reported. Consumers' insights into the enablers and barriers to recovery that they encountered were also identified. Gaps in the literature remain, particularly those related to the effects of gender and culture on consumers' experiences of and recovery from psychosis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses' understanding of consumers' perspectives and experiences of psychosis is vital to enhancing the quality of mental health nursing when caring for people living with psychosis. To support user-based recovery, mental health nurses need to incorporate person-centred approaches and reduce their preferencing of medical understandings of recovery.

ABSTRACT

INTRODUCTION: Psychosis is a distressing disorder. Consumers' perspectives about their experiences of psychosis and recovery are essential aspects of mental health nursing.

AIMS

To review contemporary evidence related to consumers' experiences of and recovery from psychosis.

METHOD

An integrative review was the method used; six databases were systematically searched. Of the 157 articles screened, 14 met the inclusion criteria and were assessed for quality using Joanna Briggs Institute Appraisal tools. Data were compared, classified and integrated.

RESULTS

Findings revealed that consumers' experiences of psychosis included issues with self-expression and language, psychosocial problems and stigma. Also, consumers' experiences associated with their recovery were reported, and this included their perspectives on the enablers and barriers that they encountered.

DISCUSSION

Consumer's experiences of and recovery from psychosis provide an essential basis for managing and working with people experiencing psychosis. Further research identifying the potential effects of gender and culture into consumers' lived experiences is required.

IMPLICATIONS FOR PRACTICE

Exploring the experience of someone with psychosis will help nurses to understand the impacts of this condition. This understanding can guide nurses to apply recovery-oriented practices. Specific aspects of psychosis experience, including gender and culture, should inform nurses' practices towards recovery.

“Suffering as a Lifelong Companion: A Phenomenological-Hermeneutic Study of Men Living With Severe Psychiatric Illness”Lidelse som livslang følgesvenn: En fenomenologisk-hermeneutisk studie av menn som lever med alvorlig psykiatrisk sykdom

Accumulation of suffering in later life due to severe psychiatric illness has received surprisingly little interest in nursing research. Suffering in daily living seems to be more demanding for men, a phenomenon still debated in the literature. This phenomenological-hermeneutic study aims at describing and interpreting the perspectives of adult men and their experiences of suffering in daily living with severe psychiatric illness, diagnosed as schizophrenia. Data were collected in dialogical conversations with four men aged between 20 and 40 years, living alone in northern Norway. The themes created from the structural understanding illuminate the participants’ suffering as simultaneously struggling against the grasp of the illness and for reshaping the future. The theoretical interpretation unfolds the multidimensionality of their suffering and the need for confirmation of the suffering and reconciliation with the losses from illness, thus making reorientation to the future possible.

Effects of Rehabilitation Models on Self-Stigma among Persons with Mental Illness

Social stigma is inevitable for mentally ill patients, but how patients treat themselves is a priority for rehabilitation and an important buffer mechanism. This study thus aimed to measure the effectiveness of rehabilitation models for improving self-stigma. This quasi-experimental research design applied purposeful sampling. The participants (n = 250) were persons with mental illness who received rehabilitation treatment in central Taiwan. They were divided into community- (n = 170) and institution-based (n = 80) rehabilitation groups. The Internalized Stigma of Mental Illness Scale was evaluated at the time of recruitment, and a follow-up was conducted after 1 and 3 months. A generalized estimation equation was used in data analysis to measure whether self-stigma improved with the rehabilitation model and time, and to test the effect of different rehabilitation models on participants’ self-stigma improvement. The study found that the self-stigma of patients receiving CBR improved more than that of those receiving IBR when behavioral problems, education, OT level, sex, and first-time self-stigma were controlled. Returning to the community is the goal of rehabilitation for patients with mental illness, but IBR still dominates the rehabilitation model in Taiwan. Thus, it is necessary to continue promoting CBR plans for future mental health policies.

The effect of nursing interventions to instill hope on the internalized stigma, hope, and quality of life levels in patients With schizophrenia

PURPOSE

This study was conducted to determine the effect of nursing interventions to instill hope on the internalized stigma, hope, and quality of life.

METHODS

The study was conducted as a quasi-experimental study with the experimental and control groups and repeated measurements. The data were collected using the Personal Information Form, Internalized Stigma Scale in Mental Illnesses (ISMI), Herth Hope Index (HHS), and Quality of Life Scale (QLS) for schizophrenia patients.

RESULTS

The difference between ISMI, HHS, and QLS posttest and follow-up test average scores was found to be statistically significant between the experimental and control groups.

CONCLUSION

It was determined that nursing interventions aimed at improving hope effectively decreased the internalized stigmatization level of patients with schizophrenia and increased hope and life quality levels.

A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis

PURPOSE

Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery).

METHODS

Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full 'functional recovery criteria' (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups.

RESULTS

Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group.

CONCLUSION

Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients

This study was conducted to determine the effect of psychoeducation based on motivational interview techniques on medication adherence, hope, and psychological well-being in schizophrenia patients. There are many studies using Motivational Interviewing for individuals with schizophrenia. However, there are no studies on whether the concept of "adherence to treatment," which is clearly shown to be corrected with 6 to 8 weeks of motivational interviewing, will positively affect concepts such as "hope and well-being," which require longer interventions, in a shorter time. In this context, there are not enough studies in which motivational interviewing techniques are integrated into psychoeducational interventions that can be organized with more individuals. The study was conducted with a pretest-posttest control group design. The sample size of the study was determined as 150 schizophrenia patients including 75 in the experimental group and 75 in the control group based on power analysis. The researcher provided the patients in the experimental group with a six-session psychoeducation program based on motivational interview techniques. A "Descriptive Characteristics Form," the "Herth Hope Index," the "Morisky Medication Adherence Scale," and the "Psychological Well-Being Scale" were used to collect the data. In the study, psychoeducation based on motivational interview techniques created a statistically significant difference in the medication adherence, hope and psychological well-being levels of the patients in the experimental and control groups (p < .05). Psychoeducation based on motivational interview techniques provided for schizophrenia patients was found to be effective in enhancing their medication adherence, hope, and psychological well-being levels.

Experiences and perceptions of people living with schizophrenia in Japan: A qualitative study

This descriptive study used a qualitative inductive approach to investigate the subjective experiences and perceptions of people with schizophrenia living in the community during times of difficulty and how they coped. We conducted semi-structured interviews with nine community-dwelling people with schizophrenia and used the KJ method developed by Kawakita Jiro to structure the data obtained. We identified 10 symbols with his method: bewilderment at the onset; helplessness and longing for death; solitude linked to death; precarious daily life; relationships at risk; fear of being stigmatized; pillars of emotional support; will to overcome; hope to never give up; and living with the illness. The results suggest that community mental health nurses should provide support so their patients can continue to have pillars of emotional support and the will to overcome difficulties, as well as continue to use their coping methods, even when experiencing many difficulties. It is important that nurses understand and share in their patients' difficult experiences and hopes when providing support toward their recovery.

Why We Come: Clubhouse Members Seek Connection, Purpose and Meaning

Approximately 4.5% of U.S. adults live with a serious mental illness (SMI) (Substance Abuse and Mental Health Services Administration, 2018). Creating a place for people seeking structure, connection, and purpose following psychiatric hospitalization or for mental health recovery is difficult given several factors associated with illness trajectories, lack of community-based support programs, and reliance on traditional models of care. Using semi-structured interviews, the current study examined the reasons people attend community programs referred to as psychosocial "clubhouses." Interviews with 140 people across 10 clubhouse programs in one state were conducted. Qualitative analyses revealed that social connections and the need to reduce social isolation were driving forces for attending. Further, individuals noted that the "structure" of engaging in meaningful activities and roles was a main reason for participating. Authors discuss the continued need for community models that provide a "place" for all people to successfully engage and recover from psychiatric illnesses.

Feasibility of the Schizophrenia Hope Scale-9: A Psychometric Study

Hope is essential in rehabilitating persons with schizophrenia, though scales to measure hope are not appropriate for this population. The purpose of this cross-sectional study was to identify the psychometric properties of the Schizophrenia Hope Scale-9 (SHS-9) using data from 83 people with schizophrenia in four mental health centers and 762 healthy persons from two universities in South Korea. The total SHS-9 score is calculated by adding all items’ scores and ranges from 0 to 18. The mean (standard deviation) SHS-9 score of the participants with schizophrenia and healthy participants was 11.53 (SD = 4.78) and 14.78 (SD = 3.19), respectively. Lower scores indicate a lower level of hope. The Cronbach’s alpha coefficient was 0.92 with a four-week test-retest reliability of 0.89. Criterion-related construct validity was established by examining the correlation between the SHS-9 and the State-Trait Hope Inventory scores. Divergent validity was identified through a negative relationship of SHS-9 with the Beck Hopelessness Scale. In persons with schizophrenia and healthy college students, Bartlett’s test of sphericity yielded χ² = 465.03 (p < 0.001) and χ2 = 2679.24 (p < 0.001) respectively. The values of the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy were 0.89 and 0.90, respectively. The construct validity of the SHS-9 was confirmed through principal component analysis with extraction methods, which resulted in a one-factor solution, accounting for 61.83% of the total item variance. This study provides evidence for the validity and reliability of the SHS-9; therefore, it could be used to study the relationships between hope and other variables (e.g., depression and recovery) in persons with schizophrenia and measure the effect of psychosocial interventions on their hope.

Giving a voice to patient experiences through the insights of pragmatism

As a philosophical position, pragmatism can be critiqued to distinguish truth only with methods that bring about desired results, predominantly with scientific enquiry. The article hopes to dismiss this oversimplification and propose that within mental health nursing, enquiry enlightened by pragmatism can be anchored to methods helping to tackle genuine human problems. Whilst pragmatists suggest one reality exists, fluctuating experiences and shifting beliefs about the world can inhabit within; hence, pragmatists propose reality has the potential to change. Moreover, pragmatism includes being cognisant of what works to whom reality concerns, making reality context-driven, with a view to understand how actions shape experiences so what is generated has usefulness. Hence, it somewhat follows pragmatism can inform mental health nursing, after all, nursing is a discipline of action, and awareness is needed in how actions produce experiences that patients find helpful. Given the principles of recovery are preferably adopted in mental health care, the paper will explore how pragmatism can help nurses move towards that goal; specifically, with patients voicing their experiences. This is because like pragmatism, recovery subscribes to hope that reality can progress, and through meaningful experiences and beliefs, patients have expertise about personal difficulties alongside how life may flourish, despite mental illness.

Hope and belonging in patients with schizophrenia: A phenomenological study

PURPOSE

The aim of this study was to examine in depth the senses of hope and belonging in patients with schizophrenia and factors which affect these.

DESIGN AND METHODS

The data were collected through the phenomenological interview method and interpreted using Strauss and Corbin's approach to qualitative data analysis.

FINDINGS

Patients with schizophrenia reported that having hope and feeling a sense of belonging were very important to them and patients with the same diagnosis, and that being accepted by society, being employed and being productive increased their senses of both hope and belonging.

PRACTICE IMPLICATIONS

For the rehabilitation of patients with schizophrenia, which is a chronic disease, psychiatric nurses should carry out activities which increase their senses of hope and belonging.

Barriers to belonging: the need for relatedness amongst people living with severe asthma

BACKGROUND

Severe asthma, that is, asthma that is relatively refractory to conventional therapy, affects 3-10% of the asthma population. It is associated with a significant burden affecting social and working life. Supporting the need for relatedness facilitates health behavior change and improves overall well-being. However, this has not been closely examined from the patients' perspective. This study examines relatedness in patients' narratives about their experiences of living with and managing severe asthma.

METHODS

Rigorous and systematic qualitative research methods were used to conduct in-depth semi-structured interviews. Participants were included if they were ≥18 years old and diagnosed with severe asthma. Interviews were video and/or audio recorded, transcribed, and analyzed inductively and deductively informed by the self-determination theory construct of relatedness. Thirty-eight face-to-face interviews, lasting 1.5 - 4 hours, were conducted around Australia.

RESULTS

Our findings show that living with a debilitating and unpredictable illness challenged participants' sense of relatedness. Two themes emerged: 1) the desire to be understood: feeling isolated and 2) the desire to be accepted: 'I'm supposed to be like everybody else'. For people living with severe asthma, feeling cared for, understood, connected to others and having a sense of belonging was valued. Their overall psychological well-being was dependent upon their sense of connection to others.

CONCLUSION

Future research should consider our findings of the challenges faced to preserve their sense of relatedness, when developing and implementing patient-driven self-management interventions for those living with severe asthma.

Inception of a Peer-Run Wellness Center at a State Psychiatric Hospital

Peer-run wellness centers provide safe places in the community for individuals with psychiatric disorders to develop personal and community supports, feel needed, and be accepted and grow. Until now, these centers have existed only in the community, not in the state hospital setting. The current article chronicles the development of what the authors believe is the first peer-run wellness center on the grounds of a state psychiatric hospital. After 8 years of operation, the center has served hundreds of visitors. In that time, centers have opened in the state's other state hospitals and contributed to peer presence in the hospitals' units and treatment malls. The benefits of peer-run wellness centers are important in the hospital setting as well as the community. Despite institutional barriers, the center was able to address the needs of hospitalized individuals while informing a more recovery-oriented inpatient culture. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 31-35.].

Ethical and methodological issues in qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions: a critical review

Undertaking research studies in the field of mental health is essential in mental health nursing. Qualitative research methodologies enable human experiences to become visible and recognize the importance of lived experiences. This paper argues that involving people with schizophrenia in research is critical to promote their health and well-being. The quality of qualitative research needs scrutinizing according to methodological issues such as trustworthiness and ethical standards that are a fundamental part of qualitative research and nursing curricula. The aim of this study was to critically review recent qualitative studies involving people with severe and persistent mental illness such as schizophrenia and other psychotic conditions, regarding descriptions of ethical and methodological issues in data collection and analysis. A search for relevant papers was conducted in three electronic databases, in December 2016. Fifteen qualitative interview studies were included and reviewed regarding methodological issues related to ethics, and data collection and analysis. The results revealed insufficient descriptions of methodology regarding ethical considerations and issues related to recruitment and sampling in qualitative interview studies with individuals with severe mental illness, putting trustworthiness at risk despite detailed descriptions of data analysis. Knowledge from the perspective of individuals with their own experience of mental illness is essential. Issues regarding sampling and trustworthiness in qualitative studies involving people with severe mental illness are vital to counteract the stigmatization of mental illness.

Encerrado a oscuras: significado de vivir con esquizofrenia para diagnosticados y sus cuidadores, Medellín-Colombia

Vivir con esquizofrenia representa un enigma para todas aquellas personas que no presentan la enfermedad o conviven con alguien que la padece. Objetivo: comprender el significado de vivir con esquizofrenia para personas que presentan la enfermedad y sus familiares, quienes acudieron a una institución estatal para la atención de problemas de salud mental de alta complejidad en Colombia durante el 2014 y 2015. Materiales y método: se utilizó un enfoque cualitativo y la información fue analizada por medio del método de la teoría fundamentada. Las técnicas de recolección de información fueron ocho entrevistas a profundidad y dos grupos focales, con una participación de 21 personas diagnosticadas y sus cuidadores. Resultados: por medio de la codificación, el muestreo teórico, la comparación constante y los memos analíticos, se llegó a la categoría “Vivir con esquizofrenia es vivir encerrado, a oscuras y con los sueños truncados”. Conclusiones: para los pacientes, la familia y para los cuidadores, vivir con esquizofrenia conlleva una sensación de encerramiento que afecta el proyecto de vida de unos y otros.

The Correlation Between Schizophrenic Patients' Level of Internalized Stigma and Their Level of Hope

AIM

The aim of this study is to determine the correlation between schizophrenic patients' level of internalized stigma and their level of hope.

MATERIAL AND METHOD

The population of the study consisted of patients who had been diagnosed with schizophrenia and also met the study inclusion criteria. The study sample selection from the population was not further divided; the study was conducted with 76 patients. The data of the study were collected using a personal information form, the Internalized Stigma of Mental Illness (ISMI) Scale, and Herth Hope Scale.

FINDINGS

The patients' mean score on the Internalized Stigma Scale was 72.78±16.05. Their score on the Hope Scale is 50.36±11.91. A significant negative correlation was found between the total mean scores of ISMI and the Herth Hope Scale (r=-0.360, p<0.01). A significant positive correlation was found between the stigma resistance subscale mean score of ISMI and the total mean score of the Herth Hope Scale (r=0.510, p<0.01).

CONCLUSION

The internalized stigma levels of schizophrenic patients were found to be high, whereas their hope levels were found to be moderate. A significant negative correlation was found between internalized stigma and hope. This study also found a significant positive correlation between the stigma resistance of patients and their hope levels.