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Eklund M, Bäckström M. Worker role perceptions and work participation among people with mental health issues taking part in interventions focusing on everyday life. Work 2023; 76:533-547. [PMID: 36938770 PMCID: PMC10657704 DOI: 10.3233/wor-220582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/21/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Knowing whether interventions addressing everyday life as a whole can affect work readiness for people with severe mental health issues would be important for how to develop support. OBJECTIVE To compare two groups of people with mental health problems, receiving either of two types of 16-week activity-based interventions, Balancing Everyday Life (BEL) or Care as Usual (CAU), regarding work readiness in terms of perceived worker role and satisfaction with recent work experience. Changes from baseline (T1) to completed intervention (T2) and a six-month follow-up (T3) and variables of potential importance to changes were also explored. METHODS This cluster RCT recruited participants for BEL (n = 133) and CAU (n = 93) from specialized and community-based psychiatry. Questionnaires addressing work readiness and potentially influencing variables (sociodemographic, clinical, type of intervention, work experience, non-work activity factors, social interaction and self-esteem) were used. Mixed model regression analyses were employed. RESULTS Positive changes occurred for both groups in one worker role aspect (resources for a future worker role) and in satisfaction with recent work participation. Satisfaction with non-work everyday activities, having valued activities, and self-esteem were important for change in the work readiness variables, whereas intervention type, age, sex or general activity level were not. CONCLUSION Both interventions yielded equally positive work readiness outcomes. Support that emphasizes engagement in satisfying and valued everyday activities and boosts self-esteem would be a potential way to help people with mental health issues develop work readiness in terms of the worker role and satisfaction with work participation.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, The Mental Health, Activity and Participation (MAP) Group, Lund University, Lund, Sweden
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Eklund M, Jansson JÅ, Eklund L, Pooremamali P, Gunnarsson AB. Work experiences, resources, and beliefs among vulnerable subgroups of mental health care users. Work 2021; 70:125-134. [PMID: 34487010 PMCID: PMC8673540 DOI: 10.3233/wor-213559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: People with mental illness may have difficulties related to work and employment, especially if they experience additional difficult life situations. OBJECTIVE: To explore how subgroups with mental illness and additional adversities perceived their situation with respect to work and employment prospects. METHODS: Three subgroups were included, exposed to an additional difficult life situation: i) psychosis interrupting their career development at young age (n = 46), ii) having a history of substance use disorder (SUD) (= 57) or iii) having recently immigrated (n = 39). They responded to questionnaires addressing sociodemographics, work-related factors, everyday activity, and well-being. A professional assessed their level of functioning and symptom severity. RESULTS: The young people with psychosis had a low education level, little work experience, the poorest worker role resources, and a low level of functioning, but a high quality of life. The SUD group had the fewest work experiences, were the least satisfied with work experiences, and had the lowest activity level, but had the least severe psychiatric symptoms. The immigrant group had severe psychiatric symptoms, but high ratings on work experiences, work resources, and activity level. CONCLUSIONS: Each group presented unique assets and limitations pertaining to work and employment, suggesting that they also needed unique support measures.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Jan-Åke Jansson
- Department of Psychology and Department of Health Sciences, Lund University, Lund, Sweden
| | - Lisa Eklund
- Department of Sociology, Lund University, Lund, Sweden
| | - Parvin Pooremamali
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - A Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden and Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Sweden
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Gunnarsson AB, Wagman P, Sternudd HT, Holmberg S, Holmgren K, Hörberg U. A study protocol of the photo-supported conversations about the well-being intervention (Be Well™) for people with stress related disorders. BMC Psychol 2021; 9:123. [PMID: 34419148 PMCID: PMC8379605 DOI: 10.1186/s40359-021-00625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stress-related illnesses constitute a huge problem in society. The primary care services in Sweden form the first line of care whose role is to coordinate interventions for reducing symptoms, as well as health-promoting interventions. There is lack of knowledge concerning health-promoting interventions for these illnesses. The aim of this study is to evaluate whether photo-supported conversations about well-being (Be Well™) as an intervention, in addition to care as usual within the primary care services, improves health and well-being for patients with stress-related illnesses. The intervention will be compared to a control group, who receive care as usual. A further aim is to conduct a process evaluation. METHODS/DESIGN This ongoing project has a quasi-experimental design, using quantitative and qualitative methods, and includes patients from primary care centres in two Swedish counties. Seventy patients, 20-67 years, with stress-related illnesses will be recruited. They constitute an intervention group, which receive the intervention together with care as usual, and a control group, which receive care as usual. The intervention, photo-supported conversations about well-being, involves 12 sessions. Care as usual entails medication, occupational therapy, physiotherapy and/or psychotherapy. Data collection is carried out at baseline, and outcomes are assessed directly after the intervention, as well as six months after completion of the intervention. The outcomes are evaluated based on factors related to health, well-being and everyday occupations. Furthermore, data concerning experiences of well-being and perceptions of the intervention will be collected in interviews. The therapists will also be interviewed about their experiences of performing the intervention. Data will be analysed with non-parametric statistics, and qualitative methodology. DISCUSSION The project is based on the concept that focusing on well-being despite living with stress-related illness may positively impact health and well-being as well as activity-related aspects, and that photo-supported conversations about well-being can contribute a complement to other treatment and rehabilitation. A strength is the use of a wide range of methods: such as quantitative measures, photographs, and qualitative interviews with participants and therapists. The results will thus provide knowledge about potential effects of this health-promoting intervention. Trial registration Clinical Trials.gov: NCT04832295; retrospectively registered 2nd April 2021 https://clinicaltrials.gov/ct2/show/NCT04832295.
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Affiliation(s)
- A. Birgitta Gunnarsson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Petra Wagman
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Hans T. Sternudd
- Department of Music and Art, Faculty of Arts and Humanities, Linnaeus University, Växjö, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Kristina Holmgren
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Eklund L, Gunnarsson AB, Jansson JÅ, Pooremamali P, Eklund M. A cross-sectional study addressing the importance of work and other everyday activities for well-being among people with mental illness: does additional vulnerability matter? BMC Psychiatry 2021; 21:383. [PMID: 34332573 PMCID: PMC8325838 DOI: 10.1186/s12888-021-03388-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Work and other everyday activities are beneficial for well-being among people with mental illness, but poor circumstances can create detrimental effects, possibly aggravated by additional vulnerabilities linked with their mental illness. This study aimed to investigate how activity factors were related to well-being and functioning among three vulnerable groups using outpatient mental health care - young people with psychosis, people with a history of substance use disorder (SUD), and immigrants with post-traumatic stress disorder (PTSD) - while controlling for vulnerability group, age and gender. METHODS Participants represented the three types of vulnerability (n = 46/57/39). Data collection, using self-report and interviewer-rated questionnaires, concerned aspects of everyday activity (work experiences; views of the worker role; satisfaction with everyday occupations; activity level), well-being (quality of life: life and health; quality of life: environmental aspects; recovery) and functioning (psychosocial functioning; symptom severity). Spearman correlations and General Linear Modelling were used. RESULTS Activity satisfaction was positive (p < 0.001) but recent work experience negative (p = 0.015) for the life and health aspect of quality of life. Activity satisfaction was positive for the environmental aspects of quality of life (p < 0.001). Resources for having a worker role (p < 0.001) and belief in having a future worker role (p = 0.007) were positively associated with better recovery. Activity level (p = 0.001) and resources for having a worker role (p = 0.004) showed positive associations with psychosocial functioning. Belief in a future worker role (p = 0.011) was related with symptom level. Women had less severe symptoms in the young group with psychosis. Regarding vulnerability group, young people with psychosis perceived better quality of life; those with a history of SUD had less severe psychiatric symptoms; and the recent immigrants with PTSD had the highest level of psychosocial functioning. CONCLUSION Work experience may not be conducive to well-being in itself; it is satisfaction with work and other activities that matters, and worker and employer expectations need alignment. No vulnerability group seemed consistently more disadvantaged regarding well-being and functioning, but the fact that differences existed is vital to acknowledge in activity-based rehabilitation. Inquiring about meaningful activities and providing opportunities for executing them would be a fruitful way of support.
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Affiliation(s)
- Lisa Eklund
- grid.4514.40000 0001 0930 2361Department of Sociology, Lund University, Lund, Sweden
| | - A. Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden ,grid.8761.80000 0000 9919 9582Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Åke Jansson
- grid.4514.40000 0001 0930 2361Department of Psychology and Department of Health Sciences, Lund University, Lund, Sweden
| | - Parvin Pooremamali
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Mona Eklund
- Department of Health Sciences, Lund University, P. O. Box 157, SE-22100, Lund, Sweden.
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Eklund M, Bäckström M, Hansson L. Psychometric evaluation of the Swedish version of Rosenberg's self-esteem scale. Nord J Psychiatry 2018; 72:318-324. [PMID: 29607717 DOI: 10.1080/08039488.2018.1457177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The widely used Rosenberg's self-esteem scale (RSES) has not been evaluated for psychometric properties in Sweden. AIMS This study aimed at analyzing its factor structure, internal consistency, criterion, convergent and discriminant validity, sensitivity to change, and whether a four-graded Likert-type response scale increased its reliability and validity compared to a yes/no response scale. METHODS People with mental illness participating in intervention studies to (1) promote everyday life balance (N = 223) or (2) remedy self-stigma (N = 103) were included. Both samples completed the RSES and questionnaires addressing quality of life and sociodemographic data. Sample 1 also completed instruments chosen to assess convergent and discriminant validity: self-mastery (convergent validity), level of functioning and occupational engagement (discriminant validity). Confirmatory factor analysis (CFA), structural equation modeling, and conventional inferential statistics were used. RESULTS Based on both samples, the Swedish RSES formed one factor and exhibited high internal consistency (>0.90). The two response scales were equivalent. Criterion validity in relation to quality of life was demonstrated. RSES could distinguish between women and men (women scoring lower) and between diagnostic groups (people with depression scoring lower). Correlations >0.5 with variables chosen to reflect convergent validity and around 0.2 with variables used to address discriminant validity further highlighted the construct validity of RSES. The instrument also showed sensitivity to change. CONCLUSIONS The Swedish RSES exhibited a one-component factor structure and showed good psychometric properties in terms of good internal consistency, criterion, convergent and discriminant validity, and sensitivity to change. The yes/no and the four-graded Likert-type response scales worked equivalently.
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Affiliation(s)
- Mona Eklund
- a Department of Health Sciences , Lund University , Lund , Sweden
| | | | - Lars Hansson
- a Department of Health Sciences , Lund University , Lund , Sweden
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Eklund M, Bäckström M, Bejerholm U. How do Swedish day center attendees with psychiatric disabilities view their worker role? A structural equation modeling study. Scand J Occup Ther 2017; 25:203-212. [PMID: 28562142 DOI: 10.1080/11038128.2017.1335776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To investigate how day center attendees with psychiatric disabilities perceived their worker role and the importance of current work situation and personal factors in that respect. METHODS Two-hundred attendees completed the Worker Role Self-assessment and questionnaires addressing possible predictors of the worker role: current employment situation, satisfaction with that situation, and a personal factor (encompassing self-esteem, self-mastery and engagement). Structural equation modeling was used. RESULTS A model indicated two worker role factors; belief in a future worker role (WR1) and current capacities and routines (WR2). WR1 was positively influenced by having a job, younger age and the personal factor. Satisfaction with current work situation (usually unemployment) was negatively associated with WR1. The personal factor was single predictor of WR2. The attendees rated WR2 more positively than WR1. CONCLUSIONS The personal factor was crucial for both WR1 and WR2. Work-related factors were only important for WR1. The more negative rating of belief in a future worker role may be interpreted as mistrust in the services. The attendees' positive ratings of capacities indicate, however, that they had a rehabilitation potential to develop. Enhancing self-esteem, mastery and engagement may be an avenue for staff in efforts to support the attendee's worker role.
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Affiliation(s)
- Mona Eklund
- a Department of Health Sciences/Mental Health, Activity and Participation , Lund University , Lund , Sweden
| | | | - Ulrika Bejerholm
- c Department of Health Sciences/Mental Health, Activity and Participation , Lund University , Lund , Sweden
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Eklund M, Bejerholm U. Staff ratings of occupational engagement among people with severe mental illness - psychometric properties of a screening tool in the day center context. BMC Health Serv Res 2017; 17:338. [PMID: 28482841 PMCID: PMC5422941 DOI: 10.1186/s12913-017-2283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Staff who plan and organize day center activities may need to observe the attendees’ performance and progression. This led us to develop a tool for that purpose, termed General Occupational Engagement in people with Severe mental illness (GOES). The aim was to investigate its psychometric properties in terms of factor structure, internal consistency, corrected item-total correlations (CITC), convergent and discriminant validity, and test-retest stability. Methods Ninety-three day center attendees were assessed by the GOES and instruments addressing constructs hypothesized to be either similar to (activity level, motivation for day center attendance, perceptions of the worker role, hours spent in the day center) or divergent from the GOES (attendees’ ratings of engagement in specified occupations, self-rated health, psychosocial functioning, psychiatric symptoms). A second sample of 41 attendees were included for the test-retest analysis. Exploratory factor analysis, Cronbach’s alpha analysis, Pearson correlations and paired-samples t-tests were performed. Results Exploratory factor analysis indicated one factor, which was in line with the intentions of the scale. The alpha value was 0.85 and all CITC were above 0.30. The tests for convergent validity resulted in correlations ranging between 0.23 and 0.47, most of which were moderately strong and mainly confirmed the hypotheses. Discriminant validity was clearly indicated, since all correlations with the selected constructs were <0.20. GOES also showed preliminary test-retest stability (r = 0.32). Conclusions The GOES is ready for use in rehabilitation services and research where productive and other types of activities are of interest. It may serve as an important supplement to attendees’ self-reported occupational engagement.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences/ Mental Health, Activity and Participation, Lund University, Box 157, SE 221 00, Lund, Sweden.
| | - Ulrika Bejerholm
- Department of Health Sciences/ Mental Health, Activity and Participation, Lund University, Box 157, SE 221 00, Lund, Sweden
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Tjörnstrand C, Argentzell E, Eklund M. Perceived social status among people with psychiatric disabilities attending work-oriented and meeting place-oriented day centers. Work 2016; 55:19-28. [DOI: 10.3233/wor-162388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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