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Rutakumwa R, Knizek BL, Tusiime C, Mpango RS, Birungi C, Kinyanda E. Victimisation in the life of persons with severe mental illness in Uganda: a pluralistic qualitative study. BMC Psychiatry 2024; 24:329. [PMID: 38689240 PMCID: PMC11061965 DOI: 10.1186/s12888-024-05720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and victims' in-depth experiences of victimisation of persons with severe mental illness. We explore the lived experiences and meanings of victimisation of persons with severe mental illness in Uganda, and discuss their implications for care of the mentally ill. METHODS A pluralistic qualitative study was undertaken to explore victimisation among patients with severe mental illness. Patients who had suffered victimisation were purposively sampled from Butabika National Referral Mental Clinic and Masaka Regional Referral Hospital, following confirmation of symptom remission. In-depth interviews were held with 18 participants, comprising 13 females and 5 males from low to moderate socioeconomic status. Interpretative phenomenological analysis and thematic content analysis were conducted. RESULTS Victimisation was exhibited in three main forms: (a) psychological, expressed in attitudes towards mentally ill family members as valueless and dispensable, and stigmatisation, (b) physical, as manifested in beatings, indoor confinement and tethering mostly by family members and (c) sexual victimisation, particularly rape. Also observed were victim's various responses that pointed to the negative impact of victimisation, including a heightened risk of suicide, social withdrawal, a sense of hatefulness and a predisposition to more victimisation. CONCLUSION The family environment plays a predominant role in perpetrating victimisation of the mentally ill in some sub-Saharan African contexts such as Uganda. We propose a holistic framework for mental health interventions, incorporating biomedical but notably also social determinants of mental health, and targeted at improving familial relationships, social support and a sense of belongingness both within the family and the broader community.
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Affiliation(s)
- Rwamahe Rutakumwa
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda.
| | - Birthe Loa Knizek
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Christine Tusiime
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
- Butabika National Referral Mental Hospital, Old Port Bell Road, P. O. Box 7017, Kampala, Uganda
| | - Richard Stephen Mpango
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
| | - Carol Birungi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eugene Kinyanda
- Medical Research Council, Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Plot 50-59 Nakiwogo Road, P. O. Box 49, Entebbe, Uganda
- Department of Psychiatry, Makerere University, P. O. Box 7072, Kampala, Uganda
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Tesselaar JM, Mendoza RR, Siegel JA, Elbe CI, Caravelli NS, DeJesus J, Fenton M, Victoria BS, Blashill AJ. A qualitative analysis of relationship advice from the perspective of people living with and recovering from eating disorders while in diverse romantic relationships. Eat Disord 2023; 31:632-650. [PMID: 37194296 DOI: 10.1080/10640266.2023.2206753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Eating disorders (EDs) have adverse consequences across life domains, ranging from physical health to interpersonal relationships. While research suggests that romantic partners have the potential to support ED recovery, partners to those with EDs often report feeling confused and helpless in the face of the condition. The extant literature on EDs in relationships centers on the experiences of cisgender, heterosexual women. The present study aimed to garner a more comprehensive understanding of the types of support people with EDs believe are most helpful from romantic partners by analyzing relationship advice from a diverse group of individuals with EDs who were in romantic relationships. As part of a larger study on romantic relationships in ED recovery, we analyzed responses to the question, "If you had to give one piece of advice to someone who learns that their partner has an ED, what would it be?" Through Consensual Qualitative Research-Modified, we identified 29 themes, which we grouped into 7 domains: Foster Open Communication, Create an Environment of Emotional Intimacy, Let Your Partner Guide You, Educate Yourself, Be Compassionate with Yourself, Use Caution when Discussing Food and Bodies, and a Miscellaneous domain. These findings highlight the importance of patience, flexibility, psychoeducation, and self-compassion for individuals working to support their partner's ED recovery, and can inform future couples-based treatments and interventions for EDs.
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Affiliation(s)
- Juliana M Tesselaar
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Rebecca R Mendoza
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Connor I Elbe
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Nicolas S Caravelli
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jennifer DeJesus
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Margo Fenton
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Brianna S Victoria
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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Kiely L, Conti J, Hay P. Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis. BMC Psychiatry 2023; 23:606. [PMID: 37596588 PMCID: PMC10439651 DOI: 10.1186/s12888-023-05098-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment refinement. Qualitative research, particularly lived experience literature, can contribute to a process of revision and enrichment of understanding the SE-AN experience and further develop treatment interventions. Poor outcomes to date, as evidenced in clinical trials and mortality for people with SE-AN (1 in 20) demonstrate the need for research that informs conceptualisations and novel treatment directions. This interpretative, meta-ethnographic meta-synthesis aimed to bridge this gap. METHODS A systematic search for qualitative studies that explored the AN experiences of people with a duration of greater than 3 years was undertaken. These studies included those that encompassed phenomenology, treatment experiences and recovery. RESULTS 36 papers, comprising 382 voices of SE-AN experiences informed the meta-ethnographic findings. Four higher order constructs were generated through a synthesis of themes and participant extracts cited in the extracted papers: (1) Vulnerable sense of self (2) Intra-psychic processes (3) Global impoverishment (4) Inter-psychic temporal processes. Running across these meta-themes were three cross cutting themes (i) Treatment: help versus harm, (ii) Shifts in control (iii) Hope versus hopelessness. These meta-themes were integrated into conceptualisations of SE-AN that was experienced as a recursive process of existential self-in-relation to other and the anorexia nervosa trap. CONCLUSIONS The alternative conceptualisation of SE-AN proposed in this paper poses a challenge to current conceptualisations of AN and calls for treatments to engage with the complex intra and inter-psychic processes of the SE-AN, more fully. In doing so, clinicians and researchers are asked to continue to be bold in testing novel ideas that may challenge our own rigidity and attachment to dominant paradigms to best serve the individual person with SE-AN. The 'global impoverishment of self', found in this synthesis of AN experiences, should inform proposed diagnostic criteria for SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University. Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, Australia
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Constant E, Brugallé E, Wawrziczny E, Sokolowski C, Manceau C, Flinois B, Baille G, Luc D, Dujardin K, Antoine P. Relationship Dynamics of Couples Facing Advanced-Stage Parkinson’s Disease: A Dyadic Interpretative Phenomenological Analysis. Front Psychol 2022; 12:770334. [PMID: 35140654 PMCID: PMC8818672 DOI: 10.3389/fpsyg.2021.770334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background/ObjectiveSeveral studies have examined the impact of Parkinson’s disease (PD) on the quality of couples’ relationships. To date, few studies have explored how couples experience their relationship dynamic by taking into account the disease stage. The objectives of this study were to understand the experience of each partner and to study the mechanisms that underlie their couple organization in the advanced stage of PD.MethodsSemistructured individual interviews conducted with fifteen patients and their partners were the subject of a dyadic interpretative phenomenological analysis.ResultsThree themes were identified from the analysis: the first, “A Closeness That Separates,” allows the identification of different patterns of interactions that lead to emotional distancing between the partners; the second, “The Adversity Is Not Unbearable, But Going It Alone Would Be,” emphasizes the importance of how the assisting partner provides support; and the third, “Be Prepared for Anything and Facing an Uncertain Future,” reveals the extent and modes of the dyadic regulation of the emotions linked to what the future may hold.ConclusionPsychological support is important to help couples express both their feelings and their respective needs in the evolving context of PD.
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Affiliation(s)
- Emilie Constant
- Université de Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
- *Correspondence: Emilie Constant,
| | - Elodie Brugallé
- Université de Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Emilie Wawrziczny
- Université de Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Céline Sokolowski
- Université de Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Charlotte Manceau
- Université de Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
| | - Bérengère Flinois
- Centre Hospitalier Regional et Universitaire de Lille, Lille, France
| | - Guillaume Baille
- Centre Hospitalier Regional et Universitaire de Lille, Lille, France
| | - Defebvre Luc
- Centre Hospitalier Regional et Universitaire de Lille, Lille, France
| | - Kathy Dujardin
- Centre Hospitalier Regional et Universitaire de Lille, Lille, France
| | - Pascal Antoine
- Université de Lille, CNRS, UMR 9193 – SCALab – Sciences Cognitives et Sciences Affectives, Lille, France
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Demirtepe-Saygılı D. Multiple sclerosis experiences of couples: Examination of patient and partner perspectives. J Health Psychol 2021; 27:2079-2090. [PMID: 34111986 DOI: 10.1177/13591053211017192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study aims to investigate Multiple Sclerosis (MS) experiences of couples. Using a dyadic qualitative method, separate simultaneous interviews were conducted with 20 couples, including one partner with MS. The themes resulting from content analysis were examined in two categories: Convergent (anxiety about future, acceptance of MS and MS as an accelerator of the relationship) and divergent (sexual problems, the experience of MS symptoms, the priority of the problems and untold issues). The findings revealed shared and unique perspectives of partners in the illness process, having the potential to guide the psychosocial interventions for couples living with a chronic illness.
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The relationship between eating disorder psychopathology and sexuality: etiological factors and implications for treatment. Curr Opin Psychiatry 2020; 33:554-561. [PMID: 32858598 DOI: 10.1097/yco.0000000000000646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW There is a remarkable overlap between eating disorders and sexual problems, both in terms of sexual dysfunctions and risky sexual behaviors. This systematic review of the recent literature aimed at clarifying the nature of this relationship in terms of psychopathological meaning. RECENT FINDINGS Body image disturbance, and particularly body dissatisfaction and embodiment disorder, emerged as shared psychopathological dimensions between eating disorder symptoms and sexual dysfunctions. Interpersonal difficulties, a disturbed intimacy and insecure attachment style, but not a history of sexual abuse per se, resulted to play a pivotal role in the interconnection between eating disorder psychopathology and sexual dysfunctions. On the other hand, several studies confirmed the association between eating disorder symptoms and risky sexual behaviors, which has been explained in terms of several common psychopathological dimensions, including impulsivity and addiction. SUMMARY Sexuality is deeply interconnected with eating disorder psychopathology, and it should be considered a fundamental aspect in managing these disorders. An accurate assessment of sexual function might allow to characterize etiological information (e.g., sexual abuse) and maintaining factors (embodiment disorder and emotion dysregulation). Accordingly, the recovery of a good sexuality should be considered a crucial signal of recovery.
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Mokoena AG, Poggenpoel M, Myburgh C, Temane A. Lived experiences of couples in a relationship where one partner is diagnosed with a mental illness. Curationis 2019; 42:e1-e7. [PMID: 31588763 PMCID: PMC6779990 DOI: 10.4102/curationis.v42i1.2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background A partner with mental illness can be challenging in a couple’s relationship. Mental illness brings about disintegration in the relationship because the partner without mental illness takes on more responsibilities than before. The partner without mental illness can be subjected to multiple risks, including stress and burden of care. The lived experiences of couples in a relationship where one partner is diagnosed with a mental illness is an under-researched area of mental health. Objectives To explore and describe the lived experiences of couples in a relationship where one partner is diagnosed with a mental illness. Method A qualitative, descriptive, exploratory and contextual research design was utilised. A purposive sampling method was used to sample participants for this study. Five couples, where one partner was diagnosed with a mental illness, participated in the study. Ten in-depth, individual, phenomenological interviews were conducted to provide rich descriptions of the couples’ experiences. Data were analysed using thematic analysis. An independent coder assisted with the data analysis. A consensus discussion was held between the independent coder and the interviewing researcher to agree on the identified themes. Results Four themes with categories emerged from the data analysis: couples experienced changed social roles in their relationship, emotional upheaval was experienced by the individual partners in the couple relationship, interpersonal distance was experienced in the couple’s relationship and a changed relationship with the self was experienced by the individual partners in the couple relationship. Conclusion The results concluded that couples experienced that the presence of mental illness in their relationship adversely affects the relationship, thus emphasising the need to empower the couples dealing with challenges of being in a relationship where one partner is diagnosed with a mental illness.
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Affiliation(s)
- Andile G Mokoena
- Department of Nursing Science, University of Johannesburg, Johannesburg.
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"Waiting for breast reconstruction": An interpretative phenomenological analysis of heterosexual couples' experiences of mastectomy for breast cancer. Eur J Oncol Nurs 2019; 42:42-49. [PMID: 31446263 DOI: 10.1016/j.ejon.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/17/2019] [Accepted: 07/20/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Treatment decisions, such as breast reconstruction is made by the dyad patient-physician, but close others can have an influence on the process. Shared decision-making models include close others but current studies generally investigate physician-patient interactions only. Moreover, little is known about couples' interactions throughout the breast cancer journey and treatment decision-making. Thus, the aim of the present study was to explore couples' experiences of mastectomy and breast reconstruction decision-making, the month following the mastectomy. METHOD Ten unstructured individual interviews, with five couples facing mastectomy for breast cancer, were conducted. A dyadic interpretative phenomenological analysis (IPA) was carried on the data set. RESULTS Eight super-ordinate themes emerged from the data. Couples' experiences were marked by the experience of the disease, the mastectomy and the impact they produced. The relationships with health professionals and partners were also important. Partners were not only supportive and protective, but directly (i.e., couples talk about treatments) and indirectly influenced (i.e., women make a decision taking into consideration how it will impact their couple) the women in their decision to have or not a breast reconstruction. The interpretative accounts underline how women and partners cope with the disease thinking about the aftertreatment. CONCLUSIONS This study explains for the first time how intimate partners influence breast reconstruction decision-making and how couples cope individually with the disease immediately after mastectomy. Health professionals need to involve partners more in the treatment decision-making process as the women consider and talks to them about the choices they have to make.
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