Adolescents' voices on self-engagement in mental health treatment: a scoping review.

INTRODUCTION: According to the United Nations Convention on the Rights of the Child, adolescents' involvement in their healthcare is a fundamental right, and self-engagement in mental health treatment is vital for realizing their potential within person-centered care (PCC). Research exists that highlights barriers to involving adolescents in their care decisions. However, research on adolescents' own voices about self-engagement in mental health treatment has been scarce. This scoping review aimed to examine and summarize current knowledge on adolescents' voices regarding self-engagement in mental health treatment. METHOD: The review followed the scoping methodology of Arksey and O'Malley from 2005, updated by Levac and colleagues in 2010, involving five stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing and reporting the results. RESULTS: Nineteen studies were included. The following themes on adolescents` voices regarding self-engagement in mental health treatment were identified: (1) the therapeutic alliance, (2) the need for active engagement in treatment, (3) different experiences due to time of data collection, (4) treatment context and healthcare system, and (5) adolescent-caregiver interaction. CONCLUSION: Adolescents' understanding of self-engagement was multilevel and comprehensive, including individual, contextual and relational factors. A strong therapeutic alliance with healthcare providers, and a need to be actively engaged in treatment were highlighted. To succeed in strengthening PCC in mental healthcare for adolescents, health professionals must take this complex understanding into consideration, as treatment without adolescents` self-engagement may worsen their clinical outcomes. Future research should explore specific PCC interventions and incorporate diverse methodologies in various clinical contexts. Additionally, insights from healthcare providers and caregivers on self-engagement in mental health treatment will complement these findings.

Older people with incurable cancer: Existential meaning-making from a life-span perspective.

OBJECTIVE: An increasing number of older people in Western countries are living with incurable cancer, receiving palliative care from specialized healthcare contexts. The aim of our article was to understand how they experience the existential meaning-making function in daily living from a life-span perspective. METHOD: Some 21 participants (12 men and 9 women), aged 70-88, were interviewed in a semistructured framework. They were recruited from somatic hospitals in southeastern Norway. We applied the model of selective optimization with compensation (SOC) from life-span developmental psychology in a deductive manner to explore the participants' life-oriented adaptive strategies. A meaning component was added to the SOC model. RESULTS: The participants experienced the existential meaning-making function on two levels. On a superordinate level, it was an important component for interpreting and coordinating the adaptive strategies of SOC for reaching the most important goals in daily living. The existential meaning-making framework provided for a comprehensive understanding of resilience, allowing for both restoration and growth components to be identified. The second level was related to strategy, in that the existential meaning-making function was involved in a complex interaction with behavioral resources and resilience, leading to continuation of goals and more realistic goal adjustments. A few experienced existential meaning-making dysfunction. SIGNIFICANCE OF RESULTS: The modified SOC model was seen as applicable for palliative care in specialized healthcare contexts. Employing the existential meaning-making framework with its complementary understanding of resilience as growth potential to the SOC model's restoration potential can help older people to identify how they make meaning and how this influences their adaptation process to being incurably sick.

How older people with incurable cancer experience daily living: A qualitative study from Norway.

OBJECTIVE: An increasing number of older people are living with incurable cancer as a chronic disease, requiring palliative care from specialized healthcare for shorter or longer periods of time. The aim of our study was to describe how they experience daily living while receiving palliative care in specialized healthcare contexts. METHOD: We conducted a qualitative research study with a phenomenological approach called "systematic text condensation." A total of 21 participants, 12 men and 9 women, aged 70-88, took part in semistructured interviews. They were recruited from two somatic hospitals in southeastern Norway. RESULTS: The participants experienced a strong link to life in terms of four subthemes: to acknowledge the need for close relationships; to maintain activities of normal daily life; to provide space for existential meaning-making and to name and handle decline and loss. In addition, they reported that specialized healthcare contexts strengthened the link to life by prioritizing and providing person-centered palliative care. SIGNIFICANCE OF RESULTS: Older people with incurable cancer are still strongly connected to life in their daily living. The knowledge that the potential for resilience remains despite aging and serious decline in health is considered a source of comfort for older people living with this disease. Insights into the processes of existential meaning-making and resilience are seen as useful in order to increase our understanding of how older people adapt to adversity, and how their responses may help to protect them from some of the difficulties inherent to aging. Healthcare professionals can make use of this information in treatment planning and for identification of psychosocial and sociocultural resources to support older people and to strengthen patients' life resources.

What information did the DSM-5 Cultural Formulation Interviews provide when used with Swedish-speaking patients in a psychiatric setting in Stockholm?

Introduction: Cultural and contextual factors affect communication and how psychiatric symptoms are presented, therefore psychiatric assessments need to include awareness of the patients' culture and context. The Cultural Formulation Interview (CFI) in DSM-5 is a person-centred tool developed to support the exploration of cultural and contextual factors in an individualized and non-stereotypic way. Methods: The aim of this qualitative study was to find out what information the DSM-5 CFI revealed when used with native Swedish-speaking patients as part of routine clinical psychiatric assessment at an outpatient clinic. An additional aim was to enhance understanding of what kind of information the questions about background and identity yielded. The CFI was added to the psychiatric assessment of 62 native Swedish-speaking patients at an outpatient psychiatric clinic in Stockholm. Results: From the thematic analysis of the documented CFI answers, six central themes were found; Descriptions of distress and dysfunction, Managing problems and distress, Current life conditions affecting the person, Perceived failure in meeting social expectations, Making sense of the problem, and Experiences of, and wishes for, help. The CFI questions about identity yielded much information, mainly related to social position and feelings of social failure. Discussion: For further refinement of the CFI, we see a need for re-framing the questions about cultural identity and its impact on health so that they are better understood. This is needed for majority population patients as direct questions about culture may be difficult to understand when cultural norms are implicit and often unexamined. For clinical implications, our findings suggest that for cultural majority patients the DSM-5 CFI can be a useful person-centred tool for exploring cultural and, in particular, social factors and patients' perception and understanding of distress.

A qualitative analysis of the documentation of DSM-5 Cultural Formulation Interviews with non-native speaking patients in a Swedish mental health care setting.

Introduction: Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients. Materials and methods: The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients. Results: We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms. Discussion: Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians' identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.

Brief intervention for risk-drinking women: a mixed methods analysis of content and process.

BACKGROUND AND OBJECTIVES: Although brief interventions (BIs) are among the most highly promoted treatments for alcohol problems, their effective components are unknown. This may be particularly important when considering women since some reviews have suggested that BIs are more efficacious among men. The purpose of this pilot study is to utilize a mixed methods and gender analysis approach to generate hypotheses about the effective components of BIs given to women with medical problems exacerbated by problem drinking. METHODS: Random sample of 20 BIs given to women with diabetes, hypertension, infertility, or osteoporosis. Quantitative and qualitative analytic methods were undertaken in a stepwise progression, followed by a gender analysis using the Worldview Assessment Framework. RESULTS: Main findings include that a worldview encompassing drinking as an entitlement may be a moderator limiting the effectiveness of a BI, that understanding the impact of alcohol on infertility problems as distinct from prenatal alcohol use may be a mediator for BI effectiveness, and that providing information about sensible drinking limits in the context of a specific medical problem was feasible. CONCLUSIONS AND SIGNIFICANCE: Content and process areas are important to consider when offering BI for risk-drinking women with medical problems and may help to improve treatment efficacy in this group.

Being in-between; exploring former cult members' experiences of an acculturation process using the cultural formulation interview (DSM-5).

Objective: To explore the experiences of acculturation into secular Swedish society of former members of cults, with particular focus on mental health, needs and resources. Design: Qualitative method using the Cultural Formulation Interview (CFI) from the DSM-5 as an interview guide. Analysis of participants' experiences of acculturation through systematic text condensation. Participants: Eleven Swedish former members of ideological or religion-based cults. Setting: Swedish mainstream, secular society. Results: Former cult members experience an 'in-between time' in the period after leaving the cult and find themselves in a confusing, chaotic state. They describe having lived in an honor culture where acts of violence were normalized. In the cult, they felt disconnected from themselves, and post-cult they try to regain access to their own values and feelings as well as create new bonds with family members and friends outside the cult. They find it hard to talk about their cult background and find relief in communicating with other former cult members. In their post-cult life, they eventually start seeing the world in a brighter, more hopeful way than before. However, they are also at risk of re-experiencing cult-related traumatic events and of new traumatic experiences within the post-cult acculturation process, and of persistent psychological distress. Conclusion: Former cult members face a challenging acculturation process, having lost a functioning worldview upon leaving the cult but not yet gained another to take its place. While the in-between time is often transient, they may need support from the healthcare system, especially regarding mental health concerns, while establishing themselves into mainstream society.

Public Mental Health Approaches to Online Radicalisation: An Empty Systematic Review.

This systematic review seeks to position online radicalisation within whole system frameworks incorporating individual, family, community and wider structural influences whilst reporting evidence of public mental health approaches for individuals engaging in radical online content. METHODS: the authors searched Medline (via Ovid), PsycInfo (via Ebscohost) and Web of Science (Core Collection) with the use of Boolean operators across "extremism", "online content" and "intervention". RESULTS: Following full-text assessments, all retrieved papers were excluded. No publications fulfilled the primary objective of reporting public mental health interventions specifically addressing online radicalisation. However, six publications fulfilled the secondary objective of identifying theoretical and conceptual relationships amongst elements in the three inclusion criteria (online extremism, psychological outcomes and intervention strategy) that could inform interventions within public mental health frameworks. These publications were quality assessed and discussed following the Cochrane Effective Practice and Organisation of Care guide for reporting empty reviews. CONCLUSIONS: there is an immediate need for further research in this field given the increase in different factions of radicalised beliefs resulting from online, particularly social media, usage.

Safe but isolated - an interview study with Iraqi refugees in Sweden about social networks, social support, and mental health.

BACKGROUND: Problems with social networks and social support are known to be associated with mental ill-health in refugees. Social support after migration promotes resilience. AIM: To study how Iraqi refugees who arrived in Sweden after the year 2000 perceived their social networks and social support, and to relate the observed network characteristics and changes to the refugees' mental health and well-being. METHOD: Semi-structured interviews with 31 refugees, including questions on background and migration experiences, a biographical network map, and three health assessment scales. The findings were analysed with descriptive statistics and content thematic analysis. RESULTS: The respondents' networks were diminished. Social support was continued to be provided mainly by family members and supplemented by support from authorities. The main themes of the refugee experience of post-migration challenges were weakened social networks, barriers to integration and challenges to cultural and religious belonging. Failed reunion and worrying about relatives was described as particularly painful. Negative contacts with authority persons were often seen as humiliating or discriminating. Acquiring a new cultural belonging was described as challenging. At the same time, changing family and gender roles made it more difficult to preserve and develop the culture of origin. Traumatic experiences and mental health problems were common in this group. Family issues were more often than integration difficulties associated with mental health problems. CONCLUSION: In order to strengthen post-migration well-being and adaptation, authorities should support the refugees' social networks. Clinicians need to address post-migration problems and challenges, including the meaning and function of social networks.

A Public Mental Health Study Among Iraqi Refugees in Sweden: Social Determinants, Resilience, Gender, and Cultural Context.

This public mental health study highlights the interactions among social determinants and resilience on mental health, PTSD and acculturation among Iraqi refugees in Sweden 2012-2013. Objectives: The study aims to understand participants' health, resilience and acculturation, paying specific attention to gender differences. Design: The study, using a convenience sampling survey design (N = 4010, 53.2% men), included measures on social determinants, general health, coping, CD-RISC, selected questions from the EMIC, PC-PTSD, and acculturation. Results: Gender differences and reported differences between life experiences in Iraq and Sweden were strong. In Sweden, religious activity was more widespread among women, whereas activity reflecting religion and spirituality as a coping mechanism decreased significantly among men. A sense of belonging both to a Swedish and an Iraqi ethnic identity was frequent. Positive self-evaluation in personal and social areas and goals in life was strong. The strongest perceived source of social support was from parents and siblings, while support from authorities generally was perceived as low. Self-rated health was high and the incidence of PTSD was low. A clear majority identified multiple social determinants contributing to mental health problems. Social or situational and emotional or developmental explanations were the most common. In general, resilience (as measured with CD-RISC) was low, with women's scores lower than that of men. Conclusions: Vulnerability manifested itself in unemployment after a long period in Sweden, weak social networks outside the family, unsupportive authorities, gender differences in acculturation, and women showing more mental health problems. Though low socially determined personal scores of resilience were found, we also identified a strong level of resilience, when using a culture-sensitive approach and appraising resilience as expressed in coping, meaning, and goals in life. Clinicians need to be aware of the risks of poorer mental health among refugees in general and women in particular, although mental health problems should not be presumed in the individual patient. Instead clinicians need to find ways of exploring the cultural and social worlds and needs of refugee patients. Authorities need to address the described post-migration problems and unmet needs of social support, together comprising the well-established area of the social determinants of health.

Moods and expectancies of female alcohol drinking--an exploratory study.

Gaining access to information concerning mood states and expectations of change preceding a typical drinking occasion is important for understanding the trigger factors for drinking, and for alcohol abuse treatment planning. The objective of the present study was twofold: (i) to explore self-reported states of mood and expectancies preceding a typical drinking occasion vs. relations with parents and drinking outcome; and (ii) to investigate if vulnerability factors in terms of personality and health are related to severity of alcohol problems. The population consisted of 50 women attending a Swedish alcohol clinic. Semi-structured interviews were conducted. A mixed-methods design was used encompassing qualitative interview-data and quantitative data from questionnaires and medical journals. Nine out of ten patients had a diagnosis of alcohol dependence, and four out of five had parents with dependency problems. As compared to a female norm group, the patients displayed significantly higher anxiety-related traits and irritability. Moods were described by patients as mostly negative and expectancies of change were evenly distributed between reducing, enhancing or flight from feeling. An expectancy of flight when drinking was also related to a positive relation to mother. The findings pointed to the need for differentiating between coping with and expectancies of drinking. Further, a hierarchical cluster analysis resulted in two groups, indicating one group characterized by higher risk values on personality scales and more severe consequences of drinking. The contribution of a treatment design informed through a gender and culture perspective to treatment outcome was discussed.

Cultural analysis as a perspective for gender-informed alcohol treatment research in a Swedish context.

AIM: An exploratory study to investigate the role of culture in women's drinking at a clinic for women with alcohol problems in a Swedish treatment context. METHODS: A content analysis of the case journal material of 20 consecutive female patients at the EWA clinic (Early treatment of Women with Alcohol addiction) in Stockholm, Sweden, was conducted using an original instrument informed by the field of cultural psychiatry and emerging from recurrent themes in the case journals. RESULTS: The patients perceived themselves as having a sub-group status. A trajectory of ritualized actions around drinking, especially private drinking rituals, was identified. Existential components of patients' struggles with addiction in a highly secularized cultural context were identified. Multiple, contradictory explanatory frameworks for understanding drinking problems were creating cognitive dissonance. CONCLUSION: Using cultural analysis as a perspective for gaining gendered information may allow for identifying new patterns within specific cultural and subgroup contexts. It may contribute new information to the following treatment research areas: gender-appropriate measurement issues; service integration; gender-appropriate services for women; and, drinking rituals and patterns.

Caught Between Expectations and the Practice Field.

Background: Volunteer crisis line responders are a valuable resource for suicide prevention crisis lines worldwide. Aim: The aim of this study was to gain a deeper understanding of how volunteers operating a diaconal crisis line in Norway experienced challenges and how these challenges were met. Method: A qualitative, explorative study was conducted. A total of 27 volunteers were interviewed through four focus groups. The material was analyzed using systematic text condensation. Results: The greatest challenge to the volunteers was the perception of a gap between their expectations and the practice field. The experience of many volunteers was that the crisis line primarily served a broad ongoing support function for loneliness or mental illness concerns, rather than a suicide prevention crisis intervention function. Limitations: The focus group design may have made the participants more reluctant to share experiences representing alternative perspectives or personally sensitive information. Conclusion: The findings of this study suggest that a uniform response to callers using crisis lines as a source of ongoing support is warranted and should be implemented in volunteer training programs.

Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study.

OBJECTIVE: To explore existential meaning-making in an ethnic-majority subgroup with mental ill health and to increase knowledge about the importance of gaining access to such information in mental healthcare. DESIGN: Qualitative study using in-depth interviews and systematic text condensation analysis. PARTICIPANTS: 17 devote Christians with an ethnic-Swedish background, 12 women and 5 men, 30-73 years old, from different congregations across Sweden, having sought medical care for mental ill health of any kind. SETTING: The secular Swedish society. RESULTS: A living, although asymmetric, relationship with God often was seen as the most important relationship, giving hope and support when ill, but creating feelings of abandonment and fear if perceived as threatened. Symptoms were interpreted through an existential framework influenced by their view of God. A perceived judging God increased feelings of guilt, sinfulness and shame. A perceived merciful God soothed symptoms and promoted recovery. Existential consequences, such as being unable to pray or participate in congregational rituals, caused feelings of 'spiritual homelessness'. Participants gave biopsychosocial explanations of their mental ill health, consonant with and sometimes painfully conflicting with existential explanations, such as being attacked by demons. Three different patterns of interaction among biopsychosocial and existential dimensions in their explanatory systems of illness causation were identified: (a) comprehensive thinking and consensus; (b) division and parallel functions and (c) division and competitive functions. CONCLUSIONS: Prevailing medical models for understanding mental ill health do not include the individual's existential experiences, which are important for identifying risk and protective factors as well as possible resources for recovery. The various expressions of existential meaning-making identified in this devout religious subgroup illustrate that existential information cannot be generalised, even within a small, seemingly homogenous group. The three identified patterns of interactions formed a typology that may be of use in clinical settings.

Women with alcohol problems: the possible significance of personality clustering for treatment planning.

INTRODUCTION AND AIMS: Establishing subgroups in clinical practice is important for treatment planning. The aim of the study was to cluster the study group subjects according to personality traits and psychological health variables and to establish possible differences in treatment outcome in terms of: (i) drinking outcomes (gram and number of drinking days); (ii) perceived physiological health; and (iii) use of treatment resources (length of time in treatment and number of visits) among 134 treatment-seeking women with alcohol problems in a clinical context, between the two clusters obtained. DESIGN AND METHODS: Data were collected from 134 consecutive women at a Swedish clinic specialised in treating women with alcohol problems. A hierarchical cluster analysis was performed on the basis of self-rated personality scale scores and psychological health variables. RESULTS: Two clusters were identified: one in which the women displayed personality and psychological health scores indicating problems (Cluster 1); and another where the women showed personality and psychological health scores within the norm range (Cluster 2). Alcohol consumption rates at the start of treatment were the same in both clusters. The consumption rates were also the same at the end of treatment for the cluster, showing a significant decrease in alcohol consumption in each. The Cluster 1 women, however, had a significantly higher number of visits at the clinic, and rated the consequences of their alcohol drinking as being significantly worse than Cluster 2 women. DISCUSSION AND CONCLUSIONS: The importance of individual differences according to personality traits for treatment planning is discussed in terms of the need for variation in treatment time and methods.