Experiencias, actitudes y expectativas laborales de personas con trastornos mentales severos en un hospital de día del sector privado / Experiences, attitudes and expectations towards work among individuals with severe mental disorders in a private day hospital

INTRODUCCIÓN: El empleo es uno de los componentes centrales de la recuperación en personas con trastornos mentales severos y un aspecto clave en la validación social. El objetivo del estudio fue conocer la experiencia laboral, el interés por trabajar, las conductas específicas de búsqueda laboral, el estatus ocupacional y las actitudes frente al trabajo en esta población. MÉTODOS: Un total de 103 personas en tratamiento en una institución de salud mental de la ciudad de Buenos Aires completaron un cuestionario censal en 2018 con preguntas abiertas y cerradas. El análisis fue mixto, con cálculo y comparación de frecuencias según grupos y análisis temático. RESULTADOS: La mayoría de los participantes tenía experiencia laboral, aunque solo el 29% estaba trabajando. El 93% de quienes no trabajaban dijo tener interés en hacerlo. Solo un 33% de quienes no tenían trabajo realizaban actividades para conseguirlo. Un 85% consideró que podría tener problemas en caso de trabajar y el 15% señaló que podría hacerle mal. No se observaron diferencias significativas según diagnóstico o género. DISCUSIÓN: El elevado interés por trabajar de las personas con trastornos mentales severos contrasta con un porcentaje considerable que, pese a ello, no busca trabajo y anticipa dificultades laborales. El estigma podría ser uno de los mayores obstáculos para la búsqueda y la inclusión laboral. Los programas de apoyo al empleo deben considerar algunos de los problemas hallados en este estudio.

Day hospital treatment for people with severe mental illness according to users' perspectives: what helps and what hinders recovery?

BACKGROUND: Scarce information is available about how users experience treatment at mental health day hospitals, particularly in South America. AIMS: To explore users' perspectives about elements of day hospital treatment that facilitate or hinder the recovery process in a mental health facility in Buenos Aires, Argentina. METHODS: Semi-structured individual interviews (n = 8) and focus groups (n = 4) were carried out with a convenience sample of users of a mental health day hospital program based on a formulation, testing and redevelopment of propositions approach. Results were analyzed through grounded theory techniques. RESULTS: Categories indicating recovery were: starting to do things, being able to see themselves from a new perspective, mood improvement and changes in interpersonal relationships. Aspects facilitating recovery were: activities organized by the facility, the group approach, the care provided by facility workers and the physical environment. Hindering aspects were: heterogeneity of users in terms of age, severity, diagnosis and being underestimated by staff. CONCLUSIONS: Being active again was considered to be the main recovery indicator in this cultural context and participating in activities led by skilled facilitators was the most beneficial factor of the program according to the users.

Family care in chronic obstructive pulmonary disease: what happens when the carer is a man?

Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for family carers. However, knowledge regarding the specific issues faced by men in the COPD caregiving role is nonexistent. This study explored the experience of husbands and sons providing care to a family member with moderate-to-severe COPD. A cross-sectional qualitative study using in-depth, semi-structured individual interviews was conducted with twelve men carers: seven husbands with a mean age of 70.9 ± 8.8 years and five sons with a mean age of 43.4 ± 10.5 years. The interviews were analysed for recurrent themes using thematic analysis. Main findings suggest that men are committed and dedicated carers; however, differences between husbands and sons related to 'meaning', 'challenges and constraints', 'fears and concerns about the future', 'needs' and 'positive aspects' have emerged. These differences reflect relationship and generational differences and are of relevance when planning adequate community support interventions.

Global Functioning of COPD Patients With and Without Functional Balance Impairment: An Exploratory Analysis Based on the ICF Framework.

Balance impairment is a common manifestation in older people with COPD and may contribute to overall functional decline; however, the relationship between balance and global functioning has not been studied. This study aimed to explore the global functioning of COPD patients with and without functional balance impairment. Functional balance was assessed with the Timed Up-and-Go (TUG) test and global functioning with the Comprehensive ICF Core Set for Obstructive Pulmonary Diseases. Participants (n = 134) were divided in 2 groups according to their performance in TUG (with and without balance impairment) and the ICF Core Set results were compared between groups. Fifty-four (40.3%) participants had functional balance impairment. The groups presented a similar extent of problems in several categories of the ICF components. However, participants with balance impairment were more severely affected (p < 0.05) in energy, pain, respiratory system, weight maintenance, exercise tolerance, neuromusculoskeletal and movement-related functions, and structure of head and neck. They also presented a significantly worse performance in handling psychological demands and activities related to mobility, self-care, domestic, community and social life, and a more negative perception of Environmental factors related to products and technology of buildings for private use and social support services (p < 0.05). Patients with functional balance impairment have more functional problems and are more severely restricted in daily life than patients without compromised balance. Understanding the relationship between balance control and global functioning will contribute to guide interventions aimed at maintaining functioning and minimizing disability.

Development of a family-based pulmonary rehabilitation programme: an exploratory study.

PURPOSE: This study explored the expectations of patients with chronic obstructive pulmonary disease (COPD) and family members about a family-based pulmonary rehabilitation (PR) programme; developed and implemented a family-based PR programme and explored the impacts of the intervention on patients and family members. METHOD: Patients with COPD and family members were interviewed. A family-based PR programme was designed. Patients' breathlessness, muscle strength, exercise tolerance, functional balance and health-related quality of life were collected pre/post-programme. Family coping and adjustment to illness were measured in patients and family members. Focus groups were conducted after the programme. RESULTS: Patients (n = 35; 69 ± 10 years; FEV1 62 ± 15% predicted) and family members (n = 35; 57 ± 12 years) had similar expectations/needs about a PR programme. Nine dyads participated. Patients' quadriceps strength, exercise tolerance and functional balance improved significantly (all p values < 0.023). Patients and family members seem to use more positive coping behaviours (p = 0.026; p = 0.011). Patients (n = 7; 78%) and family members (n = 8; 89%) considered having more knowledge about COPD and its management. Patients felt more functional (n = 9; 100%) and reported their family members to be more active (n = 3; 38%). In family members' perspective, their relationship with the care receiver was enhanced (n = 2; 22%). CONCLUSIONS: PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD. Implications for Rehabilitation Patients with chronic obstructive pulmonary disease (COPD) and their family members have similar expectations and needs about a family-based pulmonary rehabilitation (PR) programme. A family-based PR programme is feasible to implement within primary care. PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

Family-based psychosocial support and education as part of pulmonary rehabilitation in COPD: a randomized controlled trial.

BACKGROUND: Involving family as part of the patient's rehabilitation plan of care might enhance the management of COPD. The primary aim of this study was to investigate the impact of a family-based pulmonary rehabilitation (PR) program on patients and family members' coping strategies to manage COPD. METHODS: Family dyads (patient and family member) were randomly assigned to family-based (experimental) or conventional (control) PR. Patients from both groups underwent exercise training three times a week and psychosocial support and education once a week, during 12 weeks. Family members of the family-based PR attended the psychosocial support and education sessions together with patients. In the conventional PR, family members did not participate. Family coping and psychosocial adjustment to illness were assessed in patients and family members of both groups. Patients' exercise tolerance, functional balance, muscle strength, and health-related quality of life were also measured. All measures were collected pre/post-program. RESULTS: Forty-two dyads participated (patients: FEV1, 70.4% ± 22.1% predicted). Patients (P = .048) and family members (P = .004) in the family-based PR had significantly greater improvements in family coping than the control group. Family members of the family-based PR had significantly greater changes in sexual relationships (P = .026) and in psychologic distress (P = .033) compared with the control group. Patients from both groups experienced significant improvements in exercise tolerance, functional balance, knee extensors strength, and health-related quality of life after intervention (P < .001). CONCLUSIONS: This research supports family-based PR programs to enhance coping and psychosocial adjustment to illness of the family system. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02048306; URL: www.clinicaltrials.gov.

Effects of a pulmonary rehabilitation program with balance training on patients with COPD.

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) have balance impairments. However, pulmonary rehabilitation (PR) is associated with only minor improvements in functional balance. Therefore, there is a need to explore the role of balance training within PR. This study aimed at assessing the effects of a PR program, with a specific component of balance training, on functional balance of patients with COPD. METHODS: Outpatients with COPD (N = 22, age = 68.0 ± 11.8 years; forced expiratory volume in 1 second = 72.2 ± 22.3% predicted) participated in a 12-week PR program including exercise training and psychosocial support and education. Exercise training sessions comprised endurance, strength, and a specific component of balance training. The Timed Up and Go (TUG) test was used to assess functional balance before and after the PR. Health-related quality of life (St George's Respiratory Questionnaire), quadriceps muscle strength (10 repetition maximum), and exercise tolerance (6-minute walk test) were also assessed. RESULTS: Patients demonstrated significant improvements in TUG scores after PR (mean change -1.7 ± 1.4 seconds; P = .001; effect size = 1.249). Before PR, 9 (41%) participants and after PR only 1 (4.5%) participant had a TUG performance worse than the average performance of age-matched healthy peers (P = .008). The St George's Respiratory Questionnaire symptoms score (P = .012), quadriceps muscle strength (P = .001), and exercise tolerance (P = .001) were also improved. CONCLUSIONS: Pulmonary rehabilitation with a specific component of balance training had a large effect on functional balance in patients with COPD. Findings highlight the value of including balance training in PR programs. Further research is needed to determine the optimal intervention to improve balance and its specific components among patients with COPD.

Day-to-day living with severe chronic obstructive pulmonary disease: towards a family-based approach to the illness impacts.

OBJECTIVE: This study explores the perspectives of both patients and family members regarding the impact of chronic obstructive pulmonary disease (COPD) in their family life. DESIGN: An exploratory qualitative study was conducted with patients and their family members in the chronic phase of COPD. Individual interviews were performed to explore participants' perspectives and submitted to thematic analysis. RESULTS: Six major themes emerged from patients' perspective: (1) impact of COPD symptoms on personal and family daily life; (2) (over)protective family support; (3) difficulties in couple communication; (4) sense of identity loss; (5) fear of COPD progression; and (6) coping resources. Five main themes emerged from the family members' perspective: (1) restrictions in family's social life; (2) emotional distress related to COPD exacerbations; (3) tension in couple relationship; (4) financial strain of COPD; and (5) coping resources. CONCLUSIONS: The overall findings illustrate the complex interaction between the experience of living with COPD and communication patterns, emotional states, social support and social roles within the family. The results highlight the need to develop family-based interventions to facilitate a functional adjustment to COPD. However, these interventions in COPD remain undeveloped and empirical evidence is needed.

Predicting anxiety and depression among family carers of people with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) can be highly incapacitating, imposing a significant burden on family members, however, limited research has been conducted on psychological health of family carers. Thus, this study examined anxiety and depression symptoms in family carers of people with COPD and their predictors. METHODS: A cross-sectional study was conducted with family carers and respective patients with COPD. The caregiving situation and the perceived burden, through the Carers' Assessment of Difficulties Index, were collected from family carers. Patients' COPD severity and activities limitation were assessed. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression symptoms in family carers and patients. Scores ≥8 were considered clinically significant. RESULTS: A total of 203 family carers (58.2 ± 14.8 years old; 75.4% female) and respective patients with COPD (69.2 ± 11.5 years old; 36.5% female) were included. Clinically significant anxiety symptoms (HADS-anxiety ≥8) were present in 63.5% (n = 129) of family carers, depression symptoms (HADS-depression ≥8) were in 34% (n = 69) and both were in 27.1% (n = 55). Perceived burden [odds ratio (OR) 1.04, 95% confidence intervals (CI) = 1.01-1.06; 1.05, 95% CI = 1.03-1.07] and patients' activities limitation (OR 1.32, 95% CI = 1.01-1.79; 1.41, 95% CI = 1.01-1.96) were significant predictors of anxiety and depression symptoms. Anxiety symptoms were also predicted by female gender (OR 0.33, 95% CI = 0.16-0.66) and depression symptoms by older age (OR 1.03, 95% CI = 1.01-1.06). CONCLUSION: Family carers of patients with COPD experience anxiety and depression symptoms. Perceived burden, female gender, older age, and patient's activities limitation were predictors of these distressing symptoms. These findings highlight the need to address family carers' needs, namely by investigating the effectiveness of supportive interventions on family's psychological health.

Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the patient's perspective.

This study aimed to validate the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for obstructive pulmonary diseases (OPDs) from the perspective of patients with chronic obstructive pulmonary disease. A cross-sectional qualitative study was carried out with outpatients with chronic obstructive pulmonary disease using focus groups with an ICF-based approach. Qualitative data were analysed using the meaning condensation procedure by two researchers with expertise in the ICF. Thirty-two participants (37.5% women; 63.8 ± 11.3 years old) were included in six focus groups. A total of 61 (86%) ICF categories of the Comprehensive ICF Core Set for OPD were confirmed. Thirty-nine additional second-level categories not included in the Core Set were identified: 15 from the body functions component, four from the body structures, nine from the activities and participation and 11 from the environmental factors. The majority of the categories included in the Comprehensive ICF Core Set for OPD were confirmed from the patients' perspective. However, additional categories, not included in the Core Set, were also reported. The categories included in the Core Set were not confirmed and the additional categories need to be investigated further to develop an instrument tailored to patients' needs. This will promote patient-centred assessments and rehabilitation interventions.

Caring for people with early and advanced chronic obstructive pulmonary disease: how do family carers cope?

AIMS AND OBJECTIVES: To examine the coping strategies of family carers of people with early and advanced chronic obstructive pulmonary disease and how those relate to their subjective health. BACKGROUND: Caring for a family member with chronic obstructive pulmonary disease can be a stressful experience. Understanding how carers cope with this is critical for improving outcomes. However, this topic has received little attention in the literature, particularly considering the care-giving experience with early chronic obstructive pulmonary disease. DESIGN: A cross-sectional study with a convenience sample of family carers of people with chronic obstructive pulmonary disease. METHODS: A structured questionnaire was used to collect data on socio-demographics and care-giving characteristics. Self-rated physical and mental health was measured by two items from the International Classification of Functioning, Disability and Health checklist. Coping strategies were assessed with the Carers' Assessment of Managing Index. Descriptive and inferential analyses were performed. RESULTS: A total of 158 family carers participated: 109 caring for people with early and 49 with advanced chronic obstructive pulmonary disease. The two groups differed significantly on self-rated mental health and on problem-solving, emotional-cognitive and managing stress coping type. Significant correlations between self-rated physical health and problem-solving coping and between self-rated mental health and emotion-cognitive and managing stress coping were found for carers of patients with advanced chronic obstructive pulmonary disease. CONCLUSIONS: This study provides a unique insight into family carer coping strategies at different stages of chronic obstructive pulmonary disease. Carers of people with early and advanced chronic obstructive pulmonary disease cope differently with their caring demands. Nevertheless, problem-focused coping strategies were perceived as the most helpful by both groups. RELEVANCE TO CLINICAL PRACTICE: The findings are relevant to informing early supportive interventions aiming to prevent burden and promote healthy adjustment to care-giving demands within the specific context of chronic obstructive pulmonary disease.

Functional balance in older adults with chronic obstructive pulmonary disease.

This study assessed functional balance among older adults at all grades of chronic obstructive pulmonary disease (COPD) and explored balance impairment predictors. A cross-sectional study with outpatients with COPD (N = 160; M = 72.2 years, SD = 7.9; mean forced expiratory volume in 1 s = 63.8% predicted, SD = 23.7) was conducted. The Timed Up and Go (TUG) test was used to assess functional balance. Functional balance impairment was defined as a TUG score exceeding the upper limit of the confidence intervals of normative values for healthy older adults. Participants performed the TUG test in 11.0 s (SD = 4.8 s). Functional balance impairment was present in 44.4% of the participants and was significantly more frequent in severe to very severe COPD (62.5%). Body mass index (odds ratio [OR] = 1.12), number of medications (OR = 1.20), restriction in recreational activities (OR = 1.66), and depression score (OR = 1.14) were multivariate predictors of functional balance impairment. Functional balance impairment is present in early COPD, although more evident at advanced grades. These findings highlight the importance of balance assessment in older patients at all COPD grades.

Caring for relatives with chronic obstructive pulmonary disease: how does the disease severity impact on family carers?

OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for families. However, information on the impacts of caring for relatives with COPD on carers' psychological health is limited. This study aimed to analyse the subjective burden of family carers of people with early and advanced COPD and its predictor variables. METHODS: A cross-sectional study was conducted. A structured questionnaire was used to collect socio-demographics and care-giving characteristics. Self-rated physical and mental health were measured by two items from the International Classification of Functioning, Disability and Health checklist. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Subjective burden was assessed with the Carers' Assessment of Difficulties Index (CADI). Descriptive and inferential analyses were performed. RESULTS: A total of 167 family carers participated: 113 were caring for people with early and 54 with advanced COPD. Both groups presented anxiety/depression symptoms. Those caring for people with advanced COPD reported higher subjective burden, more depression symptoms and poorer self-rated mental health than those caring for early COPD. Advanced COPD (coefficient 6.7), depression (coefficient 6.3), anxiety (coefficient 5.6), care-giving hours per week (coefficient 3.2) and self-rated mental health (coefficient 2.8) were significant predictors of carers' subjective burden. CONCLUSION: The findings suggest that the gradual course of COPD imposes an increasing physical and emotional burden on carers, with negative impacts on their psychological health. The study highlights the relevance of early interventions in the context of COPD to prevent carers' burden.

Comprehensive ICF core set for obstructive pulmonary diseases: validation of the activities and participation component through the patient's perspective.

PURPOSE: This study aimed to validate the Activities and Participation component of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Obstructive Pulmonary Diseases (OPD) from the patient's perspective. METHODS: A cross-sectional qualitative study was conducted with a convenience sample of outpatients with Chronic Obstructive Pulmonary Disease (COPD). Individual interviews were performed and analysed according to the meaning condensation procedure. RESULTS: Fifty-one participants (70.6% male) with a mean age of 69.5 ± 10.8 years old were included. Twenty-one of the 24 categories contained in the Activities and Participation component of the Comprehensive ICF Core Set for OPD were identified by the participants. Additionally, seven second-level categories that are not covered by the Core Set were reported: complex interpersonal interactions, informal social relationships, family relationships, conversation, maintaining a body position, eating and preparing meals. CONCLUSIONS: The activities and participation component of the ICF Core Set for OPD was largely supported by the patient's perspective. The categories included in the ICF Core Set that were not confirmed by the participants and the additional categories that were raised need to be further investigated in order to develop an instrument according to the patient's perspective. This will promote a more patient-centred assessments and rehabilitation interventions. Implications for Rehabilitation The Activities and Participation component of the Comprehensive ICF Core Set for OPD is largely supported by the perspective of patients with COPD and therefore could be used in the assessment of patients' individual and social life. The information collected through the Activities and Participation component of the Comprehensive ICF Core Set for OPD could be used to plan and assess rehabilitation interventions for patients with COPD.

Chronic obstructive pulmonary disease and functioning: implications for rehabilitation based on the ICF framework.

PURPOSE: This study aimed to describe the functioning of patients with Chronic Obstructive Pulmonary Disease (COPD) according to the International Classification of Functioning, Disability and Health (ICF) framework to inform future rehabilitation interventions. METHOD: A cross-sectional study with a convenience sample of outpatients with COPD was conducted. Data were collected using the Comprehensive ICF Core Set for Obstructive Pulmonary Diseases. Descriptive and inferential statistics were applied. RESULTS: In total, 119 participants (71.43% male) with a mean age of 68.71 ± 11.61 years old were included. The frequency and extent of the majority of the impairments assessed were similar among participants at different COPD grades. The most relevant (frequency >70%) Body functions and structures impairments were related to exercise tolerance functions, sensations associated with cardiovascular and respiratory functions and respiratory system structure. Mobility and domestic life restrictions were the most frequently reported in the activities and participation component. Products for personal consumption, immediate family, health professionals and their attitudes were most frequently understood as facilitators whilst climate and air quality were perceived as barriers. CONCLUSIONS: Recommendations were drawn from this study in order to improve comprehensive rehabilitation interventions for patients with COPD based on ICF framework. IMPLICATIONS FOR REHABILITATION: Functioning of patients with Chronic Obstructive Pulmonary Disease can be comprehensively assessed in a worldwide common language - the International Classification of Functioning, Disability and Health. Rehabilitation interventions for patients with Chronic Obstructive Pulmonary Disease should be designed according to the International Classification of Functioning, Disability and Health framework, i.e. assessing and monitoring Body functions, Body structures, Activities and participation and Environmental factors.