Oral health and quality of life among people with severe or long-term mental illness: A call for interprofessional collaboration

People with severe or long-term mental illness (SMI) have poorer oral health than the general population has, but little is known about how, to what extent, and in what ways oral health problems affect daily functioning, quality of life and well-being among people in this patient group. The present study investigated oral health and oral health-related quality of life for persons with SMI in Norway. The longitudinal clinical study targeted SMI patients with their age- and gender-matched control patients at a public dental clinic in Norway. SMI patients were recruited from an ambulatory team within community mental health services. Clinical examinations followed the WHO criteria. We used a validated Oral Impact on Daily Performance (OIDP) instrument to assess oral health-related quality of life (OHRQoL). The prevalence of oral impact (OIDP > 0) was 77% among SMI patients and 22% among the controls. More than 60% of the SMI patients reported difficulties showing their teeth without embarrassment, compared to 5.5% of the controls. The results suggest that shame is a key factor inhibiting patients faced with the need for dental treatment. Collaboration between dental and mental health professionals is therefore essential for this patient group to enjoy dignified oral health and quality of life.publishedVersio

Oral health and quality of life among people with severe or long-term mental illness: A call for interprofessional collaboration

People with severe or long-term mental illness (SMI) have poorer oral health than the general population has, but little is known about how, to what extent, and in what ways oral health problems affect daily functioning, quality of life and well-being among people in this patient group. The present study investigated oral health and oral health-related quality of life for persons with SMI in Norway. The longitudinal clinical study targeted SMI patients with their age- and gender-matched control patients at a public dental clinic in Norway. SMI patients were recruited from an ambulatory team within community mental health services. Clinical examinations followed the WHO criteria. We used a validated Oral Impact on Daily Performance (OIDP) instrument to assess oral health-related quality of life (OHRQoL). The prevalence of oral impact (OIDP > 0) was 77% among SMI patients and 22% among the controls. More than 60% of the SMI patients reported difficulties showing their teeth without embarrassment, compared to 5.5% of the controls. The results suggest that shame is a key factor inhibiting patients faced with the need for dental treatment. Collaboration between dental and mental health professionals is therefore essential for this patient group to enjoy dignified oral health and quality of life.</p

God nok? Selvaktelse og interpersonlig fungering hos pasienter innen psykisk helsevern: Forholdet til diagnoser, symptomer og behandlingsutbytte

The purpose of this thesis is to contribute to the understanding of self-esteem and interpersonal functioning in psychiatric outpatients. Self-esteem is commonly regarded as the evaluative aspects of the person’s self-perception, defined as the overall evaluation of one’s worthiness as a human being, or to what degree he or she feels her- or himself as “good enough”. Mental health research has documented statistically significant associations between low self-esteem and poor mental health. However, the nature of these associations is not well explored empirically in clinical samples. The aims of the current study were (1) to explore how self-esteem is associated with general symptomatic distress, psychiatric diagnosis and interpersonal problems, (2) to explore associations between self-esteem and interpersonal style, and (3) to explore if self-esteem and interpersonal style predicted treatment outcome and drop out rates in cognitive behaviourally based psychoeducational group treatment. The study was carried out on data collected in a local psychiatric outpatient clinic in Western Norway. All patients (n = 338) admitted for an intake interview over a 12-month period completed questionnaires assessing self-esteem (RSES), symptomatic distress (SCL- 90-R), and interpersonal problems (IIP-C) as part of the assessment. Clinical and diagnostic evaluations were conducted as usual, according to the ICD-10. In addition, Paper 3 comprises a subsample (n = 65) of patients who received cognitive behaviourally based psychoeducational group treatment (12 weekly sessions). The results showed that level of symptomatic distress and interpersonal problems predicted more of the variance in self-esteem than psychiatric diagnosis. When symptomatic distress and interpersonal problems were controlled for, only affective disorders (pure and comorbid) predicted lower levels of self-esteem on a statistically significant level (Paper 1). Furthermore, the results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Also, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions (Paper 2). Lastly, low self-esteem predicted poor outcome in terms of change in interpersonal problems. However, self-esteem was not associated with outcome as measured by the Global Severity Index derived from SCL-90-R. Fifty percent of the patients improved reliably during treatment (general symptomatic reduction), but only seven patients (13 %) met the criteria for clinically significant change. Considering interpersonal problems, 25 % of the patients reported a reliable reduction; eight of these (15 %) met the criteria for clinically significant change. Fourteen patients (22 %) did not complete treatment. Drop out was predicted by marital status (single) and low levels of interpersonal agency. Based on the findings, we conclude that psychological interventions should always consider the patient’s self-esteem, regardless of the psychiatric diagnosis. Further, therapeutic work with interpersonal problems should include self-esteem issues. We also conclude that the fostering of patient agency should be considered as an important goal in psychotherapy

Oral health and quality of life among people with severe or long-term mental illness: A call for interprofessional collaboration

People with severe or long-term mental illness (SMI) have poorer oral health than the general population has, but little is known about how, to what extent, and in what ways oral health problems affect daily functioning, quality of life and well-being among people in this patient group. The present study investigated oral health and oral health-related quality of life for persons with SMI in Norway. The longitudinal clinical study targeted SMI patients with their age- and gender-matched control patients at a public dental clinic in Norway. SMI patients were recruited from an ambulatory team within community mental health services. Clinical examinations followed the WHO criteria. We used a validated Oral Impact on Daily Performance (OIDP) instrument to assess oral health-related quality of life (OHRQoL). The prevalence of oral impact (OIDP > 0) was 77% among SMI patients and 22% among the controls. More than 60% of the SMI patients reported difficulties showing their teeth without embarrassment, compared to 5.5% of the controls. The results suggest that shame is a key factor inhibiting patients faced with the need for dental treatment. Collaboration between dental and mental health professionals is therefore essential for this patient group to enjoy dignified oral health and quality of life

Barriers and facilitators for dental care among patients with severe or long-term mental illness

Background Persons who struggle with severe or long‐term mental illness (SMI) have a higher prevalence of oral health problems than the general population. Obtaining and continuing dental treatment is challenging for this patient group for many reasons, and many drop out of active treatment. Our study aimed to explore perceived barriers to obtaining optimal dental health care for patients with SMI. Further, we sought to identify possible ways to facilitate for providing true access to dental services for this population. Methods The study utilised a flexible qualitative design with data collected during ordinary clinical practice in a public dental clinic in Norway. We conducted semi‐structured face‐to‐face interviews with 51 persons with SMI twice: an initial interview before dental treatment and a final one after dental treatment. We applied the thematic analysis method. Results Thematic analysis revealed two key themes in the participants’ experiences of access to dental health services: practical conditions and relationship with the dentist. Patients reported barriers and facilitators for access to care as factors associated with patients (patient factors), with the dentist (dentist factors) and with healthcare services (system factors). Conclusions Our study indicates that persons with SMI appreciate oral health and want to obtain needed oral care and dental treatment, but they encounter barriers on several fronts. The participants offered suggestions for how to facilitate attendance and adherence. Our findings suggest that dental healthcare services require reorganisation to meet the needs of patients with SMI