The impact of providing care to relatives with a severe mental illness : the caregivers’ experience

The purpose of this study is to explore the impact on Maltese family caregivers in providing care to a relative with a severe mental illness (SMI). Purposive sampling and in-depth semi-structured interviews were conducted with seven caregivers (four females and three males). The interview data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (IPA). Four themes emerged from the analysis, namely Range of Emotions, Increased Responsibility, Toll on Physical Health and Change in Lifestyle. This study demonstrates that the caregivers experienced a range of negative emotional and physical responses. Changes in their lifestyle were made, as caregivers provided complete care to their ill relative, as well as ensured that they came to no harm. Female participants tended to self-blame, attributing behavioural problems in the ill relative to their actions. Parent caregivers experienced distress regarding care provision in the eventuality that they suffered from ill health or death. Although parents acknowledged the support provided by siblings, they strived to cope by themselves, as siblings were perceived to have responsibilities of their own. The role of mental health professionals in such a scenario includes the understanding of the unique perceptions of family caregivers, as well as targeting any dysfunctional perceptions. Furthermore, caregivers should be made aware of entities that provide support within the community setting. Sufficient resources also need to be provided to ensure effective community support to family caregivers.peer-reviewe

Health perceptions and adherence to diet

Advances in the medical and technological field have greatly extended the life-expectancy of individuals with chronic conditions. However, such individuals may still experience difficulties in various domains such as in adjusting to their condition and in adhering to a recommended treatment regimen. Hence, one potential role of research on health perspectives is to provide information on factors which contribute to the favorable management of a chronic condition. This paper will utilize Leventhal’s self-regulation model1 in order to explain plausible cognitive factors that may have an influence on adherence to a diet regimen.peer-reviewe

Facilitators and barriers to treatment with haemodialysis among persons in mid-adulthood : an interpretative phenomenological analysis

This study demonstrated the need for healthcare professionals to allocate time and space, where persons on HD may discuss personal issues that relate to their care experience in a private care setting. By identifying and exploring the barriers and facilitators of patients on haemodialysis, healthcare professionals may formulate individualised care plans which may improve patients' adherence to their HD treatment

Coping experiences when caring for a person with severe mental illnesses : a qualitative study

Within a community setting the responsibility of caring for a mentally ill individual, often falls on a family member. The aim of this study is to explore the coping experiences of carers of persons with severe mental illnesses. Semi-structured interviews were conducted with seven family carers having relatives with severe mental illnesses. Data collected was analysed using Interpretative Phenomenological Analysis. Three main themes emerged: 'Positively re-interpreting a situation', 'Seeking information and assistance' and 'Planning for the future'. Findings demonstrate that interventions should be sensitive to and responsive to the unique needs of carers and should target and respond to their need for knowledge, skills and support. Provision of support by health care providers in a community setting were perceived as a necessary means of support and enabled carers to cope more effectively. Planning for the ill relative's future helped to re-assure carers that quality care would still be provided to the person, even when their own health and strength might fail.peer-reviewe

Meeting the challenges of person-centredness in mental health care and education

The provision of mental health care is undergoing significant changes, transitioning from a medical model that focuses on the diagnosis and treatment of mental health conditions to a person-centred holistic approach, that puts the individual at the centre of care. Nonetheless, the narratives of persons with mental health challenges still resonate with experiences of being viewed in terms of ‘problems, symptoms and deficits rather than being citizens with strengths and areas of competence’ (Borg & Karlsson, 2017, p.221). Such experiences often result in feelings of isolation, shame and/or stigmatization by others. The experience of stigmatising attitudes has been further linked to diagnostic overshadowing, which can negatively impact access to healthcare within both mental health and general services (Banks, Scerri & Davidson, 2021).peer-reviewe

Navigating the storm to recovery through the pictorial representations of persons in the recovery phase from unipolar depression

Depression is a highly complex mental illness that presents challenges, such as difficulties for persons with depression to communicate their experiences. This is compounded further by a paucity of in-depth and pictorial accounts on their experiences of the recovery process. The combination of pictorial representations and interviews with persons who are recovering from depression, may assist them in communicating these lived experiences. Five participants recovering from unipolar depression and who were in the late stages of recovery were recruited through purposive sampling. Data were collected through the conduction of art sessions, where participants pictorially represented their experience of living with depression and their road to recovery. Semi- structured interviews were then used to explore their artwork. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Two superordinate themes emerged from participants’ interviews, namely: ‘A New Me in Me’ that incorporating changes in their identity, physical, emotional, and social experiences, and ‘Life as an amalgamation of colour’ describing their search for meaning and the importance of spirituality, hope, gaining control and positivity in the recovery process. The use of pictorial representations combined with interviews can add depth to participant narratives, that serve to enhance the therapeutic alliance between the patient– professional dyad.peer-reviewe

Intimate partner violence : psychological and verbal abuse during pregnancy

AIM: To examine the association between sociodemographic, pregnancy related variables and psychological and verbal intimate partner abuse (PIPA), as well as determine which of these variables, are predictors of PIPA during pregnancy. BACKGROUND: Intimate partner violence is a significant health issue, with severe implications to both mother and foetus. However, much of the research to date focuses on the outcomes of physical abuse. This article addresses the dearth in literature by examining the association between sociodemographic, pregnancy related variables and PIPA during pregnancy. DESIGN: A survey research design was used. METHOD: Three hundred postnatal women were recruited by convenience, non-proportional quota sampling technique. The WHO Violence Against Women Instrument was self-administered by participants. Association between categorical variables was assessed using Pearson's Chi-square, strength of association using Cramer's V and the phi coefficient, and identification of predictor variables for psychological and verbal abuse using Logistic regression. RESULTS: Four predictors were identified for psychological abuse namely i.e., low education level in women, an unplanned pregnancy, experiencing two or more pregnancy related health problems and living with an unemployed partner. Whilst unemployment in women, an unplanned pregnancy, fear of partner, and a low education level of partner, were identified as predictors of verbal abuse. CONCLUSION: This study identified a number of variables which strongly predict PIPA during pregnancy; however, it extends the available literature by identifying a low standard of education in males, unemployment and fear of the intimate partner as significant predictors of PIPA

A sociocultural perspective of mental health stigma in Malta

Introduction: Epidemiological research depicting the overall prevalence of mental health disorders in Malta is sparse. With a population of over 535,000 inhabitants, it is estimated that around 120,000 individuals have a mental disorder. The reported local percentage prevalence stands at 6.6% for depression; 7.8% for anxiety, and for schizophrenia, at 0.026% for the general population and 0.4% for asylum seekers. Approximately 25.2% of individuals under the age of 14 are at risk of developing a mental disorder, which is higher than that estimated in Europe. Stigma, or the negative judgement toward individuals with a mental illness , is a prevailing concern that has been on local and international agendas for years. Research worldwide depicts that stigma affects various dimensions, including treatment adherence, family dynamics, employment, social inclusion, and the occurrence of other mental health illnesses. Individuals having mental illnesses in Malta also experience stigma, and an exploration of this phenomenon requires immersion in a Mediterranean cultural context, due to its influence on Maltese society. Such cultural beliefs are of significance as they influence how disorders are understood, described, and managed, how help is sought and how treatment is received. Malta, being at the center of the Mediterranean Sea, and having been under the governance of Arabic, Central and Southern European territories, has been inspired to develop into what it is today, with Mediterranean values remaining prominent. Familial support, honor, religion, shame, and strong family values are factors shaping overall wellbeing in a Mediterranean culture, possibly affecting how Maltese society views and behaves when confronted with mental illness. Despite efforts to shift institutional care to community care, discussing mental health disorders is still not a customary practice and many refrain from admitting to any pertinent mental health challenges. Conversely, discussing mental health wellbeing in general is becoming more acceptable, possibly due to the ever-increasing mental wellbeing awareness campaigns, focusing on the importance of creating a healthy work-life balance. The association between Maltese cultural and societal norms and public attitudes toward mental health poses concern, particularly when trying to curb stigmatizing behaviors. This article aims at raising awareness on the impact of this relationship and offers views on the effectiveness of current stigma reduction movements and initiatives.peer-reviewe

Post-Traumatic Growth after Cancer: A Thematic Analysis Study

Background: That a diagnosis of, and treatment to cancer brings along shock, distress and possible long-term negative life changes is very clear from human experience and research alike. But such an experience can also relate to positive life changes, as increasing research on the aftermath of serious illness, such as cancer diagnosis consistently shows. Observations of positive outcomes linked to quality of life are increasingly being found in cancer studies. These results seem to converge with post-traumatic growth (PTG)  which emphasize positive life changes as resulting from considerable life-changing events that are borne from crises or trauma. Objectives: Aims to this study were to 1) investigate the holistic impact and ramifications of PTG on the recovery from serious illness such as cancer; 2) clarify the relationship, if any, of PTG with mental health outcomes; and 3) how is PTG strengthened or otherwise, when one is faced by such life-changing event. Methods: Using a Thematic Analysis design, we investigated how the diagnosis of, and treatment to cancer impacted the patients and survivors. Semi-structured interviews were conducted with people who had received treatment for breast (n=3), MSS (n=1), ovarian (n=2), bone (n=2), H. Lymphoma (n=1), Liver (n=1). Using descriptive mapping, we clarified whether this study results are consistent with Tedeschi and Calhoun’s PTG framework. Results: Findings charted on the key factors of PTG. Conclusions: Cancer results in varied consequences and in negative and positive adjustments. Further development of findings which charted on major PTG dimensions is warranted

Mental Health Perceptions from Artwork

The relationship between artwork and mental health has been the subject of various research endeavours. Whilst artwork has been long used as a means of emotional expression, it is also a method of raising mental health awareness. In this study, an art collection was presented to depict the challenges faced by many individuals living with a mental illness. Through a series of open-ended questions, twenty-nine participants were requested to give a title to each piece and to describe the perceived message and emotions related to each painting. The thematic analysis process of the participants’ descriptions led to the identification of three themes, namely those of Darkness, Solitude and Recovery. Whilst congruence was often observed between the participants themselves and between the viewers and the artist, discrepancies were also noted. Artwork can be an important medium in addressing stigma and in guiding reflections on mental health topics