Beliefs about mental health in incarcerated males: a qualitative interview study

Introduction: Beliefs about mental health are shaped by the sociocultural context. Prisons have unique environmental and social features, and the prevalence of mental health problems in incarcerated populations is exceptionally high. These features make prisons especially interesting settings for exploring health beliefs. The aim of this study was to explore the conceptualizations of mental health and coping preferences in a prison environment. Methods: Individual in-depth interviews were conducted with fifteen incarcerated males from three prisons in Northern Norway. The design draws on central elements from Grounded Theory. Results: Mental health was perceived as distinct from mental illness by many of the participants. They coped with the prison environment by focusing on the things that gave them a sense of meaning and autonomy – this also formed their conceptualization of mental health. Furthermore, social interaction and activities were perceived as important to enhance and maintain mental wellbeing, however there were institutional barriers to using these coping strategies. The prison environment was integrated in the participants conceptualizations of mental health problems, and psychosocial stressors were emphasized in causal attributions. Biological and dispositional factors were less frequently mentioned. The participants preferred non-medical management for mental health problems and most displayed a reserved attitude towards psychotropic medications. The exception was attention-deficit hyperactivity disorder, for which they held neurobiological causal beliefs, together with a corresponding preference for medication as treatment. Conclusion: The main finding was a firm integration of the prison context in in the participants’ beliefs about mental health. We theorize that fusion of prison conditions and mental health beliefs were brought on by the processes of prisonization, observing mental distress in peers and attempts to protect selfesteem by externalizing the causes for mental health problems. Access to activities, social time, and “someone to talk to” were perceived to be crucial for improving and preserving mental health.publishedVersio

Seasonality in pain, sleep and mental distress in patients with chronic musculoskeletal pain at latitude 69° N

This is an Accepted Manuscript of an article published by Taylor & Francis in Chronobiology International on 28 May 2020, available online: https://doi.org/10.1080/07420528.2020.1764011.Seasonality is evident in several aspects of human health and behavior, whereas seasonality in chronic pain is less well studied. We examined seasonal variation in pain severity and pain dissemination, as well as in pain-associated conditions, such as sleep impairment, sleep timing, mental distress, fatigue and physical activity. We also examined if any of these associated conditions moderated the seasonality in pain. This prospective study was conducted in the subarctic municipality of Tromsø, Norway (69º North), on a sample of patients with chronic musculoskeletal pain (N = 56). Data were collected with self-report questionnaires and objective actigraphy measures (7 days) twice: winter and summer. Mixed linear regression models were fitted. A modest seasonality effect was observed in pain severity (highest in summer), but not in pain dissemination. Seasonality with increased physical activity and delayed sleep timing in the summer was also present. The remaining pain-associated self-report or objective measures indicated no seasonality. The season–pain association was not significantly moderated by any of the pain-associated conditions. Previous studies on healthy individuals residing in polar areas have suggested an opposite seasonal effect with delay of the sleep–wake rhythm in winter. Our results based on a clinical sample thus represent a novel finding that needs to be examined further with regard to seasonal circadian entrainment and alignment in pain populations. These results may have clinical value for the treatment of patients with musculoskeletal pain as seasonality may require seasonal adjustments of pain treatment strategies

Sleep Characteristics in Adults With and Without Chronic Musculoskeletal Pain. The Role of Mental Distress and Pain Catastrophizing

Objectives: Sleep disturbance is associated with persistence and exacerbation of chronic pain. As this relationship seems to be bidirectional, factors underpinning sleep disturbance may prove important in multimodal rehabilitation approaches. The aim of this cross-sectional study was to examine the impact of psychological symptoms on subjective and objective sleep measures in patients with chronic musculoskeletal pain (CMP), as compared with pain-free controls. Materials and Methods: Sleep was assessed by self-report questionnaires, actigraphy, and polysomnography recordings in 56 patients (75.0% female; Mage=41.7 y, SD=10.8 y) with CMP and compared with 53 matched pain-free controls (71.7% female; Mage=41.8 y, SD=10.7). Mental distress (Hopkins Symptoms Checklist [HSCL]) and Pain Catastrophizing Scale (PCS) were tested as predictors of objective and subjective sleep measures in multiple regression models, and their indirect effects were tested in bootstrapped mediation models. Results: The sleep data revealed substantially more subjective sleep disturbance (Hedge g: 1.32 to 1.47, P<0.001), moderately worse sleep efficiency in the actigraphy measures (Hedges g: 0.5 to 0.6, P<0.01), and less polysomnography measured slow wave sleep (Hedges g: 0.43, P<0.05) in patients, as compared with controls. HSCL was strongly associated with the self-reported measures Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). HSCL also partially explained the association between pain and sleep, but HSCL was not associated with any of the objective sleep measures. More pain catastrophizing was related to less slow wave sleep. Discussion: The differences in subjective and objective sleep measures indicate that they probe different aspects of sleep functioning in patients with musculoskeletal pain, and their combined application may be valuable in clinical practice. Self-reported sleep disturbance seems to overlap with affective dimensions reflected by the HSCL questionnaire

Beliefs about mental health in incarcerated males: a qualitative interview study

IntroductionBeliefs about mental health are shaped by the sociocultural context. Prisons have unique environmental and social features, and the prevalence of mental health problems in incarcerated populations is exceptionally high. These features make prisons especially interesting settings for exploring health beliefs. The aim of this study was to explore the conceptualizations of mental health and coping preferences in a prison environment.MethodsIndividual in-depth interviews were conducted with fifteen incarcerated males from three prisons in Northern Norway. The design draws on central elements from Grounded Theory.ResultsMental health was perceived as distinct from mental illness by many of the participants. They coped with the prison environment by focusing on the things that gave them a sense of meaning and autonomy – this also formed their conceptualization of mental health. Furthermore, social interaction and activities were perceived as important to enhance and maintain mental well-being, however there were institutional barriers to using these coping strategies. The prison environment was integrated in the participants conceptualizations of mental health problems, and psychosocial stressors were emphasized in causal attributions. Biological and dispositional factors were less frequently mentioned. The participants preferred non-medical management for mental health problems and most displayed a reserved attitude towards psychotropic medications. The exception was attention-deficit hyperactivity disorder, for which they held neurobiological causal beliefs, together with a corresponding preference for medication as treatment.ConclusionThe main finding was a firm integration of the prison context in in the participants’ beliefs about mental health. We theorize that fusion of prison conditions and mental health beliefs were brought on by the processes of prisonization, observing mental distress in peers and attempts to protect self-esteem by externalizing the causes for mental health problems. Access to activities, social time, and “someone to talk to” were perceived to be crucial for improving and preserving mental health

Psychological factors in the recovery of coronary artery disease patients in Northern Norway

The thesis comprises four studies of psychosocial factors associated with the recovery of patients following Coronary Artery Bypass Graft (CABG) surgery and Percutaneous Coronary Intervention (PCI) treatment in Northern Norway. Paper I describes an interview study of nine patients following CABG surgery. The patients reported extensive use of avoidant (e.g. neglecting symptoms, avoiding thoughts about illness) and approach coping strategies (e.g. persistently searching for a diagnosis, mentally preparing for surgery). In paper II, a Norwegian translation of the Type D personality measure (DS14) was tested in a survey of 432 CABG and PCI patients. The instrument showed acceptable psychometric properties. The prevalence of Type D personality was relatively low (18%) compared to other European and US studies. Based on the same survey, paper III describes a study of psychosocial and treatment factors associated with Return To Work (RTW) in 185 CABG and PCI patients that were working prior to hospitalization. Six independent and significant factors were associated with RTW, including age below 67 years, higher education and Internal Locus of Control (LoC) as positive predictors. CABG, smoking and Powerful Others LoC were negative predictors. Paper IV describes the development, training and implementation of a patientcentred information procedure provided by nurses to CABG patients. Using a qualitative method, a set of case descriptions was developed, illustrating difficult nurse-patient interactions and how the patient-centered approach could be applied in these situations. The nurses found the patient-centered approach useful in a range of communicatively challenging situations, including when patients asked a very high number of questions, when patients seemed to have difficulties expressing their worries, when patients had many complaints, and when spouses of patients expressed their own worries

The case of case reports: A decade of publications by staff at a major university hospital

Rationale: The place of case reports in the medical literature has been much debated in recent years. This study was undertaken to gain knowledge about the publication practice of case reports and case series from a major university hospital. Method: We decided to conduct a retrospective, bibliographic, descriptive study of published case reports and case series from a university hospital in a period of 10 years. The following variables were studied: number of reports, authorship characteristics, collaboration practices, titles, medical specialities represented, educational versus non-educational purpose and number of citations.The data were extracted from the national research information system database in Norway. Results: 2.2%of all the publications were case reports. Multiple authorship was common. Male authors outnumbered female authors. Collaboration across hospitals and nations occurred for one third of the articles. 43% of the titles did not contain information that identified them as case reports or case series. The most frequently represented specialties were neurology, rheumatology, plastic surgery and medical genetics. Nine out of 10 articles were non- educational. A third of the articles had not been cited. Conclusions: The case report seems to be a minor, although viable, genre. The proportion of case reports and case series was low. A plausible hypothesis could be that clinician-researchers at the study hospital prioritized controlled clinical and paraclinical/laboratory studies that rank higher on the evidence hierarchy. Since case reports document the presentations of individual patients and their treatment, a declining interest in their publication has a significant implication for person-centered healthcare education and training

Long-term dropout from school and work and mental health in young adults in Norway: A qualitative interview-based study

School dropout is related to difficult life trajectories in Western society. Developing effective preventive interventions is urgent. Nevertheless, few studies have interviewed unemployed young adults in the aftermath of school dropout to understand their experiences with influential factors. We interviewed seven former students two to five years after they had dropped out and seven same-aged students in their final year at college. The participants were given qualitative semi-structured interviews focusing on questions about what kept them on track and what pushed them off track when struggling to complete school. The participants were also clinically interviewed, drawing on the Mini International Neuropsychiatric Interview. The analysis revealed that the students who had dropped out described a larger number of mental health problems and problems of a more serious nature than the college students did. The participants who had dropped out also described less access to resources and social support. The clinical interviews supported the impression given in the qualitative interviews, that those who had dropped out were more burdened by mental disorders than the college students. The college students described comprehensive social support to play a major role in their coping with school and mental health problems. The former students who were unemployed and who had dropped out described internalizing mental health problems in combination with a lack of social support as important influences in their dropping out from school and employment, indicating the importance of further exploring the role of internalizing mental health problems in school dropout processes

Mediators of pain and physical function in female and male patients with chronic pain

Purpose: Chronic pain is often multifactorial and accompanied by psychological distress, catastrophizing thoughts, reduced physical function, and socio-economic worries. In this explorative study, we investigated potential mediators in the relationships of psychological and demographic variables with chronic pain and physical function in women and men. Patients and Methods: The study included 301 patients admitted to a multidisciplinary pain clinic. Prior to their first consultation, patients completed a questionnaire including items on demographics (age, education, occupational and financial situation), catastrophizing thoughts, psychological distress, pain intensity, and physical function. Hierarchical multiple regression analyses examined demographic and psychological factors associated with pain intensity and physical function. Mediation and reversed mediation models were tested and developed based on calculated relations in the regression analyses between demographic, psychological, pain intensity and physical function variables. Results: Fifty-eight percent were females and mean age 43.8 and 46.0 years for women and men, respectively. In the regression analyses, psychological factors accounted better for pain intensity than demographic variables, while physical function was best accounted for by demographic variables. Among women, catastrophizing thoughts mediated significantly the relationships between education and pain intensity, and between education and physical function. Psychological distress mediated significantly the relationships between financial situation and pain intensity, and between financial situation and physical function in women. In men, the only significant mediation model was psychological distress mediating the relationship between financial situation and pain intensity. Some of the reversed models revealed indirect effects, indicating bidirectionality. Conclusion: The results indicate that there might be gender-specific mediators in how demographic variables are associated with pain intensity and physical function. This suggests an awareness among clinicians of potential gender-specific factors mediating pain problems, and the need for a gender-specific, multidisciplinary approach in the treatment of chronic pain

Women with coronary heart disease – making sense of their symptoms and their experiences from interacting with their general practitioners

Cardiovascular disease and particularly coronary heart disease (CHD) is the leading cause of death among women and men worldwide. CHD in women, and their symptoms and treatment trajectory are not well understood. Studies indicate gender-related differences in symptom presentation, comorbidity, help-seeking behavior, and the quality of diagnostics and treatment of CHD. Although the incidence rates among men have decreased over the last decades, myocardial infarction among women has been increasing. Studies suggest limited knowledge among patients and doctors about the nature of CHD symptoms in women. Knowledge of patients’ experiences and descriptions of symptoms may have important impact on diagnostic decision-making. This qualitative interview study explored how female patients experienced and understood their CHD symptoms and the treatment provided by their general practitioners (GPs). Nine patients scheduled for coronary artery bypass graft surgery were recruited from the waiting list, and interviewed before surgery. Data were analyzed by drawing on phenomenological method. The women reported various symptoms, including atypical symptoms such as fatigue, back and shoulder pain and dyspnea. The CHD symptoms were sometimes masked, and interpreted as gastro-esophageal reflux, chronic obstructive pulmonic disorder, asthma, nervous problems and muscular pain. While some accepted their doctors’ diagnoses, others perceived their symptoms as due to tiredness, burnout and increasing age. Delayed treatment and misdiagnosis were explained by factors including failing to seek help and misinterpreting symptoms. There were a widespread frustration with doctors’ ignorance of symptom descriptions, diagnostics and treatment approach. Women and their GPs may experience difficulties in recognizing CHD symptoms, resulting in misdiagnosis and inadequate and/or delayed treatment. The quality of the patient–provider communication is vital in preventing these problems. More knowledge and awareness about women’s CHD is needed – both among health providers and in public

Daily associations between sleep and pain in patients with chronic musculoskeletal pain

Patients with chronic pain commonly report sleep problems, and the evidence for a relationship between sleep disturbance and pain seems robust. The day‐to‐day associations between these constructs are less well studied, particularly with objective sleep measures such as actigraphy. Moreover, the concurrent presence of negative affective symptoms, as well as seasonality effects at extreme latitudes may complicate it further. Here, we studied 56 patients with chronic primary musculoskeletal pain conditions, contributing data in two separate 7‐day data‐collection periods during the summer and winter, respectively. The effect of self‐reported sleep quality, and actigraphy measured sleep duration, efficiency and timing on next‐day pain, as well as the effect of pain on the same sleep indices were estimated by generalised linear mixed regression models. The models were additionally adjusted for age, sex, education, data collection period, weekend, season and mental distress, with the latter two also specified as moderators. We observed a significant effect of pain as a predictor of next‐night sleep quality (p = .003) and marginally of next‐night sleep duration (p = .079). Conversely, sleep quality tentatively predicted next‐day pain (p = .063). No other day‐to‐day associations were present. Mental distress was the strongest predictor of pain, but it did not modify the sleep–pain associations, nor did season. In conclusion pain, sleep quality and mental distress are closely related, underscoring the importance of encompassing this complexity in assessment and treatment of patients with chronic pain