Adolescent's adherence to treatment in psychiatric care

Abstract The purpose of this study was to investigate treatment adherence among adolescents receiving mental health care, with a special focus on psychiatric inpatient treatment. Key goals were to derive a general definition of adherence suitable for this purpose and to assess adolescents’ adherence to medication and non-pharmacological treatments. This study had two phases; phase one involved conducting systematic literature reviews, and phase two was based on empirical research in which data were collected by analyzing notes on hospital patients. The aim of the reviews were to review current research evidence into treatment adherence in adolescents and factors relating adherence among adolescents receiving mental health care (original publication n=15 and original publication n=17). Phase two was part of a clinical follow-up project called STUDY-70 conducted at the Department of Psychiatry at Oulu University Hospital in Finland. This phase yielded two further original publications – papers III and IV. Paper III examined adherence among adolescents receiving psychiatric inpatient care (n=72), focusing on both medication and non-pharmacological treatments. Paper IV examined factors affecting treatment adherence among these 72 inpatient adolescents, including family- and clinic-related variables. The systematic reviews demonstrated that many different definitions of adherence have been used in the literature. A concept synthesis was applied to these definitions to establish a basis for empirical research. The main factors that were found to correlate positively with treatment adherence among adolescents were the patients’ own will to be treated and positive sentiments, but family also played an important role. Factors that correlated negatively with adherence included negative feelings, a lack of cooperation with treatment, and adverse mental symptoms. Adolescent who has received special support at school was found to favor treatment adherence, whereas involuntary treatment, self-mutilative behavior and a close maternal relationship were all linked to non-adherence. Treatment adherence is an ongoing process, and achieving high levels of adherence should be an important goal in all treatment processes. It is important for clinical staff to be aware of factors influencing adherence in order to support the provision of effective and high-quality care for adolescents.Tiivistelmä Tutkimuksen tarkoituksena oli selvittää mielenterveyspalveluita käyttävien nuorien hoitoon sitoutumista ja erityisesti psykiatrisessa osastohoidossa olevan nuoren sitoutumista hoitoon. Keskeisinä tavoitteina oli kuvata hoitoon sitoutumisen määrittelyä ja arvioida nuoren sitoutumista lääke- ja ei-lääkinnälliseen hoitoon. Tutkimus sisälsi kaksi vaihetta: vaihe yksi systemaattiset kirjallisuuskatsaukset sekä vaihe kaksi empiirisen tutkimuksen, jossa tieto kerättiin analysoimalla potilasasiakirjoja. Systemaattisen kirjallisuuskatsauksen tarkoituksena oli selvittää nuoren hoitoon sitoutumista ja siihen yhteydessä olevia tekijöitä (alkuperäisjulkaisu I n=15, alkuperäisjulkaisu II n=17). Vaihe kaksi oli osa Oulun yliopistollisen sairaalan psykiatrian klinikan projektia, STUDY-70, joka tuotti kaksi osajulkaisua. Alkuperäisjulkaisun III tarkoituksena oli tutkia osastohoidossa olevan nuoren sitoutumista lääke- sekä ei lääkinnälliseen hoitoon (n=72). Alkuperäisjulkaisussa IV selvitettiin näiden nuoren sitoutumista hoitoon ja erityinen mielenkiinto tässä tutkimuksessa oli perhe- ja kliinisillä tekijöillä sitoutuminen (n=72). Systemaattisen kirjallisuuskatsauksen perusteella sitoutumisen määrittelyt vaihtelivat. Tästä huolimatta käsitteen määrittelyjen synteesi oli mahdollinen ja se loi pohjan empiiriselle tutkimukselle. Tämän tutkimuksen perusteella nuoren oma tahto ja positiivinen asenne olivat positiivisesti yhteydessä hoitoon sitoutumiseen. Myös perheen toiminta vaikutti hoitoon sitoutumiseen. Nuoren negatiiviset tunteet, yhteistyökyvyttömyys ja mielenterveysoireet vaikuttivat negatiivisesti sitoutumiseen. Lisäksi nuoren saamat erityispalvelut koulussa tukivat osastohoidossa olevan nuoren hoitoon sitoutumista. Vastentahtoinen hoito, viiltely sekä läheinen ja kestävä äitisuhde olivat yhteydessä sitoutumattomuuteen. Hoitoon sitoutuminen on kokonaisvaltainen prosessi ja yksi hoidon tavoitteista, joka voidaan saavuttaa. Hoitoon sitoutumisen edistämiseksi henkilökunnan tulee tiedostaa ne tekijät, jotka vaikuttavat hoitoon sitoutumiseen. Näin voidaan suunnitella ja toteuttaa laadukasta ja vaikuttavaa hoitoa

Permafrost thaw challenges and life in Svalbard

Abstract Svalbard is facing changes related to climate change and permafrost thaw, which have impacts on the life and well-being of people. This study evaluated impacts of climate change and permafrost thaw on the life of locals living in Longyearbyen, Svalbard and focused on investigating self-rated health, well-being, quality of life, satisfaction with life, and feeling of empowerment when facing the changes and impacts. The aim was to find out which perceived environmental and adaptation factors relate to these dependent variables. The data was collected using a multidisciplinary questionnaire (n = 84); for statistical analysis cross-tabulation was used and the associations were tested either by the Pearson χ2 test or Fisher’s exact test, when appropriate. Binary logistic regression analysis was used to investigate associations between the dependent variables and perceived environmental and adaptation factors. Results suggested that well-being, quality of life, satisfaction with life, and life balance (a sum variable of earlier parameters) were associated with the recognized challenges related to infrastructure or physical environment. Quality of life and life balance were supported by the opinion that not enough has been done to adapt to permafrost thaw by national and global authorities. Despite recognized challenges, participants appear to live satisfied lives. People seemed to have knowledge about the impacts of permafrost thaw, they wanted to adapt to the changes, but more actions are needed from national and global authorities. Research with a larger sample size is needed due to the complexity of the relationships between people, holistic well-being, and climate change

Self-rated health, life balance and feeling of empowerment when facing impacts of permafrost thaw:a case study from Northern Canada

Abstract Climate warming in Arctic Canada, e.g., permafrost thaw, comprehensively impacts biota and the environment, which then affects the lives of people. This study aimed to investigate which perceived environmental and adaptation factors relate to self-rated well-being, quality of life, satisfaction with life (sum variable = life balance), self-rated health, and feeling of empowerment to face the changes related to permafrost thaw. The study sample was collected from one community using a questionnaire (n = 53) and analyzed by cross-tabulation. Results indicated that most participants had at least good well-being, quality of life, satisfaction with life, and a medium level of health, and over 40% assessed being empowered to face the changes related to permafrost thaw. Problems and challenges associated with permafrost thaw, e.g., health, traditional lifeways, and infrastructure, were recognized; these had impacts on life balance, feeling of empowerment, and self-rated health. Traditional knowledge regarding adaptation to face changes was seen as important. More adaptation actions from the individual to global level seemed to be needed. This study provides an overview of the situation in one area, but more research, with a larger study sample, should be conducted to achieve a deeper understanding of climate-related impacts on life and holistic well-being

Living conditions and mental wellness in a changing climate and environment:focus on community voices and perceived environmental and adaptation factors in Greenland

Abstract Background: Climate change is a major global challenge, especially for Indigenous communities. It can have extensive impacts on peoples’ lives that may occur through the living environment, health and mental well-being, and which are requiring constant adaptation. Objectives: The overall purpose of this research was to evaluate the impacts of climate change and permafrost thaw on mental wellness in Disko Bay, Greenland. It contained two parts: multidisciplinary fieldwork and a questionnaire survey. The aim of the fieldwork was to learn about life and living conditions and to understand what it is like to live in a community that faces impacts of climate change and permafrost thaw. For the questionnaire the aim was to find out which perceived environmental and adaptation factors relate to very good self-rated well-being, quality of life and satisfaction with life. Analysis: Fieldwork data was analyzed by following a thematic analysis, and questionnaire data statistically by cross-tabulation. First, the associations between perceived environmental and adaptation factors were studied either by the Pearson χ² test or by Fisher's exact test. Second, binary logistic regression analysis was applied to examine more in depth the associations between perceived environmental/adaptation variables and self-rated very good well-being, satisfaction with life and quality of life. The binary logistic regression analysis was conducted in two phases: as univariate and multivariate analyses. Results: Nature and different activities in nature were found to be important to local people, and results suggest that they increase mental wellness, specifically well-being and satisfaction with life. Challenges associated with permafrost thaw, such as changes in the physical environment, infrastructure and impacts on culture were recognized in everyday life. Conclusions: The results offer relevant information for further plans and actions in this field of research and at the policy level. Our study shows the importance of multidisciplinary research which includes the voice of local communities

Thawing permafrost in Arctic coastal communities:a framework for studying risks from climate change

Abstract Thawing permafrost creates risks to the environment, economy and culture in Arctic coastal communities. Identification of these risks and the inclusion of the societal context and the relevant stakeholder involvement is crucial in risk management and for future sustainability, yet the dual dimensions of risk and risk perception is often ignored in conceptual risk frameworks. In this paper we present a risk framework for Arctic coastal communities. Our framework builds on the notion of the dual dimensions of risk, as both physically and socially constructed, and it places risk perception and the coproduction of risk management with local stakeholders as central components into the model. Central to our framework is the importance of multidisciplinary collaboration. A conceptual model and processual framework with a description of successive steps is developed to facilitate the identification of risks of thawing permafrost in a collaboration between local communities and scientists. Our conceptual framework motivates coproduction of risk management with locals in the identification of these risks from permafrost thaw and the development of adaptation and mitigation strategies