Impact of coping styles on wellbeing in older adults with severe and enduring mental illness: a systematic review; and, From powerless to empowered: a grounded theory approach to chronic psychosis in middle aged and older adults

Abstract

Aim: The aim of this thesis portfolio was to develop a preliminary, theoretical understanding of the experiences of middle-aged and older adults with chronic psychosis, their beliefs about illness and the impact on their self-identity. Additionally, it aimed to assess the impact of coping styles of middle-aged and older adults with severe mental illness (SMI) on overall wellbeing, and to identify if there was a certain type of coping style that had a more positive impact on outcomes. Method: A systematic review of the literature was conducted assessing the impacts of coping strategies on wellbeing outcomes for adults over the age of 55 with severe mental illness. A search strategy was developed and carried out on PsychInfo, Web of Science, Ovid-Medline, EMBASE, CINAHL, ERIC and PubMed. From the 154 records identified, a narrative synthesis of 19 papers were included for review. For the empirical paper, interviews were conducted with middle-aged and older adults with chronic psychosis, with a grounded theory methodology applied to develop a theoretical understanding of their experiences of their mental health. Results: Key findings from the systematic review indicated that active coping strategies (e.g. reinterpreting thoughts or seeking social contacts) were more beneficial than passive coping strategies (e.g. doing nothing or avoiding). A number of studies were divergent in their findings regarding which specific strategy led to better outcomes, but there appears to be slightly more consistent evidence that the use of cognitive strategies as opposed to behavioural strategies can lead to better wellbeing outcomes in people over the age of 55 with SMI. Within the empirical paper, the preliminary emerged model identified a core concept of “From Powerless to Empowered”, which was a key experience of all participants in relation to their experiences with mental health services, along with two major categories of “Stigma” and “Family/Community” which also influenced participants beliefs about illness. Conclusions: Both the systematic review and the empirical study of this portfolio suggest that, along with traditional interventions of cognitive behavioural therapy, interventions with a focus on acceptance, mindfulness and compassion can be beneficial for middle-aged and older adults with chronic psychosis and severe mental illness. Formulation of the operation of institutional power should be considered when working with this population, and coping mechanisms encouraged and developed, with a focus on cognitive strategies where possible