Work and psychiatric illness in Aotearoa/New Zealand: implications for career practice

ABSTRACT

This paper aims to examine the influence of Māori culture upon psychiatric service provision in Aotearoa/New Zealand and the implications of this for career counselling of people with experience of mental illness in Aotearoa/New Zealand. The research explored the experiences of a group of women in Aotearoa/New Zealand who have been diagnosed with a psychiatric illness, with the aim of gaining some understanding about how they negotiate issues around diagnosis, recovery and resilience development and employment. The women interviewed for the study ranged in age from 17 to late 60s. They displayed academic ability ranging from literacy issues to postdoctoral experience. Their psychiatric illnesses ranged from single episodes to chronic lifetime conditions and from depression to psychotic bi-polar disorder. Their occupations ranged from unemployed status to an acting CEO. All but one of the women identified as Pākehā/tauiwi. One woman had Māori heritage but had been adopted at birth by Pākehā adoptive parents and had no knowledge of her Māori whakapapa [genealogy; descent lines; ancestry] until later in her adult life. The key idea that emerged was the importance of mentors in vocational settings, and the helpfulness of Māori-focused group and family wellness models for renegotiating vocational identity when suffering from a psychiatric illness. Implications for career practitioners are discussed.     

Travail cognitivo-émotionnel chez des patients en soins palliatifs : étude du vécu,de la réminiscence et du silence

IntroductionFacing one's own mortality allows one to be more aware of one's life history, to make the link between one's different personal experiences and to open up to introspection, be it in exchange or in silence.ObjectiveTo collect the cognitive-emotional work taking place in palliative care patients and to appreciate the use and contribution of reminiscence as well as the place of silence in the discourse.MethodOur study is cross-sectional, exploratory and qualitative. The interviews were conducted by the psychologist using an interview guide previously defined for this study. Non-verbal elements were taken into account following the interview. Nine patients, exclusively women, with an average age of 71 years, suffering from cancer, hospitalized and who were told that their curative treatments were over, were included.FindingsAfter a thematic analysis, it appears that the patients’ concerns are mainly focused on their relationship with their end of life and death. We observe a majority of negative reminiscences as well as a diversity in their contributions. The main function of silence is emotional when the themes of the end of life and illness are discussed.ConclusionIt seems necessary to support questions about the end of life and the reminiscences that may be activated following the proximity of death. Recognition of the different types of silence must also be part of the listening skills of professionals.     

Generation of stress in the course of unipolar depression.

The effect of stressful events on depression has been amply demonstrated, but the opposite relation is also important. I examined event occurrence over 1 year in 14 women with unipolar depression who were compared with demographically matched groups of women with bipolar disorder (n = 11), chronic medical illness (n = 13), or no illness or disorder (n = 22). Interview assessments of life events, severity, and independence of occurrence confirmed the hypothesis that unipolar women were exposed to more stress than the normal women, had significantly more interpersonal event stress than all others, and tended to have more dependent events than the others. The implication is that unipolar women by their symptoms, behaviors, characteristics, and social context generate stressful conditions, primarily interpersonal, that have the potential for contributing to the cycle of symptoms and stress that create chronic or intermittent depression.     

The Stories and Strengths of Women Who Leave Battering Relationships

SUMMARY

With the dearth of research on reasons battered women leave abusive relationships, the authors felt urgency in addressing this side of battered women's issues, which has traditionally focused on why women stay. The authors directly studied 10 battered women, who had been out of the relationship for at least six months. This qualitative study was composed of open-ended questions and a Self-Control Schedule to determine learned resourcefulness. Significant sources of strength, other than parental support, were found in the lives of these women, which included siblings, close friends, and in childhood, relationships with other adults. Ninety percent of the participants attribute their ability to cope with stress, as well as leave the abusive relationship, to having a sense of spirituality.     

La fausse couche : du côté des hommes

ObjectiveThe experience and psychological consequences of a miscarriage have been widely studied but mainly among women. This qualitative study aims to examine the experience of men whose woman has had a spontaneous abortion.MethodThirteen men who have lost an early pregnancy during the five past years participated to a semi-directive interview. The interview was based on the analytical framework previously established and took into account various themes such as psychological experience, marital relationship, guilt, coping strategies, social support given to the spouse, and significance of the loss. All the interviews have been transcribed and studied with a thematic analyse.ResultsResults underline the difficulties linked to the experience of miscarriage among men. Many of them were shocked and have had a sustainable significant distress expressed by sadness, tears or depressive symptoms. In addition to their own difficulties, men have to confront women's distress and want to be a support. Guilt was expressed more or less directly, concerning the miscarriage but also concerning men's reactions toward women. Some of them who encountered psychological problems found very difficult not to be able to support their wife. A miscarriage is a difficult event for a couple and two men interviewed separated shortly after. Several coping strategies were used by men, the most common were seeking social support and avoidance. As in women, significance of the loss was different among men, some of them have lost a child, others an embryo or a life project.ConclusionResults show the variety of feelings and reactions of men that highlight the need to consider their psychological distress. While all men are not equally involved in miscarriage, difficulties encountered by some of them can last several months. Given this results, support interventions for males seems interesting.     

Predictors of cancer survivors’ response to a community-based exercise program

ObjectiveTo explore the degree to which sociodemographic (i.e., age, sex, ethnicity, weight status, vocational status, marital status), medical (i.e., stage of cancer, treatment status, comorbidity burden), functional (i.e., self-rated health, exercise capacity), cognitive (i.e., exercise self-efficacy beliefs), and behavioural (i.e., program adherence, extra-curricular exercise) factors predicted cancer-related fatigue and quality of life among 224 cancer survivors who participated in the community-based Wellspring Cancer Exercise Program (WCEP).DesignProspective, quasi-experimental single-group repeated measures design.MethodData on predictors and outcomes were collected using self-report and objective measures upon enrollment in the program (week 0), every 10 weeks until program completion (weeks 10, 20, 30), and at 16-weeks follow-up (46 weeks). Data were analyzed using multilevel modeling.ResultsIn general, participants who were working or transitioning to work, rated their health better, and had higher exercise self-efficacy beliefs had lower cancer-related fatigue, and those who rated their health better and had higher exercise self-efficacy beliefs had higher quality of life. Also, there was a significant interaction between time and exercise self-efficacy beliefs for cancer-related fatigue and quality of life such that greater improvements were observed among participants with higher exercise self-efficacy beliefs.ConclusionCancer survivors’ perceptions of their health and their ability to exercise should be fostered to ensure they respond positively to exercise programs in terms of cancer-related fatigue and quality of life.     

People's positions regarding social security's health insurance programs: The case of Romania

BackgroundIn Romania, the passage from a culture in which healthcare were freely available to a culture in which people must contribute financially, at least in part, has generated controversies among the population. We examined and mapped the views of people living in Romania regarding social security's health insurance programs.MethodsA convenience sample of 271 adults aged 18–80 who lived in big cities in Romania or in the rural areas around these cities were presented with realistic vignettes that depicted a health insurance program and asked to rate its goodness. The vignettes were created by combining orthogonally the levels of five factors: amount of employers’ contribution to the program, amount of workers’ contribution, extent of coverage of ordinary medical and dental care, extent of coverage of chronic or severe illness, and identity of health insurance recipients.ResultsFive qualitatively different positions were found. They were called Private insurance (8%), Health insurance only for contributors (14%), Health insurance for contributors and for everyone with severe or chronic illness (12%), Health insurance for everyone (29%), and Any insurance program is better than nothing (37%).ConclusionOverall, most participants (78%) favored a health insurance program that would protect all citizens in case of severe or chronic illness or injury, and 66% favored the protection of all citizens in all cases.     

What are the positive consequences of illness?

Abstract

Fifty five people, either currently sick or having recovered from their illness, were recruited if they reported positive consequences of illness. They were questioned about their experiences of illness, 41 by semi-structured interview and 14 by open-ended questionnaire and responses were classified into 17 categories. The categories were similar but slightly more extensive than previous accounts of positive consequences reported in the literature. The content of the interviews and questionnaires was used to construct a 66 item questionnaire about positive consequences of illness which was then completed by 97 patients. A principal components analysis indicated a large first factor accounting for 27% of the variance. Endorsement of items varied between 87% and zero for chronic lung disease patients attending pulmonary rehabilitation. However, all patients endorsed at least one item and the median number of items endorsed was 31. Positive consequences of illness are highly varied and more common than often realised, and this has implications for the concept and measurement of quality of life.     

Being Forgotten: Implications for the Experience of Meaning in Life

ABSTRACT

Two studies investigated the effects of being forgotten on the target of memory. In Study 1, undergraduate women (N = 96) who had completed a lab session two days prior, were randomly assigned to be remembered, forgotten, complimented, or to a control group. In the absence of effects on mood or social self-esteem, being forgotten resulted in lower meaning in life. In Study 2, participants (N = 47) who had completed a group exercise were informed two days later that no one remembered them, that everyone remembered them, or that no one wanted to work with them. Being forgotten led to lower meaning in life than being remembered but did not differ from being excluded. Being forgotten may be considered a type of incipient ostracism that influences meaning in life but not mood or state social self-esteem.     

The Role of Religious Beliefs in Coping With Chronic Illness

The authors examined the ways in which 40 women with chronic illnesses (rheumatoid arthritis, osteoporosis, multiple sclerosis, systemic lupus erythematosus, or a combination of these disorders) used religious beliefs as a means of coping with their illnesses, The participants, all between the ages of 28 and 79 years, were interviewed about the role religious beliefs played in their experiences and the ways in which they made meaning in their lives or coped with their illnesses. The majority of the women reported that religious beliefs were important in living with a chronic illness. In addition, more women who were identified as coping well with their illness reported strong religious beliefs, whereas the majority of women identified as poor copers reported that religion was unimportant or that they had no religious beliefs.     

Social comparisons and quality of life among survivors of childhood cancer and their mothers

Abstract

Sixty-three survivors of childhood cancer (mean age 17 years), currently well and off-treatment, and their mothers were interviewed individually about their experiences and the impact of their illness on their lives. Survivors also completed four questionnaire measures of different aspects of quality of life (perceptions of illness experience, future worries, health problems and body image satisfaction), whereas mothers recorded their perceptions of their child's quality of life on the same four scales. These scales showed good internal consistency and convergent validity for both survivors and mothers. Mothers also completed a measure of their own quality of life (the SF-36). The interviews with both survivors and mothers were content-analysed for statements expressing social comparisons. These statements were coded according to whether the comparison implied a favourable, neutral or unfavourable evaluation of the individual survivor. Mothers who made a higher proportion of unfavourable comparisons reported worse adjustment for their child on all four scales and described their own quality of life more negatively. Among survivors, those who made a higher proportion of unfavourable comparisons gave significantly more negative self-ratings on one of the four scales. Correlations between survivors' and mothers' ratings on the four scales were positive, but comparatively low. This reinforces concerns about using parents as proxy judges of young people's quality of life, although the correlations were more satisfactory in the case of younger rather than older (>18.5 years) survivors. Mothers who rated their own quality of life as less satisfactory reported more problems for their child on all four scales, irrespective of how the survivors described themselves.     

Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise

ObjectivesIt has been suggested that mental illness threatens identity and sense of self when one's personal story is displaced by dominant illness narratives focussing on deficit and dysfunction. One role of therapy, therefore, is to allow individuals to re-story their life in a more positive way which facilitates the reconstruction of a meaningful identity and sense of self. This research explores the ways in which involvement in sport and exercise may play a part in this process.DesignQualitative analysis of narrative.MethodWe used an interpretive approach which included semi-structured interviews and participant observation with 11 men with serious mental illness to gather stories of participants’ sport and exercise experiences. We conducted an analysis of narrative to explore the more general narrative types which were evident in participants’ accounts.FindingsWe identified three narrative types underlying participants’ talk about sport and exercise: (a) an action narrative about “going places and doing stuff”; (b) an achievement narrative about accomplishment through effort, skill or courage; (c) a relationship narrative of shared experiences to talk about combined with opportunities to talk about those experiences. We note that these narrative types differ significantly from—and may be considered alternatives to—dominant illness narratives.ConclusionThis study provides an alternative perspective on how sport and exercise can help men with serious mental illness by providing the narrative resources which enabled participants to re-story aspects of their lives through creating and sharing personal stories through which they rebuilt or maintained a positive sense of self and identity.     

Beliefs of teachers versus non-teachers about people who stutter

PurposeAlthough prior research has investigated teachers’ beliefs about people who stutter (PWS), this work has not indicated how these beliefs compare with those of the general public or taken into account key demographic variables that may be related to these beliefs. The main purpose of this study was to evaluate whether beliefs about PWS in teachers are different from those in the general public. The second purpose of this study was to examine whether gender is related to beliefs about PWS for teachers, who are more frequently women.MethodsAnalyses were based on questionnaire responses regarding beliefs about PWS from 269 teachers and 1388 non-teachers in the United States. Due to their potential link to beliefs about PWS, familiarity with PWS and sociodemographic variables were included in the statistical model for this study.ResultsTeachers’ beliefs about PWS are no different than those of people in non-teaching professions. Findings also indicated that, regardless of whether respondents were teachers, women had more accurate beliefs about PWS than men. The statistical model tested indicated that beliefs about PWS were more accurate when the respondents were older, had more education, and had familiarity with a PWS.ConclusionIn the first study to compare teachers’ beliefs about PWS to the general public, findings indicated that teachers are no more accurate than the public in their beliefs about PWS. Associations found between these beliefs and several variables may indicate some promising mechanisms for improving beliefs, such as increased familiarity with individuals who stutter.Educational Objectives: Readers should be able to: (a) describe stuttering's potential effects on children's participation in the school setting; (b) identify actions teachers can take to improve the school experience of their students who stutter; (c) summarize findings regarding teachers’ beliefs about people who stutter (PWS); (d) identify key variables that are associated with beliefs about PWS.     

Reminders of an agentic ingroup buffer disease uncontrollability

Chronic illness has negative impacts beyond those on physical health. In particular, because it is often experienced as uncontrollable, chronic illness might reduce people's general sense of personal control and, subsequently, personal well-being. Drawing on recent theory and research, we proposed and tested in four experiments (N_total = 1323) a potential buffer to these negative effects: thinking about an agentic social ingroup in one's life. In Study 1, patients suffering from a chronic illness that was either high or low in medical disease controllability were asked either to think about an agentic ingroup or a personal issue. Low perceived disease-related control was associated with low perceived personal control only when participants' personal self, but not when their ingroup, was salient. In three follow-up vignette studies, we asked participants to take the perspective of a person who suffered from a health problem of low medical disease controllability and attended a self-help group that was described as either high or low in agency. The findings supported the predicted buffering effect: participants who reflected on a target suffering from a low control disease thought that the target would experience more personal control when the agentic (vs. the nonagentic) self-help group was salient. These findings suggest ingroups can serve as a source of personal control in the context of health-related threats to the extent that they are perceived as agentic. Thus, focusing on agentic properties of (health-related) ingroups might be a promising novel strategy when designing effective group-based interventions to cope with chronic illness.     

No Doubt About It: When Doubtful Role Models Undermine Men's and Women's Math Performance Under Threat

ABSTRACT

Past work has shown that female role models are effective buffers against stereotype threat. The present research examines the boundary conditions of this role model effect. Specifically, we argue that female role models should avoid expressing doubt about their math abilities; otherwise they may cease to buffer women from stereotype threat. For men, a non-doubtful male role model should be seen as threatening, thus harming performance. A doubtful male role model, however, should be seen as non-threatening, thus allowing men to perform up to their ability in math. To test this reasoning, men and women were exposed to either an outgroup or ingroup role model who either expressed doubt or did not. Participants then took a math exam under stereotype threat conditions. As expected, doubtful ingroup role models hurt women, but helped men's performance. Outgroup role models' expressed doubt had no differential effect on performance. We also show that expressions of doubt take on a different meaning when expressed by a female rather than a male role model.     

‘It's as if PBC didn’t exist’: The illness experience of women affected by primary biliary cirrhosis

This study investigates the illness experience of women who are affected by primary biliary cirrhosis (PBC), a rare chronic liver disease which mostly affects women. Despite the fact that PBC is medically recognised, it shares many characteristics with other chronic and controversial conditions which may lead to delegitimation of the patient's experience of illness, impacting on the construction of the patient's self-identity. Twenty three women took part in semi-structured interviews. Data were analysed using interpretative phenomenological analysis and the analysis identified three themes that are interrelated and characterised by a dynamic of normalisation. The first theme, the delegitimation of women's experience, implies denial of patients’ sick-role, trivialisation of fatigue and lack of consideration of patients’ needs. The second theme, PBC as a challenge to women's social identity refers to how patients face delegitimation and manage the illness's consequences for relationships and social roles. The third theme, the need for biographical continuity, focuses on how patients construct their ill identities as a consequence of both the delegitimation and the challenges posed by PBC. Results are discussed in a gender perspective, highlighting how delegitimation and identity construction processes are influenced by women's social roles and conditions.     

Explorer l’expérience subjective du confinement lié à l’épidémie de la Covid-19 par les familles : une analyse interprétative et phénoménologique (IPA) du discours de parents

IntroductionThe COVID-19 containment measures had many effects on parents and children (stress, concerns), and the functioning of the whole family has been disrupted (lifestyle, habits, relationships).ObjectiveThe objective of this work is to highlight the idiosyncratic nature of the experience of confinement, its psychological consequences, and the changes it has induced within families.MethodInterested in the experiences of parents who had been confined within their families, we conducted interviews with parents and analyzed their discourse using the IPA method. We interviewed five parents (38–44 years old) with at least two children each (3–13 years old). Three of the interviewees were women.ResultsWe have identified seven major axes that illustrate the confinement experience of these families: accompanied by extracts from participants’ interviews (verbatims). The subjects lived this experience in confinement as a unique opportunity to spend time with their family and recalibrate what matters to them fundamentally in life.ConclusionThe experience of confinement has brought changes in the daily lives of these parents as well as in their way of understanding their existence. A form of positive revaluation emanates from their discourse.     

Evaluation of a Brief Group Based Psychological/Educational Treatment Programme for Women with an Iatrogenic Chronic Hepatitis C Virus Infection

Thirty-two women with an iatrogenic chronic hepatitis C virus (HCV) infection were assigned to a treatment or waiting list control group and completed the SF-36, GHQ30, Battles SE, and two in-house questionnaires. A series of mixed model ANOVAs indicated a significant Group × Time effect for SF-36 physical functioning (F = 9.01, p < .01) and a series of repeated measures ANOVAs (treatment group only) indicated a significant time effect for a sustained improvement in psychological well-being (F = 8.01, p < .01) at 3 months posttreatment. Furthermore, most women posttreatment felt more positive and informed about their illness, had more confidence, and reported a greater ability to control and cope with their lives. Psychological/educational treatment programmes show promise for increasing adjustment and coping in women with an iatrogenic HCV infection and may be modified for use in other HCV cohorts.     

Running as a way fat women re-story their bodies and construct a runner identity in a North American sociocultural context

AimThis research sought to identify the process by which women who identify as fat or as not having a typical athletic body construct an athletic identity and persist in their running and other athletic endeavors despite body size-related barriers.MethodsFrom an online recruitment effort, 19 North American women runners in larger bodies completed interviews in which they told the story of how they had become runners. A narrative analysis with a feminist, constructivist approach was conducted to identify story types.ResultsFour narrative types were identified: reclaiming the body, reclaiming health, space-making, and future-imagining. Through finding a size- and pace-inclusive running community, running persistently, and completing races, women relinquished the stories they’d believed that their bodies were not athletic since childhood and constructed an identity of runner in a fat body.ConclusionsThese women’s engagement in running is a personal form of resistance against those who define athletic and healthy as “thin” or “fit.” They have found a welcoming athletic community and have moved on to leadership where they are working to make running accessible to other women in bodies like theirs. Those reading these narratives should consider ways in which fat bodies have been excluded from athletics, as well as ways to support the work being done by women runners in fat bodies to redefine health and athleticism.