Jan-Ake Jansson’s research while affiliated with Lund University and other places

BACKGROUND: Unemployment is high not only among people with mental illness, but also among young adults in general. The combination of having a severe mental illness and being young entails a particularly problematic situation for young people with psychosis. This study aimed to understand how this group envision their future possibilities for entering the labour market or engaging in other productive activities. OBJECTIVE: To explore how young adults with psychosis perceive their possibilities, wishes and support needs for gaining employment or engaging in other productive activities. METHODS: A descriptive design with qualitative individual in-depth interviews was used. Eighteen young adults with psychosis, aged 18–30 years, were interviewed. Data was analysed with qualitative content analysis. RESULTS: Four categories based on the experiences of the participants as being vital for having work or other productive activities were generated: “Wishing for a role in the community”, “Being my own coach”, “Needing personal support” and “Having a supportive workplace”. Each of them included sub-categories. CONCLUSION: The young adults with psychosis were a long way from having paid work, but they desired to have a worker role in the community. They are a heterogeneous group, which entails that it is important that professionals and employers have a person-centered and holistic approach, listening to the individuals themselves.

Background: People with mental illness may have difficulties related to work and employment, especially if they experience additional difficult life situations. Objective: To explore how subgroups with mental illness and additional adversities perceived their situation with respect to work and employment prospects. Methods: Three subgroups were included, exposed to an additional difficult life situation: i) psychosis interrupting their career development at young age (n = 46), ii) having a history of substance use disorder (SUD) (= 57) or iii) having recently immigrated (n = 39). They responded to questionnaires addressing sociodemographics, work-related factors, everyday activity, and well-being. A professional assessed their level of functioning and symptom severity. Results: The young people with psychosis had a low education level, little work experience, the poorest worker role resources, and a low level of functioning, but a high quality of life. The SUD group had the fewest work experiences, were the least satisfied with work experiences, and had the lowest activity level, but had the least severe psychiatric symptoms. The immigrant group had severe psychiatric symptoms, but high ratings on work experiences, work resources, and activity level. Conclusions: Each group presented unique assets and limitations pertaining to work and employment, suggesting that they also needed unique support measures.

Background: Work and other everyday activities are beneficial for well-being among people with mental illness, but poor circumstances can create detrimental effects, possibly aggravated by additional vulnerabilities linked with their mental illness. This study aimed to investigate how activity factors were related to well-being and functioning among three vulnerable groups using outpatient mental health care - young people with psychosis, people with a history of substance use disorder (SUD), and immigrants with post-traumatic stress disorder (PTSD) - while controlling for vulnerability group, age and gender. Methods: Participants represented the three types of vulnerability (n = 46/57/39). Data collection, using self-report and interviewer-rated questionnaires, concerned aspects of everyday activity (work experiences; views of the worker role; satisfaction with everyday occupations; activity level), well-being (quality of life: life and health; quality of life: environmental aspects; recovery) and functioning (psychosocial functioning; symptom severity). Spearman correlations and General Linear Modelling were used. Results: Activity satisfaction was positive (p < 0.001) but recent work experience negative (p = 0.015) for the life and health aspect of quality of life. Activity satisfaction was positive for the environmental aspects of quality of life (p < 0.001). Resources for having a worker role (p < 0.001) and belief in having a future worker role (p = 0.007) were positively associated with better recovery. Activity level (p = 0.001) and resources for having a worker role (p = 0.004) showed positive associations with psychosocial functioning. Belief in a future worker role (p = 0.011) was related with symptom level. Women had less severe symptoms in the young group with psychosis. Regarding vulnerability group, young people with psychosis perceived better quality of life; those with a history of SUD had less severe psychiatric symptoms; and the recent immigrants with PTSD had the highest level of psychosocial functioning. Conclusion: Work experience may not be conducive to well-being in itself; it is satisfaction with work and other activities that matters, and worker and employer expectations need alignment. No vulnerability group seemed consistently more disadvantaged regarding well-being and functioning, but the fact that differences existed is vital to acknowledge in activity-based rehabilitation. Inquiring about meaningful activities and providing opportunities for executing them would be a fruitful way of support.

This study investigated how visitors and staff in community-based activity centers in Sweden perceived the psychosocial atmosphere and whether this could be explained by the centers' orientation (work-oriented versus meeting place-oriented centers). Eighty-eight visitors and 37 staff members at three work-oriented and three meeting place-oriented centers participated. The Community-oriented Programs Environmental Scale was used to estimate the psychosocial atmosphere. The result showed that the psychosocial atmosphere at the centers was in accordance with a supportive ward atmosphere profile. Visitors and staff perceived several aspects of the psychosocial atmosphere differently, especially in the meeting place-oriented centers. The visitors in the meeting place-oriented centers did not perceive the psychosocial atmosphere differently from those visiting the work-oriented centers. The results indicated that the psychosocial atmosphere at the centers was in line with what previous research has shown to be beneficial for visitors regarding outcome and favorable for promoting a good therapeutic alliance and a good functioning in daily life.

The present study focuses on how patients diagnosed with psychosis deal with a conflicting situation. In the study, two groups of patients were assessed. One group consisted of patients diagnosed with psychosis (n = 41), while the comparison group (n = 135) consisted of inpatients diagnosed either with anorexia nervosa or with bulimia nervosa. The groups were assessed using the Serial Color Word Test (S-CWT), designed for studying an individual's successive adaptation over time to a conflicting situation. The S-CWT differentiated the two groups regarding both reading time and adaptive styles. Patients diagnosed with psychosis had longer reading times and an adaptive style that was deviant throughout the test, indicating poorer cognitive functioning and more serious psychopathology. These problems may in turn influence functioning in work or study and daily living, all of which are important in treatment planning.

This study investigated how occupational therapists experience utilization of the Tree Theme Method, an intervention based on creative activities and life-story telling and making. The Tree Theme Method is comprised of five sessions in which the therapist asks the client to paint symbolic trees, with specific themes representing their present life situation, childhood, adolescence, adulthood, and the future. Nine occupational therapists in mental health care were asked about their experiences when using the Tree Theme Method. The informants formed two focus groups and each group was interviewed twice. Qualitative content analysis was used to identify five categories including: (1) therapeutic frames, (2) therapist requirements, (3) client requirements, (4) the therapeutic relationship, and (5) the Tree Theme Method as a multi-dimensional process. Overall the informants were satisfied with the intervention with some variation as to therapists' perception about the helpfulness of the tool. The Tree Theme Method was experienced as a structured method of starting a therapeutic process and initiating a therapist–client relationship. The therapeutic attitude, self-knowledge, and expert knowledge seemed to be important prerequisites for the therapists when using the Tree Theme Method intervention.

This study investigated the importance of the therapeutic alliance in a routine psychiatric out-patient unit regarding treatment outcome and the influence of patient factors. The study had a naturalistic and longitudinal design where the treatments the patient received were determined by the normal routines at the unit and were performed by a variety of staff representative of a psychiatric out-patient unit. Newly admitted patients were diagnosed according to the International Classification of Diseases-10th Revision and completed questionnaires regarding the therapeutic alliance, symptoms, and interpersonal problems at the beginning and termination of their treatment (N=76). The time limit for the termination assessments was set at 18 months. The therapeutic alliance at the beginning of treatment did not correlate with outcome, however, at the end of the treatment the alliance significantly explained about 15% of the variance of the outcome (global severity index). An improvement of the alliance during the treatment significantly correlated with most of the outcome variables. The relation of the alliance to outcome was equal among the different diagnosis groups and treatment forms. The results showed that the therapeutic alliance is an important variable for treatment outcome in routine psychiatric treatment, and improving the therapeutic alliance may be one of the most important factors for increasing the total effectiveness of a treatment unit.

The Tree Theme Method (TTM) is an intervention based on sessions involving creative activities and life storytelling/story-making, in which the client paints trees representing various periods of his/her life. The aim of this study was to investigate clients' experiences of participating in a TTM intervention and their perceptions of the therapeutic relationship. Thematic interviews were undertaken. Twenty clients attending general outpatient mental healthcare units were recruited after having participated in the intervention. A qualitative content analysis resulted in six categories: “From feeling a pressure to perform to becoming focused and expressive”, “Expressing oneself and one's life situation led to awakening of memories and feelings”, “New perspectives of self-image, everyday life and relations to others”, “Story-making led to shaping and reconstructing one's life story”, “Interaction was of importance when reconstructing one's life story” and, finally, “The attitude of the occupational therapist was of importance for the development of the therapeutic relationship”. There seemed to be a close association between the intervention and the therapeutic relationship in starting a process of opening up new perspectives on everyday life, but there is a need for further studies including therapists' experience of using the TTM and their perception of the client–therapist relationship.

This study aimed to describe the Tree Theme Method (TTM) as a method for intervention in psychosocial occupational therapy. The TTM is based on theories concerning creative activities and occupational storytelling and story making. In order to exemplify the method a case study of a treatment process with follow up was undertaken. The participant was a female client suffering from anxiety and depression. During an interview the client painted symbolic trees on five different occasions with specific variations of the tree theme: a tree symbolizing her present life, her childhood, adolescence, adulthood, and, finally, a tree representing her future. The trees were used as starting points for the client to tell her life story. The intention was that she would find new strategies for how to change her daily life. Three years later there was a follow up stage where the client painted new trees and told her story. Some life themes were identified. The TTM appears suitable for intervention in psychosocial occupational therapy. In future studies the TTM should be subjected to evaluation research based on several clients in order to develop a deeper understanding of the process and what kind of results changes in the TTM intervention may provide.

This study focused on how cognitive ability, personality traits, self-rated psychiatric symptoms, and social functioning were related to the way in which patients with psychosis perceived supportive aspects of the ward atmosphere. Patients at a psychiatric rehabilitation unit (PRU) in southern Sweden completed a ward atmosphere questionnaire (COPES), rated their psychiatric symptoms (SCL-90), self-image (SASB), and were tested on cognitive functioning (WAIS-R) and global social functioning (GAF). They were diagnosed according to ICD-10. Data were analysed by means of logistic regression analyses. Self-monitoring and restraining (self-control), one cluster in the SASB, was the strongest factor associated with how the patients perceived the ward atmosphere. A perceived high level of self-control indicated high levels of perceived Support, Practical orientation, and Order and organisation of the ward atmosphere. A high level of self-rated paranoid symptoms (SCL-90) increased the risk of perceiving a high level of Anger and aggression and a low level of Program clarity. Regarding cognitive ability (WAIS-R), two factors were important for predicting perceived ward atmosphere. A low level of social competence was associated with a low level of perceived Order and organisation. Furthermore, a low level of abstract thinking was related to a low level of perceived Anger and aggression, while a high level of abstract thinking was associated with a low level of Program clarity. Patients with schizophrenia exhibited a lower level of Self-monitoring and restraining than patients with other psychoses. The results from this study indicate that individual factors such as self-control, paranoid symptoms and social competence may be important for how the ward atmosphere is perceived. This is important knowledge when monitoring the ward atmosphere to better fit a unit's target group.