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Psychosocial illness. Community, primary health care and individual perspectives

Karlsson, Kent LU (2004)
Abstract (Swedish)
Popular Abstract in Swedish

Syftet med avhandlingsarbetet har varit att ge ökad kunskap om (1) psykosocial ohälsa i befolkningen, (2) prevalens och orsaker till psykosocial ohälsa bland patienter i primärvården, och (3) bland långtidssjukskrivna. Datainsamlingen inkluderar resultatet av en befolkningsenkät riktad till ett slumpmässigt urval av 13 000 personer (20-84 år), ett frågeformulär till samtliga allmänläkare anställda i tidigare Malmöhus läns landsting (N=199) samt djupintervjuer och psykologiska test med 30 långtidssjukskrivna (Känsla av sammanhang, KASAM och Karolinska Scales of Personality, KSP).



Allmänläkarna bedömer att cirka en tredjedel av deras patienter i primärvården har problem som kan... (More)
Popular Abstract in Swedish

Syftet med avhandlingsarbetet har varit att ge ökad kunskap om (1) psykosocial ohälsa i befolkningen, (2) prevalens och orsaker till psykosocial ohälsa bland patienter i primärvården, och (3) bland långtidssjukskrivna. Datainsamlingen inkluderar resultatet av en befolkningsenkät riktad till ett slumpmässigt urval av 13 000 personer (20-84 år), ett frågeformulär till samtliga allmänläkare anställda i tidigare Malmöhus läns landsting (N=199) samt djupintervjuer och psykologiska test med 30 långtidssjukskrivna (Känsla av sammanhang, KASAM och Karolinska Scales of Personality, KSP).



Allmänläkarna bedömer att cirka en tredjedel av deras patienter i primärvården har problem som kan härledas till psykosociala faktorer. Allmänläkare med psykosocialt intresse såväl som kvinnliga allmänläkare bedömer generellt att en större andel patienter har problem som kan härledas till psykosociala faktorer. Smärta, trötthet och multipla symtom är de mest frekvent rapporterade besvären och ensamhet, familjeproblematik och konflikter på arbetsplatsen de mest frekventa psykosociala problemen. En majoritet av allmänläkarna anser att läkarutbildningen inte gav tillräckligt adekvata kunskaper om psykologiska och psykosociala faktorers betydelse för hälsan. En tredjedel av allmänläkarna anser att deras nuvarande kunskaper och erfarenheter inte är tillräckligt tillfredsställande för att ge patienter med psykosociala problem adekvat hjälp.



Majoriteten av respondenterna i befolkningsstudien bedömer att deras hälsa och livssituation är tillfredsställande. Hälsa och levnadsförhållanden är emellertid ojämlikt fördelad mellan olika grupper. Högriskgrupper med dålig hälsa och psykosocial problematik inkluderar långtidssjukskrivna, såväl som arbetslösa, kvinnor, invandrare, ensamstående, lågutbildade, arbetare och jordbrukare. Samma högriskgrupper är överrepresenterade när det gäller nästan samtliga variabler i studien. Patienter i primärvården rapporterar dock fler symtom och psykosociala problem än övriga respondenter i befolkningsstudien.



De trettio långtidssjukskrivna rapporterar att de varit utsatta för olika påfrestningar och två tredjedelar av dem har haft en besvärlig uppväxt. Två tredjedelar är lågutbildade, hälften saknar yrkesutbildning och en femtedel är arbetslösa. En tredjedel av den totala undersökningsgruppen är en psykosocialt särskilt utsatt grupp med en mul-tiproblematisk situation, såväl under uppväxten som i den aktuella livssituationen. Denna undergrupp har signifikant lägre KASAM i jämförelse med de övriga samt högre somatisk ångest, muskulär spänning, psykasteni och lägre socialisationsbenägenhet i enlighet med KSP. Känsla av sammanhang sjunker signifikant över tid vid en uppföljning efter sex år. (Less)
Abstract
The aim of the thesis is to contribute to knowledge of (1) psychosocial illness in the population, (2) the prevalence and nature of psychosocial illness encountered in primary health care, and (3) encountered among persons with long-term illness. The data collected include the results of a questionnaire given to a population-based sample of 13 000 persons (20-84 years), a questionnaire given to general practitioners (GP) (N=199), and interviews with 30 persons with long-term illness and results of psychological testing of them (Sense of Coherence, SOC, and Karolinska Scales of Personality, KSP).



The GPs estimated that approximately one third of their patients in primary health care had problems that could be attributed... (More)
The aim of the thesis is to contribute to knowledge of (1) psychosocial illness in the population, (2) the prevalence and nature of psychosocial illness encountered in primary health care, and (3) encountered among persons with long-term illness. The data collected include the results of a questionnaire given to a population-based sample of 13 000 persons (20-84 years), a questionnaire given to general practitioners (GP) (N=199), and interviews with 30 persons with long-term illness and results of psychological testing of them (Sense of Coherence, SOC, and Karolinska Scales of Personality, KSP).



The GPs estimated that approximately one third of their patients in primary health care had problems that could be attributed to psychosocial causes. GPs with a psychosocial orientation, as well as female GPs generally, gave higher estimates of the proportion of patients suffering from psychosocial illness. Pain, fatigue and multiple symptoms were the most frequently reported complaints, and loneliness, family problems and conflict at the work-place the most frequent psychosocial problems. A majority of the GPs felt that their medical training gave them inadequate knowledge of psychological and psychosocial issues. One third of the GPs considered their present level of education and experience to be insufficient to give patients with psychosocial problems adequate help.



A majority of the respondents in the population study considered their health and life-situation to be satisfactory. Health and living conditions were unequally distributed between groups, however. High-risk groups, defined as those with poor health and psychosocial problems, included persons with long-term illness, as well as unemployed persons, women, immigrants, single persons, low-educated persons, workers and farmers. The same high-risk groups were overrepresented on nearly all variables included in the study. Patients in primary health care reported a greater number of symptoms and of psychosocial problems than the remaining participants in the population sample did. A certain degree of correspondence was found between the symptoms and the psychosocial problems found in the population study and the GPs’ appraisal of their patients’ concerns.



The 30 persons with long-term illness who were interviewed reported that they had been exposed to various adverse conditions. Two thirds of them had experienced a harsh upbringing and had received only a minimal level of education. Half of the group had no vocational education at all and one fifth was unemployed. One third of the total group had been exposed to a variety of hardships concerning their health and their life situation. This subgroup had significantly lower SOC scores than the remaining individuals, as well as higher scores on somatic anxiety, muscular tension, psychasthenia and lower scores on socialization in terms of the KSP. A significant decrease in SOC scores was shown in a follow-up study six years later, indicating a continuous deterioration of the patients’ overall well-being. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Hallberg, Hans, Med. dr., Dalarnas Forskningsråd
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Social psychology, Socialpsykologi, KSP., SOC, long-term illness, population study, general practitioners, Psychosocial illness, primary health care
pages
506 pages
publisher
Kent Karlsson, Östra Mårtensgatan 14 E, 221 00 Lund,
defense location
Hörsal 128, Stora Algatan 4
defense date
2004-06-11 13:00
external identifiers
  • Other:ISRN: LUSADG/SAPS--04/1123--SE
ISBN
91-628-5657-X
language
Swedish
LU publication?
yes
id
86458ea2-ffa1-4b25-a891-b70887892422 (old id 467108)
date added to LUP
2007-09-10 15:52:22
date last changed
2016-09-19 08:45:08
@misc{86458ea2-ffa1-4b25-a891-b70887892422,
  abstract     = {The aim of the thesis is to contribute to knowledge of (1) psychosocial illness in the population, (2) the prevalence and nature of psychosocial illness encountered in primary health care, and (3) encountered among persons with long-term illness. The data collected include the results of a questionnaire given to a population-based sample of 13 000 persons (20-84 years), a questionnaire given to general practitioners (GP) (N=199), and interviews with 30 persons with long-term illness and results of psychological testing of them (Sense of Coherence, SOC, and Karolinska Scales of Personality, KSP).<br/><br>
<br/><br>
The GPs estimated that approximately one third of their patients in primary health care had problems that could be attributed to psychosocial causes. GPs with a psychosocial orientation, as well as female GPs generally, gave higher estimates of the proportion of patients suffering from psychosocial illness. Pain, fatigue and multiple symptoms were the most frequently reported complaints, and loneliness, family problems and conflict at the work-place the most frequent psychosocial problems. A majority of the GPs felt that their medical training gave them inadequate knowledge of psychological and psychosocial issues. One third of the GPs considered their present level of education and experience to be insufficient to give patients with psychosocial problems adequate help.<br/><br>
<br/><br>
A majority of the respondents in the population study considered their health and life-situation to be satisfactory. Health and living conditions were unequally distributed between groups, however. High-risk groups, defined as those with poor health and psychosocial problems, included persons with long-term illness, as well as unemployed persons, women, immigrants, single persons, low-educated persons, workers and farmers. The same high-risk groups were overrepresented on nearly all variables included in the study. Patients in primary health care reported a greater number of symptoms and of psychosocial problems than the remaining participants in the population sample did. A certain degree of correspondence was found between the symptoms and the psychosocial problems found in the population study and the GPs’ appraisal of their patients’ concerns.<br/><br>
<br/><br>
The 30 persons with long-term illness who were interviewed reported that they had been exposed to various adverse conditions. Two thirds of them had experienced a harsh upbringing and had received only a minimal level of education. Half of the group had no vocational education at all and one fifth was unemployed. One third of the total group had been exposed to a variety of hardships concerning their health and their life situation. This subgroup had significantly lower SOC scores than the remaining individuals, as well as higher scores on somatic anxiety, muscular tension, psychasthenia and lower scores on socialization in terms of the KSP. A significant decrease in SOC scores was shown in a follow-up study six years later, indicating a continuous deterioration of the patients’ overall well-being.},
  author       = {Karlsson, Kent},
  isbn         = {91-628-5657-X},
  keyword      = {Social psychology,Socialpsykologi,KSP.,SOC,long-term illness,population study,general practitioners,Psychosocial illness,primary health care},
  language     = {swe},
  pages        = {506},
  publisher    = {ARRAY(0x952ec18)},
  title        = {Psychosocial illness. Community, primary health care and individual perspectives},
  year         = {2004},
}