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Occupational group therapy in a psychiatric day care unit for long-term mentally ill patients: ward atmosphere, treatment process, and outcome

Eklund, Mona LU (1996)
Abstract (Swedish)
Popular Abstract in Swedish

Tjugo patienter som deltog i psykiatrisk öppenvård baserad på arbetsterapi undersöktes beträffande behandlingsresultat, uppfattningen om vårdklimatet och upplevelsen av behandlingsrelationen med arbetsterapeuten. Psykiatriska symtom, global mental hälsa, livskvalitet och fungerandet i dagligt liv studerades vid inskrivning i behandlingen, vid utskrivning, samt vid en ettårsuppföljning.



Vårdklimatet visade sig vara stabilt över en 5-årsperiod. Enligt patienternas och personalens skattningar var det gynnsamt för både psykos- och icke-psykospatienter. De mest framträdande dragen i vårdklimatet var låga nivåer av aggression-och- vrede och av personalens-kontroll samt höga nivåer av... (More)
Popular Abstract in Swedish

Tjugo patienter som deltog i psykiatrisk öppenvård baserad på arbetsterapi undersöktes beträffande behandlingsresultat, uppfattningen om vårdklimatet och upplevelsen av behandlingsrelationen med arbetsterapeuten. Psykiatriska symtom, global mental hälsa, livskvalitet och fungerandet i dagligt liv studerades vid inskrivning i behandlingen, vid utskrivning, samt vid en ettårsuppföljning.



Vårdklimatet visade sig vara stabilt över en 5-årsperiod. Enligt patienternas och personalens skattningar var det gynnsamt för både psykos- och icke-psykospatienter. De mest framträdande dragen i vårdklimatet var låga nivåer av aggression-och- vrede och av personalens-kontroll samt höga nivåer av stöd och ordning-och-organisation. Flera drag i vårdklimatet visade sig ha samband med behandlingsresultat, bl a påvisades signifikanta samband mellan en gynnsam nivå på aggression-och-vrede och förbättring under behandlingsperioden beträffande global mental hälsa och fungerande i dagligt liv.



Patienterna förbättrades signifikant från inskrivning till utskrivning på alla de studerade resultatkriterierna utom livskvalitet. En jämförelse med en matchad jämförelsegrupp som fick traditionell öppenvård gav som resultat att arbetsterapigruppen förbättrades mer enligt en global funktionsskattningsskala. Tretton av 20 patienter bedömdes ha förbättrats på ett kliniskt signifikant sätt, dvs att de ansågs vara betydligt förbättrade och normalt fungerande individer vid utskrivning.



Beträffande behandlingsprocess var den viktigaste aspekten att patienten upplevde relationen till sin egen arbetsterapeut som bättre än relationen till någon av de andra. Detta hade ett signifikant samband med förbättring avseende global mental hälsa och fungerande i dagligt liv. Dessutom kunde ett signifikant samband påvisas mellan patientens grad av deltagande, särskilt ur psykologisk synvinkel, och ett bättre fungerande i dagligt liv.



Djupare analyser i form av 3 representativa fallstudier illustrerade de samband som påvisats på gruppnivå och förmedlade specifika patient- upplevelser. Enligt ett percept-genetiskt instrument (PORT) avspeglades patienternas interna objektrelationer i deras yttre livssituationer och vice versa. En mer gynnsam bild vid ettårs- uppföljningen pekade på att behandlingen hade påverkat patienternas interna objektrepresentationer. (Less)
Abstract
The outcomes of 20 patients participating in occupational group therapy at a psychiatric outpatient unit were explored and related to perceptions of the ward atmosphere and the treatment process. The outcome variables - psychiatric symptoms, global mental health, quality of life, and occupational functioning - were measured at admission, at discharge, and 1 year after discharge. The ward atmosphere was rated twice a year and the treatment process once a month. The study used a combined within-group and between-groups design. The ward atmosphere showed stability over a period of 5 years and was rated by patients and staff as beneficial for both psychosis and nonpsychosis patients. Low levels of anger and aggression and staff control and... (More)
The outcomes of 20 patients participating in occupational group therapy at a psychiatric outpatient unit were explored and related to perceptions of the ward atmosphere and the treatment process. The outcome variables - psychiatric symptoms, global mental health, quality of life, and occupational functioning - were measured at admission, at discharge, and 1 year after discharge. The ward atmosphere was rated twice a year and the treatment process once a month. The study used a combined within-group and between-groups design. The ward atmosphere showed stability over a period of 5 years and was rated by patients and staff as beneficial for both psychosis and nonpsychosis patients. Low levels of anger and aggression and staff control and high levels of support and order and organization were the most prominent features of the unit. Several characteristics of the ward atmosphere were related to outcome, e.g., an optimal level of anger and aggression as perceived by the patients initially in treatment was significantly related to improvement in global mental health and occupational functioning.



The patients improved from admission to discharge on all the outcome variables except for quality of life. Contrasted with a matched comparison group, the patients’ improvement was significantly higher regarding a measure of global functioning. Thirteen of the 20 patients were judged as having attained clinically significant change.



With respect to the treatment process, patient ratings of a better working relationship vis à vis the main therapist compared to the other occupational therapists were significantly related to improvement in global mental health and occupational functioning, as well as to a principal component accounting for a large proportion of the variance in the outcome measures used. Furthermore, patient participation, especially in a psychological sense, was related to a better performance in everyday occupations and to the principal component reflecting outcome.



Indepth analyses of three representative case studies illustrated the relationships that were established at a group level and mediated specific patient experiences. A percept-genetic test (PORT) revealed that the patients’ external life situations and psychiatric problems were reflected in their internal object representations and vice versa. A more benign picture from the testing at a 1-year follow-up indicated that the therapy had influenced the patients’ internal object representations. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Professor Armelius, Bengt-Åke, Umeå University, Department of Applied Psychology, Umeå
organization
publishing date
type
Thesis
publication status
published
subject
keywords
object relations, psychiatric community care, occupational therapy, treatment outcome, ward atmosphere, working relationship, case study, clinically significant change, Psychology, Psykologi
pages
183 pages
publisher
Department of Psychology, Lund University
defense location
Palaestra, Lundagård, Lund
defense date
1996-12-20 10:15
external identifiers
  • Other:ISRN: LUSADG/SAPS--96/1072--SE
ISBN
91-628-2285-3
language
English
LU publication?
yes
id
df15a3cd-6648-4619-ad09-9feaf1b380e7 (old id 28844)
date added to LUP
2007-06-12 13:44:33
date last changed
2016-09-19 08:45:09
@phdthesis{df15a3cd-6648-4619-ad09-9feaf1b380e7,
  abstract     = {The outcomes of 20 patients participating in occupational group therapy at a psychiatric outpatient unit were explored and related to perceptions of the ward atmosphere and the treatment process. The outcome variables - psychiatric symptoms, global mental health, quality of life, and occupational functioning - were measured at admission, at discharge, and 1 year after discharge. The ward atmosphere was rated twice a year and the treatment process once a month. The study used a combined within-group and between-groups design. The ward atmosphere showed stability over a period of 5 years and was rated by patients and staff as beneficial for both psychosis and nonpsychosis patients. Low levels of anger and aggression and staff control and high levels of support and order and organization were the most prominent features of the unit. Several characteristics of the ward atmosphere were related to outcome, e.g., an optimal level of anger and aggression as perceived by the patients initially in treatment was significantly related to improvement in global mental health and occupational functioning.<br/><br>
<br/><br>
The patients improved from admission to discharge on all the outcome variables except for quality of life. Contrasted with a matched comparison group, the patients’ improvement was significantly higher regarding a measure of global functioning. Thirteen of the 20 patients were judged as having attained clinically significant change.<br/><br>
<br/><br>
With respect to the treatment process, patient ratings of a better working relationship vis à vis the main therapist compared to the other occupational therapists were significantly related to improvement in global mental health and occupational functioning, as well as to a principal component accounting for a large proportion of the variance in the outcome measures used. Furthermore, patient participation, especially in a psychological sense, was related to a better performance in everyday occupations and to the principal component reflecting outcome.<br/><br>
<br/><br>
Indepth analyses of three representative case studies illustrated the relationships that were established at a group level and mediated specific patient experiences. A percept-genetic test (PORT) revealed that the patients’ external life situations and psychiatric problems were reflected in their internal object representations and vice versa. A more benign picture from the testing at a 1-year follow-up indicated that the therapy had influenced the patients’ internal object representations.},
  author       = {Eklund, Mona},
  isbn         = {91-628-2285-3},
  keyword      = {object relations,psychiatric community care,occupational therapy,treatment outcome,ward atmosphere,working relationship,case study,clinically significant change,Psychology,Psykologi},
  language     = {eng},
  pages        = {183},
  publisher    = {Department of Psychology, Lund University},
  school       = {Lund University},
  title        = {Occupational group therapy in a psychiatric day care unit for long-term mentally ill patients: ward atmosphere, treatment process, and outcome},
  year         = {1996},
}