Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Post-Traumatic Stress Disorder | Research article

A cross-sectional study addressing the importance of work and other everyday activities for well-being among people with mental illness: does additional vulnerability matter?

Authors: Lisa Eklund, A. Birgitta Gunnarsson, Jan-Åke Jansson, Parvin Pooremamali, Mona Eklund

Published in: BMC Psychiatry | Issue 1/2021

Abstract

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.

Available only for authorised users

Wilcock AA, Hocking C. An occupational perspective of health 3ed. Thorofare, NJ: Slack; 2015.

Gilman CP. Human work. Walnut Creek: AltaMira Press; 1905.

Artazcoz L, Benach J, Borrell C, Cortes I. Unemployment and mental health: understanding the interactions among gender, family roles, and social class. Am J Publ Health. 2004;94(1):82–8. https://doi.org/10.2105/AJPH.94.1.82.CrossRef

OECD. Sick on the job? Myths and realities about mental health and work. Paris: OECD Publishing; 2012. https://doi.org/10.1787/9789264124523-en.CrossRef

Klachefsky M. Hidden costs, productivity losses of mental health diagnoses. Benefits Magazine. 2013;50(2):34–8.

Leufstadius C, Eklund M, Erlandsson LK. Meaningfulness in work - experiences among employed individuals with persistent mental illness. Work. 2009;34(1):21–32. https://doi.org/10.3233/WOR-2009-0899.CrossRefPubMed

Argentzell E, Håkansson C, Eklund M. Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scand J Occup Ther. 2012;19(1):49–58. https://doi.org/10.3109/11038128.2010.540038.CrossRefPubMed

Nagle S, Valiant Cook J, Polatajko HJ. I’m doing as much as I can: occupational choices of persons with a severe and persistent mental illness. J Occup Sci. 2002;9(2):72–81. https://doi.org/10.1080/14427591.2002.9686495.CrossRef

Saavedra J, Lopez M, Gonzales S, Cubero R. Does employment promote recovery? Meanings from work experience in people diagnosed with serious mental illness. Cult Med Psychiatry. 2016;40(3):507–32. https://doi.org/10.1007/s11013-015-9481-4.CrossRefPubMed

10.

Gunnarsson AB, Eklund M. Young people with psychiatric disabilities and their views of day centres. Scand J Occup Ther. 2016:1–11.

11.

Shaw LR, Chan F, McMahon BT. Intersectionality and disability harassment: the interactive effects of disability, race, age, and gender. Rehab Counsel Bull. 2012;55(1):82–91. https://doi.org/10.1177/0034355211431167.CrossRef

12.

Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet. 2016;387(10023):1123–32. https://doi.org/10.1016/S0140-6736(15)00298-6.CrossRefPubMed

13.

Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry. 2007;190(3):192–3. https://doi.org/10.1192/bjp.bp.106.025791.CrossRefPubMed

14.

Goffman E. Stigma: notes on the management of spoiled identity. Harmondsworth: Penguin Books; 1990.

15.

Gary FA. Stigma: barrier to mental health care among ethnic minorities. Issues Ment Health Nurs. 2005;26(10):979–99. https://doi.org/10.1080/01612840500280638.CrossRefPubMed

16.

Perese EF. Stigma, poverty, and victimization: roadblocks to recovery for individuals with severe mental illness. J Am Psychiatr Nurs Assoc. 2007;13(5):285–95. https://doi.org/10.1177/1078390307307830.CrossRef

17.

Mackenzie C, Rogers W, Dodd S. Introduction: what is vulnerability and why does it matter for moral theory? In: Mackenzie C, Rogers W, Dodd S, editors. Vulnerability: new essays in ethics and feminist philosophy. Oxford: Oxford Scholarship Online; 2014.

18.

Alvarez-Castillo F, Lucas JC, Castillo RC. Gender and vulnerable populations in benefit sharing: an exploration of conceptual and contextual points. Camb Q Healthc Ethics. 2009;18(2):130–7. https://doi.org/10.1017/S0963180109090227.CrossRefPubMed

19.

Cotter J, Lin A, Drake RJ, Thompson A, Nelson B, McGorry P, et al. Long-term employment among people at ultra-high risk for psychosis. Schizophr Res. 2017;184:26–31. https://doi.org/10.1016/j.schres.2016.11.033.CrossRefPubMed

20.

Tognin S, Grady L, Ventura S, Valmaggia L, Sear V, McGuire P, et al. The provision of education and employment support at the outreach and support in South London (OASIS) Service for People at clinical high risk for psychosis. Front Psychiatry. 2019;10:799. https://doi.org/10.3389/fpsyt.2019.00799.CrossRefPubMedPubMedCentral

21.

Bassett J, Lloyd C, Bassett G. Work issues for young people with psychosis: barriers to employment. Br J Occup Ther. 2001;64(2):66–72. https://doi.org/10.1177/030802260106400203.CrossRef

22.

Strickler DC, Whitley R, Becker DR, Drake RE. First person accounts of long-term employment activity among people with dual diagnosis. Psychiatr Rehabil J. 2009;32(4):261–8. https://doi.org/10.2975/32.4.2009.261.268.CrossRefPubMed

23.

Schuckit MA. Comorbidity between substance use disorders and psychiatric conditions. Addiction. 2006;101(Suppl 1):76–88. https://doi.org/10.1111/j.1360-0443.2006.01592.x.CrossRefPubMed

24.

Conway KP, Compton W, Stinson FS, Grant BF. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry. 2006;67(2):247–57. https://doi.org/10.4088/JCP.v67n0211.CrossRefPubMed

25.

Tinghög P, Al-Saffar S, Carstensen J, Nordenfelt L. The association of immigrant- and non-immigrant-specific factors with mental ill health among immigrants in Sweden. Int J Soc Psychiatry. 2010;56(1):74–93. https://doi.org/10.1177/0020764008096163.CrossRefPubMed

26.

Pooremamali P, Persson D, Östman M, Eklund M. Facing the challenges during rehabilitation – middle eastern immigrants’ paths to occupational well-being in Sweden. J Occup Sci. 2015;22(2):228–41. https://doi.org/10.1080/14427591.2013.790667.CrossRef

27.

Röder-Wanner UU, Oliver JP, Priebe S. Does quality of life differ in schizophrenic women and men? An empirical study. Int J Soc Psychiatry. 1997;43(2):129–43. https://doi.org/10.1177/002076409704300206.CrossRefPubMed

28.

Wang WL, Zhou YQ, Chai NN, Li GH, Liu DW. Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia. BMC Psychiatry. 2020;20(1):22. https://doi.org/10.1186/s12888-020-2436-5.CrossRefPubMedPubMedCentral

29.

Försäkringskassan [Social Insurance Offices]. Psykisk ohälsa [Mental ill-health] 2016 [Available from: https://www.forsakringskassan.se/wps/wcm/connect/41903408-e87d-4e5e-8f7f-90275dafe6ad/korta_analyser_2016_2.pdf?MOD=AJPERES&CVID=.

30.

Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry. 2010;22(5):417–28. https://doi.org/10.3109/09540261.2010.515205.CrossRefPubMed

31.

WHO. Gender and mental health. Geneva: World Health Organization; 2002.

32.

Strandh M, Hammarström A, Nilsson K, Nordenmark M, Russel H. Unemployment, gender and mental health: the role of the gender regime. Sociol Health Illn. 2013;35(5):649–65. https://doi.org/10.1111/j.1467-9566.2012.01517.x.CrossRefPubMed

33.

Wästberg BA, Haglund L, Eklund M. Psychometric properties of the worker role self-assessment instrument used to evaluate unemployed people in Sweden. Scand J Occup Ther. 2009;16(4):238–46. https://doi.org/10.3109/11038120902730166.CrossRefPubMed

34.

Eklund M, Bäckström M. Factor structure and construct validity of the worker role self-assessment (WRS) when used for people with psychiatric disabilities in Sweden. Eval Health Prof. 2016;39(3):299–316. https://doi.org/10.1177/0163278716643825.CrossRefPubMed

35.

Eklund M. Satisfaction with daily occupations – a tool for client evaluation in mental health care. Scand J Occup Ther. 2004;11(3):136–42. https://doi.org/10.1080/11038120410020700.CrossRef

36.

Eklund M, Bäckström M, Eakman A. Psychometric properties and factor structure of the 13-item satisfaction with daily occupations scale when used with people with mental health problems. Health Quality Life Outc. 2014;12(1):7.CrossRef

37.

Eklund M, Gunnarsson AB. Satisfaction with daily occupations (SDO): construct validity and test-retest reliability of a screening tool for people with mental disorders. Austr Occup Ther J. 2007;54(1):59–65.

38.

Priebe S, Huxley P, Knight S, Evans S. Application and results of the Manchester short assessment of quality of life (MANSA). Int J Soc Psychiatry. 1999;45(1):7–12. https://doi.org/10.1177/002076409904500102.CrossRefPubMed

39.

Björkman T, Svensson B. Quality of life in people with severe mental illness. Reliability and validity of the Manchester short assessment of quality of life (MANSA). Nord J Psychiatry. 2005;59(4):302–6. https://doi.org/10.1080/08039480500213733.CrossRefPubMed

40.

Petkari E, Giacco D, Priebe S. Factorial structure of the Manchester short assessment of quality of life in patients with schizophrenia-spectrum disorders. Qual Life Res. 2020;29(3):833–41. https://doi.org/10.1007/s11136-019-02356-w.CrossRefPubMed

41.

Eklund M, Bäckström M. A model of subjective quality of life for outpatients with schizophrenia and other psychoses. Qual Life Res. 2005;14(4):1157–68. https://doi.org/10.1007/s11136-004-2960-7.CrossRefPubMed

42.

Anthony W. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. 1993;16(4):11–23.

43.

Argentzell E, Hultqvist J, Neil S, Eklund M. Measuring personal recovery - psychometric properties of the Swedish questionnaire about the process of recovery (QPR-Swe). Nord J Psychiatry. 2017;71(7):529–35. https://doi.org/10.1080/08039488.2017.1346144.CrossRefPubMed

44.

Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33(6):766–71. https://doi.org/10.1001/archpsyc.1976.01770060086012.CrossRefPubMed

45.

Startup M, Jackson MC, Bendix S. The concurrent validity of the global assessment of functioning (GAF). Br J Clin Psychol. 2002;41(4):417–22. https://doi.org/10.1348/014466502760387533.CrossRefPubMed

46.

Vatnaland T, Vatnaland J, Friis S, Opjordsmoen S. Are GAF scores reliable in routine clinical use? Acta Psychiatr Scand. 2007;115(4):326–30. https://doi.org/10.1111/j.1600-0447.2006.00925.x.CrossRefPubMed

47.

Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale NJ: Lawrence Erlbaum; 1988.

48.

IBM SPSS Statistics 26 core system user’s guide Armonk [NY]: IBM Corp.; 2019 [Available from: ftp://public.dhe.ibm.com/software/analytics/spss/documentation/statistics/26.0/en/client/Manuals/IBM_SPSS_Statistics_Core_System_User_Guide.pdf.

49.

Honey A. Benefits and drawbacks of employment: perspectives of people with mental illness. Qual Health Res. 2004;14(3):381–95. https://doi.org/10.1177/1049732303261867.CrossRefPubMed

50.

Socialstyrelsen. Nationella riktlinjer för psykosociala insatser vid schizofreni och schizofreniliknande tillstånd. Stockholm: Stöd för styrning och ledning; 2018.

51.

Eklund M, Erlandsson LK, Persson D. Occupational value among individuals with long-term mental illness. Can J Occup Ther. 2003;70(5):276–84. https://doi.org/10.1177/000841740307000504.CrossRefPubMed

52.

Goldberg B, Britnell ES, Goldberg J. The relationship between engagement in meaningful activities and quality of life in persons disabled by mental illness. Occup Ther Ment Health. 2002;19(2):17–44.CrossRef

53.

Pedersen G, Urnes O, Hummelen B, Wilberg T, Kvarstein EH. Revised manual for the global assessment of functioning scale. Eur Psychiatry. 2018;51:16–9. https://doi.org/10.1016/j.eurpsy.2017.12.028.CrossRefPubMed

54.

Drake RE, Whitley R. Recovery and severe mental illness: description and analysis. Can J Psychiatr. 2014;59(5):236–42. https://doi.org/10.1177/070674371405900502.CrossRef

55.

Charzynska K, Kucharska K, Mortimer A. Does employment promote the process of recovery from schizophrenia? A review of the existing evidence. Int J Occup Med Environ Health. 2015;28(3):407–18. https://doi.org/10.13075/ijomeh.1896.00341.CrossRefPubMed

56.

Aubin G, Hachey R, Mercier C. Meaning of daily activities and subjective quality of life in people with severe mental illness. Scand J Occup Ther. 1999;6(2):53–62. https://doi.org/10.1080/110381299443744.CrossRef

57.

Hoye A, Rezvy G, Hansen V, Olstad R. The effect of gender in diagnosing early schizophrenia--an experimental case simulation study. Soc Psychiatry Psychiatr Epidemiol. 2006;41(7):549–55. https://doi.org/10.1007/s00127-006-0066-y.CrossRefPubMed

58.

Iniesta R, Ochoa S, Usall J. Gender differences in service use in a sample of people with schizophrenia and other psychoses. Schizophr Res Treatment. 2012;2012:365452.CrossRef

59.

Hammell KW. Dimensions of meaning in the occupations of daily life. Can J Occup Ther. 2004;71(5):296–305. https://doi.org/10.1177/000841740407100509.CrossRefPubMed

60.

Burns-Lynch B, Brusilovskiy E, Salzer MS. An empirical study of the relationship between community participation, recovery, and quality of life of individuals with serious mental illnesses. Isr J Psychiatry Relat Sci. 2016;53(1):46–54.PubMed

61.

Rosenberg D, Argentzell E. Service users experience of receiving peer support in Swedish mental health care – a “tipping point” in the care-giving culture? J Psychosoc Rehabil Ment Health. 2018;5(5):53–61. https://doi.org/10.1007/s40737-018-0109-1.CrossRef

62.

Eklund M, Tjörnstrand C, Sandlund M, Argentzell E. Effectiveness of balancing everyday life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness - a cluster RCT study. BMC Psychiatry. 2017;17(1):363. https://doi.org/10.1186/s12888-017-1524-7.CrossRefPubMedPubMedCentral

63.

Bjørkedal STB, Bejerholm U, Epløv LF, Møller T. Meaningful activities and recovery (MA&R): the effect of a novel rehabilitation intervention among persons with psychiatric disabilities on activity engagement-study protocol for a randomized controlled trial. Trials. 2020;21(1):789. https://doi.org/10.1186/s13063-020-04722-3.CrossRefPubMedPubMedCentral

64.

Gunnarsson AB, Wagman P, Hedin K, Håkansson C. Treatment of depression and/or anxiety – outcomes of a randomised controlled trial of the tree theme method® versus regular occupational therapy. BMC Psychology. 2018;6(1):25. https://doi.org/10.1186/s40359-018-0237-0.CrossRef

65.

Nordström M, Skärsäter I, Björkman T, Wijk H. The life circumstances of persons with a psychiatric disability: a survey in a region in southern Sweden. J Psychiatr Ment Health Nurs. 2009;16(8):738–48. https://doi.org/10.1111/j.1365-2850.2009.01455.x.CrossRefPubMed

66.

Lengnick-Hall ML, Gaunt PM, Kulkarni M. Overlooked and underutilized: people with disabilities are an untapped human resource. Hum Resour Manag. 2008;47(2):255–73. https://doi.org/10.1002/hrm.20211.CrossRef

67.

Rinaldi M, Killackey E, Smith J, Shepherd G, Singh SP, Craig T. First episode psychosis and employment: a review. Int Rev Psychiatry. 2010;22(2):148–62. https://doi.org/10.3109/09540261003661825.CrossRefPubMed

68.

Gureje O, Herrman H, Harvey C, Morgan V, Jablensky A. The Australian National Survey of psychotic disorders: profile of psychosocial disability and its risk factors. Psychol Med. 2002;32(4):639–47. https://doi.org/10.1017/S0033291702005627.CrossRefPubMed

69.

Weinberg D, Shahar G, Davidson L, McGlashan TH, Fennig S. Longitudinal associations between negative symptoms and social functioning in schizophrenia: the moderating role of employment status and setting. Psychiatry. 2009;72(4):370–81. https://doi.org/10.1521/psyc.2009.72.4.370.CrossRefPubMed

70.

Sweet D, Byng R, Webber M, Enki DG, Porter I, Larsen J, et al. Personal well-being networks, social capital and severe mental illness: exploratory study. Br J Psychiatry. 2018;212(5):308–17. https://doi.org/10.1192/bjp.bp.117.203950.CrossRefPubMed

Title: A cross-sectional study addressing the importance of work and other everyday activities for well-being among people with mental illness: does additional vulnerability matter?
Authors: Lisa Eklund
A. Birgitta Gunnarsson
Jan-Åke Jansson
Parvin Pooremamali
Mona Eklund
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Post-Traumatic Stress Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03388-8

At a glance: The STEP trials

Springer Medicine

A cross-sectional study addressing the importance of work and other everyday activities for well-being among people with mental illness: does additional vulnerability matter?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Correlational research on facial and clinical characteristics of adolescents with obsessive-compulsive disorder

Self-reported burden of caregiver of adults with depression: a cross-sectional study in five Western European countries

Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial

A randomized controlled trial of cognitive control training (CCT) as an add-on treatment for late-life depression: a study protocol

In search of the optimum structural model for Internet Gaming Disorder