Participation in novelty-seeking leisure activities and Alzheimer's disease

The objective was to study the associations between participation in different types of mentally stimulating leisure activities and status as Alzheimer's disease (AD) case or normal control. Research suggests that participation in leisure activities, especially mentally stimulating activities, is associated with a lower risk for AD. However, no study has yet evaluated associations between AD and different types of mental leisure activities, especially those involving "novelty seeking." The authors used a case-control design to compare participation in activities across the life span in persons with AD and normal controls. Cases (n = 264) were recruited from clinical settings and from the community. Controls were drawn from 2 populations. Control group A members (n = 364) were the friends or neighbors of the cases or members of the same organizations to which the cases belonged. Control group B members (n = 181) were randomly drawn from the community. The 2 control groups did not differ in their responses to most activity questions, so they were combined. Factor analysis of activity questions identified 3 activity factors: (1) novelty seeking; (2) exchange of ideas; and (3) social. Logistic regression analysis indicated that, adjusting for control variables, greater participation in novelty-seeking and exchange-of-ideas activities was significantly associated with decreased odds of AD. The odds of AD were lower among those who more often participated in activities involving exchange of ideas and were lower yet for those who more frequently participated in novelty-seeking activities. We conclude that participation in a variety of mental activities across the life span may lower one's chances of developing AD.     

Consumer-directed supports: economic, health, and social outcomes for families

The impact of a consumer-directed support program on family caregivers of adults with developmental disabilities was explored. Economic, health, and social outcomes were compared between families in the program and families on the waiting list for the program. Caregivers of adults in the program reported fewer out-of-pocket disability expenses, greater access to health care, engagement in more social activities, and greater leisure satisfaction. There also appeared to be greater impacts on lower income families; these caregivers reported better mental health and access to health care than did similar caregivers on the waiting list.     

Follow-up on behavioral intervention with troublesome adolescents

This investigation represents the second of two efforts to obtain follow-up information on past participants in a school-based social learning program designed for problem adolescents. The follow-up occurred approximately four years after the students' participation in the program. The behavior of 40 of the original 60 adolescents was assessed on the basis of their employment and educational status, program participation, involvement in leisure time and community activities, self-esteem, aspirations and expectations, delinquent activity, relationships with family and friends, and their anticipated aversive consequences of engaging in criminal acts. Data comparisons between experimental and control participants indicate no long-term maintenance of behavioral change. Various issues pertinent to delinquency research are also briefly reviewed.     

Social Value of Supported Employment for Psychosocial Program Participants

Members of a psychiatric psychosocial program designed to provide both supported employment and peer support were surveyed about their current social activities, sources of social support, and social life improvement since joining the program. Survey respondents who worked a mainstream job (n = 17) reported greater peer contact in community locations, and correspondingly greater social life improvement, than those who remained unemployed or worked volunteer jobs (n = 45). Results of a hierarchical regression analysis (N = 62) that explored this positive correlation between mainstream work, community-based peer contact, and social life satisfaction suggest that working a job in an integrated setting that paid at least minimum wage encouraged program participants to meet and interact in community locations, thereby strengthening peer mutual support while furthering social integration. This unique pattern of findings requires replication, and we recommend that other psychosocial programs conduct similar quality improvement studies to provide further insights into the relationship between peer support and community integration.     

Characteristics predicting successful outcomes of participants with severe mental illness in supported education

OBJECTIVE: The study sought to identify characteristics of participants in a supported education program that were related to a successful outcome. Supported education programs provide rehabilitation and support services to help people attain postsecondary education. METHODS: A total of 147 persons who completed such a program were interviewed six or 12 months later, or at both times, to determine whether they were involved in productive activity, which was defined as engaging in either college or vocational education or in paid employment. Variables examined as predictors of productive activity were demographic characteristics; education and work background; social support; self-perceptions related to self-esteem, empowerment, quality of life, and school self-efficacy; and illness-related variables, including diagnosis, symptoms, and length of illness. RESULTS: Multivariate logistic regression identified the strongest predictor as productive activity at baseline. Marital status was the only significant demographic variable in the model; single participants were less likely to be engaged in productive activity. For participants who reported more frequent contact with their social network, the likelihood of engagement in productive activity was higher, and for those who reported more encouragement for education from their network, the likelihood was lower. A lower level of adjustment in the financial domain decreased the likelihood of productive activity, and a higher level of problems with housework increased the likelihood. No illness-related variable or self-perception was a significant predictor. CONCLUSIONS: Factors related to a successful outcome from a supported education program for persons with severe mental illness are also likely to be important factors for nondisabled populations. Among those with mental illness, social support is a key factor in attaining educational and vocational goals.     

The social functioning of older adults with schizophrenia

A cross-sectional survey of the social functioning of community dwelling older adults was undertaken. Older adults with no psychiatric morbidity, depressed older adults and older adults with schizophrenia were surveyed to see if there were differences in the level of social functioning of the three groups. The setting was two old age psychiatric services, one in an urban area of London and the other in a semi-rural area of Leicestershire. Participants consisted of depressed (n = 81) or normal (n = 101) older persons identified as part of a general practice over 75 years check and clients over 65 years with schizophrenia (n = 30) known to mental health teams for older adults. All participants were interviewed by one of two trained researchers and completed the Mini-Mental State Examination questionnaire, the 15-item Geriatric Depression Scale, a social functioning questionnaire, and the Schedules for Clinical Assessment in Neuropsychiatry or the Brief Psychiatric Rating Scale. In our sample population, community dwelling older persons without any psychiatric diagnosis were the least isolated from their local community, reported more private leisure activities, and had the least contact with professional community services. Clients with schizophrenia reported more isolation from their local community and fewer private leisure activities than clients with a diagnosis of depression.     

The relationship between social networks and occupational and self-care functioning in people with psychosis

BACKGROUND: Relatively few studies have examined relationships between the social networks of people with psychotic disorder and other aspects of their functioning. The aim of this paper is to describe the social networks of people with psychosis and to investigate relationships between social networks and personal and occupational functioning, taking account of illness course. METHODS: A two-phase epidemiological survey of persons with psychosis was conducted in four predominantly urban areas of Australia. A census and screen for psychosis was followed by a semi-structured interview of a stratified random sample of participants to assess their functioning. Data relating to functioning and social networks from 908 individuals (most with a diagnosis of schizophrenia) were analysed using structural equation modelling (SEM). RESULTS: The majority of people with psychosis (67 %) had a network comprising of family and friends, 15 % were defined as having a family-dominated network, 11 % a friends-dominated network and 7 % of participants were defined as socially isolated (no family or friends). Participants who had friends and family in their network (12 %) or who had a family-dominated network (7 %) were more likely to be in full-time employment compared with those with a friends-dominated network (4 %) or those who were socially isolated (5 %). Dysfunction in self-care was more frequently reported among socially isolated people (50 %) and those with family-dominated networks (47 %) than among those with friends-dominated networks (35 %) and those who had friends and family in their social network (23 %). SEM revealed a strong association between social integration and functioning (r = 0.71), even after controlling for illness course. Social integration was defined as having contact with family and/or friends and functioning was defined as having employment and no difficulties in self-care. Male gender was associated with poorer self-care, and female gender was slightly, but significantly, associated with a greater likelihood of having friends. CONCLUSION: There is a strong relationship between social networks and functioning after taking account of course of illness. That is, the presence of family and friends is generally associated with better self-care and employment. Interventions that are targeted at improving social relationships are likely to have a positive impact on self-care and occupational functioning (and vice versa).     

Aging among persons with intellectual disability in Israel in relation to type of residence, age, and etiology

This study was conducted to compare aging phenomena of persons with intellectual and developmental disability (ID) aged 40 years and older living in community residence (N = 65) with those living with their families (N = 43) in Jerusalem, Israel. All 108 persons and care givers were interviewed to ascertain health problems, sensory impairment, activity of daily living (ADL), cognitive skills, and leisure activities. Health problem had already developed by age 40 years. The most frequent were visual (33%), hearing impairments (20%) and dental problems (30%). The community residence group displayed more medical problems, whereas individuals living at home had more dental problems. Health problems in persons with Down syndrome were significantly higher. ADL functioning for all participants was high, but persons with Down syndrome and cerebral palsy had more dependence. A decline in functioning in both residential groups was observed concerning leisure time, but scores for social life leisure activities were better for the community residential group. The data provided in this study can serve as information to develop geriatric services for persons with ID and provide a basis for comparison with peers in the general population in Israel. Dental service to persons with ID living at home should be improved.     

The social and community involvement of older Australians with intellectual disabilities

This paper describes the involvement of older people with intellectual disabilities in residential-and community–based activities and programmes. The 446 participants v/ere selected from a national database of people of 55 years of age and over with intellectual disabilities in Australia. The data indicate that participants made infrequent use of public amenities and social and recreational facilities. With the exception of those living with relatives, most had limited contact with family and friends. The discussion draws attention to the need for independence training which will enable the current generation of middle-aged people with an intellectual disability to make decisions and choices about social and community activities.     

Interpersonal correlates of generalized anxiety disorder: Self versus other perception

The present investigation examined the interpersonal functioning of undergraduate students who met self-report criteria for generalized anxiety disorder (GAD), both as they perceive it and as perceived by their self-nominated friends. Forty-eight participants who met self-report criteria for GAD endorsed greater global severity of interpersonal problems on the 64-item version of the Inventory of Interpersonal Problems [Horowitz, L. M., Alden, L. E., Wiggins, J. S., Pincus, A. L. (2000). Inventory of Interpersonal Problems: Manual. San Antonio, TX: The Psychological Corporation] than 53 control participants. However, friends of GAD participants did not attribute significantly greater interpersonal problems to them than did friends of control participants. GAD participants reported less secure attachment to their parents than control participants but reported similar levels of attachment to peers and perceived social support. Furthermore, there were no significant differences between the friends of the GAD participants and friends of the control participants on ratings of their friendships quality. Findings are discussed in the context of their relevance to the etiology, maintenance, and treatment of GAD.     

Using personal goal setting to promote the social inclusion of people with intellectual disability living in supported accommodation

Background The social exclusion of persons with intellectual disability is more marked in congregated than in individualised supported accommodation. Goal setting was used as a means of increasing individuals' choices and engaging support staff in personalised planning. Method People living in four different housing and support options were invited to identify up to three ‘social inclusion’ goals they wanted to achieve in the coming months. Nine months later, a review was undertaken to see if their goals had been attained and also to identify what had helped or hindered individuals in doing this. The goal selection was then repeated and reviewed again after a further 9 months. Results The most commonly chosen goals were around social activities with other people and over half the participants were reported to have attained at least one of their goals within 9 months, particularly those in supported living arrangements that had greater hours of individual staff support. In the second 9‐month period, fewer people chose goals, although the same proportion as before were successful. The main reason given for goal attainment was the information and support provided by staff. Conclusions Goal setting seems a suitable way of promoting social inclusion as it can be tailored to the needs and aspirations of individuals, although extra efforts may be needed to implement and sustain it with staff across all accommodation options.     

Subjective impairment and social recovery after closed head injury.

The level of social recovery achieved by a representative series of 50 young adults was assessed six months after a severe closed head injury (post-traumatic amnesia greater than 24 hours). Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process. Many patients were still suffering from subjective symptoms, but these appeared to have relatively minor effects on ability to resume normal activities. Physical disability was a much more important factor at this stage. A control group of patients with limb injuries suffered similar disruption of their lives, but reported few subjective complaints.     

Psychiatric leisure rehabilitation: conceptualization and illustration

Leisure or recreational rehabilitation is not much developed in psychiatric rehabilitation. I present some definitions and a (very) brief history of the notion of leisure, as well as the role of leisure in health. I then describe a novel classification of leisure activities relevant to people with psychiatric disabilities. Following that, I conceptualize the process of psychiatric leisure rehabilitation, illustrated by a case study. I conclude with the benefits of psychiatric leisure rehabilitation and with suggestions for further study and development in this field. Leisure or recreational activities are central in modern life. Not so for persons who have serious and disabling mental disorders. This is manifest even in psychiatric rehabilitation, which mostly addresses vocational and residential--rather than leisure--environments (Anthony, Cohen, Farkas & Gagne, 2002; Corrigan, 2003). Yet leisure is important for persons with psychiatric disabilities, perhaps especially so for those who are not successful or satisfied in vocational environments. This paper outlines a conceptual framework for psychiatric leisure rehabilitation, based on a novel classification of leisure activities, and illustrates this with a case vignette. But first, some definitions and a (very) brief history of the notion of leisure is in order, as well as a presentation of facts about the role of leisure in health (physical and mental).     

Self-reported restrictions in different life domains and associated factors among people with multiple sclerosis in Sweden

Background and purpose

The heterogeneous symptoms of multiple sclerosis (MS) can considerably impact the lives of people with MS (PwMS). The aim of this study was to describe the extent of restrictions in different life domains that PwMS experience in relation to their symptoms and level of disability.

Methods

A cross-sectional survey was conducted among working-age PwMS in Sweden. The 4052 participants who answered the questions on restrictions in work and private life domains (family, leisure activities, and contact with friends/acquaintances) were included. Predictors of restrictions in the four domains were determined through multinomial logistic regression.

Results

Approximately one-third of the PwMS reported no restrictions in the domains of work (35.7%), family (38.7%), leisure activities (31.1%) or contact with friends/acquaintances (40.3%), the remaining participants reported moderate to severe restrictions. Tiredness/fatigue was the most commonly reported most-limiting symptom (49.5%). PwMS with Expanded Disability Status Scale (EDSS) scores of zero reported restrictions in life domains ranging from 39.6% (friends/acquaintances) to 45.7% (leisure activities). Age, sex, education, type of living area, MS type, type of most-limiting symptom, and EDSS score predicted restrictions in work and private life domains.

Conclusions

Most PwMS reported similar levels of restrictions in both their work and private lives. Restrictions in these life domains were also reported by PwMS with low disability levels (EDSS = 0) and were often associated with invisible symptoms such as fatigue. Even in a contemporary MS cohort, close to 90% of PwMS report limitations due to MS.     

The relationship between coping and psychological well-being among people with osteoarthritis: A problem-specific approach

We examined the strategies that people with osteoarthritis (OA) use to cope with illness-related problems in four areas: household activities, leisure activities, pain management, and social relationships. We also examined the relationship between the coping strategies participants reported using upon entry to the study (Time 1) and psychological well-being reported six months later. Three hundred people, aged 50 and over, with OA participated in the study. Data were collected via two mailed questionnaires, administered at six-month intervals. We found that two of the coping strategies examined, self-criticism and social withdrawal, were used more frequently for social relationship problems than for any of the other three types of problems. None of the other coping strategies (i.e. problem solving, cognitive restructuring, social support, emotional expression, problem avoidance, turning to religion, information seeking) were used differentially across problem areas. Multivariate analyses revealed that the coping strategies people used at Time 1 significantly predicted psychological well-being, as assessed by measures of positive affect, negative affect, and depressive symptoms, six months later. However, the specific strategies that predicted positive affect were different from those that predicted negative affect and depressive symptoms. Implications of these findings for future research on coping with chronic illness are discussed.     

Occupation and communication programs for post-coma persons with or without consciousness disorders who show extensive motor impairment and lack of speech

These two studies were aimed at extending the assessment of technology-aided programs for post-coma persons with extensive motor impairment and lack of speech. Specifically, Study I assessed a new program arrangement, in which stimulation access and caregiver attention could be obtained with variations of the same response (i.e., single- versus double-hand closure) by three participants who were diagnosed at the upper level of the minimally conscious state at the start of the study. Study II was aimed at enabling two persons who had emerged from a minimally conscious state to engage in leisure activities, listen to audio-recordings of family members, and send and receive messages. The responses selected for these participants were hand pressure and eyelid closure, respectively. The results of both studies were positive. The participants of Study I increased their responding to increase their stimulation input and caregiver interaction. The participants of Study II managed to successfully select all the options the program included (i.e., the leisure options, as well as the family and communication options). General implications of the programs and the related technology packages for intervention with post-coma persons with multiple disabilities are discussed.     

Participant evaluation of a CBT program for enhancing work function in schizophrenia

OBJECTIVES: While much has been written about the benefits of CBT for persons with schizophrenia, little has been published to date exploring participant evaluations of these programs. This paper reports on participant evaluations of such a program. METHODS: Forty-four participants with schizophrenia or schizoaffective disorder were surveyed regarding their satisfaction with a 6-month weekly group and individual CBT intervention developed as an adjunct to work therapy or the control condition support group during a randomized controlled feasibility study. RESULTS: Results suggest that all participants, those receiving the CBT intervention and the support group, were satisfied with their program, on average rating the program between "good" and "excellent." However, in comparison, the CBT intervention was associated with greater participant satisfaction than support alone, particularly the perception of the overall quality of services and assistance with problem-solving. CONCLUSIONS: It appears that participant evaluations can function as a source of useful data for evaluation of CBT interventions for persons who have schizophrenia. However, further study is needed to more fully identify and understand aspects of CBT that participants with schizophrenia evaluate as particularly positive or negative and to explore acceptable trade-offs among them.     

Picture me playing—A portrait of participation and enjoyment of leisure activities in adolescents with cerebral palsy

In recent years attention has been paid to the participation levels of children and youth with Cerebral Palsy (CP), particularly the extent to which they have the opportunity to be involved in and enjoy leisure activities. The objective of this study is to describe the level of participation and enjoyment in leisure activities among adolescents with CP and to identify potential differences in participation patterns related to sociodemographic attributes. A cross-sectional design was used. Participants were 175 adolescents 12–20 years old (M = 15.3; ±2.2), GMFCS I = 55/II = 43/III = 13/IV = 18/V = 39 who completed the Children's Assessment of Participation and Enjoyment (CAPE). The types of activities participants engaged in most frequently were social and recreational activities, whereas self-improvement and skill-based activities were least frequent. Social activities were the activities they enjoyed most. In general, participation decreases, as youth grow older. Girls engaged in more self-improvement activities than boys. Adolescents who study in special segregated schools experienced a lower diversity and intensity of engagement in all leisure activity domains. Adolescents who were not ambulatory and those presenting with more severe manual ability limitations participated less in all activity types except skill-based activities. Adolescents with CP place a high value on the ability to engage in activities of their own choosing and on interacting with friends. Engagement in a variety of leisure activities is important for a healthy development. Understanding the leisure patterns and preferences of this population, in addition to the contextual factors, may help in the elaboration of interventions and programs to promote a healthy development for this population.