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Background Although most mental disorders have their onset in early life, the mental health needs of young people are often not addressed adequately. Open Dialogue is a need-adapted approach that mobilizes psychosocial resources in a crisis struck person’s social network. Open Dialogue is organised as a series of network meetings and seeks to promote collaborative integrated care, and a non-directive psychotherapeutic stance. Its effectiveness for young people has not previously been assessed. Objectives The aim of the study was to examine whether a Danish Open Dialogue approach directed at young people, who sought help from Child and Adolescent Mental Health Services, reduced their utilisation of psychiatric and other health services, compared to peers receiving usual psychiatric treatment. Design A retrospective register-based cohort study. Methods Using clinical and national register data, a cohort of patients aged 14–19 years (n = 503) enrolled from one region during 2000 to 2015 were compared to a matched comparison group from two other regions using propensity scores. Utilisation of psychiatric health services, GP services, and social markers were assessed after 1, 2, 5 and 10 year of follow-up using logistic and Poisson regression models. Results Patients receiving Open Dialogue intervention had more psychiatric outpatient treatments at one year of follow-up (RR = 1.2, CI: 1.1–1.4) than the comparison group, but not at subsequent follow-ups. Recipients of the intervention had fewer emergency psychiatric treatments (1 year follow-up: RR = 0.2, CI: 0.1-0.5; 10 years follow-up: RR = 0.5, CI: 0.3-0.8) and less use of general practitioner services (1 year follow-up: RR = 0.90, CI: 0.82-0.99; 10 years follow-up: RR = 0.85, CI: 0.78-0.92). There was no significant reduction in the number of psychiatric hospitalisation contacts or treatment days. Conclusions Open Dialogue was significantly associated with some reduced risks of utilising health care services. These mixed results should be tested in a randomized design.

BACKGROUND: An increasing number of qualitative research articles have reported on relatives' experiences of providing care for individuals displaying suicidal behaviour. To contribute more fully to theory and practice, these reported experiences must be synthesized.OBJECTIVES: To identify original qualitative studies of relatives' experiences of providing care for individuals with non-fatal suicidal behaviour and to systematically review and synthesize this research using a meta-ethnographic approach.DESIGN: Systematic review and meta-ethnography.DATA SOURCES: Literature searches were undertaken in six bibliographic databases (PubMed, CINAHL, Embase, PsycINFO, Web of Science and Scopus) and limited to peer-reviewed original studies. Eligible studies reported relatives' experiences of providing care for individuals with suicidal behaviour, published in English or a Scandinavian language.REVIEW METHODS: One reviewer screened the titles, abstracts and full texts and then collaborated with another reviewer on excluding ineligible studies. A two-step strategy was used while reviewing publications: 1) appraising study quality, and 2) classifying study findings according to degree of data interpretation. This strategy was used for each study by two independent reviewers who subsequently reached a shared decision on inclusion. Noblit and Hare's methodology for translation and synthesis was followed in developing a novel theoretical interpretation of relatives' experiences. The concept of moral career was adopted in producing this synthesis.RESULTS: Of 7,334 publications screened, 12 studies were eligible for inclusion. The synthesis conveyed relatives' moral career as comprising four stages, each depicting relatives' different perspectives on life and felt identities. First, relatives negotiated conventional ideas about normalcy and positioned themselves as living abnormal family lives in the stage from normal to abnormal. The first career movement could be mediated by social interactions with professionals in the stage feeling helpful or feeling unhelpful. For some relatives, this negotiated perspective of abnormality got stuck in an impasse. They did not interact with their surroundings in ways that would enable them to renegotiate these fixed views, and this stage was named stuck in abnormality. For other relatives, career movement took place as relatives re-positioned themselves as negotiating an alternative perspective of normalcy in the stage from abnormal to normal.CONCLUSIONS: Interactions with other people facing similar difficulties enabled relatives to shift perspectives and alleviated experiences of distress.

Background Using checklists to critically evaluate and report qualitative research is a common practice in the health sciences and there is currently a plethora of checklists available. One strategy for developing such checklists is to identify and amalgamate items from previous checklists into more comprehensive, consolidated ones. Objective This paper aims to critically review the credibility of a widely endorsed checklist of this type, the Consolidated Criteria for Reporting Qualitative Research (COREQ), by replicating the procedures that led to the consolidation of its 32 items. The original development of COREQ consisted of four phases: 1. A literature search and identification of a sample (n = 22) of references, 2. Data extraction through coding the references, 3. A simplification of an intermediate list of items, and 4. Addition of two items. Design and methods A replication of the four-phased development of COREQ. We used the reported account of the development of COREQ to replicate the procedures and rationale applied in the four phases. However, we were rarely able to replicate them completely because of uncertainty about the actual procedures. The problems with the replication indicated that COREQ's items were not credible because the coding processes were not trustworthy and because they decontextualized original checklist items and significantly distorted their meaning in COREQ's final list of items. We discuss the use of checklists by means of Haraway's figure of the “modest witness”, which emphasizes that checklists can de-politicize research and create an illusion of rationality and objectivity. Conclusions Considering that COREQ is widely endorsed by scholarly journals, it is alarming that the checklist's particular technical and a-political approach to achieve more complete reporting of qualitative research and its particular perspective on what constitutes quality in qualitative research remains unchallenged.

BACKGROUND: The role of the psychiatric emergency services has undergone extensive changes following a significant downsizing of the number of psychiatric hospital beds during the past decades. A relatively small number of "frequent visitors" accounts for a disproportionately large amount of visits to psychiatric emergency services.OBJECTIVES: To identify predictors of frequent use of a psychiatric emergency room at a Danish University Psychiatric Hospital through a 12-year period (1995-2007) and to speculate on how changes in the mental healthcare services affect predictors of frequent use through time.DESIGN: A large-scale register based logistic regression analysis combined with a small-scale explorative, interpretative interview study. Register data were drawn from the Danish Central Psychiatric Research Register. Four-year cohorts (1995, 1998, 2001 and 2004) of patients with at least one visit to the psychiatric emergency room were followed for 3 years to identify general trends of predictors throughout the period. A purposeful sample of 15 frequent visitors were interviewed about their personal motives for visiting the psychiatric emergency room, their pathways to care, and their social network and social support.RESULTS: The study identified two overall trends of predictors of frequent use of the psychiatric emergency room. High use of psychiatric services: ≥5 visits to the psychiatric emergency room, ≥3 admissions or ≥60 bed days during the year, was and continued to be predictive of high use of the psychiatric emergency room throughout the whole period. Furthermore, the emergence and continual presence of the predictors: severe mental illness (1999-onwards), substance abuse (2002-onwards) and sheltered housing (2002-2003-2005-onwards) indicated changes in the general profile of frequent visitors to the psychiatric emergency room, where predictors related to illness behaviour were supplemented by predictors related to disease.CONCLUSION: The changing profile of the conditions predicting frequent visits at the psychiatric emergency room was most probably related to the adverse effects of the continuous deinstitutionalising of the Danish mental health services and a radical health care reform. A basic multiplicative model was designed for the early detection of individual frequent visitors.

Background Low back pain often becomes a chronic condition and causes physical, psychological, social, and occupational impairment. Despite huge allocations of resources into the healthcare system and the labour market for treating and preventing low back pain, problems related to low back pain persist. A Danish randomised controlled trial identified an effective counselling intervention on low back pain patients' physical function, bodily pain and sick leave. Counselling addressed experienced workplace barriers and physical activity. Objective The objective of the present study was to achieve a deeper understanding of how the patients interpreted the explanatory resources that were made available to them during the intervention, and how they integrated these resources into their personal biographies. Design The present study was a qualitative analysis of a purposive sample of transcripts of status interviews performed during the randomised controlled trial's intervention. Analysis Between two individual counselling sessions, all 110 participants were interviewed about their perspectives on adhering to their individual plans for reaching specific goals for adjustments at their workplace and for enhancing physical activity. These plans were developed and agreed upon by the participants and the counsellor. A sample ( n =20) of these interviews was analysed in the present study using the three steps in Ricoeur's method for text analysis. Bury's concept of chronic illness as a biographical disruption was used as a theoretical framework for further interpretations of the dataset. Results The participants valued the counsellor's open inquiry into the problems they had with their back. The participants' active engagement in creating new explanatory systems was crucial for their benefits from the intervention. If participants managed to change their health behaviour, it assisted them in transforming from being passive victims of pain into becoming active and in control. Participants who did not feel that they were sufficiently able to adhere to the treatment plan felt increasingly stigmatised, because they understood themselves to be in a position of disgrace in their own eyes and in the eyes of the system that offered them help. Conclusion The counsellor's assistance in crafting the first possible and manageable steps towards returning to work and enhancing exercising supported the participants' commitment to the treatment plan.