Search

Introduction and Aims: Novel treatments for substance use disorders are needed. Acute bouts of exercise can improve mood states in non‐clinical populations, but effects in those with poly‐substance dependence are understudied. We examined the feasibility and short‐term effects of three types of exercise on drug cravings, self‐esteem, mood and positive/negative affect in nine poly‐drug‐dependent inpatients. Design and Methods: Using a cross‐over design, changes in the four study outcomes were assessed immediately before exercise and on four separate occasions post‐exercise (immediately after, then at 1, 2 and 4 h post‐exercise) enabling patterns of change over time (analysis of covariance) to be observed. Results: Participants were willing and able to engage in different non‐laboratory based exercises. Football was associated with non‐significant short‐term reductions in drug cravings. A similar trend was seen for circuit‐training, but not walking. Football and circuit‐training were associated with brief improvements in mood and positive/negative affect. No adverse events were reported. Discussion and Conclusions: Football, circuit training and walking are feasible therapeutic activities for inpatients with poly‐substance dependence. Controlled trials are needed to determine the long‐term effects of these activities.

Background: Depression in pregnancy increases the risk of complications for mother and child. Few studies are done in ethnic minorities. We wanted to identify the prevalence of depression in pregnancy and associations with ethnicity and other risk factors. Method: Population-based, prospective cohort of 749 pregnant women (59% ethnic minorities) attending primary antenatal care during early pregnancy in Oslo between 2008 and 2010. Questionnaires covering demographics, health problems and psychosocial factors were collected through interviews. Depression in pregnancy was defined as a sum score ≥ 10 by the Edinburgh Postnatal Depression Scale (EPDS) at gestational week 28. Results: The crude prevalence of depression was; Western Europeans: 8.6% (95% CI: 5.45-11.75), Middle Easterners: 19.5% (12.19-26.81), South Asians: 17.5% (12.08-22.92), and other groups: 11.3% (6.09-16.51). Median EPDS score was 6 in Middle Easterners and 3 in all other groups. Middle Easterners (OR = 2.81; 95% CI (1.29-6.15)) and South Asians (2.72 (1.35-5.48)) had significantly higher risk for depression than other minorities and Western Europeans in logistic regression models. When adjusting for socioeconomic position and family structure, the ORs were reduced by 16-18% (OR = 2.44 (1.07-5.57) and 2.25 (1.07-4.72). Other significant risk factors were the number of recent adverse life events, self-reported history of depression and poor subjective health three months before conception. Conclusion: The prevalence of depression in pregnancy was higher in ethnic minorities from the Middle East and South Asia. The increased risk persisted after adjustment for risk factors

Historically, asylums were surrounded by gardens, parks and open landscapes, and patients often participated in horticultural activities. Horticultural therapy and therapeutic horticulture are today widely known therapeutic strategies within mental health, despite the fact that formal research in this field is scarce. Depressed individuals suffer from impaired mood, attentional impairment, rumination, reduced interest, inactivity and social withdrawal. Depression is further highly co-morbid with anxiety and inversely associated with existential issues such as a sense of meaning in life. The main aim of the present research was to assess changes in depression severity, anxiety, positive affects, perceived stress, perceived attentional capacity, rumination and existential issues during a twelve week therapeutic horticulture program in a Green Care farm context. The research also aimed to identify when during a therapeutic horticulture program the most significant changes took place, and to investigate if the elements of attention restoration theory, being away, fascination and group cohesiveness acted as possible active components. The research further aimed to investigate the persistence of changes at 3-month follow-up. Two single-group design studies with multiple measurement points and convenience samples were used (Study 1:2008 and Study 2:2009). The participants, all meeting the DSM IV criteria for major depressive disorder, completed a group-based therapeutic horticulture program in twelve weeks, attending twice a week for three hours each time. The thesis includes four papers: an empirical investigation of changes in depression severity and perceived attentional capacity in relation to the restorative qualities being away and fascination (Study 1, Paper I); an empirical investigation of changes in depression severity, perceived attentional capacity and rumination as mediated by the restorative qualities being away and fascination (Study 2, Paper II); an empirical investigation of levels of group cohesiveness in relation to changes in depression severity, anxiety, positive affects and perceived stress in the pooled sample (Study 1 and Study 2), with an analysis of qualitative data related to social aspects of the therapeutic horticulture intervention (Paper III); and finally an empirical investigation of changes in life regard (Study 1) and sense of coherence (Study 2) in relation to changes in depression severity, together with an analysis of qualitative data related to these existential issue in therapeutic horticulture for clinical depression (Paper IV). In both studies, depression severity declined significantly during the intervention, and the most significant change took place during the first four weeks. The decline compared to baseline was still significant at 3-month follow-up in both studies. Perceived attentional capacity increased in both studies; the most significant change took place after four weeks in Study 1 and after eight weeks in Study 2. However, the increase dissipated by the 3-month follow-up in both studies. Rumination decreased significantly during the intervention in Study 2. The participants reported high and stable values on the restorative qualities being away and fascination during the intervention. Those participants who were most fascinated by the intervention showed a significantly greater decline in depression severity (Paper I). Decline in depression severity and increase in perceived attentional capacity were mediated by change in the restorative qualities being away and fascination from home to the garden context. Brooding acted as a moderator of decline in depression severity (Paper II). The improvements in anxiety, positive affects and perceived stress during the intervention were all statistically significant. The participants reported high levels of group cohesiveness, and the levels of group cohesiveness correlated positively, but not significantly, with the improvements in depression severity, anxiety, affects and perceived stress. The participants evaluated positively the social aspects of the therapeutic horticulture intervention and more than a third of the participants reported increased social activity after having participated in the intervention (Paper III). There were no significant changes in the two studies in the existential issues life regard and sense of coherence. However, more than two thirds of the participants evaluated that participation in the therapeutic horticulture intervention had contributed to change in their view of life. The qualitative data supported these evaluations (Paper IV). This research is limited by a lack of control group, small sample sizes in each study and a complex intervention performed at four different locations. The research is strengthened by double assessments at baseline, multiple measurement points and two data collection periods, enabling replication that increases confidence in the findings. The research is theoretically consistent looking across perspectives on depression, the selection of measures and the active components of the intervention. It is also considered a strength that the statistical analysis used allowed for determining when the most substantial changes took place, and for examining possible mediators and moderators. Additional strengths were that the design allowed for investigating changes at 3-month follow-up. This research appears to be the first to investigate the benefits of therapeutic horticulture in clinical depression. De psykiatriske asylene har i et historisk perspektiv vært omgitt av hager, parker og åpne landskap. Terapeutisk hagebruk er i dag vel kjent som terapeutisk strategi innen psykisk helsevern, til tross for at det er lite forskning på dette feltet. Depresjon kjennetegnes av nedstemthet, kognitive begrensinger, grubling, redusert interesse for aktiviteter, inaktivhet og sosial tilbaketrekning. Depresjon opptrer ofte sammen med angst og er inverst assosiert med eksistensielle forhold som mening i livet. Den primære hensikten med dette forskningsprosjektet var å evaluere endringer i alvorlighetsgrad av depresjon, angst, positive emosjoner, opplevd stress, opplevd oppmerksomhetskapasitet, grubling og eksistensielle forhold etter deltakelse i et tolv ukers terapeutisk hagebruksprogram på Grønn Omsorg gårder. Forskningen hadde også til hensikt å identifisere når den største endringen fant sted, og å undersøke om endring i omgivelser, fascinasjon og gruppetilhørighet var mulige aktive komponenter i intervensjonen. Videre hadde studien til hensikt å undersøke i hvilken grad endringene holdt seg ved 3 måneder oppfølging etter avsluttet intervensjon. To studier med single-group design, repeterte målepunkter og bekvemmelighetsutvalg ble benyttet (Studie 1:2008 og Studie 2:2009). Deltakerne, alle med diagnosen major depressive disorder i henhold til DSMIV, fullførte et gruppebasert terapeutisk hagebruksprogram over tolv uker, to ganger i uken tre timer hver gang. Avhandlingen inkluder fire artikler; en empirisk undersøkelse av endringer i alvorlighetsgrad i depresjon og opplevd oppmerksomhetskapasitet relatert til de restorative kvalitetene endring i omgivelser og fascinasjon (Studie 1, Paper I); en empirisk undersøkelse av endringer i alvorlighetsgrad av depresjon, opplevd oppmerksomhetskapasitet og grubling mediert av de restorative kvalitetene endring i omgivelser og fascinasjon (Studie 2, Paper II) en empirisk undersøkelse av niva av gruppesamhold i relasjon til endringer i alvorlighetsgrad i depresjon, angst, positive emosjoner og opplevd stress i det samlede utvalget (Studie 1 og Studie 2) og en analyse av kvalitative data relatert til den sosiale dimensjonen av terapeutisk hagebruk (Paper III); en empirisk undersøkelse av endringer i syn på livet (Studie 1) og opplevelse av sammenheng (Studie 2) i relasjon til endringer i alvorlighetsgrad av depresjon samt en analyse av kvalitative data relatert til den eksistensielle dimensjonen i terapeutisk hagebruk for klinisk depresjon (Paper IV). I begge studiene var det en signifikant reduksjon i alvorlighet av depresjon i løpet av intervensjonen, med den mest signifikante endring etter fire uker. Endringen var fremdeles signifikant sammenlignet med baseline ved 3 måneders oppfølging. Opplevd oppmerksomhetskapasitet økte i begge studiene med den mest signifikante endring etter fire uker i studie 1 og etter åtte uker i studie 2. Imidlertid hadde denne økningen falt bort ved 3 måneders oppfølging i begge studiene. Grubling avtok signifikant i løpet av intervensjonen i Studie 2. Deltakerne rapporterte høye og stabile verdier på de restorative kvalitetene som endring i omgivelser og fascinasjon under intervensjonen. De deltakerne som var mest fascinert i intervensjonen hadde en signifikant større reduksjon i alvorlighetsgrad av depresjon (Paper I). Reduksjon i alvorlighetsgrad av depresjon og økning i opplevd oppmerksomhetskapasitet var mediert av de restorative kvalitetene som endring i omgivelser og fascinasjon. Grubling opererte som en moderator på reduksjon i alvorlighetsgrad av depresjon (Paper II). Bedringer i angst, positive emosjoner og opplevd stress i løpet av intervensjonen var alle statistisk signifikante. Deltakerne rapporterte høye nivåer av guppesamhold, og nivå av gruppesamhold korrelerte positivet, men ikke signifikant, med bedringer i alvorlighetsgrad av depresjon, angst, positive emosjoner og opplevd stress. Deltakerne evaluerte positivt den sosiale dimensjonen ved terapeutisk hagebruk og mer enn en tredjedel av deltakerne rapporterte økt sosial aktivitet etter deltakelse i intervensjonen (Paper III). Det var ingen signifikante endringer i de to studiene i de to instrumentene som var valgt til å måle eksistensielle forhold (syn på livet og opplevelse av sammenheng). Imidlertid rapporterte mer en to tredjedeler av deltakerne at deltakelse i terapeutisk hagebruk hadde bidradd til å endre deres syn på livet. Dette ble videre støttet av de kvalitative data (Paper IV). Studiens begrensninger er knyttet til mangel på kontroll gruppe, lite utvalg i hver studie og en kompleks intervensjon gjennomført på fire forskjellige steder. Studiens styrke er dobbel baseline, multiple malepunkter og to perioder med innsamling av data, noe som impliserte en replikasjon med styrket tilliten til funnene. Studien anses å være teoretisk konsistent i sine perspektiver på depresjon, valg av måleinstrumenter og intervensjonens aktive komponenter. De statistiske analysene som ble benyttet for a bestemme når den mest signifikante bedringen fant sted, og for å identifisere mulige mediatorer og moderatorer, anses også å styrke studien. Likeledes vurderes det som en styrke at designet muliggjorde målinger ved 3 måneder oppfølging. Denne studien antas å være den første som undersøker nytten av terapeutisk hagebruk ved klinisk depresjon.