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Journal article review: Activity and social participation following psychosis

Dr Alison Laver-FawcettActivity and social participation in the period following a first episode of psychosis and implications for occupational therapy - reviewed by Dr Alison Laver Fawcett, Deputy Director Research Centre for Occupation and Mental Health (RCOMH)

Dr. Terry Krupa, from Queen’s University in Canada, Harriet Woodside, who works in an Early Intervention in psychosis programme in Canada, and Karen Pocok, who is based in a mental health service in South Australia, conducted a qualitative study using several data collection methods to increase understanding of the impact of a first episode of psychosis on activity and social participation in younger adults. Their primary data collection method involved a semi-structured interview with 25 people (17 male; 8 female) which was recorded and transcribed. The majority of data was collected in Canada with 5 of the primary participants living in Australia. Further data was obtained through:

  1. document analysis (such as mental health records, school reports and personal journals);
  2. interviews with secondary participants who comprised 15 people who knew the person well, such as a family member or friend; and c) six ‘key informants’ who ‘included specialists in psychology, disability counselling and occupational therapy’ (p.15).

The researchers found that ‘the first episode of psychosis was highly disruptive and even damaging to activity and social participation’ (p13) and concluded that ‘in the wake of the first episode of psychosis individuals are at a high risk for disengagement from important and meaningful activity and social participation’ (p19). Productive occupations were found to be ‘particularly important’ for individuals in their recovery to construct ‘a future that was directed and meaningful’ (p18). Data analysis revealed ‘six critical tasks for re-engagement in activity and social participation’ (p15) and provided interesting quotes from primary and secondary participants to illustrate these tasks:

  1. Making new plans (p15)
  2. Developing a balance of activity and routines (p16)
  3. Participating despite disturbances in emotional connection to activities and socialising (p16)
  4. Matching participation to the person’s recovery of performance abilities (p16)
  5. Managing new self-care and social skills (p17)
  6. Making changed conditions and contexts for activity and social participation (p17)

The six critical tasks are then discussed in light of occupational therapy practice and recommendations are made.

Whilst some discussion about the trustworthiness and the limitations of this research by the authors would have been valuable, the study appears robust. The researchers have used several sources of data and, after coding and analysing data from the primary participants, have triangulated data with documentary analysis and the views of secondary participants and key informants through a ‘constant comparative method’ (p14) to identify the core categories. Findings are well supported with direct quotations.

The authors refer to the World Health Organisation and International Early Psychosis Association outcomes for early intervention in psychosis services which include ‘the expectation that within 2 years of diagnosis at least 90% of service recipients will be participating in social roles and activities similar to their peers’ (p13). This led me to ponder: how well equipped are we to deliver this outcome and what further research is required to better understand how occupation based interventions can support people to re-engage in desired and needed occupations and roles following a first episode of psychosis? This study makes a valuable contribution to our understanding of the complexities and challenges for people when re-establishing activity and social participation following a first episode of psychosis and the approaches that are required to support recovery.

If you would like to find out more about this study the full article was published in the British Journal of Occupational Therapy in January 2010 and Terry Krupa is listed as the corresponding author and can be contacted via e-mail at: terry.krupa@queensu.ca

Reference: Krupa T, Woodside H, Pocock K (2010) Activity and Social participation in the period following a first episode of psychosis and implications for occupational therapy. British Journal of Occupational Therapy, 73(1) 13 – 20.