Understanding mental illness and promoting mental health -Experiences of Exhaustion Disorder and Effects of a Person-Centred eHealth Intervention

Abstract: Health is subjective, involving the whole person, and cannot be determined by others. It is a resource in life, not merely the absence of disease and illness. Common mental disorders (CMDs), including stress-related conditions, are a growing public health problem in Sweden and account for an increasing proportion of sick leave due to psychiatric diagnoses. The overall aim of this thesis was to build an understanding of the meaning of being affected by exhaustion disorder (ED), and to explore experiences of support and evaluate the effects of a person-centred eHealth intervention in patients on sick leave due to CMDs. A multi-method qualitative and quantitative approach was used to gather and analyse data. Studies I and II involved interviews with twelve people affected by ED; the aim was to describe and interpret their experiences of being affected by ED and of support in the process of promoting health. Studies III and IV report from a randomized controlled trial (RCT) evaluating the effects of a person-centred eHealth intervention (consisting of phone support and a digital platform) in primary care patients (n=209) on sick leave due to CMDs. The findings show that people with ED experience existential challenges and need allies in their struggle for acknowledgement as persons. Person-centred eHealth support improves self-efficacy and partly decreases symptoms of burnout. Still, it does not seem to affect sick leave for patients with CMDs. This thesis concludes that the illness perspective and health-promoting care initiatives need a broader recognition in health care and other institutional organizations that encounter people with CMDs. This approach begins with interpersonal relationships where professionals need to meet the patient as a person rather than the disease alone, which is emphasized in person-centred care (PCC). Key words: health, common mental disorders, exhaustion disorder, interview, experiences, phenomenological hermeneutics, person-centred care, eHealth, randomized controlled trial.