title: Residents' perceptions of their own sadness--a qualitative study in Norwegian nursing homes.
abstract: BACKGROUND
  Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression may be challenging, and we know little of the older peoples' perspectives. The aim of this qualitative interview study was to explore residents' perceptions of their own sadness.
  
  
  METHODS
  We performed individual, semi-structured interviews with twelve older people residing in nursing homes with no dementia. The interview guide comprised questions on what made the informants sad and what prevented sadness. We recorded, transcribed verbatim and analysed the interviews using systematic text condensation.
  
  
  RESULTS
  The interviews revealed three main themes. I. Decay and loss of agency. The informants perceived their sadness to be caused by loss of health and functional ability, reliance on long-term care, dysfunctional technical aids and poor care. II. Loneliness in the middle of the crowd. Loss of family and friends, and lack of conversations with staff members and fellow patients were also sources of sadness. III. Relating and identity. The informants kept sadness at bay through: acceptance and re-orientation to their current life situation, maintaining narratives about their identity and belonging, and religiosity.
  
  
  CONCLUSIONS
  Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness.
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway. kristina.iden@gmail.com.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. kristina.iden@gmail.com.
authors.forename: Kristina Riis
authors.initials: KR
authors.lastname: Iden
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway. sabine.ruths@igs.uib.no.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. sabine.ruths@igs.uib.no.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ruths
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. stefan.hjorleifsson@igs.uib.no.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hjørleifsson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D008132:Loneliness / Q000523:psychology; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D036301:Qualitative Research; D012649:Self Concept