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Noland, E., Virtanen, S., Klötz Logan, F., Chang, Z. & Strandh, M. (2024). Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden. Frontiers in Psychiatry, 15, Article ID 1342722.
Open this publication in new window or tab >>Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden
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2024 (English)In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 15, article id 1342722Article in journal (Refereed) Published
Abstract [en]

Introduction: Most forensic psychiatric patients have chronic psychiatric disorders that require long-term pharmacological treatment even after discharge from care. However, the prevalence and correlates of post-discharge medication discontinuation in this patient group remain unclear.

Objective: The aim of this study was to investigate the prevalence and correlates of post-discharge discontinuation of pharmacological treatment in forensic psychiatric patients in Sweden.

Methods: Data on individuals discharged from forensic psychiatric care between 2009 and 2018 (n = 1,142) with ongoing pharmacological treatment at the time of discharge (n = 856) were identified from the Swedish National Forensic Psychiatric Register. Cox regression models were used to estimate the association between patient characteristics and medication discontinuation.

Results: Of the 856 individuals with pharmacological treatment at discharge, 488 (57%) discontinued treatment within 2 years of discharge. Factors associated with an increased risk of treatment discontinuation varied between different types of psychotropic medications: the most important correlate was comorbidity between psychosis and personality disorder. Higher age at discharge, longer length of stay, having a history of several psychiatric care episodes, having a trustee, having a limited guardian, and a residing in a supported living accommodation at the time of discharge were associated with a decreased rate of medication discontinuation. This applied for antipsychotics, antidepressants, antiepileptics, and any psychotropic medication, but not for psychostimulants or drugs used in addictive disorders.

Conclusion: For many former forensic psychiatric patients, there are situational factors associated with medication discontinuation. This insight holds significance for professionals who are involved in pre-discharge planning within forensic psychiatric care and those who interact with this cohort of former patients post-discharge.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
discharge, forensic psychiatry, medication discontinuation, mentally disordered offender, pharmacological treatment discontinuation, psychotropic medications
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-221667 (URN)10.3389/fpsyt.2024.1342722 (DOI)38404465 (PubMedID)2-s2.0-85185502699 (Scopus ID)
Funder
Swedish Research Council, 2021-06370
Available from: 2024-03-01 Created: 2024-03-01 Last updated: 2024-03-01Bibliographically approved
Högberg, B. & Strandh, M. (2024). Temporal trends and inequalities in school-related stress in three cohorts in compulsory school in Sweden. Scandinavian Journal of Educational Research
Open this publication in new window or tab >>Temporal trends and inequalities in school-related stress in three cohorts in compulsory school in Sweden
2024 (English)In: Scandinavian Journal of Educational Research, ISSN 0031-3831, E-ISSN 1470-1170Article in journal (Refereed) Epub ahead of print
Abstract [en]

School stress is widespread among students’ worldwide, impacting academic success and mental health. Most research focuses on average stress levels but lacks insights into temporal trends and inequalities. Using repeated longitudinal survey data on 33,000 students in Swedish compulsory school from the Evaluation Through Follow-up (ETF) study, we investigate temporal trends in stress across three cohorts of students (born 1992, 1998, and 2004), with a focus on inequalities by school year, sex, socio-economic status, migration background, school grades, and school difficulties. The results show that (1) stress increased more in year 6 than in year 9 in recent cohorts; (2) stress increased more for girls than for boys; and (3) low school grades and school difficulties have become stronger risk factors for stress. We discuss the findings in the context of recent educational reforms and broader societal trends concerning the role of education for young people’s prospects in life.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2024
Keywords
Mental health, well-being, academic stress, disparities, secular trends, performance, special education needs
National Category
Educational Sciences
Identifiers
urn:nbn:se:umu:diva-222542 (URN)10.1080/00313831.2024.2330932 (DOI)001189424100001 ()2-s2.0-85188624830 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-06-05
Cashman, M. R., Strandh, M. & Högberg, B. (2023). Does fear-of-failure mediate the relationship between educational expectations and stress-related complaints among Swedish adolescents?: A structural equation modelling approach. European Journal of Public Health, 34(1), 101-106
Open this publication in new window or tab >>Does fear-of-failure mediate the relationship between educational expectations and stress-related complaints among Swedish adolescents?: A structural equation modelling approach
2023 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 34, no 1, p. 101-106Article in journal (Refereed) Published
Abstract [en]

Background: This study investigated the possible mediating role of fear-of-failure between educational expectations and adolescent stress-related complaints with a specific focus on gender differences among Swedishadolescents, and related these findings more broadly to school-related demands and stress-related complaints.

Methods: A total of N¼ 5504 Swedish adolescents (Mage¼ 15 years, SD ¼ 0.0 years, 50.2% girls) were drawn from the2018 Swedish Programme for International Student Assessment study for our investigation. We used structural equation models to explore if fear-of-failure mediates the relationship between educational expectations and negativeaffect, with a specific focus on gender differences. Educational expectations were utilized in the measurement model.Fear-of-failure was constructed as a latent mediating variable. Negative affect was constructed as a latent variableand utilized as an outcome variable. We subsequently undertook bootstrapping tests of indirect effects and nonlinear comparisons of indirect effects to assess the reliability of the results.

Results: Fear-of-failure partially mediatedthe association between educational expectations and negative affect (39%). Our gender-specific structural equation model demonstrated that this relationship was more pronounced for girls, suggesting girls are more vulnerable to negative affect as a result of experiencing higher levels of fear of failing.

Conclusions: The findingssuggest that fear-of-failure partially explains the association between educational expectations and negativeaffect and that this association is more pronounced for girls. This study provides insights into better understanding adolescent stress-related complaints, and the differential role fear of failing has in regards to gender.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Social Work Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; Psychology; Sociology; Social Medicine; educational work
Identifiers
urn:nbn:se:umu:diva-216812 (URN)10.1093/eurpub/ckad200 (DOI)001102263800001 ()37968234 (PubMedID)2-s2.0-85183961814 (Scopus ID)
Funder
Swedish Research Council, 2018-03870_3Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2024-03-06Bibliographically approved
Cashman, M., Strandh, M. & Högberg, B. (2023). Have performance-based educational reforms increased adolescent school-pressure in Sweden?: A synthetic control approach. International Journal of Educational Development, 103, Article ID 102922.
Open this publication in new window or tab >>Have performance-based educational reforms increased adolescent school-pressure in Sweden?: A synthetic control approach
2023 (English)In: International Journal of Educational Development, ISSN 0738-0593, E-ISSN 1873-4871, Vol. 103, article id 102922Article in journal (Refereed) Published
Abstract [en]

Increased levels of stress and other mental health problems have been reported among adolescents in high-income countries. In particular, rates of school pressure have increased significantly. Despite such increases, little is known about the underlying determinants of increased adolescent stress, making this an emerging public health concern. The educational stressors hypothesis contends that increased rates of stress result from pronounced performance pressures placed on adolescents resulting from educational policy initiatives which emphasize academic goal attainment. The present study tests this hypothesis using a synthetic control method and panel data techniques to analyze data from the Health Behavior in School-aged children (HBSC) survey, including more than 150,000 adolescents per survey wave in 25 European countries over 16 years, to assess if the Swedish Educational reforms implemented in the 2011–13 period were associated with increased self-reported school pressure. These reforms implemented increased summative assessments, new grading systems and increased eligibility criteria in accessing further education. Results demonstrate that following the reforms, Swedish adolescents experienced greater levels of school-pressure and led to a greater gender difference in experienced school-pressure where girls were relatively more affected. We conclude that, consistent with the educational stressors hypothesis, the educational reforms have likely contributed to increasing levels of school-pressure for Swedish adolescents.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Adolescent stress, School stress, Education, Educational policy, Educational stressors hypothesis, Cross-country comparative, Synthetic control, Gender differences
National Category
Social Work
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-216711 (URN)10.1016/j.ijedudev.2023.102922 (DOI)2-s2.0-85176240362 (Scopus ID)
Funder
Swedish Research Council, 2018-03870Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2023-11-15 Created: 2023-11-15 Last updated: 2023-12-05Bibliographically approved
Högberg, B., Strandh, M., Johansson, K. & Petersen, S. (2023). Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985–2017. Scandinavian Journal of Public Health, 51, 619-624
Open this publication in new window or tab >>Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985–2017
2023 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, p. 619-624Article in journal (Refereed) Published
Abstract [en]

Background and aims: According to recent criticism, survey-based measures of adolescent psychosomatic complaints have poor content validity insofar as they conflate trivial with severe complaints. It is argued that this means that estimates of prevalence and trends in complaints may reflect trivial complaints that are not indicators of health problems. In this study, two observable implications of this criticism were investigated: (a) that self-reported psychosomatic complaints should have a bimodal distribution; and (b) that the increase in complaints over time should be of approximately equal size throughout the distribution of complaints.

Methods: Three decades (1985/1986–2017/2018) of repeated cross-sectional data from the Swedish Health Behaviour in School-aged Children survey were used. Psychosomatic complaints were measured using the screening instrument Health Behaviour in School-aged Children symptom checklist. Histograms, bar charts and quantile regression models were used for the analysis.

Results and conclusions: With regard to the first implication, the results showed that the distribution of complaints was not bimodal and that there were no clusters of respondents. This suggests that binary categorisations of students can be reductive and conceal important variations across students. With regard to the second implication, the results showed that the increase in complaints was greatest among students who report frequent and co-occurring complaints. This suggests that reports of increasing complaints in adolescents cannot be explained as being primarily due to a greater inclination to report trivial complaints. It is concluded that any conflation of trivial and more severe complaints in surveys of psychosomatic complaints is not reflected in population-based estimates.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Adolescents, children, health complaints, psychosomatic, mental health, temporal trends, HBSC, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-194508 (URN)10.1177/14034948221094497 (DOI)000796285200001 ()2-s2.0-85132638212 (Scopus ID)
Funder
Swedish Research Council, 2018–03870_3Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00048
Available from: 2022-05-08 Created: 2022-05-08 Last updated: 2023-07-14Bibliographically approved
Noland, E., Klötz Logan, F., Sjöström, S. & Strandh, M. (2023). What happens after forensic psychiatric care?: A latent class analysis of dimensions of welfare for former forensic psychiatric patients. BMC Psychiatry, 23(1), Article ID 937.
Open this publication in new window or tab >>What happens after forensic psychiatric care?: A latent class analysis of dimensions of welfare for former forensic psychiatric patients
2023 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 937Article in journal (Refereed) Published
Abstract [en]

Background: Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions.

Methods: Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009–2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership.

Results: The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors.

Conclusions: This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Criminal recidivism, Forensic psychiatry, Latent class analysis, Level of living, Life situation, Mentally disordered offender, Post-discharge, Welfare dimensions
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-218304 (URN)10.1186/s12888-023-05428-x (DOI)38087234 (PubMedID)2-s2.0-85179356735 (Scopus ID)
Available from: 2023-12-22 Created: 2023-12-22 Last updated: 2024-01-17Bibliographically approved
Bortes, C., Nilsson, K. & Strandh, M. (2022). Associations between children’s diagnosed mental disorders and educational achievements in Sweden. Scandinavian Journal of Public Health, 50(8), 1140-1147
Open this publication in new window or tab >>Associations between children’s diagnosed mental disorders and educational achievements in Sweden
2022 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 8, p. 1140-1147Article in journal (Other academic) Published
Abstract [en]

Aims: To examine associations between multiple clinically diagnosed mental disorders among children in Sweden and educational achievements at the end of ninth grade.

Methods: Data from Swedish administrative registers were utilised. Diagnoses of specific mental disorders (unipolar depression, mood, anxiety, obsessive compulsive, eating, attention deficit hyperactivity disorder) were used as exposure variables. Educational achievements were assessed in terms of teacher-assigned school grades and eligibility for upper secondary education. The sample comprised 266,664 individuals (49% females) born in 2000 to 2002 who were alive and resident in Sweden in 2017. Exposed and unexposed individuals were compared in terms of outcome variables by fitting linear and logistic regression models.

Results: The results revealed negative associations between all the examined mental disorders and educational achievements, except for positive associations between eating disorders and grades among female students. Attention deficit hyperactivity disorder was the most strongly associated disorder in terms of non-successful completion of compulsory education, among both male and female students (odds ratio (OR): 3.58 (95% confidence interval (CI), 3.42 to 3.74) and 4.31 (95% CI, 4.07 to 4.57), respectively). This was followed by unipolar depression among males (OR: 2.92 (95% CI, 2.60 to 3.28)) and anxiety disorder among females (OR: 2.68 (95% CI, 2.49 to 2.88)). Obsessive compulsive disorder had the weakest negative association with educational achievements among both males (OR: 1.48 (95% CI, 1.01 to 2.17)) and females (OR: 1.38 (95% CI, 1.11 to 1.72)).

Conclusions: Specific diagnosed mental disorders have varying, largely disadvantageous, associations with educational achievements of students in Sweden that differ between males and females.

Place, publisher, year, edition, pages
Sage Publications, 2022
Keywords
Mental disorders, educational achievement, register data, Sweden, sex differences
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-192125 (URN)10.1177/14034948221089056 (DOI)000783876500001 ()35416111 (PubMedID)2-s2.0-85129236583 (Scopus ID)
Funder
Swedish Research CouncilRiksbankens Jubileumsfond
Note

Originally included in thesis in manuscript form. 

Available from: 2022-02-02 Created: 2022-02-02 Last updated: 2023-03-23Bibliographically approved
Noland, E., Strandh, M. & Klötz Logan, F. (2022). The reconvictions of mentally disordered offenders: how, when, and where?. BMC Psychiatry, 22(1), Article ID 264.
Open this publication in new window or tab >>The reconvictions of mentally disordered offenders: how, when, and where?
2022 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 264Article in journal (Refereed) Published
Abstract [en]

Background: Little is known about the recidivism of mentally disordered offenders after discharge from forensic psychiatric services. This is problematic because such knowledge could (i) help professionals who encounter this group to better plan interventions to prevent recidivism, (ii) clarify the rates of recidivism post-discharge from forensic psychiatric care and (iii) further develop instruments for specific risk assessment. The aim of this study was to investigate the new crimes of mentally disordered offenders who had been reconvicted after discharge from forensic psychiatric care.

Methods: Included in this study were all individuals (n = 1142) who had been discharged from forensic psychiatric care in Sweden during 2009–2018, were included in the Swedish National Forensic Psychiatric Register, and had been reconvicted in a criminal court within the follow-up period of 2009–2018 (n = 157, 14% of the population). The follow-up times of the discharged patients within the period varied from 4 to 3644 days, (m = 1697, Md = 1685). Retrospective registry data along with coded data from criminal court judgments (n = 210) were used to create a database. Kaplan–Meier survival analysis and descriptive statistical analysis was performed.

Results: 75% of included individuals were reconvicted for at least one violent crime, but only 9 individuals were reconvicted for a serious violent crime, which can be compared to the 44 individuals with serious violent index crimes. The most common crime was “Other violent”. The most common sentence was probation. The offender’s most common relationship to the victim was having no known relationship, followed by the victim being a person of authority. The most common circumstance of the crime leading to the reconviction was that it occurred without apparent provocation; other common circumstances were related to the exercise of public authority. The most common crime scene was a public place.

Conclusions: Even though the reconvictions of this group included many violent crimes, there were very few serious violent crimes. The findings that the victims of the crimes of mentally disordered offenders are most commonly either unknown to the perpetrator or persons of authority, and that the crimes are often perpetrated without apparent provocation or reason, are important information for all professionals who encounter this group and should be taken into consideration to assess risk more accurately.

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Criminal recidivism, Forensic psychiatry, Mentally disordered offenders, Reconviction
National Category
Psychiatry Law and Society
Identifiers
urn:nbn:se:umu:diva-194345 (URN)10.1186/s12888-022-03912-4 (DOI)000782429800004 ()35418045 (PubMedID)2-s2.0-85128303935 (Scopus ID)
Available from: 2022-05-03 Created: 2022-05-03 Last updated: 2024-01-17Bibliographically approved
Högberg, B., Lindgren, J., Johansson, K., Strandh, M. & Petersen, S. (2021). Consequences of school grading systems on adolescent health: evidence from a Swedish school reform. Journal of education policy, 36(1), 84-106
Open this publication in new window or tab >>Consequences of school grading systems on adolescent health: evidence from a Swedish school reform
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2021 (English)In: Journal of education policy, ISSN 0268-0939, E-ISSN 1464-5106, Vol. 36, no 1, p. 84-106Article in journal (Refereed) Published
Abstract [en]

Education reforms that entail increased emphasis on high-stakes testing, assessment and grading have spread across education systems in recent decades. Critics have argued that these policies could have consequences for stress, identity, self-esteem and the overall health of pupils. However, these potentially negative consequences have rarely been investigated in a systematic and rigorous way. In this study we use a major education reform in Sweden, which introduced grades and increased the use of testing for pupils in the 6th and 7th school year (aged 12 to 13 years), to study the consequences of grading and assessment for health outcomes. Using data from the Health Behaviours of School-Aged Children Survey, we find that the reform increased school-related stress and reduced the academic self-esteem of pupils in the 7th school year. This, in turn, had an indirect effect on psychosomatic symptoms and life satisfaction for these pupils. Moreover, the negative effects of the reform were generally stronger for girls, thereby widening the already troubling gender differences in health. We conclude that accountability reforms aimed at increased use of testing, assessment and grading can potentially have negative side effects on pupils’ health.

Place, publisher, year, edition, pages
Routledge, 2021
Keywords
Stress, health, grading, accountability, education reform, gender
National Category
Educational Sciences Social Work
Identifiers
urn:nbn:se:umu:diva-165211 (URN)10.1080/02680939.2019.1686540 (DOI)000493743800001 ()2-s2.0-85074555659 (Scopus ID)
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2021-03-29Bibliographically approved
Högberg, B., Petersen, S., Strandh, M. & Johansson, K. (2021). Determinants of Declining School Belonging 2000–2018: The Case of Sweden. Social Indicators Research, 157(2), 783-802
Open this publication in new window or tab >>Determinants of Declining School Belonging 2000–2018: The Case of Sweden
2021 (English)In: Social Indicators Research, ISSN 0303-8300, E-ISSN 1573-0921, Vol. 157, no 2, p. 783-802Article in journal (Refereed) Published
Abstract [en]

Students' sense of belonging at school has declined across the world in recent decades, and more so in Sweden than in almost any other high-income country. However, we do not know the characteristics or causes of these worldwide trends. Using data on Swedish students aged 15–16 years from the Programme for International Student Assessment (PISA) between 2000 and 2018, we show that the decline in school belonging in Sweden was driven by a disproportionately large decline at the bottom part of the distribution, and was greatest for foreign-born students, students from disadvantaged social backgrounds, and for low-achieving students. The decline cannot be accounted for by changes in student demographics or observable characteristics related to the school environment. The decline did, however, coincide with a major education reform, characterized by an increased use of summative evaluation, and an overall stronger performance-orientation.

Place, publisher, year, edition, pages
Springer, 2021
Keywords
School belonging, School connectedness, Adolescence, Temporal trends, School environment
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-181599 (URN)10.1007/s11205-021-02662-2 (DOI)000627696800001 ()2-s2.0-85102503831 (Scopus ID)
Funder
Swedish Research Council, 2018–03870_3Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00048
Available from: 2021-03-18 Created: 2021-03-18 Last updated: 2021-12-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6867-6205

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