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Salander Renberg, Ellinor
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Publications (10 of 69) Show all publications
Beckman, K., Lindh, Å., Waern, M., Strömsten, L. M. J., Salander Renberg, E., Runesson, B. & Dahlin, M. (2018). Impulsive suicide attempts among young people: a prospective multicentre cohort study in Sweden. Journal of Affective Disorders, 243, 421-426
Open this publication in new window or tab >>Impulsive suicide attempts among young people: a prospective multicentre cohort study in Sweden
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2018 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 243, p. 421-426Article in journal (Refereed) Published
Abstract [en]

Background: We aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group.

Method: A prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18-25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months.

Results: 43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0-4.2), and adjusted OR 2.1 (0.99-4.4). Affective disorder and unemployment/sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups.

Limitations: The study was set in psychiatric emergency services, which limits the generalizability.

Conclusions: Clinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Suicide, Young, Suicide attempt, Cohort study, Mental illness
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-151956 (URN)10.1016/j.jad.2018.09.070 (DOI)000446860300055 ()
Funder
Swedish Research Council, 521-2011-299Stockholm County CouncilVästerbotten County Council, ALFVLL-549931
Available from: 2018-09-19 Created: 2018-09-19 Last updated: 2018-11-02
Öhlund, L., Ott, M., Oja, S., Bergqvist, M., Lundqvist, R., Sandlund, M., . . . Werneke, U. (2018). Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 18, Article ID 37.
Open this publication in new window or tab >>Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study
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2018 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 37Article in journal (Refereed) Published
Abstract [en]

Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

Keywords
Lithium, Bipolar disorder, Physical health, Compliance, Side effects
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-145594 (URN)10.1186/s12888-018-1622-1 (DOI)000424707200003 ()29415689 (PubMedID)
Note

Correction: Louise Öhlund, Michael Ott, Sofia Oja, Malin Bergqvist, Robert Lundqvist, Mikael Sandlund, Ellinor Salander Renberg and Ursula Werneke. Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 2018;18. DOI: 10.1186/s12888-018-1895-4

Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2018-10-31Bibliographically approved
Lindh, Å. U., Waern, M., Beckman, K., Salander Renberg, E., Dahlin, M. & Runeson, B. (2018). Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry, 18, Article ID 319.
Open this publication in new window or tab >>Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm
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2018 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 319Article in journal (Refereed) Published
Abstract [en]

Background: The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm. Methods: Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score. Results: In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69. Conclusions: The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Self-harm, Suicide, Risk factors, Classification, Outcome
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-152881 (URN)10.1186/s12888-018-1883-8 (DOI)000446389100002 ()30285661 (PubMedID)
Funder
Swedish Research Council, 521-2011-299Swedish Research Council, ALFGBG-715841Stockholm County Council, 20120225Stockholm County Council, 20150290Västerbotten County Council, VLL-549931
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-10-31Bibliographically approved
Rajalin, M., Hirvikoski, T., Salander Renberg, E., Åsberg, M. & Jokinen, J. (2017). Family history of suicide and interpersonal functioning in suicide attempters. Psychiatry Research, 247, 310-314
Open this publication in new window or tab >>Family history of suicide and interpersonal functioning in suicide attempters
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2017 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 247, p. 310-314Article in journal (Refereed) Published
Abstract [en]

Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters’ interpersonal problems is of importance to lower their distress.

Keywords
Inventory of Interpersonal Problems, Interpersonal functioning suicide attempt, Familial transmission of suicidal behavior, Suicide
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-129645 (URN)10.1016/j.psychres.2016.11.029 (DOI)000392772400049 ()27951478 (Scopus ID)
Available from: 2017-01-06 Created: 2017-01-06 Last updated: 2018-08-08Bibliographically approved
Ott, M., Stegmayr, B., Salander Renberg, E. & Werneke, U. (2017). Prognosis and outcome of severe lithium poisoning: authors' reply [Letter to the editor]. Journal of Psychopharmacology, 31(9), 1275-1277
Open this publication in new window or tab >>Prognosis and outcome of severe lithium poisoning: authors' reply
2017 (English)In: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 31, no 9, p. 1275-1277Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Sage Publications, 2017
National Category
Neurology Psychiatry Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-143950 (URN)000419008300016 ()
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2018-06-09Bibliographically approved
Idenfors, H., Strömsten, L. M. J. & Salander Renberg, E. (2016). Are Non-Psychiatric Hospitalisations Before Self-Harm Associated with Increased Risk of Unnatural Deaths Among Young People?. Journal of Psychosomatic Research, 85, 66-67
Open this publication in new window or tab >>Are Non-Psychiatric Hospitalisations Before Self-Harm Associated with Increased Risk of Unnatural Deaths Among Young People?
2016 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 66-67Article in journal, Meeting abstract (Other academic) Published
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-123985 (URN)10.1016/j.jpsychores.2016.03.163 (DOI)000377627200046 ()
Note

Meeting Abstract: 37

Available from: 2016-08-19 Created: 2016-07-07 Last updated: 2018-06-07Bibliographically approved
Strömbäck, M., Wiklund, M., Salander Renberg, E. & Malmgren-Olsson, E.-B. (2016). Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women. Physiotherapy Theory and Practice, 32(1), 20-33
Open this publication in new window or tab >>Gender-sensitive and youth-friendly physiotherapy: Steps toward a stress management intervention for girls and young women
2016 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 32, no 1, p. 20-33Article in journal (Refereed) Published
Abstract [en]

This article describes and evaluates initial steps of a gender-sensitive, youth-friendly group intervention model designed for teenage girls and young women who experience stress-related or psychosomatic problems. Fifty-four young women (16–25 years of age) participated in a gendersensitive physiotherapy stress management course at a youth health center. Inclusion criteria were self-defined stress-related problems and a wish to participate in the group intervention. Measurements of aspects of body perception, self-image, multiple somatic problems, and mental health symptom areas were assessed both before and after intervention with the Body Perception Questionnaire ad modum Schiöler, social analysis of social behavior, and Adult Self-Report scale. Significant positive changes were found in aspects of body perception, self-image, and mental health and somatic symptoms. The changes were most significant in lower internalization of anxiety and depression symptoms. Symptoms such as headaches and sleeping problems decreased. Participants were more satisfied with their bodies and more able to listen to body signals. Among cognitive issues, significant change occurred in thought problems, but not in attention problems. The intervention model needs further evaluation in controlled trials, but is promising and should be developed further in other physiotherapy settings and subgroups of young people.

Keywords
Anxiety, body awareness therapy, body image, gender, mental health, physiotherapy, psychosomatics, self-image, stress, stress management, youth, stress, genus, psykisk hälsa, kroppsbild, självbild, ångest, kroppskännedom, basal kroppskännedom, avspänning, fysioterapi, ungdomsmottagning, ungdomar, unga vuxna, unga kvinnor, flickor
National Category
Physiotherapy Psychiatry Gender Studies
Research subject
genusvetenskap; Psychiatry; Physiotherapy; Public health
Identifiers
urn:nbn:se:umu:diva-88766 (URN)10.3109/09593985.2015.1075639 (DOI)000369278600003 ()
Projects
Umeå SHY
Funder
Swedish Research Council, 344-2011-5478
Note

Originally published in manuscript form with title "Gender-sensitive and youth-friendly physiotherapy: initial steps towards a stress management intervention for girls and young women".

Available from: 2014-05-14 Created: 2014-05-14 Last updated: 2018-06-07Bibliographically approved
Haglund, A., Lindh, A. U., Lysell, H., Renberg, E. S., Jokinen, J., Waern, M. & Runeson, B. (2016). Interpersonal violence and the prediction of short-term risk of repeat suicide attempt. Scientific Reports, 6, Article ID 36892.
Open this publication in new window or tab >>Interpersonal violence and the prediction of short-term risk of repeat suicide attempt
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2016 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 36892Article in journal (Refereed) Published
Abstract [en]

In this multi-center cohort study, suicide attempters presenting to hospital (N = 355, 63% women) were interviewed using the Karolinska Interpersonal Violence Scale (KIVS) and followed-up by medical record review. Main outcome was non-fatal or fatal repeat suicide attempt within six months. Also, repeat attempt using a violent method was used as an additional outcome in separate analyses. Data were analyzed for the total group and for men and women separately. Repeat attempts were observed within six months in 78 persons (22%) and 21 (6%) of these used a violent method. KIVS total score of 6 or more was associated with repeat suicide attempt within six months (OR = 1.81, CI 1.08-3.02) and predicted new attempts with a sensitivity of 62% and a specificity of 53%. A three-fold increase in odds ratio was observed for repeat attempt using a violent method (OR = 3.40, CI 1.22-9.49). An association between exposure to violence in adulthood and violent reattempt was seen in women (OR = 1.38, CI 1.06-1.82). The overall conclusions are that information about interpersonal violence may help predict short-term risk for repeat suicide attempt, and that structured assessment of interpersonal violence may be of value in risk assessment after attempted suicide.

National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-129835 (URN)10.1038/srep36892 (DOI)000387570000001 ()27841333 (PubMedID)
Available from: 2017-01-16 Created: 2017-01-09 Last updated: 2018-08-08Bibliographically approved
Idenfors, H., Strömsten, L. M. . & Salander Renberg, E. (2016). Non-psychiatric inpatient care preceding admission for self-harm in young people. Journal of Psychosomatic Research, 88, 8-13
Open this publication in new window or tab >>Non-psychiatric inpatient care preceding admission for self-harm in young people
2016 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 88, p. 8-13Article in journal (Refereed) Published
Abstract [en]

Objective

Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm.

Methods

From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for being admitted with different diagnoses during the year preceding the self-harm admission.

Results

The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma.

Conclusions

Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.

Keywords
Case-control, Register study, Self-harm, Somatic disorders, Suicide attempt, Young people
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-120695 (URN)10.1016/j.jpsychores.2016.06.011 (DOI)000381841600002 ()27521645 (PubMedID)
Note

Originally included in thesis in manuscript form.

Available from: 2016-05-18 Created: 2016-05-18 Last updated: 2018-06-07Bibliographically approved
Waern, M., Kaiser, N. & Salander Renberg, E. (2016). Psychiatrists' experiences of suicide assessment. BMC Psychiatry, 16, Article ID 440.
Open this publication in new window or tab >>Psychiatrists' experiences of suicide assessment
2016 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 16, article id 440Article in journal (Refereed) Published
Abstract [en]

Background: Clinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments. The aim was to investigate psychiatrists' own accounts of suicide assessment consultations, with a focus on their behaviors, attitudes and emotions.

Method: Semi-structured in depth interviews were carried out with a purposive selection of 15 psychiatrists.

Results: Thematic analysis revealed three main themes: understanding the patient in a precarious situation, understanding one's own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions. Emotional contact and credibility issues were common subthemes that arose when the respondents talked about trying to understand the patient. The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety, and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the assessment consultation could kick-start a therapeutic process.

Conclusion: This study highlights psychiatrists' experiences in clinical suicide assessment situations. Findings have implications for professional development as well as for service delivery.

Keywords
Suicide assessment, Psychiatrists' experiences, Involuntary care, Medical training, Professional development
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-130230 (URN)10.1186/s12888-016-1147-4 (DOI)000390391400001 ()
Available from: 2017-01-16 Created: 2017-01-14 Last updated: 2018-06-09Bibliographically approved
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