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Kullgren, Gunnar
Publications (10 of 94) Show all publications
Melander, M., Dahlblom, K., Jegannathan, B. & Kullgren, G. (2016). Exploring communication of traumatic experiences from Khmer Rouge genocide survivors to their offspring: In-depth interviews with both generations. International Journal of Social Psychiatry, 62(4), 327-333
Open this publication in new window or tab >>Exploring communication of traumatic experiences from Khmer Rouge genocide survivors to their offspring: In-depth interviews with both generations
2016 (English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 62, no 4, p. 327-333Article in journal (Refereed) Published
Abstract [en]

Background: Traumatic events experienced by parents who have survived genocide influence mental health among their offspring. This study aims at exploring how the communication of traumatic events between Khmer Rouge survivors and their offspring was perceived by both generations.

Methods: Qualitative interviews were performed with six Khmer Rouge survivors and with six young people representing the second generation and were analysed using a content analysis approach.

Discussion: Parents felt that informing their children was important to instill gratitude for living a better life and to empower them. Among children, this was met with empathy but sometimes also disbelief and at times they blamed their parents for being too submissive.

Conclusion: The study discloses the complexity, pros and cons of intergenerational sharing of trauma.

Keywords
Trauma, genocide, second generation, communication, qualitative analysis
National Category
Social Psychology
Identifiers
urn:nbn:se:umu:diva-124191 (URN)10.1177/0020764016631364 (DOI)000378423200003 ()26896030 (PubMedID)
Available from: 2016-08-05 Created: 2016-07-28 Last updated: 2018-06-07Bibliographically approved
Trang, P. M., Rocklöv, J., Giang, K. B., Kullgren, G. & Nilsson, M. (2016). Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam. PLoS ONE, 11(5), Article ID e0155609.
Open this publication in new window or tab >>Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155609Article in journal (Refereed) Published
Abstract [en]

Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low-and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008-2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35 degrees C daily maximum temperature (90th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95-1.13), 1.15 (1.005-1.31), and 1.36 (1-1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low-and middle-income country characterized by rapid epidemiological transitions and environmental changes.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Identifiers
urn:nbn:se:umu:diva-122564 (URN)10.1371/journal.pone.0155609 (DOI)000376291100068 ()27195473 (PubMedID)
Available from: 2016-07-25 Created: 2016-06-20 Last updated: 2018-06-07Bibliographically approved
Jegannathan, B., Kullgren, G. & Dahlblom, K. (2016). How do young people in Cambodia perceive the impact of societal attitudes, media and religion on suicidal behaviour?. International Journal of Social Psychiatry, 62(2), 114-122
Open this publication in new window or tab >>How do young people in Cambodia perceive the impact of societal attitudes, media and religion on suicidal behaviour?
2016 (English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 62, no 2, p. 114-122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Young people in low and middle income countries (LMICs) in societal transitions with rapidly changing norms face an increased risk of suicide. This study explores how young people in Cambodia understand the impact on suicidal behaviour from societal attitudes, media and religion.

MATERIAL: Focus group discussions were held with school students from a suburban area. Thematic analysis was used to interpret the data.

DISCUSSION: Participants perceived the prevailing suicide-stigmatizing societal attitudes, the double-edged media and suicide-ambiguity in Buddhist religion as challenging. Globalization was recognized as contradicting with traditional Cambodian norms and values.

CONCLUSION: Suicide prevention programmes should take into consideration the complex picture of suicide that young people are exposed to.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Societal attitudes, media, religion, suicide, young people, Cambodia
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-106859 (URN)10.1177/0020764015597952 (DOI)000370422200003 ()26238990 (PubMedID)
Available from: 2015-08-11 Created: 2015-08-11 Last updated: 2018-06-07Bibliographically approved
Shibre, T., Medhin, G., Alem, A., Kebede, D., Teferra, S., Jacobsson, L., . . . Fekadu, A. (2015). Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort. Schizophrenia Research, 161(2-3), 414-420
Open this publication in new window or tab >>Long-term clinical course and outcome of schizophrenia in rural Ethiopia: 10-year follow-up of a population-based cohort
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2015 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 161, no 2-3, p. 414-420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although the few available studies from LMICs report favorable outcome, the course of schizophrenia is more complex than has been indicated so far.

METHODS: A sample of 361 people with a standardized clinical diagnosis of schizophrenia were recruited from a predominantly rural community in Ethiopia and followed up regularly for an average of 10years. Psychiatrists used the Longitudinal Interval Follow-up Evaluation chart to carry out assessment of illness course. Duration of time in clinical remission was the primary outcome.

RESULT: About 61.0% of the patients remained under active follow-up, while 18.1% (n=65) were deceased. The mean percentage of follow-up time in complete remission was 28.4% (SD=33.0). Female patients were significantly more likely to have episodic illness course with no inter-episode residual or negative symptoms (χ(2)=6.28, P=0.012). Nearly 14.0% had continuous psychotic symptoms for over 75% of their follow-up time. Only 18.1% achieved complete remission for over 75% of their follow-up time. Later onset of illness was the only significant predictor of achieving full remission for over 50% of follow-up time in a fully adjusted model. Conventional antipsychotic medications were fairly well tolerated in 80% of the patients and 4.2% (n=15) experienced tardive dyskinesia.

CONCLUSION: This population-based study is one of the very few long-term outcome studies of schizophrenia in LMICs. The study demonstrated clearly a differential and more favorable course and outcome for female patients but overall course and outcome of schizophrenia appeared less favorable in this setting than has been reported from other LMICs.

Keywords
Schizophrenia, Course, Outcome, Gender, Follow-up study, Ethiopia
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-101498 (URN)10.1016/j.schres.2014.10.053 (DOI)000348452100040 ()25468171 (PubMedID)
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2018-06-07Bibliographically approved
Jegannathan, B., Kullgren, G. & Deva, P. (2015). Mental health services in Cambodia, challenges and opportunities in a post-conflict setting. Asian Journal of Psychiatry, 13, 75-80
Open this publication in new window or tab >>Mental health services in Cambodia, challenges and opportunities in a post-conflict setting
2015 (English)In: Asian Journal of Psychiatry, ISSN 1876-2018, E-ISSN 1876-2026, Vol. 13, p. 75-80Article in journal (Refereed) Published
Abstract [en]

Cambodia had suffered enormously due to war and internecine conflict during the latter half of the twentieth century, more so during the Vietnam War. Total collapse of education and health systems during the Pol Pot era continues to be a challenge for developing the necessary infrastructure and human resources to provide basic minimum mental health care which is compounded by the prevailing cultural belief and stigma over mental, neurological and substance abuse disorders (MNSDs). The mental health research and services in Cambodia had been predominantly 'trauma focused', a legacy of war, and there is a need to move toward epidemiologically sound public health oriented mental health policy and service development. Integrating mental health program with primary health care services with specifically stated minimum package of activities at primary level and complementary package of activities at secondary level is an opportunity to meet the needs and rights of persons with mental, neurological and substance abuse disorders (PWMNSDs) in Cambodia, provided there is mental health leadership, government commitment and political will.

Keywords
Mental health, Challenges, Opportunities, Cambodia, Post-conflict setting
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-101499 (URN)10.1016/j.ajp.2014.12.006 (DOI)25563073 (PubMedID)
Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2018-06-07Bibliographically approved
Idenfors, H., Kullgren, G. & Renberg, E. S. (2015). Professional care after deliberate self-harm: a qualitative study of young people's experiences. Patient Preference and Adherence, 9, 199-207
Open this publication in new window or tab >>Professional care after deliberate self-harm: a qualitative study of young people's experiences
2015 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 199-207Article in journal (Refereed) Published
Abstract [en]

Background: Deliberate self-harm (DSH) is increasingly common among young people. At the same time, treatment and support after DSH are often hampered by low compliance. Aim: To explore young people's perceptions of care and support during a 6-month period following their first contact for DSH. Methods: We conducted nine semistructured interviews with young people aged 16-24 years 6 months after their first contact for DSH. The interviews were analyzed using qualitative content analysis. Results: Three main themes were extracted from the interviews. "Am I really in good hands?" describes whether the participants felt they were being listened to and taken seriously and whether they could rely on the competence of the professionals and the appropriateness of treatment, including keeping agreements and communication with other relevant agencies. "Help should match life circumstances" comprises how basic practicalities such as travel possibilities affect treatment and concomitant assistance in everyday living. Financial matters and jobseeking were perceived as necessary for optimal treatment and well-being. "Making yourself better" includes participants' efforts to manage on their own, through realizing their own responsibility to be engaged and actively take part in treatment planning. Conclusion: Flexibility and responsiveness to young people's own views and specific needs in treatment arrangements are of crucial importance. The significance of basic practical help cannot be underestimated and should not be overlooked.

Keywords
young adults, deliberate self-harm, qualitative, treatment experiences
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-100141 (URN)10.2147/PPA.S76244 (DOI)000348433600001 ()25670889 (PubMedID)
Available from: 2015-02-26 Created: 2015-02-24 Last updated: 2018-06-07Bibliographically approved
Idenfors, H., Kullgren, G. & Renberg, E. S. (2015). Professional Care as an Option Prior to Self-Harm A Qualitative Study Exploring Young People's Experiences. Crisis, 36(3), 179-186
Open this publication in new window or tab >>Professional Care as an Option Prior to Self-Harm A Qualitative Study Exploring Young People's Experiences
2015 (English)In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 36, no 3, p. 179-186Article in journal (Refereed) Published
Abstract [en]

Background: Deliberate self-harm (DSH) is a growing problem among young people and is a major risk factor for suicide. Young adults experiencing mental distress and suicidal ideation are reluctant to seek help, requiring new strategies to reach this group. Aims: The present study explored young people's views of professional care before first contact for DSH, and factors that influenced the establishing of contact. Method: Interviews with 10 young individuals, shortly after they had harmed themselves, were analyzed using qualitative content analysis. Results: The participants emphasized the importance of receiving more knowledge on where to turn, having different help-seeking options, and receiving immediate help. Family and friends were vital for support and making health care contact. The quality of the professional contact was stressed. Several reasons for not communicating distress were mentioned. Two themes were identified: "A need for a more flexible, available and varied health care" and "A struggle to be independent and yet being in need of reliable support." Conclusion: These findings suggest that easy and direct access to professional help is a decisive factor for young people experiencing psychological problems and that health services must find new ways of communicating information on seeking mental health help.

Place, publisher, year, edition, pages
Hogrefe Publishing, 2015
Keywords
young people's experiences, deliberate self-harm, qualitative, help-seeking
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-109393 (URN)10.1027/0227-5910/a000310 (DOI)000360771700004 ()26088828 (PubMedID)
Available from: 2015-09-29 Created: 2015-09-25 Last updated: 2018-06-07Bibliographically approved
Obando Medina, C., Kullgren, G. & Dahlblom, K. (2014). A qualitative study on primary health care professionals' perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua. BMC Family Practice, 15, 129
Open this publication in new window or tab >>A qualitative study on primary health care professionals' perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua
2014 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, p. 129-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mental health problems among young peoples are a growing public health issue around the world. In low- income countries health systems are characterized by lack of facilities, human resources and primary health care is rarely an integrated part of overall health care services. This study aims at exploring how primary health care professionals in Nicaragua perceive young people's mental health problems, suicidal problems and help-seeking behaviour.

METHODS: Twelve in-depth interviews were conducted with nurses and doctors working in primary health care services in León, Nicaragua. A qualitative research design was applied. Data was analysed using thematic analysis approach.

RESULTS: This study revealed that doctors and nurses were reluctant to deal with young people presenting with suicidal problems at the primary health care. This was more likely to stem from feelings of incompetence rather than from negative attitudes. Other barriers in providing appropriate care to young people with mental health problems were identified such as lack of time, lack of privacy, lack of human resources, lack of trained professionals and difficulties in communicating with young people. The primary health care (PHC) professionals suggested different solutions to improve care for young people with suicidal problems.

CONCLUSION: PHC doctors and nurses in Nicaragua felt that providing skilled mental health services to young people was a priority for them but they also identified a number of barriers to be able to do so. They discussed ways to improve young people's willingness to share sensitive issues with them and suggested ways to make PHC more appreciated by young people.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
young people, focus-group discussion, suicidal behaviour, Cambodia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-91945 (URN)10.1186/1471-2296-15-129 (DOI)000339513900001 ()24989871 (PubMedID)
Available from: 2014-08-18 Created: 2014-08-18 Last updated: 2018-06-07Bibliographically approved
Jegannathan, B., Dahlblom, K. & Kullgren, G. (2014). Outcome of a school-based intervention to promote life-skills amongyoung people in Cambodia. Asian Journal of Psychiatry
Open this publication in new window or tab >>Outcome of a school-based intervention to promote life-skills amongyoung people in Cambodia
2014 (English)In: Asian Journal of Psychiatry, ISSN 1876-2018Article in journal (Refereed) In press
Abstract [en]

Background Most of the school-based interventions to prevent suicide are from high income countries and there is a need for evidence based interventions in resource-poor settings. The aim of this study is to evaluate the outcome of a school based intervention to reduce risk factors for suicide among young people in Cambodia by promoting life skills.

Method Six classes were randomly selected from two schools each, one designated as experimental and the other as control school, respectively. In experimental school 168 young people (M = 92, F = 76) received 6 sessions of life skills education and in the control school 131 students (M = 53, F = 78) received three general sessions on health. We looked at the pre-post differences on Life-Skills Development Scale Adolescent Form (LSDS-AF)- and Youth Self-Report (YSR) questionnaire to measure the effect size (ES) from the intervention after 6 months. We analyzed the data by stratifying for gender and for those who reported more severe suicidal expressions at baseline (high-risk group).

Results The girls showed improvement in Human Relationship (ES = 0.57), Health Maintenance (ES = 0.20) and the Total Life Skills Dimensions (ES = 0.24), whereas boys with high-risk behavior improved on Human Relationship (ES = 0.48), Purpose in Life (ES = 0.26) and Total Life Skills Dimensions (ES = 0.22). Effect size for YSR-syndrome scores among all individuals showed no improvement for either gender. Among high-risk individuals boys had a small to moderate effect size from intervention on Withdrawn/Depressed (ES = 0.40), Attention problems (ES = 0.46), Rule breaking behavior (ES = 0.36), Aggressive behavior (ES = 0.48) and Externalizing syndrome (ES = 0.64).

Conclusion Promoting life skills in schools may enhance the overall mental health of young people, indirectly influencing suicide, particularly among boys with high-risk behavior in Cambodia.

Keywords
Outcome; School based intervention; Life skills; Cambodia
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-88194 (URN)10.1016/j.ajp.2014.01.011 (DOI)
Available from: 2014-04-25 Created: 2014-04-25 Last updated: 2018-06-07Bibliographically approved
Jegannathan, B., Dahlblom, K. & Kullgren, G. (2014). ‘Plue plun’ male, ‘kath klei’ female: gender differences in suicidal behavior as expressed by young people in Cambodia. International Journal of Culture and Mental Health, 7(3), 326-338
Open this publication in new window or tab >>‘Plue plun’ male, ‘kath klei’ female: gender differences in suicidal behavior as expressed by young people in Cambodia
2014 (English)In: International Journal of Culture and Mental Health, ISSN 1754-2863, E-ISSN 1754-2871, Vol. 7, no 3, p. 326-338Article in journal (Refereed) Published
Abstract [en]

Few studies from low- and middle-income countries use qualitative methodologyto explore suicidal behavior among young people. In Cambodia, young peopleface the challenge of rapidly changing times and are vulnerable for suicidalbehavior as revealed by research in transitional economies. This study seeks togain a deeper understanding of the suicidal phenomena from a gender, psychosocialand cultural perspective. Six focus-group discussions were conductedamong boys and girls, aged 15–19 years, in two secondary schools in a suburbanarea close to Phnom Penh, the capital city. The data was analyzed using thematicanalysis approach. The participants highlighted the gender difference in suicidalbehavior by describing the suicide-prone, acting-out male as ‘plue plun’, whilesuicide-prone females were described as caught in constricted, tunneled-thinkingbehavior, expressed as ‘kath klei’. Parental attitude and family environment werealso pointed out as the chief causes of discontent and there was a strong wish onthe part of young people to find space for modern values within the traditionalfamily. The young people’s awareness of their challenges in everyday life suggeststhat school-based programs to prevent suicidal behavior ought to be gendersensitiveand peer-focused.

Place, publisher, year, edition, pages
Taylor & Francis, 2014
Keywords
young people, focus-group discussion, suicidal behaviour, Cambodia
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-83539 (URN)10.1080/17542863.2013.800568 (DOI)
Available from: 2013-12-02 Created: 2013-12-02 Last updated: 2018-06-08Bibliographically approved
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