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  • 1. Beckman, Karin
    et al.
    Lindh, Åsa
    Waern, Margda
    Strömsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Runesson, Bo
    Dahlin, Marie
    Impulsive suicide attempts among young people: a prospective multicentre cohort study in Sweden2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 243, p. 421-426Article in journal (Refereed)
    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.

  • 2.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Are Non-Psychiatric Hospitalisations Before Self-Harm Associated with Increased Risk of Unnatural Deaths Among Young People?2016In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 66-67Article in journal (Other academic)
  • 3.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta M.J
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Non-psychiatric inpatient care preceding admission for self-harm in young people2016In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 88, p. 8-13Article in journal (Refereed)
    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.

  • 4.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?2019In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 120, p. 96-101Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to investigate any increased risk for suicide in young people with admission for self-harm and if the risk is further increased due to somatic inpatient admissions before a first act of self-harm.

    Methods: This register study included 16,235 cases in the ages 16–24, with a first admission for self-harm, and 32,465 matched controls. All admissions and diagnoses were recorded from the year preceding cases first admission for self-harm. Subjects were followed until death or end of study, registering the cause of death for all deceased. Group differences were analysed using survival analysis with death by suicide as primary outcome.

    Results: In cases with a previous somatic admission, the risk for death by suicide during the study period was higher than in cases without a somatic admission (457 and 316 suicides per 100,000 people and year, respectively, p = 0.01). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04–1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.

    Conclusions: This study suggests that admission for physical illness before self-harm is associated with a higher risk for suicide among young people, and that their contact with healthcare due to physical problems could provide an opportunity to detect suicide risk.

  • 5.
    Johansson, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Self-conscious emotions: Shame and guilt proneness in transsexuals2009Conference paper (Other academic)
  • 6.
    Jonsson, F.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Strömsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Paths of adversity linking adolescent socioeconomic conditions to adult functional somatic symptoms2016Conference paper (Refereed)
  • 7.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stromsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarstrom, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155963Article in journal (Refereed)
    Abstract [en]

    While research examining the health impact of early socioeconomic conditions suggests that effects may exist independently of or jointly with adult socioeconomic position, studies exploring other potential pathways are few. Following a chain of risk life course model, this prospective study seeks to examine whether pathways of occupational class as well as material and social adversities across the life course link socioeconomic disadvantage in adolescent to functional somatic symptoms in mid-adulthood. Applying path analysis, a multiple mediator model was assessed using prospective data collected during 26 years through the Northern Swedish Cohort. The sample contained 987 individuals residing in the municipality of Lulea, Sweden, who participated in questionnaire surveys at age 16, 21, 30 and 42. Socioeconomic conditions (high/low) in adolescence (age 16) were operationalized using the occupation of the parents, while occupational class in adulthood (manual/nonmanual) was measured using the participant's own occupation at age 21 and 30. The adversity measurements were constructed as separate age specific parcels at age 21 and 30. Social adversity included items pertaining to stressful life events that could potentially harm salient relationships, while material adversity was operationalized using items concerning unfavorable financial and material circumstances. Functional somatic symptoms at age 42 was a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties that had occurred during the last 12 months. An association between socioeconomic conditions at age 16 and functional somatic symptoms at age 42 (r = 0.068) which was partially explained by people's own occupational class at age 21 and then material as well as social adversity at age 30 was revealed. Rather than proposing a direct and independent health effect of the socioeconomic conditions of the family, the present study suggests that growing up in an unfavorable socioeconomic environment might be a source for a chain of adverse material and social living situations, which in turn affects adult health.

  • 8.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Post-traumatic distress after a single violent crime: Interaction between shame-proneness and event-related shame and symptoms2011In: European Journal of Psychotraumatology, 2011, Vol. 2:1, p. 117-Conference paper (Other academic)
  • 9.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychological distress associated with interpersonal violence: a prospective two-year follow-up study of female and male crime victimsManuscript (preprint) (Other academic)
  • 10.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta M J
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shame and post-traumatic distress2012Conference paper (Refereed)
  • 11.
    Semb, Olof
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Distress after a single violent crime: how shame-proneness and event-related shame work together as risk factors for post-victimization symptoms2011In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 109, no 1, p. 3-23Article in journal (Refereed)
    Abstract [en]

    To increase understanding of post-victimization symptom development, the present study investigated the role of shame- and guilt-proneness and event-related shame and guilt as potential risk factors. 35 individuals (M age = 31.7 yr.; 48.5% women), recently victimized by a single event of severe violent crime, were assessed regarding shame- and guilt-proneness, event-related shame and guilt, and post-victimization symptoms. The mediating role of event-related shame was investigated with structural equation modeling (SEM), using bootstrapping. The guilt measures were unrelated to each other and to post-victimization symptoms. The shame measures were highly intercorrelated and were both positively correlated to more severe post-victimization symptom levels. Event-related shame as mediator between shame-proneness and post-victimization symptoms was demonstrated by prevalent significant indirect effects. Both shame measures are potent risk factors for distress after victimization, whereby part of the effect of shame-proneness on post-victimization symptoms is explained by event-related shame.

  • 12.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    More or less than human: the influence of shame on psychological distress2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Shame is a powerful emotion involved in a wide variety of phenomena including psychopathology. The propensity to react with shame to situations of transgression is formed early in life, but the processes by which elevated shame-proneness causes higher levels of psychological distress and functional impairment in some people rather than in others is as yet poorly understood.

    Objectives The main objective of this thesis was to further elucidate these processes by investigating the implications for shame states, guilt, general coping strategies, attachment styles, and shame-related coping in this context, as well as to evaluate an assessment method for shame-proneness.

    Methods The self-report questionnaires Test of Self-Conscious Affect (TOSCA), Compass of Shame Scale (CoSS-5), Harvard Trauma Questionnaire (HTQ), Ways of Coping Questionnaire (WCQ), Attachment Style Questionnaire (ASQ), Symptom Checklist 90 (SCL-90), and an interview measure for event-related shame and guilt were used for assessment in adult normative, healthy-only, crime victim, and patient samples (n=25-361). A combination of uni- and bivariate approaches and multivariate soft and hard modeling approaches were used for statistical analysis.

    Results Paper I showed that the TOSCA could be used as a reliable measure for shame-proneness. Paper II showed that guilt was unrelated to post-victimization distress. Elevated shame-proneness was related to higher levels of post-victimization distress. This effect was partially mediated by event-related shame. Paper III showed that in CFS patients, higher levels of shame-proneness, escape-avoidance, and accepting responsibility coping contributed to elevated levels of psychological distress. Seeking support, positive reappraisal coping, and proneness to detachment contributed in the opposite direction. These relationships were weaker in the comparison groups. Paper IV showed that shame-proneness was associated with secure attachment style in a negative direction. Higher levels of secure attachment style contributed to lower levels of psychological distress, whereas shame-proneness, insecure attachment styles and withdrawal, attack self, and attack other shame coping strategies contributed in the opposite direction. There were mean differences between women and men regarding most of the variables, butiithe relationships between variables did not differ between men and women.

    Conclusions The association between shame-proneness and psycho-logical distress seem to involve a complex balancing act between motives toward preserving close relationships and protecting a relatively positive sense of self. If others are perceived as trustworthy and compassionate and are utilized for support in times of need, the effects of shame-proneness may be less debilitating, whereas if others are perceived as distancing or disapproving, and life stress and social transgressions are managed by escape strategies, social withdrawal, self-blame or by transferring blame onto others, the distress effects become more severe. The inner psychodynamics of these functional patterns seem to be rather similar in women and men.

  • 13.
    Strömsten, Lotta MJ
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Holm, Ulla
    Department of Education, Uppsala University, Uppsala, Sweden.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Assessment of self-conscious emotions: a Swedish psychometric and structure evaluation of the test of self-conscious affect (TOSCA)2009In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 50, no 1, p. 71-77Article in journal (Refereed)
    Abstract [en]

    The Test of Self-Conscious Affect (TOSCA) is a well-established scenario-based questionnaire assessing self-conscious emotions, such as shame and guilt, which have been shown to be differentially associated with a variety of functional, motivational, behavioral and health outcomes. The aim of this study was to evaluate the psychometric properties and internal structure of a Swedish version of TOSCA in a sample of 361 healthy adults. The psychometric properties and internal consistency of the Swedish version were at level with the original US TOSCA version for shame, guilt and detachment. The internal structure of the Swedish version was acceptable for shame, guilt and detachment but contained shortcomings in assessment of externalization.

  • 14.
    Strömsten, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Forsberg, Anita
    Psykiatriska kliniken Umeå, Psychiatric clinic Umeå.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Moberg, Erik
    Endokrinkliniken Karolinska universitetssjukhuset Huddinge, Department of Endocrinology Karolinska University Hospital Huddinge.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Relationships among shame-proneness, coping, and psychological distress in chronic fatigue syndrome patientsManuscript (preprint) (Other academic)
  • 15.
    Strömsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Katastrofövning med Google Apps2017Conference paper (Other academic)
  • 16.
    Strömsten, Lotta M. J.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Institutionen för klinisk vetenskap, psykiatri, Umeå Universitet.
    Wiktorsson, Stefan
    Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden.
    Waern, Margda
    Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden.
    Lindh, Åsa
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander-Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Runesson, Bo
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Stockholm, Sweden.
    Interpersonal violence is differentially associated with repeated suicidal behavior in men, women and different age groups2019Conference paper (Refereed)
  • 17.
    Strömsten, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyström, Markus
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shame and psychological distress: the influence of attachment styles, shame-proneness and shame coping among women and menManuscript (preprint) (Other academic)
  • 18.
    Sundbom, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Henningsson, Mikael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Semb, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Betydelse av tidig kontakt och behandling av våldsdrabbade brottsoffer: en prospektiv longitudinell studie2011Report (Other academic)
1 - 18 of 18
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