umu.sePublications
Change search
Refine search result
12 1 - 50 of 94
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa. Ethiopia.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 40-47Article in journal (Refereed)
    Abstract [en]

    One hundred key informants were interviewed about their awareness, attitudes and practices regarding mental illness using the Key Informant Questionnaire developed by WHO. Case vignettes of seven common neuropsychiatric disorders were presented to the key informants. Informants' awareness about these disorders and help-seeking practices for mental and physical symptoms or conditions were assessed. An additional question on the prototype symptoms of mental disorders was also posed. Among the presented seven conditions, epilepsy was perceived as the most common condition and major depression was regarded as the least common one. Schizophrenia was judged as the most severe problem, and mental retardation was considered the second most severe condition. Talkativeness, aggression and strange behaviour were the most frequently perceived prototype symptoms of mental illness. Traditional treatment methods were preferred more often for treating symptoms of mental disorders and modern medicine was preferred more often for treating physical diseases or symptoms. Findings of this study are similar to other studies conducted in socio-culturally different communities. Working in close connection with traditional healers would give the primary health care worker a better opportunity to gain acceptance from the community and modify certain harmful practices.

  • 2.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa. Ethiopia.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Awareness and attitudes of a rural Ethiopian community toward suicidal behaviour. A key informant study in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 65-69Article in journal (Refereed)
    Abstract [en]

    One hundred key informants were interviewed regarding their awareness and attitudes toward suicidal behaviour. Eighty-eight informants were male, 58 were Muslim and 42 were Christian. Informants on average, claimed to know more persons who had completed suicide than those who had attempted suicide. Almost all informants mentioned more than one cause for suicide. Of these, frustration was the most frequently mentioned cause. Most informants believed that suicide attempters are cruel, feared and not trustworthy. Their attitude toward suicide completers was expressed as condemned sinners, do not deserve funeral ceremony, and should be buried separately from others. Christians gave importance to the funeral issue more than did the Muslims. Generally, the attitudes of informants were punitive and disapproving.

  • 3.
    Alem, Atalay
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lynöe, Niels
    Kohn, Robert
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Attitudes and practices among Ethiopian health care professionals in psychiatry regarding compulsory treatment.2002In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 25, no 6, p. 599-610Article in journal (Refereed)
  • 4.
    Alem, Atalay
    et al.
    Arnanuel Psychiatric Hospital, Addis Ababa, Ethiopia.
    Kebede, D
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Suicide attempts among adults in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 70-76Article in journal (Refereed)
    Abstract [en]

    In a cross-sectional survey, 10,468 adults of a rural and semi-urban community were interviewed to determine lifetime suicide attempts. Among the study population, 58% were female, 74.4% were Muslim and 79.3% had had no formal education. The majority of the population were in the age group 25-59 years. Lifetime suicide attempt was reported by 3.2% (n = 332) of the study population. Of these, 63% (n = 208) were women. The most frequent age of attempt was between 15 and 24 years and the frequency of attempt decreased with increasing age. Hanging and poisoning were the most frequently reported methods of attempting suicide. Marital or family conflict was the most frequently reported cause for attempting suicide and most of those who reported this cause were women (Chi-square = 17.42; P < 0.001). Men were significantly more likely to use hanging to attempt suicide than women (Chi-square = 8.21; P < 0.001). Among Christians 3.9% had a lifetime suicide attempt compared to 2.9% among Muslims (Chi-square = 6.15; P < 0.05). People who currently had mental distress and problem drinking reported lifetime suicide attempt more often than others.

  • 5.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa, Ethiopia.
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The epidemiology of problem drinking in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 77-83Article in journal (Refereed)
    Abstract [en]

    In order to determine the prevalence and socio-demographic correlates of problem drinking, a total of 10,468 persons aged 15 and above, most residing in a rural district, were interviewed using the CAGE questionnaire as an important element of a general mental health survey. Twenty-three per cent of the respondents admitted that they currently drank alcohol. The prevalence of alcohol drinking was 15% for women and 36% for men. Among those who drank, 16% met the criterion for problem drinking as defined by two or more positive responses to the CAGE. The overall prevalence for problem drinking was found to be 3.7%. Stratified analysis for sex showed that Christian religion, male sex, being ethnically non-Gurage, and smoking were strongly associated with problem drinking in both sexes. Marital status, mental distress and income were found to be associated factors with problem drinking only in men.

  • 6.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital. Addis Ababa, Ethiopia.
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The prevalence and socio-demographic correlates of khat chewing in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 84-91Article in journal (Refereed)
    Abstract [en]

    A house-to-house survey was carried out in a rural Ethiopian community to determine the prevalence and socio-demographic correlates of khat use. A total of 10,468 adults were interviewed. Of these, 58% were female, and 74% were Muslim. More than half of the study population (55.7%) reported lifetime khat chewing experience and the prevalence of current use was 50%. Among current chewers, 17.4% reported taking khat on a daily basis; 16.1% of these were male and 3.4% were female. Various reasons were given for chewing khat; 80% of the chewers used it to gain a good level of concentration for prayer. Muslim religion, smoking and high educational level showed strong association with daily khat chewing.

  • 7.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa, Ethiopia.
    Kebede, D
    Woldesemiat, G
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The prevalence and socio-demographic correlates of mental distress in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 48-55Article in journal (Refereed)
    Abstract [en]

    A cross-sectional survey was conducted on 10,468 rural and semi-urban adults in an Ethiopian district using the Self Reporting Questionnaire (SRQ) to detect the prevalence of mental distress and its association with socio-demographic risk factors. Fifty-eight per cent of the study population were women, 74% were Muslim, 79% were illiterate. Those experiencing 11 or more symptoms out of the 20 SRQ items were considered as having mental distress. Accordingly, the prevalence of mental distress was 17%, which is comparable with the previous hospital-based studies in Ethiopia and elsewhere. However, it was higher than the previous community-based studies in Ethiopia. Mental distress was more prevalent among women. Part of the explanation was that women in the study population were older and that they were more often widowed or divorced, which were factors associated with mental distress. Illiteracy, which was more common among women and older individuals, was also independently associated with mental distress.

  • 8.
    Alem, Atalay
    et al.
    Addis Ababa University, Ethiopia.
    Kebede, Derege
    WHO Regional Office for Africa, Brazzaville, Congo .
    Fekadu, Abebaw
    King's College London, United Kingdom.
    Shibre, Teshome
    Addis Ababa University, Ethiopia.
    Fekadu, Daniel
    Maudsley Hospitall, London, United Kingdom.
    Beyero, Teferra
    Addis Ababa University, Ethiopia.
    Medhin, Girmay
    Addis Ababa University, Ethiopia.
    Negash, Alemayehu
    Addis Ababa University, Ethiopia.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia2009In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 35, no 3, p. 646-654Article in journal (Refereed)
    Abstract [en]

    The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.

  • 9.
    Armelius, Bengt-Åke
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Borderline diagnosis from hospital records:  reliability and validity of Gunderson's diagnostic interview for Borderlines (DIB)1985In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 173, no 1, p. 32-4Article in journal (Refereed)
    Abstract [en]

    Two trained and experienced clinical psychologists and two nontrained students rated the sections in Gunderson's Diagnostic Interview for Borderlines (DIB) on the basis of hospital records for 16 patients (DIB-R). The results showed that both reliability and validity, i.e., correlations with an actual interview, were unexpectedly high, around .80 for the trained judges and around .55 for the nontrained judges. The conclusion is that the DIB may be used for retrospective diagnosis of borderline patients from hospital records.

  • 10.
    Armelius, Bengt-Åke
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Personality organization defined by DMT and the structural interview1990In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 31, no 2, p. 81-8Article in journal (Refereed)
    Abstract [en]

    The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Structural Interview and a projective test called the Defence Mechanism Test (DMT) to operationalize the PO concept on a sample of 50 psychiatric inpatients. The reliability of the PO judgements were found to be acceptable for both the Structural Interview and the DMT. The validity, which was estimated as the correlation between the two methods, was also found to be substantial. The conclusion is that the concept of PO may be reliably operationalized for psychiatric patients and seems to have concurrent validity. Both the DMT and the Structural Interview may be used for differential diagnosis of PO.

  • 11.
    Bhoomikumar, Jegannathan
    et al.
    Center for Child and Adolescent Mental Health, Chey Chumneas Hospital, Cambodia .
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Gender difference in suicidal expressions and it's determinants among young people in Cambodia, a post-conflict country2011In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 11, no 1, p. 47-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Suicide among young people is a global public health problem, but adequate information on determinants of suicidal expression is lacking in middle and low income countries. Young people in transitional economies are vulnerable to psychosocial stressors and suicidal expressions. This study explores the suicidal expressions and their determinants among high school students in Cambodia, with specific focus on gender differences.

    METHODS: A sample of 320 young people, consisting of 153 boys and 167 girls between 15-18 years of age, was randomly selected from two high schools in Cambodia. Their self-reported suicidal expressions, mental health problems, life-skills dimensions, and exposure to suicidal behavior in others were measured using the Youth Self-Report (YSR), Life-Skills Development Scale (LSDS)-Adolescent Form, and Attitude Towards Suicide (ATTS) questionnaires.

    RESULTS: Suicidal plans were reported more often by teenage boys than teenage girls (M=17.3%, F=5.6%, p=0.001), whereas girls reported more attempts (M=0.6%, F=7.8%, p=0.012). Young men scored significantly higher on rule-breaking behavior than young women (p=0.001), whereas young women scored higher on anxious/depression (p=0.000), withdrawn/depression (p=0.002), somatic complaints (p=0.034), social problems (p=0.006), and internalizing syndrome (p=0.000). Young men exposed to suicide had significantly higher scores for internalizing syndrome compared to those unexposed (p=0.001), while young women exposed to suicide scored significantly higher on both internalizing (p=0.001) and externalizing syndromes (p=0.012). Any type of exposure to suicidal expressions increased the risk for own suicidal expressions in both genders (OR=2.04, 95% CI=1.06-3.91); among young women, however, those exposed to suicide among friends and partners were at greater risk for the serious suicidal expressions (OR=2.79, 95% CI=1.00-7.74). Life skills dimension scores inversely correlated with externalizing syndrome in young men (p=0.026) and internalizing syndrome in young women (p=0.001).

    CONCLUSIONS: The significant gender differences in suicidal expressions and their determinants in Cambodian teenagers highlight the importance of culturally appropriate and gender-specific suicide prevention programs. School-based life skills promotion may indirectly influence the determinants for suicidal expressions, particularly among young women with internalizing syndrome in Cambodia.

  • 12.
    Binzer, M
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Andersen, P M
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study.1997In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 63, no 1, p. 83-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Previous studies have suggested associations between conversion and many different clinical characteristics. This study investigates these findings in a prospective design including a control group. METHODS: Thirty consecutive patients with a recent onset of motor disability due to a conversion disorder were compared with a control group of patients with corresponding motor symptoms due to a definite organic lesion. Both groups had a similar duration of symptoms and a comparable age and sex profile and were assessed on a prospective basis. Background information about previous somatic and psychiatric disease was collected and all patients were assessed by means of a structured clinical interview linked to the diagnostic system DSM III-R, the Hamilton rating depression scale, and a special life events inventory. RESULTS: The conversion group had a higher degree of psychopathology with 33% of the patients fulfilling the criteria for psychiatric syndromes according to DSM-III-R axis I, whereas 50% had axis II personality disorders compared with 10% and 17% respectively in the control group. Conversion patients also had significantly higher scores according to the Hamilton rating depression scale. Although patients with known neurological disease were not included in the conversion group, a concomitant somatic disorder was found in 33% of the patients and 50% complained of benign pain. The educational background in conversion patients was poor with only 13% having dropped out of high school compared with 67% in the control group. Self reported global assessment of functioning according to the axis V on DSM IV was significantly lower in conversion patients, who also registered significantly more negative life events before the onset of symptoms than controls. Logistic regression analysis showed that low education, presence of a personality disorder, and high Hamilton depression score were significantly associated with conversion disorder. CONCLUSION: The importance of several previously reported predisposing and precipitating factors in conversion disorder is confirmed. The results support the notion that conversion should be treated as a symptom rather than a diagnosis and that efforts should be made in diagnosing and treating possible underlying somatic and psychiatric conditions.

  • 13.
    Binzer, M
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Eisemann, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Illness behavior in the acute phase of motor disability in neurological disease and in conversion disorder: a comparative study.1998In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 44, no 6, p. 657-66Article in journal (Refereed)
    Abstract [en]

    Sixty patients with a sudden onset of motor disability were assessed for illness behavior and depression. In 30 of the patients, etiology was attributed to a definite structural lesion. The remaining 30 patients were diagnosed as having conversion disorder. The Illness Behaviour Questionnaire (IBQ) and the Hamilton Rating Depression Scale (HRDS) were used as instruments for assessment. The mean HRDS score was significantly higher in the conversion group, indicating a higher degree of affective disease in these patients. According to the results of the IBQ, the patients with conversion disorder showed a higher degree of irritability, disease conviction, and phobic preoccupation, and also, to a greater extent, rejected psychological explanations for their symptoms. Denial was high in both patient groups, coexisting with affective symptoms in the conversion patients but not in the neurological patients. Although valuable information could be extracted from the IBQ, it was not found to be a reliable instrument for distinguishing between psychogenic and organic causes of motor disability.

  • 14.
    Binzer, M
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Motor conversion disorder. A prospective 2- to 5-year follow-up study.1998In: Psychosomatics, ISSN 0033-3182, E-ISSN 1545-7206, Vol. 39, no 6, p. 519-27Article in journal (Refereed)
    Abstract [en]

    In this prospective study, 30 patients with motor conversion disorder were assessed for key psychiatric and demographic variables. At reassessment 2 to 5 years later, 19 patients had completely recovered and 8 patients had improved, whereas only 3 were unchanged or worse. Contrary to other follow-up studies, none of the patients received a rediagnosis of neurological disease. The presence of a personality disorder and overall personality pathology, particularly within cluster C, the presence of a concomitant somatic disease, low DSM-IV Axis V score, and high score on the Becks Hopelessness Scale proved to be associated with poor outcome.

  • 15. Binzer, MN
    et al.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [Psychogenic paralysis. A prospective study].2000In: Ugeskrift for læger, ISSN 0041-5782, E-ISSN 1603-6824, Vol. 162, no 42, p. 5632-5636Article in journal (Refereed)
    Abstract [da]

    The results of this study stresses the need for careful and well-conducted neurological and psychiatric assessments in patients with psychogenic paralyses, bearing in mind the substantial possibility for coinciding illnesses. If this is ensured, it appears that the risk of subsequent neurological rediagnosis is negligible.

  • 16.
    Bodlund, Owe
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Transsexualism--general outcome and prognostic factors: a five-year follow-up study of nineteen transsexuals in the process of changing sex.1996In: Archives of Sexual Behavior, ISSN 0004-0002, E-ISSN 1573-2800, Vol. 25, no 3, p. 303-16Article in journal (Refereed)
    Abstract [en]

    Nineteen transsexuals, approved for sex reassignement, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n = 13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socio-economic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.

  • 17.
    Bodlund, Owe
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ekselius, L
    Lindström, E
    von Knorring, Lars
    Axis V--Global Assessment of Functioning Scale. Evaluation of a self-report version.1994In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 90, no 5, p. 342-7Article in journal (Refereed)
    Abstract [en]

    The present study examines a self-report version of the Global Assessment of Functioning Scale according to Axis V (GAF self-report). The sample (n = 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48-86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self-report overall at r = 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: -4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self-report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self-report version as a complement, Axis V could be more frequently used in future clinical practice and research.

  • 18.
    Bodlund, Owe
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sundbom, Elisabet
    Höjerback, T
    Personality traits and disorders among transsexuals.1993In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 88, no 5, p. 322-7Article in journal (Refereed)
    Abstract [en]

    A group of transsexuals, 9 biological men and 10 women, was assessed according to clinical DSM-III-R diagnosis and a self-report instrument for Axis II diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID screen). A control group of 133 individuals was assessed by the same instrument. Combined with a functional criterion according to the Global Assessment of Functioning, the SCID screen showed good agreement with clinical Axis II diagnoses. The overall proportion of Axis II criteria fulfilled, proportion of criteria fulfilled for every single personality disorder and number of personality disorders were calculated from the modified version of the SCID screen. Personality disorders, mainly within cluster B, were identified among 5 of 19 transsexuals, and a majority had multiple personality disorders. Among controls, no personality disorder was identified. Personality traits as measured by the SCID screen revealed significantly more subthreshold pathology among transsexuals than controls in 8 of 12 personality categories. The proportion of overall Axis II criteria fulfilled was 29% among transsexuals versus 17% among controls. Sex differences among transsexuals, the usefulness of the SCID screen and diagnostic problems in DSM-III-R with respect to gender identity disorders are discussed.

  • 19.
    Caldera, Trinidad
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Herrera, Andrés
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Suicide intent among parasuicide patients in Nicaragua.: A surveillance and follow-up study.2007In: Archives of Suicide Research, ISSN 1381-1118, E-ISSN 1573-8159, Vol. 11, no 4, p. 351-360Article in journal (Refereed)
  • 20.
    Caldera, Trinidad
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Herrera, Andrés
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Parasuicide in a low income country: results from a three year hospital surveillance in Nicaragua.2004In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 5, p. 349-355Article in journal (Refereed)
    Abstract [en]

    Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.

  • 21.
    Caldera, Trinidad
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Penayo, Ulises
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua.1995In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 92, no 5, p. 386-91Article in journal (Refereed)
    Abstract [en]

    Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.

  • 22.
    Caldera, Trinidad
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Palma, L
    Penayo, Ulises
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective2001In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 36, no 3, p. 108-114Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. METHOD: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. RESULTS: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (beta-coefficient 0.257, P = 0.000), a house destroyed (beta-coefficient 0.148, P = 0.001), female sex (beta-coefficient 0.139, P = 0.001), previous mental health problems (beta-coefficient 0.109, P = 0.009) and illiteracy (beta-coefficient 0.110, P = 0.009). Those with previous mental health problems (OR = 4.84; 95% CI = 3.04-7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR = 0.38; 95% CI = 0.21-0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI = 1.12-4.37) and those with previous mental health problems (OR 2.84; 95% CI = 1.12-4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. CONCLUSION: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention.

  • 23.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asberg, M
    CSF monoamine metabolites in relation to the diagnostic interview for borderline patients (DIB).1998In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 38, no 4, p. 207-12Article in journal (Refereed)
    Abstract [en]

    The cerebrospinal fluid concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), 3-methoxy-4-hydroxyphenylglycol, and their ratios were studied in relation to the Diagnostic Interview for Borderline patients (DIB) evaluated retrospectively from hospital records for a sample of 202 patients participating in psychobiological programs on mood disorders. No correlations with the total DIB score were significant. Patients with borderline personality disorder (BPD) defined by a total DIB score of at least 7 or 6, respectively, did not differ significantly from non-BPD regarding the metabolites. However, for section II (impulse action pattern) of the DIB, those with an intermediate value of the section score had significantly higher levels of 5-HIAA and HVA, suggesting that such higher than normal concentrations may be protective against impulsive or suicidal behavior generated by an underlying psychiatric morbidity due to other risk factors.

  • 24.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asberg, M
    Season of birth variations in dimensions of functioning evaluated by the diagnostic interview for borderline patients.2000In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 41, no 3, p. 132-8Article in journal (Refereed)
    Abstract [en]

    In view of recent reports showing that cerebrospinal fluid (CSF) levels of monoamine metabolites exhibit season of birth variations, and that they are also associated with section II (impulse action patterns) of the diagnostic interview for borderline patients (DIB), we analyzed two samples of data to investigate the relationship between the season of birth and the DIB. The first sample comprised 202 patients participating in psychobiological research in Stockholm, and the second sample comprised 130 patients who had committed suicide in Västerbotten in northern Sweden. Those with intermediate score for section II (impulse action patterns) were significantly more likely to have been born during the season October to January in the pooled data, and this tendency persisted in separate analyses for the two samples and for the two diagnostic groups mood disorders and schizophrenia, respectively. Those with high score for section IV (psychosis) were significantly more likely to have been born during February to April in the pooled sample and in the nonschizophrenic group. In the group with schizophrenia, those born during February to April had significantly high scores for section III (affects). These results throw further light on the role of season of birth in suicidology and in psychiatric morbidity.

  • 25.
    Deyessa Kabeta, Negussie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Berhane, Y
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Depression among women in rural Ethiopia as related to socioeconomic factors: a community-based study on women in reproductive age groups2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 6, p. 589-597Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several previous studies have reported on socioeconomic and sociodemographic factors associated with depression among women, but knowledge in this area remains scarce regarding women living in extreme poverty in developing countries.

    OBJECTIVE: The study was aimed at examining the 12-month prevalence of depressive episodes as related to socioeconomic and sociocultural conditions of women in the reproductive age group in rural Ethiopia.

    METHODS: A community-based cross-sectional study was undertaken among 3016 randomly selected women in the age group 15-49 years. Cases of depression were identified using the Amharic version of the Composite International Diagnostic Interview. A standardized World Health Organization questionnaire was used to measure the socioeconomic status of the women and their spouses. Data were analysed among all women and then separately among currently married women.

    RESULTS: The 12-month prevalence of depression among all women was 4.4%. After adjusting for common sociodemographic characteristics, only marital status showed a significant association with depressive episode in terms of higher odds ratios (ORs) for divorced/separated women and widowed women than for not-married women (4.05 and 4.24, respectively). Among currently married women, after adjusting for common sociodemographic characteristics, living in rural villages (OR=3.78), a frequent khat-chewing habit (OR=1.61), having a seasonal job (OR=2.94) and being relatively better off in terms of poverty (OR=0.48) were independently associated with depression.

    CONCLUSIONS: The prevalence of depression among women was in the lower range as compared to studies from high-income countries, but very poor economic conditions were associated with a higher prevalence of depression in this overall very poor setting. This further supports the notion that the relative level of poverty rather than the absolute level of poverty contributes to depression among women. Whether the association with khat chewing and depression is a causative effect or can be explained by self-medication remains unclear.

  • 26.
    Deyessa Kabeta, Negussie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Berhane, Y
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ellsberg, MC
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia2010In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 95, no 10, p. 771-775Article in journal (Refereed)
    Abstract [en]

    An awareness of the devastating consequences on child survival in low income setting of violence against women and depression is needed among public health workers as well as clinicians, for both community and clinical interventions.

  • 27.
    Deyessa Kabeta, Negussie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Berhane, Yemane
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ellsberg, Mary
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Intimate partner violence and depression among women in rural Ethiopia: a cross-sectional study2009In: Clinical practice and epidemiology in mental health, ISSN 1745-0179, Vol. 5, no 1, p. 8-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies from high-income countries have shown intimate partner violence to be associated with depression among women. The present paper examines whether this finding can be confirmed in a very different cultural setting in rural Ethiopia.

    METHOD: A community-based cross-sectional study was undertaken in Ethiopia among 1994 currently married women. Using the Composite International Diagnostic Interview (CIDI), cases of depressive episode were identified according to the ICD-10 diagnosis. Using a standardized questionnaire, women who experienced violence by an intimate partner were identified. A multivariate analysis was conducted between the explanatory variables and depressive status of the women, after adjusting for possible confounders.

    RESULTS: The 12-month prevalence of depressive episode among the women was 4.8% (95% CI, 3.9% and 5.8%), while the lifetime prevalence of physical intimate partner violence was 49.5%. Physical violence (OR=2.56, 95% CI, 1.61, 4.06), childhood sexual abuse (OR=2.00, 95% CI, 1.13, 3.56), mild emotional violence (OR=3.19, 95% CI, 1.98, 5.14), severe emotional violence (OR= 3.90, 95% CI, 2.20, 6.93) and high spousal control of women (OR=3.30, 95% CI, 1.58, 6.90) by their partners were independently associated with depressive episode, even after adjusting for socioeconomic factors.

    CONCLUSIONS: The high prevalence of intimate partner violence, a factor often obscured within general life event categories, requires attention as an independent factor for depression, and thus to find new possibilities of prevention and treatment in terms of public health strategies, interventions and service provision.

  • 28.
    Deyessa Kabeta, Negussie
    et al.
    School of Public Health, Addis Ababa University, Ethiopia .
    Berhane, Yemane
    Addis Continental Institute of Public Health, Ethiopia .
    Ellsberg, Mary
    International Center for Research on Women, Washington DC, United States .
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Violence against women in relation to literacy and area of residence2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, no 2070Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study explores violence against women in a low-income setting in relation to residency and literacy. SETTING: The study was conducted within the Butajira Rural Health Programme (a Health and Demographic Surveillance Site), which includes rural and semi-urban settings in south-central Ethiopia. DESIGN: This is a community-based cross-sectional study and is part of the WHO Women's Health and Life Events multi-country study. It included 1,994 randomly selected married women. METHODS: A standardised WHO questionnaire was used to measure physical violence, residency, literacy of the woman and her spouse, and attitudes of women about gender roles and violence. Analyses present prevalence with 95% confidence intervals and odds ratios derived from bivariate and multivariate logistic regression models. RESULTS: In urban and rural areas of the study area, the women were of varying ages, had varying levels of literacy and had spouses with varying levels of literacy. Women in the overall study area had beliefs and norms favouring violence against women, and women living in rural communities and illiterate women were more likely to accept such attitudes. In general, violence against women was more prevalent in rural communities. In particular, violence against rural literate women and rural women who married a literate spouse was more prevalent. Literate rural women who were married to an illiterate spouse had the highest odds (Adj. OR = 3.4; 95% CI: 1.7-6.9) of experiencing physical violence by an intimate partner. CONCLUSION: Semi-urban lifestyle and literacy promote changes in attitudes and norms against intimate partner violence; however, within the rural lifestyle, literate women married to illiterate husbands were exposed to the highest risks of violence.

  • 29. Ekselius, L
    et al.
    Lindström, E
    von Knorring, L
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Personality disorders in DSM-III-R as categorical or dimensional.1993In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 88, no 3, p. 183-7Article in journal (Refereed)
    Abstract [en]

    Despite the atheoretical approach of the DSM-III-R, the personality disorders have their roots in specific theoretical schools. Due to clinical tradition, analogies with Axis I and the tradition in psychiatry and medicine, the personality disorders are presented as categories although there is more empirical support for a dimensional approach. This study attempted to determine whether the separate personality disorders meet Kendell's criteria for distinct entities, i.e., bimodality with distinct points of rarity. None of the personality disorders met the criteria for a distinct disease entity. Instead, all of the personality disorders presented as continuous, dimensional personality traits present among healthy subjects and more pronounced in patients with mental disorders.

  • 30. Ekselius, L
    et al.
    Lindström, E
    von Knorring, L
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R.1994In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 90, no 2, p. 120-3Article in journal (Refereed)
    Abstract [en]

    A modified version of the SCID Screen questionnaire covering 103 criteria by means of 124 questions was compared with SCID II interviews in 69 psychiatric patients. The correlation between the number of criteria fulfilled in the SCID II interviews or the questionnaires was 0.84. In the SCID interviews, 54% of the patients had a personality disorder. When the SCID Screen questionnaire was used, 73% had a personality disorder. When the cut-off level for diagnosis was adjusted, the frequency found by means of the SCID screen questionnaire or the interviews was roughly the same, 58% and 54%, respectively. The overall kappa for agreement between the SCID II interviews and questionnaire with adjusted cut-off was 0.78.

  • 31. Giang, Kim Bao
    et al.
    Allebeck, Peter
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Tuan, Nguyen Van
    The Vietnamese version of the Self Reporting Questionnaire 20 (SRQ-20) in detecting mental disorders in rural Vietnam: a validation study.2006In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 52, no 2, p. 175-184Article in journal (Refereed)
    Abstract [en]

    Background: There is a need to develop instruments to measure mental disorders in developing countries because mental disorders are increasingly being recognised as a major public health problem. There has been no previous study in Vietnam validating screening instruments for mental health problems. Aim: To adapt and to validate the Self Reporting Questionnaire-20 (SRQ-20) in the Vietnamese community.

    Methods: A Vietnamese version of the SRQ-20 was developed and tested in 52 persons in a district hospital sample and 485 persons in a community sample. The psychiatrists' diagnoses were taken as the validity criterion. Receiver Operating Characteristic (ROC) analysis was performed to identify the optimal cut-off value. The area under the ROC curve (AUC) was calculated to assess the performance of SRQ in different sociodemographic groups.

    Results: In the district hospital sample, the optimal cut-off score was 5/6 with a sensitivity of 85%, a specificity of 46% and an AUC of 0.74 (95% CI: 0.59–0.89). In the community sample, it was 6/7 with a sensitivity of 85%, a specificity of 61% and AUC of 0.86 (95% CI: 0.81–0.93). In terms of AUC, SRQ performed significantly better in the age group 18–24 years as compared with other ages and with single persons as compared with widowed or divorced people.

    Conclusion: The SRQ-20 was found feasible to use and adapt to the Vietnamese setting. We confirmed the value of this instrument for use in developing countries, but the optimal cut-off limit has to be assessed and determined according to local conditions.

  • 32. Giang, Kim Bao
    et al.
    Dzung, Truong Viet
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Allebeck, Peter
    Prevalence of mental distress and use of health services in a rural district in Vietnam2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, p. 2025-Article in journal (Refereed)
    Abstract [en]

    Although there was a low prevalence of mental distress, the low use of mental health services indicated that there was a treatment gap in mental health care. Since many people used private services, intervention programs should include private providers to strengthen their capacity to provide mental health care for the community.

  • 33. Grann, Martin
    et al.
    Långström, Niklas
    Tengström, Anders
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychopathy (PCL-R) predicts violent recidivism among criminal offenders with personality disorders in Sweden.1999In: Law and human behavior, ISSN 0147-7307, E-ISSN 1573-661X, Vol. 23, no 2, p. 205-17Article in journal (Refereed)
    Abstract [en]

    Psychopathy as conceptualized with Hare's Psychopathy Checklist Revised, PCL-R, has attracted much research during the 1990s. In the Scandinavian countries, few studies that empirically support the validity of North American risk assessment techniques in our regional context have been published. The purpose of this paper is to explore the predictive power of the PCL-R in a population of personality-disordered violent offenders subjected to forensic psychiatric evaluation in Sweden. Following release from prison (n = 172), discharge from forensic psychiatric treatment (n = 129), or probation (n = 51), a total of 352 individuals were followed for up to 8 years (mean = 3.7 years) with reconviction for violent crime as endpoint variable (base rate 34%). As the estimate of predictive power, the area under the curve of a receiver operating characteristic (AUC of ROC) analysis was calculated. For PCL-R scores to predict 2-year violent recidivism, AUC of ROC was .72 (95% CI: .66-.78). In addition, the personality dimension of psychopathy (Factor 1) and the behavioral component (Factor 2) both predicted 2-year recidivism significantly better than random: AUC of ROC .64 (95% CI: .57-.70) and .71 (95% CI: .65-.77), respectively. We conclude that psychopathy is probably as valid a predictor of violent recidivism in Swedish forensic settings as seen in previous North American studies.

  • 34. Grann, Martin
    et al.
    Sturidsson, Knut
    Haggård-Grann, Ulrika
    Hiscoke, Ulrika L
    Alm, Per-Olof
    Dernevik, Mats
    Gumpert, Clara
    Hallqvist, Johan
    Hallquist, Tommy
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Långström, Niklas
    Lotterberg, Malin
    Nordström, Kristina
    Ståhle, Birgitta
    Woodhouse, Anni
    Methodological development: structured outcome assessment and community risk monitoring (SORM).2005In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 28, no 4, p. 442-456Article in journal (Refereed)
    Abstract [en]

    This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.

  • 35.
    Herrera, Andrés
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Caldera, Trinidad
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Suicidal expressions among young people in Nicaragua: a community-based study2006In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 9, p. 692-697Article in journal (Refereed)
  • 36.
    Herrera, Andrés
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Caldera, Trinidad
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Pena, Rodolfo
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Attitudes towards suicide among young people in Nicaragua: a community-based studyManuscript (Other academic)
  • 37.
    Herrera Rodríguez, Andrés
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Pathways to suicidal behaviour among adolescent girls in Nicaragua2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 4, p. 805-814Article in journal (Refereed)
    Abstract [en]

    Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour.

    A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt.

    Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls.

    Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.

  • 38.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Professional care after deliberate self-harm: a qualitative study of young people's experiences2015In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 199-207Article in journal (Refereed)
    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.

  • 39.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Professional Care as an Option Prior to Self-Harm A Qualitative Study Exploring Young People's Experiences2015In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 36, no 3, p. 179-186Article in journal (Refereed)
    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.

  • 40.
    Jegannathan, Bhoomikumar
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Outcome of a school-based intervention to promote life-skills amongyoung people in Cambodia2014In: Asian Journal of Psychiatry, ISSN 1876-2018Article in journal (Refereed)
    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.

  • 41.
    Jegannathan, Bhoomikumar
    et al.
    Center for Child and Adolescent Mental Health, Chey Chumneas Hospital, Takhmau, Cambodia.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    ‘Plue plun’ male, ‘kath klei’ female: gender differences in suicidal behavior as expressed by young people in Cambodia2014In: International Journal of Culture and Mental Health, ISSN 1754-2863, E-ISSN 1754-2871, Vol. 7, no 3, p. 326-338Article in journal (Refereed)
    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.

  • 42.
    Jegannathan, Bhoomikumar
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Religion, culture, media and their impact on suicide in the eyes of young people in CambodiaManuscript (preprint) (Other academic)
  • 43.
    Jegannathan, Bhoomikumar
    et al.
    Center for Child and Adolescent Mental Health, Chey Chumneas Hospital, Cambodia.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    High exposure to suicide, a risk factor among university students in Cambodia2010In: Journal of Indian Association for Child and Adolescent Mental Health, ISSN 0973-1342, Vol. 6, no 4, p. 84-100Article in journal (Refereed)
    Abstract [en]

    Suicide rates are on the increase among young people in several countries. Exposure to suicide among significant others, a well-known risk factor for suicidal behavior, is less studied in low-income, post-conflict countries. This study focuses on university students, a group known to be at risk for suicidal expressions, such as death-wishes, suicidal ideation, plans and attempts.

    Aim: To investigate suicidal expressions among university students in Cambodia and their relationship to exposure to suicidal behavior among significant others.

    Methods: 109 university students in the age group 18 to 24 from the Royal University of Phnom Penh (RUPP) responded to Attitude Towards Suicide (ATTS) questionnaire, that reveals the exposure to suicidal behavior among significant others and self-reported suicidal expressions.

    Results: 44.9% reported any of the suicidal expressions during the previous year. Young men reported significantly more exposure to suicide among relatives than women (34.5%, 13.7%, p=0.015). Exposure to completed/attempted suicide among siblings and other relatives was s own suicidal ideation (OR=5.09, 3.16, respectively) and self-reported probability for suicide (OR=4.35, 3.36, respectively). Young men exposed to suicide among siblings and friends were more at risk for suicidal ideation (OR= 7.17, 4.56, respectively) and those exposed to suicide among relatives reported suicide as a probability (OR= 4.58), whereas exposure was not associated to suicidal expression in young women.

    Conclusions: Suicide prevention strategies in the universities in Cambodia should focus on the students exposed to suicide, as they are vulnerable for increased suicidal expressions.

  • 44.
    Jegannathan, Bhoomikumar
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Center for Child and Adolescent Mental Health, Chey Chumneas Referral Hospital, Takhmau, Cambodia.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    How do young people in Cambodia perceive the impact of societal attitudes, media and religion on suicidal behaviour?2016In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 62, no 2, p. 114-122Article in journal (Refereed)
    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.

  • 45.
    Jegannathan, Bhoomikumar
    et al.
    Center for Child and Adolescent Mental Health, Chey Chumneas Hospital Takhmau, Kandal Province, Cambodia.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Deva, Parameshvara
    Mental health services in Cambodia, challenges and opportunities in a post-conflict setting2015In: Asian Journal of Psychiatry, ISSN 1876-2018, E-ISSN 1876-2026, Vol. 13, p. 75-80Article in journal (Refereed)
    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.

  • 46. Kebede, D
    et al.
    Alem, Atalay
    Dept. of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Shibre, Teshome
    Negash, Alemayehu
    Fekadu, A
    Fekadu, Daniel
    Deyessa, Negussie
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Onset and clinical course of schizophrenia in Butajira-Ethiopia--a community-based study.2003In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 38, no 11, p. 625-631Article in journal (Refereed)
    Abstract [en]

    Background:

    There are reports on favourable course and outcome of schizophrenia in lowincome countries. The aim of the present study was to examine onset and clinical course of the illness in a community-based sample in rural Ethiopia based on crosssectional information.

    Method:

    A two-stage survey was carried out in Butajira-Ethiopia, a predominantly rural district. Altogether 68,378 individuals aged 15–49 years were CIDI-interviewed, of whom 2,159 were identified as cases according to the CIDI interview with regard to psychotic or affective disorders. Key informants identified another group of 719 individuals as being probable cases and a total of 2,285 individuals were SCAN-interviewed. The present paper reports on cases with schizophrenia.

    Results:

    There were 321 cases of schizophrenia giving an estimated lifetime prevalence of 4.7/1,000). Of the cases,83.2% (N = 267) were males. Mean age of first onset of psychotic symptoms for males was 23.8 (sd 8.6) compared to 21.0 (sd 7.8) for females (P = 0.037; 95 %CI 0.16–5.47). Over 80% had negative symptoms and over 67% reported continuous course of the illness. Less than 10% had a history of previous treatment with neuroleptic medication. About 7% were vagrants, 9 % had a history of assaultive behaviour,and 3.8% had attempted suicide. The male to female ratio was nearly 5:1.

    Conclusion:

    This large community-based study differs from most previous studies in terms of higher male to female ratio, earlier age of onset in females and the predominance of negative symptoms.

  • 47.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    An empirical comparison of three different borderline concepts.1987In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 76, no 3, p. 246-55Article in journal (Refereed)
    Abstract [en]

    Forty-six inpatients were independently diagnosed according to the DSM-III concept of borderline personality disorder, the diagnostic interview for borderlines (DIB) and the concept of borderline personality organization, which is linked to Kernbergs structural interview. The interviews were videotaped. Satisfactory inter-rater reliability was demonstrated for the DIB, which furthermore showed high sensitivity and specificity in identifying patients with a clinical DSM-III diagnosis of borderline personality disorder from patients with a other personality disorders or schizophrenic disorders. Discriminant features, demographic profile and earlier treatment history for the patients with a borderline personality disorder are described and discussed. The structural interviews were scored according to a specified format. Inter-rater reliability was satisfactory but not too impressive. Borderline personality organization turned out to be a very broad concept and only half of the patients within this concept received a syndrome diagnosis of borderline personality disorder. A general conclusion was that borderline personality organization should not be considered as a diagnostic entity but rather as a different diagnostic dimension representing an intermediate level of personality structure.

  • 48.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Clinical studies on the borderline concept with special reference to suicidal behavior1987Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The diagnostic concept of borderline personality has had various meanings throughout the last decades. From current clinical practice and research two principally different concepts have emerged: The syndrome concept of borderline personality disorder ( BPD ) as identified by the DSM-III or the Diagnostic Interview for Borderline (DIB) and the psychodynamic concept of borderline personality organization (BPO) as defined from the structural Interview (SI) by Otto Kernberg.

    In the first part of the present study, the DIB, the SI and a percept-genetic test called Defense Mechanism test (DMT) have been utilized in a clinical study on psychiatric inpatients. In the second part completed suicides are studied among patients with borderline personality disorder.

    Inter-rater reliability was satisfactory for the DIB both when utilized as a clinical interview and as a chart scoring instrument. Previous research findings concerning descriptive validity of the BPD concept were further supported. Fairly reliable scorings of personality organization could be made from the SI. BPO turned out to be a very inclusive concept and a subgroup (46%) also met criteria for BPD. By means of the DMT specific psychodynamic features were identified among patients with BPD which discriminated them from patients with other personality disorders or schizophrenic disorder. It is concluded, that there is empirical support to consider BPD a valid diagnostic entity. BPO should be conceptualized as a level of personality functioning rather than a diagnostic category and its validity remains to be proven.

    Patients with BPD were not seriously overrepresented in a material of 145 psychiatric patients, suicided during inpatient care or shortly after discharge 1961 to 1980. The number and proportion of borderline patients, however, increased for every five- years-period. In an analysis of cases suicided during inpatient treatment, repressive/rejective behavior from staff was frequently observed. Risk factors were identified in comparative studies. Male sex, extensive earlier hospitalization, repressive/rejective staff behavior and frequent previous suicide attempts were associated with completed suicides. A specific pattern of psychological variables was identified among suicided borderline patients including antisocial traits, drug abuse and a less intense interpersonal attachment.

  • 49.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Factors associated with completed suicide in borderline personality disorder.1988In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 176, no 1, p. 40-4Article in journal (Refereed)
    Abstract [en]

    Fifteen patients with a diagnosis of borderline personality disorder (BPD) who had committed suicide while under inpatient care or within a month after discharge were compared with a group of 13 inpatients with a diagnosis of BPD who did not kill themselves. Suicides occurred in all ages from 20 to 49 years. Age, sex, and age when first in contact with psychiatry did not differ between groups. DIB profiles differed only with respect to slightly higher scores on the affect section among patients who committed suicide. Axis I affective disorders were equally frequent. The patients who committed suicide had been more often hospitalized and they had made more suicide attempts in their lifetime. Male patients who killed themselves showed a more extensive suicidal behavior at admission than did their matched control subjects. Earlier suicide attempts during inpatient treatment were only identified among the patients who committed suicide. An imminent mandatory discharge preceded the inpatient suicides in five of 11 cases.

  • 50.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [Legislation concerning mentally disabled criminal offenders: the question of responsibility must be separated from the question of penalty]2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, no 24, p. 2995-6Article in journal (Refereed)
12 1 - 50 of 94
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf