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  • 1.
    Araya, Mesfin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Komproe, Ivan H
    de Jong, Joop TVM
    Effect of trauma on quality of life as mediated by mental distress and moderated by coping and social support among postconflict displaced Ethiopians2007In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 16, no 6, p. 915-927Article in journal (Refereed)
  • 2.
    Araya, Mesfin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Komproe, Ivan H
    de Jong, Joop TVM
    Gender differences in traumatic life events, coping strategies, perceived social support and socio-demographics among postconflict displaced persons in Ethiopia2007In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 42, no 4, p. 307-315Article in journal (Refereed)
  • 3.
    Araya, Mesfin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Komproe, Ivan H
    de Jong, Joop TVM
    Quality of life after postconflict displacement in Ethiopia: comparing placement in a community setting with that in shelters2011In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 46, no 7, p. 585-593Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The resilience of post-war displaced persons is not only influenced partly by the nature of premigration trauma, but also by postmigration psychosocial circumstances and living conditions. A lengthy civil war leading to Eritrea separating from Ethiopia and becoming an independent state in 1991 resulted in many displaced persons.

    METHOD: A random sample of 749 displaced women living in the shelters in the Ethiopian capital Addis Ababa was compared with a random sample of 110 displaced women living in the community setting of Debre Zeit, 50 km away from Addis Ababa, regarding their quality of life, mental distress, sociodemographics, living conditions, perceived social support, and coping strategies, 6 years after displacement.

    RESULTS: Subjects from Debre Zeit reported significantly higher quality of life and better living conditions. However, mental distress did not differ significantly between the groups. Also, Debre Zeit subjects contained a higher proportion born in Ethiopia, a higher proportion married, reported higher traumatic life events, employed more task-oriented coping, and perceived higher social support. Factors that accounted for the difference in quality of life between the shelters and Debre Zeit groups in three of the four quality of life domains of WHOQOL-BREF (physical health, psychological, environment), included protection from insects/rodents and other living conditions. However, to account for the difference in the fourth domain (social relationships), psychosocial factors also contributed significantly.

    CONCLUSION: Placement and rehabilitation in a community setting seems better than in the shelters. If this possibility is not available, measures to improve specific living conditions in the shelters are likely to lead to a considerable increase in quality of life.

  • 4.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [Advances in the analysis of genetic linkage with family data].1988In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 85, no 24, p. 2175-6Article in journal (Refereed)
  • 5.
    Chotai, Jayanti
    Umeå University, Faculty of Science and Technology, Mathematical statistics.
    Likelihood ratio procedures for subset selection and ranking problems1979Report (Other academic)
    Abstract [en]

    This report deals with procedures for random-size subset selection fromk(> 2) given populations where the distribution of ir^(i = l, ..., k)has a density f^(x;0^). Let ••• -®[k] denote unknown values ofthe parameters, and let ^[i]» ***'ïï[k] denote the corresponding populations.First, we have considered the problem of selection for consider the/sprocedure that selects TT. if sup L(0;x) > c L(0;x), where L(*;x) is the1 e e u . - - - - -itotal likelihood function, where is the region m the parameter space foriA9= (0^, ..., 0^) having 0^ as the largest component, where 9 is the maximum likelihood estimate of 0 , and where c is a given constant with 0 < c < l .With the densities satisfying seme reasonable requirements given in this report,we have shown that for each i, the probability of includingthe selected subset is decreasing in ®[j] f°r j t i anc* increasing inWe have then derived some results on selection for the t(> 1) best populations,thereby generalizing the results for t = 1. For this problem, we haveconsidered a) selection of a set whose elements consist of subsets of thegiven populations having t members, and requiring that the set of the t• » • • •best populations is included with probability at least P , b) selection ofa subset of the populations so as to include all the t best populationswith probability at least P'*, and c) selection of a subset of the populationssuch that TT[j ^ is included with probability at least P*, j=k-t+l,.•., k. In the final section, we have discussed the relation between thetheories of subset selection based on likelihood ratios and statistical inferenceunder order restrictions, and have considered the complete rankingproblem.

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    Likelihood ratio procedures for subset selection and ranking problems
  • 6.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Month of birth in relation to suicide.2008In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 192, no 4, p. 313-Article in journal (Refereed)
  • 7.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Novelty seekers and summer-borns are likely to be low in morningness2005In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 20, no 3, p. 307-307Article in journal (Other academic)
  • 8.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    On the lod score method in linkage analysis.1984In: Annals of Human Genetics, ISSN 0003-4800, E-ISSN 1469-1809, Vol. 48, no Pt 4, p. 359-78Article in journal (Refereed)
    Abstract [en]

    Genetic epidemiology deals with the interaction of environmental and genetic determinants in common diseases. Linkage analysis is an important branch of this field. The current practice of claiming linkage between two genetic loci when the maximum lod score z(theta) exceeds 3 has not received theoretical justification, whether considered as a sequential or as a fixed sample size test. Within the framework of significance testing, Wald's (1947) formulae are not applicable to allow this procedure a sequential interpretation. Considered as a fixed sample size test, we find that a chi 2 approximation would instead be very adequate. Since repeated significance testing is performed on linkage data, the nominal significance level should be more stringent for each test than the overall level. Some recent developments in group sequential trials by Pocock (1977) and in repeated significance testing by Woodroofe (1979) seem to indicate that the critical value of the maximum lod score should lie roughly between 0.9 and 3.3, depending on the maximum number of repetitions anticipated, on whether the significance level is desired to be 0.05, 0.01 or 0.001, and on whether the test is derived from a one-sided or a two-sided consideration. In terms of the group sequential approach, if a maximum of twenty repetitions is allowed, if z(theta) greater than log10 A is considered as a one-sided test and assumed to be symmetric when linkage is absent, then the type I error is approximately given by 1/A. We also treat the confidence interval approach for exclusion of unlikely recombination values.

  • 9.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Season of birth in suicidology: neurobiological and epidemiological studies1999Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Several neuropsychiatrie disorders have shown season of birth associations. Low cerebrospinal fluid (CSF) levels of the serotonin metabolite 5-HIAA and the dopamine metabolite HVA have been associated with suicidal behaviour, impulsivity, and aggression. This thesis investigated associations between the season of birth, the CSF levels of three monoamine metabolites (including MHPG of norepinephrine), the scales of the diagnostic interview for borderline patients (DIB), and psychiatric diagnoses. Also, the methods of suicide were investigated in relation to the season of birth.

    Methods: We studied a clinical sample of 241 patients in Stockholm with mood, anxiety and adjustment disorders with respect to the CSF levels of monoamine metabolites in relation to the season of birth, and in relation to the DIB in an overlapping sample. We also analysed all completed suicides during the 42 years 1952- 1993inVästerbottenin northern Sweden (1466 cases) by multiple logistic regressions to relate suicide methods with season of birth, gender, age, urban-rural residence, marital status, year of suicide, and season of suicide. For the 20 years 1961- 1980 (693cases), psychiatric in-patient and out-patient records were also examined for any history of psychiatric contacts and psychiatric diagnoses. In two mutually independent samples, we investigated the DIB in relation to the season of birth.

    Results: In the Stockholm sample, those born during February to April had significantly lower CSF levels of 5-HIAA, and those born during October to January had significantly higher CSF levels of HVA, HVA/5-HIAA, and HVA/MHPG, as well as (non-significantly) higher levels of 5-HIAA. Those with an intermediate score of section II (impulse action patterns) of the DIB had significantly higher CSF levels of 5-HIAA and HVA, and they were significantly more likely to have been born during October to January. In the Västerbotten register, those born during February to April were significantly more likely to have preferred hanging rather than poisoning or petrol gases, and conversely for those born during October to January. These associations with suicide methods were found for the total sample and for those without any history of psychiatric contacts, but not for those with psychiatric contacts.

    Conclusions: Suicidal behaviour shows statistically significant variation according to the season of birth, most probably mediated by a variation in an independent trait of vulnerability to suicide based on neurodevelopmental parameters, particularly the serotonergic system. The suicidal process differs between those who seek psychiatric care compared to those who do not, reflecting differences in the diagnostic spectra and in the extent of mental illness.

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    Season of birth in suicidology
  • 10.
    Chotai, Jayanti
    Umeå University, Faculty of Science and Technology, Mathematical statistics.
    Selection and ranking procedures based on likelihood ratios1979Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis deals with random-size subset selection and ranking procedures• • • )|(derived through likelihood ratios, mainly in terms of the P -approach.Let IT , . .. , IT, be k(> 2) populations such that IR.(i = l, . . . , k) hasJ_ K. — 12the normal distribution with unknwon mean 0. and variance a.a , where a.i i i2 . . is known and a may be unknown; and that a random sample of size n^ istaken from . To begin with, we give procedure (with tables) whichselects IT. if sup L(0;x) >c SUD L(0;X), where SÎ is the parameter space1for 0 = (0-^, 0^) ; where (with c: ß) is the set of all 0 with0. = max 0.; where L(*;x) is the likelihood function based on the total1sample; and where c is the largest constant that makes the rule satisfy theP*-condition. Then, we consider other likelihood ratios, with intuitivelyreasonable subspaces of ß, and derive several new rules. Comparisons amongsome of these rules and rule R of Gupta (1956, 1965) are made using differentcriteria; numerical for k=3, and a Monte-Carlo study for k=10.For the case when the populations have the uniform (0,0^) distributions,and we have unequal sample sizes, we consider selection for the populationwith min 0.. Comparisons with Barr and Rizvi (1966) are made. Generalizai<j<k Jtions are given.Rule R^ is generalized to densities satisfying some reasonable assumptions(mainly unimodality of the likelihood, and monotonicity of the likelihoodratio). An exponential class is considered, and the results are exemplifiedby the gamma density and the Laplace density. Extensions and generalizationsto cover the selection of the t best populations (using various requirements)are given. Finally, a discussion oil the complete ranking problem,and on the relation between subset selection based on likelihood ratios andstatistical inference under order restrictions, is given.

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    Selection and ranking procedures based on likelihood ratios
  • 11.
    Chotai, Jayanti
    Umeå University, Faculty of Science and Technology, Mathematical statistics.
    Subset selection based on likelihood from uniform and related populations1979Report (Other academic)
    Abstract [en]

    Let π1,  π2, ... π be k (>_2) populations. Let  πi (i = 1, 2, ..., k) be characterized by the uniform distributionon (ai, bi), where exactly one of ai and bi is unknown. With unequal sample sizes, suppose that we wish to select arandom-size subset of the populations containing the one withthe smallest value of 0i = bi - ai. Rule Ri selects πi iff a likelihood-based k-dimensional confidence region for the unknown (01,..., 0k) contains at least one point having 0i as its smallest component. A second rule, R, is derived through a likelihood ratio and is equivalent to that of Barr and Rizvi (1966) when the sample sizes are equal. Numerical comparisons are made. The results apply to the larger class of densities g(z; 0i) = M(z)Q(0i) iff a(0i) < z < b(0i). Extensions to the cases when both ai and bi are unknown and when 0max is of interest are i i indicated.

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    Subset selection based on likelihood from uniform and related populations
  • 12.
    Chotai, Jayanti
    Umeå University, Faculty of Science and Technology, Mathematical statistics.
    Subset selection based on likelihood ratios: the normal means case1979Report (Other academic)
    Abstract [en]

    Let π1, ..., πk be k(>_2) populations such that πi, i = 1, 2, ..., k, is characterized by the normal distribution with unknown mean and ui variance aio2 , where ai is known and o2 may be unknown. Suppose that on the basis of independent samples of size ni from π (i=1,2,...,k), we are interested in selecting a random-size subset of the given populations which hopefully contains the population with the largest mean.Based on likelihood ratios, several new procedures for this problem are derived in this report. Some of these procedures are compared with the classical procedure of Gupta (1956,1965) and are shown to be better in certain respects.

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    Subset selection based on likelihood ratios: the normal means cas
  • 13.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Suicide aggregation in relation to socio-demographic variables and the suicide method in a general population: assortative susceptibility.2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 5, p. 325-30Article in journal (Refereed)
    Abstract [en]

    One area of research in suicidology aims at understanding the processes underlying aggregation or clustering of suicide cases within a limited period of time or space (suicide epidemics). Susceptibility to, or propagation of, suicidal behavior due to given risk factors may be operating through media other than space, and its susceptibility for the receiver may be different within different types of strata that are determined by socio-demographic, personality-related or biological-susceptibility differences. We use the term "assortative susceptibility" for this phenomenon. Aggregated cases, comprising calendar months with an unusually large number of suicides after adjusting for seasonal and yearly variations, were defined in the register of all 1093 completed suicides during 1969-93 in the county of Västerbotten in northern Sweden. Binary multiple logistic regressions were performed to compare the aggregated cases with the remaining cases. Compared with the remaining cases, the aggregated cases included significantly more of males and of those living in the rural forested regions. Also, suicide by firearms was significantly more aggregated than the other methods. Our results suggest that middle-aged or older men from the rural areas, who have access to firearms, are likely to belong to the socio-demographic stratum that is susceptible to the processes that give rise to aggregations or clusters of suicides in this county (assortative susceptibility).

  • 14.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Converging evidence suggests that monoamine neurotransmitter turnover in human adults is associated with their season of birth.2002In: European Archives of Psychiatry and Clinical Neuroscience, ISSN 0940-1334, E-ISSN 1433-8491, Vol. 252, no 3, p. 130-4Article in journal (Refereed)
    Abstract [en]

    Separate studies on adults, including those in suicidology and another regarding personality in the general population, have indicated associations with their season of birth. We analyse each of these studies by multiple nonlinear regression employing a cosine function for the month of birth, and compare these studies regarding the birth months giving the maxima and minima. The method of suicide in suicide studies shows a significant month-of-birth variation similar to that for the serotonin metabolite 5-HIAA in the separate study on cerebrospinal fluid, with a peak around the birth month September and a nadir around birth in March. When comparing the personality study with the study on cerebrospinal fluid, the trait novelty seeking varies similar to that for the dopamine metabolite HVA or the norepinephrine metabolite MHPG, and the trait reward dependence varies similar to that for HVA. The trait self-transcendence varies similar to the ratio of the dopamine and serotonin metabolites. Dopamine turnover in adults thus shows a peak around the birth months November-December, and a nadir around the birth months May-June, suggesting a possible involvement of the length of photoperiod during their perinatal period. These results provide strong evidence for the influence of season of birth on adult monoamine neurotransmitter turnover, and give further support for the monoaminergic modulation of the temperament and character traits.

  • 15.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asberg, M
    Variations in CSF monoamine metabolites according to the season of birth.1999In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 39, no 2, p. 57-62Article in journal (Refereed)
    Abstract [en]

    The cerebrospinal fluid (CSF) concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) as well as their ratios and correlations were analyzed in relation to the season of birth. The sample consisted of 241 drug-free patients participating in psychobiological programs and comprising the DSM-III-R diagnoses of mood, anxiety and adjustment disorders. Significant season-of-birth variations were found even after adjusting for sex, age, height, the diagnostic category and the month of lumbar puncture. Those born during February to April had significantly lower values of 5-HIAA. Values of HVA and of the ratios HVA/5-HIAA and HVA/MHPG were significantly higher for those born during October to January. Correlation coefficients also showed season-of-birth variations. These results may provide an important link for the season-of-birth variations reported for several neuropsychiatric disorders.

  • 16.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Eisemann, Martin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Perception of spouse in relation to perception of self by semantic differentials in depressed patients and their spouses.1994In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 90, no 2, p. 114-9Article in journal (Refereed)
    Abstract [en]

    Several studies have shown correlations between personality types and affective disorders. To investigate the influence on personality assessment of the reporting individual's own schemata according to the cognitive theory of depression, we used an instrument of 29 items of semantic differentials. We obtained responses from 45 patients (18 men, 27 women) upon their recovery and from their spouses. Each of these 90 individuals indicated self-perception on one copy and his or her perception of spouse on another. Factor analysis yielded four factors. Self-perception and perception by spouse were significantly positively correlated for all these factors for the patients and their spouses, indicating lack of schemata influence. Anxiety scores were higher for patients and for women. There was negative correlation for extroversion within couples. Male (but not female) patients showed a negative correlation with their spouses for anxiety.

  • 17.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Engström, C
    Ekholm, Birgit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    son Berg, M L
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nylander, P O
    Anticipation in Swedish families with schizophrenia.1995In: Psychiatric Genetics, ISSN 0955-8829, E-ISSN 1473-5873, Vol. 5, no 4, p. 181-6Article in journal (Refereed)
    Abstract [en]

    Nineteen parent-offspring pairs obtained from 14 two-generation families with available medical records and diagnosis of schizophrenia were studied to compare the ages of onset of the parent generation with those of the offspring generation. The mean age of onset for the parent generation was 37.3 +/- 6.0 years and for the offspring generation was 20.8 +/- 4.4. The mean difference was thus 16.5 +/- 6.2, suggesting the occurrence of anticipation in schizophrenia (p < 0.001). Although some ascertainment biases (like reduced fertility in early-onset parents or early detection of symptoms in offsprings of affected parents) may partially contribute to the occurrence of anticipation, this study replicates recent reports of anticipation in several neuropsychiatric disorders, some of which have been shown to be associated with unstable expansions of trinucleotide repeats in the genomic DNA.

  • 18.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Forsgren, Tomas
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, L G
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Season of birth variations in the temperament and character inventory of personality in a general population.2001In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 44, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since several studies show season of birth variations in morbidity, suicidal behavior and CSF (cerebrospinal fluid) monoamine metabolites, we investigated season of birth variations in personality in the population. METHODS: We analyzed by multiple logistic regressions the Temperament and Character Inventory (TCI) for 2,130 individuals taking part in the Betula prospective random cohort study of Umeå, Sweden. RESULTS: The personality dimensions were correlated significantly with age and gender. We stratified the data according to age, gender and the season of TCI measurement. By the median split in each stratum, a high-value group and a low-value group were obtained for each of the personality dimensions. Those born during February to April were significantly more likely than those born during October to January to have high NS (novelty seeking) among women, particularly the subscale NS2 (impulsiveness vs. reflection), and to have high PS (persistence) among men. Temperament profiles also showed season of birth variations. CONCLUSIONS: We discuss the associations in the literature between personality and the monoamines serotonin and dopamine, and suggest that our results are compatible with a hypothesis of season of birth variation in the monoamine turnover. The personality traits are likely to be influenced by several genetic and environmental factors, one of them being the season of birth.

  • 19.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jonasson, Mattias
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolescent attachment styles and their relation to the temperament and character traits of personality in a general population.2005In: Eur Psychiatry, ISSN 0924-9338, Vol. 20, no 3, p. 251-9Article in journal (Refereed)
  • 20.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jonasson, Mattias
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The Temperament Scale of Novelty Seeking in adolescents shows an association with season of birth opposite to that in adults.2002In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 111, no 1, p. 45-54Article in journal (Refereed)
    Abstract [en]

    We investigated the relationship between season of birth and the Junior Temperament and Character Inventory of Personality (Junior TCI, JTCI) in adolescents. The Temperament Scale of Novelty Seeking (NS) is significantly higher for females born during October-January as compared to females born otherwise. This association is opposite to that obtained earlier for adults. For both genders pooled, NS is significantly higher for those born during October-March compared to April-September. This association is also found when examining the data for those of age up to 18 years in a third independent study on the age range 11-81 years with the adult TCI. There is a greater tendency for exploration and risk-taking behavior as the child individuates from the family. Our study suggests that the effects of such environmental and developmental changes on personality are different in those born during October-March as compared to those born during April-September. The former show a higher rise in NS during adolescence and a steeper fall in NS during the years of adulthood, compared to the latter. Dopamine turnover is likely associated with NS, and the mutually inhibitory systems of dopamine and melatonin are the paracrine signals of day and night, respectively. Thus, the maternal entrainment of these systems during the prenatal period, or the postnatal environmental influence on these systems, may be different for those born during the short photoperiod of October-March as compared to those born during the long photoperiod part of the year.

  • 21.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Joukamaa, Matti
    Tampere School of Public Health, University of Tampere, Finland.
    Taanila, Anja
    Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland.
    Lichtermann, Dirk
    Methadone Maintenance Clinic "Cafe Ersatz", Bonn, Germany.
    Miettunen, Jouko
    Department of Psychiatry, Oulu University Hospital, Oulu, Finland.
    Novelty seeking among adult women is lower for the winter borns compared to the summer borns: replication in a large Finnish birth cohort2009In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 50, no 6, p. 562-566Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Earlier general population studies have shown that novelty seeking (NS) of the Temperament and Character Inventory (TCI) of personality is lower for persons born in winter compared to those born in summer, particularly for women. Here, we investigate if this result can be replicated in another population. METHOD: The Northern Finland 1966 Birth Cohort, comprising 4968 subjects (2725 women, 2243 men), was investigated with regard to the temperament dimensions of the TCI and the season of birth. RESULTS: Novelty seeking and reward dependence (RD) showed significant variations according to the month of birth. We found that women born during winter have significantly lower levels of NS compared to women born during summer, with a minimum for the birth month November and maximum for May. These results are similar to those found in a previous Swedish study. Furthermore, our study showed that men born during spring had significantly lower mean scores of RD compared to men born during autumn, with a minimum for birth month March. This was in contrast to the Swedish study, where the minimum of RD was obtained for the birth month December. CONCLUSION: Women born in winter have lower NS as adults compared to women born in summer. Because NS is modulated by dopamine, this study gives further support to the studies in the literature that show that dopamine turnover for those born in winter is higher than for those born in summer.

  • 22.
    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.

  • 23.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Murphy, Dennis L
    Constantino, John N
    Cerebrospinal fluid monoamine metabolite levels in human newborn infants born in winter differ from those born in summer.2006In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 145, no 2-3, p. 189-97Article in journal (Refereed)
    Abstract [en]

    An earlier study has shown significant differences in the CSF monoamine metabolite levels in adults born during different seasons of the year. We study here the relationship between season of birth and CSF monoamine metabolite levels in 283 newborn febrile infants without neurological abnormalities, with an age distribution ranging from birth to about 3 months, adjusting for the confounding variables age and time at lumbar puncture, weight at birth, estimated gestational age at birth, gender, race, and medicaid status. Each of the three metabolite levels as well as their ratios HVA/5-HIAA and 5-HIAA/MHPG showed significant month-of-birth variations, but not the ratio HVA/MHPG. For HVA and MHPG levels, the maximum was obtained around the winter birth months November-December, whereas for 5-HIAA level, the maximum was obtained around the summer birth months June-July. The correlations between HVA and 5-HIAA were, in general, significantly positive within the different birth seasons and races. Among summer-born Caucasian infants, MHPG was significantly positively correlated with HVA and with 5-HIAA, whereas among winter-born Black infants, MHPG was significantly positively correlated with HVA. Season of birth is an unspecific environmental factor that may be proxy for several possible seasonally varying environmental circumstances such as the length of photoperiod, temperature, infections, nutrition, stress and lifestyle. Studies relating season of birth to monoaminergic turnover at different stages of life may yield important clues about the gestational and perinatal origins of neurodevelopment.

  • 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.
    Season of birth variations in suicide methods in relation to any history of psychiatric contacts support an independent suicidality trait.2002In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 69, no 1-3, p. 69-81Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Due to reports on season of birth variations in suicidal behaviour as well as in cerebrospinal fluid levels of monoamine metabolites, we investigated season of birth variations in suicide methods for completed suicides in relation to any history of psychiatric contacts. Relationships with the psychiatric diagnoses for those with psychiatric contacts were also studied. METHODS: Sociodemographic variables and suicide methods were examined for all the 693 suicide victims during 1961-1980 in Västerbotten, Sweden. Information on any history of psychiatric contacts was obtained from psychiatric in-patient and out-patient records. RESULTS: Gender differences in the choice of suicide method were found in the group without any history of psychiatric contacts, but not in those with such a history. Only those without a history of psychiatric contacts showed season of birth variations for suicide methods -- those born during February to April were significantly more likely, and those born during October to January significantly less likely, to have preferred hanging rather than poisoning or petrol gases. These associations were stronger for the determined suicides, for males, and for urban residence. Suicide victims with a history of psychiatric contacts were significantly younger than those without. LIMITATIONS: No psychological autopsies for those without psychiatric contacts. No information on eventual contacts with general practitioners. No measures of monoamine neurotransmitters were available. CONCLUSIONS: Season of birth association for suicide methods is likely to be mediated by a suicidality trait independently of specific major psychiatric disorders. Monoamine neurotransmitters, particularly serotonin, are likely to underlie such a trait.

  • 25.
    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.

  • 26.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Serretti, Alessandro
    Lattuada, Enrico
    Lorenzi, Cristina
    Lilli, Roberta
    Gene-environment interaction in psychiatric disorders as indicated by season of birth variations in tryptophan hydroxylase (TPH), serotonin transporter (5-HTTLPR) and dopamine receptor (DRD4) gene polymorphisms.2003In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 119, no 1-2, p. 99-111Article in journal (Refereed)
    Abstract [en]

    Genetic and environmental factors, as well as their interactions, are likely to be involved in psychiatric disorders. Considerable progress has been made in association and linkage studies with various candidate genes, at times with conflicting or ambiguous results. An environmental factor that has persistently shown associations with several psychiatric and neurological disorders is the season of birth. If it is the interaction of a specific gene allele with a specific season of birth that constitutes an increased (or decreased) risk for a disorder, then the individuals with this disorder are likely to have a season of birth variation in this gene allele. We investigated the variations in TPH, 5-HTTLPR and DRD4 gene polymorphisms according to seasonality of birth in 954 patients with unipolar affective disorder, bipolar affective disorder, and schizophrenia, respectively, and in 395 controls. We first analyzed season of birth variations in the gene alleles with one cycle or two cycles per year, and then compared specified birth seasons with each other. We found season of birth variations in these gene alleles that were different for different psychiatric disorders. Significant differences between cases and controls could be obtained when restricting the analysis within certain birth seasons but not within others. Our results thus suggest an interaction between the seasons of birth and the expression of the candidate genes, and that season of birth is a confounding variable when investigating the role of the candidate genes in susceptibility to psychiatric disorders.

  • 27.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Serretti, Alessandro
    Lorenzi, Cristina
    Interaction between the tryptophan hydroxylase gene and the serotonin transporter gene in schizophrenia but not in bipolar or unipolar affective disorders.2005In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 51, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Increasing focus is being given to identify possible combinations of genes related to specific clinical phenotypes. In our sample of 814 patients comprising 114 with schizophrenia, 416 with bipolar affective disorder and 284 with unipolar affective disorder, we studied interactions between the tryptophan hydroxylase (TPH), the serotonin transporter (5-HTTLPR), and the dopamine receptor (DRD4) genes in relation to five major psychiatric symptomatology scores. There was significant interaction between the TPH and the 5-HTTLPR genes. With an increasing number of short (s) alleles of 5-HTTLPR, the scores for delusions, disorganization and negative symptoms were significantly decreasing among subjects having the TPH genotype AA but increasing among subjects having the TPH genotype AC, yielding the highest scores for the combinations AA x ll and AC x ss. Since high scores on just delusions, disorganization and negative symptoms but low scores on excitement and depression were found among subjects with schizophrenia, we conducted comparisons among the three diagnostic categories and controls as regards the combined TPH x 5-HTTLPR genotype distribution. Schizophrenia subjects had a significantly different distribution of the genotype combination for TPH x 5-HTTLPR as compared to 241 controls or to unipolar or bipolar subjects, and had significantly higher frequencies of AA x ll and of AC x ss. Thus, an interaction between TPH and 5-HTTLPR genes constitutes susceptibility to schizophrenia, thereby yielding apparent relationships between the major psychiatric symptomatology scores and genotype combinations in samples that are obtained by pooling schizophrenia with other diagnostic categories.

  • 28.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Smedh, Kristina
    Johansson, Carolina
    Nilsson, Lars-Göran
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    An epidemiological study on gender differences in self-reported seasonal changes in mood and behaviour in a general population of northern Sweden.2004In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 58, no 6, p. 429-37Article in journal (Refereed)
    Abstract [en]

    Gender differences have been reported regarding symptoms, prevalence and heritability of seasonal affective disorders (SAD). We focus on gender aspects in this study of self-reported seasonal changes in mood and behaviour in a general population. The Seasonal Pattern Assessment Questionnaire (SPAQ) was completed by 2620 adults (55.6% women) aged 35-85 years, enrolled in the Betula prospective random cohort study of Umeå, Sweden. October to February turned out to be suitable winter months. SAD was found in 2.2% and sub-syndromal SAD (S-SAD) in 5.7%. Women had about 1.5 times higher prevalences than men, and seasonality problems decreased with age in both genders. Preference for eating least was distributed with a peak in summer, whereas preference for eating most had a major peak in winter (winter eaters) and a minor peak in summer (summer eaters). Significantly more of winter eaters in women, and significantly more of summer eaters in men, felt worst in winter. Seasonal change in weight was considered significantly as a problem by women but not by men. Winter behaviour of sleeping most was considered significantly as a problem by men but not by women. Women reacted significantly to temperature-related changes (negatively to cold/short days and positively to hot/long days), whereas men reacted significantly to sunshine-related changes (negatively to cloudy days and positively to sunny days). Subtle gender differences may thus underlie the pathophysiology of seasonal problems. Studies of an eventual efficacy of treating SAD women with raised ambient temperature, and gender-specific comparisons with other therapies, would be of interest.

  • 29.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Smedh, Kristina
    Nilsson, Lars-Göran
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    A dual vulnerability hypothesis for seasonal depression is supported by the seasonal pattern assessment questionnaire in relation to the temperament and character inventory of personality in a general population.2004In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 82, no 1, p. 61-70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Personality structure obtained from the psychobiological Temperament and Character Inventory (TCI) was studied in relation to self-reported seasonal variations in mood and behavior measured by the Seasonal Pattern Assessment Questionnaire (SPAQ). METHODS: The subjects comprised 1761 adults (57.6% women) in the age range 35-85 years, enrolled in the Betula prospective random cohort study of Umea, Sweden. RESULTS: Personality profiles of subjects who reported the occurrence of a high degree of seasonal variation as such were associated with a combination of high self-transcendence (ST) and high persistence (PS), irrespective of the level of harm avoidance (HA). Subjects who reported feeling worst in winter were associated with high HA, irrespective of the levels of ST and PS. Also, subjects feeling worst in summer or experiencing overall problems with seasonal variation were associated with high HA in their personality profiles. Using the SPAQ criteria to define seasonal affective disorder (SAD) or subsyndromal SAD (S-SAD), subjects with these disorders often had combinations of high self-transcendence (ST) and high persistence (PS), but with different associations with HA. LIMITATIONS: No evaluations were made for SAD or subsyndromal SAD according to the DSM-IV or ICD 10 criteria. CONCLUSIONS: Our results relating SPAQ with TCI give support for a dual vulnerability hypothesis for seasonal depression proposed in the literature, where it is attributed to a combination of a seasonal factor and a depression factor. Examining the literature regarding the relationships between the different TCI scales and monoamine neurotransmitter functions, those relationships suggest that these two vulnerability factors for seasonal depression may be modulated by different neurotransmitter systems.

  • 30. Dahl, N
    et al.
    Goonewardena, P
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Anvret, M
    Pettersson, U
    DNA linkage analysis of X-linked retinoschisis.1988In: Human Genetics, ISSN 0340-6717, E-ISSN 1432-1203, Vol. 78, no 3, p. 228-32Article in journal (Refereed)
    Abstract [en]

    Four families with juvenile retionoschisis (RS) have been studied by linkage analysis utilizing eleven polymorphic X-chromosomal markers. The results suggest a close linkage between DXS43, DXS41, and DXS208 and the RS locus at Xp22. The RS locus is distal to the OTC locus, DXS84, and the DMD locus but proximal to DXS85. No recombination events were observed between the RS locus and DXS43 and DXS41. The maximum likelihood estimate of the recombination fraction (theta) was thus zero and the peak lod scores (z) were 4.98 (DXS43) and 4.09 (DXS41). The linkage data suggest that the gene order on Xp is DXS85-(DXS43, RS, DXS41)-DMD-DXS84-OTC.

  • 31. Engström, C
    et al.
    Thornlund, A S
    Johansson, E L
    Långström, M
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nylander, P O
    Anticipation in unipolar affective disorder.1995In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 35, no 1-2, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Anticipation describes an inheritance pattern within a pedigree with an increase in disease severity and/or decrease in age at onset in successive generations. The phenomenon of anticipation has recently been shown to be correlated with the expansion of trinucleotide repeat sequences in a neuromuscular disease, various neurodegenerative disorders and mental retardation. We have studied parent-offspring differences in age at onset and disease severity in 31 pairs with unilineal inheritance of unipolar affective disorder (UPAD). Life-table analyses showed a significant decrease in survival to 1st episode of major depression in the offspring generation compared with the parental generation (P = 0.0007). There was also a significant difference in age at onset (P < 0.001) between parents and offsprings. The offspring generation experienced onset 15.6 years earlier and illness 1.5 x more severe than did the parent generation. Furthermore, there was a significant correlation (P < 0.05) in age at onset between parent and offspring generations. When we excluded pairs where the affected parent has an age of onset greater than the age of the child at the time of ascertainment (i.e., 23 pairs left), there was still a significant (P = 0.02) decrease in age at onset (8.4 years) and 1.5 x more severe disease in the offspring generation. No evidence for specific maternal or paternal inheritance was found. We found evidence of anticipation in 75-80% of this sample of unilineal family pairs of UPAD. Anticipation is, thus, an inheritance pattern in a large group of UPAD which suggests that the expansion of trinucleotide repeat sequences is a possible mode of inheritance in this group of UPAD. The findings of anticipation in this study of families with UPAD and previous findings in families with BPAD suggest that the variable expression of unstable expansions of trinucleotide repeats may turn out to be the basis of the continuum of liability in affective disorders.

  • 32. Goonewardena, P
    et al.
    Gustavson, K H
    Holmgren, G
    Tolun, A
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Johnsen, E
    Pettersson, U
    Analysis of fragile X-mental retardation families using flanking polymorphic DNA probes.1986In: Clinical Genetics, ISSN 0009-9163, E-ISSN 1399-0004, Vol. 30, no 4, p. 249-54Article in journal (Refereed)
    Abstract [en]

    Fragile-X mental retardation (FRAX-MR) is one of the more common X-linked disorders affecting 1 in 1,500 newborn males. This disease is characterized by the expression of fragile site in the region q27.3 of the X-chromosome of affected boys when their lymphocytes are cultured in folate deficient medium. In most patients there is macroorchidism postpubertally. The clinical diagnosis of carrier females based on the expression of fragile site in Xq27.3 is usually difficult and sometimes impossible. About half of the carrier females escape diagnosis by this method. Furthermore, prenatal diagnosis is not always feasible. Using Restriction Fragment Length Polymorphism (RFLP) and cloned DNA segments from the region Xq27-Xqter as probes, we have investigated Swedish families with FRAX-MR in three generations. Interesting observations, previously unreported to our knowledge, have been made in some patients and carrier mothers, using one of the probes which is localized to the distal end of Xq. The significance of these findings and the linkage of the disease locus to the different probes used in this study is presented.

  • 33.
    Hansson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Patient education and group counselling to improve the treatment of depression in primary care: a randomized controlled trial2008In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 105, no 1-3, p. 235-240Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Contactus program for depressed patients in primary care, consists of six lectures about depression, each followed by a group discussion. The aim of this study was to investigate if Contactus can improve treatment outcome in comparison to a control group. METHODS: Forty-six primary care centres in Sweden, each randomly allocated either to the Contactus group or to the control group, included depressed patients, 205 in the Contactus group and 114 in the control group. Besides regular treatment of depression, the Contactus group participated in the educational program. At start and after 6 weeks, patients filled in a questionnaire and the self-reports: HADS (Hospital Anxiety and Depression Scale) and GAF-self (Global Assessment of Functioning). RESULTS: After 6 weeks, clinically depressed patients (HAD-depression score >10) had a mean improvement in HAD-D of 4.6 in Contactus vs. 3.0 in controls (p=0.02), and 72% vs. 47% considered themselves to feel better (p=0.01). Increase in GAF score was 11.8 vs. 5.8 (p=0.04), respectively. According to HADS, 55% in Contactus were responders vs. 29% among controls (p=0.006), and 42% vs. 21% (p=0.02) were in remission. LIMITATIONS: Only 40% of the patients in Contactus and 35% among controls were clinically depressed according to the HADS (>10 points) at inclusion. CONCLUSIONS: Patient education and group counselling contributes significantly to better improvement among depressed patients. Group treatment is inexpensive and could be implemented in the routine care of depressed patients in primary care.

  • 34.
    Hansson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Patients' beliefs about the cause of their depression2010In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 124, no 1-2, p. 54-59Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients' beliefs about the cause of their depression can affect their help-seeking behavior, treatment preferences, coping strategies and treatment compliance. There are few studies exploring depressed patients' beliefs about the causes and to our knowledge none in a Swedish population. However, previous studies show that the patients more often mention environmental and psychological causes than biological. The aim of this study was to further explore depressed patients' answers to an open-ended question about the etiology of their depression. METHODS: Primary care patients, participating in a study evaluating patient education, were asked an open-ended question about their beliefs about what had caused their depression. Answers were obtained from 303 patients. RESULTS: The analysis of the patients' beliefs emerged into 16 different categories of explanations for depression that could be organized into three larger themes: current life stressors, past life events and constitutional factors. Work-related stress was the most commonly mentioned cause, followed by personality and current family situation. Only 3.6% stated biological reasons. LIMITATIONS: We could only count the frequency of mentioned causes, but no ranking of the importance of these causes. CONCLUSIONS: Primary care patients often gave multi-causal explanations to their depression. Biological explanations were rare. Their beliefs were predominantly current life stressors such as work or family situation and also their own personality. Patients' beliefs about their illness are important in the patient-doctor encounter, when developing new treatment strategies aiming at improved adherence to both psychopharmacological and psychotherapeutic treatments and also in patient education programs.

  • 35.
    Hansson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    What made me feel better?: patients' own explanations for the improvement of their depression2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 4, p. 290-296Article in journal (Refereed)
    Abstract [en]

    Background: Depression is common among primary care patients and the usual treatment often consists of antidepressant medication and supportive counselling/follow-ups. Previous studies have shown that patients and professionals have different beliefs about treatment, which in turn can decrease acceptance of the diagnosis, compliance and treatment outcome. Aims: The purpose of this study was to investigate previously depressed patients' beliefs about the cause of their improvement. Methods: Depressed primary care patients (n = 184) who considered themselves improved at follow-up answered an open-ended question about what they believed had made them better. Among these 117 patients had, in addition to treatment as usual, participated in an intervention with patient education and group counselling (the Contactus programme), whereas 67 were controls. The groups were comparable at baseline and 82% were on antidepressants. Results: In total, the patients mentioned 14 separate improving factors, which could be organized to the larger themes external factors, self-management, passing spontaneously and professional help. The most frequently mentioned factors for improvement were the Contactus programme (53.0%), antidepressants (40.2%) and personal development (27.2%). Few gender and age differences were seen. The controls who mentioned professional help were more likely to have a better outcome. Conclusions: The patients were generally positive to professional help such as antidepressants and the Contactus programme. Patient education and group counselling seems to be a valuable supplement to treatment of depressed patients in primary care.

  • 36.
    Hansson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    What made me feel better?: patients’ own explanations for the improvement of their depressionArticle in journal (Refereed)
    Abstract [en]

    Background: Depression is common among primary care patients and among those recognized the usual treatment often consists of antidepressants and supportive counselling/follow-ups. Previous studies have shown that patients and professionals have different beliefs about treatment which in turn can decrease acceptance of the diagnosis, compliance and treatment outcome.

    Methods: Depressed primary care patients (N=184) who considered themselves improved at follow-up answered an open-ended question about what they believed had made them better. Among these 117 patients had, in addition to treatment as usual, participated in an intervention with patient education and group counselling (the Contactus program) while 67 were controls. The groups were comparable at baseline and 82 % were on antidepressants.

    Results: In total, the patients mentioned 14 separate improving factors which could be organized to the larger themes external factors, self-management, passing spontaneously and professional help. The most frequently mentioned factors for improvement were the Contactus program (53.0 %), antidepressants (40.2 %) and personal development (27.2 %). Few gender and age differences were seen. The controls who mentioned professional help were more likely to have a better outcome.

    Limitations: The construct of the open-ended question did not allow us to analyze the rank order of importance of each improving factor.

    Conclusions: The patients were generally positive to professional help such as antidepressants and the Contactus program. Patient education and group counselling seems to be a valuable supplement to treatment of depressed patients in primary care.

  • 37.
    Hansson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nordström, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Comparison of two self-rating scales to detect depression: HADS and PHQ-92009In: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 59, no 566, p. e283-288Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: More than half of patients with depression go undetected. Self-rating scales can be useful in screening for depression, and measuring severity and treatment outcome. AIM: This study compares the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) with regard to their psychometric properties, and investigates their agreement at different cut-off scores. METHOD: Swedish primary care patients and psychiatric outpatients (n = 737) who reported symptoms of depression completed the self-rating scales. Data were collected from 2006 to 2007. Analyses with respect to internal consistency, factor analysis, and agreement (Cohen's kappa) at recommended cut-offs were performed. RESULTS: Both scales had high internal consistency (alpha = 0.9) and stable factor structures. Using severity cut-offs, the PHQ-9 (> or =5) diagnosed about 30% more patients than the HADS depression subscale (HADS-D; > or =8). They recognised the same prevalence of mild and moderate depression, but differed in relation to severe depression. When comparing recommended screening cut-offs, HADS-D > or =11 (33.5% of participants) and PHQ-9 > or =10 (65.9%) agreement was low (kappa = 0.35). Using the lower recommended cut-off in the HADS-D (> or =8), agreement with PHQ-9 > or =10 was moderate (kappa = 0.52). The highest agreement (kappa = 0.56) was found comparing HADS-D > or =8 with PHQ-9 > or =12. This also equalised the prevalence of depression found by the scales. CONCLUSION: The HADS and PHQ-9 are both quick and reliable. The HADS has the advantage of evaluating both depression and anxiety, and the PHQ-9 of being strictly based upon the Diagnostic and Statistical Manual of Mental Disorders. The agreement between the scales at the best suitable cut-off is moderate, although the identified prevalence was similar. This indicates that the scales do not fully identify the same cases. This difference needs to be further explored.

  • 38. Lathrop, G M
    et al.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, J
    Lalouel, J M
    Tests of gene order from three-locus linkage data.1987In: Annals of Human Genetics, ISSN 0003-4800, E-ISSN 1469-1809, Vol. 51, no Pt 3, p. 235-49Article in journal (Refereed)
    Abstract [en]

    Exact tests for gene order are derived and compared for three loci using linkage data from phase-known, completely informative marker loci (i.e. parents are heterozygotes with at most one allele identical at each locus), or from triple back-cross matings. A simulation method, based on resampling genotypes of children, is introduced to obtain approximations to the distribution of the test statistics for general mating types in families consisting of children and parents, with or without grandparents, as are used in many studies in human gene mapping. The method is illustrated by an application to linkage data on chromosome 13.

  • 39. Lindblad, K
    et al.
    Nylander, P O
    De bruyn, A
    Sourey, D
    Zander, C
    Engström, C
    Holmgren, G
    Hudson, T
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mendlewicz, J
    Detection of expanded CAG repeats in bipolar affective disorder using the repeat expansion detection (RED) method.1995In: Neurobiology of Disease, ISSN 0969-9961, E-ISSN 1095-953X, Vol. 2, no 1, p. 55-62Article in journal (Refereed)
    Abstract [en]

    Genetic factors are of major aetiological importance in Bipolar Affective Disorder (BPAD type I and II). The exact mode of inheritance of BPAD is unknown, but the recent demonstration of anticipation suggests that dynamic mutations could be involved in the clinical expression of the disease. We have used the repeat expansion detection (RED) method to test whether the anticipation in BPAD could be explained by the presence of expanded trinucleotide repeat sequences. Using a (CTG)10 oligonucleotide a significantly higher number of expanded CAG repeats were found in the genomic DNA of two independent samples of unrelated BPAD patients of Swedish and Belgian ancestry as compared with normal controls. The difference in repeat number was more consistent if data of the two samples of patients was pooled. In this study a CAG trinucleotide repeat expansion was associated for the first time with a major psychiatric disorder. It is possible that the CAG trinucleotide repeat expansion is involved in the clinical expression of BPAD and that it is the molecular basis explaining the phenomenon of anticipation observed in this disorder.

  • 40. Natale, Vicenzo
    et al.
    Adan, Ana
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Further results on the association between morningness-eveningness preference and the season of birth in human adults2002In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 46, no 4, p. 209-214Article in journal (Refereed)
    Abstract [en]

    Morningness-eveningness preference by the self-rated Morningness-Eveningness Questionnaire (MEQ) has earlier been shown to be associated with the subjects' season of birth. Here, we obtain this result for a new sample of 2,125 university students and for the sample obtained by pooling the data with the earlier study, yielding totally 3,709 Italian and Spanish subjects. An nonlinear regression of MEQ as a cosine curve according to the month of birth, adjusting for age and gender, gave a maximum (morningness) around the transition between the birth months December and January, and a minimum (eveningness) around the transition between the birth months June and July. Multiple logistic regressions showed that for females as well as for males, the group born during the half-year April to September containing summer had a significantly lower proportion of morning types as compared with the group born during the half-year October to March containing winter. This was more pronounced for males. Moreover, a significantly higher proportion of morning types among females compared with males was found only in the group born during April to September, but not in the group born during October to March. There was a weak but statistically significant positive correlation between MEQ and age in the sample's limited age range of 17-30 years. We discuss the results in terms of the mutually inhibitory systems of melatonin and dopamine, and find further support for a hypothesis that it is the variation in the length of photoperiod during the gestational or perinatal period that contributes significantly to the season of birth variation found in the morningness-eveningness preference among adults.

  • 41. Natale, Vincenzo
    et al.
    Adan, Ana
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Season of birth modulates mood seasonality in humans2007In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 153, no 2, p. 199-201Article in journal (Refereed)
    Abstract [en]

    We investigate whether mood seasonality is modulated by season of birth. A sample of 1682 university students were administered the Seasonal Pattern Assessment Questionnaire. We found that subjects born during spring or summer months had significantly higher Global Seasonality scores than those born during autumn or winter months.

  • 42. Nylander, P O
    et al.
    Engström, C
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Wahlström, J
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Anticipation in Swedish families with bipolar affective disorder.1994In: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 31, no 9, p. 686-9Article in journal (Refereed)
    Abstract [en]

    Anticipation describes an inheritance pattern within a pedigree with an increase in disease severity or decrease in age at onset or both in successive generations. The phenomenon of anticipation has recently been shown to be correlated with the expansion of trinucleotide repeat sequences in different disorders. We have studied differences of age at onset and disease severity between two generations in 14 families with unilinear inheritance of bipolar affective disorder (BPAD). There was a significant difference in age at onset (p < 0.008), in episodes per year with (p < 0.006) and without (p < 0.03) lithium treatment, and in total episodes per year (p < 0.002) between generations I and II. Furthermore, there was a highly significant correlation (p < 0.001) in age at onset between generations I and II. No evidence for specific paternal or maternal inheritance was found. We found evidence of anticipation and could rule out ascertainment bias or some other artefact. Anticipation is thus an inheritance pattern in BPAD which suggests that the expansion of trinucleotide repeat sequences is a possible mode of inheritance in BPAD.

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