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  • 251. Forsberg, Karl-Anton
    et al.
    Johansson, M
    Åhman, K
    Borgstedt, M
    Karlsson, EC
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hälsa och ett liv i balans för personer med psykisk funktionsnedsättning: en arbetsbok för dig som coachar2012 (ed. 1)Book (Refereed)
  • 252.
    Forsberg, Karl-Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy Nils
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.2011In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 2, p. 357-364Article in journal (Refereed)
    Abstract [en]

    Lifestyle changes that affect physical and psychological health are described in research literature; however, the meaning of participating in a lifestyle intervention programme together with the staff has not been described. This study illuminates meanings of participating in a lifestyle programme as experienced by persons with psychiatric disabilities. The first author interviewed five women and six men with schizophrenia and depressive syndrome, aged 26-53, participating in a lifestyle programme. The transcribed interviews were analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. Meanings of participating in a lifestyle programme include my health can be improved as both the physical effects and the obstacles are considered and the daily life is partially given a changed content in new experiences and by participating in something to take pride in. The meanings of participating together with the staff mean an increased sense of closeness and equality with the staff expressed in changes in relationships and the difference between the two groups being revealed and also in becoming aware of the life situation, an insight into the loss of a healthy life but also hope for the future is expressed. The conclusions that could be drawn from this study are that a lifestyle intervention affects health and other important life areas such as the content of daily life and the relationship with the carers, which appears to affect the sense of hope and the ability to see new possibilities. Carers should find situations and activities where the residents and carers participate under equal conditions giving the residents the opportunity to leave the sick roll, experience equality and develop good relationships.

  • 253. Forsell, Erik
    et al.
    Bendix, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Holländare, Fredrik
    Szymanska von Schultz, Barbara
    Nasiell, Josefine
    Blomdahl-Wetterholm, Margareta
    Eriksson, Caroline
    Kvarned, Sara
    Lindau van der Linden, Johanna
    Söderberg, Elin
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Wide, Katarina
    Kaldo, Viktor
    Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 221, p. 56-64Article in journal (Refereed)
    Abstract [en]

    Major depression occurs in 5-10% of pregnancies and is associated with many negative effects for mother and child, yet treatment options are scarce. To our knowledge, this is the first published randomised controlled trial on Internet delivered Cognitive Behavior Therapy (ICBT) for this group.

    Objective: To test the efficacy of a pregnancy adapted version of an existing 10-week ICBT-program for depression as well as assessing acceptability and adherence.

    Design: Randomised controlled trial.

    Setting: Online and telephone.

    Population or sample: Self-referred pregnant women (gestational week 10-28 at intake) currently suffering from major depressive disorder.

    Methods: 42 pregnant women (gestational week 12-28) with major depression were randomised to either treatment as usual (TAU) provided at their antenatal clinic or to ICBT as an add-on to usual care.

    Main outcome measures: The primary outcome was depressive symptoms measured with the Montgomery-Asberg depression rating scale-self report (MADRS-S). The Edinburgh Postnatal Depression Scale and measures of anxiety and sleep were used. Credibility, satisfaction, adherence and utilization were also assessed.

    Results: The ICBT group had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g = 1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) (RR = 0.36; p = 0.004). Measures of treatment credibility, satisfaction, utilization, and adherence were comparable to implemented ICBT for depression.

    Limitations: Small sample size and no long-term evaluation.

    Conclusion: Pregnancy adapted ICBT for antenatal depression is feasible, acceptable and efficacious. These results need to be replicated in larger trials to validate these promising findings.

  • 254.
    Forsgren, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ghanean, Helia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Richter, Jorg
    On the experience of stigma by persons with epilepsy in Sweden and Iran: a comparative study2013In: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 22, no 9, p. 748-751Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this paper is to compare the experience of stigma by persons with epilepsy in Sweden and Iran.

    METHOD: An adapted version of the Internalized Stigma of Mental Illness Scale was completed by 130 persons with epilepsy in Tehran and 93 patients at a neurology clinic in Sweden.

    RESULTS: The Swedish subjects reported a significantly lower level of experienced stigmatization than the Iranian patients, which we think is an effect of a more individualized medical treatment and a longer experience of health education in the Swedish society.

    CONCLUSION: Improved seizure control, legislative measures and health education are major contributory factors for stigma reduction in a society as regards epilepsy and probably also other medical conditions.

  • 255. Forssén, B.
    et al.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lithium use among psychiatric patientsor: a risk factor for hypernatremia?2018In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 109, p. 103-103Article in journal (Other academic)
    Abstract [en]

    Aims: Hypernatremia is a serious condition that can potentially become life threatening. It is known, but not well-studied, that lithium can induce nephrogenic diabetes insipidus and thereby increase the risk for hypernatremia. In this study, we tested the hypothesis that lithium was a risk factor for hypernatremia in patients with severe affective disorders. Methods: A retrospective study of hypernatremia episodes in all patients aged 18 years or over in the county of Norrbotten who received treatment with lithium or any other mood stabilizing medication during 1997-2013. We identified all episodes of hypernatremia during this period and compared the patients using lithium with those who did not. Results: We identified a total of 204 hypernatremia episodes in 185 patients. For all the 204 episodes, infection (37%) was the dominating cause. Harmful use of substances including alcohol came second. Lithium was only identified as a cause for hypernatremia in 1 % of all the episodes. In patients aged 65 years or less, harmful use of substances including alcohol was the most common cause. Infection was the dominating cause in patients >65 years. There was no significant difference in hypernatremia episodes between lithium users and non-lithium users. Patients who had suffered episodes of hyponatremia or died of these were significantly older. Conclusion: Lithium does not increase the risk of hypernatremia in patients with severe affective disorder compared to patients who do not use lithium. However, in some patients using lithium, severe episodes of hypernatremia can still occur. Thus, clinicians need to remain vigilant. There is a need for more research concerning other risk factors that may contribute to hypernatremia in patients with severe affective disorder.

  • 256.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Defense Mechanism Test (DMT) and Kernberg’s theory of personality organization related to adolescents in psychiatric care1997In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 38, no 2, p. 95-102Article in journal (Refereed)
    Abstract [en]

    75 adolescent psychiatric patients were diagnosed with the perceptual projective test the Defense Mechanism Test (DMT) and also according to Kernberg’s theory of personality organization (PO). The test protocols were scored in respect of 130DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis. The objective was to try to separate the three types of PO, psychotic (PPO), borderline (BPO) and neurotic (NPO) by means of the DMT and also to compare the results with a similar study on adult psychiatric patients. The results showed that it is possible to separate significantly the three groups of PO. The BPO group seemed to be heterogeneous. The results were fairly similar to those obtained with adult psychiatric patients. The overall results supported the concurrent validity of Kernberg’s theory of PO and for the DMT as well. The DMT seems to be a useful diagnostic method in respect of adolescent psychiatric patients.

  • 257.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Defense Mechanism Test (DMT) and Kernberg's theory of personality organization related to adolescents in psychiatric care1994Report (Other academic)
  • 258.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Influence of gender and age in the defense mechanism test among adolescents and adults2008In: Process and personality: actualization of the personal world with process-oriented methods / [ed] Gudmund J. W. Smith and Ingegerd M. Carlsson, Heusenstamm: Ontos , 2008, p. 114-125Chapter in book (Other academic)
  • 259.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    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.
    A comparative study of adolescents in psychiatric care assessed by means of the Defense Mechanism Test and the DSM-IV classification system1998In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 52, no 6, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Twenty-seven adolescents in psychiatric care, assessed by means of DSM-IV, and 33 healthy controls were tested using the projective percept-genetic Defense Mechanism Test (DMT). Three diagnostic subgroups were created: psychotic (Axis 1), borderline personality disorder (Axis 2), and a non-patient group. The test protocols were scored with regard to 130 DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis and by means of a pattern analysis of the DMT variables. The results showed that it was possible to distinguish significantly among the three groups. Specific perceptual distortions were identified among the three groups. It was concluded that DMT is a promising instrument in the assessment of adolescents in psychiatric care.

  • 260.
    Fröjd, Agnes
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Temperaments and course of illness in bipolar disorder2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 261. Gedeon, Charlotte
    et al.
    Sandell, Mikael
    Birkemose, Inge
    Kakko, Johan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Runarsdottir, Valgerdur
    Simojoki, Kaarlo
    Clausen, Thomas
    Nyberg, Fred
    Littlewood, Richard
    Alho, Hannu
    Standards for opioid use disorder care: An assessment of Nordic approaches2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, no 3, p. 286-298Article in journal (Refereed)
    Abstract [en]

    Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard.

    Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country.

    Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community.

    Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.

  • 262.
    Ghanean, Helia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Studies on the perception of mental illness and epilepsy in Tehran, Iran: a study in stigma and discrimination2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Stigma and discrimination because of medical conditions is a global phenomenon. Epilepsy and mental illness belong to the most stigmatizing disorders world-wide. Culture, religion, education, life-style influences the perception of stigma. There are two aspects of stigma of special interest for this thesis; internalized stigma, which is the perception of a person suffering from a condition and the public perception of this disorder. This study investigates both aspects of stigma because of mental illness and epilepsy. Internalized stigma of mental illness and epilepsy are also studied in Umea, Sweden, with the same instrument as in Iran in order to look at the cultural influence.

    Methods

    Paper 1 and 2 on internalized stigma because of mental disorders and epilepsy in Tehran:

    These studies are cross-sectional with 138 persons with mental illness recruited from three different hospitals in Tehran and 130 persons with epilepsy from one neurologic clinic in Tehran and the Iran epilepsy association. Internalized stigma because of mental illness was measured using ISMI (Internalized Stigma of Mental Illness) questionnaire and because of epilepsy with the same instrument adapted for epilepsy (ISEP). ISMI/ISEP contains 29 items measured by a 4-point Likert scale. An open-ended question about the experiences of discrimination was added.

    Paper 3 and 4 on public attitudes towards mental disorders and epilepsy in Tehran:

    These two studies were performed with 800 individuals randomly chosen from households in four districts of Iran (north, south, east and west). In Paper 3 on attitudes and knowledge of mental illness a modified version of a questionnaire developed for the World Association program to reduce discrimination and stigma because of schizophrenia was used. In Paper 4 on awareness of and attitudes towards epilepsy a questionnaire originally developed by Caveness and Gallup in United States as early as 1949 was used and since used in many studies all over the world.

    Paper 5 and 6 comparing internalized stigma because of mental disorders and epilepsy in Tehran and Umea:

    These two studies included patients suffering from mental disorders (N=163) and epilepsy (N=93) recruited from the university hospital in Umea, Sweden. The same questions as used in Paper 1 and 2 were applied.

    Results

    The experience of stigma because of mental disorders was high in the Iranian sample. The Swedish sample generally reported lower levels of experienced stigma than the Iranian except for items covering self-blame and feelings of alienation. As regards epilepsy the Iranian sample reported quite a high level of experienced stigma compared to the Swedish sample. Generally the patients with epilepsy reported lower levels of experienced stigma compared to patients with mental illness in the two settings. Attitudes towards mentally ill persons in Tehran were at the same levels as in western high income countries. The knowledge about and attitudes towards persons with epilepsy was also generally at the same level as found in other European studies expect for a much lower acceptance as regards accepting a person with epilepsy to marry someone in the family.

    Conclusion

    Stigma because of mental illness and epilepsy is a reality even in Iran, which is an Islamic setting in spite of the teachings of the Koran to show mercy with people who suffer from different ailments and rather well developed health services. The levels of experienced stigma is higher in Iran compared to Sweden, but still there is quite a lot of stigma because of mental illness even in Sweden in spite of several national efforts to reduce stigma. The lower levels of stigma because of epilepsy in both settings and especially in Sweden, is suggested to be the consequence of effective treatments available for epilepsy compared to the less successful treatments available for mental illness. The differences in internalized stigma reported and the public perceptions of stigma because of both mental illness and epilepsy between Iran and Sweden is suggested partly a consequence of the different cultural settings, Sweden being an extremely individualistic society compared to the more collectivistic Iranian society.

  • 263.
    Ghanean, Helia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nojomy, Marzieh
    Self-perception of stigma in persons with epilepsy in Tehran, Iran2013In: Epilepsy & Behavior, ISSN 1525-5050, E-ISSN 1525-5069, Vol. 28, no 2, p. 163-167Article in journal (Refereed)
    Abstract [en]

    Epilepsy is one of the most stigmatizing medical conditions worldwide. It could be argued that the problem of stigma and discrimination might be different in an Islamic culture. A cross-sectional study of 130 patients with epilepsy was performed using the Internalized Stigma of Mental Illness (ISMI) questionnaire that was adapted for epilepsy. The questionnaire contained 29 items on a 4-point scale in addition to an open-ended question about experience of discrimination. An average score above the midpoint (2.5) is suggested to indicate a high level of stigma. Approximately 23.7% of the patients reported a score above the midpoint. Unemployment and low education were significantly associated with a high level of internalized stigma. Although epilepsy can be effectively treated, patients in Tehran still experience much stigma. For this reason, strategies for reducing self-perception of stigma should be included in a treatment plan.

    (C) 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  • 264.
    Ghanean, Helia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nojomi, M
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Community study on attitudes to and knowledge of mental illness in TehranIn: Stigma Research and Action, ISSN 2210-5174Article in journal (Refereed)
  • 265.
    Ghanean, Helia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nojomi, M
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Internalized stigma of mental illness in Tehran, Iran2011In: Stigma Research and Action, ISSN 2210-5174, Vol. 1, no 1, p. 11-17Article in journal (Refereed)
  • 266.
    Ghanean, Helia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nojomi, M.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Public awareness and attitudes towards epilepsy in Tehran, Iran2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-5Article in journal (Refereed)
    Abstract [en]

    Background: Epilepsy is a prototypical, stigmatised disorder. Numerous studies have been conducted regarding the public perception of epilepsy, but they are primarily from high-income western countries; few studies have taken place in low-to middle-income countries with a traditional culture and a religious orientation. Objective: The public knowledge and attitudes towards epilepsy in Tehran, Iran, is studied. Design: A survey of 800 subjects ranging from 18 to 85 years was randomly chosen from households in Tehran in 2009. The questionnaire used was based on the Caveness and Gallup's studies conducted in the United States in 1949 and it has been used in numerous similar studies all over the world. The mean age of the participants was 37.5 years and 46.7% were female. Pearson's Chi-squared test was used for subgroup analyses. Results: The majority of subjects cited brain disorders as a cause of epilepsy, while 17% indicated the will of God as the cause. Most individuals were willing to work with a person with epilepsy, allow their children to play with a child with epilepsy, and allow people with epilepsy to use public transportation (78-82%). However, only 28% were willing to accept the marriage of a family member to someone with epilepsy. Conclusion: The knowledge and attitudes towards epilepsy are similar to those in Europe, with the exception of a much lower acceptance regarding marriage to a person with epilepsy. However, the low acceptance for marrying someone with epilepsy reveals the remaining misconceptions about the nature of epilepsy in Iran, despite the high educational level in the studied population. Therefore, informational efforts must be employed to change the perception of epilepsy.

  • 267.
    Ghazinour, Mehdi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Trauma and resiliency: a study of refugees from Iran resettled in Sweden2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Several single factors have been identified as related to coping with trauma and as protective factors. Several studies emphasize the importance of personality, core beliefs, coping strategies and social support. However little attention has been paid to resiliency. The aim of the study was to identify some determinants of an individual’s resiliency after experienced traumatic life events, and to address the issue of its relationship to personality characteristics, psychopathology, coping resources and strategies, social support, sense of coherence and quality of life.

    In the present study, a convenience sample of 100 Iranian refugees, 66 males and 34 females in the age range of 18-65 were investigated. All the subjects have experienced one or several traumatic life events as soldiers, political prisoners or have been victims of torture or have escaped from the country in a stressful way. At the time of the present investigation the mean time living in Sweden was for male subject’s 12.8 years and for female 11.8.

    Nine instruments were administered during individual sessions, Temperament, Character Inventory (TCI), The EMBU (Swedish acronym for own memories concerning upbringing), The Symptom Checklist-90-Revised (SCL-90 – R), Beck Depression Inventory (BDI), Interview Schedule of Social Interaction (ISSI), Coping Resources Inventory (CRI), The Dysfunctional Attitude Scale (DAS), WHOQoL Group, 1995 (WHOQoL-100), The Sense of Coherence Scale (SoC).

    Several significant associations were found between personality temperament and character, parental rearing and psychopathology. When experiences of parental rearing were investigated in relation to psychopathology, male subjects scored high on parental rejection and were also more depressed compared to females. Although the individuals in the sample suffered from depression or anxiety, there were individuals that had adapted them-self well with the new life in Sweden and its demands. Nineteen percent of subjects who had low harm avoidance and high self directedness received more social support, had better coping strategies, higher sense of coherence and finally a better quality of life.

    This dissertation underscores the importance of multiple indicators when trying to understand resiliency. Personality traits, parental rearing, coping resources, social support and sense of coherence were the strongest predictors for resiliency. Having a systemic perspective helps to explain why some individuals are healthy and resilient despite traumatic life events, escaping from home country, applying for asylum, establishing a new home, learning new languages, to study and stablish and develop new bonds.

  • 268.
    Ghazinour, Mehdi
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Emami, Habib
    Toxicological Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran, and the Tobacco Control and Prevention Research Center.
    Richter, Jörg
    Centre of Child and Adolescent Mental Health, Regions South and East, Oslo, Norway.
    Abdollahi, Mohammad
    Faculty of Pharmacy, and Pharmaceutical Sciences Research Center Tehran University of Medical Sciences, Iran.
    Pazumand, Abdolkarim
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Age and gender differences in the use of various poisoning methods for deliberate self-harm in individuals admitted to Loghman Hospital in Tehran (2000-2004)2008In: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 39, no 2, p. 231-239Article in journal (Refereed)
    Abstract [en]

    Different methods of poisoning used by individuals with the diagnosis of parasuicide admitted to the Loghman Hospital, Tehran, from 2000 to 2004 were investigated, with particular focus on gender and age differences. Drugs, pesticides, and other agricultural chemicals (women: 12.7%, men: 9%) were the most commonly used methods. In males, the percentage of use of drugs increased with age, but the frequency of pesticides use decreased with age. In females, drugs were most often used in the youngest age group, whereas the use of pesticides was lowest in the youngest age category. Females outnumbered males, especially in the youngest age group of 10 to 19 years olds. Drugs and pesticides were the substances used most often for parasuicide in each age group regardless of gender.

  • 269.
    Ghazinour, Mehdi
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mofidi, Naser
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Richter, Jörg
    Centre of Child and Adolescent Mental Health, Regions South and East, Oslo, Norway.
    Continuity from suicidal ideations to suicide attempts?: An investigation in 18-55 years old adult Iranian Kurds2010In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 45, no 10, p. 973-981Article in journal (Refereed)
    Abstract [en]

    A continuum of suicidal behaviour is supported; but, this did not include self-reported suicide attempts. The reported frequency of suicidal thoughts and suicide attempts was highly dependent on applied response categories and the considered timeframe, which has to be considered thoroughly when interpreting related results.

  • 270.
    Ghazinour, Mehdi
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Richter, Jörg
    University of Rostock-Germany.
    Eisemann, Martin
    Department of Psychology-Tromsö Unversity.
    Do Parental Rearing and Personality Characteristics have a Buffering Effect against Psychopathological manifestations among Iranian Refugees in Sweden?2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 6, p. 419-428Article in journal (Refereed)
  • 271.
    Ghazinour, Mehdi
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Richter, Jörg
    Mofidi, Naser
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Continuity from suicidal ideations to suicide attempts in Iranian Kurds?Manuscript (Other academic)
    Abstract [en]

    Background. Suicidal ideation is a critical point for the identification of individuals at risk of committing suicide/attempting suicide. Whilst existing studies provide valuable data from Western countries, more research is needed to determine the applicability of these findings outside of the context of Western culture.

    Method. In a cross–sectional study in Sanandaj, capital of Iranian Kurdistan, 1,000 randomly selected individuals were investigated by means of the Attitudes towards Suicide questionnaire which includes items concerning various suicidal thoughts.

    Results. The Iranian Kurds reported very few suicide attempts, whereas the prevalence of reported suicidal thoughts was found to be very high. The assumption of a continuum of suicidal behaviour is supported by our data; but, this did not include self-reported suicide attempts. The various suicidal thoughts showed very low sensitivity and low predictive power in relation to suicide attempts. The reported frequency of suicidal thoughts and the number of suicide attempts during the last year was significantly higher than that from earlier in life. Age was determined to be a substantial moderator variable related to the occurrence of suicidal thoughts and suicide attempts with increasing impact with increasing severity of suicidal behaviour. Gender, cohabitation status and employment situation were largely only weakly associated with the occurrence of suicidal behaviours.

    Conclusions. Culture seems to be of low impact upon the relationship between socio-demographical variables and suicidal behaviour. The reported frequency of suicidal thoughts and suicide attempts seems to be highly dependent on applied response categories and the considered timeframe, which has to be considered thoroughly when interpreting related results, and when comparing with findings from other investigations.

  • 272. 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.

  • 273. 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.

  • 274. Giddaluru, Sudheer
    et al.
    Espeseth, Thomas
    Salami, Alireza
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Aging Research Center, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden.
    Westlye, Lars T
    Lundquist, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Christoforou, Andrea
    Cichon, Sven
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Steen, Vidar M
    Reinvang, Ivar
    Nilsson, Lars Göran
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). ARC, Karolinska Institutet, Stockholm, Sweden.
    Le Hellard, Stéphanie
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Genetics of structural connectivity and information processing in the brain2016In: Brain Structure and Function, ISSN 1863-2653, E-ISSN 1863-2661, Vol. 221, no 9, p. 4643-4661Article in journal (Refereed)
    Abstract [en]

    Understanding the genetic factors underlying brain structural connectivity is a major challenge in imaging genetics. Here, we present results from genome-wide association studies (GWASs) of whole-brain white matter (WM) fractional anisotropy (FA), an index of microstructural coherence measured using diffusion tensor imaging. Data from independent GWASs of 355 Swedish and 250 Norwegian healthy adults were integrated by meta-analysis to enhance power. Complementary GWASs on behavioral data reflecting processing speed, which is related to microstructural properties of WM pathways, were performed and integrated with WM FA results via multimodal analysis to identify shared genetic associations. One locus on chromosome 17 (rs145994492) showed genome-wide significant association with WM FA (meta P value = 1.87 × 10(-08)). Suggestive associations (Meta P value <1 × 10(-06)) were observed for 12 loci, including one containing ZFPM2 (lowest meta P value = 7.44 × 10(-08)). This locus was also implicated in multimodal analysis of WM FA and processing speed (lowest Fisher P value = 8.56 × 10(-07)). ZFPM2 is relevant in specification of corticothalamic neurons during brain development. Analysis of SNPs associated with processing speed revealed association with a locus that included SSPO (lowest meta P value = 4.37 × 10(-08)), which has been linked to commissural axon growth. An intergenic SNP (rs183854424) 14 kb downstream of CSMD1, which is implicated in schizophrenia, showed suggestive evidence of association in the WM FA meta-analysis (meta P value = 1.43 × 10(-07)) and the multimodal analysis (Fisher P value = 1 × 10(-07)). These findings provide novel data on the genetics of WM pathways and processing speed, and highlight a role of ZFPM2 and CSMD1 in information processing in the brain.

  • 275.
    Gonzalez, Henrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ottervald, Jan
    Nilsson, Kerstin C
    Sjögren, Niclas
    Miliotis, Tasso
    Von Bahr, Helena
    Khademi, Mohsen
    Eriksson, Bodil
    Kjellström, Sven
    Vegvari, Akos
    Harris, Robert
    Marko-Varga, György
    Borg, Kristian
    Nilsson, Johan
    Laurell, Thomas
    Olsson, Tomas
    Franzén, Bo
    Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation.2009In: Journal of Proteomics, ISSN 1874-3919, E-ISSN 1876-7737, Vol. 71, no 6, p. 670-81Article in journal (Refereed)
    Abstract [en]

    Survivors of poliomyelitis often develop increased or new symptoms decades after the acute infection, a condition known as post-polio syndrome (PPS). The condition affects 20-60% of previous polio patients, making it one of the most common causes of neurological deficits worldwide. The underlying pathogenesis is not fully understood and accurate diagnosis is not feasible. Herein we investigated whether it was possible to identify proteomic profile aberrations in the cerebrospinal fluid (CSF) of PPS patients. CSF from 15 patients with well-defined PPS were analyzed for protein expression profiles. The results were compared to data obtained from nine healthy controls and 34 patients with other non-inflammatory diseases which served as negative controls. In addition, 17 samples from persons with secondary progressive multiple sclerosis (SPMS) were added as relevant age-matched references for the PPS samples. The CSF of persons with PPS displayed a disease-specific and highly predictive (p=0.0017) differential expression of five distinct proteins: gelsolin, hemopexin, peptidylglycine alpha-amidating monooxygenase, glutathione synthetase and kallikrein 6, respectively, in comparison with the control groups. An independent ELISA confirmed the increase of kallikrein 6. We suggest that these five proteins should be further evaluated as candidate biomarkers for the diagnosis and development of new therapies for PPS patients.

  • 276. 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.

  • 277. Gothefors, Dan
    et al.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Swedish Psychiatric Association. .
    Attvall, Stig
    Erlinge, David
    Jarbin, Håkan
    Lindström, Kjell
    von Hausswolff-Juhlin, Yvonne Linné
    Morgell, Roland
    Toft, Eva
    Osby, Urban
    Swedish clinical guidelines: prevention and management of metabolic risk in patients with severe psychiatric disorders2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 5, p. 294-302Article in journal (Refereed)
    Abstract [en]

    Individuals with severe psychiatric disorders are more likely than the population at large to develop metabolic derangements such as overweight and diabetes. Cardiovascular disease is also more frequently seen in this group. Contributing factors may include inappropriate diet or lack of physical activity, but antipsychotic medication may also play a role. Seven Swedish specialist medical societies have collaborated in formulating a set of concise clinically applicable guidelines-reproduced here in modified form-for the prevention and management of metabolic risk in this patient group. The importance of implementation is emphasized.

  • 278. 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.

  • 279. 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.

  • 280. Grunewald, Karl
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    [The child or the bathing water? - The psychiatry reform again]2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 6, p. 496-8Article in journal (Refereed)
  • 281. Grunewald, Karl
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Markström, Urban
    [The psychiatric reform was necessary! Normalized life conditions for tens of thousands of persons].2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 4, p. 307-8Article in journal (Refereed)
  • 282.
    Gustafsson, Carina
    et al.
    Institute for Evidence-Based Social Work Practice, Sweden .
    Öjehagen, Agneta
    Lund University, Sweden.
    Hansson, Lars
    Lund University, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nyström, Marie
    Institute for Evidence-Based Social Work Practice, Sweden.
    Glad, Johan
    Institute for Evidence-Based Social Work Practice, Sweden.
    Cruce, Gunilla
    Lund University, Sweden.
    Jonsson, Ann-Kristin
    National Board of Health and Welfare, Sweden.
    Fredriksson, Maja
    National Board of Health and Welfare, Sweden.
    Effects of psychosocial interventions for people with intellectual disabilities and mental health problems: A survey of systematic reviews2009In: Research on social work practice, ISSN 1049-7315, E-ISSN 1552-7581, Vol. 19, no 3, p. 281-290Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to provide a survey of systematic reviews that have evaluated the effects of psychosocial interventions for adult people with intellectual disabilities and/or an autistic syndrome with concurrent mental health problems. Reviews for inclusion were identified through searches of 10 electronic databases. The authors found that 3 out of 126 published reviews met the inclusion criteria for interventions, population, and being considered a systematic review. The results imply a weak scientific support for behavioral therapy, cognitive-behavioral therapy, and some forms of integrated care and support. However, the primary studies included in the reviews have several methodological shortcomings. The results suggest future research initiatives in the direction of more effectiveness studies of good quality and reproduction of high-quality systematic reviews.

  • 283. Güzey, Cüneyt
    et al.
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Brännström, Thomas
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Spigset, Olav
    Radioligand binding to brain dopamine and serotonin receptors and transporters in Parkinson's disease: relation to gene polymorphisms2012In: International Journal of Neuroscience, ISSN 0020-7454, E-ISSN 1563-5279, Vol. 122, no 3, p. 124-132Article in journal (Refereed)
    Abstract [en]

    The influence of variations in genes coding for dopamine and serotonin transporters and receptors on the expression of these structures in the brains of patients with Parkinson's disease (PD) is not known. In order to investigate the significance of dopamine and serotonin transporter and receptor gene polymorphisms on the expression of dopamine and serotonin transporters and the dopamine D(2) and serotonin 5HT(2A) receptors in brain tissue in PD, we conducted a study on brain autopsy material from 16 patients diagnosed with clinical PD and 11 controls. The polymorphisms studied were DAT1 VTNR, DRD2 Taq1A, 5HTTLPR, and 5HTR2A 102 T>C, 516 C>T, His425Tyr and Thr25Asn. Compared to control subjects, patients with PD had a significantly lowered radioligand binding to the dopamine transporter in nucleus caudatus (P = 0.001) and putamen (P = 0.008), and to the serotonin transporter in gyrus cingulatus (P = 0.010) and nucleus caudatus (P = 0.032). We did not observe any significant associations between genetic polymorphisms and the extent of radioligand binding or between the polymorphisms and a diagnosis of PD. In conclusion, the density of brain dopamine and serotonin transporters in patients with PD was reduced. However, there were no associations between the investigated genotypes and the expression of the corresponding receptors and transporters.

  • 284. Hagg, S.
    et al.
    Zhan, Y.
    Karlsson, R.
    Gerritsen, L.
    Ploner, A.
    van der Lee, S. J.
    Broer, L.
    Deelen, J.
    Marioni, R. E.
    Wong, A.
    Lundquist, Anders
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Zhu, G.
    Hansell, N. K.
    Sillanpaa, E.
    Fedko, I. O.
    Amin, N. A.
    Beekman, M.
    de Craen, A. J. M.
    Degerman, Sofie
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Harris, S. E.
    Kan, K-J
    Martin-Ruiz, C. M.
    Montgomery, G. W.
    Adolfsson, Annelie N.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Reynolds, C. A.
    Samani, N. J.
    Suchiman, H. E. D.
    Viljanen, A.
    von Zglinicki, T.
    Wright, M. J.
    Hottenga, J-J
    Boomsma, D. I.
    Rantanen, T.
    Kaprio, J. A.
    Nyholt, D. R.
    Martin, N. G.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kuh, D.
    Starr, J. M.
    Deary, I. J.
    Slagboom, P. E.
    van Duijn, C. M.
    Codd, V.
    Pedersen, N. L.
    Short telomere length is associated with impaired cognitive performance in European ancestry cohorts2017In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 7, article id e1100Article in journal (Refereed)
    Abstract [en]

    The association between telomere length (TL) dynamics on cognitive performance over the life-course is not well understood. This study meta-analyses observational and causal associations between TL and six cognitive traits, with stratifications on APOE genotype, in a Mendelian Randomization (MR) framework. Twelve European cohorts (N = 17 052; mean age = 59.2 +/- 8.8 years) provided results for associations between qPCR-measuredTL (T/S-ratio scale) and general cognitive function, mini-mental state exam (MMSE), processing speed by digit symbol substitution test (DSST), visuospatial functioning, memory and executive functioning (STROOP). In addition, a genetic risk score (GRS) for TL including seven known genetic variants for TL was calculated, and used in associations with cognitive traits as outcomes in all cohorts. Observational analyses showed that longer telomeres were associated with better scores on DSST (beta = 0.051 per s. d.-increase of TL; 95% confidence interval (CI): 0.024, 0.077; P = 0.0002), and MMSE (beta = 0.025; 95% CI: 0.002, 0.047; P = 0.03), and faster STROOP (beta = -0.053; 95% CI: -0.087, -0.018; P = 0.003). Effects for DSST were stronger in APOE epsilon 4 non-carriers (beta = 0.081; 95% CI: 0.045, 0.117; P = 1.0 x 10(-5)), whereas carriers performed better in STROOP (beta = -0.074; 95% CI: -0.140, -0.009; P = 0.03). Causal associations were found for STROOP only (beta = -0.598 per s. d.-increase of TL; 95% CI: -1.125, -0.072; P = 0.026), with a larger effect in epsilon 4-carriers (beta = -0.699; 95% CI: -1.330, -0.069; P = 0.03). Two-sample replication analyses using CHARGE summary statistics showed causal effects between TL and general cognitive function and DSST, but not with STROOP. In conclusion, we suggest causal effects from longer TL on better cognitive performance, where APOE epsilon 4-carriers might be at differential risk.

  • 285. Haglund, Axel
    et al.
    Lindh, Asa U.
    Lysell, Henrik
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Waern, Margda
    Runeson, Bo
    Interpersonal violence and the prediction of short-term risk of repeat suicide attempt2016In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 36892Article in journal (Refereed)
    Abstract [en]

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

  • 286. Haglund, Axel
    et al.
    Tidemalm, Dag
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Långström, Niklas
    Lichtenstein, Paul
    Fazel, Seena
    Runeson, Bo
    Suicide after release from prison: a population-based cohort study from Sweden2014In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 75, no 10, p. 1047-53Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Released prisoners have high suicide rates compared with the general population, but little is known about risk factors and possible causal pathways. We conducted a population-based cohort study to investigate rates and risk factors for suicide in people previously imprisoned.

    METHOD: We identified individuals released from prison in Sweden between January 1, 2005, and December 31, 2009, through linkage of national population-based registers. Released prisoners were followed from the day of release until death, emigration, new incarceration, or December 31, 2009. Survival analyses were conducted to compare incidence rates and psychiatric morbidity with nonconvicted population controls matched on gender and year of birth.

    RESULTS: We identified 38,995 releases among 26,985 prisoners (7.6% female) during 2005-2009. Overall, 127 suicides occurred, accounting for 14% of all deaths after release (n = 920). The mean suicide rate was 204 per 100,000 person-years, yielding an incidence rate ratio of 18.2 (95% CI, 13.9-23.8) compared with general population controls. Previous substance use disorder (hazard ratio [HR] = 2.1; 95% CI, 1.4-3.2), suicide attempt (HR = 2.5; 95% CI, 1.7-3.7), and being born in Sweden versus abroad (HR = 2.1; 95% CI, 1.2-3.6) were independent risk factors for suicide after release.

    CONCLUSIONS: Released prisoners are at high suicide risk and have a slightly different pattern of psychiatric risk factors for suicide compared with the general population. Results suggest appropriate allocation of resources to facilitate transition to life outside prison and increased attention to prisoners with both a previous suicide attempt and substance use disorder.

  • 287.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Patient and health care delays in malignant melanoma2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Unlike other cancers, malignant melanoma (MM) is generally visible and can be easily and effectively cured if treated in time. Optimal cure of MM requires early detection, diagnosis, and treatment, which improves prognosis. However, patients as well as the health care organization and its professionals contribute to delayed treatment in various ways.

    Aims and objectives: The general aim of this PhD thesis was to explore reasons for delay in care seeking, diagnosis, and treatment of malignant melanoma. The specific objectives to be addressed were

    • To explore patients’ decision making about seeking care for malignant melanoma
    • To identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men
    • To compare self-reported decision making coping styles between men and women in various ages, who live with or without a partner and are diagnosed with various stages of malignant melanoma in northern Sweden.
    • To describe and compare patients diagnosed with MM, depending on their initial contact with care, and with regard to age, sex, and MM type and thickness, and to explore pathways and time intervals between clinics from the initial contact to diagnosis and treatment.

    Methods: In studies I and II, 21 and 30 patients, respectively, were interviewed about their decision making to seek care for MM. Study II focused on gender patterns in this decision making. The interviews were analysed using Grounded Theory (I) and qualitative content analysis (II). Study III included 270 people with MM who completed a translated questionnaire (Melbourne Decision Making Questionnaire) about coping styles in decision making. In study IV the pathways and time delay in health care for 71 people with MM were explored. Studies I and II were qualitative, whereas studies III and IV were quantitative.

    Results: In study I, the insights into severity and feelings of fear and existential threat were identified as key motivators for patients to decide to seek care for a suspected melanoma. Results in study II showed that gender constructions influenced the care-seeking behaviour. Women acknowledged the skin changes and attempted self-care first. They delayed care seeking due to family responsibilities. Men seldom acknowledged the suspicious skin change, but sought care immediately after prompting, and most often complied with relatives’ advice to seek care. Study III showed that men generally scored higher in buck-passing, while women and those living without a partner scored higher in hypervigilance. Participants with nodular melanoma (NM), a rapid-growing form of MM, scored higher in vigilance than those diagnosed as in situ melanoma. No correlation was found between tumour thickness and coping styles. Some differences concerning treatment of MM were found in study IV between people who initially had sought care at primary health care centres (PHC) and those who had sought care at dermatological and specialist clinics (Derm). Thicker tumours as well as NM were more common in the PHC group. A larger proportion of patients from PHCs were primarily excided within the primary health care; however, almost all of them were later referred to surgical clinics for wide excision. Patients within the PHC group also had to wait longer for the registered results of histopathological assessments. In general, women waited a shorter time for primary excision, and older people waited longer for wide excision.

    Conclusions: Time delay of diagnosis and treatment of MM is still common, and crucial to decrease. Future interventions should include gender aspects to influence people to seek care earlier. In health care, time delay could be decreased by facilitating access for patients with suspected skin melanomas, but also by reducing unnecessary referrals. Moreover, organizational changes whereby general practitioners and primary health care nurses are supported in using new technology for faster diagnoses and management of MM in collaboration with specialist clinics should be considered. Easy access and frequently used guidelines for MM could further decrease delay. Lastly, more efficient transfer and registration of laboratory results and referrals could decrease delay and improve patient safety.

  • 288.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Patients' decision making in seeking care for suspected malignant melanoma2010In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 2, no 2, p. 164-173Article in journal (Refereed)
    Abstract [en]

    Aim. To explore patients' decision making about seeking care for malignant melanoma (MM).

    Background. Unlike other cancers, MM is generally visible and can be easily and cheaply cured if treated in time. It is the delay in diagnosis, most often attributable to the patient rather than to care providers, that results in mortality. Self-examination of suspicious lesions is important, but it is not a guarantee of immediate care-seeking, nor is early detection and increased melanoma awareness associated with early care-seeking.

    Method. During 2009, men (n = 10) and women (n = 11) diagnosed with malignant melanoma were interviewed within two years after excision and the text was analysed according to Grounded Theory.

    Results. The perception of a critical level of severity, feelings of fear and threat were found to be a key motivator for patients to seek care for suspected melanomas; as soon as sufficient insight into the severity of the disease was achieved, the patient reached a turning point and sought care immediately.

    Conclusions. Most of the participants described the process from the discovery of the lesion to the decision to seek care as a time-consuming inner negotiation about the severity of the disease, personal and social considerations, and interactions with the healthcare system.

    Relevance to clinical practice. We analysed the complex reasoning of the patients leading up to the turning point when they sought care. This study illustrates for caregivers the importance of simplifying the pathways to care, emphasising the seriousness of MM, and taking worried patients seriously from their first contact with health care. Health professionals, through their attitudes in contact with patients, can either facilitate or obstruct the patient's decision making process.

  • 289.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Health care delay in malignant melanoma: various pathways to diagnosis and treatment2014In: Dermatology Research and Practice, ISSN 1687-6105, E-ISSN 1687-6113, p. 294287-Article in journal (Refereed)
    Abstract [en]

    We aimed to describe and compare patients diagnosed with malignant melanoma (MM), depending on their initial contact with care andwith regard to age, sex, andMMtype and thickness, and to explore pathways and time intervals (lead times) between clinics from the initial contact to diagnosis and treatment.The sample from northern Sweden was identified via the Swedish melanoma register. Data regarding pathways in health care were retrieved from patient records. In our unselected population of 71 people diagnosedwith skinmelanoma of SSMandNMtypes, 75%of patients were primarily treated by primary health-care centres (PHCs). The time interval (delay) from primary excision until registration of the histopathological assessment in the medical records was significantly longer in PHCs than in hospital-based and dermatological clinics (Derm). Thicker tumors were more common in the PHC group. Older patients waited longer times for wide excision. Most MM are excised rapidly at PHCs, but some patients may not be diagnosed and treated in time. Delay of registration of results from histopathological assessments within PHCs seems to be an important issue for future improvement. Exploring shortcomings inMMpatients’ clinical pathways is important to improve the quality of care and patient safety.

  • 290.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hörnsten, Asa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Malignant melanoma: gender patterns in care seeking for suspect marks2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, p. 2676-2684Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. Gender patterns in self-detection of melanoma are not sufficiently highlighted in the literature. The aim of the study was to identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men.

    Background. Females have a more favourable prognosis than males and also a higher level of perceived susceptibility and a higher level of knowledge about melanoma. Women are, furthermore, more prone to participate in screening.

    Method. Thirty patients (15 women and 15 men) with a mean age of 55.5 years and diagnosed with malignant melanoma were interviewed about their decisions to seek care for suspect skin marks. The interviews were transcribed and analysed with qualitative content analysis.

    Results. Care-seeking behaviour for suspect melanoma was influenced by gender constructions. Men seldom or never acknowledged interest in attention to bodily changes, but when they became aware of changes, they often took a quick decision and sought an expert's assessment. Men were compliant with wives' and relatives' advice about seeking care. All women reported that they paid attention to bodily changes, but they often delayed care seeking, due to family responsibilities and emotional struggles. The women also attempted self-care remedies, such as applying ointment, before seeking professional care.

    Conclusions. There are gender-specific patterns that may influence decision making in the care-seeking process. Such patterns are important to identify, since health care professionals must take these factors into account in communicating with men and women.

    Relevance to clinical practice. Nurses and in particular those working in telephone counselling, are often at the frontlines, deciding who can have access to health services. They are ideally placed to tackle the issue of gender constructions in the development of effective health care services.

  • 291.
    Hajdarevic, Senada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Nursing.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Coping styles in decision making among men and women diagnosed with malignant melanoma2013In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 18, no 11, p. 1445-1455Article in journal (Refereed)
    Abstract [en]

    Early care seeking is important for prognosis of malignant melanoma. Coping styles in decision-making to seek care can relate to prognosis since avoidant strategies could delay care seeking. The aim of this study was to compare self-reported coping styles in decision-making between men and women diagnosed with malignant melanoma. We used the Swedish version of the Melbourne Decision-Making Questionnaire to assess coping styles. Men generally scored higher in buck-passing while women and those living without a partner scored higher in hypervigilance. This knowledge could be used in the development of preventive programmes with intention to reach those who delay care seeking.

  • 292. Hallberg, Jonas
    et al.
    Kaldo, Viktor
    Arver, Stefan
    Dhejne, Cecilia
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Oberg, Katarina Gorts
    A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men2019In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 16, no 5, p. 733-745Article in journal (Refereed)
    Abstract [en]

    Background: Hypersexual disorder (HD) is defined as a condition in which the individual loses control over engagement in sexual behaviors, leading to distress and negative effects on key life areas. Cognitive behavioral therapy (CBT) has been proven to reduce symptoms of hypersexual behavior; however, no randomized controlled study of CBT interventions for HD has been reported previously.

    Aim: To investigate the efficacy of group-administered CBT for HD.

    Methods: Male participants (n = 137) diagnosed with HD, were randomized between 7 weeks of group-administered CBT (n = 70) and a waitlist control receiving the intervention after 8 weeks (n = 67). Measurements were administered at pre-, mid-, and posttreatment, with follow-up after 3 and 6 months.

    Outcomes: The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD:CAS), and secondary outcomes were the Sexual Compulsivity Scale (SCS) and measures of depression (Montgomery–Åsberg Depression Rating Scale (MADRS-S), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and treatment satisfaction (CSQ-8).

    Results: A significantly greater decrease in HD symptoms and sexual compulsivity, as well as significantly greater improvements in psychiatric well-being, were found for the treatment condition compared with the waitlist. These effects remained stable at 3 and 6 months after treatment.

    Clinical Implications: CBT can ameliorate HD symptoms and psychiatric distress, suggesting that the CBT program may serve as a first-line treatment in clinical settings.

    Strengths & Limitations: This is the first randomized controlled study evaluating the efficacy of a CBT program in a rather large sample of HD-specific diagnosed men. The long-term treatment effects are vague due to the low response rate on follow-up measurements, and the efficacy of this program for hypersexual women remains unknown.

    Conclusion: This study supports the efficacy of a group-administered CBT program as a treatment option for HD; however, future studies should include women, comprise dismantling analysis of the constituting interventions, and evaluate other treatment formats, for example, administration via the Internet.

  • 293. Hallmans, Göran
    et al.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Granqvist, E
    Johansson, Gunnar
    Nygren, Charlotte
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Sandman, P
    Sehlstedt, E
    Winblad, B
    Auswirkungen eines Knäckebrotes mit hohem Kleiegehalt auf die defäkationsgewohnheiten von älteren, obsipierten demenz-patienten sowie jungen personen mit oder ohne obstipation1985In: Ernärungs-Umschau, Vol. 32, no 2, p. 44-47Article in journal (Refereed)
  • 294. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Hughes, Marcus
    Tesfaye, Markos
    Wondimagegn, Dawit
    Patel, Vikram
    Prince, Martin
    Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale.2008In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 108, no 3, p. 251-62Article in journal (Refereed)
    Abstract [en]

    EPDS demonstrated limited clinical utility as a screen for perinatal CMD in this rural, low-income setting. The SRQ-20 was superior to EPDS across all domains for evaluating cultural equivalence and showed validity as a dimensional measure of perinatal CMD.

  • 295. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Tesfaye, Markos
    Wondimagegn, Dawit
    Taha, Hassan
    Anbesse, Birke
    Baheretibeb, Yonas
    Dewey, Michael
    Prince, Martin
    Measuring common mental disorders in women in Ethiopia: reliability and construct validity of the comprehensive psychopathological rating scale.2008In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 43, no 8, p. 653-9Article in journal (Refereed)
    Abstract [en]

    Detection of socioculturally meaningful cases of CMD in Ethiopia can be reliably achieved with local psychiatrist assessment using CPRS, although thorough training is essential.

  • 296. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Tomlinson, Mark
    Hughes, Marcus
    Patel, Vikram
    Dewey, Michael
    Prince, Martin
    Sociocultural practices in Ethiopia: association with onset and persistence of postnatal common mental disorders2010In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 197, p. 468-475Article in journal (Refereed)
    Abstract [en]

    There is evidence for an independent role of sociocultural practices in maintaining perinatal mental health in this Ethiopian community.

  • 297. Hanlon, Charlotte
    et al.
    Whitley, Rob
    Wondimagegn, Dawit
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Prince, Martin
    Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia2010In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 13, no 5, p. 385-393Article in journal (Refereed)
    Abstract [en]

    The high prevalence of antenatal common mental disorders in sub-Saharan Africa compared to high-income countries is poorly understood. This qualitative study explored the sociocultural context of antenatal mental distress in a rural Ethiopian community. Five focus group discussions and 25 in-depth interviews were conducted with purposively sampled community stakeholders. Inductive analysis was used to develop final themes. Worry about forthcoming delivery and fears for the woman's survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity. Sociocultural practices such as continuing physical labour, dietary restriction, prayer and rituals to protect against supernatural attack were geared towards safe delivery and managing vulnerability. Despite strong cultural norms to celebrate pregnancy, participants emphasised that many pregnancies were unwanted and an additional burden on top of pre-existing economic and marital difficulties. Short birth interval and pregnancy out of wedlock were both seen as shameful and potent sources of mental distress. The notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced. Although antenatal mental distress may be self-limiting for many women, in those with enduring life difficulties, including poverty and abusive relationships, poor maternal mental health may persist.

  • 298. Hanlon, Charlotte
    et al.
    Wondimagegn, Dawit
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lessons learned in developing community mental health care in Africa2010In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 9, no 3, p. 185-189Article in journal (Refereed)
    Abstract [en]

    This paper summarizes the findings for the African region of the WPA task force on steps, obstacles and mistakes to avoid in the implementation of community mental health care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region.

  • 299. Hansson, L
    et al.
    Christiansen, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Göstas, G
    Zandrén, T
    Lindhardt, A
    Saarento, O
    Oiesvold, T
    The Nordic Comparative Study on Sectorized Psychiatry. Part V. Contact rates, contact patterns and care level at index contact.1997In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 32, no 1, p. 12-8Article in journal (Refereed)
    Abstract [en]

    As part of a Nordic comparative study on sectorized psychiatry in seven Nordic catchment areas, a prospective investigation of contact rates of new patients and pathways to the psychiatric services was performed. The results showed that there was more than a twofold difference between the services in the total contact rates. Regarding diagnostic groups, contact rates for neurosis were predominant in three of the services, while adjustment disorders, dependencies and personality disorders were predominant in other the services. The contact rate of functional psychosis, as well as the ratio of psychotic patients to the total contact rate were highest in two catchment areas serving inner parts of big cities. The most common way of getting into contact with the services was by self-referral, 39.4% of total referrals, followed by primary care referrals, although there were large differences between the services. Psychotic patients made contact with the services to a significantly less extent by self-referral. The majority of patients were treated in outpatient care at entry to the services, with a large variation between the services. It was also found that inpatient care at index contact was predicted by clinical characteristics-a diagnosis of psychosis and a history of former inpatient care-as well as by social characteristics-male, widowed or divorced, sick pension/old age pension.

  • 300. Hansson, L
    et al.
    Middelboe, T
    Merinder, L
    Bjarnason, O
    Bengtsson-Tops, A
    Nilsson, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sourander, A
    Sørgaard, K W
    Vinding, H
    Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study.1999In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 45, no 4, p. 247-58Article in journal (Refereed)
    Abstract [en]

    As part of a Nordic multi-centre study investigating the life and care situation of community samples of schizophrenic patients the aim of the present part of the study was to examine the relationship between global subjective quality of life and objective life conditions, clinical characteristics including psychopathology and number of needs for care, subjective factors such as satisfaction with different life domains, social network, and self-esteem. A sample of 418 persons with schizophrenia from 10 sites was used. The results of a final multiple regression analysis, explaining 52.3% of the variance, showed that five subjective factors were significantly associated with global subjective quality of life, together with one objective indicator, to have a close friend. No clinical characteristics were associated with global subjective quality of life. The largest part of the variance was explained by satisfaction with health, 36.3% of the variance, and self-esteem, 7.3% of the variance. It is concluded that the actual relationship between objective life conditions and subjectively experienced quality of life still remains unclear. Furthermore, it seems obvious that personality related factors such as self-esteem, mastery and sense of autonomy also play a role in the appraisal of subjective quality of life, which implies that factors like these are important to consider in clinical and social interventions for patients with schizophrenia in order to improve quality of life for these persons.

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