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  • 301. Hansson, L
    et al.
    Muus, S
    Vinding, H R
    Göstas, G
    Saarento, O
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lönnerberg, O
    Oiesvold, T
    The Nordic Comparative Study on Sectorized Psychiatry: contact rates and use of services for patients with a functional psychosis.1998In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 97, no 5, p. 315-20Article in journal (Refereed)
    Abstract [en]

    As part of a Nordic comparative study on contact rates of new patients and use of services in seven catchment areas, contact rates and use of services for patients with a functional psychosis during a 1-year follow-up period were investigated. The highest contact rates were found in two large city catchment areas in Stockholm and Copenhagen. Compared to other patients in the cohorts, patients with a functional psychosis were more often found to be unemployed and living alone. They also showed more extensive service use in terms of both voluntary and compulsory admissions, and in the use of day-care facilities. In addition, they were more often multiple users of in-patient care (> or =3 admissions during the follow-up period). Large differences in service use among patients with a functional psychosis were discovered between the catchment areas, with the most extensive use of voluntary in-patient care and day-care facilities in Frederiksberg. Patients most frequently had compulsory admissions in Bodö and least frequently had them in Frederiksberg. Out-patient services were most frequently used in Stockholm. Correlations between levels of resources and use of services for patients with a functional psychosis were in general low, except for the rates of short-term beds, which showed a strong and significant correlation with the number of days in voluntary in-patient care (r=0.89).

  • 302. Hansson, L
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Utilization and patterns of care in comprehensive psychiatric care organizations. A review of studies and some methodological considerations.1992In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 86, no 4, p. 255-61Article in journal (Refereed)
    Abstract [en]

    This article reviews and analyzes studies on the utilization of care and patterns of care in psychiatric care organizations with a defined catchment area responsibility. Eight studies fulfilled the inclusion criteria. The main results of the studies were reviewed with regard to distribution of utilization, typical patterns of care, sociodemographic characteristics, clinical characteristics and, when appropriate, organizational characteristics related to utilization. The results show that a small proportion of patients use a large proportion of resources. Sociodemographic factors such as living alone or having no occupation in some of the studies predicted a higher utilization. Only one study reported sex differences, men being more common among heavy users. In most of the studies a psychosis diagnosis predicted a higher utilization. A history of prior contacts with psychiatric care predicted a higher utilization in 2 studies. It is concluded that future studies should make efforts to develop standardized models of classification of patterns of care to enhance possibilities of comparisons. Cost, as a common unit for summarizing and comparing resource utilization, has not been used, but is viewed as a highly relevant measure. Furthermore, measures of utilization should be separated from evaluations of outcome or quality of care. However, the latter is a neglected area that should also be promoted in studies of utilization of psychiatric care to create knowledge of the relationship of utilization to outcome.

  • 303. Hansson, L
    et al.
    Vinding, H R
    Mackeprang, T
    Sourander, A
    Werdelin, G
    Bengtsson-Tops, A
    Bjarnason, O
    Dybbro, J
    Nilsson, L
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sørgaard, K
    Middelboe, T
    Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.2001In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 103, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.

  • 304. Hansson, Lars
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bengtsson-Tops, Anita
    Bjarnason, Olafur
    Karlsson, Hasse
    Mackeprang, Torben
    Merinder, Lars
    Nilsson, Liselotte
    Sørgaard, Knut
    Vinding, Hanne
    Middelboe, Thomas
    The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study.2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 1, p. 5-11Article in journal (Refereed)
    Abstract [en]

    The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.

  • 305.
    Hansson, Maja
    Umeå University, Faculty of Medicine, Clinical Sciences, Psychiatry.
    Depression in primary care: detection, treatment, and patients’ own perspectives2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Depression is a very common disorder that causes great suffering for the patient. Recognizing depressed patients in primary care (PC) settings is a challenge and only about half are identified as depressed by their general practitioner (GP). Among patients receiving antidepressants (AD) about 70 % are improved, but only about 35 % reach remission. Hence, there is a need to identify depressed patients and to develop optimal treatment strategies in PC. Self-rating scales can be helpful in assisting the recognition. Patients’ beliefs about the cause of depression and their attitudes towards treatment options have been found to influence their help-seeking behavior, coping strategies, treatment preferences and adherence. To increase depressed patients’ knowledge about their disorder and to help them reach and stay in remission, the “Contactus program” was launched in Sweden, containing patient education and group counseling, as supplement to the usual care in PC.

    Aims To explore patients’ beliefs about causes and improvement factors for depression, and evaluate if the Contactus program could help to improve treatment outcome. Also, to investigate the psychometrics of two commonly used self-rating scales for depression, HADS and PHQ-9.

    Methods Treatment outcome among patients participating in the Contactus program (N=205) was compared to a control group (N=114) treated as usual. The outcome was measured by HADS, GAF-self and by questionnaires. Both groups also answered an open-ended question about the cause of their depression at baseline and another question about improvement factors at follow-up after six weeks. To compare HADS and PHQ-9, patients (N=737) visiting their physician because of depression filled in both scales. The scales cut-offs were compared with Cohen’s Kappa, internal consistency was calculated and factor analysis was performed. 

    Results Depressed patients participating in the Contactus program had a response rate of 55 % compared to 29 % in the control group (p=0.006). Also, remission was reached among 42 % in the Contactus group and 21 % among the controls (p=0.02). The patient’s subjective evaluation of the outcome after six weeks showed that 72% of the Contactus patients considered themselves improved vs. 47% among controls (p=0.01). The most common described reason for depression was current stress, most often work related, and own personality traits. Very few mentioned biological factors. For improvement, the most commonly mentioned aspects were participation in the Contactus program and AD. When comparing HADS to PHQ-9 their agreement at recommended cut-offs, HADS-D≥11 and PHQ-9≥10, was low (k=0.35). The highest Kappa value (0.56) and also equal prevalence of depression were found at HADS-D≥8 and PHQ≥12. Both scales had a high internal consistency (α=0.9).

    Conclusions The results of this thesis indicate that patient education and group counseling are valuable supplements to usual treatment of depression in PC. It is also clear that patients and professionals often have different opinions about the causes of depression, at least concerning biological factors. The patients were generally positive to professional help. The patients’ own beliefs about their illness must be considered when developing new types of interventions and when trying to reach an understanding in the patient-doctor encounter. Finally, there are many self-rating scales for depression. Here two scales were compared and both showed good psychometric properties in terms of internal consistency and factor structure. However their optimal cut-offs were questioned. In conclusion, self-rating scales are useful in identifying depressed patients in PC and might also be apt for measuring treatment outcome. Offering the patient education about their disorder and possibility to share experiences seems to increase response and remission rates, substantially. More studies are needed to explore the effects of educational programs, group interventions, and how patients’ own believes interact with the choice of treatment, adherence and outcome.

  • 306.
    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.

  • 307.
    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.

  • 308.
    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.

  • 309.
    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.

  • 310.
    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.

  • 311.
    Hansson, Patrik
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Eriksson Sörman, Daniel
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Bergdahl, Jan
    Umeå University, Faculty of Social Sciences, Department of Psychology. Institute of Clinical Dentistry, UIT The Arctic Universityof Norway, Tromsø, Norway.
    Bergdahl, Maud
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nilsson, Lars-Goran
    Dental status is unrelated to risk of dementia: a 20-year prospective study2014In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 62, no 5, p. 979-981Article in journal (Refereed)
  • 312. Hardy, J
    et al.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alafuzoff, I
    Bucht, G
    Marcusson, J
    Nyberg, P
    Perdahl, E
    Wester, P
    Winblad, B
    Transmitter deficits in Alzheimer's disease.1985In: Neurochemistry International, ISSN 0197-0186, E-ISSN 1872-9754, Vol. 7, no 4, p. 545-63Article in journal (Refereed)
    Abstract [en]

    The pattern of neurotransmitter pathway losses in Alzheimer's disease are reviewed. Deficits of the cholinergic pathway from the nucleus basalis, the noradrenergic pathway from the locus coeruleus and the serotoninergic pathway from the raphe nuclei are established. Cortical somatostatin interneurons are affected and dopaminergic neurons may be affected although these may be late or secondary phenomena in the disease process. Other neuronal systems, particularly in the hippocampus and temporal cortex, are also damaged. However, the disease is not one of generalised neuronal atrophy since some neurons are selectively spared. The established pathway-specific losses are discussed in relation to the clinical symptomatology and the pathology of the disorder. The biochemical and histological findings are compared with similar measurements made on tissues from other dementing disorders in an attempt to trace features common to dementias. Finally, as an addendum, a hypothesis is briefly outlined which attempts to explain the common features of the affected neurons and the pathogenesis of the disorder.

  • 313. Hawton, K
    et al.
    Arensman, E
    Wasserman, D
    Hultén, A
    Bille-Brahe, U
    Bjerke, T
    Crepet, P
    Deisenhammer, E
    Kerkhof, A
    De Leo, D
    Michel, K
    Ostamo, A
    Philippe, A
    Querejeta, I
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Schmidtke, A
    Temesváry, B
    Relation between attempted suicide and suicide rates among young people in Europe.1998In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 52, no 3, p. 191-4Article in journal (Refereed)
    Abstract [en]

    Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

  • 314.
    Hellström, Olle
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Vansbro Primary Health Care Unit, Vansbro, Sweden..
    Bullington, J
    Karlsson, G
    Lindqvist, P
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mattsson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Doctors' attitudes to fibromyalgia: a phenomenological study1998In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 26, no 3, p. 232-237Article in journal (Refereed)
    Abstract [en]

    Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.

  • 315.
    Hellström, Olle
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Lindqvist, P
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mattsson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    A phenomenological analysis of doctor-patient interaction: a case study1998In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 33, no 1, p. 83-89Article in journal (Refereed)
    Abstract [en]

    The fact that the biomedical model has been very successful in practice does not preclude that some health issues can be understood by way of other health care perspectives. Acquiring skills in meeting patients requires theories that structure other fields of knowledge than the biomedical sciences. An old man, who experiences himself as deeply misunderstood by the medical profession, is interviewed, his personal life-story is gone into and his case records and other available data are analysed. A phenomenological method is used, i.e. disciplined and rigorous reflection upon available data, remaining close to the particular pieces of the patient's narrative as they stand forth in their contextual relationships. The study shows that the doctors involved did not relate to the patient but to a biomedical image of him. His efforts to make himself understood were converted into instrumentally manageable disorders. Finally, dialogue medicine is briefly introduced as a model for counselling patients, especially when they need assistance to abandon the notion that they have been afflicted with a disease, a perception that might serve the purpose of keeping a threatening self-image out of consciousness.

  • 316. Henningsson, Susanne
    et al.
    Westberg, Lars
    Nilsson, Staffan
    Lundström, Bengt
    Ekselius, Lisa
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lindström, Eva
    Hellstrand, Monika
    Rosmond, Roland
    Eriksson, Elias
    Landén, Mikael
    Sex steroid-related genes and male-to-female transsexualism2005In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 30, no 7, p. 657-664Article in journal (Refereed)
    Abstract [en]

    Transsexualism is characterised by Lifelong discomfort with the assigned sex and a strong identification with the opposite sex. The cause of transsexualism is unknown, but it has been suggested that an aberration in the early sexual differentiation of various brain structures may be involved. Animal experiments have revealed that the sexual differentiation of the brain is mainly due to an influence of testosterone, acting both via androgen receptors (ARs) and-after aromatase-catalyzed conversion to estradiol-via estrogen receptors (ERs). The present study examined the possible importance of three polymorphisms and their pairwise interactions for the development of male-to-female transsexualism: a CAG repeat sequence in the first exon of the AR gene, a tetra nucleotide repeat polymorphism in intron 4 of the aromatase gene, and a CA repeat polymorphism in intron 5 of the ER beta gene. Subjects were 29 Caucasian male-to-female transsexuals and 229 healthy mate controls. Transsexuals differed from controls with respect to the mean Length of the ER repeat polymorphism, but not with respect to the length of the other two studied polymorphisms. However, binary logistic regression analysis revealed significant partial effects for all three polymorphisms, as well as for the interaction between the AR and aromatase gene polymorphisms, on the risk of developing transsexualism. Given the small number of transsexuals in the study, the results should be interpreted with the utmost caution. Further study of the putative role of these and other sex steroid-related genes for the development of transsexualism may, however, be worthwhile.

  • 317.
    Herrera, Andrés
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Caldera, Trinidad
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Suicidal expressions among young people in Nicaragua: a community-based study2006In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 9, p. 692-697Article in journal (Refereed)
  • 318.
    Herrera, Andrés
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Caldera, Trinidad
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Pena, Rodolfo
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Attitudes towards suicide among young people in Nicaragua: a community-based studyManuscript (Other academic)
  • 319.
    Herrera Rodríguez, Andrés
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Heaven can wait: studies on suicidal behaviour among young people in Nicaragua2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others.

    The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools.

    Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model.

    The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes.

    The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.

  • 320.
    Herrera Rodríguez, Andrés
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahlblom, Kjerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Pathways to suicidal behaviour among adolescent girls in Nicaragua2006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 4, p. 805-814Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 321.
    Hirvikoski, T
    et al.
    Karolinska Inst, Dept Mol Med, Stockholm, Sweden.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Personality traits in attempted and completed suicide2012In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 27, no 7, p. 536-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Though widely used in clinical and biological studies, no investigation of the factor structure of the Karolinska Scales of Personality (KSP) has been performed in suicide attempters. There are very few studies of personality traits in suicide completers. The aim of the present study was to assess the factor structure of KSP in suicide attempters. A secondary aim was to examine whether the factor structure of the KSP was related to gender and/or to violent method of the suicide attempt or to suicide completion.

    METHOD: The factor structure of the KSP was analysed in data from 165 suicide attempters from the Suicide Prevention Clinic at the Karolinska University Hospital using principal component analysis and orthogonal varimax rotation for the factor extraction. The effect of gender and (1) used method in the suicide attempt (violent versus nonviolent), and (2) later completed suicide on the factors was assessed in two separate series of the two-way ANOVAs.

    RESULT: A four-factor solution appeared: (1) Neuroticism, (2) Nonconformity, (3) Psychoticism and (4) Extraversion. Men who later completed suicide reported more Extroversion than male survivors.

    CONCLUSION: The obtained factor structure is comparable to a previous factor structure in a group of twins from the population-based Swedish Twin Registry indicating that no specific personality structure characterized the current sample. Differences in personality traits between suicide completers and survivors indicate that these groups may have some distinct characteristics.

  • 322. Hirvikoski, T.
    et al.
    Lindstrom, T.
    Carlsson, J.
    Waaler, E.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bolte, S.
    Psychoeducational groups for adults with ADHD and their significant others (PEGASUS): A pragmatic multicenter and randomized controlled trial2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 44, p. 141-152Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the feasibility, efficacy, and effectiveness of PEGASUS, a group-based structured psychoeducation for adults with ADHD and their significant others.

    Method: A pragmatic parallel group add-on design multicenter randomized controlled trial was conducted, comparing an 8-session treatment with PEGASUS (allocated n = 97; 48 with ADHD and 49 with significant others) to treatment as usual (TAU, allocated n = 82; 39 with ADHD and 43 significant others). Participants (individuals with ADHD and significant others) were recruited from five psychiatric outpatient departments and block randomized to PEGASUS or TAU. Knowledge about ADHD was measured using the ADHD 20 scale pre- and post-intervention and served as primary outcome.

    Results: Knowledge about ADHD (d = 0.97 [95% CI: 0.61–1.31]) increased following PEGASUS participation compared to TAU. Improvements were also observed in secondary outcomes e.g. global life satisfaction (d = 0.25 [95% CI: from –0.09 to 0.59]). Overall treatment satisfaction was good. Over 90% of the participants completed the program. Post-intervention data was obtained from n = 89 in PEGASUS group and n = 70 in TAU group and analyses were conducted per protocol. No important adverse effects or side effects were observed.

    Conclusions: Group-based structured psychoeducation PEGASUS for adults with ADHD and their significant others is a feasible, efficacious, and effective treatment option to increase ADHD knowledge and general life satisfaction in psychiatric outpatient care.

  • 323. Huckins, Laura M.
    et al.
    Dobbyn, Amanda
    Ruderfer, Douglas M.
    Hoffman, Gabriel
    Wang, Weiqing
    Pardinas, Antonio F.
    Rajagopal, Veera M.
    Als, Thomas D.
    Nguyen, Hoang T.
    Girdhar, Kiran
    Boocock, James
    Roussos, Panos
    Fromer, Menachem
    Kramer, Robin
    Domenici, Enrico
    Gamazon, Eric R.
    Purcell, Shaun
    Demontis, Ditte
    Borglum, Anders D.
    Walters, James T. R.
    O'Donovan, Michael C.
    Sullivan, Patrick
    Owen, Michael J.
    Devlin, Bernie
    Sieberts, Solveig K.
    Cox, Nancy J.
    Im, Hae Kyung
    Sklar, Pamela
    Stahl, Eli A.
    Johnson, Jessica S.
    Shah, Hardik R.
    Klein, Lambertus L.
    Dang, Kristen K.
    Logsdon, Benjamin A.
    Mahajan, Milind C.
    Mangravite, Lara M.
    Toyoshiba, Hiroyoshi
    Gur, Raquel E.
    Hahn, Chang-Gyu
    Schadt, Eric
    Lewis, David A.
    Haroutunian, Vahram
    Peters, Mette A.
    Lipska, Barbara K.
    Buxbaum, Joseph D.
    Hirai, Keisuke
    Perumal, Thanneer M.
    Essioux, Laurent
    Rajagopal, Veera Manikandan
    Mattheisen, Manuel
    Grove, Jakob
    Werge, Thomas
    Mortensen, Preben Bo
    Pedersen, Carsten Bocker
    Agerbo, Esben
    Pedersen, Marianne Giortz
    Mors, Ole
    Nordentoft, Merete
    Hougaard, David M.
    Bybjerg-Grauholm, Jonas
    Baekvad-Hansen, Marie
    Hansen, Christine Soholm
    Ripke, Stephan
    Neale, Benjamin M.
    Corvin, Aiden
    Farh, Kai-How
    Holmans, Peter A.
    Lee, Phil
    Bulik-Sullivan, Brendan
    Collier, David A.
    Huang, Hailiang
    Pers, Tune H.
    Agartz, Ingrid
    Albus, Margot
    Alexander, Madeline
    Amin, Farooq
    Bacanu, Silviu A.
    Begemann, Martin
    Belliveau, Richard A., Jr.
    Bene, Judit
    Bergen, Sarah E.
    Bevilacqua, Elizabeth
    Bigdeli, Tim B.
    Black, Donald W.
    Bruggeman, Richard
    Buccola, Nancy G.
    Buckner, Randy L.
    Byerley, William
    Cahn, Wiepke
    Cai, Guiqing
    Campion, Dominique
    Cantor, Rita M.
    Carr, Vaughan J.
    Carrera, Noa
    Catts, Stanley, V
    Chambert, Kimberly D.
    Chan, Raymond C. K.
    Chen, Ronald Y. L.
    Chen, Eric Y. H.
    Cheng, Wei
    Cheung, Eric F. C.
    Chong, Siow Ann
    Cloninger, C. Robert
    Cohen, David
    Cohen, Nadine
    Cormican, Paul
    Craddock, Nick
    Crowley, James J.
    Curtis, David
    Davidson, Michael
    Davis, Kenneth L.
    Degenhardt, Franziska
    Del Favero, Jurgen
    Dikeos, Dimitris
    Dinan, Timothy
    Djurovic, Srdjan
    Donohoe, Gary
    Drapeau, Elodie
    Duan, Jubao
    Dudbridge, Frank
    Durmishi, Naser
    Eichhammer, Peter
    Eriksson, Johan
    Escott-Price, Valentina
    Fanous, Ayman H.
    Farrell, Martilias S.
    Frank, Josef
    Franke, Lude
    Freedman, Robert
    Freimer, Nelson B.
    Friedl, Marion
    Friedman, Joseph, I
    Genovese, Giulio
    Georgieva, Lyudmila
    Giegling, Ina
    Giusti-Rodriguez, Paola
    Godard, Stephanie
    Goldstein, Jacqueline, I
    Golimbet, Vera
    Gopal, Srihari
    Gratten, Jacob
    de Haan, Lieuwe
    Hammer, Christian
    Hamshere, Marian L.
    Hansen, Mark
    Hansen, Thomas
    Hartmann, Annette M.
    Henskens, Frans A.
    Herms, Stefan
    Hirschhorn, Joel N.
    Hoffmann, Per
    Hofman, Andrea
    Hollegaard, Mads, V
    Ikeda, Masashi
    Joa, Inge
    Julia, Antonio
    Kahn, Rene S.
    Kalaydjieva, Luba
    Karachanak-Yankova, Sena
    Karjalainen, Juha
    Kavanagh, David
    Keller, Matthew C.
    Kennedy, James L.
    Khrunin, Andrey
    Kim, Yunjung
    Klovins, Janis
    Knowles, James A.
    Konte, Bettina
    Kucinskas, Vaidutis
    Kucinskiene, Zita Ausrele
    Kuzelova-Ptackova, Hana
    Kahler, Anna K.
    Laurent, Claudine
    Keong, Jimmy Lee Chee
    Lee, S. Hong
    Legge, Sophie E.
    Lerer, Bernard
    Li, Miaoxin
    Li, Tao
    Liang, Kung-Yee
    Lieberman, Jeffrey
    Limborska, Svetlana
    Loughland, Carmel M.
    Lubinski, Jan
    Lonnqvist, Jouko
    Macek, Milan, Jr.
    Magnusson, Patrik K. E.
    Maher, Brion S.
    Maier, Wolfgang
    Mallet, Jacques
    Marsal, Sara
    Mattingsdal, Morten
    McCarley, Robert W.
    McDonald, Colm
    McIntosh, Andrew M.
    Meier, Sandra
    Meijer, Carin J.
    Melegh, Bela
    Melle, Ingrid
    Mesholam-Gately, Raquelle, I
    Metspalu, Andres
    Michie, Patricia T.
    Milani, Lili
    Milanova, Vihra
    Mokrab, Younes
    Morris, Derek W.
    Murphy, Kieran C.
    Murray, Robin M.
    Myin-Germeys, Inez
    Muller-Myhsok, Bertram
    Nelis, Mari
    Nenadic, Igor
    Nertney, Deborah A.
    Nestadt, Gerald
    Nicodemus, Kristin K.
    Nikitina-Zake, Liene
    Nisenbaum, Laura
    Nordin Adolfsson, Annelie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    O'Callaghan, Eadbhard
    O'Dushlaine, Colm
    O'Neill, F. Anthony
    Oh, Sang-Yun
    Olincy, Ann
    Olsen, Line
    Van Os, Jim
    Pantelis, Christos
    Papadimitriou, George N.
    Papiol, Sergi
    Parkhomenko, Elena
    Pato, Michele T.
    Paunio, Tiina
    Pejovic-Milovancevic, Milica
    Perkins, Diana O.
    Pietilainen, Olli
    Pimm, Jonathan
    Pocklington, Andrew J.
    Powell, John
    Price, Alkes
    Pulver, Ann E.
    Purcell, Shaun M.
    Quested, Digby
    Rasmussen, Henrik B.
    Reichenberg, Abraham
    Reimers, Mark A.
    Richards, Alexander L.
    Roffman, Joshua L.
    Salomaa, Veikko
    Sanders, Alan R.
    Schall, Ulrich
    Schubert, Christian R.
    Schulze, Thomas G.
    Schwab, Sibylle G.
    Scolnick, Edward M.
    Scott, Rodney J.
    Seidman, Larry J.
    Shi, Jianxin
    Sigurdsson, Engilbert
    Silagadze, Teimuraz
    Silverman, Jeremy M.
    Sim, Kang
    Slominsky, Petr
    Smoller, Jordan W.
    So, Hon-Cheong
    Spencer, Chris C. A.
    Stefansson, Hreinn
    Steinberg, Stacy
    Stogmann, Elisabeth
    Straub, Richard E.
    Strengman, Eric
    Strohmaier, Jana
    Stroup, T. Scott
    Subramaniam, Mythily
    Suvisaari, Jaana
    Svrakic, Dragan M.
    Szatkiewicz, Jin P.
    Soderman, Erik
    Thirumalai, Srinivas
    Toncheva, Draga
    Tosato, Sarah
    Veijola, Juha
    Waddington, John
    Walsh, Dermot
    Wang, Dai
    Wang, Qiang
    Webb, Bradley T.
    Weiser, Mark
    Wildenauer, Dieter B.
    Williams, Nigel M.
    Williams, Stephanie
    Witt, Stephanie H.
    Wolen, Aaron R.
    Wong, Emily H. M.
    Wormley, Brandon K.
    Xi, Hualin Simon
    Zai, Clement C.
    Zheng, Xuebin
    Zimprich, Fritz
    Wray, Naomi R.
    Stefansson, Kari
    Visscher, Peter M.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Andreassen, Ole A.
    Blackwood, Douglas H. R.
    Bramon, Elvira
    Cichon, Sven
    Darvasi, Ariel
    Ehrenreich, Hannelore
    Esko, Tonu
    Gejman, Pablo, V
    Gill, Michael
    Gurling, Hugh
    Hultman, Christina M.
    Iwata, Nakao
    Jablensky, Assen, V
    Jonsson, Erik G.
    Kendler, Kenneth S.
    Kirov, George
    Knight, Jo
    Lencz, Todd
    Levinson, Douglas F.
    Li, Qingqin S.
    Liu, Jianjun
    Malhotra, Anil K.
    McCarroll, Steven A.
    McQuillin, Andrew
    Moran, Jennifer L.
    Mortensen, Preben B.
    Mowry, Bryan J.
    Nothen, Markus M.
    Ophoff, Roel A.
    Palotie, Aarno
    Pato, Carlos N.
    Petryshen, Tracey L.
    Posthuma, Danielle
    Rietschel, Marcella
    Riley, Brien P.
    Rujescu, Dan
    Sham, Pak C.
    St Clair, David
    Weinberger, Daniel R.
    Wendland, Jens R.
    Daly, Mark J.
    Sullivan, Patrick F.
    Gene expression imputation across multiple brain regions provides insights into schizophrenia risk2019In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 51, no 4, p. 659-+Article in journal (Refereed)
    Abstract [en]

    Transcriptomic imputation approaches combine eQTL reference panels with large-scale genotype data in order to test associations between disease and gene expression. These genic associations could elucidate signals in complex genome-wide association study (GWAS) loci and may disentangle the role of different tissues in disease development. We used the largest eQTL reference panel for the dorso-lateral prefrontal cortex (DLPFC) to create a set of gene expression predictors and demonstrate their utility. We applied DLPFC and 12 GTEx-brain predictors to 40,299 schizophrenia cases and 65,264 matched controls for a large transcriptomic imputation study of schizophrenia. We identified 413 genic associations across 13 brain regions. Stepwise conditioning identified 67 non-MHC genes, of which 14 did not fall within previous GWAS loci. We identified 36 significantly enriched pathways, including hexosaminidase-A deficiency, and multiple porphyric disorder pathways. We investigated developmental expression patterns among the 67 non-MHC genes and identified specific groups of pre- and postnatal expression.

  • 324. Hultdin, M
    et al.
    Rosenquist, R
    Thunberg, U
    Tobin, G
    Norrback, K-F
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Johnson, A
    Sundström, C
    Roos, G
    Association between telomere length and V(H) gene mutation status in chronic lymphocytic leukaemia: clinical and biological implications.2003In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 88, no 4, p. 593-8Article in journal (Refereed)
    Abstract [en]

    The immunoglobulin V(H) gene mutation status can divide B-cell chronic lymphocytic leukaemia (CLL) into two entities with a different clinical course. Cases with unmutated V(H) genes, considered to evolve from pregerminal centre (GC) cells, have a worse outcome compared to cases showing mutated V(H) genes, that is, post-GC derived. Also, telomere length has been reported to be of prognostic significance in CLL. Interestingly, telomerase becomes activated during the GC reaction and an elongation of the telomeres occurs in GC B cells. We performed telomere length and V(H) gene analysis in a series of 61 CLL cases, in order to investigate if the unique telomere lengthening shown in GC B cells could reflect the telomere status in the two subsets of mutated and unmutated CLL. A novel association was found between V(H) gene mutation status and telomere length, since significantly shorter telomeres were demonstrated in the unmutated group compared to the mutated group (mean length 4.3 vs 6.3 kbp). Shorter telomeres also constituted a subgroup with a worse prognosis than cases with longer telomeres (median survival 59 vs 159 months). Furthermore, the Ig gene sequence data revealed that samples with high mutations frequency (>6%) had long telomeres ( approximately 8 kbp). Thus, both the telomere and V(H) gene mutation status in CLL appear linked, which may reflect the proliferative history of the clonal cells with regard to the GC reaction.

  • 325.
    Hultgren, Rickard
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Staff attitudes towards follow-up and screening via the patient’s smartphone, exemplified by a questionnaire for self-rating of depression symptoms2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 326. Hultén, A
    et al.
    Wasserman, D
    Hawton, K
    Jiang, G X
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Schmidtke, A
    Bille-Brahe, U
    Bjerke, T
    Kerkhkof, A
    Michel, K
    Querejeta, I
    Recommended care for young people (15-19 years) after suicide attempts in certain European countries.2000In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 9, no 2, p. 100-8Article in journal (Refereed)
    Abstract [en]

    Data on recommended care for young people aged 15-19 years after attempted suicide from nine European research centres during the period 1989-1992 were analysed in terms of gender, history of previous suicide attempt and methods used. Altogether 438 suicide attempts made by 353 boys and 1,102 suicide attempts made by 941 girls were included. Analyses of the total data from all centres showed that young people with a history of previous suicide attempt and those using violent methods had significantly higher chance of being recommended aftercare than first-time attempters or those choosing self-poisoning. There were no significant differences of being recommended care between genders. Logistic regression analyses of the material were performed and the results were similar. Both having previous attempted suicide (odds ratio 2.0, 95% CI 1.53-2.61) and using "hard" methods (odds ratio 1.71, 95% CI 1.49-1.96) were significantly associated with increased possibility of being recommended aftercare. When individual centres were analysed, large disparities of recommended care after suicide attempts were found and there were no uniform criteria of recommending care for young suicide attempters in Europe.

  • 327.
    Hägg, Staffan
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Lindblom, Yvonne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mjörndal, Tom
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    High prevalence of the metabolic syndrome among a Swedish cohort of patients with schizophrenia2006In: International Clinical Psychopharmacology, ISSN 0268-1315, E-ISSN 1473-5857, Vol. 21, no 2, p. 93-98Article in journal (Refereed)
    Abstract [en]

    Several cardiovascular risk factors have been linked to antipsychotic treatment and cardiovascular mortality is increased in these patients compared to the general population. The full metabolic syndrome (or its components) is associated with an increased risk of cardiovascular disorders. The prevalence of the metabolic syndrome was investigated using a cross-sectional study design in a cohort of 269 patients, aged 20-69 years, with schizophrenia living in Northern Sweden, and was defined according to the criteria of the National Cholesterol Education program. The prevalence of the metabolic syndrome was 34.6% (95% CI = 28.8-40.3) and highest (43%; 95% CI = 32-53) for participants aged 40-49 years. Clozapine treated subjects reached the highest prevalence of the metabolic syndrome (48%; 95% CI = 34-62). The prevalence was similar for men (32.8%; 95% CI = 25.8-39.8) and women (38.0%; 95% CI = 27.9-48.2). Men had a high prevalence of hypertension (49.2%; 95% CI = 41.7-56.6) and women had high prevalence of low high-density lipoprotein cholesterol (40.2%; 95% CI = 30.0-50.4) and abdominal obesity (75.0%; 95% CI = 66.0-84.0). Subjects with the metabolic syndrome had significantly higher mean body mass index (BMI) (P < 0.001), HbA1c (P = 0.002), and fasting serum insulin (P < 0.001) compared to non-metabolic syndrome subject. Subjects with the metabolic syndrome had also significantly more often a positive history of cardiovascular diseases compared to non-metabolic syndrome subjects (25.8% versus 12.5%; P = 0.01). Of all study subjects 36.8% were obese (BMI > 30). These results clearly show that the metabolic syndrome and its components are highly prevalent in patients with schizophrenia. Physicians treating patients with schizophrenia are recommended to monitor the components included in the metabolic syndrome.

  • 328.
    Idenfors, Hans
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Young people's contact with healthcare before and after suicidal behaviour2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Self-harm is a major and growing public health issue among young people worldwide. Self-harm is an important risk factor for suicide, which is one of the leading causes of death for young people. Although suicide rates are declining overall, this trend is not seen in young people. Young people with mental distress and/or suicidal thoughts are reluctant to seek help, and often drop out of treatment initiated after a self-harm episode. Many young people who self-harm have had contact with healthcare before their first self-harm episode, but often for reasons other than suicidal thoughts or psychiatric problems. In this context, physical illness is associated with increased risk for self-harm and suicide among young people. The present thesis investigated how young people perceived the help and support they received before and after an episode of self-harm. A further aim was to map the inpatient somatic healthcare contacts young patients had before an episode of self-harm, and determine any relationship to risk for self-harm and suicide.

    Method

    Four studies were conducted using qualitative and quantitative methods. Participants were people aged 16-24 years. The definition of self-harm was based on the intentional self-harm criteria in the International Classification of Diseases, tenth revision, which includes all forms of self-harm without ascribing suicidal intent. In the first two studies, 10 respective 9 participants with a first healthcare contact for self-harm were interviewed during 2009-2011. The interviews covered participants’ knowledge and experience of professional care before their healthcare contact for self-harm. Participants were interviewed a second time 6 months later about their experiences with professional care during the period since their initial interview. Qualitative content analysis was used for all interviews. For the next two studies, we selected 16,235 participants with a first hospitalisation for self-harm during 1999-2009 from the Swedish National Inpatient Register. These cases were compared with matched controls to determine the odds of having been admitted with a non-psychiatric diagnosis during the year preceding the self-harm admission. To assess risk for suicide, data were retrieved from the Swedish Cause of Death Register for all deceased participants until 2013, and group differences were determined using survival analysis.

    Results

    In the first interview, participants described how they wanted more information on where they could turn for professional help. They also wanted different help-seeking pathways and emphasised the importance of the quality of professional contact. After 6 months, participants stressed the importance of being able to rely on professionals and treatment. Their life circumstances significantly affected their treatment, and practical help was appreciated. The register studies showed that young people admitted for self-harm were more likely to have been hospitalised with symptomatic diagnoses such as abdominal pain and syncope/collapse, and somatic illnesses such as epilepsy and diabetes mellitus type 1. A higher proportion of cases (4.5%; women 2.6%, men 8.8%) died during the study period than controls (0.3%; women 0.2%, men 0.6%) (p<0.001). For both cases and controls, a higher proportion of those with a previous somatic admission died from suicide during the study period than those without a somatic admission (cases: 4.2% vs. 2.8%, p<0.05). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year.

    Conclusion

    These findings suggest that healthcare providers need to find new ways to reach young people at risk for suicidal behaviour. Access to professional help should be easy and direct. Treatment for young people after self-harm should be flexible, and be receptive to input from the patient. The importance of and need for basic practical help should not be overlooked. Somatic healthcare contact provides an opportunity for intervention, particularly as psychiatric problems can manifest as physical symptoms, and physical illness is a risk factor for self-harm and suicide.

  • 329.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Professional care after deliberate self-harm: a qualitative study of young people's experiences2015In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 199-207Article in journal (Refereed)
    Abstract [en]

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

  • 330.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Professional Care as an Option Prior to Self-Harm A Qualitative Study Exploring Young People's Experiences2015In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 36, no 3, p. 179-186Article in journal (Refereed)
    Abstract [en]

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

  • 331.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta M. J.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Are Non-Psychiatric Hospitalisations Before Self-Harm Associated with Increased Risk of Unnatural Deaths Among Young People?2016In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 85, p. 66-67Article in journal (Other academic)
  • 332.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta M.J
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Non-psychiatric inpatient care preceding admission for self-harm in young people2016In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 88, p. 8-13Article in journal (Refereed)
    Abstract [en]

    Objective

    Many young people contact health services before they harm themselves intentionally. However, they often seek care for non-suicidal or non-psychiatric causes despite having suicidal thoughts. We investigated the non-psychiatric hospital diagnoses received by young people during the year before their first admission to hospital for self-harm.

    Methods

    From a national register, we selected people who were hospitalised for an episode of self-harm during the period 1999-2009, at which time they were aged 16 to 24. We compared them with matched controls regarding the probability for being admitted with different diagnoses during the year preceding the self-harm admission.

    Results

    The study included 48,705 young people (16,235 cases and 32,470 controls). Those admitted for self-harm were more likely than controls to have been hospitalised for non-psychiatric reasons, which included symptomatic diagnoses such as abdominal pain, syncope/collapse, unspecified convulsions, and chest pain. Certain chronic somatic illnesses were also overrepresented, such as epilepsy, diabetes mellitus type 1, and asthma.

    Conclusions

    Symptomatic diagnoses were more common in those who had been admitted for self-harm. It is possible that psychiatric problems could have been the cause of the symptoms in some of these admissions where no underlying illness could be found, and if this was not uncovered it might lead to a delay in suicide risk assessment. For several chronic illnesses, when admitted to hospital, a psychiatric evaluation might be indicated.

  • 333.
    Idenfors, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Strömsten, Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Are non-psychiatric hospitalisations before self-harm associated with an increased risk for suicide among young people?2019In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 120, p. 96-101Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 334. Ineland, Lisa
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sjölander, Per
    Attitudes towards mental disorders and psychiatric treatment--changes over time in a Swedish population.2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 192-7Article in journal (Refereed)
    Abstract [en]

    Over the years a lot of research of attitudes towards mental disorders, towards people with mental illness and towards psychiatric services and treatment have shown a persistent negative attitude. There are, however, few studies on changes over time. The aim of this study was to compare responses to a questionnaire on attitudes towards mental disorders and psychiatric patients and the perception of psychiatric treatment in a community in northern Sweden in 1976 and 2003. In 1976 a random sample of 391 persons 18-70 years of age were asked and in 2003 a new sample of 500 persons from the same community were approached with the same questions. There are considerable changes over time. In 2003, almost 90% agree to the statement that mental illness harms the reputation more than physical illness, compared with 50% in 1976. In 2003, 51% agreed to the statement "Most people with mental disorders commit violent acts more than others" compared with 24% in 1976. There is an apparent ambivalence towards psychiatric treatment. Whilst 88% would advice a person with mental problems to contact a psychiatrist, still 26% would not like themselves to be referred to a psychiatrist. We argue that improving treatment methods is as important as changing attitudes through accurate information.

  • 335.
    Israelsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Symptoms of Depression are Common in Patients With Idiopathic Normal Pressure Hydrocephalus: The INPH-CRasH Study2016In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 78, no 2, p. 161-168Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: If patients with idiopathic normal pressure hydrocephalus (INPH) also have depression, this could have important clinical ramifications in assessment and management of their cognitive function and response to shunting. In many dementias, depression is overrepresented, but the prevalence of depression in shunted patients with INPH is unknown.

    OBJECTIVE: The objective of this case-control study was to assess the prevalence of symptoms of depression in shunted INPH patients compared with population-based controls.

    METHODS: INPH patients consecutively shunted from 2008 to 2010 in Sweden were analyzed. Patients remaining after inclusion (within 60-85 years and not having dementia, ie, mini-mental state examination >=23) had a standardized visit to their healthcare provider and answered an extensive questionnaire. Age- and sex-matched population-based controls underwent the same procedure. Symptoms of depression were assessed using the Geriatric Depression Scale 15 (suspected depression defined as >=5 points, suspected severe depression as >=12 points). This study is part of the INPH-CRasH study.

    RESULTS: One hundred seventy-six INPH patients and 368 controls participated. After adjustment for age, sex, cerebrovascular disease, and systolic and diastolic blood pressure, patients had a higher mean depression score (patients: 4.9 ± 3.7 SD, controls: 1.9 ± 2.3 SD; OR 1.4, 95% CI 1.3-1.6, P < .001), more patients had suspected depression (46% vs 13%, OR 6.4, 95% CI 3.8-10.9, P < .001), and more patients had suspected severe depression (7.3% vs 0.6%, OR 14.4, 95% CI 3.0-68.6, P < .005).

    CONCLUSION: Symptoms of depression are overrepresented in INPH patients compared with the population, despite treatment with a shunt. Screening for depression should be done in the evaluation of INPH patients in order to find and treat a coexisting depression.

  • 336. Isung, J
    et al.
    Aeinehband, S
    Mobarrez, F
    Nordström, P
    Runeson, B
    Asberg, M
    Piehl, F
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    High interleukin-6 and impulsivity: determining the role of endophenotypes in attempted suicide2014In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 4, no e470Article in journal (Refereed)
    Abstract [en]

    The dysregulation of inflammation has been associated with depression and, more recently, with suicidal behaviors. The reports regarding the relationship between interleukin-6 (IL-6) and suicide attempts are inconsistent. Personality traits such as impulsivity and aggression are considered endophenotypes and important factors that underlie suicidal behaviors. The aim of the current study was to assess whether plasma and cerebrospinal fluid (CSF) levels of IL-6 are associated with personality traits among suicide attempters. We assessed the relationships among personality traits, IL-6 and violent suicide attempts. The plasma and CSF levels of IL-6 were measured in suicide attempters (plasma=58, CSF=39) using antibody-based immunoassay systems. Personality domains were assessed using the Karolinska Scale of Personality (KSP). IL-6 levels in plasma and CSF were used to predict personality domains via regression models. Plasma IL-6 was significantly and positively correlated with extraversion as well as the KSP subscales impulsivity and monotony avoidance. CSF IL-6 was positively correlated with monotony avoidance. Violent suicide attempts tended to be associated with high plasma IL-6 levels. Plasma and CSF levels of IL-6 were not significantly associated with each other. These results indicate that impulsivity and the choice of a violent suicide attempt method might be related to higher levels of IL-6 in individuals who attempt suicide. The neuroinflammation hypothesis of suicidal behavior on the basis of elevated IL-6 levels might be partly explained by the positive association between IL-6 and impulsivity, which is a key element of the suicidal phenotype.

  • 337.
    Jacobsson, L
    Umeå University, Faculty of Medicine, Department of Clinical Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The transition from mental hospital based to community based psychiatry.1999In: Medicinski arhiv, ISSN 0350-199X, Vol. 53, no 3, p. 131-3Article in journal (Refereed)
    Abstract [en]

    The reformation of psychiatry has been a central topic in health planning and care in most industrialized countries during the last decades. A short review of the political, professional and other forces behind this development is done. A short history of the development in Sweden is given as an example of the general tendencies in this change and the actors involved. There is now a rapidly growing scientific basis for the psychiatric service with a definite shift into a community based orientation. It is concluded that early intervention and prevention will be in focus for the development during the next decades.

  • 338.
    Jacobsson, L
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    von Schoultz, B
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Lalos, A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Björk, I B
    [Health personnel in the matter of legal abortion: physicians and other personnel should have the right to refuse to perform abortions].1983In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 80, no 39, p. 3541-5Article in journal (Refereed)
  • 339.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [Also physicians must interpret laws: not only the lawyers]2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 22, p. 1448-1449Article in journal (Refereed)
  • 340.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    "Bra karl reder sig själv - om inte så...!?": om det manliga självmordet2014In: Psykisk hälsa, ISSN 0033-3212, Vol. 55, no 3, p. 28-33Article in journal (Other academic)
  • 341.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Existentiella samtal lika viktiga som suicidpreventiva riskbedömningar2014In: Psykisk hälsa, ISSN 0033-3212, Vol. 55, no 1, p. 62-66Article in journal (Other academic)
  • 342.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [How we can get more researching psychiatrists].2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 7, p. 464-5Article in journal (Refereed)
  • 343.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Law and mental health: on the role of lawmaking in the process of developing psychiatric care1998In: Medicine and law, ISSN 0723-1393, Vol. 17, no 4, p. 571-579Article in journal (Refereed)
    Abstract [en]

    Mental health (as well as somatic health) depends on individual biological, psychological and social factors as well as more general societal factors. If one wishes to promote health, it is necessary to work in many different fields hopefully in a synergistic way. As a psychiatrist and clinician one is inclined to believe that developments in psychiatric science and practice are the most important activities to improve the mental health situation in a population. But, at the same time it is apparent that societal processes of social, political and economic nature also play a decisive role. One of the most important factors in the development of society is lawmaking by which its nature is setting the norms in a society and which is also usually combined with some kind of sanction system to support the norms. Lawmakers also have the possibility to interfere in the process of developing knowledge and practice in different fields, for example through supporting treatment and research of a special kind or even to forbid special kinds of treatment and research in certain areas. Lawmakers are also inclined to believe that if there is a law this will be enough to answer these challenges. I think it is extremely important that lawmaking in the field of mental health is in broad agreement with the development in the scientific and practical field of psychiatry and other mental health disciplines. This is the subject of this paper.

  • 344.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Living in conflict: talks with reindeer herding sami in southern Swedish Sápmi with special reference to psychosocial conditions2012In: Rivers to cross: Sami land use and the human dimension / [ed] Peter Sköld & Krister Stoor, Umeå: Vaartoe, Centrum för samisk forskning, Umeå universitet , 2012, p. 30-39Chapter in book (Other academic)
  • 345.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Om kritiken av psykvården2014In: Västerbotten, ISSN 0346-493-8, no 3, p. 49-53Article in journal (Other (popular science, discussion, etc.))
  • 346.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    On the picture of depression and suicide in traditional societies1988In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 344, p. 55-63Article in journal (Refereed)
    Abstract [en]

    The paper deals with three problem areas regarding depression and suicide in traditional society; 1) What is the relation between the depression and suicide? 2) Is there any illness like depression all over the world? 3) What do we know about suicide in traditional societies? The author agrees with Dürkheim's classical conclusion that the incidence of suicide in a society has no clear correlation with the prevalence of mental disorders and no clear correlation with different forms of mental disorders. There are a number of studies showing that depressive syndromes exist in traditional societies. However, there is a clear difference in symtomatology between different cultures which might be the result of differences in the conception of illness. The suicide rate is generally very low in traditional societies. The ultimate solution to an unbearable life situation is apparently known to all human cultures and the suicide rate is an important indication in every society of the existential conditions of life.

  • 347.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    [Suicide not only psychiatry's responsibility!]2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 3, p. 84-85Article in journal (Refereed)
  • 348.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The roots of stigmatization.2002In: World psychiatry : official journal of the World Psychiatric Association (WPA), ISSN 1723-8617, Vol. 1, no 1, p. 25-Article in journal (Refereed)
  • 349.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    "Therapeutic abortion" on demand: a social-psychiatric study of some background factors in legal abortion1975Doctoral thesis, comprehensive summary (Other academic)
  • 350.
    Jacobsson, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Arctic Research Centre at Umeå University.
    Fagerström, Anna
    Centre for Rural Medicine, County Council of Västerbotten, Umeå University, Umeå , Sweden.
    Daerga, Laila
    Centre for Rural Medicine, County Council of Västerbotten, Umeå University, Umeå , Sweden.
    Edin-Liljegren, Anette
    Centre for Rural Medicine, County Council of Västerbotten, Umeå University, Umeå , Sweden.
    Experiences of Psychiatric Care among Young Sami in Northern Sweden2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, no 33200Article in journal (Refereed)
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