| 1. |
- Jemberie, Wossenseged Birhane, 1985-, et al.
(författare)
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Substance Use Disorders and COVID-19 : Multi-Faceted Problems Which Require Multi-Pronged Solutions
- 2020
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
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| 2. |
- Markström, Urban, 1969-, et al.
(författare)
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Attitudes towards mental illness among health care students at Swedish universities : a follow-up study after completed clinical placement
- 2009
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Ingår i: Nurse Education Today. - : Elsevier Sciencedirect. - 0260-6917 .- 1532-2793. ; 29:6, s. 660-665
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to examine the changes in attitudes towards mental illness after theorethical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaries were used, measuring the level of familaritiy with mental illness and attitudes towards mental illness in general and toward specific mental illnesses. The data were collected on two occasions, before the theorethical course and after the completed clinical placement. The result showed that the attitudes toward mental illnes in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific illnesses did not show any major changes.
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| 3. |
- Forsberg, Karl Anton, 1955-, et al.
(författare)
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Influence of a life style intervention among persons with a psychiatric disability : a cluster randomised controlled trial on symptoms, quality of life and sense of coherence
- 2010
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Ingår i: Journal of Clinical Nursing. - Malden : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 19:11-12, s. 1519-1528
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The aim of this study was to investigate how a life style intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities. Background: Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at life style interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities.Design: a cluster randomised controlled trail.Methods: Forty one persons with a DSM- ІV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12 month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance.Results: A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up.Conclusions: Structured activities in the form of life style intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence.Relevance to clinical practice: Improving physical health with life style programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.
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| 4. |
- Bejerholm, Ulrika, et al.
(författare)
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Individual Placement and Support in Sweden-A randomized controlled trial
- 2015
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 69:1, s. 57-66
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Tidskriftsartikel (refereegranskat)abstract
- Background: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. Aims: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. Methods: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. Results: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. Conclusions: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.
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| 5. |
- Nilsson, Ingeborg, et al.
(författare)
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Measuring perceived meaningfulness in day centres for persons with mental illness
- 2011
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 18:4, s. 312-320
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: As support in leading a meaningful and active life, a person with mental illness is often given the opportunity to attend a day centre. However, few studies have investigated the meaningfulness perceived by the person visiting a day centre. For such a purpose, a self-report instrument was developed. Aims: To explore whether perceived meaningfulness, as expressed in the recently developed instrument Evaluation of Perceived Meaning in Day Centers (EPM-DC), could be viewed as one dimension and also to investigate the psychometric properties of this instrument. Methods: Persons with mental illness attending five day centres in Sweden participated and completed the questionnaire. The data were analysed by Rasch analysis. Major findings: The study showed that the concept captured in the instrument could be viewed as unidimensional and the result gave preliminary evidence for sound psychometric properties. Principal conclusion: The results indicate promising signs of validity and reliability, but the suitability of self-reporting may be questioned.
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| 6. |
- Hadding, Cecilia, 1976-
(författare)
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”Att nästan inte få existera” : före detta sektmedlemmars erfarenheter – med fokus på psykisk hälsa och mötet med sjukvården
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The controlling culture of a cult can be harmful to its members. Living in and leaving a cult can be challenging, lead to mental illness and experience the need for support.Aims: I - To explore former cult members' perceptions of consultations with healthcare professionals for mental illness that they relate to their cult involvement. The study also aims to identify the needs, obstacles, and facilitating factors related to these consultations. II - To explore the experiences of acculturation into secular Swedish society of former members of cults, with particular focus on mental health, needs and resources. III - To explore exposure to violence and coercive control in cults, and its consequences for mental health.Design: A qualitative approach was used in all studies. Semi structured interviews (I, III) and the cultural formulation interview from DSM -5 (II) were used to collect data. Studies I and II were analyzed using qualitative content analysis with systematic text condensation. Study III was analyzed using reflexive thematic analysis.Participants: Adult former members of ideological or religion-based cults. Studies I and III include nineteen participants who had been in contact with Swedish healthcare professionals due to mental illness related to their cult involvement. Study II include eleven participants.Results: Being a cult member involved constant exposure to threats and violence. The acculturation process after leaving the cult put them in an in-between state and it took time and effort to resettle in mainstream society. They struggled with a persisting coercive bond to the cult's ideals, shame, trauma, and mental health sequalae. In their consultations with healthcare professionals the former cult members remained affected by the cults rules and belief system. This made it harder for them to communicate their needs and accept care.Conclusion: Former cult members face a complex acculturation process while they struggle in several aspects of life with mental health, shame, problems with trust and personal boundaries. To effectively understand and support former cult members, healthcare professionals must consider both the cultural and existential aspects of former cult members' lives, in addition to their mental health and persisting bond to the cult.
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| 7. |
- Gustafsson, Carina, et al.
(författare)
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Effects of Psychosocial Interventions for People With Intellectual Disabilities and Mental Health Problems : A Survey of Systematic Reviews
- 2009
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Ingår i: Research on social work practice. - : Sage Publications. - 1049-7315 .- 1552-7581. ; 19:3, s. 281-290
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Forskningsöversikt (refereegranskat)abstract
- 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.
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| 8. |
- Omma, Lotta, 1952-, et al.
(författare)
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Suicidal expressions in young Swedish Sami, a cross-sectional study
- 2013
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Ingår i: International Journal of Circumpolar Health. - : International Association of Circumpolar Health Publishers. - 1239-9736 .- 2242-3982. ; 72, s. 19862-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To investigate the experience of suicidal expressions (death wishes, life weariness, ideation, plans and attempts) in young Swedish Sami, their attitudes toward suicide (ATTS), and experience of suicidal expressions and completed suicide in significant others and to compare with Swedes in general. Methods. A cross-sectional study comprising 516 Swedish Sami, 18-28 years of age together with an age and geographically matched reference group (n = 218). Parts of the ATTS questionnaire have been used to cover different aspects of the suicidal complex. Data were analysed with regard to gender, occupation, counties and experience of negative societal treatment due to Sami background. Results. Both young Sami and young Swedes reported suicidal ideation, life weariness, and death wishes in a high degree (30-50%), but it was more common among the Sami. Having had plans to commit suicide showed a significant gender difference only in the Sami. The prevalence of suicide attempts did not differ significantly between Sami and Swedes. Subgroups of the Sami reported a higher degree of suicidal behaviour, Sami women and reindeer herders reported a 3, 5-fold higher odds of suicide attempts and a 2-fold higher odds having had plans committing suicide. Sami living in Vasterbotten/Jamtland/Vasternorrland and Sami with experience of ethnicity related bad treatment 2-fold higher odds of suicidal plans compared to those living in other counties. Conclusion. An increased occurrence of suicidal ideation/death wishes/life weariness in young Sami compared to young majority Swedes was found, but not an increased prevalence of suicide attempts and positive attitudes together with an increased awareness to handle suicide problems could be a contributing factor. Severe circumstances and experience of ethnicity-related bad treatment seems to contribute to increased levels of suicidal plans and attempts in subgroups of Sami.
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| 9. |
- Pihkala, Heljä, 1961-, et al.
(författare)
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Initiating communication about parental mental illness in families : an issue of confidence and security
- 2012
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Ingår i: International Journal of Social Psychiatry. - London : Sage Publications. - 0020-7640 .- 1741-2854. ; 58:3, s. 258-265
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Tidskriftsartikel (refereegranskat)abstract
- Background: Beardslee's family intervention (FI) is a family-based intervention to prevent psychiatric problems for children of mentally ill parents. The parents' experiences are of importance in family-based interventions.Method: Twenty five parents were interviewed about their experiences of FI. Data were analysed by qualitative methods.Discussion: Confidence and security in the professionals and in FI as a method were prerequisites for initiating communication about the parents' mental illness with the children.Conclusions: FI provides a solid base for an alliance with the parents and might be a practicable method when parenthood and children are discussed with psychiatric patients.
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| 10. |
- Öhlund, Louise, 1983-
(författare)
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Factors affecting the pharmacological treatment of bipolar disorder
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In patients with bipolar disorder, long-term treatment with mood-stabilisers is often required to prevent manic and depressive episodes. At present, our knowledge remains limited regarding factors that influence the outcomes of mood-stabiliser treatment.Lithium is a first-line treatment of bipolar disorder, thought to be superior regarding the prevention of acute relapse, self-harm and suicide. But despite its therapeutic superiority, patients may find lithium difficult to take long-term. The reasons why patients discontinue lithium treatment remain largely unknown. Neither do we know whether lithium is equally effective in patients with bipolar I and bipolar II disorder. Finally, there is only little evidence on how patients with a dual diagnosis of bipolar disorder and adult attention-deficit hyperactivity disorder (ADHD) should be treated. In this patient group, central stimulant treatment may be of benefit, as long as mood-stabilisers are given simultaneously to prevent manic relapses. However, there are no studies that have explored the impact of central stimulants on suicidal and non-suicidal self-injurious behaviour in patients with such a dual diagnosis.Aim: The overall aim of this thesis was to study three factors that may modify treatment outcomes in patients with bipolar disorder or schizoaffective disorder; (1) adherence to lithium and reasons for lithium discontinuation, (2) impact of lithium discontinuation on clinical course in different bipolar disorder subtypes, and (3) impact of central stimulants on suicidal and non-suicidal self-injurious behaviour in patients with a dual diagnosis of bipolar disorder and ADHD.Method shared by all studies: All three studies were part of LiSIE (Lithium – Study into Effects and Side Effects), a retrospective cohort study in the regions of Norrbotten and Västerbotten, exploring effects and side-effects of lithium and other mood-stabilisers. For our studies, we identified 1566 individuals who had been diagnosed with bipolar disorder or schizoaffective disorder. Study II and III are based on 1564 patients due to consent withdrawal in one patient and diagnosis reassessment in another. For the respective study included in this thesis, we extracted routine clinical data from the medical records.Study I identified and assessed the reasons for lithium discontinuation in 468 patients with bipolar disorder or schizoaffective disorder in relation to (a) type of underlying disorder, bipolar I or schizoaffective disorder versus bipolar II or other bipolar disorder, (b) gender, and (c) person taking the initiative to discontinue lithium (doctor or patient).Study II applied a mirror-image design to examine the clinical course and need for hospital admissions in 194 patients with either bipolar I or schizoaffective disorder or bipolar II or other bipolar disorder within two years before and after lithium discontinuation.Study III assessed occurrence of suicidal or non-suicidal self-injurious behaviour in 206 patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD. This study also used a mirror-image design, comparing the number of suicide attempts and non-suicidal self-injury events within six months and two years before and after central stimulant initiation.Results: Study I: More than half of all patients discontinued lithium at some point. Lithium discontinuation mainly occurred because of adverse effects. More patients with bipolar II or other bipolar disorder than patients with bipolar I or schizoaffective disorder discontinued lithium because of a perceived lack of effect. Men were more likely to discontinue lithium when feeling well. They were also less likely to consult with a doctor prior discontinuation.Study II: The number of hospital admissions and bed-days doubled after lithium discontinuation. This increase was exclusively attributable to patients with bipolar I or schizoaffective disorder. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood-stabiliser at the time of lithium discontinuation led to more admissions.Study III: In patients with a dual diagnosis of bipolar or schizoaffective disorder and ADHD, central stimulant treatment reduced the number of suicide attempts and non-suicidal self-injury events. There was no increase in number of hospital admissions.Conclusion: Lithium discontinuation in patients with bipolar disorder or schizoaffective disorder is common and mainly occurs because of adverse effects. It is important that patients who may benefit from lithium can continue their treatment. Therefore, clinicians should discuss and manage potential adverse effects of lithium treatment with patients before initiation and continuously during treatment. Particularly men may require proactive follow-up since they may be more likely to discontinue their treatment without consulting a doctor.Lithium discontinuation in patients with bipolar I or schizoaffective disorder comes at a cost of deteriorated mental health and increased hospital utilisation. In patients with bipolar II or other bipolar disorder, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admissions. The higher relapse risk in patients with bipolar I or schizoaffective disorder points towards a need to apply a higher threshold for lithium discontinuation in this group.In patients with both bipolar disorder and ADHD, addition of central stimulant treatment may reduce the risk of suicide attempts and non-suicidal self-injury events. This suggests that central stimulants can be safely given in this patient group, as long mood-stabiliser treatment are given concomitantly.
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