| 1. |
- Pat, Puthy, 1985-
(författare)
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Insights from inside : addressing mental health, well-being and healthcare needs of young prisoners in Cambodia
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Globally, studies have indicated a significantly higher prevalence of mental health disorders and suicidal behaviours among young prisoners compared to adult prisoners and the general population. In Cambodia, the experience of historical trauma and contemporary challenges exacerbate mental health concerns among young people, yet there is a lack of adequate mental health resources and research within the prison system. To address these issues, there is a critical necessity for comprehensive assessments of mental health needs, interventions tailored to local contexts, and reforms in the prison healthcare system, all of which are essential for improving the well-being and quality of life of young prisoners in Cambodia and beyond.Aims: This thesis aimed to address the mental health, well-being, and healthcare needs of young Cambodian prisoners by exploring their mental health situation, efficacy of life skills interventions, coping mechanisms, and health system strengthening strategies, all informed by insider perspectives to enhance their well-being.Methods: The thesis was conducted in four selected prisons. Both quantitative and qualitative approaches were used to fulfil its aims. The quantitative component was used to assess the current mental health of youngprisoners and to evaluate the impact of the Life Skills Education (LSE) intervention. The qualitative elements aimed to explore the perspectives of both young prisoners and prison staff regarding their current mental health status and coping mechanisms and the strategies applied to enhance the prison health system.Results: The quantitative findings revealed high levels of mental health problems but low suicidal behaviours among the participants. Factors such as younger age, lower education, and a history of drug use were associated with higher level of mental health problems. While the LSE intervention led to an improvement in mental health, the differences with the controlgroup were not statistically significant. Qualitative insights highlighted the challenges faced by young prisoners, including loneliness, lack of family support, and unmet basic needs, impacting their mental wellbeing.Some employed coping strategies, but overall there was a reliance on self-help and family support due to the limited availability of healthcare services acknowledged by prison staff. Staff emphasized the need for reforms, including mental health awareness activities, staff training, governance improvements, and external support to enhance prison healthcare services.Conclusion: This thesis revealed a high level of mental health problems among young prisoners in Cambodia, underscoring the critical need for contextualized mental health interventions. While the impacts of the LSE programme were limited, it lays the groundwork for future improvements. Perspectives from both young prisoners and staff emphasized the importance of self-help strategies and staff training. Moving forward, policymakers should prioritize mental health services and reforms to better support young prisoners' well-being in Cambodian prisons.
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| 2. |
- Ekman, Anna-Theresia, et al.
(författare)
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Prevalence of children under five with disabilities in Sierra Leone in 2017: Insights from a population-based multiple indicator cluster survey
- 2023
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Ingår i: Disability and Health Journal. - : ELSEVIER SCIENCE INC. - 1936-6574 .- 1876-7583. ; 16:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Children with disabilities have been low on the agenda of child health, including in Sierra Leone, and there are still many gaps in our knowledge and understanding of the issue.Objective: To estimate the prevalence of children with disabilities in Sierra Leone using functional difficulty as a proxy and to understand the factors associated with disabilities among children two to four years living in Sierra Leone.Methods: We used cross-sectional data from the Sierra Leone 2017 Multiple Indicator Cluster Survey. Disability was defined using a functional difficulty definition with additional thresholds used to define children with severe functional difficulty and multiple disabilities. Logistic regression models estimated odds ratios (ORs) of childhood disability and how they were associated with socioeconomic factors and living conditions.Results: Prevalence of children with disabilities was 6.6% (95% confidence interval (CI) 5.8-7.6%) and there was a high risk of comorbidity between different functional difficulties. Children with disabilities were less likely to be girls (adjusted odds ratio (AOR) 0.8 (CI 0.7-1.0) and older (AOR 0.3 (CI 0.2-0.4)), but more prone to be stunted (AOR 1.4 (CI 1.1-1.7)) and have younger caregivers (AOR 1.3 (CI 0.7-2.3)).Conclusion: The prevalence of disabilities in young Sierra Leonean children was comparable to other countries in West and Central Africa when using the same measure of disability. Preventive as well as early detection and intervention efforts are recommended to be integrated with other programs, e.g vaccinations, nutrition, and poverty reducing programs.(c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 3. |
- Lok, Veeleah, et al.
(författare)
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Changes in anxiety and depression during the COVID-19 pandemic in the European population : A meta-analysis of changes and associations with restriction policies
- 2023
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Ingår i: European psychiatry. - 0924-9338 .- 1778-3585. ; 66:1
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Forskningsöversikt (refereegranskat)abstract
- Background. Early studies of common mental disorders (CMDs) during the COVID-19 pandemic mainly report increases; however, more recent findings have been mixed. Also, studies assessing the effects of restriction measures on CMDs show varied results. The aim of this meta-analysis was to assess changes in levels of CMDs from pre-/early to during the pandemic and the effects of restriction policies in the European population.Methods. We searched for studies assessing both pre-pandemic and peri-pandemic self-reported emotional distress and symptoms of depression or anxiety among nationally/regionally representative samples in Europe and collected microdata from those studies. Estimates of corona containment index were related to changes in CMDs using random-effects meta-regression.Results. Our search strategy resulted in findings from 15 datasets drawn from 8 European countries being included in the meta-analysis. There was no evidence of change in the prevalence of emotional distress, anxiety, or depression from before to during the pandemic; but from early pandemic periods to later periods, there were significant decreases in emotional distress and anxiety. Increased school restrictions and social distancing were associated with small increases in self-reported emotional distress.Conclusions. Despite initial concerns of increased emotional distress and mental illness due to the COVID-19 pandemic, the results from this meta-analysis indicate that there was a decrease in emotional distress and no change in anxiety or depression in the general population in Europe. Overall, our findings support the importance of strong governance when implementing periodic and robust restriction measures to combat the spread of COVID-19.
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| 4. |
- Bjork Thordardottir, Edda, et al.
(författare)
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Mortality and major disease risk among migrants of the 1991-2001 Balkan wars to Sweden : A register-based cohort study
- 2020
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 17:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991-2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period.Methods and findings: We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991-2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34-1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29-1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08-1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15-1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14-1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96-10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48-0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51-0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration.Conclusions: Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.
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| 5. |
- Hollander, Anna-Clara, et al.
(författare)
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Validation study of randomly selected cases of PTSD diagnoses identified in a Swedish regional database compared with medical records : is the validity sufficient for epidemiological research?
- 2019
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In Sweden, the patients' diagnoses are recorded in administrative registers. The research value of these registers is determined by their diagnostic validity, that is, if the diagnosis recorded meets the relevant diagnostic criteria. The aim of the study was to assess the validity of post-traumatic stress disorder (PTSD)-diagnoses as compared with case notes in medical records (MRs) and to test if there was a difference in validity by gender, migration status and those with and without psychotic symptoms. We hypothesised that the validity would be sufficient, using both Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV and DSM-5 but higher according to DSM-IV than DSM-5, and that the validity would be the same for men and women, but different for Swedish-born and migrants, and for those with and without psychotic symptoms.DESIGN AND SETTING: A validation of the register-diagnoses using MRs from treatment centres within the Region of Stockholm to examine whether patients with a register-diagnosis of PTSD fulfilled DSM criteria of PTSD according to the case notes in their MRs.PARTICIPANTS: A random sample of 187 patients aged 18-64, who had been diagnosed with PTSD (F43.1 in the ICD-10) were drawn from the Region of Stockholm's MR database 2013-2015.PRIMARY OUTCOME MEASURE: Validity of the PTSD diagnoses according to DSM-IV and DSM-5 as proportions of true positives with 95% CI.RESULTS: The hypothesised sufficient validity of the PTSD diagnoses was confirmed. Although the point-estimates for DSM-IV were higher than for DSM-5, the hypothesis that there would be significant differences in validity between DSM-IV and DSM-5 was not confirmed. There were no significant validity differences by gender, migration status and for those with and without psychotic symptoms.CONCLUSIONS: This study has found that validity of the PTSD diagnoses in the register of the Region of Stockholm to be sufficient for epidemiological research.
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| 8. |
- Sjöström, Stefan, 1965-, et al.
(författare)
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Collegiality, therapy and mediation : the contribution of experts in Swedish mental health law
- 2017
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Ingår i: Laws. - : MDPI AG. - 2075-471X. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Independent experts serve a vital role in how the human rights of patients are protected in mental health law. This article investigates the contribution of court-appointed psychiatrists (APs) in civil commitment court hearings. Analysis is based on 12 court hearings that were audiotaped. Supplementary informal interviews with participants were also conducted. Data were analysed through a combination of rhetoric analysis and discourse analysis. Analysis of the hearings reveals that APs do not fulfil their function to critically investigate treating psychiatrists’ (CPs) recommendations that patients meet commitment criteria. They typically do not ask any questions from CPs, and the few questions that are asked do not cast light on the legal issues at stake. To further understand the role of APs, their communication has been analyzed in terms of four interpretative repertoires: collegial, disclosing, therapeutic and mediating. In conclusion, the human rights of patients subjected to involuntary commitment might be at risk when therapeutic concerns are built into the process. The specific Swedish model where APs deliver their own assessment about whether commitment criteria are met may be counterproductive. This argument possibly extends to the role of medical members in mental health tribunals in the United Kingdom, Australia and New Zealand.
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| 9. |
- Manhica, Hélio, et al.
(författare)
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Origin and schizophrenia in young refugees and inter-country adoptees from Latin America and East Africa in Sweden : a comparative study
- 2016
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 2:1, s. 6-9
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Tidskriftsartikel (refereegranskat)abstract
- Background Migrants’ socioeconomic adversity has been linked to schizophrenia.Aims To investigate whether the more favourable socioeconomic situation of adoptees prevents them from the high risk of schizophrenia found in other migrants.Method Register study in a cohort of refugees and inter-country adoptees aged 16–40 years, born in East Africa (n=8389), Latin America (n=11 572) and 1.2 million native Swedes. Cox-regression models estimated hazard ratios (HRs) of schizophrenia in data from psychiatric care.Results Despite diverse income levels, HRs for schizophrenia were similar for refugees and adoptees, with East Africans having the highest HRs: 5.83 (3.30–10.27) and 5.80 (5.03–6.70), followed by Latin Americans: HRs 3.09 (2.49–3.83) and 2.31 (1.79–2.97), compared with native Swedes. Adjustment for income decreased these risks slightly for refugees, but not for adoptees.Conclusions This study suggests that risk factors associated with origin are more important determinants of schizophrenia than socioeconomic adversity in the country of settlement.
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| 10. |
- Alexius, Katarina, et al.
(författare)
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Forskare: Ge socialtjänsten rätt verktyg
- 2015
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Ingår i: Svenska dagbladet. - Stockholm. - 1101-2412. ; :2015-12-11
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Att socialtjänstens personal kan hantera och tolka nyckelbegrepp som ”barnets bästa” och ”god vård” är helt avgörande för förstärkningar av barns reella rättigheter, skriver forskare vid Stockholms universitet och Ersta Sköndal högskola.
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