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- Lu, Donghao, et al.
(författare)
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Increased risk for psychiatric disorders immediately before and after cancer diagnosis : A nationwide matched cohort study in Sweden
- 2015
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Ingår i: Psychoneuroendocrinology. - : Elsevier BV. - 0306-4530 .- 1873-3360. ; 61, s. 50-50
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To examine whether undergoing diagnostic workup leading up to a cancer diagnosis entrails increased risks for depression, anxiety disorder, substance use disorder, somatoform/conversion disorder, severe stress and adjustment disorder.Methods: Based on the nationwide health registers in Sweden, we conducted a matched cohort study during 2001–2010, including 304,118 cancer patients and five cancer-free individuals per cancer patient randomly selected from the Swedish population and matched on year of birth and sex. Flexible parametric survival models were used to estimate the time-varying hazard ratios [HRs] of any first in-/outpatient diagnosis of the studied psychiatric disorders from two years before cancer diagnosis (Year−2), through the time at diagnosis (Year 0), until ten years after diagnosis (Year 10).Results: The overall risk for the studied psychiatric disorders started to increase from Year−1 (HR 1.2, 95% confidence interval [CI] 1.0–1.5), peaked immediately after diagnosis (Week 1: HR 12.9, 95% CI 9.4–17.8), and decreased rapidly thereafter to be comparable with cancer-free individuals at approximately Year 10 (HR 1.0, 95% CI 0.8–1.3). The risk elevation was clear for all main cancer types except for non-melanoma skin cancer; and was stronger for cancers of relatively poor prognosis after (P= 0.0005) but not before diagnosis (P= 0.47).Conclusion: Patients recently diagnosed with cancer experience a dramatic increase in risks of psychiatric disorders. The clear risk elevation during the year before diagnosis suggests an impact of cancer symptoms pre-diagnosis as well as the stress of undergoing clinical evaluation for a suspected malignancy. This work is supported by Cancerfonden and FORTE.
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- Bergh Johannesson, Kerstin, 1949-
(författare)
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Traumatic Exposure, Bereavement and Recovery among Survivors and Close Relatives after Disasters
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- International studies of disasters indicate the risk for developing posttraumatic stress reactions among survivors is high. Modern life implicates increased traveling. During the last decades a large number of Swedish citizens were confronted with disasters taking place outside of their country. The prevalence of trauma reactions in a population that does not normally experience natural disasters, but are able to return to a community unaffected by the catastrophe, is not well studied. In addition, the effects of bereavement after traumatic circumstances have not been satisfactorily explored. Longitudinal studies on the effects of natural disasters are underrepresented and there are few studies investigating the course of recovery after traumatic exposure. The aim for this thesis was to examine long-term post-traumatic stress reactions, mental health, and complicated grief after disaster exposure and traumatic bereavement. Data from returned questionnaires were analysed from bereaved Italian and Swedish relatives 18 months after the Linate airplane disaster 2001, and at 14 months and three years from Swedish travelers returning from Southeast Asia after the 2004 tsunami disaster, and from home staying bereaved relatives within the second year after the tsunami disaster. The main outcome measures were GHQ-12, IES-R and Inventory of Complicated Grief. The findings indicated many survivors were resilient and had ability to recover, but severe exposure to a disaster had considerable impact on psychological distress. Life threat was associated with higher levels of post-traumatic stress reactions, and increased the risk for affected mental health and suicidal ideation. Loss in combination with severe life threat exposure indicated a further increased risk of posttraumatic stress reactions and for complicated grief; this should be considered a substantial risk factor for general mental health. Loss of close relatives, especially loss of children, was associated with higher levels of posttraumatic stress and created a greater risk for complicated grief. Many survivors recovered over time; however, severe exposure and traumatic loss appeared to slow the recovery process. The findings have implications for government and health agencies, regarding the importance of knowledge and awareness of these risks for health, and for organizational structure, training, and accessibility of support and adequate treatment.
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