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- Bohman, Hannes
(författare)
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Adolescents with Depression Followed up : Prognostic Significance of Somatic Symptoms and Their Need of In-Patient Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A dualist approach that distinguishes between mind and body is still the norm in Western medicine. Although we now know that physical and mental health are related in adults, little is known about if, or with what mechanisms, mental illnesses or depression early in life, will affect future physical and psychological health. In-between mental and somatic disorders there are somatic symptoms without medical explanation. These are symptoms that cause much suffering and impairment which are costly for society. Still little is known what they are, how they should be treated and what consequences they have for adolescents when they grow up. This study aims to investigate the long-term relationship between mental and somatic disease and the outcome of adolescents with functional somatic symptoms.The thesis is based on a 15-year follow-up study of a population-based investigation of adolescent depression. In 1991–1993 first year students in upper secondary school (age 16–17) in Uppsala, Sweden, were screened for depression (n=2300). Adolescents with positive screening and selected peers with negative screening (n=631) were assessed regarding mental health and somatic symptoms. At around age 31, the participants were followed-up in personal interviews (n=369) and national registers (n=609). Outcomes regarding mental DSM-IV diagnosis, in-patient ICD-10 disease diagnosis from the patient register, and blood vessel wall thickness were assessed.The most important finding is the unexpected poor short and long-term outcome in adolescents with somatic symptoms. The result proves the need for better treatment. The strong prediction of functional somatic symptoms for mental disorder, independent of adolescent depression, suggests that somatic symptoms and depression symptoms are different expressions of a common disorder. Female adolescents with depression need more psychiatric and somatic in-patient care but the males do not. Instead, they have considerably more in-patient stays due to alcohol and drug abuse. The males might be taken care of outside the health care system and seem to need special attention. In women with adolescent and recurrent adult depression there is an association with premature aging of the carotid wall. These women are at risk of developing early cardio-vascular disease and need early interventions.
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- Haglund, Kristina, 1950-
(författare)
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Patient and Staff Perceptions of Medication Administration and Locked Entrance Doors at Psychiatric Wards
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim was, within psychiatric inpatient care, to explore patient and staff perceptions with regard to medication administration and locked entrance doors. In Study I, medication administration was illuminated according to a mini-ethnographic approach. Nurses and voluntarily admitted patients were observed and interviewed. Two central categories of patient and nurse experiences were identified, get control and leave control. In Study II, patients and nurses were interviewed about patient experiences of forced medication. Identified experiences were related to the disease, being forcibly medicated, and the drug. In Study III, the frequency of and reasons for locked entrance doors on Swedish psychiatric inpatient wards were investigated. Seventy three per cent of the doors were locked on a specific day. According to ward managers, doors were most often locked in order to prevent patients from escaping, provide security and safety, and because legalisation. In Study IV/V, voluntarily admitted patients/mental nurse assistants and nurses were interviewed about advantages and disadvantages about being cared for/working on a psychiatric inpatient ward with a locked entrance door. Most advantages mentioned by patients and staff were categorised as protection against “the outside”, secure and efficient care, and control over patients. Most disadvantages mentioned by patients were categorised as confinement, dependence on the staff, and emotional problems for patients. Most disadvantages mentioned by staff were categorised as extra work, confinement, dependence on the staff, and a non-caring environment. In conclusion, medication administration and locked entrance doors are perceived as connected with staff’s control and restricted freedom for patients. Increased reflection among staff about how medication administration and locked entrance doors are perceived by patients would increase staff’s possibilities to prevent potential experiences of coercion due to these situations among patients in psychiatric inpatient care.
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- Jonsson, Ulf, 1974-
(författare)
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Adolescents with Depression Grown up : Education, Intimate Relationships, Mental Health, and Personality
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unipolar depression, estimated to be the leading contributor to burden of disease in middle- and high-income countries, often has an onset in adolescence. The disorder is associated with substantial role impairment and is highly recurrent. This raises questions about both subsequent mental health and social outcome. In order to shed light on this, a community sample of adolescents with depression and non-depressed peers was followed-up after 15 years. In 1991-93, first-year students in upper secondary school (age 16-17) in the town of Uppsala, Sweden, were screened for depression. Adolescents with positive screening and selected peers with negative screening (n=631 in total) were assessed regarding mental health, social situation, and personality. At around age 31, the participants were followed-up in both national registers (n=609) and personal interviews (n=409). Outcome regarding social factors, mental health, and personality was assessed. At follow-up, the former depressed adolescents had completed higher education to a lesser extent than the former non-depressed adolescents. The females with adolescent depression were also at increased risk of subsequent abortion, divorce, single parenthood, and partner violence. Characteristics associated with depression in adolescence (such as poor school performance and disruptive disorders) seemed to contribute to the poor outcome in the social domain. Regarding adult mental health, long-term depression in adolescence was associated with a particularly poor outcome. Compared to adolescents with shorter episodes of depression, those with long-term depression were more likely to report recurrent depression, suicidal ideation, and a range of other mental disorders in adulthood. Measures of personality traits related to neuroticism (a tendency towards negative emotionality) were elevated during ongoing depression and anxiety disorders, but were normalized with remission. However, repeated depressive episodes seemed to leave the individual more vulnerable to stress. It is now important to assess if early treatment can alter the poor outcome depicted in this thesis. Since social adversity, educational difficulties, and interpersonal problems accompany the depressive disorder from adolescence onward, it should also be investigated if interventions aimed at such contextual factors can prevent recurrence and improve quality of life.
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- Fekadu, Abebaw
(författare)
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Studies on affective disorders in rural Ethiopia
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Affective disorders are poorly defined and studied in sub-Saharan Africa despite their substantial public health impact. Objectives Overall objective: To describe the epidemiology of selected affective disorders in rural Ethiopia. Specific objectives 1. To describe the validity and utility of the concept of minor depressive disorder (mD). 2. To describe the manifestation, prevalence and the short-term clinical and functional course and outcome of bipolar disorder. Subjects and methods Population: Zay community residents (age ≥16), and residents of Butajira (ages 15-49), in Southern Ethiopia. Study design: Population-based cross-sectional and longitudinal studies Case identification: For the identification of cases with bipolar disorder, a two stage process was employed. An initial screen used key informants and interview with the Composite International Diagnostic Interview (CIDI) to identify cases with probable bipolar disorder. A second confirmatory diagnostic assessment stage employed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). For the identification of cases with mD, data from the CIDI was used. Follow-up: 312 cases with bipolar disorder from Butajira were followed up for a mean of 2.5 years (ranging 1-4 years) through monthly clinical assessments and annual symptom and functional ratings. Results The CIDI was administered to 1714 adults among the Zay and to 68, 378 adults among the Butajira residents. The prevalence of mD among the Zay and Butajira was 20.5% and 2.2% respectively. Up to 80% of cases with mD had used services for their symptoms, while a third to a half of cases had thought about self harm. Up to a sixth of cases had attempted suicide. Age, marital status, education and somatic symptoms were independently associated with mD. The prevalence of bipolar disorder among the Zay was 1.8%. During a 2.5-year follow-up of 312 cases with bipolar disorder from Butajira, 65.9% relapsed (47.8% manic, 44.3% depressive and 7.7% mixed episodes) while 31.1% experienced persistent illness. Female gender predicted depressive relapse whereas male gender predicted manic relapse. Only being on psychotropic medication predicted remission (OR=3.42; 95% CI=1.82, 6.45). Disability was much worse among bipolar patients than in the general population and was predicted by symptom se3verity. Conclusions This is the largest study on mD and bipolar disorder in Africa. mD appears to have potential clinical utility in this setting given its association with service use and risk. The identified risk factors for mD also suggest potential aetiological continuity with major depression. The relatively high prevalence of bipolar disorder among the Zay may be related to genetic predisposition perhaps mediated through a founder effect, but other factors need exploring. In relation to the outcome of bipolar disorder, this study indicates that, contrary to previous assumptions, the course of bipolar disorder is characterised by both manic and depressive relapses in a relatively proportionate fashion. Bipolar disorder also leads to significant levels of disability. This is the only prospective outcome study of bipolar disorder in Africa where cases were monitored systematically at short assessment intervals. Therefore, findings are likely to be more robust than previous reports.
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