| 1. |
- Zetterberg, Hedvig
(författare)
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A Behavioral Medicine Perspective on Pain Disability in a Work Context : Prevention, Assessment, and Tailored Physiotherapy
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain (>3 months) is associated with work limitations and sick leave. This thesis aimed to evaluate assessments and interventions targeting work disability for individuals at risk of or with chronic pain. Specific aims for studies I and II were to compare the preventive effects of a brief psychosocial program with an active educational control. Study III aimed to evaluate the construct validity and internal consistency of the Work Ability Index (WAI). Study IV aimed to systematically replicate a behavioral medicine physiotherapy intervention within a return-to-work context and evaluate its effects on an individual level. Methods: Studies I and II were based on a cluster-randomized controlled trial, including 191 employees with reported pain and/or stress-related ill-health and 53 supervisors. Study I reported on the primary outcome of sick leave and secondary health-related outcomes on employees at 6-months follow-up; study II reported on the supervisors’ communication behavior and perceived stress. Study III was a cross-sectional study including 118 patients with chronic pain referred to specialized care. Study IV was a single case experimental design study including five participants with chronic pain on long-term sick leave. Results: In studies I and II, no effects of the brief psychosocial program were found on outcomes on employees or supervisors. In study III, the construct validity and internal consistency of the WAI were supported. In study IV, the physiotherapy protocol was successfully replicated, and the results indicated an effect on task-specific self-efficacy for target activities at work, but not on experience of target activities or work ability.Conclusion: The results highlight the importance of selecting participants for preventive workplace interventions based on their assessed risk profiles for long-term pain disability, and that targeting mainly the supervisors might be insufficient. The WAI appears to be a valid measurement of work ability for patients with chronic pain in specialized care. Accordingly, behavioral medicine physiotherapy can be successfully adapted to work disability needs for patients with chronic pain. Large-scale trials are needed to evaluate its effects on return-to-work. A behavioral medicine perspective on pain disability in a work context motivates a focus on target activities at work, which can be seen to mediate the incorporation of behavioral knowledge in assessments and interventions for individuals with pain.
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| 2. |
- Bäckström, Josefin, 1977-
(författare)
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Family Members of Patients with Burns : Experiences of a Distressful Episode
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods.The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms.Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms.Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character. Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved.Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge.In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.
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| 3. |
- Halford, Christina, 1960-
(författare)
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Self-rated Health with special reference to Prevalence, Determinants and Consequences
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The overall aim was to investigate determinants and consequences of global non-comparative self-ratings of health (SRH). Concerning determinants, the aim was more specifically to investigate the association between age, year of investigation, stress-theory based psychobiological variables, and SRH.Materials and methods: Papers I and IV were based on eight ongoing population-based cohort studies, with sampling performed 1973-2003. The study-population consisted of 11,880 men and women, aged 25-99 years, providing 14,470 observations. Papers II and III were based on a longitudinal study of 212 adult, healthy, women and men.Results: In women, SRH declined linearly with age and year of investigation, after adjustment for influence of covariates, while in men the association was based on a third degree polynomial function. The most important covariates were complaint score, sick-leave or disability pension, and leisure time physical activity. The final model explained 76.2% of the variance in women and 74.5% in men. SRH was directly associated with psychological resources and inversely associated with psychological strain, in healthy, adult, women and men. In men with SRH which decreased to fair or poor, higher levels of prolactin and lower levels of testosterone were observed at follow-up as compared to baseline. There were no associations between endocrine variables and SRH in women. There was a significant inverse association between SRH and mortality, disability pension, and sick-leave during follow-up, in women and men, adjusted for covariates. Associations between SRH and mortality were robust during the follow-up period.Conclusions: Age and year of investigation were associated with SRH, but differently in women and men. Psychological resources and psychological strain were consistently associated with SRH, but there were no robust associations between endocrine measures and SRH. SRH was associated with mortality, disability pension, and sick-leave, during follow-up. The association between SRH and mortality was robust during the follow-up period
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| 4. |
- Vikström Eckevall, Josefin, 1984-
(författare)
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The influence of infertility and in vitro fertilization treatment on postpartum and long-term mental health in women
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: It is estimated that about 10-15% of couples suffer from infertility, i.e. the inability to achieve a clinical pregnancy after at least one year of regular, unprotected intercourse and that between 2-5% of births are a result of in vitro fertilization (IVF) treatment. Infertility and its treatment can have adverse effects on psychological well-being. While previous studies on postpartum depression (PPD) in IVF women suffer some methodological issues, there are no published studies on the risk of postpartum psychosis (PPP) after IVF pregnancies. Long-term, most women adjust well emotionally after IVF treatment but some, especially the childless, still suffer negative consequences. Meanwhile, few studies have extended beyond the first decade after treatment. Some studies have found that the childless elderly have social networks of less support potential but most show that psychological well-being is not affected by parental status. None of the studies have focused on the oldest old (≥85 years) and many have excluded those who live in institutional care, thus the frailest.Objective: The overall aim of this thesis was to study postpartum mental health in women who have undergone IVF treatment, using psychiatric diagnoses as outcomes, while controlling for major PPD and PPP risk factors as well as to determine the influences of childlessness, infertility and IVF treatment on long-term mental health in women. Materials and methods: Studies I-II are register-based, case control studies of 3532 (I) and 10,412 (II) primiparous women included in the Swedish IVF register. A control group of 8,553 (I) and 18,624 (II) primiparous women with spontaneous conceptions was selected from the Medical Birth Register. The main outcomes were PPD and PPP diagnoses the 1st year postpartum collected from the National Patient Register. Studies III-IV are cross-sectional. Study III included 470 women who had undergone IVF treatment 20-23 years previously. The Symptom Checklist-90 was used to investigate self-reported mental health. The results were compared with those from a population-based study and by parental status group. Study IV included 496 85-year olds. Psychological well-being, living situation, demographics and social network was investigated through a questionnaire and an interview.Results: Study I-II: There were no differences between the IVF and control group in the risk of receiving a PPD or PPP diagnosis. Having previously been diagnosed with any psychiatric, an affective or personality disorder increased the risk of PPD while any previous psychiatric, psychotic, bipolar, depressive, anxiety or personality disorder diagnosis increased the risk of PPP. None of the women had committed suicide. Study III: The IVF women reported symptoms of higher intensity and were at increased risk of symptoms of depression, obsessive-compulsion and somatisation compared with the reference group. Childless women, compared with parents, reported a higher level of mental health problems as well as symptoms of depression and phobic anxiety. Study IV: No differences in psychological wellbeing, living situation or having friends close by were found across parental status groups. The childless 85-year olds were less likely to have relatives close by and to receive help.Discussion: This thesis indicates that the risk of receiving a PPD or PPP diagnosis from in- or outpatient psychiatric care or of committing suicide during the first year postpartum is not increased in women who have undergone IVF treatment. Any negative effects of infertility and its treatment might have been mitigated by the “healthy patient effect”; those who choose to enter treatment are generally psychologically robust. A history of mental illness is a major risk factor for PPD and PPP. The risk of some adverse symptoms of mental illness might be increased in women who have undergone IVF treatment twenty years previously, especially in those who have remained childless. The childless elderly appear to have social networks of less support potential but are not more likely to live in institutional care and do not experience more adverse effects on psychological well-being than the elderly who are parents.
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| 5. |
- Edvinsson, Dan
(författare)
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Attention Deficit/Hyperactivity Disorder in Adults : Prevalence, Psychiatric Comorbidities and Long-term Outcome
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Attention Deficit/Hyperactivity Disorder (ADHD) was originally thought to occur only in children, but is increasingly recognised as causing functional impairment also in adulthood. The overall aim of this thesis was to achieve a comprehensive understanding of ADHD in adulthood.A questionnaire based on the DSM-IV criteria of ADHD, reported childhood symptoms, reading and spelling problems, difficulties and suffering and general assessment of functioning (GAF) was distributed to three samples: the general population (GP), outpatient psychiatry (OPP) and female prison inmates. Symptoms consistent with ADHD were more than three times higher in the OPP sample than in the GP sample (6.6 versus 2.1%). ADHD symptoms and related problems occurred in 50% of the prison inmates.A cohort of 168 patients diagnosed with ADHD in adulthood was interviewed about current ADHD symptoms and psychiatric comorbidity on axis I and II. The lifetime prevalence of psychiatric comorbidity on axis I was 92% and current comorbidity, including autism spectrum disorders and Tourette’s syndrome, was 47%. The sex-specific pattern of the comorbid disor-ders was similar to that in the general population. Forty-six per cent of the patients endorsed the specific criteria for at least one personality disorder.After a mean follow-up of six years, there was remission of adult ADHD in about 30% of the patients, regardless of whether there was ongoing medication or not. There were no differences in function and quality of life, except for global general improvement, which was better in patients currently on medication.The most prevalent long-term side effects of pharmacological treatment with mainly stimulants were decreased appetite, dry mouth, anxiousness/restlessness and an increase in pulse frequency. The discontinuation rate was about 50%: 29% discontinued because of a perceived lack of effect, followed by elevated mood or hypomania (11%). No detectable evidence of tolerance and increased need for dosage over time was observed.To conclude, Symptoms of ADHD is highly overrepresented in OPP and in female inmates compared with the GP. Furthermore, adults diagnosed with ADHD have a high lifetime prevalence of psychiatric comorbidity. Long-term pharmacological treatment with stimulants is safe with relatively mild and tolerable adverse effects. Continued medication, however, is not related to remission.
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| 6. |
- Hedlund, Mathilde, 1968-
(författare)
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Coping, Psychiatric Morbidity and Perceived Care in Patients with Aneurysmal Subarachnoid Haemorrhage
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Many patients with an aneurysmal subarachnoid haemorrhage (SAH) exhibit difficulties in rehabilitation, even in cases of a good prognosis. The present project investigates this using qualitative methods and standardised outcome measures. Patients with SAH treated at Uppsala University Hospital between 2002 and 2005 with an expected good prognosis were consecutively included. In addition, nurses working with such patients were interviewed. Outcome was assessed in terms of perception of care, psychiatric health, coping and health related quality of life (HRQoL). Qualitative content analyses revealed eight categories, which were divided into two patterns, Confident or Pessimistic perception of recovery, largely on the basis of the presence or absence of depression. Eighty-three patients were assessed by The Structured Clinical Interview for DSM-IV, Axis I (SCID-I). Forty-one percent fulfilled criteria for any psychiatric disorder seven months after SAH and 45 % presented with a history of lifetime psychiatric morbidity. Logistic regressions indicated that a psychiatric history was related to a higher risk of psychiatric problems seven months after SAH, as well as a lower return to work. SAH patients had lower HRQoL than the general Swedish population; almost entirely in the subgroup with a psychiatric history prior to the SAH. Those with a psychiatric history used more evasive, fatalistic, emotive and palliative coping strategies associated with inability to handle illness. Multiple regressions revealed that a psychiatric history and use of coping were independently associated with HRQoL, albeit more in the mental than the physical domains. Qualitative content analyses revealed that nurses viewed patients’ support needs as a process ranging from technological to emotional care. Shortcomings in the communication between nurses in acute and rehabilitation settings on the subject of support were acknowledged. The results underline the importance of early diagnosis of coexisting psychiatric illness and the need for an intact health care chain.
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| 7. |
- Lindahl, Andreas, 1974-
(författare)
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Neuroendocrine Stress Response after Burn Trauma
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Some aspects of the stress response during acute intensive care for severe burns are described and quantified by measuring hormonal and neuroendocrine patterns and relating these to organ function in the short term. This includes an assessment of whether there are markers for the severity of stress that are better than conventional descriptors of the severity of a burn in predicting failing organ function.P-CgA after a major burn injury is an independent and better predictor of organ dysfunction assessed as SOFA score than the traditionally used TBSA% burned. The results also suggest that the extent of neuroendocrine activation is related to organ dysfunction, and this motivates a more extensive effort to evaluate P-CgA as a prognostic marker with respect to mortality and long-term outcome.P-NT-proBNP exhibited a complex pattern with considerable inter-individual and day-to-day variations. Values of P-NT-proBNP were related to size of burn, water accumulation and systemic inflammatory response. A considerable covariation with trauma response and SOFA scores was observed in day by day analyses, but with weight change only on day 2.Maximum P-NT-proBNP showed a stronger correlation with SOFA score on day 14, with mortality, and with LOS, than did age and TBSA% burned. High values were also independent predictors of all subsequent SOFA scores up to two weeks after injury.P-NT-proBNP and NT-proANP reflect and predict organ function after burn injury similarly, notwithstanding a significantly larger intra-individual variability for P-NT-proBNP. P-NT-proBNP, but not NT-proANP, reflects the systemic inflammatory trauma response.Free cortisol concentration was related to the size of burns, as was the circadian cortisol rhythm. This effect of burn size was, at least in part, related to its effect on organ function.This thesis points to the fact that the stress response is richly interwoven, and cannot be adequately assessed by one biomarker only. All biomarkers studied here can be viewed as representing efferent limbs of the stress reaction, and they would need to be supplemented by biomarkers representing individual physiologic responses that follow the stress signaling.
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| 8. |
- Makris, Georgios, 1977-
(författare)
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Suicide Seasonality : Theoretical and Clinical Implications
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Although suicide seasonality has been well-documented, surprisingly little is known about its underlying mechanisms.Methods: In this thesis, data from three Swedish registers (Cause of Death Register, National Patient Register, Prescribed Drugs Register) and data from the Swedish Meteorological and Hydrological Institute were used.In Study I, the amplitude of suicide seasonality was estimated in completed suicides in 1992-2003 in individuals with different antidepressant medications or without antidepressants.In Study II, monthly suicide and sunshine data from 1992-2003 were used to examine the association between suicide and sunshine in groups with and without antidepressants.In Study III, the relationship between season of initiation of antidepressant treatment and the risk of suicidal behavior was explored in patients with a new treatment episode with antidepressant medication.In Study IV, the complex association between sunshine, temperature and suicidal behavior was investigated in patients with a new treatment episode with an antidepressant in two exposure windows (1-4 and 5-8 weeks) before the event.Findings: Study I: Higher suicide seasonality was found in individuals treated with selective serotonin reuptake inhibitors (SSRIs) compared with those given a different antidepressant treatment or those without any antidepressant treatment.Study II: In individuals treated with SSRIs, there was a positive association between sunshine and suicide, with the association stronger in men treated with SSRIs compared with men treated with other antidepressants. An effect modification by age was observed.Study III: The elderly (65+) had a higher risk of suicide when initiating antidepressant treatment in summer and a higher risk of suicide attempt when starting antidepressant therapy in spring and summer. Younger patients (0-24) demonstrated a higher risk of suicide attempt when treatment was initiated in autumn.Study IV: In the elderly (65+), a harmful association was observed between the risk of suicide attempt and the average daily temperature during the four weeks before the suicide attempt, as well as with average daily sunshine during both exposure windows (1-4 and 5-8 weeks) before the suicide attempt.Significance: Our results provide epidemiological support for the role of the serotonergic system in seasonality of suicide in which both medication and climate may be involved.
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| 9. |
- Syk, Mikaela, 1990-
(författare)
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Immunometabolic patterns in psychiatric disease
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Many forms of immune system dysregulation are linked to psychiatric disorders. This thesis examines specific types of immune dysregulation in broad cohorts with psychiatric disease. The first section focuses on adipokines and other immunometabolic biomarkers and their interaction with state vs. trait symptoms. Direct-acting autoantibodies are an increasingly recognized mechanism for causing psychosis and obsessive-compulsive disorder, but it is unclear how prevalent this patient group is. To identify which patients to investigate more extensively, superior methods are needed. Therefore, the second section addresses the value of clinical red flags in predicting elevated central nervous system (CNS) damage biomarkers and other CNS pathology.In paper I-III, a psychiatric cohort of young adults was examined for plasma immunometabolic biomarkers, depressive symptom severity, bulimia nervosa and neurotic traits. Psychiatric diagnoses were based on diagnostic interviews while depressive symptom severity was assessed with the self-rating version of the Montgomery-Åsberg Depression Rating Scale. Personality traits were evaluated using the Swedish universities Scales of Personality. Young adults with higher leptin levels self-reported more severe depressive symptoms (paper I) and leptin levels were independently linked to neuroticism (paper III). Neuroticism was also linked to other immunometabolic alterations. Women with bulimia nervosa had elevated plasma adiponectin levels that remained stable over time (paper II), suggesting long-term metabolic changes.In paper IV, a psychiatric patient cohort enriched for clinical signs of suspected autoimmune psychiatric disease was investigated for psychiatric symptoms, neurological findings and signs of CNS pathology in radiological, neurophysiological, blood and CSF analyses. In this cohort, 27% had CSF signs of CNS tissue damage and 21% had CSF signs of neuroinflammation or blood-brain barrier dysfunction. Six percent had known anti-neuronal autoantibodies in serum and 2% in CSF. CNS damage biomarkers in CSF were also linked to red flags and specific psychiatric features.In summary, the thesis confirms different patterns of immunometabolic biomarkers and associations with trait and state symptoms in a psychiatric patient cohort that may have important implications for the future health of young adults with psychiatric morbidity. The final study supports clinical red flags in previous guidelines, indicating that a more comprehensive inclusion of patients with diverse psychiatric symptoms (not restricted to purely psychosis) is necessary to find all psychiatric patients requiring further investigation for immune system involvement.
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| 10. |
- Condén, Emelie, 1979-
(författare)
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Type D Personality : Psychometric Properties of the DS14 and Associations with Ill Health and Coronary Heart Disease in General and Clinical Populations
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type D personality, or distressed personality, refers to the joint tendency to experience negative emotions and to inhibit self-expression in social interactions. The overall aims of this thesis were to examine the impact of Type D personality on adolescents’ self-perceived health, to examine the factorial and temporal stability of the Type D personality construct DS14, and to clarify whether type D personality is an independent risk factor for recurrent myocardial infarction and all-cause mortality among patients with myocardial infarction.The prevalence of Type D personality in the adolescent population was 10.4% for boys and 14.6% for girls. Boys and girls with Type D personality were approximately twice as likely to report musculoskeletal pain and five times as likely to report psychosomatic symptoms.Adolescents with Type D personality were four times more likely to have sleep disturbances and to sleep fewer hours, especially on school nights.Among patients with myocardial infarction, the Swedish DS14 had stable structural validity. Our measurements confirmed the two-factor model of the DS14. However, the DS14 exhibited low temporal stability, especially when comparing the measurement obtained during hospitalization with the 1- and 12-month follow-up measurements.Among patients with myocardial infarction, the Framingham risk score had a strong predictive value for recurrent myocardial infarction, and a somewhat weaker predictive value for all-cause mortality. However, none of the previously proposed methods for the analysis of the DS14 Type D personality measurement predicted recurrent myocardial infarction or all-cause mortality, either in univariable analyses or in addition to the Framingham risk score.In conclusion, the present thesis found significant associations between the DS14 and psychosomatic symptoms in adolescents. However, the measurement exhibited a low stability over time and no predictive value for recurrent myocardial infarction and mortality among patients with myocardial infarction. Taken together, these results raise the question of whether the Swedish DS14 really is a measure of personality. An alternative explanation for the strong cross-sectional associations observed between the DS14 and psychosomatic symptoms might be that the DS14 functions as a pseudo-measure of ill health, or co-varies with depressive or psychosomatic characteristics.
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