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- Paul, Elisabeth R., 1991-
(författare)
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Immunological Changes and Brain Function over a Psychotic-Depressive Spectrum
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychotic and depressive disorders are severe psychiatric disorders that contribute significantly to the global burden of disease. They are distinct disorders with different symptom profiles according to both the Diagnostic and Statistical Manual and the International Classification of Diseases. However, these disorders share commonalities in various aspects, such as high comorbidity, prevalence of subclinical symptoms, and shared genetics. Furthermore, both disorders have been associated with a dysregulated immune system functioning.In this thesis, we aimed to identify common biological dimensions of both depression and psychosis by first investigating proteins related to immune system activation in depression and psychosis separately, and then identifying biological underpinnings of psychotic-like symptoms in depression.Specifically, we first assessed in major depressive disorder central nervous system levels of metabolites along the kynurenine pathway, a pathway that is regulated by the immune system and implicated in depressive and psychotic disorders (paper I). We found an imbalance between neuroprotective versus neurotoxic metabolites in blood and decreased levels of a neuroprotective metabolite in cerebrospinal fluid of patients with depression.Next, we assessed patterns of proteins implicated in immune-system function that distinguish first episode psychosis and healthy controls (paper II). Results indicate prominent changes in patients compared to controls, partially replicating previous findings and partially highlighting proteins that have not previously been assessed in psychosis.Lastly, we investigated psychotic-like symptoms in patients with major depressive disorder, finding a relation to immune system markers (paper III) and changes in connectivity between brain structures that integrate information about the physical body and autobiographic information into a sense of self (paper IV).In summary, the results from this thesis suggest that both in major depressive disorder and first episode psychosis there might be a dysregulation of the immune system and closely related systems such as the kynurenine pathway. These commonalities could further underlie the prevalence of subclinical psychotic-like symptoms in major depressive disorder. Ultimately, a better understanding of the underlying biological mechanisms of psychiatric disorders and, transdiagnostically, their symptoms will help formulate empiricallyinformed frameworks to guide clinical diagnostic processes and treatments.
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| 2. |
- Mattelin, Erica, 1987-
(författare)
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Resilience, mental health, and exposure to violence among individuals with former or current experiences of being a refugee in Sweden : quantitative and qualitative studies
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Studies indicate that individuals with current or former experiences of being a refugee are more likely to have experienced adverse events, like violence, and face mental health challenges in their host countries. After arrival in host countries, people with refugee experiences often confront various post-migration adversities like discrimination. However, research in this area has been hampered by limitations and a lack of child perspective. This thesis aims to examine both pre-, peri- and post-migration factors that impact the health, well-being, and experiences of children and adults who have migrated to Sweden as refugees.Article I is a systematic review of Nordic studies on resilience, risk and protective factors for health in refugee children. We found that adversity was consistently identified as a risk factor for poorer health, but otherwise, findings were inconsistent. No study explicitly examined resilience. Article II examined the relationship between refugee experiences in childhood and health in adulthood in a nationally representative sample. The study found no clear link between childhood refugee experiences and worse health in adulthood. Article III investigated differences in health and health-related behaviours between sexual and gender minority refugees, migrants, and Swedish/Western-born individuals and their heterosexual peers. We found higher rates of mental and general ill-health and worse health-related behaviours in sexualand gender-minority individuals regardless of whether they were refugees, migrants, or Swedish and Western-born. Surprisingly, our study revealed no indications of inferior health outcomes among refugee or migrant sexual and gender minorities in comparison to Swedish/Western-born individuals. Article IV investigated mental health and functioning of refugee children and young adults in Sweden. We found lower rates of mental ill-health than previously reported in other studies on refugee children and young adults. Unaccompanied refugee children had worse outcomes than those accompanied. Article V explored the experiences of refugee children and their agency in constructing their own lives during migration. We found that child refugees express a longing for a good life and demonstrate active agency despite facing diverse challenges.Overall, the prevalence rates for mental ill-health were lower than in many previously published studies even though the prevalence rates are higher than in many studies published on the general population of children in Sweden. Further, the results suggest that these effects are transient. The studies highlight the need to focus on the heterogeneity of the population, for example, by addressing factors that pose a risk to health and rights in refugee children and adults. Moreover, the research emphasizes the importance of adopting a perspective that simultaneously acknowledges both the strengths and vulnerabilities of refugee children. Additionally, this perspective should recognize individual differences, rights, and goals.
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| 3. |
- Aspeqvist, Erik, 1983-, et al.
(författare)
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Measurement and stratification of nonsuicidal self-injury in adolescents
- 2024
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Ingår i: BMC Psychiatry. - : BMC. - 1471-244X. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI.MethodsThe performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures.ResultsA total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures.ConclusionsWhen investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.
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| 5. |
- Korhonen, Laura, Professor, 1974-, et al.
(författare)
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Multivariate analyses of immune markers reveal increases in plasma EN-RAGE in first-episode psychosis patients
- 2023
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Ingår i: Translational Psychiatry. - : Springer. - 2158-3188. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Immune cells and cytokines are largely recognized as significant factors in the pathophysiology of neuropsychiatric disorders. The possible role of other blood cells such as leukocytes in events of acute psychosis is in contrast only emerging. To study blood-born markers in acute psychosis we here evaluated plasma proteins in drug-naive first-episode psychosis (FEP) patients and healthy controls using a multiplex proximity extension assay technique. We analyzed a panel of 92 immune markers and plasma samples from 60 FEP patients and 50 controls and evaluated the changes obtained using multivariate statistical methods followed by protein pathway analyses. Data showed that 11 proteins are significantly different between FEP patients and healthy controls We observed increases in pro-inflammatory proteins such as interleukin-6, oncostatin-M, and transforming growth factor-alpha in FEP patients compared with controls. Likewise, the extracellular newly identified RAGE-binding protein (EN-RAGE) that regulates the expression of various cytokines was also elevated in the plasma of FEP patients. The results indicate that neutrophil-derived EN-RAGE could play an important role during the early phase of acute psychosis by stimulating cytokines and the immune response targeting thereby likely also the brain vasculature.
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| 7. |
- Lundqvist, Carolina, 1977-, et al.
(författare)
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Aligning categories of mental health conditions with intervention types in high-performance sports: a narrative cornerstone review and classification framework
- 2024
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Ingår i: Journal of Science and Medicine in Sport. - 1440-2440 .- 1878-1861.
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological studies suggest that psychiatric disorders are as prevalent amongst high-performance athletes as in general populations, challenging the myth of invulnerability. Despite efforts of sport organisations to highlight the significance of athletes' mental health, it is still many times tough to combine the sport performance ethos with a discourse on mental health. This narrative cornerstone review examines challenges related to definitions and classifications of athlete mental health in high-performance sports and how these influence assessments and the implementation of interventions. We discuss challenges with concept creep and psychiatrisation and outline their consequences for sport healthcare professionals. Based on this, we present a framework that aligns different categories of athlete mental health conditions (from the reduction of wellbeing to psychiatric disorders) with intervention types (from the provision of supporting environments to pharmacotherapy). We conclude that researchers and sport practitioners need to carefully consider conceptual creep and the risk of pathologising normal and healthy, albeit emotionally aversive, reactions to athlete lifeworld events when assessing athlete mental health. A clear separation of terminology denoting the athlete's resources to handle the lifeworld (including salutogenic factors) and terms describing psychiatric conditions and their management is necessary to avoid misguidance in intervention planning.
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| 9. |
- Mattelin, Erica, et al.
(författare)
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“You cannot just stop life for just that”: a qualitative study on children’s experiences on refugee journey to Sweden
- 2024
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Ingår i: European Child and Adolescent Psychiatry. - : SPRINGER. - 1018-8827 .- 1435-165X.
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Tidskriftsartikel (refereegranskat)abstract
- Children with refugee backgrounds are often exposed to violence and other adverse experiences with well-known detrimental consequences on mental health. However, the current group of approximately 40 million child refugees is heterogeneous, stressing the importance of first-person perspectives in understanding children's unique experiences and needs related to the migration process. Identifying contextual factors promoting health and resilience is also essential. For instance, the roles children play as active agents in constructing their own lives and adapting to different environments are poorly described in contemporary research on child refugees and their mental health. To address these knowledge gaps, we conducted qualitative interviews with a reflexive thematic analysis with eighteen children with refugee backgrounds in Sweden. This resulted in two main themes: Longing for a good life that cannot be taken for granted and Challenged agency and changing rights. The narratives indicate that children, although exposed to different challenges in different migration phases and based on gender and asylum status, have experiences of ordinary childhood with a desire for a good life with prospects. The results also show that children execute active and adaptable agency that is impacted by various factors. Reaching the full age appears to be a confusing and ambivalent transition due to changes in rights. The results pinpoint several possibilities to address factors that pose a risk to health and restrictions of rights among child refugees.
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| 10. |
- Otterman, Gabriel, et al.
(författare)
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Clinical care of childhood sexual abuse: a systematic review and critical appraisal of guidelines from European countries
- 2024
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Ingår i: The Lancet Regional Health. - : Elsevier. - 2666-7762. ; 39
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting.MethodsWe systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. PROSPERO: CRD42022320747.FindingsOf 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation.InterpretationA notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors.
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