| 1. |
- Lönnberg, Lena, et al.
(författare)
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Early screening for metabolic syndrome opens a window of opportunity : learnings from a long-term, population-based study
- 2023
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Ingår i: European Heart Journal. - 0195-668X .- 1522-9645. ; 44:Supplement_2
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The metabolic syndrome (MetS) represents a cluster of risk factors that predict cardiovascular disease (CVD) and type 2 diabetes. Early detection of MetS opens up for a successful treatment of the cardiovascular (CV) risk factors involved, hopefully leading to later advent of CVD in the general population.Purpose: In this long-term, population-based study we aimed to investigate how presence of MetS, in middle-aged men and women, was associated with all-cause mortality and non-fatal CVD later in life.Methods: Between 1990 -1999 a screening program was conducted among 40- and 50-year-old inhabitants in the County of Västmanland, Sweden. Data on lifestyle habits and socio-economic status were collected. Total cholesterol, fasting blood glucose, blood pressure, weight, height, waist and hip circumference were measured. Individuals that met three or more of the following risk factors were classified with MetS: waist circumference: ≥102 cm (men) and ≥88 cm (women), total cholesterol: ≥6.1 mmol/ l, blood pressure: ≥130 and/ or ≥85 mm Hg (or previous diagnosis of hypertension) or fasting plasma glucose: ≥5.6 mmol/ l (or previous diagnosis of type 2 diabetes). A control group was identified with individuals from the same population, without MetS diagnosis. Each participant with MetS was matched to two controls regarding sex, age and date for the health examination. The association between midlife MetS and all-cause mortality and non-fatal CV events (stroke and myocardial infarction) was adjusted for age, sex, smoking, physical inactivity, educational level, BMI, hip circumference and living alone or with family members. Multivariable cox regression and Kaplan-Meier analyses were used.Results: A total number of 5084 individuals met the criteria for MetS and a control group of 10 168 individuals was identified. The median (Q1, Q3) follow-up time was 27 years (24.6, 30.1), corresponding to 130 820 and 269 696 person-years at risk in the MetS and the control group respectively. During follow up, 1317 MetS and 1904 control subjects died, implying 10 deaths in the MetS group and 7 deaths in the controls per 1000 person-years at risk (fig. 1). Cox analysis showed increased mortality in the MetS group compared to the controls, hazard ratio (HR) 1.30 (95% CI: 1.20-1.40); p<0.001. Non-fatal CV events in the MetS group and in the controls were 32.4% vs 22.8%, respectively (p<0.001); HR 1.35 (CI;1.25–1.46) (fig 2). Median time (Q1, Q3) for first non-fatal CV event was 16.8 years (9.9,22.3) in the MetS group and 19.1 (12.2, 23.6) for the controls.Conclusions: Results from this long-term, population-based study underline that the risk of non-fatal CVD and all-cause mortality was significantly higher in individuals with asymptomatic MetS. Present results support previous studies that early identification of MetS with screening programs might open a window of opportunity for prevention of CVD and premature death in the general population.
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| 2. |
- Pellas, Johnny
(författare)
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Assessment and psychological treatment of depression in older adults
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is one of the leading causes of disability in older adults worldwide. Many older adults with depression are undetected, and there is a need for brief, scalable psychological treatments for depression that can be delivered remotely.The aims of this thesis were 1) to investigate the diagnostic accuracy of two rating scales (PHQ-9 and GDS-15) for the detection of depression in older adults, and 2) to investigate the feasibility, preliminary efficacy and patients’ experiences of a telephone-based psychological intervention, Behavioral activation with mental imagery (BA-MI), for the treatment of depression in older adults in the context of the covid-19 pandemic. Study I showed that a cutoff of ≥6 on the GDS-15 and ≥5 on the PHQ-9 were optimal to identify major depressive disorder. When identifying both major depressive disorder and subthreshold depression, the optimal cutoff on the GDS-15 was ≥5. Study II was a randomized clinical pilot trial, CoviDep, with a treatment group receiving the BA-MI intervention, and a control group. The drop-out rate was low. Compared to the control group, the treatment group reported a decrease in depressive symptoms throughout the treatment, with a large effect-size at posttreatment. Study III was a long-term follow-up of participants in CoviDep that received the BA-MI intervention. The drop-out rate over time was low, and compared to baseline, decreases in depressive symptoms were observed with a medium effect-size at posttreatment that was maintained 1- and 3 months post-treatment but lower after 6 months. Study IV was a qualitative study. The BA-MI intervention in CoviDep was described as increasing activities and improving mood. Telephone-delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was healing, but the manualized mode of treatment seemed to impair the relationship.In sum, this thesis shows that both the GDS-15 and the PHQ-9 are useful tools for the detection of depression in older adults, and adds to the support for telephone-delivered BA for the treatment of depression and indicates that MI-interventions are feasible as an augmentation of BA in older adults.
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| 3. |
- Andrén, Victoria, et al.
(författare)
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Gender and arson : psychosocial, psychological, and somatic offender characteristics at the time of the crime
- 2023
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Ingår i: Journal of Forensic Psychiatry & Psychology. - : Informa UK Limited. - 1478-9949 .- 1478-9957. ; 34:1, s. 113-130
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Tidskriftsartikel (refereegranskat)abstract
- Deliberate fire-setting, such as the crime of arson, can have devastating, even lethal, consequences. This study compared factors at the time of arson by female and male offenders in Sweden between 2000–2010. The women (n = 100), and men (n = 100) included in this study were randomly chosen from among all individuals who had been convicted for arson during this period and who underwent forensic psychiatric investigations. Information regarding psychiatric and somatic characteristics, their psychosocial situation, and whether they were in contact with health or social services before the arsons were examined. The results showed that both women and men have complex psychiatric and somatic characteristics, as well as psychosocial situations. Women showed more self-destructive behaviour, lower Global Assessment of Functioning scores, and had been in contact with psychiatric health services to a greater extent than men. More women than men had children. These findings suggest that specific actions may be needed for preventing and treating women compared with men at risk for committing arson.
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| 4. |
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| 5. |
- Lönnberg, Lena, et al.
(författare)
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Lifestyle counselling – a long-term commitment based on partnership
- 2022
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Ingår i: BMC Primary Care. - : BioMed Central Ltd. - 2731-4553. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lifestyle habits are important factors in the development of non-communicable diseases. Different ways of providing counselling in primary care to promote healthier lifestyle habits have been launched and evaluated in recent years. It is important to provide an insight into what makes lifestyle counselling useful for patients and healthcare providers. Objective: The overall aim of this study was to explore patients´ and community health nurses´(CHNs) experiences of lifestyle counselling in primary care to support healthier lifestyle habits. Methods: Patients and CHNs were interviewed, face to face. Sixteen patients (eight men, eight women, aged 51–75 years) diagnosed with hypertension or type 2 diabetes mellitus and three CHNs participated. Data material was analysed with qualitative content analysis to explore the participants experiences of lifestyle counselling. Results: The theme demonstrates that lifestyle counselling is a long-term commitment based on partnership between patients and CHNs. Five categories describe this partnership: respect and mutual interest, understanding of illness, measurements and goal setting, long-term support, and a structure to support counselling within the primary care unit. Conclusion: The results from this study are consistent with and add to previous understanding of how lifestyle counselling can be performed successfully in the context of primary health care. The results emphasize that lifestyle counselling should encompass a partnership based on mutual respect, recognition of the patient as the expert on his/her current life situation, and the need for both parties to engage in the process of lifestyle change. Practice implications: A structured lifestyle program with five counselling sessions within primary care was experienced as helpful for enhanced lifestyle habits and considered to be feasible by both patients and CHNs.
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| 6. |
- Pellas, Johnny, et al.
(författare)
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Assessment of executive functions in older adults : Translation and initial validation of the Swedish version of the Frontal Assessment Battery, FAB-Swe
- 2021
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Ingår i: Applied neuropsychology. Adult. - : Routledge. - 2327-9095 .- 2327-9109. ; , s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The Frontal Assessment Battery (FAB) is a screening test for executive functions. The purpose of this study was to describe the translation process and to make an initial evaluation of the reliability and convergent validity of the Swedish version of the FAB, the FAB-Swe.Methods The FAB-Swe was translated and adapted to Swedish using a translation and back-translation procedure. Seventy community-dwelling participants aged 65 years or older participated. Participants completed the FAB-Swe, the Mini-Mental State Examination – Swedish Revision (MMSE-SR), three established tests of executive functions (FAS, Trail Making Test—part B [TMT-B] and Stroop), and self-ratings of executive abilities. Reliability of the FAB-Swe was measured using Cronbach’s alpha. Convergent validity was measured using Spearman’s rank correlation.Results Internal consistency was moderately high (.675). Statistically significant correlations were found between the FAB-Swe and MMSE-SR, FAS, TMT-B, Stroop, and education. No significant correlations were found between the FAB-Swe and age or self-rated executive functioning.Conclusions This study indicates that the FAB-Swe has acceptable reliability and convergent validity. Further normative studies are needed to further investigate the effect of age and educational level. Studies are also needed to evaluate the diagnostic accuracy in clinical populations.
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| 7. |
- Pellas, Johnny, et al.
(författare)
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Not the same, but similar: a qualitative study of older adults’ experiences of a telephone-based psychological treatment for depression during the covid-19 pandemic
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The covid-19 pandemic prompted the use of telehealth interventions for treating depression in older adults. We conducted a pilot study of a telephone-based brief psychological intervention, Behavioral Activation with Mental Imagery (BA-MI), for the treatment of depression in isolated older adults during the covid-19 pandemic. The results showed promising results regarding satisfaction and reduction in depressive symptoms. The purpose of the present study was to investigate the participants’ experiences of the intervention and provide insight into how the intervention could be improved. Methods: Fourteen participants from the pilot study, aged 67 – 85 years, were purposively selected and interviewed. The interviews were analyzed using thematic analysis with a descriptive phenomenological approach. Results: The BA-MI intervention was experienced as a good way of increasing activities and improving mood. Telephone-delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was healing, but the manualized mode of treatment seemed to impair the relationship.Conclusions: Telephone-based psychological treatment is similar to face-to-face treatment but not the same, with several advantages but also with shortcomings that should be considered by the clinician. When using manual-based psychological interventions one should aim to make them as person-centred as possible by making room for the patients as individuals with both past and present rather than just focusing on intervention delivery.
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| 8. |
- Pellas, Johnny, et al.
(författare)
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Telephone-based behavioral activation with mental imagery for depression : A pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic
- 2022
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Ingår i: International Journal of Geriatric Psychiatry. - : John Wiley & Sons. - 0885-6230 .- 1099-1166. ; 37:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo shield vulnerable persons, particularly the elderly, during the Covid-19 pandemic governments around the world have advised to use social distancing and self-isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the Covid-19 pandemic.MethodsIn this open-label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a BA-MI treatment condition, or an Attention-Assessment control condition delivered over the telephone over a 4-week period.ResultsDepressive symptoms decreased more in the treatment condition compared to the control condition. At post-treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed.ConclusionsThis pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed.
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| 9. |
- Pellas, Johnny, et al.
(författare)
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Telephone-Based Behavioral Activation with Mental Imagery for Depression in Older Adults in Isolation During the covid-19 Pandemic : Long-term Results from a Pilot Trial
- 2023
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Ingår i: Clinical Gerontologist. - : Taylor & Francis Group. - 0731-7115 .- 1545-2301. ; 46:5, s. 801-807
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The covid-19 pandemic has highlighted the need for psychological interventions for depression that can be delivered remotely to older adults. Pellas et al. (2022) conducted a pilot trial on the preliminary effectiveness of a four-week telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) intervention to N= 38 adults 65 years and older with clinically significant depressive symptoms living in isolation due to covid-19 in Sweden. This study assessed the feasibility of follow-up assessments and within-group symptom change over a six-month post-intervention period.Methods: Retention rates at post-intervention and follow-up assessments of depressive symptoms (MADRS-S) at five time points were assessed (baseline, post-intervention, 1-, 3-, and 6-month follow- up). Effect sizes (Hedges' g) for within-group change scores were calculated between each time point.Results: Retention rates over time were 95, 82, 89, and 84%. Mean MADRS-S score was 18.26 at baseline, 13.69 at post-intervention (g= .68), 13.42 at 1 month (g= .74), 13.82 at 3 months (g= .74), and 15.59 at 6 months (g= .41).Conclusions: Long-term follow-ups were feasible. Within-group decreases in depressive symptoms were maintained with medium effect sizes at 6 months post-intervention.Clinical implications: Telephone-based BA-MI may be a feasible intervention for depressive symptoms in older adults in isolation with maintained effects over time.
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| 10. |
- Pellas, Johnny, et al.
(författare)
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Telephone-Based Behavioral Activation with Mental Imagery Reduced Depressive Symptoms in Isolated Older Adults during The COVID-19 Pandemic
- 2023
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Ingår i: Abstracts from the 26th Nordic Congress of Gerontology. - : MDPI. ; , s. 203-432
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Konferensbidrag (refereegranskat)abstract
- Introduction: To shield older adults during the COVID-19 pandemic, governments around the world have recommended social distancing. This can lead to social isolation and increase the risk for mental health problems such as depression. There is a need for brief, easy-accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone-delivered Behavioral Activation with Mental Imagery (BA-MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the COVID-19-pandemic.Materials and methods: In this open-label pilot randomized clinical trial, n = 41 individuals aged 65 years or older with clinically significant symptoms of depression were assigned to either a BA-MI treatment condition or an Attention control condition delivered over the telephone over a four week period.Results: Depressive symptoms decreased in the treatment condition but not the control condition. The results in the treatment group were maintained 3 months post intervention. After treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared with 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment. Conclusions: This pilot study suggests that BA-MI delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples in different healthcare settings is needed.
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| 11. |
- Pellas, Johnny, et al.
(författare)
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The Swedish version of the Geriatric Anxiety Scale – 10 item, GAS-10: Translation and pilot evaluation of reliability and concurrent validity
- 2023
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Konferensbidrag (refereegranskat)abstract
- Background and aims: Among older adults, the prevalence of anxiety disorders is 5 – 10 %, and one third report anxiety symptoms. Assessment of anxiety in older adults is complicated by age-related differences in anxiety symptoms, high rates of medical and psychiatric comorbidities, and cognitive impairment. The Geriatric Anxiety Scale – 10 item (GAS-10) is a self-rating scale designed to capture anxiety specifically in older adults, with items reflecting affective-, cognitive- and somatic anxiety symptoms. The aim of this study was to make an initial evaluation of the reliability and concurrent validity of the Swedish version of the GAS-10. Methods: The GAS-10 was translated and adapted to Swedish using a translation and back-translation procedure. The final version was reviewed by an expert panel of researchers and clinicians. Seventy-two community-dwelling participants 65 years or older (range 65 – 92 years) then completed the GAS-10 and the Hospital Anxiety and Depression Scale (HADS). Reliability of the GAS-10 was measured with Cronbach’s alpha, and concurrent validity was measured using Spearman’s rank correlation between the GAS-10 and the HADS anxiety (HADS-A) and depression (HADS-D) subscales. Results: Reliability was excellent (.88). Statistically significant moderate correlations were found between the GAS-10 and HADS-A (rs = .653, p = < .001) and HADS-D (rs = .527, p = < .001). Conclusions: This pilot study suggests that the Swedish GAS-10 has acceptable reliability as well as acceptable concurrent validity compared to the HADS-A. Further full-scaled psychometric studies are needed as well as studies evaluating the diagnostic accuracy in clinical populations.
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