| 1. |
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| 2. |
- Alaie, Iman, et al.
(författare)
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Adolescent depression, early psychiatric comorbidities, and adulthood welfare burden : a 25-year longitudinal cohort study
- 2021
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 56:11, s. 1993-2004
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Depression at all ages is recognized as a global public health concern, but less is known about the welfare burden following early-life depression. This study aimed to (1) estimate the magnitude of associations between depression in adolescence and social transfer payments in adulthood; and (2) address the impact of major comorbid psychopathology on these associations.METHODS: This is a longitudinal cohort study of 539 participants assessed at age 16-17 using structured diagnostic interviews. An ongoing 25-year follow-up linked the cohort (n = 321 depressed; n = 218 nondepressed) to nationwide population-based registries. Outcomes included consecutive annual data on social transfer payments due to unemployment, work disability, and public assistance, spanning from age 18 to 40. Parameter estimations used the generalized estimating equations approach.RESULTS: Adolescent depression was associated with all forms of social transfer payments. The estimated overall payment per person and year was 938 USD (95% CI 551-1326) over and above the amount received by nondepressed controls. Persistent depressive disorder was associated with higher recipiency across all outcomes, whereas the pattern of findings was less clear for subthreshold and episodic major depression. Moreover, depressed adolescents presenting with comorbid anxiety and disruptive behavior disorders evidenced particularly high recipiency, exceeding the nondepressed controls with an estimated 1753 USD (95% CI 887-2620).CONCLUSION: Adolescent depression is associated with considerable public expenditures across early-to-middle adulthood, especially for those exposed to chronic/persistent depression and psychiatric comorbidities. This finding suggests that the clinical heterogeneity of early-life depression needs to be considered from a longer-term societal perspective.
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| 3. |
- Alaie, Iman
(författare)
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Adulthood Outcomes of Child and Adolescent Depression : From Mental Health to Social Functioning
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is a common mental disorder affecting people across the lifespan, with first onset frequently occurring in the teenage years. The disorder is costly to society and constitutes one of the leading causes of disability in youths and adults worldwide. Research demonstrates that depression in childhood or adolescence is linked to adverse adult consequences, including mental health problems, physical health issues, various social difficulties, and economic hardships. While the specific factors and mechanisms associated with these long-term adversities are not well understood, previous studies point to the relevance of considering the heterogeneity in early-life depression.The overarching aim of this doctoral thesis was to shed more light on long-term outcomes of childhood and adolescent depression across multiple life domains. This work made use of extensive follow-up data gathered in Sweden and USA, as part of two community-based longitudinal cohort studies of depressed and nondepressed youths prospectively followed into adulthood. In the Uppsala Longitudinal Adolescent Depression Study, participants were interviewed around age 16 (n=631) and age 31 (n=409). Using linkage to nationwide population-based registries, participants were followed up around age 40 (n=576). In the Great Smoky Mountains Study, participants were interviewed at repeated occasions in childhood and adolescence (n=1,420), and at further follow-ups in adulthood extending up to age 30 (n=1,336).Findings from this work suggest that childhood/adolescent depression can have long-lasting associations with a broad spectrum of adverse outcomes. First, the risk of adult depression is known to be elevated among those exposed to depression in early life; however, depressed youths experiencing major conflicts with parents may be at an additionally increased risk of subsequent depression recurrence. Second, early-life depression was found to be associated with higher levels of adult psychiatric disorders, and also with worse health, criminal, and social functioning, even when accounting for a multitude of potential confounders. Third, early-life depression was predictive of poor labor market outcomes, especially for those with persistent depression. This link was partially mediated by the course of depression. Fourth, the welfare burden associated with early depression amounted to considerable public expenditures in adulthood, particularly for those with persistent depression or comorbid psychiatric conditions such as anxiety and disruptive behavior disorders.The adverse long-term consequences in the wake of early-life depression underscore the importance of prevention and treatment approaches that are both efficacious and cost-effective. Such targeted efforts may have the potential to avert later ill-health, impairment, and possibly also economic disadvantage.
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| 4. |
- Alaie, Iman, et al.
(författare)
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Uppsala Longitudinal Adolescent Depression Study (ULADS)
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.
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| 5. |
- Alaie, Iman, et al.
(författare)
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Adolescent depression and adult labor market marginalization : a longitudinal cohort study
- 2022
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Ingår i: European Child and Adolescent Psychiatry. - : Springer. - 1018-8827 .- 1435-165X. ; 31, s. 1799-1813
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Tidskriftsartikel (refereegranskat)abstract
- Adolescent depression is linked to adult ill-health and functional impairment, but recent research suggests that individual/contextual factors might account for this association. This study aimed to test whether the clinical heterogeneity of adolescent depression is related to marginalization from the labor market across early to middle adulthood. Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort initially assessed with structured clinical interviews at age 16-17. The cohort (n = 321 depressed; n = 218 nondepressed) was followed up after 2+ decades through linkage to nationwide population-based registries. Outcomes included consecutive annual data on unemployment, work disability, social welfare recipiency, and a composite marginalization measure, spanning from age 21 to 40. Longitudinal associations were examined using logistic regression analysis in a generalized estimating equations modeling framework. Subsequent depressive episodes and educational attainment in early adulthood were explored as potential pathways. The results showed that adolescent depression was associated with adult marginalization outcomes, but the strength of association varied across depressed subgroups. Adolescents with persistent depressive disorder had higher odds of all outcomes, including the composite marginalization measure (adjusted OR = 2.0, 95% CI = 1.4-2.7, p < 0.001), and this was partially (31%) mediated by subsequent depressive episodes in early adulthood. Exploratory moderation analysis revealed that entry into tertiary education mitigated the association with later marginalization, but only for adolescents with episodic major depression. In conclusion, the risk for future labor market marginalization is elevated among depressed adolescents, particularly those presenting with persistent depressive disorder. Targeted interventions seem crucial to mitigate the long-lasting impact of early-onset depression.
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| 6. |
- Axfors, Cathrine, et al.
(författare)
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Investigating the association between neuroticism and adverse obstetric and neonatal outcomes
- 2019
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (Cis) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.
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| 7. |
- Axfors, Cathrine, et al.
(författare)
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Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
- 2019
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 98:4, s. 470-478
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionElevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.Material and methodsParticipants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).ResultsAfter adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).ConclusionsNeuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.
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| 8. |
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| 9. |
- Axfors, Cathrine, et al.
(författare)
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Psychometric properties of the attachment style questionnaire in Swedish pregnant women : short and full versions
- 2017
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Ingår i: Journal of Reproductive and Infant Psychology. - : Routledge. - 0264-6838 .- 1469-672X. ; 35:5, s. 450-461
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. Background: Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.Methods: A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item- subscale correlations, Cronbach’s α, and α if item deleted) was evaluated for the seven available subscales. Con rmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test–retest correlations were assessed in a subgroup (n = 48).Results: All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach’s α’s for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Con dence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α’s. The CFA demonstrated better model t for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test–retest correlations ranged from 0.65 to 0.84.Conclusion: The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts.
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| 10. |
- Fransson, Emma, PhD, 1973-, et al.
(författare)
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Maternal perinatal depressive symptoms trajectories and impact on toddler behavior : the importance of symptom duration and maternal bonding
- 2020
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 273, s. 542-551
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Maternal perinatal depression is a public health problem affecting mothers and children worldwide. This study aimed to increase the knowledge regarding the impact of timing of maternal depression on child behavioral difficulties at 18 months, taking into consideration child gender and maternal bonding.METHODS: Data from a Swedish population-based longitudinal mother-infant study (n = 1,093) were used for linear regression modeling. Associations between antenatal depression, postpartum depression, persistent depression and child behavioral problems were assessed.RESULTS: Maternal antenatal and persistent depression were associated with higher Child Behavior Checklist scores. Girls were affected to a greater degree. Postpartum bonding mediated most of the negative effects of postpartum and persistent depression on child behavior; not the effects of antenatal depression, however.LIMITATIONS: Child behavioral problems were reported by the mother. Information regarding paternal depressive symptoms was lacking.CONCLUSION: Different onset and timing of maternal depression showed distinct associations with child behavioral problems. The effects of antenatal depression were not mediated by maternal bonding, indicating underlying mechanisms possibly related to fetal programming. Screening of depressive symptoms even during pregnancy would be important in routine care in order to early identify and treat depression.
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| 11. |
- Hörberg, Niklas, et al.
(författare)
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Early Trauma Inventory Self-Report Short Form (ETISR-SF) : validation of the Swedish translation in clinical and non-clinical samples.
- 2019
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 73:2, s. 81-89
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Childhood trauma in an important public health concern, and there is a need for brief and easily administered assessment tools. The Early Trauma Inventory (ETI) is one such instrument. The aim of this paper is to test the psychometric properties of the Swedish translation of the short, self-rated version (ETISR-SF), and to further validate the instrument.MATERIALS AND METHODS: In this cross-sectional study, 243 psychiatric patients from an open care unit in Sweden and 56 controls were recruited. Participants were interviewed and thereafter completed the ETISR-SF. Internal consistency was calculated using Cronbach's alpha, a confirmatory factor analysis (CFA) was performed and goodness-of-fit was determined. Intra Class Correlation (ICC) was used to calculate test-retest reliability. Discriminant validity between groups was gauged using the Mann-Whitney U-test.RESULTS: Cronbach's alpha varied between 0.55 and 0.76, with higher values in clinical samples than in controls. Of the four domains, general trauma showed a lower alpha than the other domains. The CFA confirmed the four-factor model previously seen and showed good to acceptable fit. The ICC value was 0.93, indicating good test-retest reliability. According to the Mann-Whitney U-test, the non-clinical sample differed significantly from the clinical sample, as did those with PTSD or borderline diagnosis from those without these diagnoses.CONCLUSIONS: The Swedish translation of the ETISR-SF was found to have similar psychometric properties as both the original version and translations. ETISR-SF scores could also distinguish between different diagnostic groups associated with various degrees of trauma, which supports its discriminant validity.
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| 12. |
- Isaksson, Johan, et al.
(författare)
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Psychological and social risk factors associated with development of psychopathology, controlling for biological influence.
- 2021
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Ingår i: Current Opinion in Psychiatry. - : Wolters Kluwer. - 0951-7367 .- 1473-6578. ; 34:6, s. 600-607
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF THE REVIEW: To evaluate and summarize recent research investigating psychological, social and environmental risk factors for development of psychopathology in childhood, while controlling for biological (genetic) influences by using a matched sibling, twin or adoptee design.RECENT FINDINGS: Nineteen studies were included, of which eleven were longitudinal and eight were cohort studies. Included studies used adequate designs and statistical methods, controlled for unmeasured confounders and, in many cases, for other measured risk factors. None of the studies used the framework for environmental factors presented in the International Classification of Functioning, Disability and Health (ICF). The outcome variable psychopathology was rarely assessed using a diagnostic standard. The findings were sorted in five themes based on included exposures: 'Social support, social rejection and perceived identity,' 'Early symptoms of psychopathology,' 'Antibiotic exposure,' 'Factors in the family' and 'Nature versus nurture'.SUMMARY: Using twin/sibling/adoptee designs, a number of unique predictors of psychopathology were found, even when controlling for familial confounders and other specified risk factors. Future studies of psychopathology development should benefit from longitudinal, genetically sensitive designs and from use of diagnostic standards for psychopathology outcome, and should also incorporate ICF for classification of risk factors.
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| 13. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Overcontrolled, undercontrolled, and resilient personality styles among patients with eating disorders
- 2021
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Personality has been suggested to be an important factor in understanding onset, maintenance, and recovery from eating disorders (ED). The objective of the current study was to evaluate personality style in different ED diagnostic groups as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Methods: The overcontrolled, undercontrolled, and resilient personality styles were compared in four groups of patients with EDs: anorexia nervosa restricting (ANr) (n = 34), anorexia nervosa binge eating/purging (ANbp) (n = 31), atypical anorexia nervosa (AAN) (n = 29), and bulimia nervosa (BN) (n = 76). These groups were compared with a group of patients with borderline personality disorder (BPD) (n = 108) and a non-clinical group (NC) (n = 444). Patient data were collected at two outpatient clinics in Uppsala, Sweden. NC control data were collected through convenience sampling. Participants filled out questionnaires assessing personality style. Results: The main findings were more pronounced overcontrol reported by the ANr and AAN groups compared with the BN, BPD, and NC groups, and no significant difference in resiliency between the ED and the NC groups. Considerable variability of over- and undercontrol was also found within each group. Conclusions: The results replicate previous findings when EDs are classified according to current diagnostic criteria (DSM-5). Results indicate that taking personality style into account may improve understanding of EDs. For example, it may facilitate understanding of characteristics like social deficits and rigidity that are attributed to poor treatment outcome in anorexia.
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| 14. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Psychometric properties of the Swedish version of the Ego Resilience scale (ER) and a new shortened version of the Ego Undercontrol scale (EUC)
- 2021
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Ingår i: Current Psychology. - : Springer Science and Business Media LLC. - 1046-1310 .- 1936-4733. ; 40:3, s. 1498-1506
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Tidskriftsartikel (refereegranskat)abstract
- The Ego Resilience scale (ER) and The Ego Undercontrol scale (EUC) are designed to assess personality types based on how people inhibit or express their emotional impulses. The study aim was to evaluate the psychometric properties of the Swedish version of both scales. Two community samples were recruited through convenience sampling and were informed about the study either while attending an undergraduate class at University or through advertisement on the Internet. For the two samples respectively, 483 and 197 individuals aged 18–70 completed the self-rating questionnaires via a website. In the first sample, factor structure, internal consistency, test-retest reliability and construct validity of the ER and the EUC were evaluated and a shorter version ofthe EUC (EUC-13) was developed based on the outcome. In the second sample, factor structure and psycho- metric properties ofthe EUC-13 were analyzed. Exploratory and confirmatory factor analysis supported both the original version of the ER and the EUC-13. Both instruments showed satisfactory levels of internal consistency for all subscales but Socially restrained behavior from the EUC-13, good test-retest reliability, as well as satisfactory preliminary evidence ofvalidity. Further validation studies are recommended, such as investigating the scales in clinical settings.
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| 15. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Radically open dialectical behavior therapy for anorexia nervosa : A multiple baseline single-case experimental design study across 13 cases.
- 2021
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Ingår i: Journal of Behavior Therapy and Experimental Psychiatry. - : Elsevier. - 0005-7916 .- 1873-7943. ; 71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: No treatment for adult anorexia nervosa (AN) has shown sufficient effectiveness or superiority to other treatments. Overcontrol has been suggested as a viable mechanism to target in the treatment of patients with AN. Radically open dialectical behavior therapy (RO DBT) is developed for disorders related to maladaptive overcontrol. Our objective was to evaluate the outcome of RO DBT for AN in a clinical outpatient setting.METHODS: Thirteen adult female patients with mild to moderate AN provided written consent and entered a multiple baseline single-case experimental design study. Median age at eating disorder (ED) onset was 15 years and the median duration of the ED was 10 years. Individual changes were assessed weekly during a baseline phase (A) of four to six weeks, and during the subsequent 40-week RO DBT phase (B). Additional assessments were conducted before and after treatment, and at a six-month follow-up. Primary outcome was ED psychopathology. Secondary outcomes were psychosocial impairment, quality of life, social connectedness, and adaptive control strategies.RESULTS: Eight patients (62%) completed treatment. All completers were in full remission after treatment, with BMI ≥18.5 kg/m2 and ED psychopathology within one standard deviation of the community mean. Improvements occurred after introducing RO DBT, not during baseline.LIMITATIONS: Participants were female with mild to moderate AN, limiting generalizability to severe AN or males.CONCLUSIONS: The study provides preliminary support for using RO DBT in adult outpatients with AN and overcontrol. Further studies should replicate these findings.
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| 16. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Sharing and connecting with others – patient experiences of radically open dialectical behavior therapy for anorexia nervosa and overcontrol : a qualitative study
- 2021
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recovery rates after psychological treatments for anorexia nervosa are low to moderate, and in adults, no treatment outperforms any other. The aim of this study was to evaluate patient experiences of radically open dialectical behavior therapy, a treatment developed for disorders related to maladaptive overcontrol. Methods: Eleven female patients with anorexia nervosa were interviewed after either treatment completion (eight patients) or drop-out (three patients). Interviews were transcribed ans analyzed with inductive thematic analysis. Results: The analysis yielded five main themes: 1) a comprehensive treatment, 2) the benefits of sharing and connecting with others, 3) growing trust, 4) moving toward valued goals – but some remain, and 5) doing well in treatment. Conclusion: Patients appreciated what they described as a comprehensive treatment and holistic view of their problems, which helped them reduce both maladaptive overcontrol and eating disorder symptoms. Gradually sharing personal experiences both in- and outside therapy was described as essential and led to enhanced social connectedness.
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| 17. |
- Kask, Jan, et al.
(författare)
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Anorexia nervosa in males : excess mortality and psychiatric co-morbidity in 609 Swedish in-patients
- 2017
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Ingår i: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 47:8, s. 1489-1499
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Anorexia nervosa (AN) is a psychiatric disorder with high mortality.METHOD: A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses.RESULTS: The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1-5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6-12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9-2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0-22.7), and that for unnatural causes was 35.5 (95% CI 17.7-63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality.CONCLUSION: Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.
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| 18. |
- Kouros, Ioannis, et al.
(författare)
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Wender Utah Rating Scale-25 (WURS-25) : psychometric properties and diagnostic accuracy of the Swedish translation
- 2018
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 123:4, s. 230-236
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to examine the psychometric properties and diagnostic accuracy of the Swedish version of the Wender Utah Rating Scale (WURS) in psychiatric patients with similar symptoms but diagnosed with either attention deficit hyperactivity disorder (ADHD), bipolar disorder (BP), and/or borderline personality disorder (BPD).Methods: A total of 121 patients from an outpatient psychiatric clinic for young adults (18–25 years) were diagnosed using the Structured Clinical Interview for DSM Axis I and Axis II (SCID-I and SCID-II), and ADHD was diagnosed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). WURS were filled in by the participants and compared with a diagnosis of ADHD according to K-SADS.Results: Internal consistency of the WURS was 0.94. The principal component analysis resulted in a three-factor solution that accounted for 61.3% of the variance. The ADHD group had significantly higher mean scores compared to all other groups. The diagnostic accuracy of the WURS was examined using AUC and ROC analysis, and the optimal cut-off score was 39, with a sensitivity of 0.88 and specificity of 0.70, with AUC 0.87, 95% CI 0.80–0.94, PPV 0.59, and NPV 0.92.Conclusion: The psychometric properties of the Swedish WURS were good. For assessment of adult ADHD, in patients with symptoms of emotional instability, impulsivity, and attention problems but of different origins, a somewhat higher cut-off score than the originally suggested was preferable for identification of ADHD.
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| 19. |
- Meyer, Jenny, et al.
(författare)
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Evaluation of a structured skills training group for adolescents with attention deficit/hyperactivity disorder (ADHD) : study protocol of a randomised controlled trial
- 2019
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Ingår i: BMC Psychiatry. - London, UK : BioMed Central. - 1471-244X. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Attention deficit/hyperactivity disorder (ADHD) has a negative impact on several domains of life.However, there is a shortage of evidence-based non-pharmacological treatments for adolescents with ADHD. Astructured skills training group (SSTG) based on dialectical behaviour therapy (DBT) has been used in adult patientswith ADHD with some promising results, although the treatment has not yet been adapted or evaluated foradolescents with ADHD. This study protocol describes how this treatment was adapted for an adolescentpopulation and how the efficacy of the SSTG will be evaluated using a randomised controlled trial (RCT) design.Methods: A sample of 184 adolescents (15–18 years of age) with a diagnosis of ADHD has been recruited fromseven child and adolescent psychiatric outpatient units and randomised to either the SSTG or an active controlgroup based on psychoeducation. Measures are conducted weekly during the treatment, as well as 2 weeks beforetreatment and 2 weeks and 6 months after treatment. The primary outcome measures are ADHD symptoms, functionalimpairment, quality of life and mindfulness. Secondary outcome measures are symptoms of comorbid psychopathology,perceived stress and sleep problems. This article describes the design, methods and analysis plan for evaluating theefficacy of the SSTG.Discussion: The study will be the first RCT to examine the acceptability and efficacy of a SSTG based on DBT adapted foradolescents with ADHD. We believe that the study will extend the current knowledge base about psychologicaltreatment for adolescents with ADHD.
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| 20. |
- Meyer, Jenny, et al.
(författare)
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You are not alone : adolescents' experiences of participation in a structured skills training group for ADHD.
- 2020
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 61:5, s. 671-678
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based on dialectical behavioral therapy. Semi-structured interviews were conducted with 20 adolescents (15-18 years of age) with ADHD after participating in a structured skills training group. The interviews were transcribed verbatim and qualitative content analysis were used to analyze the text. The participants emphasized the value of meeting other adolescents with ADHD and the opportunity to exchange experiences, strategies and tips. Participating in the group treatment made the adolescents realize that they were not alone, and feelings of togetherness and an increased acceptance of themselves were described. The participants associated the treatment with elevated knowledge and understanding, for example, about ADHD, their own functioning and helpful strategies. They also described emotional and behavioral changes, such as higher self-esteem, fewer inter-personal conflicts and improved concentration. Activating and experiential exercises were considered important elements of the treatment, and the participants expressed a need for a variation of exercises, as well as more time for practicing skills, discussions and breaks. The results indicate that the group format add an extra value to the treatment and that the use of an active approach throughout the treatment is of importance for this group of patients.
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| 21. |
- Nasir, Stefan, et al.
(författare)
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Report from an Effort to Optimize Feedback in Undergraduate Psychiatry Training
- 2020
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Ingår i: Academic Psychiatry. - : Springer Nature. - 1042-9670 .- 1545-7230. ; 44:2, s. 205-207
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Few studies report about the feedback students receive in undergraduate psychiatry training. The aim of this study was to evaluate an effort to optimize feedback to medical students during rotations in psychiatry.METHODS: A structured feedback tool was constructed and introduced during psychiatric rotations. At the end of each week during 3 weeks of clinical psychiatry training, 86 medical students anonymously reported whether they had received any feedback, if the new feedback tool had been used and if the received feedback felt valuable. At the end of rotations, students were also asked to leave text comments about their experience of the feedback tool. Course evaluations concerning perceived feedback, before and after introducing a feedback tool, were compared.RESULTS: The 86 students reported about feedback at three occasions, leaving a total of 212 reports (82% response rate). In all reports, the students affirmed having received some feedback, either with or without the feedback tool. In the 123 (58%) reports where feedback was received with the feedback tool, 110 (89%) answered that the feedback was experienced as valuable. Among those 89 (42%) reports where feedback had been delivered without the feedback tool, 41 (46%) described the feedback as valuable. Course evaluation of perceived feedback improved.CONCLUSIONS: Feedback to medical students during psychiatry rotations seems to be optimized by using a structured feedback tool.
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| 22. |
- Ntini, Iordana, 1978-, et al.
(författare)
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The Montgomery and Åsberg Depression Rating Scale – self-assessment for use in adolescents : an evaluation of psychometric and diagnostic accuracy
- 2020
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 74:6, s. 415-422
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Forskningsöversikt (refereegranskat)abstract
- Background: The Montgomery-angstrom sberg Depression Rating Scale - Self Assessment (MADRS-S) is used to assess symptom severity in major depressive disorder (MDD) among adolescents, but its psychometric properties and diagnostic accuracy are unclear.Aim: The aim of this study was to explore psychometric properties, including diagnostic accuracy, of the MADRS-S in adolescent psychiatric outpatients.Method: Adolescent psychiatric outpatients (N = 105, mean age 16 years, 46 boys) completed the MADRS-S and were interviewed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).Results: In principal component analysis, two components with eigenvalues of 4.6 and 1.3 explained 51.1% and 14.4% of the variance, respectively. On the first component loaded items assessing Mood, Feelings of unease, Appetite, Initiative, Pessimism, and Zest for life. On the second component loaded items assessing Sleep, Ability to concentrate, and Emotional involvement. Cronbach's alpha (internal consistency) for all items was 0.87. Spearman's rho was 0.68 for concurrent validity (correlation between total MADRS-S-score and K-SADS MDD severity score). In receiver-operating characteristic analysis, the area under the curve was 0.86 (95% confidence interval 0.78-0.93, p < .001). For all the participants, the highest combined sensitivity and specificity were reached using cut-offs of 15 and 16 (sensitivity 0.82, specificity 0.86). Optimizing sensitivity for MDD, with specificity still >= 0.5, cut off for all was 9, for boys 7 and for girls 10.Conclusion: Psychometric properties of MADRS-S showed good reliability and validity as well as satisfying diagnostic accuracy, indicating good to excellent properties for MDD screening of adolescent psychiatric patients.
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| 23. |
- Richter, Miriam, et al.
(författare)
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The clinical relevance of asking young psychiatric patients about childhood ADHD symptoms
- 2020
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Ingår i: Nordic Journal of Psychiatry. - : TAYLOR & FRANCIS LTD. - 0803-9488 .- 1502-4725. ; 74:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to explore the relevance of asking young psychiatric patients about childhood symptoms of attention deficit hyperactivity disorder (ADHD).Method: A total of 180 young adults (18-25 years of age) from a general psychiatric out-patient clinic in Uppsala filled in the Child and Adolescent Psychiatric Screening Inventory-Retrospect (CAPSI-R) as part of the diagnostic procedure. The study population was divided into groups based on number and subtype of reported ADHD symptoms, inattention (IN) or hyperactivity/impulsivity (HI). The clinical characteristics associated with different symptoms of ADHD were explored.Results: The groups with five or more self-reported ADHD childhood symptoms, of either IN or HI, had more psychiatric comorbid conditions, a significantly higher co-occurrence of substance use disorders and personality disorders, and experienced more psychosocial and environmental problems.Conclusion: High level of self-reported ADHD childhood symptoms in young psychiatric patients identified a group more burdened with psychiatric comorbid conditions and more psychosocial problems. This group should be offered a thorough diagnostic assessment of ADHD.
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| 24. |
- Sonnby, Karin
(författare)
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Co-occurring Symptoms of Attention Deficit Hyperactivity Disorder and Depression : Sex, Aetiology, Help-Seeking and Assessment
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the thesis was to contribute to the knowledge about co-occurring symptoms of ADHD and depression in adolescence, focusing on sex differences, as well as aetiology, help-seeking and assessment.Studies I–III used epidemiological samples of self-reports from all students in Västmanland aged 15–16 and 17–18 years. Study I investigated the prevalence of co-occurring symptoms of ADHD and depression, as well as associations between co-occurring symptoms of ADHD and depression and one environmental stress factor; experience of sexual abuse. Study II examined associations between one biological factor—a polymorphism in TFAP-2β—and co-occurring symptoms of ADHD with andco-occurringsymptoms of depression. Study III investigated the association between the parent–adolescent relationship and seeking help from specialized mental health services in relation to symptoms of ADHD and/or depression. Study IV was a clinical study among adolescent psychiatric patients that compared self-reported ADHD symptoms via the Adult ADHD Self-Report Scale–Adolescent version (ASRS-A) and the Adult ADHD Self-Report Scale–Adolescent–Screening version (ASRS-A-S) with an ADHD diagnosis determined by the gold-standard method; the Kiddie Schedule of Affective Disorders and Schizophrenia diagnostic interview.Studies I–III showed that the phenotype of co-occurring symptoms of ADHD and depression is frequent, with a distinct preponderance among girls. Approximately 50% of both boys and girls with co-occurring symptoms of ADHD and depression had also experienced sexual abuse, indicating that this is a group with multiple risk factors for long-term impaired mental health.Results also support biological sex differences because girls with symptoms of ADHD and a common polymorphism of TFAP-2β (absence of a 9 repeat) reported more symptoms of depression, but boys did not.Further, only 5% of the adolescents with symptoms of ADHD and/or depression sought help from specialized mental health services. The co-occurrence of symptoms of ADHD and depression was a stronger predictor of help-seeking than all other psychosocial factors investigated, including secure attachment cognitions styles to parents. Among help-seeking girls, co-occurring symptoms of ADHD and depression were more common than symptoms of ADHD without co-occurring symptoms of depression.The ASRS-A/ASRS-A-S showed promising psychometric properties for further validation in adolescentsresults as a screening tool for use in adolescents.
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| 25. |
- Spangenberg, Hanna, et al.
(författare)
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Long-term stability of personality traits in a clinical psychiatric sample
- 2019
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Ingår i: Nordic Journal of Psychiatry. - : TAYLOR & FRANCIS LTD. - 0803-9488 .- 1502-4725. ; 73:6, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to describe personality traits in psychiatric patients and to investigate whether these traits are stable over 13 years. Methods: A total of 95 individuals who were patients at a psychiatric outpatients' clinic in 2003 completed the Swedish universities Scales of Personality (SSP). Scores from 2003 were compared with SSP scores from 2016. Based on the current score on the comprehensive psychopathological rating scale - self rating for affective disorders (CPRS-S-A), the participants were divided into two groups representing 'good' and 'poor' current mental states, to investigate the effect of current mental state on reports of personality traits. Results: Out of 13 personality traits, 11 showed a significant change in mean T-score over the study interval. The group with lower CPRS-S-A scores showed a significant change in T-score for 10 traits, whereas in the group with higher CPRS-S-A scores only 3 traits showed a significant change. Conclusions: The findings support the theory that personality is changeable over the course of life, also in psychiatric patients. We do not know if persisting psychiatric symptoms halter change or if deviant personality traits cause psychiatric symptoms to continue.
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| 26. |
- Spangenberg, Hanna, et al.
(författare)
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Moving in together, marriage, and motherhood : A follow up study of relationships in psychiatric patients with personality disorders
- 2021
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Ingår i: Personality and Mental Health. - : John Wiley & Sons. - 1932-8621 .- 1932-863X. ; 15:3, s. 186-197
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Tidskriftsartikel (refereegranskat)abstract
- Background Personality disorders (PDs) are related to poor psychosocial function, including fewer relationships with friends and romantic partners. Methods One-hundred eighty-six psychiatric patients were included in a study cohort in 2002-2003. In 2017, data regarding living arrangements and marital status between 2003 and 2016 were collected for these participants and from a matched control group. Data on birth of first child during the study period were collected for women. The former patients were divided into two groups based on occurrence of PD or not. Groups were compared with each other and with the controls. Results The proportion of participants with PD who lived together with someone did not increase at the same rate as in the other groups. PD was associated with a reduced likelihood of getting married during the study period. Women in the PD group had children to a lower extent than females in the other groups. Conclusion Personality disorder was associated with an increased likelihood of living alone and being unmarried. Female participants with PD had a decreased likelihood of having children compared with controls.
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| 27. |
- Stenson Zerpe, Anna, et al.
(författare)
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Parents' Experiences of Their Child's Craniosynostosis and the Initial Care Process
- 2020
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Ingår i: The Journal of craniofacial surgery (Print). - 1049-2275 .- 1536-3732. ; 31:1, s. 251-256
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Tidskriftsartikel (refereegranskat)abstract
- Craniosynostosis is usually diagnosed in early infancy. Treatment almost always involves surgery and care is optimally organized around an interdisciplinary team of specialists at a craniofacial center. This study aimed to investigate Swedish parents' experiences of having a child with craniosynostosis and their perceptions of the initial care process. Semistructured telephone interviews were conducted with 20 parents (10 fathers and 10 mothers) of children with nonsyndromic craniosynostosis who were undergoing surgery at the Uppsala Craniofacial Center. A thematic data analysis revealed 6 themes presented in a timeline following the parents' journey from detection of their child's abnormal skull shape to waiting for surgery: Detection of the abnormal skull shape, thoughts, and feelings before the appointment with the craniofacial team, an appointment with the craniofacial team, searching the Internet and social media, waiting for surgery, and suggestions for improvement. Although meeting with the craniofacial team was considered informative, parents expressed concerns about surgery and their infant's long-term prognosis were evident. Most parents had no previous knowledge about craniosynostosis and craniofacial syndromes and wished for more information already at the time of its detection. The Internet was used both at the time of suspicion that something was wrong with the child and later to learn about risks and consequences, alternative treatments and prognosis.
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| 28. |
- Sundberg, Isak, et al.
(författare)
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Daytime melatonin levels in saliva are associated with inflammatory markers and anxiety disorders
- 2020
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Ingår i: Psychoneuroendocrinology. - : Elsevier BV. - 0306-4530 .- 1873-3360. ; 112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The bidirectional interaction between melatonin and the immune system has largely gone unexplored in a clinical context and especially in a psychiatric population. This study explored the association between melatonin during the day and inflammatory cytokines in young adult patients seeking psychiatric care.METHODS: Samples and data were collected from 108 young adults (mean age 21, SD = 2) at an outpatient clinic for affective disorders. Daytime saliva melatonin levels were analyzed with enzyme-linked immunosorbent assay (ELISA) in relation to normalized serum expression levels of 72 inflammatory markers in a proximity extension assay (PEA). In a post hoc analysis the markers associated with melatonin were tested in a generalized linear model to see whether there is a relationship to anxiety disorder or depression.RESULTS: After Bonferroni correction for multiple testing, melatonin levels at 11:00 were positively correlated with CD5 (p = 4.2e-4). Melatonin levels after lunch were correlated with CCL2/MCP-1 (p = 4.2e-4), CCL3/MPI-1α (p = 6.5e-4) and VEGF-A (p = 5.3e-6). In the generalized linear model, positive associations were found for the presence of any anxiety disorder with melatonin after lunch (p = 0.046), VEGF-A (p = 0.001) and CCL3/MPI-1α (p = 0.001).CONCLUSION: Daytime saliva levels of melatonin were related to several inflammatory markers in young adults with psychiatric disorders. This observation likely reflects the bidirectional relationship between melatonin production and the immune system. These findings may have relevance for the understanding of psychiatric disorders and other conditions associated with low-grade inflammation.
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| 29. |
- Sundberg, Isak, et al.
(författare)
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Direct-acting antiviral treatment in real world patients with hepatitis C not associated with psychiatric side effects : a prospective observational study
- 2018
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment of Hepatitis C virus (HCV) infection has evolved from interferon (IFN)-based treatments to direct-acting antivirals (DAAs). Patients with HCV have an elevated psychiatric morbidity (including substance abuse) and patients with such comorbidity have often been excluded from treatment with IFN. To date, little is known about psychiatric adverse effects of DAA-based regimens. We therefore aimed to study the psychiatric side effects of new IFN-free treatment for HCV (including depressive symptoms and sleep) in real world patients also including those with a history of psychiatric diagnosis, substance abuse or drug dependence. Methods: Consecutive patients were monitored during treatment with three of the latest DAA agents (sofosbuvir, simeprevir and daclatasvir). Repeated expert psychiatric assessments from baseline to 12 weeks post-treatment were performed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) clinical version and the self-report versions of the Montgomery Asberg Depression Rating Scale (MADRS-S) and the Pittsburgh Sleep Quality Index (PSQI). Friedman's test was performed to calculate differences in the MADRS-S and PSQI over time. In a post-hoc analysis Wilcoxon's test was used to compare baseline depressive symptoms with those at post-treatment. Spearman's rank correlation test was conducted in another post-hoc analysis to evaluate the correlation between symptoms of depression and HCV viral load at baseline. Results: At baseline, 15/17 patients (88%) had a history of any psychiatric diagnosis; 11 (65%) had a history of substance abuse or dependence; and 11 (65%) had previously been treated with IFN and six of those had experienced psychiatric side effects. There was no correlation between depressive symptoms and HCV viral load at baseline. Symptoms of depression did not increase during DAA treatment and were lower 12 weeks post-treatment compared with baseline: MADRS-S 10.7 vs. 8.3 (p = 0.01). This observation held when excluding patients taking antidepressant medication. Sleep quality did not significantly change during treatment. Adherence to treatment was estimated to 95% and sustained virological response was 88%. Conclusions: Despite high psychiatric morbidity, including previous substance abuse, patients successfully completed DAA treatment without increasing depressive symptoms or sleep disturbance. Symptoms of depression were significantly reduced 12 weeks after DAA treatment.
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| 30. |
- Syk, Mikaela, et al.
(författare)
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Plasma levels of leptin and adiponectin and depressive symptoms in young adults
- 2019
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Ingår i: Psychiatry Research. - : Elsevier BV. - 0165-1781 .- 1872-7123. ; 272, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Circulating levels of adipokines are known to be associated with depression. This study aimed to investigate a possible association between leptin, adiponectin and dimensional measures of depressive symptoms in young adults with and without psychiatric illness. Total plasma adiponectin and leptin levels were measured in 194 young adults seeking psychiatric ambulatory care and 57 healthy controls. Depressive symptoms were assessed using the Montgomery-Åsberg Depression Self-Rating Scale (MADRS-S). Analysis was performed on men and women separately. P-leptin levels were significantly elevated in patients compared with controls and correlated with total MADRS-S scores in the women. Women with P-leptin in the highest quartile reached a significantly higher MADRS-S score than women in the lowest quartile, but this difference disappeared after adjusting for body mass index (BMI) and antidepressant use. MADRS-S score was associated with P-leptin in female patients without antidepressant use, independently of BMI. There was no association between P-leptin levels and current major depression. P-adiponectin levels were not associated with depressive symptoms or current major depression. The findings indicate that P-leptin levels are associated with depressive symptom severity in young women; however, the association is linked to other factors, which challenges its usefulness as a biomarker for depression in clinical psychiatry.
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| 31. |
- Söderquist, Fanny, 1985-, et al.
(författare)
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A cross-sectional study of gastrointestinal symptoms, depressive symptoms and trait anxiety in young adults
- 2020
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Ingår i: BMC Psychiatry. - : BMC. - 1471-244X. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls.Methods: Gastrointestinal symptoms were assessed with the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS). Depressive symptoms were assessed with the Montgomery-angstrom sberg Depression Rating Scale- Self assessment (MADRS-S). Trait anxiety was estimated with three of the Swedish universities of Personality (SSP) scales: Somatic trait anxiety, Psychic trait anxiety and Stress susceptibility. Self-ratings were collected from 491 young adult psychiatric outpatients and 85 healthy controls. Gastrointestinal symptom severity was compared between patients with and without current psychotropic medication and controls. Associations between gastrointestinal symptoms, depressive symptoms and trait anxiety were assessed using Spearman's coefficients and generalized linear models adjusting for possible confounders (sex, body mass index, bulimia nervosa).Results: Patients, with and without current psychotropic medication, reported significantly more gastrointestinal symptoms than controls. In the generalized linear models, total MADRS-S score (p<0.001), Somatic trait anxiety (p<0.001), Psychic trait anxiety (p=0.002) and Stress susceptibility (p=0.002) were independent predictors of the total GSRS-IBS score. Further exploratory analysis using unsupervised learning revealed a diverse spectrum of symptoms that clustered into six groups.Conclusion: Gastrointestinal symptoms are both highly prevalent and diverse in young adult psychiatric outpatients, regardless of current psychotropic medication. Depressive symptom severity and degree of trait anxiety are independently related to the total gastrointestinal symptom burden.
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| 32. |
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| 33. |
- Söderquist, Fanny, 1985-, et al.
(författare)
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Gastrointestinal symptoms, depression and trait anxiety in young adults seeking psychiatric care
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Patients with functional gastrointestinal (GI) disorders have a high psychiatric co-morbidity, especially for mood and anxiety disorders. This study aimed to investigate and characterise GI symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult outpatients seeking psychiatric care.Material and methods: Patients, aged 18-25 years from the Uppsala Psychiatric Patient Samples (UPP) cohort seeking psychiatric care for primarily mood and anxiety disorders (n=491) were compared with healthy controls (n=85) for GI symptoms (measured using the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome, GSRS-IBS and depressive symptoms (measured using the Montgomery-Åsberg Depression Rating Scale – Self-Assessment, MADRS-S. Personality traits were assessed using the Swedish Universities Scales of Personality (SSP), in which three anxiety-related personality traits (stress susceptibility, psychic trait anxiety somatic trait anxiety) were assessed.Results: Patients, both on psychotropic medication and those not currently on psychotropic medication reported more GI symptoms than controls (median 30 vs. 22, p<0.001). GI symptom burden was higher in women than men (median 32 vs. 28, p<0.001). A principal component analysis produced a six-factor structure explaining 63% of the total variance in the data set. A cluster analysis was performed that allowed the identification of six cluster groups, characterised by the varying levels of these factors. The total GSRS-IBS score significantly correlated with depressive symptom severity (r=0.391, p<0.001), a relationship that remained after adjusting for possible confounders (sex, body mass index, bulimia). The total GSRS-IBS score correlated with the three SSP subscales: somatic trait anxiety (r=0.313, p<0.001), psychic trait anxiety (r=0.147, p=0.001) and stress susceptibility (r=0.233, p<0.001).Conclusion: GI symptoms are highly prevalent in young adult psychiatric outpatients compared with controls, regardless of whether the patient is currently on psychotropic medication or not. Depressive symptom severity and degree of trait anxiety are independently related to the total IBS symptoms score.
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| 34. |
- Söderquist, Fanny, et al.
(författare)
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The Relationship Between Daytime Salivary Melatonin and Gastrointestinal Symptoms in Young Adults Seeking Psychiatric Care
- 2019
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Ingår i: Psychosomatic Medicine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0033-3174 .- 1534-7796. ; 81:1, s. 51-56
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The pathophysiology of irritable bowel syndrome (IBS) is not completely understood, although we do know that patients with IBS have a high prevalence of psychiatric comorbidity (mainly depression and anxiety disorders). Melatonin, produced in the gastrointestinal tract, influences gutmotility. Psychiatric conditions are associated with circadian disturbances in peripheral melatonin levels. This study aimed to investigate associations between daytime salivary melatonin and gastrointestinal symptoms in young adult psychiatric patients.Methods: Ninety-six patients (86% women), aged 18-25 years (M (SD) = 21 (2)), seeking psychiatric care with primarily anxiety disorders, affective disorders, or both were included in the study. Total scores from the Gastrointestinal Symptoms Rating Scale -IBS were compared with salivary melatonin measured at three time points (30 minutes after waking up, at 11: 00 hours and 30 minutes after lunch) during the waking hours of 1 day.Results: After adjustment for potential confounders, melatonin levels in saliva 30 minutes after lunch remained significantly correlated to the total Gastrointestinal Symptoms Rating Scale -IBS score after correction for multiple testing (B = 0.016, SE = 0.006, p =.015, q = 0.045). In a post hoc analysis, symptoms of gastrointestinal pain and bloating contributed most to this association.Conclusions: In young adult psychiatric patients, salivary melatonin levels after lunch are associated with gastrointestinal symptoms, which is consistent with the proposed effect of elevated levels of gastrointestinal melatonin on gut motility. This result suggests a link between IBS symptoms and regulation of melatonin in patients with psychiatric disorders.
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| 35. |
- Tahib, Nezar, PhD student, 1975-, et al.
(författare)
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Validation of the Kurdish version of the Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C)
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C) is an instrument developed from the adult version of the Harvard Trauma Questionnaire (HTQ) by adding 13 child specific items. The HUTQ-C is used to identify traumatic events among children. However, no psychometric evaluation of the Kurdish translation of the HUTQ-C has been published. The aim of this article was to study the psychometric characteristics of the Kurdish version of the HUTQC. Data on HUTQ-C were collected for 100 street working children and 100 school children in Duhok. The internal consistency of the HUTQ-C was examined with Cronbach's alpha. The convergent validity of the HUTQ-C was examined by comparison with the Child Behavior Checklist (CBCL). The internal consistency for the total 30 items HUTQ-C of the three domains, experienced, witnessed and heard, showed good internal consistency; Cronbach’s alpha was 0.83. The HUTQ-C showed higher internal consistency than both the original 17 items from HTQ and the added 13 child specific items, when these were examined separately. There was significant difference in HUTQ-C scores for those with normal range compared to those with clinical range on the anxious/depressed scale of Child Behavior Check List (CBCL) (KruskalWallis Test=6.22, p<0.05) supporting convergent validity. The Kurdish HUTQ-C shows promising reliability and validity.
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| 36. |
- Tillman, Karin K., 1977-, et al.
(författare)
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Academic Achievement in children with orofacial clefts-a nationwide study in Sweden
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate if academic achievement among children with nonsyndromic orofacial clefts (OFC) differs compared to nonaffected children.Methods: A register-based cohort of all children born with Cleft lip (CL), Cleft Lip and Palate (CLP) and Cleft Palate only (CPO) in Sweden between 1973 and 2004, with records in the Swedish school grade register (SGR) (n=6286), was compared to a matched community cohort (n=61352). Outcome measures were academic achievements in mathematics and Swedish in school years 3, 5, 6, 9 and upper secondary school, all subjects’ grades in schoolyear 9, and university degree. Binomial-, ordinal logistic-, linear-, and binary logistic regression were used, and a number of covariates were adjusted for.Results: In the third school year, children with CLP and CPO demonstrated lower odds of passing the mathematics’ national standard tests (NSTs) (CLP; aOR 0.72, 95% CI 0.54-0.95 and CPO; aOR 0.54, 95% CI 0.418-0.697). CPO was associated with lower odds of passing Swedish NST (OR 0.54, 95% CI 0.40-0.72). In the ninth school year, students with CLP and CPO had lower grades in mathematics (CLP; aOR 0.87, 95% CI 0.78-0.97 and CPO; aOR 0.81, 95% CI 0.73-0.91), lower average percentile grade (CLP; coefficient -2.71, 95% CI (- 4.07)-(-1.36) and CPO; -3.23, 95% CI (-4.715)-(-1.736)) and CLP also presented lower Swedish grades (aOR 0.89, 95 % CI 0.80-0.99). At upper secondary school, students with CLP and CPO had lower grades in mathematics (CLP; aOR 0.85, 95% CI 0.75-0.98 and CPO; aOR 0.87, 95% CI 0.76-0.999). Only individuals with CPO had reduced odds of graduating from university (aOR 0.81, 95% CI 0.665-0.983).Conclusions: Our findings of worse academic achievements in children with OFC throughout the educational system emphasize the need to screen children with clefts for learning difficulties to provide additional support in school.
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| 37. |
- Tillman, Karin K., 1977-, et al.
(författare)
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Bilateral orofacial clefts confer increased risk of psychiatric morbidity relative to unilateral clefts
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundNonsyndromic orofacial clefts (OFC) are associated with neurodevelopmental disorders. The aim of this study was to compare children with bilateral clefts with unilateral clefts regarding psychiatric disorders.MethodsWe utilized data on all children born in Sweden between 1973 and 2012 with unilateral cleft lip (UCL), bilateral cleft lip (BCL), unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). We performed Cox regression analyses with direct comparisons between bilateral and unilateral clefts compared to matched community cohorts and adjusted for confounders.ResultsChildren with BCL showed risk increases for any psychiatric disorder (aHR 2.13, 95% CI 1.04-4.36), including intellectual disability (aHR 5.31, 95% CI 1.29-21.78) compared to UCL. Children with BCLP demonstrated risk increases for any psychiatric disorder (aHR 1.55, 95% CI 1.20-2.01), including speech and language disorders (aHR 1.99, 95% CI 1.00-3.97), neurodevelopmental disorders (aHR 1.66, 95% CI 1.11-2.47) and other psychiatric disorders (aHR 1.54, 95% CI 1.11-2.15), such as personality disorders (aHR 5.76, 95% CI 2.13- 15.55) compared to UCLP.ConclusionsThis large nationwide register study shows for the first time that individuals with bilateral clefts demonstrate elevated risks of psychiatric disorders compared to unilateral clefts.
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| 38. |
- Tillman, Karin K.
(författare)
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Craniofacial malformations and psychiatric disorders from a neurodevelopmental perspective
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Orofacial clefts (OFC) and craniosynostosis (CS) are the two most common craniofacial malformations. Of note, craniofacial abnormalities share some overlapping risk factors with psychiatric disorders. Thus, this thesis aimed to study psychiatric and educational outcomes in this group.In study I and III we examined psychiatric outcomes among children with nonsyndromic OFC stratified on cleft lip (CL), cleft lip and palate (CLP), cleft palate only (CPO), unilateral and bilateral CL and CLP. In study II we studied associations between nonsyndromic CS (NSCS) and psychiatric disorders. Study IV assessed national standardised tests in Swedish and mathematics, school grades and university degrees in children with CL, CLP and CPO. Children with craniofacial malformations were identified through the Swedish National Patient Register and compared to a cohort from the general population that was matched for month and year of birth, sex and county of birth. In addition, children with craniofacial malformations were compared to their unaffected siblings.Individuals with OFC presented risk increases for intellectual disability, language disorders, psychosis, autism spectrum disorder, attention-deficit/hyperactivity disorder and behavioural disorders in childhood. CPO showed the most robust associations, followed in descending order by CLP and CL. Nonaffected siblings had a lower risk of psychiatric disorders. Females generally had higher risks for psychiatric comorbidity (Study I).Children with bilateral clefts had higher risk increases for psychiatric disorders compared to children with unilateral clefts. We also found that females with bilateral CLP showed higher risks for intellectual disability and neurodevelopmental disorders compared to males with bilateral CLP (Study III).Risk increases for any psychiatric disorder including intellectual disability, language disorders, other neurodevelopmental disorders and other psychiatric disorders, were seen in individuals with NSCS. In the crude analyses full siblings with NSCS, as compared to nonaffected siblings, were more likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorders and other neurodevelopmental disorders. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders. Females displayed borderline higher risk increases than males (Study II).Finally, children with OFC had lower school performance almost throughout the educational years, especially in mathematics. Lower academic achievement was most evident in children with OFC without a concurrent psychiatric disorder. In the ninth school year and upper secondary school female academic outcomes were more negatively affected than male academic outcomes (Study IV).In summary, craniofacial malformations were associated with increased risks for multiple psychiatric disorders and lower academic achievement.
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| 39. |
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| 40. |
- Tillman, Karin K., et al.
(författare)
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Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts
- 2018
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 57:11, s. 876-883
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type.METHOD: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842) was compared to a matched cohort (n = 78,409) as well as to their unaffected siblings (n = 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models.RESULTS: Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC.CONCLUSION: Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.
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| 41. |
- Tillman, Karin K., et al.
(författare)
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Nonsyndromic craniosynostosis is associated with increased risk for psychiatric disorders
- 2020
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Ingår i: Plastic and reconstructive surgery (1963). - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052 .- 1529-4242. ; 146:2, s. 355-365
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis.METHODS: The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders.RESULTS: Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders.CONCLUSIONS: Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors).CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
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| 42. |
- Tores Soler, Catalina, et al.
(författare)
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Psychometric evaluation of the Swedish Child Sheehan Disability Scale in adolescent psychiatric patients
- 2021
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Ingår i: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. - : Exeley, Inc.. - 2245-8875. ; 9, s. 137-146
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Tidskriftsartikel (refereegranskat)abstract
- Background: Assessment of disability is part of the psychiatric diagnostic process, and validated scales are needed for the assessment of functioning. The Swedish translations of the Child Sheehan Disability Scale (CSDS) for adolescents and parents (CSDS-P) have been adapted for use in psychiatric settings.Objective: The purpose of the study was to explore the psychometric properties of the Swedish CSDS and the CSDS-P among adolescent psychiatric patients.Method: Patients (n = 107) were assessed with the CSDS, the Strengths and Difficulties Questionnaire (SDQ adolescent), and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) diagnostic interview. Their parents participated in the interview and completed the CSDS-P and SDQ parent.Results: Internal consistency was alpha =.813 for the CSDS (three items) and alpha =.842 for the CSDS-P (five items). For both scales, principal component analyses showed one component. The correlations between the total scores of the CSDS and CSDS-P in relation to a general K-SADS-PL symptom summation index were r(s) = .332, p < .001 and r(s) = .237, p = .014, respectively. Correlations with the total K-SADS function summation index were r(s) < .300 for both. The correlation between the CSDS and the total difficulties score on the SDQ was r(s) = .433,p < .001.Conclusions: The Swedish translations of the CSDS and CSDS-P had similar psychometric properties to Whiteside's CSDS and the Adult Sheehan Disability Scale. Concurrent validity and correlation between the CSDS and CSDS-P were weak.
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| 43. |
- Torres Soler, Catalina, et al.
(författare)
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Diagnostic accuracy of the Montgomery-Åsberg Depression Rating Scale parent report among adolescent psychiatric outpatients
- 2018
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis Group. - 0803-9488 .- 1502-4725. ; 72:3, s. 184-190
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The diagnostic accuracy of the parent report of the Montgomery-Åsberg Depression Rating Scale (MADRS-P) for the screening of major depressive disorder (MDD) in adolescents has not been evaluated.AIM: The aim was to explore the psychometric properties and diagnostic accuracy of the MADRS-P in general child and adolescent psychiatric outpatient services in Sweden.METHOD: The study was a validation and a diagnostic accuracy study. Consecutive adolescent psychiatric patients (n = 101, 45 males, mean age 15 years) were assessed with a diagnostic interview, the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL), as a reference test. Thereafter, their parents reported on the MADRS-P. Both categorical MDD diagnoses and dimensional MDD symptom severity scores were obtained from the K-SADS-PL.RESULTS: The internal consistency of the MADRS-P, measured with Cronbach's alpha, was 0.846. The concurrent validity, assessed by Spearman's rho as a correlation between the K-SADS MDD symptom severity score and the MADRS-P score, was 0.580. The area under the curve in a receiver operating characteristic analysis for all participants was 0.786 (95% confidence interval 0.694-0.877, p < .001). At a cut-off of 10, sensitivity was 0.86, specificity 0.54, positive predictive value 0.59 and negative predictive value 0.84.CONCLUSIONS: The parent-rated MADRS-P showed similar psychometric properties as previously shown for the self-rated MADRS-S in adults. Although the MADRS-P has acceptable diagnostic accuracy for screening for MDD in adolescents in a general psychiatric setting, it cannot be used alone for diagnosing MDD.
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| 44. |
- Öster, Caisa, et al.
(författare)
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How do adolescents with ADHD perceive and experience stress? : An interview study
- 2020
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 74:2, s. 123-130
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Tidskriftsartikel (refereegranskat)abstract
- Background: Attention-deficit/hyperactivity disorder (ADHD) is linked to high levels of perceived stress in adult populations. Thus, it is not surprising that stress managing techniques are being included in treatment protocols for adults with ADHD. There is, however, a paucity of studies on perceived stress in adolescents with ADHD.Aims: This study aims to explore how adolescents with ADHD perceive and experience stress (and stressors) using a qualitative approach. Methods: Explorative interviews were conducted with 20 adolescents (Mean age: 16.30) diagnosed with ADHD in conjunction with group treatment therapy. Data were analysed using qualitative content analysis.Results: Stress and ADHD, as well as stress, anxiety and ill-health, were described as closely intertwined. The result is presented in four categories: stress is often present, triggers of stress, stress affects daily life, and stress can be handled and prevented. A relation was found between stress and feelings of helplessness, ill-health and anxiety. Stress was viewed as being out of proportion with reality and was driven by such factors as ADHD symptoms, school demands, unpredictable situations and relational problems. Several negative consequences of stress were reported, including postponing schoolwork and the tendency to give up. Some participants also reported performing better when stressed. Accepting help from others, practising acceptance, settling down and controlling oneself, and planning in advance were seen as helpful stress managing techniques.Conclusions: Stress should be considered among other problems related to ADHD. Psychoeducation about stress, stress managing techniques and coaching should be included in the treatment of adolescents with ADHD.
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