| 1. |
- Fazel, Seena, et al.
(författare)
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Risk of death by suicide following self-harm presentations to healthcare : development and validation of a multivariable clinical prediction rule (OxSATS)
- 2023
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Ingår i: BMJ Mental Health. - : BMJ Publishing Group Ltd. - 2755-9734. ; 26:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Assessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes. OBJECTIVE: We developed and validated a predictive model for suicide following self-harm.METHODS: We used data from Swedish population-based registers. A cohort of 53 172 individuals aged 10+ years, with healthcare episodes of self-harm, was split into development (37 523 individuals, of whom 391 died from suicide within 12 months) and validation (15 649 individuals, 178 suicides within 12 months) samples. We fitted a multivariable accelerated failure time model for the association between risk factors and time to suicide. The final model contains 11 factors: age, sex, and variables related to substance misuse, mental health and treatment, and history of self-harm. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines were followed for the design and reporting of this work.FINDINGS: An 11-item risk model to predict suicide was developed using sociodemographic and clinical risk factors, and showed good discrimination (c-index 0.77, 95% CI 0.75 to 0.78) and calibration in external validation. For risk of suicide within 12 months, using a 1% cut-off, sensitivity was 82% (75% to 87%) and specificity was 54% (53% to 55%). A web-based risk calculator is available (Oxford Suicide Assessment Tool for Self-harm or OxSATS).CONCLUSIONS: OxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility.CLINICAL IMPLICATIONS: Using a clinical prediction score may assist clinical decision-making and resource allocation.
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| 2. |
- Klang, Andrea, et al.
(författare)
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Access to Rehabilitation After Hospitalization for Traumatic Brain Injury : A National Longitudinal Cohort Study in Sweden
- 2023
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Ingår i: Neurorehabilitation and Neural Repair. - : Sage Publications. - 1545-9683 .- 1552-6844. ; 37:11-12, s. 763-774
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear.OBJECTIVE: To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors.METHOD: We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors.RESULTS: Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81).CONCLUSION: Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.
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| 3. |
- Larm, Peter, et al.
(författare)
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Multiple adverse outcomes over 30 years following adolescent substance misuse treatment
- 2009
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 119:6, s. 484-493
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare outcomes over 30 years experienced by individuals who as adolescents entered substance misuse treatment and a general population sample. Method: All 1992 individuals seen at the only clinic for substance misusing adolescents in Stockholm from 1968 to 1971 were compared to 1992 individuals randomly selected from the Swedish population, matched for sex, age and birthplace. Death, hospitalization for physical illness related to substance misuse, hospitalization for mental illness, substance misuse, criminal convictions and poverty were documented from national registers. Results: Relative risks of death, physical illness, mental illness, substance misuse, criminal convictions and poverty were significantly elevated in the clinic compared to the general population sample. After adjustment for substance misuse in adulthood, the risks of death, physical and mental illness, criminality and poverty remained elevated. Conclusion: Adolescents who consult for substance misuse problems are at high risk for multiple adverse outcomes over the subsequent 30 years.
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| 4. |
- Molero Samuelson, Yasmina, et al.
(författare)
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Adolescent antisocial behavior as predictor of adverse outcomes to age 50 : A follow-up study of 1,947 individuals
- 2010
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Ingår i: Criminal justice and behavior. - : SAGE Publications. - 0093-8548 .- 1552-3594. ; 37:2, s. 158-174
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Tidskriftsartikel (refereegranskat)abstract
- The study examined associations between antisocial behavior (ASB) before age 15 and eight adverse outcomes from age 21 to 50 among 1,623 men and 324 women who as adolescents consulted a clinic for substance misuse problems. Outcomes were documented using Swedish national registers and included death, hospitalization for physical illnesses related to substance misuse, mental illness, self-inflicted harm, substance misuse, convictions for violent and nonviolent crimes, and poverty. ASB before age 15 was associated with increased odds of all outcomes in adulthood except hospitalization for mental illness after adjusting for low family socioeconomic status, sex, Sex × ASB, and substance misuse in adulthood and with an increased number of adverse outcomes up to age 50. No gender differences were detected.
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| 5. |
- Molero Samuelson, Yasmina
(författare)
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Antisocial behaviour over the life course among females and males treated for substance misuse
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: (1) To compare the prevalence of adverse outcomes in adulthood between a clinic cohort and a matched sample from the general population; (2) To examine the associations between adolescent antisocial behaviour and adverse outcomes in adulthood; (3) To identify subgroups of male and female offenders with distinct features of offending, and to examine the long-term continuity of offending in the subgroups, and; (4) To identify long-term offending trajectories and examine the relationship between these offending trajectories and concurrent problems in other areas. Method: Participants were part of a longitudinal study of adolescents who were treated at a substance misuse clinic during two periods: 1968-1971 (Cohort 1; 1992 participants), and 1980-1984 (Cohort 2; 1576 participants). The same number of individuals were randomly selected from the general population and matched to the clinic cohorts. Baseline data was extracted from archival data, and participants were followed to 2002 through multiple national registers. Results: Individuals from cohort 1 were at increased risk of several adverse outcomes in adult life when compared to the matched sample. Additionally, adolescent antisocial behaviour increased the risk of adversity in multiple domains up to age 50 in cohort 1. Several subgroups of offenders could be identified in adolescence and again in adulthood in cohort 1, and considerable continuity in offending was shown among several subgroups. Individuals with high levels of violent and non-violent offending in adulthood also demonstrated high levels of substance-related crimes. Multiple longterm offending trajectories were identified in cohort 2 and in the matched sample. Cohort 2 showed less desistance in offending than the matched sample, and trajectories with the highest offending rates displayed the highest rates of concurrent problems. Both sex differences and similarities were demonstrated in all studies; larger differences in outcomes were found between women in cohort 1 and women in the matched sample, than between their male counterparts. In cohort 1, males demonstrated higher offending levels and more offending diversity, and specific subgroups and trajectories were identified among the males that were not replicated among the females. Conversely, adolescent antisocial behaviour was associated with adult adversity equally in females and males in cohort 1, and no sex differences were found in the continuity of offending, or in the relationship between substance-related crimes and other crimes in the same cohort. Both genders also demonstrated similarities in the associations between concurrent problems and offending trajectories in cohort 2. Conclusions: An increased risk of both homotypic and heterotypic continuity of problems through 30 years of adult life was demonstrated among individuals treated for substance misuse as adolescents. This highlights the importance of assessing and treating the multiplicity of problems to prevent continuation of current problems, and the emergence of new ones. Treatment should also acknowledge heterogeneity and aim to target specific needs, instead of accommodating a wide range of problems with the same intervention strategy. The findings further suggest that intervention is equally needed among girls who present antisocial behaviour in adolescence, as this is predictive of adult adversity. Altogether, the findings point to the importance of early and effective interventions to prevent further antisocial behaviour, and the problems associated with it.
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| 6. |
- Molero, Yasmina, et al.
(författare)
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Are offending trajectories identified in population sample studies relevant for treatment settings? A comparison of long-term offending trajectories in individuals treated for substance abuse in adolescence, to a matched general population sample
- 2015
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Ingår i: CBMH. Criminal behaviour and mental health. - : Wiley. - 0957-9664 .- 1471-2857. ; 25:5, s. 416-428
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most studies on offending heterogeneity have been conducted with general population samples. It is not clear to what extent these can inform such outcomes for individuals with substance use disorders specifically.Aims: The aim of this study is to compare the offending trajectories of individuals treated for substance use disorders in adolescence with a matched general population sample, and to test for gender differences in this respect.Method: Growth mixture models were applied to identify offending trajectories from age 15 to 33 of 1568 individuals treated for substance use disorders in adolescence, and in a matched population-based sample of 1500 individuals.Results: Several parallel trajectories for men and for women were identified in both samples. The substance misuse treatment sample, however, had higher levels of offending, larger offender classes, longer careers and two additional, distinct trajectories. Although there were similarities between the men and women, the men were more heterogeneous offenders. There were two distinct offending trajectories among male substance misusersdecreasing high level and decreasing low level offending.Conclusions: Differences between substance using and general population samples indicate that results from the latter could underestimate the severity, heterogeneity, and persistence of offending trajectories if merely generalised to individuals with substance use disorders. Our results also indicated that population-based samples might be underpowered for detecting female offending heterogeneity.
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| 7. |
- Molero, Yasmina, et al.
(författare)
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Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime : population based cohort study in Sweden
- 2019
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Ingår i: The BMJ. - : BMJ Publishing Group Ltd. - 1756-1833 .- 0959-8138. ; 365
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicidal behaviour, unintentional overdoses), and criminality.DESIGN: Population based cohort study.SETTING: High quality prescription, patient, death, and crime registers, Sweden.PARTICIPANTS: 191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for gabapentinoids (pregabalin or gabapentin) during 2006 to 2013.MAIN OUTCOME MEASURES: Primary outcomes were suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidents and offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. Participants served as their own control, thus accounting for time invariant factors (eg, genetic and historical factors), and reducing confounding by indication. Additional adjustments were made by age, sex, comorbidities, substance use, and use of other antiepileptics.RESULTS: During the study period, 10 026 (5.2%) participants were treated for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. In within-individual analyses, gabapentinoid treatment was associated with increased hazards of suicidal behaviour and deaths from suicide (age adjusted hazard ratio 1.26, 95% confidence interval 1.20 to 1.32), unintentional overdoses (1.24, 1.19 to 1.28), head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences (1.13, 1.06 to 1.20). Associations with arrests for violent crime were less clear (1.04, 0.98 to 1.11). When the drugs were examined separately, pregabalin was associated with increased hazards of all outcomes, whereas gabapentin was associated with decreased or no statistically significant hazards. When stratifying on age, increased hazards of all outcomes were associated with participants aged 15 to 24 years.CONCLUSIONS: This study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences. Pregabalin was associated with higher hazards of these outcomes than gabapentin.
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| 8. |
- Molero, Yasmina, et al.
(författare)
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Associations between statin use and suicidality, depression, anxiety, and seizures : a Swedish total-population cohort study
- 2020
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Ingår i: Lancet psychiatry. - : Elsevier. - 2215-0374 .- 2215-0366. ; 7:11, s. 982-990
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Statins have shown both protective and adverse associations with neuropsychiatric outcomes. We aimed to examine the possible associations between statins and suicidality, depression, anxiety, and seizures.METHODS: Using Swedish national registers, we linked data on dispensed statin prescriptions with data on unplanned (emergency) hospital visits or specialised outpatient care for four neuropsychiatric outcomes: suicidal behaviour (including deaths from suicide), depressive disorders, anxiety disorders, and seizures. We included all individuals in the registries who were dispensed statins and who were aged 15 years or older between Jan 1, 2006, and Dec 31, 2013. We applied a within-individual design using stratified Cox proportional hazards regression to compare the incidence of the defined outcomes during periods on statins and periods off statins within each individual, thus adjusting for time-invariant confounders. Non-specific effects of treatment were tested by investigating these outcomes in relation to thiazide diuretic use and antihistamine use in the same cohort.FINDINGS: The statin-users cohort comprised 1 149 384 individuals, of whom 1 015 949 (88·4%) were aged 50 years or older, 625 616 (54·4%) were male, and 523 768 (45·6%) were female. The study period consisted of 2 053 310 non-treatment periods and 2 997 545 treatment periods, and 957 216 (83·3%) individuals had a medication status change (from on statins to off statins, or vice versa). Suicide outcomes were found in 6372 (0·6%) individuals, depressive disorders in 23 745 (2·1%), anxiety disorders in 30 100 (2·6%), and seizures in 28 844 (2·5%). There were no clear associations between periods of statin treatment and suicidal behaviour or deaths from suicide (hazard ratio 0·99 [95% CI 0·90-1·08]), anxiety disorders (0·99 [0·95-1·02]), or seizures (1·00 [0·97-1·04]). Statins were associated with reduced hazards of depressive disorders (0·91 [0·87-0·94]), which remained after adjustment for concurrent antidepressant use (0·91 [0·88-0·94]). Hazard ratios for depressive disorders were 0·61 (0·38-1·00; n=14 718) with thiazide diuretic use and 0·84 (0·67-1·06; n=23 715) with antihistamine use.INTERPRETATION: Statin use is not associated with suicidality, anxiety disorders, or seizures. Whether the observed association between statin use and reduced diagnoses of clinical depression is confounded by non-specific benefits related to being prescribed medication needs further research.
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| 9. |
- Molero, Yasmina, et al.
(författare)
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Associations between β-blockers and psychiatric and behavioural outcomes : A population-based cohort study of 1.4 million individuals in Sweden
- 2023
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: β-blockers are widely used for treating cardiac conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological problems. In addition, β-blockers have been associated with precipitating other psychiatric disorders and suicidal behaviour, but findings are mixed. We aimed to examine associations between β-blockers and psychiatric and behavioural outcomes in a large population-based cohort in Sweden.METHODS AND FINDINGS: We conducted a population-based longitudinal cohort study using Swedish nationwide high-quality healthcare, mortality, and crime registers. We included 1,400,766 individuals aged 15 years or older who had collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on dispensed β-blocker prescriptions with main outcomes, hospitalisations for psychiatric disorders (not including self-injurious behaviour or suicide attempts), suicidal behaviour (including deaths from suicide), and charges of violent crime. We applied within-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment within each individual in order to reduce possible confounding by indication, as this model inherently adjusts for all stable confounders (e.g., genetics and health history). We also adjusted for age as a time-varying covariate. In further analyses, we adjusted by stated indications, prevalent users, cardiac severity, psychiatric and crime history, individual β-blockers, β-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (n = 1,215,247) were 50 years and over, and 52.2% (n = 731,322) were women. During the study period, 6.9% (n = 96,801) of the β-blocker users were hospitalised for a psychiatric disorder, 0.7% (n = 9,960) presented with suicidal behaviour, and 0.7% (n = 9,405) were charged with a violent crime. There was heterogeneity in the direction of results; within-individual analyses showed that periods of β-blocker treatment were associated with reduced hazards of psychiatric hospitalisations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), charges of violent crime (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased hazards of suicidal behaviour (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, reduced associations with psychiatric hospitalisations during β-blocker treatment were mainly driven by lower hospitalisation rates due to depressive (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001). Reduced associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalisations and suicidal behaviour were inconsistent. Limitations include that the within-individual model does not account for confounders that could change during treatment, unless measured and adjusted for in the model.CONCLUSIONS: In this population-wide study, we found no consistent links between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further.
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| 10. |
- Molero, Yasmina, et al.
(författare)
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Medication utilization in traumatic brain injury patients-insights from a population-based matched cohort study
- 2024
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Ingår i: Frontiers in Neurology. - : Frontiers Media S.A.. - 1664-2295. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Traumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medications prescribed to address pain and somatic conditions in a population-based cohort of TBI patients, and to compare this to a sex- and age-matched cohort. We also examined how patient factors such as sex, age, and TBI severity were associated with medication use.METHODS: We assessed Swedish nationwide registers to include all individuals treated for TBI in hospitals or specialist outpatient care between 2006 and 2012. We examined dispensed prescriptions for eight different non-psychotropic medication classes for the 12 months before, and 12 months after, the TBI. We applied a fixed-effects model to compare TBI patients with the matched population cohort. We also stratified TBI patients by sex, age, TBI severity and carried out comparisons using a generalized linear model.RESULTS: We identified 239,425 individuals with an incident TBI and 239,425 matched individuals. TBI patients were more likely to use any medication [Odds ratio (OR) = 2.03, 95% Confidence Interval (CI) = 2.00-2.05], to present with polypharmacy (OR = 1.96, 95% CI = 1.90-2.02), and to use each of the eight medication classes before their TBI, as compared to the matched population cohort. Following the TBI, TBI patients were more likely to use any medication (OR = 1.83, 95% CI = 1.80-1.86), to present with polypharmacy (OR = 1.74, 95% CI = 1.67-1.80), and to use all medication classes, although differences were attenuated. However, differences increased for antibiotics/antivirals (OR = 2.02, 95% CI = 1.99-2.05) and NSAIDs/antirheumatics (OR = 1.62, 95% CI = 1.59-1.65) post-TBI. We also found that females and older patients were more likely to use medications after their TBI than males and younger patients, respectively. Patients with more severe TBIs demonstrated increased use of antibiotics/ antivirals and NSAIDs/antirheumatics than those with less severe TBIs.DISCUSSION: Taken together, our results point to poor overall health in TBI patients, suggesting that medical follow-up should be routine, particularly in females with TBI, and include a review of medication use to address potential polypharmacy.
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