| 4921. |
- Karlsson, Anna
(författare)
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Gambling Disorder – Suicidality, Mortality and Comorbidity
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Gambling disorder (GD) is a behavioural addiction in which a person faces negative consequences due to uncontrolled gambling, such as financial, personal, or relational difficulties. GD more often affects men but both men and women face severe consequences of GD. Psychiatric comorbidity is the rule rather than the exception and suicidality is abundant. Health issues such as obesity and cardiovascular disease are also common. Financial difficulties are common and might be both a consequence of and a risk factor for GD.Aim and methods: To examine, through registry and qualitative research, comorbidity, intentional self-harm, suicide and mortality in GD. In Study I, standardized mortality ratios for men and women with GD were compared to the general population and potential risk factors for suicidality and mortality were investigated (N=2099). In Study II, the effect of comorbid alcohol and drug use disorders on intentional self-harm in individuals with GD was examined (N=2099). In Study III, the effects of psychiatric and socioeconomic risk factors on intentional self-harm (N=848) were examined, and in Study IV, a gender- and age-matched cohort was utilized to investigate the association between GD,suicide, and general mortality in relation to known risk factors in men and women (N=10,792). Finally,a qualitative interview study (V) investigated, through qualitative content analysis (N=7), experiences of suicidality in women with GD and potential mediators of suicidality. Results: In the first study, mortality and suicide levels were greatly elevated in GD. Depression was associated with suicide death, and age and cardiovascular disease predicted general mortality. However,in the fourth study, GD did not appear to be a significant risk factor for the increase in suicide and general mortality when controlling for previously known risk factors. In the second and third studies,female gender, and psychiatric comorbidity such as substance use diagnoses, anxiety and depression were important risk factors for intentional self-harm. In the fifth study, the themes “internal shame and stigma”, “chaotic life circumstances due to gambling (such as eviction)” and “external stigmatization” appeared important in the development of suicidality.Conclusion: Individuals with GD suffer from increased suicide levels as well as high rates of intentional self-harm. Shame, stigma, and chaotic life circumstances might be mediators for suicidality in women with GD. Psychiatric comorbidity including substance use disorders appears to increase the risk of intentional self-harm and depression might increase the risk of suicide. This research could no tdetermine whether GD is an independent risk factor for suicide and further research is needed.Mortality levels are higher and might be due to cardio-vascular comorbidity.
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| 4922. |
- Karlsson, Anna, et al.
(författare)
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Personal experiences of suicidality in women with gambling disorder - A qualitative interview study
- 2023
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Ingår i: Journal of Behavioral Addictions. - 2062-5871. ; 12:2, s. 510-521
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Tidskriftsartikel (refereegranskat)abstract
- Background: Gambling disorder is associated with increased suicidality, especially in women who also are more likely to have psychiatric comorbid disorders and more often have experiences of traumatic life events. Although suicidality is increased and several risk factors have been identified, knowledge of the suicidal process is lacking, especially for women. Aim: To explore the lived experiences of suicidality in women with gambling disorder and to investigate potential factors involved in the development of suicidality. Method: Semi-structured interviews were held with seven women with experiences of gambling disorder and suicidality in Malmö, Sweden between November 2021 and June 2022, when saturation was reached. Interviews were audio-recorded, transcribed, and coded in NVivo. Qualitative content analysis was used to build categories and themes. Results: Several women had experienced suicidality before developing gambling disorder and gambling-related suicidality. However, for some, suicidality had appeared seemingly only due to the gambling disorder. Suicidality ranged from ideation to severe suicide attempts. Three themes of factors modulating suicidality related to gambling were found; a) guilt shame and self-stigmatization, b) loss of control/chaotic life circumstances, and c) social consequences/fear of guilt and shame from others. Conclusion: More research on the experience of suicidality in women with gambling disorder is needed. Attempts to address self-stigmatization, guilt, and shame in women with gambling disorder and society at large as well as aiding women to regain a sense of control over their economy and gambling may be ways to reduce suicidality.
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| 4923. |
- Karlsson, Anna, et al.
(författare)
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Psychiatric Comorbidity and Economic Hardship as Risk Factors for Intentional Self-Harm in Gambling Disorder—A Nationwide Register Study
- 2021
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an increased risk of suicidality in gambling disorder (GD) and economic hardship is common in the population. Economic hardship itself is a risk factor for suicidality. This study aims to explore the risk of intentional self-harm in GD utilizing social welfare payment (SWP) as a proxy for economic hardship and exploring how economic hardship, gender, criminality, socioeconomic-, and psychiatric risk factors might contribute to intentional self-harm in GD. Methods: This is a nationwide register-based study of 848 individuals diagnosed with GD in the Swedish healthcare system during the years of 2011–2014 with an average follow up of 4.9 years. Pearson's Chi-square analyses were carried out for comparisons regarding psychiatric comorbidity and intentional self-harm with regards to gender and SWPs. Univariable and multivariable Cox regression were utilized to analyse risk factors for intentional self-harm. Results: A large part of the study population received SWPs (45.5% with an insignificant overrepresentation of women) and psychiatric disorders were more common in these individuals (p < 0.001). Conviction for crime in general (p < 0.001) as well as intentional self-harm (p = 0.025) were also more common amongst recipients of SWPs. Criminal conviction in general was abundant (26.5%). In the stepwise multivariable regression, substance-related diagnoses as well as anxiety, depressive, and personality disorders remained risk factors for intentional self-harm and no significant results were found with regards to gender, criminal history, or SWPs. Conclusions: Social welfare payment was common among GD patients and intentional self-harm was more common amongst recipients than GD patients as a whole. Social welfare payments were however not a significant risk factor for intentional self-harm. However, attention to suicidality and self-injurious behavior should be paid from social services controlling SWPs due to the large prevalence of intentional self-harm in this group. In accordance with previous studies, comorbid psychiatric disorders such as anxiety, depression, substance use, and personality disorders increased the risk of intentional self-harm.
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| 4924. |
- Karlsson, Björn, et al.
(författare)
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Prevalence of social phobia in non-demented elderly from a swedish population study.
- 2009
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Ingår i: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. - 1545-7214. ; 17:2, s. 127-35
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine the prevalence of social phobia, and how the different Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic components of social phobia influence prevalence rates, among a population sample aged 70 years and older. DESIGN: A general population sample was investigated in 2000-2001 with semistructured psychiatric examinations, including the Comprehensive Psychopathological Rating Scale, the Mini International Neuropsychiatric Interview, the Global Assessment of Functioning (GAF) scale, and the Mini Mental State Examination. SETTING: General population Participants: Randomized sample of 914 nondemented elderly, response rate 68%. The sample was stratified into two age groups: 70-year olds (N = 338 women and 224 men) and aged 78 and above (N = 352 women). MEASUREMENTS: Social phobia according to DSM-IV requiring: a) fearing social situations, b) experiencing the fear as unreasonable or excessive, c) avoiding feared social situations or enduring them with intense anxiety or distress, and d) that this causes social consequences. RESULTS: The 1-month prevalence of social phobia was 1.9% (N = 17), an additional 1.6% (N = 15) fulfilled criteria a, c, and d, but not b. Thus, 3.5% had "social phobia" that caused social consequences. This was related to lower GAF-score and concurrent depression,panic attacks, and agoraphobia. Almost one fourth (N = 220) of the total sample feared social situations. This was more common in 70-year-old women compared with 70-year-old men (29.9% versus 20.5%), and to women aged 78-92 years (21.0%). CONCLUSIONS: Our results indicate that DSM-IV criteria exclude a large group of individuals with social phobia. It could be discussed whether DSM-IV criteria should be revised to also encompass these individuals.
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| 4925. |
- Karlsson, Björn, et al.
(författare)
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The prognosis and incidence of social phobia in an elderly population. A 5-year follow-up.
- 2010
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Ingår i: Acta psychiatrica Scandinavica. - : Wiley. - 1600-0447 .- 0001-690X. ; 122:1, s. 4-10
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Tidskriftsartikel (refereegranskat)abstract
- Karlsson B, Sigström R, Waern M, Ostling S, Gustafson D, Skoog I. The prognosis and incidence of social phobia in an elderly population. A 5-year follow-up. Objective: To examine the prognosis and incidence of social fears and phobia in an elderly population sample followed for 5 years. Method: A general population sample (N = 612) of non-demented men (baseline age 70) and women (baseline age 70 and 78-86) was investigated in 2000-2001 and in 2005-2006 with semi-structured psychiatric examinations including the Comprehensive Psychopathological Rating Scale, and the Mini International Neuropsychiatric Interview. Social phobia was diagnosed according to the DSM-IV criteria. Results: Among nine individuals with DSM-IV social phobia in 2000, 5 (55.6%) had no social fears in 2005, and 1 (11.1%) still met the criteria for DSM-IV social phobia. Among individuals without DSM-IV social phobia in 2000 (N = 603), 12 (2.0%) had DSM-IV social phobia in 2005. Conclusion: These findings challenge the notion that social phobia is a chronic disorder with rare occurrence in old age.
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| 4926. |
- Karlsson Good, Magnus, 1988-, et al.
(författare)
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Increasing the accessibility to internet-based cognitive behavioural therapy for depression : A single-blind randomized controlled trial of condensed versus full-text versions
- 2023
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Research shows that internet-based cognitive behavioural therapy (iCBT) is an effective treatment for depression. However, little is known about how the length of the text material in iCBT affects outcomes. Objective: The aim of this study was to test whether a condensed iCBT version for depression would be noninferior to the existing full-text version in reducing depressive symptoms at post-treatment. We also wanted to test non-inferiority for secondary outcomes and explore reading speed and ADHD symptoms as potential moderators. Method: A single-blind randomized controlled trial was conducted (N = 267) comparing two versions of guided iCBT for depression; full-text (around 60,000 words) and condensed (around 30,000 words, with the option to listen to the text). Estimated between-group effect sizes and their confidence intervals for depression, anxiety and quality of life, were compared to a pre-determined non-inferiority margin (ES = 0.4). Moderation analyses of reading speed and ADHD symptoms were conducted. Results: The condensed version of iCBT was non-inferior to the full-text version on post-treatment measures for depressive symptoms (95 % CI = - 0.42-0.24), anxiety symptoms (95 % CI = - 0.24-0.32), and quality of life (95 % CI = - 0.09-0.49). Non-inferiority was inconclusive for depressive symptoms at the one-year follow-up (95 % CI = - 0.60-0.47). There was no significant moderation effects of reading speed (p = 0.06) or ADHD symptoms (p = 0.11) on depressive symptoms. Conclusion: These results indicate that a condensed version of iCBT for depression is as effective at treating depression as the full-text version. By shortening texts, iCBT may be made available to more people. Due to unequal dropout rates between the groups, these results are preliminary and need to be replicated.
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| 4927. |
- Karlsson Good, Magnus, 1988-, et al.
(författare)
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Increasing the accessibility to internet-based cognitive behavioural therapy fordepression : A single-blind randomised controlled trial of condensed versus full-textversions
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Research shows that internet-based cognitive behavioural therapy (iCBT) is aneffective treatment for depression. However, little is known about how the length of the text material in iCBT affects outcomes. The therapy might be more accessible if the text burden is reduced, especially for patients with ADHD symptoms and lower reading speed.Objective: The aim of this study was to test the hypothesis that a condensed version would be non-inferior to the existing full-text version. We further hypothesized that the condensed version would have better outcomes for participants with a low reading speed and more ADHD symptoms.Method: A single-blind randomized controlled trial was conducted (N = 267) comparing two versions of guided iCBT for depression; full-text (around 60 000 words) and condensed (around 30 000 words, with the option to listen to the text). Estimated between-group effect sizes and their confidence intervals were compared to a pre-determined non-inferiority margin (ES = 0.4). Moderation analyses of reading speed and ADHD symptoms were conducted, as well as comparisons of treatment engagement and knowledge acquisition.Results: The condensed version of iCBT was non-inferior to the full-text version on post treatment measures for depressive symptoms, anxiety symptoms, and quality of life. Non inferiority was inconclusive for depressive symptoms at the one-year follow-up. There was no significant moderation effects of reading speed or ADHD symptoms. However, there were significant two-way interactions in the condensed version. No significant differences between the two versions were found on measures of treatment engagement or knowledge acquisition.Conclusion: A condensed version of iCBT for depression can be used with non-inferiorresults. Due to unequal dropout rates between the groups, these results are preliminary and need to be replicated.
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| 4928. |
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| 4929. |
- Karlsson, Louise, et al.
(författare)
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The SWedish Eating Assessment for Autism spectrum disorders (SWEAA)-Validation of a self-report questionnaire targeting eating disturbances within the autism spectrum.
- 2013
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Ingår i: Research in developmental disabilities. - : Elsevier BV. - 1873-3379 .- 0891-4222. ; 34:7, s. 2224-33
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to design and validate a questionnaire pertaining to eating problems in individuals with normal intelligence, within the autism spectrum. The questionnaire was based on literature search and clinical experience. The validation focused on psychometric properties of reliability and validity using a clinical group of individuals with autism spectrum disorders (ASD) (n=57) and a matched, healthy comparison group (n=31). The instrument showed high levels of reliability, convergent and discriminant validity and scaling properties. Logistic regression analyses discerned the single item Simultaneous capacity and the subscale Social situation at mealtime as the best predictors of ASD. In conclusion, the questionnaire is valid and reliable to detect disturbed eating behaviours in individuals with ASD and normal intelligence.
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| 4930. |
- Karlsson, Patrik, 1977-, et al.
(författare)
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The factor structure of the Strength and Difficulties Questionnaire in a national sample of Swedish adolescents : Comparing 3 and 5-factor models
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:3
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Tidskriftsartikel (refereegranskat)abstract
- The Strength and Difficulties Questionnaire (SDQ) is one of the most common screening instruments for emotional and behavioral problems in children and adolescents. Although exploratory factor analyses support the originally proposed 5-factor structure of SDQ as well as a 3-factor model, the evidence from confirmatory factor analyses is more mixed. Some of the difficulties items in SDQ are positively worded and it has been proposed that this leads to method effects, i.e. these items share variance that is due to the method used rather than to a substantive construct. Also, there seems to be minor factors in some subscales. This study tests a series of 3- and 5- factor models pertaining to the factor structure of SDQ, also considering method effects and minor factors. The sample consists of a nationally representative cohort of Swedish adolescents born in 2001 (n = 5549). Results show a relatively better fit of the 5-factor model compared with the 3-factor model although neither of these had a satisfactory fit. Model fit was improved when specifying cross-loadings of the positively worded difficulties items on the prosocial scale as well as minor factors on the hyperactivity scale. Although no model provided a completely satisfactory fit to the data, the results show that the 5-factor model performs better than the 3-factor model and has an acceptable fit. We conclude that for the purposes of epidemiological research, SDQ has acceptable factorial validity, provided that researchers consider method effects and minor factors.
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