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- Bäckström, Josefin, 1977-
(författare)
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Family Members of Patients with Burns : Experiences of a Distressful Episode
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods.The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms.Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms.Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character. Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved.Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge.In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.
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| 2. |
- Bäckström, Josefin, 1977-, et al.
(författare)
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Health-related quality of life in family members of patients with burns
- 2014
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Ingår i: Journal of Burn Care & Research. - 1559-047X .- 1559-0488. ; 35:3, s. 243-250
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Tidskriftsartikel (refereegranskat)abstract
- A severe burn not only affects the patients, but may also have a great impact on the lives of family members. It is known that family members of patients with burns experience psychological distress, but health-related quality of life (HRQoL) has not been studied in this group. The aim was to study predictors of HRQoL in family members of patients with burns. Forty-four family members of adult patients treated in a burn center, between 2000 and 2007, completed questionnaires during care, and at 3, 6, and 12 months after injury. HRQoL was assessed with the EuroQol 5D (EQ-5D), which consists of the dimensions: mobility, self-care, usual activities, pain, and anxiety/depression. The questionnaire generates an EQ-5D index and a visual analog scale (VAS) score. Overall, the EQ-5D index was similar to that of the general population. A slight improvement in HRQoL was found in the VAS scores and in the anxiety/depression dimension over time. In regression models, HRQoL was primarily predicted by earlier life events, symptoms of post-traumatic stress disorder, and HRQoL, assessed during the patients’ hospitalization. In summary, HRQoL assessed with VAS scores increased slightly during the first year postburn, and early screening for life events and psychological symptoms, and HRQoL might be useful in identifying family members in need of support.
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| 3. |
- Bäckström, Josefin, et al.
(författare)
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Prediction of psychological symptoms in family members of patients with burns 1 year after injury
- 2013
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 69:2, s. 384-393
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Tidskriftsartikel (refereegranskat)abstract
- AimTo report a study of predictors of psychological symptoms in family members of patients with burns.BackgroundFamily members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term.DesignThe design of the study was prospective and longitudinal.MethodsForty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses.ResultsThe mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance.ConclusionFamily members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.
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| 5. |
- Sveen, Josefin, 1976-, et al.
(författare)
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A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury
- 2011
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 71:6, s. 1808-1815
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychologic problems are common after burns, and symptoms of posttraumatic stress disorder (PTSD) are some of the most prevalent. Risk factors for PTSD have been identified, but little is known about the onset and course of these symptoms. The objective was to investigate whether there are different PTSD symptom trajectories after burns.Methods: Ninety-five adults with burns were enrolled in a prospective study from in-hospital treatment until 12 months after burn. Symptoms of PTSD were assessed with the Impact of Event Scale-Revised and scores at 3, 6, and 12 months after the burn were used in a cluster analysis to detect trajectories. The trajectories were compared regarding known risk factors for PTSD using non-parametric analysis of variance.Results: Four clusters were identified: (1) resilient, with low levels of PTSD symptoms that decreased over time; (2) recovery, with high levels of symptoms that gradually decreased; (3) delayed, with moderate symptoms that increased over time; and (4) chronic, with high levels of symptoms over time. The trajectories differed regarding several risk factors for PTSD including life events, premorbid psychiatric morbidity, personality traits, avoidant coping, in-hospital psychologic symptoms, and social support. The resilient trajectory consistently had fewer of the risk factors and differed the most from the chronic trajectory.Conclusions: There are subgroups among patients with burns that have different patterns of PTSD symptom development. These findings may have implications for clinical practice, such as the timing of assessment and the management of patients who present with these symptoms.
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| 6. |
- 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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| 10. |
- Edvinsson, Åsa, et al.
(författare)
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Different patterns of attentional bias in antenatal and postpartum depression
- 2017
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279 .- 2162-3279. ; 7:11
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBiased information processing in attention, memory, and interpretation is proposed to be central cognitive alterations in patients with major depressive disorder, but studies in women with peripartum depression are scarce. Because of the many similarities with depression in nonperipartum states as regards symptom profile and risk factors, we hypothesized that women with antenatal and postpartum depression would display attentional bias to negatively and positively valenced words. MethodsOne hundred and seventy-seven pregnant and 157 postpartum women were included. Among these, 40 suffered from antenatal depressive disorder and 33 from postpartum depressive disorder. An emotional Stroop task with neutral, positive, negative, and negatively valenced obstetric words was used. ResultsNo significant difference in emotional interference scores was noted between women with antenatal depression and nondepressed pregnant women. In contrast, women with postpartum depression displayed shorter reaction times to both positive (p=.028) and negative (p=.022) stimuli, compared with neutral words. Pregnant women on antidepressant treatment displayed longer reaction times to negatively valenced obstetric words in comparison with untreated depressed women (p=.012), and a trend toward greater interference in comparison with controls (p=.061). ConclusionsIn contrast with the hypothesis, we found no evidence of attentional bias to emotionally valenced stimuli in women with untreated peripartum depression. However, the shorter reaction times to emotional stimuli in women with postpartum depression may indicate emotional numbing, which in turn, is a functional impairment that may have repercussions for child development and well-being. Our findings emphasize the need to identify and treat women with postpartum depression at the earliest possible time point to ensure swift recovery and support for the family.
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