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  • 1.
    Addo, Rebecka N.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics. Uppsala University, Sweden.
    Wiens, Stefan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Nord, Marie
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Larsson, Maria
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Olfactory Functions in Adults With Autism Spectrum Disorders2017In: Perception, ISSN 0301-0066, E-ISSN 1468-4233, Vol. 46, no 3-4, p. 530-537Article in journal (Refereed)
    Abstract [en]

    Autism spectrum disorders (ASD) are often characterized by atypical sensory behavior (hyperor hyporeactivity) although evidence is scarce regarding olfactory abilities in ASD; 16 adults with high-functioning ASD (mean age: 38.2, SD: 9.7) and 14 healthy control subjects (mean age: 42.0 years, SD: 12.5) were assessed in odor threshold, free and cued odor identification, and perceived pleasantness, intensity, and edibility of everyday odors. Although results showed no differences between groups, the Bayes Factors (close to 1) suggested that the evidence for no group differences on the threshold and identification tests was inconclusive. In contrast, there was some evidence for no group differences on perceived edibility (BF01 = 2.69) and perceived intensity (BF01 = 2.80). These results do not provide conclusive evidence for or against differences between ASD and healthy controls on olfactory abilities. However, they suggest that there are no apparent group differences in subjective ratings of odors.

  • 2.
    Agahi, Neda
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kelfve, Susanne
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Alcohol consumption in very old age and its association with survival: A matter of health and physical function2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 159, p. 240-245Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old. Methods: Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed unti12014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed. Results: Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant. Conclusions: The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

  • 3. Ahmadi, Maliheh
    et al.
    Kazemi, Kamran
    Kuc, Katarzyna
    Cybulska-Klosowicz, Anita
    Zakrzewska, Marta
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Racicka-Pawlukiewicz, Ewa
    Sadegh Helfroush, Mohammad
    Aarabi, Ardalan
    Cortical source analysis of resting state EEG data in children with attention deficit hyperactivity disorder2020In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 131, no 9, p. 2115-2130Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigated age-dependent and subtype-related alterations in electroencephalography (EEG) power spectra and current source densities (CSD) in children with attention deficit and hyperactivity disorder (ADHD).

    Methods: We performed spectral and cortical source (exact low-resolution electromagnetic tomography, eLORETA) analyses using resting state EEG recordings from 40 children (8-16 years) with combined and inattentive subtypes of ADHD and 41 age-matched healthy controls (HC). Group differences in EEG spectra and CSD were investigated at each scalp location, voxel and cortical region in delta, theta, alpha and beta bands. We also explored associations between topographic changes in EEG power and CSD and age.

    Results: Compared to healthy controls, combined ADHD subtype was characterized with significantly increased diffuse theta/beta power ratios (TBR) with a widespread decrease in beta CSD. Inattentive ADHD subtype presented increased TBR in all brain regions except in posterior areas with a global increase in theta source power. In both ADHD and HC, older age groups showed significantly lower delta source power and TBR and higher alpha and beta source power than younger age groups. Compared to HC, ADHD was characterized with increases in theta fronto-central and temporal source power with increasing age.

    Conclusions: Our results confirm that TBR can be used as a neurophysiological biomarker to differentiate ADHD from healthy children at both the source and sensor levels.

    Significance: Our findings emphasize the importance of performing the source imaging analysis in order to better characterize age-related changes in resting-state EEG activity in ADHD and controls.

  • 4.
    Ahrén, Jennie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chiesa, Flaminia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, C.
    Goodman, A.
    We are family - parents, siblings and eating disorders: Introducing the Stockholm Youth Cohort2012In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 27, no S1, article id P-251Article in journal (Refereed)
    Abstract [en]

    Introduction: Eating disorders (ED) are among the leading causes of disease burden, especially in women.

    Objectives: The overall aim is to explore role of parental social characteristics and family composition in the development of ED in adolescent males and females.

    Aims: We investigated associations of parental socioeconomic position, family type, number of siblings and half-siblings and history of psychiatric disease in parents with the incidence of eating disorders at age 12–23 years.

    Methods: The Stockholm Youth Cohort (N = 589,114) is a database created by record-linkage for all children and adolescents, 0–17 years, resident in Stockholm County during the period 2001–2007, their parents and siblings. Hazard rations were calculated using Cox regression. Cases of ED were identified in outpatient care.

    Results: A total of 3251 cases of ED (2971 females and 280 males) were recorded among 249,884 study subjects. There was an increased risk of ED in both male and female offspring of parents who had a history of alcohol and drug abuse or psychiatric ill-health. Higher parental education was a risk factors in females. Increasing number of full siblings had a protective effect (fully adjusted HR 0.91, 95% CI 0.87–0.96, per sibling) while increasing number of half-siblings appeared to increase risk of eating disorders in females.

    Conclusions: Risk factors for ED seem to differ between females and males. While parental psychiatric health is related to risk of ED in both sexes, family socioeconomic position and relationships within family appear to be of more importance for influencing risk of ED in females.

  • 5.
    Ahrén, Jennie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Chiesa, Flaminia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Magnusson, Cecilia
    Karolinska Institutet, Sweden.
    Dalman, Christina
    Karolinska Institutet, Sweden.
    Goodman, Anna
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    We are family - parents, siblings, and eating disorders in a prospective total-population study of 250,000 Swedish males and females2013In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 46, no 7, p. 693-700Article in journal (Refereed)
    Abstract [en]

    Objective: We examined how parental characteristics and other aspects of family background were associated with the development of eating disorders (ED) in males and females.

    Method: We used register data and record linkage to create the prospective, total-population study the Stockholm Youth Cohort. This cohort comprises all children and adolescents who were ever residents in Stockholm County between 2001 and 2007, plus their parents and siblings. Individuals born between 1984 and 1995 (N = 249, 884) were followed up for ED from age 12 to end of 2007. We used Cox regression modeling to investigate how ED incidence was associated with family socioeconomic position, parental age, and family composition.

    Results: In total, 3,251 cases of ED (2,971 females; 280 males) were recorded. Higher parental education independently predicted a higher rate of ED in females [e.g., adjusted hazard ratio (HR) 1.69 (95% CI: 1.42, 2.02) for degree-level vs. elementary-level maternal education], but not in males [HR 0.73 (95% CI: 0.42, 1.28), p < 0.001 for gender interaction]. In females, an increasing number of full-siblings was associated with lower rate of ED [e.g., fully adjusted HR 0.92 (95% CI: 0.88, 0.97) per sibling], whereas an increasing number of half-siblings was associated with a higher rate [HR 1.05 (95% CI: 1.01, 1.09) per sibling].

    Discussion: The effect of parental education on ED rate varies between males and females, whereas the effect of number of siblings varies according to whether they are full or half-siblings. A deeper understanding of these associations and their underlying mechanisms may provide etiological insights and inform the design of preventive interventions

  • 6.
    Ahrén-Moonga, Jennie
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    von Blixten, Nils
    Rönnelid, Johan
    Holmgren, Sven
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Levels of tumour necrosis factor-alpha and interleukin-6 in severely ill patients with eating disorders2011In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 63, no 1, p. 8-14Article in journal (Refereed)
    Abstract [en]

    Background: The underlying pathophysiology of eating disorders (ED) is dependent on complex interactions between psychological, biological and social factors. The purpose of the present study was to examine a possible increase in cytokines indicating inflammation, as measured by tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in ED patients, and to explore possible relationships between cytokines and self-reported personality traits. Methods: Female patients with severe ED (n = 26) were recruited consecutively from an inpatient clinic and were compared to age-matched healthy females (n = 12). Commercial ELISA tests developed for the measurement of serum levels of TNF-α and IL-6 were employed. Personality traits were measured using Karolinska Scales of Personality. Results: The patient group displayed increased levels of the cytokine TNF-α and a tendency towards increased IL-6 levels. Spearman's rank correlation coefficient was used to examine possible relationships between levels of cytokines and personality traits. The results showed that IL-6 levels were positively related to both somatic and psychic anxiety and to aggression scales, such as irritability and suspicion. Increased levels of TNF-α, in turn, were significantly correlated with high scores on the depression-related anxiety scale Inhibition of Aggression. However, increased levels of cytokines in the ED group did not seem to be mainly associated with symptoms of depression. Conclusion: We cannot rule out the possibility that comorbid conditions in the group contribute to the higher cytokine values. Further studies need to explore the possible influence of cytokines on the severity of ED and whether this might be mediated or moderated by specific personality traits.

  • 7. Alaie, Iman
    et al.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Jonsson, Ulf
    Bohman, Hannes
    Parent-youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort2020In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 29, no 4, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Experiencing conflictual relations with one's parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent-youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16-17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07-4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent-youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.

  • 8. Albrecht, Daniel S.
    et al.
    Forsberg, Anton
    Sandstrom, Angelica
    Bergan, Courtney
    Kadetoff, Diana
    Protsenko, Ekaterina
    Lampa, Jon
    Lee, Yvonne C.
    Hoglund, Caroline Olgart
    Catana, Ciprian
    Cervenka, Simon
    Akeju, Oluwaseun
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
    Cohen, George
    Halldin, Christer
    Taylor, Norman
    Kim, Minhae
    Hooker, Jacob M.
    Edwards, Robert R.
    Napadow, Vitaly
    Kosek, Eva
    Loggia, Marco L.
    Brain glial activation in fibromyalgia - A multi-site positron emission tomography investigation2019In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 75, p. 72-83Article in journal (Refereed)
    Abstract [en]

    Fibromyalgia (FM) is a poorly understood chronic condition characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties. While mounting evidence suggests a role for neuroinflammation, no study has directly provided evidence of brain glial activation in FM. In this study, we conducted a Positron Emission Tomography (PET) study using [C-11]PBR28, which binds to the translocator protein (TSPO), a protein upregulated in activated microglia and astrocytes. To enhance statistical power and generalizability, we combined datasets collected independently at two separate institutions (Massachusetts General Hospital [MGH] and Karolinska Institutet [KI]). In an attempt to disentangle the contributions of different glial cell types to FM, a smaller sample was scanned at KI with [C-11]-L-deprenyl-D2 PET, thought to primarily reflect astrocytic (but not microglial) signal. Thirty-one FM patients and 27 healthy controls (HC) were examined using [C-11]PBR28 PET. 11 FM patients and 11 HC were scanned using [C-11]-L-deprenyl-D2 PET. Standardized uptake values normalized by occipital cortex signal (SUVR) and distribution volume (V-T) were computed from the [C-11]PBR28 data. [C-11]-L-deprenyl-D2 was quantified using lambda k(3). PET imaging metrics were compared across groups, and when differing across groups, against clinical variables. Compared to HC, FM patients demonstrated widespread cortical elevations, and no decreases, in [C-11]PBR28 ITT and SUVR, most pronounced in the medial and lateral walls of the frontal and parietal lobes. No regions showed significant group differences in [C-11]-L-deprenyl-Ds signal, including those demonstrating elevated [C-11] PBR28 signal in patients (p's >= 0.53, uncorrected). The elevations in [C-11]PBR28 V-T and SUVR were correlated both spatially (i.e., were observed in overlapping regions) and, in several areas, also in terms of magnitude. In exploratory, uncorrected analyses, higher subjective ratings of fatigue in FM patients were associated with higher [C-11] PBR28 SUVR in the anterior and posterior middle cingulate cortices (p's < 0.03). SUVR was not significantly associated with any other clinical variable. Our work provides the first in vivo evidence supporting a role for glial activation in FM pathophysiology. Given that the elevations in [C-11]PBR28 signal were not also accompanied by increased [C-11]-deprenyl-D2 signal, our data suggests that microglia, but not astrocytes, may be driving the TSPO elevation in these regions. Although [C-11]-L-deprenyl-D2 signal was not found to be increased in FM patients, larger studies are needed to further assess the role of possible astrocytic contributions in FM. Overall, our data support glial modulation as a potential therapeutic strategy for FM.

  • 9.
    Albrecht, Sophie Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Ojajärvi, Anneli
    Oksanen, Tuula
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Härmä, Mikko
    Association of work-time control with sickness absence due to musculoskeletal and mental disorders: An occupational cohort study2020In: Journal of Occupational Health, ISSN 1341-9145, E-ISSN 1348-9585, Vol. 62, no 1, article id e12181Article in journal (Refereed)
    Abstract [en]

    Objectives: Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control.

    Methods: Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload.

    Results: During follow-up, 2,818 individuals were on sick leave (>= 10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders.

    Conclusions: Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders.

  • 10.
    Allodi Westling, Mara
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    The experiences of mental health and well-being of Swedish children and youth with a focus on educational situations: Some results and reflections from a review of qualitative studies2010In: Trender i barns och ungdomars psykiska hälsa: Program & abstracts 12-14 april 2010, Stockholm: Kungliga vetenskapsakademien , 2010, p. 17-18Conference paper (Other academic)
    Abstract [en]

    The practice of including in reviews people’s experiences and perceptions, which are collected with non-experimental and qualitative studies, has been developed recently in the field of mental health studies. These approaches and methodologies have inspired the review of research on Swedish children and adolescents experiences of mental health and well being, with a focus on their educational situation, that was conducted as a part of a systematic review of research on School Learning and Mental health, performed by appointment of the Royal Academy of Sciences. The aim of the review was to gather testimonies that can give indications of the experiences of mental health and well being in this specific context. The results from the studies that were relevant for the aims of the review are structured in four themes: general views, protective factors, risk factors, individual factors. They are presented in a narrative synthesis, giving a particular weight to the direct and indirect report of children’s and adolescents’ own views. The adolescents defined mental health as emotional experiences, seen both as internal feelings and as relational feelings. Family, friends and educational environments as social and physical environments were perceived as determinants of mental health. A great number of feelings were related to school, both related to satisfaction and pain, in particular when the school attendance is presented as an obligation. Harassment and rejection at school, performance stress, worries about grades and future prospects could be threats against self-worth and self-esteem, while teachers that do not care could generate negative experiences. Various kind of stress could be described and various strategies to resist stressful situations: for instance emotional support, safety and involvement. The educational environments can be an arena for social, cognitive and emotional experiences, relationships and accomplishments that are enriching the individuals and increase their well being. General structural characteristics of the educational environments may also affect well being in different directions: performance, evaluation and feedback, freedom of choice and responsibility for the future may be perceived as a burden. The following reflections can be made: the experiences of children and adolescents change when they grow older, go through developmental processes and encounter different educational situations; the studies reporting views of younger children on the matters of this review were less well represented; the negative experiences may be expressed in rather cautious and non dramatic terms by younger children; there are unique contribution of the review of qualitative studies, but also several interesting correspondences with the results of the review of quantitative studies.

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  • 11. Andersson, Gerhard
    et al.
    Bergström, Jan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindefors, Nils
    The use of the Internet in the treatment of anxiety disorders2005In: Current Opinion in Psychiatry, ISSN 0951-7367, E-ISSN 1473-6578, Vol. 18, no 1, p. 73-73Article in journal (Refereed)
  • 12. Andersson, Gerhard
    et al.
    Bergström, Jan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holländare, Fredrik
    Carlbring, Per
    Kaldo, Viktor
    Ekselius, Lisa
    Internet-based self-help for depression: randomised controlled trial2005In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 187, no 5, p. 456-461Article in journal (Refereed)
  • 13. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Titov, Nickolai
    Lindefors, Nils
    Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses2019In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, no 7, p. 465-470Article, review/survey (Refereed)
    Abstract [en]

    Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.

  • 14. Andersson, Gerhard
    et al.
    Paxling, Bjorn
    Roch-Norlund, Pie
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Östman, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Norgren, Anna
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Almlöv, Jonas
    Georen, Lisa
    Breitholtz, Elisabeth
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Dahlin, Mats
    Cuijpers, Pim
    Carlbring, Per
    Silverberg, Farrell
    Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial2012In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 81, no 6, p. 344-355Article in journal (Refereed)
    Abstract [en]

    Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.

  • 15. Andersson, Lena M. C.
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Ascher, Henry
    Suicidal thoughts among undocumented migrants in Sweden2021In: International Journal of Migration, Health and Social Care, ISSN 1747-9894, E-ISSN 2042-8650, Vol. 17, no 2, p. 105-118Article in journal (Refereed)
    Abstract [en]

    Purpose - Early identification of persons at risk is essential in suicide prevention. Undocumented migrants (UM) live under limited conditions and are to a high degree invisible, both in research and in suicide prevention programmes. The aim of this study was to investigate prevalence rates of suicidal thoughts among UM in Sweden.

    Design/methodology/approach - This cross-sectional study was part of the Swedish Health Research on Undocumented Migrants project (SHERUM). The study population consisted of 104 UM over 18 years of age recruited through informal networks. Data on 112 multiple choice questions was collected via trained interviewers in Gothenburg, Stockholm and Malmo during 2014-2016. To assess suicidal thoughts (the last two weeks) one item asking about suicidal thought in the Beck Depression Inventory scale (BDI-II) was used. Logistic regression and chi-square analyses were made to identify risk and protective factors.

    Findings - Suicidal thoughts were found in 43.2% of the 88 UM that answered the question on suicidal thoughts. Being a parent had some protective influence on the prevalence of suicidal thoughts while the housing situation, having been exposed to crime and having mental illness were all statistically significant risk factors for suicidal thoughts. However, due to low sample size, few variables presented statistically significant differences.

    Originality/value - This study presents an alarmingly high prevalence of suicidal thoughts among undocumented migrants in Sweden, a difficult-to reach, vulnerable and rarely studied group. Targeted strategies are imperative to include undocumented migrants in suicidal prevention programmes.

  • 16. Andersson, Mitchell J.
    et al.
    Kenttä, Göran
    Moesch, Karin
    Borg, Elisabet
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Claesdotter-Knutsson, Emma
    Håkansson, Anders
    Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study2023In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 41, no 9, p. 874-883Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one’s career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

  • 17.
    Andreasson, Anna N.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Jones, M. P.
    Walker, M. M.
    Talley, N. J.
    Nyhlin, H.
    Agréus, L.
    Prediction pathways for innate immune pathology, IBS, anxiety and depression in a general population (The POPCOL Study)2013In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 32, p. e46-e46Article in journal (Other academic)
    Abstract [en]

    The aim of this study was to ascertain whether low grade innate inflammation contributes to a pathway of depression and anxiety via irritable bowel syndrome (IBS). We evaluated innate immune cell counts in colonic mucosa in normal subjects and those with IBS (Rome III) from a population based study in which 745 randomly selected subjects had a colonoscopy (mean age 51 years;57% women). Intraepithelial lymphocytes (IELs) per 100 enterocytes and eosinophils (eos) per five non-overlapping high power fields (HPF) were counted in 90 controls and 100 cases; immunocytochemistry (CD117) was performed for mast cells per 5HPF in 80 controls and 81 cases. IELs, mast cells and eos were individually summed over 5 sites (terminal ileum, caecum, transverse colon, sigmoid colon and rectum). Anxiety and depression scores were calculated from HADS. A causal model path model which hypothesises immune cells being associated with IBS which, in turn, is associated with elevated anxiety and depression was tested using path analysis implemented in the MPlus software. All hypothesised paths reached statistical significance (p < .05) supporting the individual hypothesized pathways. The overall model fit was reasonable although imperfect. In conclusion, a significant contribution of innate immune inflammatory load leading to anxiety and depression via IBS was found. Whether therapy directed to decreasing this inflammatory load also lifts depression and anxiety should be further explored.

  • 18.
    Andreasson, Anna N.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Schiller, Helena
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Contemplate your symptoms and re-evaluate your health2015In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 49, p. e38-e39Article in journal (Refereed)
    Abstract [en]

    Bodily signals and how these are interpreted affect self-ratings of health. It is thus reasonable that appraisals of health are affected by imminent exposures and disease primes. We aimed to investigate whether self-ratings of health are affected by a symptom rating and if changes are substantiated in persons who report more symptoms. We used data from 813 persons who completed a questionnaire daily for 21 consecutive days. The questionnaire included a one-item self-rating of health (“pre-SRH”; 1 = excellent, 7 = very poor), a subsequent 26-item rating of physical and mental symptoms and thereafter a second (identical) self-rating of health (“post-SRH”). Paired t-tests were used to test for differences between pre-SRH and post-SRH. Mixed effect regression models were used to calculate the interaction effect of pre-SRH and symptom score on post-SRH adjusted for gender, age and if the person had been working that day (13545 observations). SRH worsened significantly (p  <<.0001) after the symptom rating, from 2.72 pre-SRH (95%CI:−2.70–2.74) to 2.77 post-SRH (95%CI:2.75–2.79). There was a significant interaction between pre-SRH and symptoms on post-SRH so that persons who reported more symptoms changed their post-SRH rating to a higher degree than those who reported fewer symptoms, irrespective of their subjective health status. The results support the notion that subjective health perception is affected by focus of attention, and that the effect depends on level of symptoms.

  • 19.
    Anghammar, Fredrik
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Psykologiska bedömningar inför arbete med föräldrar inom BUP2010Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Psykologiska bedömningar av föräldrar beskrivs sällan som en mer uttalad och tydlig del av arbetet inom barn- och ungdomspsykiatri, utan det är i hög grad ett underförstått arbetsområde. Syftet med den här undersökningen var att beskriva hur arbetet med psykologiska bedömningar av föräldrar konceptualiseras och praktiseras under det inledande skedet av behandlingskontakter inom BUP. Nio psykologer vid sju öppenvårdsmottagningar intervjuades och intervjuerna analyserades tematiskt. En viktig aspekt som framkommer i resultatet är hur det gemensamma arbetet mellan psykolog och förälder för att etablera en arbetsallians erbjuder goda möjligheter till psykologiska bedömningar av föräldern. Under arbetet med alliansen, och med alliansen som bas, kan olika former av systematik och modeller för psykologiska bedömningar tillämpas. Resultatet indikerar också att arbetsalliansens centrala betydelse för bedömningsarbetet är tydligt relaterad till organisationens påverkan på det arbetet, liksom till betydelsen av psykologisk kompetens vid arbete med psykologiska bedömningar av föräldrar.

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  • 20.
    Arat, Arzu
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Östberg, Viveca
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Burström, Bo
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    ADHD medication in offspring of immigrants - does the income level of the country of parental origin matter?2018In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 18, no 1, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Child psychiatric treatment facilities vary greatly worldwide and are virtually non-existent in many low-income countries. One of the most common psychiatric disorders in childhood is ADHD, with an estimated prevalence of 3-5% in Sweden. Previous studies have shown a similar prevalence of ADHD in minority and majority children in Sweden and the UK. However, clinical studies demonstrated that children from immigrant families living in Sweden received less psychiatric care than those of native-born parents. We tested the hypothesis that the consumption of child psychiatric care in immigrant families would be determined by the availability of such treatment in the parents' country of origin. Patterns of medication for attention-deficit hyperactivity disorder (ADHD) were studied as a proxy for child psychiatric care.

    METHODS: This was a register study of dispensed stimulant medication during 2013-2014 in Swedish national birth cohorts from 1995-2009. The study population, consisting of nearly 1.4 million children, was divided by national income of the parental country of origin and whether the parents were native Swedes, European immigrants, non-European immigrants or a mixture. Logistic regression was used to calculate the odds ratios of having been dispensed at least one ADHD drug during 2013, with adjustments for gender, family status indicating whether the child is living with both parents, household income and area of residence.

    RESULTS: Having parents born in low-income (OR [95% confidence interval] 0.27 [0.24-0.29]) or middle-income (European: OR 0.23 [0.20-0.26], non-European: OR 0.39 [0.34-0.41]) countries was associated with lower ADHD treatment levels than having parents born in high-income countries (European: OR 0.60 [0.54-0.66], non-European: OR 0.68 [0.59-0.79]), when compared to children of parents born in Sweden. In families with a background in low or middle income countries, there was no significant association between household income and ADHD medication, while in children with Swedish and mixed backgrounds high level of disposable income was associated with lower levels of ADHD medication.

    CONCLUSION: The use of child psychiatric care by immigrant families in Sweden was largely associated with the income level of the country of origin.

  • 21.
    Arbjork, Asa
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Childhood maltreatment, violence and social cognition in forensic psychiatric patients2021Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Childhood maltreatment is connected to increased risk of violent offending and psychopathology. Mentalisation and emotion regulation are reduced in individuals who have experienced severe childhood maltreatment, and are involved in violent behaviour and psychotic disorders. The current study investigated if childhood maltreatment is more prevalent and more severe in forensic psychiatric patients than in community controls, if those who have committed violent acts that are more severe report a higher severity of childhood maltreatment, and if mentalisation and emotion regulation are reduced in forensic psychiatric patients. Four types of childhood maltreatment, neglect, psychological, sexual and physical abuse, were investigated separately with the use of the Childhood Experience of Care and Abuse semi-structured interview. All types of childhood maltreatment were more prevalent and more severe in forensic psychiatric patients as compared to community controls.The results suggest that different types of childhood maltreatment have different effects on mentalisation, emotion regulation and violence. Forensic psychiatric patients had lower mentalisation scores and higher emotion dysregulation. There was no significant relationship between severity of childhood maltreatment and severity of violence. 

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  • 22. Arentsen, T.
    et al.
    Qian, Y.
    Gkotzis, Spyridon
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. Karolinska Institutet, Sweden.
    Femenia, T.
    Wang, T.
    Udekwu, Klas
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Forssberg, H.
    Heijtz, R. Diaz
    The bacterial peptidoglycan-sensing molecule Pglyrp2 modulates brain development and behavior2017In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 22, no 2, p. 257-266Article in journal (Refereed)
    Abstract [en]

    Recent studies have revealed that the gut microbiota modulates brain development and behavior, but the underlying mechanisms are still poorly understood. Here, we show that bacterial peptidoglycan (PGN) derived from the commensal gut microbiota can be translocated into the brain and sensed by specific pattern-recognition receptors (PRRs) of the innate immune system. Using expression-profiling techniques, we demonstrate that two families of PRRs that specifically detect PGN (that is, PGN-recognition proteins and NOD-like receptors), and the PGN transporter PepT1 are highly expressed in the developing brain during specific windows of postnatal development in both males and females. Moreover, we show that the expression of several PGN-sensing molecules and PepT1 in the developing striatum is sensitive to manipulations of the gut microbiota (that is, germ-free conditions and antibiotic treatment). Finally, we used the PGN-recognition protein 2 (Pglyrp2) knockout mice to examine the potential influence of PGN-sensing molecules on brain development and behavior. We demonstrate that the absence of Pglyrp2 leads to alterations in the expression of the autism risk gene c-Met, and sex-dependent changes in social behavior, similar to mice with manipulated microbiota. These findings suggest that the central activation of PRRs by microbial products could be one of the signaling pathways mediating the communication between the gut microbiota and the developing brain.

  • 23.
    Arnberg, Filip K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Gudmundsdóttir, Ragnhildur
    Butwicka, Agnieszka
    Fang, Fang
    Lichtenstein, Paul
    Hultman, Christina M.
    Valdimarsdóttir, Unnur A.
    Psychiatric disorders and suicide attempts in Swedish survivors of the 2004 southeast Asia tsunami: a 5 year matched cohort study2015In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 2, no 9, p. 817-824Article in journal (Refereed)
    Abstract [en]

    Background: Survivors of natural disasters are thought to be at an increased risk of psychiatric disorders, however the extent of this risk, and whether it is linked to pre-existing psychopathology, is not known. We aimed to establish whether Swedish survivors of tsunamis from the 2004 Sumatra-Andaman earthquake had increased risks of psychiatric disorders and suicide attempts 5 years after repatriation.

    Methods: We identified Swedish survivors repatriated from southeast Asia (8762 adults and 3742 children) and 864 088 unexposed adults and 320 828 unexposed children matched for sex, age, and socioeconomic status. We retrieved psychiatric diagnoses and suicide attempts from the Swedish patient register for the 5 years after the tsunami (from Dec 26, 2004, to Jan 31, 2010) and estimated hazard ratios (HRs), then adjusted for pre-tsunami psychiatric disorders, and, for children, for parental pre-tsunami disorders.

    Findings: Exposed adults were more likely than unexposed adults to receive any psychiatric diagnosis (547 [6.2%] vs 47 734 [5.5%]; adjusted HR 1.21, 95% CI 1.11-1.32), particularly stress-related disorders (187 [2.1%] vs 8831 [1.0%]; 2.27, 1.96-2.62) and suicide attempts (38 [0.43%] vs 2752 [0.32%]; 1.54, 1.11-2.13), but not mood or anxiety disorders. Risk of psychiatric diagnoses did not differ between exposed and unexposed children and adolescents (248 [6.6] vs 22 081 [6.9%]; 0.98, 0.86-1.11), although exposed children and adolescents had a higher risk for suicide attempts with uncertain intent (1.43; 1.01-2.02) and stress-related disorders (1.79; 1.30-2.46), mainly during the first 3 months after the tsunami.

    Interpretation: The 2004 tsunami was, independently of previous psychiatric morbidity, associated with an increased risk of severe psychopathology, mainly stress-related disorders and suicide attempts, in children and adults. Survivors of natural disasters should be targeted with early interventions and active long-term follow-up to prevent, detect, and alleviate psychiatric disorders that might follow.

    Funding: The Swedish Council for Working Life and Social Research, Swedish Board of Health and Welfare, Polish Ministry of Science and Higher Education, Swedish Society for Medical Research.

  • 24.
    Arnberg, Filip K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Michel, Per-Olof
    Lundin, Tom
    Posttraumatic stress in survivors 1 month to 19 years after an airliner emergency landing2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 3, article id e0119732Article in journal (Refereed)
    Abstract [en]

    Posttraumatic stress (PTS) is common in survivors from life-threatening events. Little is known, however, about the course of PTS after life threat in the absence of collateral stressors (e.g., bereavement, social stigma, property loss) and there is a scarcity of studies about PTS in the long term. This study assessed the short- and long-term course of PTS, and the influence of gender, education and age on the level and course of PTS, in survivors from a non-fatal airliner emergency landing caused by engine failure at an altitude of 1 km. There were 129 persons on board. A survey including the Impact of Event Scale was distributed to 106 subjects after 1 month, 4 months, 14 months, and 25 months, and to 95 subjects after 19 years (response rates 64-83%). There were initially high levels of PTS. The majority of changes in PTS occurred from 1 to 4 months after the event. There were small changes from 4 to 25 months but further decrease in PTS thereafter. Female gender was associated with higher levels of PTS whereas gender was unrelated to the slope of the short- and long-term trajectories. Higher education was related to a quicker recovery although not to initial or long-term PTS. Age was not associated with PTS. The present findings suggest that a life-threatening experience without collateral stressors may produce high levels of acute posttraumatic stress, yet with a benign prognosis. The findings further implicate that gender is unrelated to trajectories of recovery in the context of highly similar exposure and few collateral stressors.

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  • 25. Atzendorf, Josefine
    et al.
    Rauschert, Christian
    Seitz, Nicki-Nils
    Lochbühler, Kirsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Eötvös Loránd University, Hungary.
    The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany2019In: Deutsches Ärzteblatt International, E-ISSN 1866-0452, Vol. 116, no 35-36, p. 577-584Article in journal (Refereed)
    Abstract [en]

    Background: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society.Methods: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people.Results: In the 30 days prior to the survey, 71.6% of the respondents (corresponding to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%: 619 000). The prevalence of the use of analgesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence).Conclusion: Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.

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  • 26. Backman, Anna
    et al.
    Zander, Eric
    Roll-Pettersson, Lise
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Vigerland, Sarah
    Hirvikoski, Tatja
    Functioning and quality of life in transition-aged youth on the autism spectrum – associations with autism symptom severity and mental health problems2023In: Research in Autism Spectrum Disorders, ISSN 1750-9467, E-ISSN 1878-0237, Vol. 104, article id 102168Article in journal (Refereed)
    Abstract [en]

    Previous research notes difficulties in functioning and low quality of life (QoL) among transition-age youth on the autism spectrum, and poor mental health may contribute to these difficulties. This study examined the role of autism symptom severity and mental health problems on self-reported functioning and QoL in treatment-seeking transition-age autistic youth. The study included 140 autistic youth (16–25 years, M = 20.44 (SD = 2.95); n = 91 females [65%], n = 42 males [30%], n = 7 non-binary [5%]). We assessed functioning using a structured interview and QoL through a self-report questionnaire. Factors potentially associated with functioning and QoL were assessed using standardized self-report questionnaires of autism symptom severity, symptoms of anxiety and depression, and information from medical records. Participants reported functioning on the 90th percentile compared to general population norms, indicating significant disability, and also rated low overall QoL. Regression analysis showed that autism symptom severity and anxiety symptoms, and to some extent gender and having an ADHD diagnosis, explained 46% of the variance in overall functioning. Symptoms of anxiety and depression, and to a lesser extent, active friendship, explained 43% of the variance in QoL. Sampling limitations of the study include the overrepresentation of women and newly diagnosed participants. We highlight that functioning and QoL are multifactorial, necessitating a comprehensive assessment of transition-aged autistic youth, including mental health problems, to plan tangible interventions.

  • 27.
    Balter, Leonie J. T.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Matheson, Granville J.
    Sundelin, Tina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Sterzer, Philipp
    Petrovic, Predrag
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Experimental Sleep Deprivation Results in Diminished Perceptual Stability Independently of Psychosis Proneness2022In: Brain Sciences, E-ISSN 2076-3425, Vol. 12, no 10, article id 1338Article in journal (Refereed)
    Abstract [en]

    Psychotic disorders as well as psychosis proneness in the general population have been associated with perceptual instability, suggesting weakened predictive processing. Sleep disturbances play a prominent role in psychosis and schizophrenia, but it is unclear whether perceptual stability diminishes with sleep deprivation, and whether the effects of sleep deprivation differ as a function of psychosis proneness. In the current study, we aimed to clarify this matter. In this preregistered study, 146 participants successfully completed an intermittent version of the random dot kinematogram (RDK) task and the 21-item Peters Delusion Inventory (PDI-21) to assess perceptual stability and psychosis proneness, respectively. Participants were randomized to sleep either as normal (8 to 9 h in bed) (n = 72; Mage = 24.7, SD = 6.2, 41 women) or to stay awake through the night (n = 74; Mage = 24.8, SD = 5.1, 44 women). Sleep deprivation resulted in diminished perceptual stability, as well as in decreases in perceptual stability over the course of the task. However, we did not observe any association between perceptual stability and PDI-21 scores, nor a tendency for individuals with higher PDI-21 scores to be more vulnerable to sleep-deprivation-induced decreases in perceptual stability. The present study suggests a compromised predictive processing system in the brain after sleep deprivation, but variation in psychosis trait is not related to greater vulnerability to sleep deprivation in our dataset. Further studies in risk groups and patients with psychosis are needed to evaluate whether sleep loss plays a role in the occurrence of objectively measured perceptual-related clinical symptoms.

  • 28.
    Balter, Leonie J. T.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Wiwe Lipsker, Camilla
    Wicksell, Rikard K.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden.
    Neuropsychiatric Symptoms in Pediatric Chronic Pain and Outcome of Acceptance and Commitment Therapy2021In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 12, article id 576943Article in journal (Refereed)
    Abstract [en]

    Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8-18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key.

  • 29.
    Barclay, Kieron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. London School of Economics and Political Science, UK; Max Planck Institute for Demographic Research, Germany.
    Myrskylä, Mikko
    Tynelius, Per
    Berglind, Daniel
    Rasmussen, Finn
    Birth order and hospitalization for alcohol and narcotics use in Sweden2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 167, p. 15-22Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have shown that birth order is an important predictor of later life health as well as socioeconomic attainment. In this study, we examine the relationship between birth order and hospitalization for alcohol and narcotics use in Sweden. Methods: We study the relationship between birth order and hospitalization related to alcohol and narcotics use before and after the age of 20 using Swedish register data for cohorts born 1987-1994. We apply Cox proportional hazard models and use sibling fixed effects, eliminating confounding by factors shared by the siblings. Results: Before age 20 we find that later born siblings are hospitalized for alcohol use at a higher rate than first-borns, and there is a monotonic increase in the hazard of hospitalization with increasing birth order. Second-borns are hospitalized at a rate 47% higher than first-borns, and third-borns at a rate 65% higher. Similar patterns are observed for hospitalization for narcotics use. After age 20 the pattern is similar, but the association is weaker. These patterns are consistent across various sibling group sizes. Conclusions: Later born siblings are more likely to be hospitalized for both alcohol and narcotics use in Sweden. These birth order effects are substantial in size, and larger than the estimated sex differences for the risk of hospitalization related to alcohol and drug use before age 20, and previous estimates for socioeconomic status differences in alcohol and drug abuse.

  • 30. Barnevik Olsson, Martina
    et al.
    Holm, Anette
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology. Gothenburg University, Sweden.
    Lundholm Hedvall, Åsa
    Gillberg, Christopher
    Fernell, Elisabeth
    Children with borderline intellectual functioning and autism spectrum disorder: developmental trajectories from 4 to 11 years of age2017In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 13, p. 2519-2526Article in journal (Refereed)
    Abstract [en]

    Background: Studies on autism have tended to focus either on those with intellectual disability (ie, those with intellectual quotient [IQ] under 70) or on the group that is referred to as high-functioning, that is, those with borderline, average or above average IQ. The literature on cognition and daily functioning in autism spectrum disorder combined specifically with borderline intellectual functioning (IQ 70-84) is limited. Methods: From a representative group of 208 preschool children diagnosed with autism spectrum disorder, those 50 children in the group with borderline intellectual functioning at ages 4.5-6.5 years were targeted for follow-up at a median age of 10 years. A new cognitive test was carried out in 30 children. Parents were interviewed with a semi-structured interview together with the Vineland Adaptive Behavior Scales (n=41) and the Autism-Tics, attention-deficit/hyperactivity disorder (AD/HD) and other comorbidities inventory (A-TAC) (n=36). Results: Most children of interviewed parents presented problems within several developmental areas. According to A-TAC and the clinical interview, there were high rates of attention deficits and difficulties with regulating activity level and impulsivity. Vineland Adaptive Behavior Scales composite scores showed that at school age, a majority of the children had declined since the previous assessment at ages between 4.5 and 6.5 years. Almost half the tested group had shifted in their IQ level, to below 70 or above 84. Conclusion: None of the children assessed was without developmental/neuropsychiatric problems at school-age follow-up. The results support the need for comprehensive follow-up of educational, medical and developmental/neuropsychiatric needs, including a retesting of cognitive functions. There is also a need for continuing parent/family follow-up and support.

  • 31. Barnevik Olsson, Martina
    et al.
    Westerlund, Joakim
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Gothenburg University, Sweden.
    Lundstrom, Sebastian
    Giacobini, MaiBritt
    Fernell, Elisabeth
    Gillberg, Christopher
    Recovery from the diagnosis of autism - and then?2015In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 11, p. 999-1005Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to follow up the 17 children, from a total group of 208 children with autism spectrum disorder (ASD), who recovered from autism. They had been clinically diagnosed with ASD at or under the age of 4 years. For 2 years thereafter they received intervention based on applied behavior analysis. These 17 children were all of average or borderline intellectual functioning. On the 2-year follow-up assessment, they no longer met criteria for ASD. Methods: At about 10 years of age they were targeted for a new follow-up. Parents were given a semistructured interview regarding the child's daily functioning, school situation, and need of support, and were interviewed using the Vineland Adaptive Behavior Scales (VABS) and the Autism - Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) telephone interview. Results: The vast majority of the children had moderate-to-severe problems with attention/activity regulation, speech and language, behavior, and/or social interaction. A majority of the children had declined in their VABS scores. Most of the 14 children whose parents were A-TAC-interviewed had problems within many behavioral A-TAC domains, and four (29%) had symptom levels corresponding to a clinical diagnosis of ASD, AD/HD, or both. Another seven children (50%) had pronounced subthreshold indicators of ASD, AD/HD, or both. Conclusion: Children diagnosed at 2-4 years of age as suffering from ASD and who, after appropriate intervention for 2 years, no longer met diagnostic criteria for the disorder, clearly needed to be followed up longer. About 3-4 years later, they still had major problems diagnosable under the umbrella term of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations). They continued to be in need of support, educationally, from a neurodevelopmental and a medical point of view. According to parent interview data, a substantial minority of these children again met diagnostic criteria for ASD.

  • 32. Been, Frederic
    et al.
    Bifisma, Lubertus
    Benaglia, Lisa
    Berset, Jean-Daniel
    Botero-Coy, Ana M.
    Castiglioni, Sara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Zobel, Frank
    Schaub, Michael P.
    Buecheli, Alexander
    Hernandez, Felix
    Delemont, Olivier
    Esseiva, Pierre
    Ort, Christoph
    Assessing geographical differences in illicit drug consumption-A comparison of results from epidemiological and wastewater data in Germany and Switzerland2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 161, p. 189-199Article in journal (Refereed)
    Abstract [en]

    Background: Wastewater analysis is an innovative approach that allows monitoring illicit drug use at the community level. This study focused on investigating geographical differences in drug consumption by comparing epidemiological, crime and wastewater data. Methods: Wastewater samples were collected in 19 cities across Germany and Switzerland during one week, covering a population of approximately 8.1 million people. Self-report data and consumption offences for the investigated areas were used for comparison and to investigate differences between the indicators. Results: Good agreement between data sources was observed for cannabis and amphetamine-type stimulants, whereas substantial discrepancies were observed for cocaine. In Germany, an important distinction could be made between Berlin, Dortmund and Munich, where cocaine and particularly amphetamine were more prevalent, and Dresden, where methamphetamine consumption was clearly predominant. Cocaine consumption was relatively homogenous in the larger urban areas of Switzerland, although prevalence and offences data suggested a more heterogeneous picture. Conversely, marked regional differences in amphetamine and methamphetamine consumption could be highlighted. Conclusions: Combining the available data allowed for a better understanding of the geographical differences regarding prevalence, typology and amounts of substances consumed. For cannabis and amphetamine-type stimulants, the complementarity of survey, police and wastewater data could be highlighted, although notable differences could be identified when considering more stigmatised drugs (i.e. cocaine and heroin). Understanding illicit drug consumption at the national scale remains a difficult task, yet this research illustrates the added value of combining complementary data sources to obtain a more comprehensive and accurate picture of the situation.

  • 33. Bejerot, Susanne
    et al.
    Nilsonne, Gustav
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Humble, Mats B.
    Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults2017In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 4, no 6, p. 437-437Article in journal (Other academic)
  • 34. Belvederi Murri, Martino
    et al.
    Triolo, Federico
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Coni, Alice
    Nerozzi, Erika
    Maietta Latessa, Pasqualino
    Fantozzi, Silvia
    Padula, Nicola
    Escelsior, Andrea
    Assirelli, Barbara
    Ermini, Giuliano
    Bagnoli, Luigi
    Zocchi, Donato
    Cabassi, Aderville
    Tedeschi, Stefano
    Toni, Giulio
    Chattat, Rabih
    Tripi, Ferdinando
    Neviani, Francesca
    Bertolotti, Marco
    Cremonini, Alessandro
    Bertakis, Klea D.
    Amore, Mario
    Chiari, Lorenzo
    Zanetidou, Stamatula
    The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition2024In: Experimental Aging Research, ISSN 0361-073X, E-ISSN 1096-4657, Vol. 50, no 3, p. 296-311Article in journal (Refereed)
    Abstract [en]

    Background: Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression.

    Methods: Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions.

    Results: Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations.

    Discussion: Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression.

  • 35.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    de Montgomery, Edith
    Brendler-Lindquist, Monica
    Mittendorfer-Rutz, Ellenor
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents2022In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, no 12, p. 1953-1962Article in journal (Refereed)
    Abstract [en]

    Parental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child's own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995-2000 and followed between 2011 and 2017 (11-18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90-3.14) among foreign-born refugee children and HR 1.77 (1.33-2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29-7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11-3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.

  • 36.
    Bergman, Hans
    Stockholm University.
    Field dependence and intellectual performance of alcoholics1975Doctoral thesis, comprehensive summary (Other academic)
  • 37. Bergman, Ingvar
    et al.
    Almkvist, Ove
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
    Neuropsychological test norms controlled for physical health: Does it matter?2015In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 56, no 2, p. 140-150Article in journal (Refereed)
    Abstract [en]

    The objective of the present study was to investigate the effects of physical health on neuropsychological test norms. Medical and neuropsychological data from 118 healthy volunteer controls, aged 26-91years, were collected during five recruitment occasions. The examinations included a clinical investigation, brain neuroimaging, and a comprehensive neuropsychological test battery. Test-specific statistical regression-weights for age, education and gender were calculated to establish preliminary test norms. Hierarchical regression analyses demonstrated that control in addition for physical health moved best performance from age 60 to 65 for abstraction; replaced a plateau above age 70 for verbal fluency, with a continued rise in performance; eliminated significant negative influences of age on auditory learning, spatial reasoning and complex copying; reduced them on wordlist recall, psychomotor speed, visual scanning and mental shifting; and slightly reduced negative influences of low education on most verbal tests, several memory tests, and psychomotor speed, indicating rises in normative scores of up to 0.8 SD at age 80 and 0.4 SD at age 60. No differences were found at age 40. Although the sample size is not adequate to be used for normative data, the findings indicate that norms uncontrolled for health overestimate the negative influence of advanced age and low education, implying a risk of drawing false diagnostic conclusions.

  • 38.
    Bergmark, Karin H.
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Internet addiction - vad är det?2016In: Tidskriften för svensk psykiatri, ISSN 1653-8579, no 1, p. 59-60Article in journal (Other (popular science, discussion, etc.))
  • 39. Berman, Anne H.
    et al.
    Biguet, Gabriele
    Stathakarou, Natalia
    Westin-Hägglöf, Beata
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Jeding, Kerstin
    McGrath, Cormac
    Karolinska Institutet, Sweden.
    Zary, Nabil
    Kononowicz, Andrzej A.
    Virtual Patients in a Behavioral Medicine Massive Open Online Course (MOOC): A Qualitative and Quantitative Analysis of Participants' Perceptions2017In: Academic Psychiatry, ISSN 1042-9670, E-ISSN 1545-7230, Vol. 41, no 5, p. 631-641Article in journal (Refereed)
    Abstract [en]

    Objective The purpose of this article is to explore learners' perceptions of using virtual patients in a behavioral medicine Massive Open Online Course (MOOCs) and thereby describe innovative ways of disseminating knowledge in health-related areas. Methods A 5-week MOOC on behavioral medicine was hosted on the edX platform. The authors developed two branched virtual patients consisting of video recordings of a live standardized patient, with multiple clinical decision points and narration unfolding depending on learners' choices. Students interacted with the virtual patients to treat stress and sleep problems. Answers to the exit survey and participant comments from the discussion forum were analyzed qualitatively and quantitatively. Results In total, 19,236 participants enrolled in the MOOC, out of which 740 received the final certificate. The virtual patients were completed by 2317 and 1640 participants respectively. Among survey respondents (n = 442), 83.1% agreed that the virtual patient exercise was helpful. The qualitative analysis resulted in themes covering what it was like to work with the virtual patient, with subthemes on learner-centered education, emotions/eustress, game comparisons, what the participants learned, what surprised them, how confident participants felt about applying interventions in practice, suggestions for improvement, and previous experiences of virtual patients. Conclusions Students were enthusiastic about interacting with the virtual patients as a means to apply new knowledge about behavioral medicine interventions. The most common suggestion was to incorporate more interactive cases with various levels of complexity. Further research should include patient outcomes and focus on interprofessional aspects of learning with virtual patients in a MOOC.

  • 40. Bjaastad, Jon Fauskanger
    et al.
    Haugland, Bente Storm Mowatt
    Fjermestad, Krister W.
    Torsheim, Torbjorn
    Havik, Odd E.
    Heiervang, Einar R.
    Öst, Lars-Goran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) for Anxiety Disorders in Youth: Psychometric Properties2016In: Psychological Assessment, ISSN 1040-3590, E-ISSN 1939-134X, Vol. 28, no 8, p. 908-916Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to evaluate the psychometric properties of the Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT). The CAS-CBT is an 11-item scale developed to measure adherence and competence in cognitive-behavioral therapy (CBT) for anxiety disorders in youth. A total of 181 videotapes from the treatment sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014) comprising youth (N = 182, M age = 11.5 years, SD = 2.1, range 8-15 years, 53% girls, 90.7% Caucasian) with mixed anxiety disorders were assessed with the CAS-CBT to investigate interitem correlations, internal consistency, and factor structure. Internal consistency was good (Cronbach's alpha = .87). Factor analysis suggested a 2-factor solution with Factor 1 representing CBT structure and session goals (explaining 46.9% of the variance) and Factor 2 representing process and relational skills (explaining 19.7% of the variance). The sum-score for adherence and competence was strongly intercorrelated, r = .79, p < .001. Novice raters (graduate psychology students) obtained satisfactory accuracy (ICC > .40, n = 10 videotapes) and also good to excellent interrater reliability when compared to expert raters (ICC = .83 for adherence and .64 for competence, n = 26 videotapes). High rater stability was also found (n = 15 videotapes). The findings suggest that the CAS-CBT is a reliable measure of adherence and competence in manualized CBT for anxiety disorders in youth. Further research is needed to investigate the validity of the scale and psychometric properties when used with other treatment programs, disorders and treatment formats.

  • 41. Björkenstam, C.
    et al.
    Bjorkenstam, E.
    Ljung, R.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Tuvblad, C.
    Suicidal behavior among delinquent former child welfare clients2013In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, no 6, p. 349-355Article in journal (Refereed)
    Abstract [en]

    Child welfare clients represent a high-risk group for delinquency and adult criminality, but also for future suicidal behavior. We examine associations between delinquency and suicidal behavior in a national child welfare population. This register-based cohort study is based on data for all Swedish former child welfare clients born between 1972 and 1981 that experienced interventions before their adolescent years. We followed 27,228 individuals from age 20 years until 31 December 2006. Juvenile delinquency was defined as being convicted of at least one crime between age 15 and 19. The risk of suicidal behavior was calculated as incidence rate ratios (IRRs). Fifteen percent of the women and 40 % of the men had at least one conviction between the age 15 and 19. The adjusted risk of suicidal behavior among women with five or more convictions was 3.5 (95 % CI 2.0-6.2); corresponding IRR for men was 3.9 (95 % CI 3.1-4.9). Child welfare experience-specifically of out-of-home care-in combination with delinquency is a potent risk factor for suicidal behavior among young adults. However, we cannot exclude that some of this association is an epiphenomenon of uncontrolled confounders, such as impulsivity or severity of psychiatric disease. Despite this caveat, results should be disseminated to practitioners in the health and correction services.

  • 42. Björkenstam, C.
    et al.
    Björkenstam, E.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Boden, R.
    Reutfors, J.
    Suicide in first episode psychosis: A nationwide cohort study2014In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 157, no 1-3, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Relatively little is known about suicide in diagnostic subtypes of first episode psychosis (FEP). Our aim was to assess suicide rates and potential risk factors for suicide in FEP. Methods: This is a national register-based cohort study of patients born in 1973-1978 in Sweden and who were hospitalized with a FEP between ages 15 and 30 years (n = 2819). The patients were followed from date of discharge until death, emigration, or 31st of December 2008. The suicide rates for six diagnostic subtypes of FEP were calculated. Suicide incidence rate ratios (IRRs) were calculated to evaluate the association between suicide and psychiatric, familial, social, and demographic factors. Results: In total 121 patients died by suicide. The overall suicide rate was 4.3 (95% confidence interval [CI] 3.5-5.0) per 1000 person-years. The highest suicide rates were found in depressive disorder with psychotic symptoms and in delusional disorder. In an adjustedmodel, the strongest risk factors for suicide were self-harm (IRR 2.7, CI 1.7-4.4) or a conviction for violent crime (IRR 2.0, CI 1.3-3.2). Also having a first-degree relative with a schizophrenia/bipolar diagnosis (IRR 2.1, CI 1.2-3.6) or substance use disorder (IRR 2.0, CI 1.2-3.2) were significant risk factors for suicide. Conclusions: Impulsive behavior such as self-harm as well as having a family history of severe mental disorder or substance use are important risk factors for suicide in FEP.

  • 43.
    Björkenstam, Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. University of California, USA; Karolinska Institutet, Sweden.
    Björkenstam, Emma
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Cochran, Susan
    Kosidou, Kyriaki
    Anxiety and Depression Among Sexual Minority Women and Men in Sweden: Is the Risk Equally Spread Within the Sexual Minority Population?2017In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 14, no 3, p. 396-403Article in journal (Refereed)
    Abstract [en]

    Introduction

    Sexual minority individuals have a higher risk of anxiety and depression compared with heterosexuals. However, whether the higher risk is spread equally across the sexual minority population is not clear.

    Aim

    To investigate the association between sexual orientation and self-reported current anxiety and a history of diagnosis of depression, paying particular attention to possible subgroup differences in risks within the sexual minority population, stratified by sex and to examine participants' history of medical care for anxiety disorders and depression.

    Methods

    We conducted a population-based study of 874 lesbians and gays, 841 bisexuals, and 67,980 heterosexuals recruited in 2010 in Stockholm County. Data were obtained from self-administered surveys that were linked to nationwide registers. Main Outcome Measures: By using logistic regression, we compared risks of current anxiety, histories of diagnosed depression, and register-based medical care for anxiety and/or depression in lesbian and gay, bisexual, and heterosexual individuals.

    Results

    Bisexual women and gay men were more likely to report anxiety compared with their heterosexual peers. Bisexual individuals and gay men also were more likely to report a past diagnosis of depression. All sexual minority groups had an increased risk of having used medical care for anxiety and depression compared with heterosexuals, with bisexual women having the highest risk.

    Conclusion

    Bisexual women appear to be a particularly vulnerable sexual minority group. Advocating for nondiscrimination and protections for lesbian, gay, and bisexual people is a logical extension of the effort to lower the prevalence of mental illness.

  • 44.
    Björkenstam, Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karolinska Institutet, Sweden; University of California, USA.
    Ekselius, Lisa
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Social Work. National Board of Health and Welfare, Sweden.
    Gerdin, Bengt
    Björkenstam, Emma
    Suicide risk and suicide method in patients with personality disorders2016In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 83, p. 29-36Article in journal (Refereed)
    Abstract [en]

    Objective: The influence of psychopathology on suicide method has revealed different distributions among different psychiatric disorders. However, evidence is still scarce. We hypothesized that having a diagnosis of personality disorder (PD) affect the suicide method, and that different PD clusters would influence the suicide method in different ways. In addition, we hypothesized that the presence of psychiatric and somatic co-morbidity also affects the suicide method. Method: We examined 25,217 individuals aged 15-64 who had been hospitalized in Sweden with a main diagnosis of PD the years 1987-2013 (N = 25,217). The patients were followed from the date of first discharge until death or until the end of the follow-up period, i.e. December 31, 2013, for a total of 323,508.8 person-years, with a mean follow up time of 11.7 years. The SMR, i.e. the ratio between the observed number of suicides and the expected number of suicides, was used as a measure of risk. Results: Overall PD, different PD-clusters, and comorbidity influenced the suicide method. Hanging evidenced highest SMR in female PD patients (SMR 34.2 (95% CI: 29.3-39.8)), as compared to non-PD patients and jumping among male PD patients (SMR 24.8 (95% CI: 18.3-33.6)), as compared to non PD-patients. Furthermore, the elevated suicide risk was related to both psychiatric and somatic comorbidity. Conclusion: The increased suicide risk was unevenly distributed with respect to suicide method and type of PD. However, these differences were only moderate and greatly overshadowed by the overall excess suicide risk in having PD. Any attempt from society to decrease the suicide rate in persons with PD must take these characteristics into account.

  • 45.
    Björkenstam, Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karolinska Institutet, Sweden; University of California, USA.
    Kosidou, Kyriaki
    Björkenstam, Emma
    Childhood adversity and risk of suicide: cohort study of 548 721 adolescents and young adults in Sweden2017In: The BMJ, E-ISSN 1756-1833, Vol. 357, article id j1334Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine the relation between childhood adversity, the role of school performance, and childhood psychopathology and the risk of suicide. DESIGN Cohort study of register based indicators of childhood adversity (at ages 0-14) including death in the family (suicide analysed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single parent household, receipt of public assistance, and residential instability. SETTING Swedish medical birth register and various Swedish population based registers. PARTICIPANTS 548 721 individuals born 1987-91. MAIN OUTCOME MEASURES Estimates of suicide risk at ages 15-24 calculated as incidence rate ratios adjusted for time at risk and confounders. Results Adjusted incidence rate ratios for the relation between childhood adversity and suicide during adolescence and young adulthood ranged from 1.6 (95% confidence interval 1.1 to 2.4) for residential instability to 2.9 (1.4 to 5.9) for suicide in the family. There was a dose-response relation between accumulating childhood adversity and risk: 1.1 (0.9 to 1.4) for those exposed to one adversity and 1.9 (1.4 to 2.5) and 2.6 (1.9 to 3.4) for those exposed to two and three or more adversities, respectively. The association with increased risk of suicide remained even after adjustment for school performance and childhood psychopathology. CONCLUSION Childhood adversity is a risk factor for suicide in adolescence and young adulthood, particularly accumulated adversity. These results emphasise the importance of understanding the social mechanisms of suicide and the need for effective interventions early in life, aiming to alleviate the risk in disadvantaged children.

  • 46. Björkenstam, E.
    et al.
    Björkenstam, C.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Reutfors, J.
    Bodén, R.
    A five year diagnostic follow-up of 1840 patients after a first episode non-schizophrenia and non-affective psychosis2013In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 150, no 1, p. 205-210Article in journal (Refereed)
    Abstract [en]

    Objective

    It is not clear which patients with a first psychotic episode will develop schizophrenia. We performed a diagnostic follow-up of patients treated for a first time non-affective, non-schizophrenia psychosis and explored potential predictors of a subsequent schizophrenia or schizoaffective diagnosis.

    Methods

    This register-based cohort study comprises individuals born between 1973 and 1978 in Sweden, with a first hospital-treated psychosis excluding schizophrenia, schizoaffective disorder, bipolar disorder and depressive disorder with psychotic symptoms (n = 1840). The patients were followed for five years regarding subsequent diagnoses. Psychiatric, social, family history of psychiatric illness, premorbid intellectual level, head injuries and obstetrical complications were investigated by logistic regression as predictors of schizophrenia or schizoaffective diagnosis.

    Results

    During the follow-up, 18% were diagnosed with schizophrenia or schizoaffective disorder, 5% were diagnosed with bipolar disorder, whereas 29% were not re-admitted to a psychiatric clinic. Patients with a first-degree relative hospitalized for schizophrenia and/or bipolar disorder had an increased risk of subsequent diagnosis for schizophrenia or schizoaffective disorder (odds ratio 1.9 and 95% confidence interval 1.1 to 3.0)), whereas previous severe criminality was associated with a decreased risk (odds ratio 0.5, 95% confidence interval 0.3–0.8).

    Conclusion

    Diagnostic outcome was diverse after a first non-schizophrenia and non-affective psychosis. Family history of severe mental illness and no previous conviction for severe criminality were the strongest risk factors for a future schizophrenia or schizoaffective diagnosis.

  • 47. Björkenstam, Emma
    et al.
    Burström, Bo
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kosidou, Kyriaki
    Childhood adversity and psychiatric disorder in young adulthood: An analysis of 107,704 Swedes2016In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 77, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Childhood adversity (CA) is associated with increased risks of psychiatric disorder in young adulthood, but details in this association are less known. We aimed to explore the association of a range of CA indicators with psychiatric disorder in young adulthood, and the impact of age at exposure, disorder type and accumulation of indicators. We capitalized on Sweden's extensive and high-quality registers and analyzed a cohort of all Swedes (N = 107,704) born in Stockholm County 1987-1991. Adversities included familial death, parental substance misuse and psychiatric disorder, parental criminality, parental separation, public assistance recipiency and residential instability. Age at exposure was categorized as: 0-6.9 years (infancy and early childhood), 7-11.9 years (middle childhood), and 12-14 years (early adolescence). Psychiatric disorders after age 15 were defined from ICD codes through registers. Risks were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI). Results showed that exposure to at least one CA was associated with an increased risk of psychiatric disorder (HR 1.4, 95% CI: 1.3-1.4). Risks were increased for mood, anxiety, and psychotic disorders and ADHD but not for eating disorders. The risk varied with type of disorder but was similar for all exposure periods. Individuals with multiple (3+) CAs had a two-fold risk of psychiatric disorder (HR 2.0, 95% CI: 1.9-2.1). In conclusion, our findings support the long-term negative impact of CA on mental health, regardless of developmental period of exposure. Given that experience of CA is common, efforts should be put to alleviate the burden of childhood adversities for children, particularly among the most disadvantaged.

  • 48. Björkenstam, Emma
    et al.
    Helgesson, Magnus
    Gustafsson, Klas
    Virtanen, Marianna
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Mittendorfer-Rutz, Ellenor
    Occupational class and employment sector differences in common mental disorders: a longitudinal Swedish cohort study2021In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, no 4, p. 809-815Article in journal (Refereed)
    Abstract [en]

    Background Recent increases in common mental disorders (CMDs) among young adults are of great concern although studies of CMDs in young employees are sparse. This study investigated the independent and interacting effects of sector of employment, occupational class and CMDs. Additionally, associations between type of employment branch and CMDs within each sector were examined.

    Methods This population-based longitudinal cohort study included 665 138 employees, 19–29 years, residing in Sweden in 2009. Employment sector (i.e. private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of CMDs, measured as new prescription of antidepressants and/or psychiatric care with a diagnosis of CMDs, between 2010 and 2016, were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using Cox multivariable regression analysis.

    Results Public sector employees (whereof 60% manual workers) had an elevated risk for CMDs compared to private sector employees [adjusted HR: 1.14 (95% CI 1.12–1.16)]. Within each sector, manual workers were at increased risk of CMDs compared to non-manual workers. There was an interaction between sector of employment and occupational class; manual workers in the public sector had the highest CMD risk [adjusted synergy index: 1.51 (95% CI 1.29–1.76)]. The most elevated risk for CMDs was observed in those employed in health and social services and the lowest risk among construction workers.

    Conclusion Sector of employment and occupational class play a role in CMDs in young employees. These findings should be taken into account in the attempts to reduce CMDs in the young working population.

  • 49. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Björkenstam, Charlotte
    Kosidou, Kyriaki
    Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood2018In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 75, no 2, p. 185-193Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Childhood adversity (CA) is associated with an increased risk of suicide in young adulthood that might be explained by maladaptive trajectories during adolescence. Although adolescent violent offending is linked with suicide, little is known about its role in the association between CA and suicide. OBJECTIVE To examine whether adolescent violent offending mediates the association between CA and suicide in early adulthood. DESIGN, SETTING, AND PARTICIPANTS This population-based, longitudinal cohort study with a follow-up time spanning 5 to 9 years included 476 103 individuals born in Sweden between 1984 and 1988. The study population was prospectively followed up from 20 years of age until December 31, 2013, with respect to suicide. Data analysis was performed from January 1, 1984, to December 31, 2013. EXPOSURES Register-based CAs included parental death, parental substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Adolescent violent offending was defined as being convicted of a violent crime between the ages of 15 and 19 years. MAIN OUTCOMES AND MEASURES Estimates of risk of suicide after 20 years of age (from 2004 if born in 1984 and from 2008 if born in 1988) until the end of 2013 were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Adjustments were made for demographics and psychiatric disorder. In addition, binary mediation analysis with logistic regression was used. RESULTS A total of 476 103 individuals (231 699 [48.7%] female) were included in the study. Those with a conviction for violent offending had been exposed to all CAs to a greater extent than those with no violent offending. Cumulative CA was associated with risk of suicide in nonconvicted (adjusted IRR, 2.4; 95% CI, 1.5-3.9) and convicted youths, who had a higher risk of suicide (adjusted IRR, 8.5; 95% CI, 4.6-15.7). Adolescent violent offending partly mediated the association between CA and suicide. CONCLUSIONS AND RELEVANCE Individuals with a history of CA who also engage in violent offending in adolescence have a high risk of suicide. Interventions to prevent externalizing behavior during childhood and increased support to youths with delinquent behavior may have the potential to prevent suicide related to CA.

  • 50. Björkenstam, Emma
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Impact of childhood adversities on depression in early adulthood: A longitudinal cohort study of 478,141 individuals in Sweden2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 223, p. 95-100Article in journal (Refereed)
    Abstract [en]

    Objective: Although the relationship between childhood adversity (CA) and depression is widely accepted, there is little information on what proportion of depression is attributable to CA. Method: We used a Swedish cohort of 478,141 individuals born in 1984-1988 in Sweden. Register-based CA indicators included parental death, parental substance abuse and psychiatric morbidity, parental criminality, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Estimates of risk of depression, measured as retrieval of prescribed antidepressants and/or psychiatric care with a clinical diagnosis of depression, between 2006 and 2012 were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using a Cox regression analysis. Results: All CAs predicted depression in early adulthood. Furthermore, the predictive association between the CA indicators and depression was graded, with highest HRs observed for 4+ CAs (HR: 3.05 (95% CI 2.83-3.29)) for a clinical diagnosis for depression and HR: 1.32 (95% CI 1.25-1.41) for antidepressant medication after adjustments were made for important confounding factors. Of the studied CAs, child welfare intervention entailed highest HR for depression. Conclusion: Regardless of causality issues, children and youth with a history of multiple CA should be regarded as a high-risk group for depression by professionals in social, and health service's that come into contact with this group.

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