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  • 1.
    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.

  • 2.
    Arnberg, Filip K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Morey, Jennifer N.
    Segerström, Suzanne C.
    Self-rated health and interleukin-6: Longitudinal relationships in older adults2016In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 54, p. 226-232Article in journal (Refereed)
    Abstract [en]

    Background: Both self-rated health (SRH) and inflammation are implicated in chronic diseases and premature mortality. Better SRH is associated with lower proinflammatory cytokines, but there is little evidence about whether this relationship is more stable or dynamic.

    Objective: To study the between- and within-person associations between SRH and IL-6.

    Methods: Older adults (N=131; Mage=75years) rated their health and provided blood samples for analysis of IL-6 at separate occasions every 6months over a period up to 5years. Age, sex, BMI, neuroticism, and statin use were examined as covariates in multilevel models.

    Results: In bivariate models, better SRH, lower BMI, younger age, and female sex correlated with lower IL-6. In multilevel models, stable SRH (between-person differences; p<.001) but not dynamic SRH (within-person changes; p=.93) correlated with IL-6. The stable relationship persisted with demographic and health covariates in the model.

    Conclusions: Better stable SRH but not dynamic SRH was robustly associated with lower IL-6 among older adults, lending support to previous cross-sectional findings on the relation between inflammatory markers and SRH. The findings suggest that trait-like mechanisms, rather than changes over a time scale of 6-month waves, govern this association. To further investigate the mechanisms behind the SRH-IL-6 association, studies with different measurement frequencies, higher within-person variability, and experimental approaches are warranted.

  • 3.
    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, ISSN 1932-6203, 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.

  • 4. Kuhn, Eric
    et al.
    van der Meer, Christianne
    Owen, Jason E
    Hoffman, Julia E
    Cash, Richard
    Carrese, Pasqualina
    Olff, Miranda
    Bakker, Anne
    Schellong, Julia
    Lorenz, Patrick
    Schopp, Matthias
    Rau, Heinrich
    Weidner, Kerstin
    Arnberg, Filip K
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Cernvall, Martin
    Iversen, Thomas
    PTSD Coach around the world2018In: mHealth, ISSN 2306-9740, article id 4:15Article in journal (Refereed)
    Abstract [en]

    Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are described, highlighting their significant adaptations, enhancements, and expansions to the original PTSD Coach app as well as emerging research on them. It is clear that the sharing of app source code and content has benefited this emerging PTSD Coach community, as well as the populations they are targeting. Despite this success, challenges remain especially reaching trauma survivors in areas where few or no other mental health resources exist.

  • 5.
    Lekander, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Arnberg, Filip K.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Segerström, S. C.
    Longitudinal relationship between inflammation and poor self-rated health in elderly2015In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 49, p. e37-e37Article in journal (Refereed)
    Abstract [en]

    Self-rated health (SRH) predicts future objective health and summarizes information in a way that goes beyond the biomedical health model. Low-grade inflammation contributes to poor SRH, but previous findings rely on cross-sectional analyses. We therefore studied the relationship between SRH and IL-6 in a longitudinal study of elderly. Participants (m = 74 years; range 60–93; 41% male) were studied in 6-month waves over a period up to 5 years. SRH was measured with a one-item question (excellent to poor). Serum was collected following the interview visit (median interval 40 days), frozen at −80 °C and later analyzed with high-sensitivity ELISA for IL-6. Overall, 999 observations were available for analysis. When analyzed as a between-subject effect, a stable relationship was observed between SRH and logIL-6 (β = −.088; p < .001). However, the within-subject effect of SRH on IL-6 was not significant. The effects were not explained by gender, age, BMI, neuroticism, or statin use. There was no main effect of interview-to-blood sample interval, neither between nor within subjects. Putative variations over time in the relation between SRH and IL-6 could thus not be captured with the present design. With the advantage of a longitudinal design and multiple sampling occasions, the present data strongly support the stability of the previously reported cross-sectional relationship between higher levels of inflammatory cytokines and less favorable health appraisals across individuals.

  • 6.
    Nilsonne, Gustav
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Hilgard, Joseph
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Arnberg, Filip K.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Post-traumatic stress disorder and interleukin 62016In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 3, no 3, p. 200-201Article in journal (Refereed)
  • 7. Song, Huan
    et al.
    Fang, Fang
    Arnberg, Filip K.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Mataix-Cols, David
    de la Cruz, Lorena Fernandez
    Almqvist, Catarina
    Fall, Katja
    Lichtenstein, Paul
    Thorgeirsson, Gudmundur
    Valdimarsdottir, Unnur A.
    Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1255Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To assess the association between stress related disorders and subsequent risk of cardiovascular disease.

    DESIGN Population based, sibling controlled cohort study. SETTING Population of Sweden.

    PARTICIPANTS 136 637 patients in the Swedish National Patient Register with stress related disorders, including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions, from 1987 to 2013; 171 314 unaffected full siblings of these patients; and 1 366 370 matched unexposed people from the general population.

    MAIN OUTCOME MEASURES Primary diagnosis of incident cardiovascular disease-any or specific subtypes (ischaemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive diseases, heart failure, arrhythmia/conduction disorder, and fatal cardiovascular disease)-and 16 individual diagnoses of cardiovascular disease. Hazard ratios for cardiovascular disease were derived from Cox models, after controlling for multiple confounders.

    RESULTS During up to 27 years of follow-up, the crude incidence rate of any cardiovascular disease was 10.5, 8.4, and 6.9 per 1000 person years among exposed patients, their unaffected full siblings, and the matched unexposed individuals, respectively. In sibling based comparisons, the hazard ratio for any cardiovascular disease was 1.64 (95% confidence interval 1.45 to 1.84), with the highest subtype specific hazard ratio observed for heart failure (6.95, 1.88 to 25.68), during the first year after the diagnosis of any stress related disorder. Beyond one year, the hazard ratios became lower (overall 1.29, 1.24 to 1.34), ranging from 1.12 (1.04 to 1.21) for arrhythmia to 2.02 (1.45 to 2.82) for artery thrombosis/embolus. Stress related disorders were more strongly associated with early onset cardiovascular diseases (hazard ratio 1.40 (1.32 to 1.49) for attained age < 50) than later onset ones (1.24 (1.18 to 1.30) for attained age >= 50; P for difference=0.002). Except for fatal cardiovascular diseases, these associations were not modified by the presence of psychiatric comorbidity. Analyses within the population matched cohort yielded similar results (hazard ratio 1.71 (1.59 to 1.83) for any cardiovascular disease during the first year of follow-up and 1.36 (1.33 to 1.39) thereafter).

    CONCLUSION Stress related disorders are robustly associated with multiple types of cardiovascular disease, independently of familial background, history of somatic/psychiatric diseases, and psychiatric comorbidity.

  • 8. Song, Huan
    et al.
    Fang, Fang
    Tomasson, Gunnar
    Arnberg, Filip K.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Mataix-Cols, David
    Fernández de la Cruz, Lorena
    Almqvist, Catarina
    Fall, Katja
    Valdimarsdóttir, Unnur A.
    Association of Stress-Related Disorders With Subsequent Autoimmune Disease2018In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 319, no 23, p. 2388-2400Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Psychiatric reactions to life stressors are common in the general population and may result in immune dysfunction. Whether such reactions contribute to the risk of autoimmune disease remains unclear. OBJECTIVE To determine whether there is an association between stress-related disorders and subsequent autoimmune disease. DESIGN, SETTING, AND PARTICIPANTS Population-and sibling-matched retrospective cohort study conducted in Sweden from January 1, 1981, to December 31, 2013. The cohort included 106 464 exposed patients with stress-related disorders, with 1 064 640 matched unexposed persons and 126 652 full siblings of these patients. EXPOSURES Diagnosis of stress-related disorders, ie, posttraumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions. MAIN OUTCOMES AND MEASURES Stress-related disorder and autoimmune diseaseswere identified through the National Patient Register. The Cox model was used to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors. RESULTS The median age at diagnosis of stress-related disorders was 41 years (interquartile range, 33-50 years) and 40% of the exposed patients were male. During a mean follow-up of 10 years, the incidence rate of autoimmune diseases was 9.1, 6.0, and 6.5 per 1000 person-years among the exposed, matched unexposed, and sibling cohorts, respectively (absolute rate difference, 3.12 [95% CI, 2.99-3.25] and 2.49 [95% CI, 2.23-2.76] per 1000 person-years compared with the population-and sibling-based reference groups, respectively). Compared with the unexposed population, patients with stress-related disorders were at increased risk of autoimmune disease (HR, 1.36 [95% CI, 1.33-1.40]). The HRs for patients with posttraumatic stress disorder were 1.46 (95% CI, 1.32-1.61) for any and 2.29 (95% CI, 1.72-3.04) for multiple (>= 3) autoimmune diseases. These associations were consistent in the sibling-based comparison. Relative risk elevations were more pronounced among younger patients (HR, 1.48 [ 95% CI, 1.42-1.55]; 1.41 [ 95% CI, 1.33-1.48]; 1.31 [ 95% CI, 1.24-1.37]; and 1.23 [95% CI, 1.17-1.30] for age at <= 33, 34-41, 42-50, and >= 51 years, respectively; P for interaction <.001). Persistent use of selective serotonin reuptake inhibitors during the first year of posttraumatic stress disorder diagnosis was associated with attenuated relative risk of autoimmune disease (HR, 3.64 [95% CI, 2.00-6.62]; 2.65 [95% CI, 1.57-4.45]; and 1.82 [95% CI, 1.09-3.02] for duration <= 179, 180-319, and >= 320 days, respectively; P for trend =.03). CONCLUSIONS AND RELEVANCE In this Swedish cohort, exposure to a stress-related disorder was significantly associated with increased risk of subsequent autoimmune disease, compared with matched unexposed individuals and with full siblings. Further studies are needed to better understand the underlying mechanisms.

  • 9. Sveen, Josefin
    et al.
    Arnberg, Filip
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Arinell, Hans
    Bergh Johannesson, Kerstin
    The role of personality traits in trajectories of long-term posttraumatic stress and general distress six years after the tsunami in Southeast Asia2016In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 97, p. 134-139Article in journal (Refereed)
    Abstract [en]

    The aims were to examine whether trajectories of posttraumatic stress (PTS) and general distress are related to personality traits and to investigate personality's contributing factor to PTS and general distress. The sample was 2549 Swedish tourists who survived the 2004 Indian Ocean tsunami and responded to postal surveys at 1, 3 and 6 years after the tsunami, including assessment of personality traits, PTS and general distress. The sample was categorized into a direct exposure group and an indirect exposure comparison group. For both PTS and general distress, individuals with a resilient trajectory were lower in the trait neuroticism than those in the symptomatic trajectories whereas there were no differences in personality traits between the resilient trajectory and the low exposure comparison group. Neuroticism was strongly related to trajectories of both PTS and general distress even when adjusting for important risk factors such as traumatic bereavement and exposure severity. Other personality traits demonstrated weak associations with the trajectories. The present findings correspond with the notion of neuroticism as a vulnerability factor for symptomatic long-term trajectories of posttraumatic and general distress whereas resiliency was not predicated by particularly low levels of neuroticism.

  • 10. Sveen, Josefin
    et al.
    Bergh Johannesson, Kerstin
    Cernvall, Martin
    Arnberg, Filip K.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Trajectories of prolonged grief one to six years after a natural disaster2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0209757Article in journal (Refereed)
    Abstract [en]

    Background

    The long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories.

    Methods

    Bereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership.

    Results

    Three trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one’s child. When examining grief indicators, the chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories.

    Conclusions

    This study highlights the importance of considering how traumatically bereaved individuals can be affected by loss for several years after a disaster, especially after losing one’s child. An inability to accept the loss, more so than yearning, appears to characterize bereaved survivors at risk of a chronic trajectory of grief.

  • 11.
    Åslund, Lie
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Arnberg, Filip
    Kanstrup, Marie
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis2018In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 14, no 11, p. 1937-1947Article, review/survey (Refereed)
    Abstract [en]

    Study Objectives

    Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents.

    Methods

    In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy.

    Results

    After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (−9.31 minutes, P = .007) and actigraphy (−19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries −15.85 minutes (P = .01) and actigraphy −23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (−14.41 minutes, P = .001) and actigraphy (−7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated.

    Conclusions

    Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.

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