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Axfors, C., Hellgren, C., Volgsten, H., Skoog Svanberg, A., Ekselius, L., Wikström, A.-K., . . . Sundström-Poromaa, I. (2019). Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women. Acta Obstetricia et Gynecologica Scandinavica, 98(4), 470-478
Öppna denna publikation i ny flik eller fönster >>Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
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2019 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, nr 4, s. 470-478Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction

Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

Material and methods

Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

Results

After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

Conclusions

Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

Nyckelord
antenatal care, health care utilization, neuroticism, personality, pregnancy, prenatal care
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:uu:diva-364260 (URN)10.1111/aogs.13506 (DOI)000460954800008 ()30457176 (PubMedID)
Forskningsfinansiär
Forte, Forskningsrådet för hälsa, arbetsliv och välfärd, 2007-1955Marianne och Marcus Wallenbergs Stiftelse, MMW2011.0115Sveriges läkarförbund, SLS-250581Vetenskapsrådet, 521-2010-3293Vetenskapsrådet, K2008-54X-20642-01-3Svenska läkaresällskapetStiftelsen Söderström - Königska sjukhemmetTore Nilsons Stiftelse för medicinsk forskning
Tillgänglig från: 2018-10-24 Skapad: 2018-10-24 Senast uppdaterad: 2019-04-15Bibliografiskt granskad
Syk, M., Ellström, S., Mwinyi, J., Schiöth, H. B., Ekselius, L., Ramklint, M. & Cunningham, J. L. (2019). Plasma levels of leptin and adiponectin and depressive symptoms in young adults. Psychiatry Research, 272, 1-7
Öppna denna publikation i ny flik eller fönster >>Plasma levels of leptin and adiponectin and depressive symptoms in young adults
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2019 (Engelska)Ingår i: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 272, s. 1-7Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Circulating levels of adipokines are known to be associated with depression. This study aimed to investigate a possible association between leptin, adiponectin and dimensional measures of depressive symptoms in young adults with and without psychiatric illness. Total plasma adiponectin and leptin levels were measured in 194 young adults seeking psychiatric ambulatory care and 57 healthy controls. Depressive symptoms were assessed using the Montgomery-Åsberg Depression Self-Rating Scale (MADRS-S). Analysis was performed on men and women separately. P-leptin levels were significantly elevated in patients compared with controls and correlated with total MADRS-S scores in the women. Women with P-leptin in the highest quartile reached a significantly higher MADRS-S score than women in the lowest quartile, but this difference disappeared after adjusting for body mass index (BMI) and antidepressant use. MADRS-S score was associated with P-leptin in female patients without antidepressant use, independently of BMI. There was no association between P-leptin levels and current major depression. P-adiponectin levels were not associated with depressive symptoms or current major depression. The findings indicate that P-leptin levels are associated with depressive symptom severity in young women; however, the association is linked to other factors, which challenges its usefulness as a biomarker for depression in clinical psychiatry.

Nyckelord
Adipokines, Depression, Inflammation, Mood disorders
Nationell ämneskategori
Psykiatri
Forskningsämne
Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-376540 (URN)10.1016/j.psychres.2018.11.075 (DOI)000460994400001 ()30562581 (PubMedID)
Forskningsfinansiär
Erik, Karin och Gösta Selanders stiftelseFredrik och Ingrid Thurings StiftelseStiftelsen Söderström - Königska sjukhemmetSveriges läkarförbund
Tillgänglig från: 2019-02-06 Skapad: 2019-02-06 Senast uppdaterad: 2019-04-10Bibliografiskt granskad
Folke, F., Hursti, T., Kanter, J. W., Arinell, H., Tungström, S., Söderberg, P. & Ekselius, L. (2018). Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.. International Journal of Mental Health Nursing, 27(1), 276-286
Öppna denna publikation i ny flik eller fönster >>Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.
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2018 (Engelska)Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, nr 1, s. 276-286Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients' experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1-day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience.

Nyckelord
activity, diary, hospitalized, mental health inpatient, reward
Nationell ämneskategori
Övrig annan medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-330226 (URN)10.1111/inm.12318 (DOI)000419717100027 ()28220616 (PubMedID)
Tillgänglig från: 2017-09-28 Skapad: 2017-09-28 Senast uppdaterad: 2018-02-14Bibliografiskt granskad
Tillman, K. K., Hakelius, M., Höijer, J., Ramklint, M., Ekselius, L., Nowinski, D. & Papadopoulos, F. (2018). Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts. Journal of the American Academy of Child and Adolescent Psychiatry, 57(11), 876-883
Öppna denna publikation i ny flik eller fönster >>Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts
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2018 (Engelska)Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 57, nr 11, s. 876-883Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type.

METHOD: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842) was compared to a matched cohort (n = 78,409) as well as to their unaffected siblings (n = 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models.

RESULTS: Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC.

CONCLUSION: Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.

Nyckelord
epidemiology, neurodevelopmental disorders, nonsyndromic clefts, psychiatric comorbidity
Nationell ämneskategori
Psykiatri Neurologi
Identifikatorer
urn:nbn:se:uu:diva-368474 (URN)10.1016/j.jaac.2018.06.024 (DOI)000453802900013 ()30392629 (PubMedID)
Tillgänglig från: 2018-12-05 Skapad: 2018-12-05 Senast uppdaterad: 2019-02-06Bibliografiskt granskad
Edvinsson, D. & Ekselius, L. (2018). Long-Term Tolerability and Safety of Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A 6-Year Prospective Naturalistic Study. Journal of Clinical Psychopharmacology, 38(4), 370-375
Öppna denna publikation i ny flik eller fönster >>Long-Term Tolerability and Safety of Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A 6-Year Prospective Naturalistic Study
2018 (Engelska)Ingår i: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 38, nr 4, s. 370-375Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder typically treated with stimulants and atomoxetine. Data on long-term tolerability and safety of such pharmacological treatment in subjects diagnosed in adulthood are limited.

Methods: A cohort of adults diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria was followed-up on an average of 6 years after first evaluation. Of 168 adults, 112 (67%) who initiated medication were available for follow-up. Data were obtained from patient record data, self-report forms, and a telephone interview.

Results: Of the 112 participants assessed, 57 (51%) were still on treatment with methylphenidate (MPH) at follow-up and 55 (49%) had discontinued. The 3 leading reasons for discontinuing treatment with MPH were lack of effect (29%), elevated mood or hypomania (11%), and losing contact with the prescribing physician (9%). The most common adverse effects in subjects still on treatment with MPH were decreased appetite (28%), dry mouth (24%), anxiousness/restlessness and increased pulse frequency (19% each), decreased sexual desire (17%), and perspiration (15%). Subjects still on treatment reported increased quality of life, a higher level of functioning, and a greater understanding of their way of functioning from those being close compared with nonmedicated subjects.

Conclusions: The high attrition rate underscores the need for further research to identify possible modes to increase retention to treatment. Those diagnosed with ADHD and on long-term treatment with stimulants experience mild and tolerable adverse effects.

Nationell ämneskategori
Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-327891 (URN)10.1097/JCP.0000000000000917 (DOI)000438053700016 ()29927781 (PubMedID)
Anmärkning

Title in dissertation reference list: Long-Term Tolerability and Safety of Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder

Tillgänglig från: 2017-08-11 Skapad: 2017-08-11 Senast uppdaterad: 2018-09-24Bibliografiskt granskad
Salberg, J., Folke, F., Ekselius, L. & Öster, C. (2018). Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences. International Journal of Mental Health Nursing, 27(5), 1401-1410
Öppna denna publikation i ny flik eller fönster >>Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences
2018 (Engelska)Ingår i: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, nr 5, s. 1401-1410Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

A promising intervention in mental health in-patient care is behavioural activation (BA). Interventions based on BA can be used by mental health nurses and other staff members. The aim of this study was to evaluate patients' and staff members' experiences of a nursing staff-led behavioural group intervention in mental health in-patient care. The intervention was implemented at three adult acute general mental health in-patient wards in a public hospital setting in Sweden. A self-administrated questionnaire, completed by 84 patients and 34 nurses and nurse assistants, was administered, and nonparametric data analysed using descriptive statistics. Our findings revealed that both patients and nursing staff ranked nursing care and care environment as important aspects in the recovery process. Patients and staff members reported overall positive experiences of the group sessions. Patients with higher frequencies of attendance and patients satisfied with overall care had a more positive attitude towards the intervention. A more positive experience of being a group leader was reported by staff members who had been leading groups more than ten times. The most common impeding factor during implementation, reported by staff members, was a negative attitude to change. Conducive factors were having support from a psychologist and the perception that patients were showing interest. These positive experiences reported by patients and nursing staff, combined with previous research in this field, are taking us one step further in evaluating group sessions based on BA as a meaningful nursing intervention in mental health in-patient care.

Nyckelord
behavioural activation, evaluation, group intervention, mental health care, nursing
Nationell ämneskategori
Omvårdnad Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-364165 (URN)10.1111/inm.12439 (DOI)000443391700009 ()29446512 (PubMedID)
Tillgänglig från: 2018-10-29 Skapad: 2018-10-29 Senast uppdaterad: 2018-11-16Bibliografiskt granskad
Ekselius, L. (2018). Personality disorder: a disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204
Öppna denna publikation i ny flik eller fönster >>Personality disorder: a disease in disguise
2018 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 4, s. 194-204Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Personality disorders (PDs) can be described as the manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both. They are common and are frequently encountered in virtually all forms of health care. PDs are associated with an inferior quality of life (QoL), poor health, and premature mortality. The aetiology of PDs is complex and is influenced by genetic and environmental factors. The clinical expression varies between different PD types; the most common and core aspect is related to an inability to build and maintain healthy interpersonal relationships. This aspect has a negative impact on the interaction between health-care professionals and patients with a PD. From being discrete and categorical disease entities in previous classification systems, the current concept of PD, reflected in the newly proposed ICD-11, is a dimensional description based on the severity of the disturbed functioning rather than on the type of clinical presentation. Insight about the characteristics of PDs among medical practitioners is limited, which is partly because persons do not seek health care for their PD, but instead for other medical issues which are obscured by their underlying personality problems. What needs to be emphasized is that PDs affect both the clinical presentation of other medical problems, and the outcome of these, in a negative manner and that the integrated effects of having a PD are a shortened life expectancy. Accordingly, PDs need to be recognized in clinical practice to a greater extent than previously.

Ort, förlag, år, upplaga, sidor
Taylor & Francis Group, 2018
Nyckelord
ICD-11, personality disorders, personality traits, review article
Nationell ämneskategori
Allmänmedicin
Identifikatorer
urn:nbn:se:uu:diva-375832 (URN)10.1080/03009734.2018.1526235 (DOI)000455890700001 ()30539674 (PubMedID)
Tillgänglig från: 2019-02-01 Skapad: 2019-02-01 Senast uppdaterad: 2019-02-01Bibliografiskt granskad
Volgsten, H., Schmidt, L., Skoog Svanberg, A., Ekselius, L. & Sundström Poromaa, I. (2018). Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment: a prospective cohort study. Human Fertility, 1-6
Öppna denna publikation i ny flik eller fönster >>Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment: a prospective cohort study
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2018 (Engelska)Ingår i: Human Fertility, ISSN 1464-7273, E-ISSN 1742-8149, s. 1-6Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

This is a prospective cohort study with the objective to describe psychiatric disorders, such as any mood and anxiety disorders, in both women and men five years after assisted reproductive technology (ART). The Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), was used as the diagnostic tool to evaluate psychiatric disorders. Logistic regression analysis was used to calculate odds ratios (ORs) and confidence interval (CI) for factors associated with psychiatric disorders at the follow-up. Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire. Approximately 11.5% of women and 5.5% of men fulfilled the criteria for any psychiatric diagnosis. Of these, any mood disorder was present in 9.4% of women and 4.4% of men. The major risk factor for mood or anxiety disorders at follow-up was mood or anxiety disorders at the time of the index ART. Mood disorders were not more common in women who remained childless after ART. In conclusion, these findings indicate that psychiatric disorders at five years follow-up after ART are less common than at the baseline assessment in conjunction with the ART.

Nyckelord
Assisted reproductive technology, cohort study, depression, follow-up, infertility, psychiatric disorders
Nationell ämneskategori
Psykiatri Reproduktionsmedicin och gynekologi
Identifikatorer
urn:nbn:se:uu:diva-351123 (URN)10.1080/14647273.2018.1474279 (DOI)29768933 (PubMedID)
Tillgänglig från: 2018-05-19 Skapad: 2018-05-19 Senast uppdaterad: 2018-09-12Bibliografiskt granskad
Edvinsson, D. & Ekselius, L. (2018). Six-Year Outcome in Subjects Diagnosed with Attention-Deficit/Hyperactivity Disorder as Adults. European Archives of Psychiatry and Clinical Neuroscience, 268(4), 337-347
Öppna denna publikation i ny flik eller fönster >>Six-Year Outcome in Subjects Diagnosed with Attention-Deficit/Hyperactivity Disorder as Adults
2018 (Engelska)Ingår i: European Archives of Psychiatry and Clinical Neuroscience, ISSN 0940-1334, E-ISSN 1433-8491, Vol. 268, nr 4, s. 337-347Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

There are very few studies on the long-term outcome in subjects diagnosed with ADHD as adults. The objective of the present study was to assess this and relate the outcome to whether there was current medication or not and to other potential predictors of favourable outcome. A prospective clinical cohort of adults diagnosed with ADHD according to DSM-IV criteria was followed-up on an average of 6 years after first evaluation (n = 124; mean age 42 years, 51% males). ADHD symptom trajectories were assessed as well as medication, global functioning, disability, health-related quality of life, and alcohol and drug consumption at follow-up. Ninety percent of those diagnosed were initially treated pharmacologically and half of them discontinued treatment. One-third reported remission, defined as not fulfilling any ADHD subtype and a GAF-value last year ≥ 70, which was not affected by comorbidity at baseline. Current medication was not associated with remission. Subjects evaluated and first diagnosed with ADHD as adults are functionally improved at follow-up 6 years later despite a high percentage of psychiatric comorbidity at baseline. Half dropped out of medication, and there was no difference in ADHD remission between subjects with on-going medication at follow-up or subjects without medication, although current medication was related to a higher degree of self-reported global improvement.

Nationell ämneskategori
Psykiatri
Forskningsämne
Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-327890 (URN)10.1007/s00406-017-0850-6. (DOI)000432412500003 ()29143159 (PubMedID)
Forskningsfinansiär
Vetenskapsrådet
Tillgänglig från: 2017-08-11 Skapad: 2017-08-11 Senast uppdaterad: 2018-07-30Bibliografiskt granskad
Kouros, I., Hörberg, N., Ekselius, L. & Ramklint, M. (2018). Wender Utah Rating Scale-25 (WURS-25): psychometric properties and diagnostic accuracy of the Swedish translation. Upsala Journal of Medical Sciences, 123(4), 230-236
Öppna denna publikation i ny flik eller fönster >>Wender Utah Rating Scale-25 (WURS-25): psychometric properties and diagnostic accuracy of the Swedish translation
2018 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 4, s. 230-236Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The aim of this study was to examine the psychometric properties and diagnostic accuracy of the Swedish version of the Wender Utah Rating Scale (WURS) in psychiatric patients with similar symptoms but diagnosed with either attention deficit hyperactivity disorder (ADHD), bipolar disorder (BP), and/or borderline personality disorder (BPD).

Methods: A total of 121 patients from an outpatient psychiatric clinic for young adults (18–25 years) were diagnosed using the Structured Clinical Interview for DSM Axis I and Axis II (SCID-I and SCID-II), and ADHD was diagnosed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). WURS were filled in by the participants and compared with a diagnosis of ADHD according to K-SADS.

Results: Internal consistency of the WURS was 0.94. The principal component analysis resulted in a three-factor solution that accounted for 61.3% of the variance. The ADHD group had significantly higher mean scores compared to all other groups. The diagnostic accuracy of the WURS was examined using AUC and ROC analysis, and the optimal cut-off score was 39, with a sensitivity of 0.88 and specificity of 0.70, with AUC 0.87, 95% CI 0.80–0.94, PPV 0.59, and NPV 0.92.

Conclusion: The psychometric properties of the Swedish WURS were good. For assessment of adult ADHD, in patients with symptoms of emotional instability, impulsivity, and attention problems but of different origins, a somewhat higher cut-off score than the originally suggested was preferable for identification of ADHD.

Nyckelord
ADHD, bipolar disorder, borderline personality disorder, Wender Utah Rating Scale
Nationell ämneskategori
Psykiatri
Identifikatorer
urn:nbn:se:uu:diva-372661 (URN)10.1080/03009734.2018.1515797 (DOI)000455702800006 ()30373435 (PubMedID)
Tillgänglig från: 2019-01-08 Skapad: 2019-01-08 Senast uppdaterad: 2019-02-01Bibliografiskt granskad
Organisationer
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0002-5760-7730

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