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  • 1. Akerblad, Ann-Charlotte
    et al.
    Bengtsson, Finn
    von Knorring, Lars
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Response, remission and relapse in relation to adherence in primary care treatment of depression: a 2-year outcome study.2006In: International Clinical Psychopharmacology, ISSN 0268-1315, E-ISSN 1473-5857, Vol. 21, no 2, p. 117-24Article in journal (Refereed)
    Abstract [en]

    Non-adherence to antidepressant drug treatment is common. In a recent study in depressed primary care patients, we reported a strong relationship between adherence and response after 6 months. With the use of a naturalistic design, the patients in that study were prospectively followed for 2 years. The purpose of the present study was to investigate the patients' long-term outcome and, in particular, to examine the impact of patients' treatment adherence on response, remission and relapse. Of the 1031 patients in the intent-to-treat (ITT) sample, 835 completed the study. After 2 years, the overall remission rate defined as a Montgomery-Asberg Depression Rating Scale score of nine or less was 68% in the ITT sample analysed with the last observation carried forward (LOCF) technique, and 75% in observed cases. In total, 34% of the responders experienced at least one relapse. Response rates (LOCF) were significantly higher in adherent compared to non-adherent patients at week 24 [95% confidence interval (CI) = 21.4-32.1], year 1 (95% CI = 12.3-22.2) and year 2 (95% CI = 9.2-19.0). Remission rates (LOCF) were also significantly higher in the group of adherent patients at week 24 (95% CI = 9.6-21.5), year 1 (95% CI = 10.0-21.5) and year 2 (95% CI = 11.0-22.0). No relationship between adherence and relapse rate was observed, although the mean time from response to first sign of relapse was significantly longer in the adherent patients (95% C I= 9-97 days). In conclusion, this 2-year follow-up study showed superior long-term recovery in patients who were adherent to antidepressant medication compared to non-adherent patients.

  • 2.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Philipson, Anna
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hagberg, Lars
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Moller, Margareta
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Olsson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Karolinska Inst KIND, Dept Womens & Childrens Hlth, Ctr Neurodev Disorders,Pediat Neuropsychiat Unit, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Ctr Psychiat Res, Stockholm, Sweden.
    Uppsala Longitudinal Adolescent Depression Study (ULADS)2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed)
    Abstract [en]

    Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

    Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

    Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

    Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

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  • 3.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Anna, Philipson
    Faculty of Medicine and Health, Örebro University.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Margareta, Möller
    Faculty of Medicine and Health, Örebro University.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Psychiatry, University hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Södersjukhuset, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lars, Hagberg
    Faculty of Medicine and Health, Örebro University.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression, early psychiatric comorbidities, and adult welfare burden: A 25-year longitudinal cohort studyManuscript (preprint) (Other academic)
  • 4. Andreou, Dimitrios
    et al.
    Saetre, Peter
    Milesson Fors, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Nilsson, Björn Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Jönsson, Erik Gunnar
    Ebeling Barbier, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Agartz, Ingrid
    Cardiac left ventricular ejection fraction in men and women with schizophrenia on long-term antipsychotic treatment2020In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 218, p. 226-232Article in journal (Refereed)
    Abstract [en]

    Patients with schizophrenia exhibit a higher cardiovascular mortality compared to the general population which has been attributed to life-style factors, genetic susceptibility and antipsychotic medication. Recent echocardiographic studies have pointed to an association between clozapine treatment and reduced left ventricular ejection fraction (LVEF), a measure that has been inversely associated with adverse outcomes including all-cause mortality. Cardiovascular magnetic resonance (CMR) is considered the reference method for LVEF measurement. The aim of the present study was to investigate the LVEF in patients with schizophrenia on long-term treatment with antipsychotics and healthy controls. Twenty-nine adult patients with schizophrenia on long-term medication with antipsychotics and 27 age-, sex- and body mass index-matched healthy controls (mean ages 44 and 45 years, respectively) were recruited from outpatient psychiatric clinics in Uppsala, Sweden. The participants were interviewed and underwent physical examination, biochemical analyses, electrocardiogram and CMR. Men with schizophrenia on long-term antipsychotic treatment showed significantly lower LVEF than controls (p = 0.0076), whereas no such difference was evident among women (p = 0.44). Specifically, clozapine-treated male patients had 10.6% lower LVEF than male controls (p = 0.0064), whereas the LVEF was 5.5% below that of controls among male patients treated with non-clozapine antipsychotics (p = 0.047). Among medicated men with schizophrenia, we found significantly lower LVEF compared to healthy individuals, suggesting the need of routine cardiac monitoring in this patient group. This is the first study showing a significant negative association between treatment with non-clozapine antipsychotics and LVEF.

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  • 5. Angelhoff, Charlotte
    et al.
    Sveen, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Ersta Sköndal Bräcke University College.
    Alvariza, Anette
    Weber-Falk, Megan
    Kreicbergs, Ulrika
    Communication, self-esteem and prolonged grief in parent-adolescent dyads, 1-4 years following the death of a parent to cancer2021In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 50, article id 101883Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Talking and grieving together may be advantageous for maintaining belief in a meaningful future and can help bereaved adolescents and their parents to cope better with the situation. The aim of this study was to explore communication, self-esteem and prolonged grief in adolescent-parent dyads, following the death of a parent to cancer.

    METHOD: This study has a descriptive and comparative design. Twenty family dyads consisting of parentally bereaved adolescents (12-19 years) and their widowed parents completed the Parent and Adolescent Communication Scale, Rosenberg Self-Esteem Scale and Prolonged Grief-13, 1-4 years following the death of a parent.

    RESULTS: Twelve family dyads reported normal-high parent-adolescent communication, 11 dyads rated normal-high self-esteem. Two adolescents and three parents scored above the cut-off for possible prolonged grief disorder (≥35), none of these were in the same dyads. There was a difference (p < .05) between boys (mean 40.0) and girls (mean 41.9) with regard to open family communication, as assessed by parents. Girls reported lower self-esteem (mean 26.0) than boys (mean 34.1, p < .01).

    CONCLUSIONS: This study provides insights from parentally bereaved families which indicate that despite experiencing the often-traumatic life event of losing a parent or partner, most participants reported normal parent-adolescent communication, normal self-esteem and few symptoms of prolonged grief. The potential usefulness of identifying families who may need professional support in family communication following the death of a parent is discussed.

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  • 6.
    Arakelian, Erebouni
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Nyholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Enblad: Neurosurgery.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    How Anesthesiologists and Nurse Anesthetists Assess and Handle Patients' Perioperative Worries Without a Validated Instrument2019In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 34, no 4, p. 810-819Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study how nurse anesthetists and anesthesiologists assess and handle patients' perioperative anxiety without using a validated instrument.

    DESIGN: Qualitative study.

    METHODS: Individual in-depth face-to-face interviews were conducted with nurse anesthetists (n = 9) and anesthesiologists (n = 5) from a university hospital in Sweden. Data were analyzed with thematic analysis according to Braun and Clark.

    FINDINGS: Two themes were identified: (1) I ask about anxiety, look for visual signs, and observe communication and (2) I handle patients' anxieties individually. In addition to subthemes describing assessment and handling of adults, it appeared that parents played an important role in children's perioperative anxiety.

    CONCLUSIONS: When not using a validated instrument, assessing perioperative anxiety is commonly based on the anesthesiologist's and nurse anesthetist's experience, knowledge, views, and attitudes. The evaluator's capability of using different strategies in the assessment and handling of perioperative anxiety is important.

  • 7.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Bränn, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Henriksson, Hanna E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Kunovac Kallak, Theodora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Reproductive Biology in Uppsala (CRU).
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.
    Lager, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Reproductive Biology in Uppsala (CRU).
    Iliadis, Stavros I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 10, article id e031514Article in journal (Refereed)
    Abstract [en]

    PURPOSE: With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection.

    PARTICIPANTS: From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16-18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort.

    FINDINGS TO DATE: In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case-control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic-pituitary-adrenal axis and immune system.

    FUTURE PLANS: In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.

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  • 8.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Investigating the association between neuroticism and adverse obstetric and neonatal outcomes2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 15470Article in journal (Refereed)
    Abstract [en]

    Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (Cis) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

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  • 9.
    Baghdassarian, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Lewander, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Auditory brainstem response (ABR) profiling in schizoaffective disorder2020In: Acta Neuropsychiatrica, ISSN 0924-2708, E-ISSN 1601-5215, Vol. 32, no 4, p. 214-217Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to assess whether the auditory brainstem response (ABR) profiling test for schizophrenia (SZ) would recognise schizoaffective disorder (SZA) patients as SZ or not.

    Method: Male and female SZA patients (n = 16) from the psychosis unit at Uppsala University Hospital were investigated. Coded sets of randomised ABR recordings intermingled with patients with SZ, adult attention-deficit hyperactivity disorder (ADHD) and healthy controls were analysed by an independent party blinded to clinical diagnoses.

    Results: The ABR profiling test for SZ was positive in 5/16 patients (31%) and negative in 11/16 patients (69%) with SZA. A surprising finding was that 4/16 (25%) SZA patients were positive for the ABR profiling test for ADHD.

    Conclusion: With the ABR profiling test, a minority of patients with SZA tested positive for SZ. In contrast, a majority (85%) of patients with SZ in a previous study tested positive. These preliminary results leave us ignorant whether SZA should be regarded as a SZ-like disorder or a psychotic mood disorder and add to the questions regarding the validity of this diagnostic entity. However, the ABR profiling method is still in its infancy and its exploration in a range of psychiatric disorders is warranted.

  • 10.
    Bengtsson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Olsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Mårtensson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Department of Medical Physics, Uppsala University Hospital.
    Gingnell, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Persson, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Autonomic modulation networks in schizophrenia: The relationship between heart rate variability and functional and structural connectivity in the brain2020In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 300, article id 111079Article in journal (Refereed)
    Abstract [en]

    Heart rate variability (HRV), a measurement of autonomic nervous system (ANS) activity, has been found reduced in schizophrenia. The anterior cingulate cortex (ACC), which is important in regulating the ANS, is structurally and functionally affected in schizophrenia. We investigate the relationship between HRV and functional and structural connectivity of the ACC in patients with schizophrenia and healthy controls. Ten patients with a diagnosis of schizophrenia and ten healthy controls were recruited. Heart rate was monitored in a naturalistic out-of-clinic setting. Magnetic resonance imaging (MRI) was performed, including resting-state functional MRI and diffusion tensor imaging. Patients with schizophrenia had significantly lower HRV compared to controls. A positive correlation between ACC connectivity with the bilateral cerebellum and HRV was found in the patients. HRV was also positively correlated with amplitude of low frequency fluctuations (ALFF) in the cerebellum, and with axial diffusivity in the middle cerebellar peduncle, in the patients. There was a significant negative relationship between antipsychotic medication dosage, HRV and all neuroimaging measures related to HRV. We conclude that ACC connectivity seems to be affected in schizophrenia, both structurally and functionally, and that the ACC-cerebellum connectivity, as well as cerebellar function, is associated with ANS regulation in patients with schizophrenia.

  • 11.
    Bengtsson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Olsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Persson, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ambulatory Heart Rate Variability in Schizophrenia or Depression: Impact of Anticholinergic Burden and Other Factors2021In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 41, no 2, p. 121-128Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Heart rate variability (HRV) has been found reduced in patients with schizophrenia and depression. However, there is a lack of knowledge on how demographic, lifestyle, and pharmacological factors contribute to the reduction in HRV in these patients.

    METHODS: We recruited 37 patients with schizophrenia, 43 patients with unipolar depression, and 64 healthy controls. A combined chest-worn HRV and accelerometer device was used in an ambulatory measurement. Age, sex, anticholinergic burden of medication, nicotine use, body mass index, and ongoing physical activity were assessed in multiple regression models regarding their influence on HRV, measured as the standard deviation of all the RR intervals (SDNN).

    RESULTS: In the fully adjusted model, schizophrenia (β = -0.23, P = 0.019), depression (β = -0.18, P = 0.028), age (β = -0.34, P < 0.000), ongoing physical activity (β = -0.23, P = 0.001), and anticholinergic burden (β = -0.19, P = 0.025) influenced SDNN negatively. Sex, nicotine use, and BMI had negligible effects on SDNN.

    CONCLUSIONS: We show for the first time that a quantified score of anticholinergic burden of medication has a negative relationship to HRV in patients with schizophrenia or depression, but that the diagnoses themselves still exhibit an effect on HRV.

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  • 12.
    Bhandage, Amol K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Birnir: Molecular Physiology and Neuroscience.
    Cunningham, Janet L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Jin, Zhe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Birnir: Molecular Physiology and Neuroscience.
    Shen, Qiujin
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular tools.
    Bongiovanni, Santiago
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Korol, Sergiy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Birnir: Molecular Physiology and Neuroscience.
    Syk, Mikaela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Kamali-Moghaddam, Masood
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular tools. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Birnir, Bryndis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Birnir: Molecular Physiology and Neuroscience.
    Depression, GABA, and Age Correlate with Plasma Levels of Inflammatory Markers2019In: International Journal of Molecular Sciences, ISSN 1661-6596, E-ISSN 1422-0067, Vol. 20, no 24, article id 6172Article in journal (Refereed)
    Abstract [en]

    Immunomodulation is increasingly being recognised as a part of mental diseases. Here, we examined whether levels of immunological protein markers changed with depression, age, or the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). An analysis of plasma samples from patients with a major depressive episode and control blood donors (CBD) revealed the expression of 67 inflammatory markers. Thirteen of these markers displayed augmented levels in patients compared to CBD. Twenty-one markers correlated with the age of the patients, whereas 10 markers correlated with the age of CBD. Interestingly, CST5 and CDCP1 showed the strongest correlation with age in the patients and CBD, respectively. IL-18 was the only marker that correlated with the MADRS-S scores of the patients. Neuronal growth factors (NGFs) were significantly enhanced in plasma from the patients, as was the average plasma GABA concentration. GABA modulated the release of seven cytokines in anti-CD3-stimulated peripheral blood mononuclear cells (PBMCs) from the patients. The study reveals significant changes in the plasma composition of small molecules during depression and identifies potential peripheral biomarkers of the disease.

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  • 13.
    Bixo, Liv
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Cunningham, Janet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    'Sick and tired': Patients reported reasons for not participating in clinical psychiatric research2021In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 24, no S1, p. 20-29Article in journal (Refereed)
    Abstract [en]

    Background: Meaningful and generalizable research depends on patients' willingness to participate. Studies often fail to reach satisfactory representativeness.

    Objective: This paper aims to investigate reasons for not participating in research among young adult patients with psychiatric illness.

    Method: A quantitative cross-sectional study was performed based on questionnaires reported on by 51 psychiatric patients (14 males, 35 females and two unspecified) who had previously declined participation in an ongoing research project. Thereafter, a qualitative interview with subsequent content analysis was conducted with ten additional patients (five males, five females).

    Results: The questionnaires indicate being 'too tired/too sick to participate' as the most common barrier. Lack of time and fear of needles were other common barriers. Lack of trust or belief in the value of research was less inhibitive. In the interviews, disabling psychiatric symptoms were confirmed as the main reason for not participating. Several potential ways to increase participation were identified, such as simplification of procedures and information as well as providing rewards and feedback, and building relationships before asking.

    Conclusion: This study is unusual as it focuses on the group of young people attending psychiatry outpatient clinics we know very little about - those who do not partake in research. Our results indicate that fatigue and sickness reduce research participation and identify factors that may facilitate enrolment of this important group.

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  • 14.
    Bjork Thordardottir, Edda
    et al.
    University of Iceland.
    Yin, Li
    Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Hollander, Anna-Clara
    Karolinska Institutet.
    Hultman, Christina M.
    Karolinska Institutet; Icahn School of Medicine, Mount Sinai Hospital, New York.
    Lichtenstein, Paul
    Karolinska Institutet.
    Ye, Weimin
    Karolinska Institutet.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Stress Research Institute, Stockholm University.
    Fang, Fang
    Karolinska Institutet.
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdottir, Unnur Anna
    Karolinska Institutet; University of Iceland; Harvard T.H. Chan School of Public Health.
    Mortality and major disease risk among migrants of the 1991–2001 Balkan wars to Sweden: A register-based cohort study2020In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 17, no 12, article id e1003392Article in journal (Refereed)
    Abstract [en]

    Background

    In recent decades, millions of refugees and migrants have fled wars and sought asylum in Europe. The aim of this study was to quantify the risk of mortality and major diseases among migrants during the 1991–2001 Balkan wars to Sweden in comparison to other European migrants to Sweden during the same period.

    Methods and findings

    We conducted a register-based cohort study of 104,770 migrants to Sweden from the former Yugoslavia during the Balkan wars and 147,430 migrants to Sweden from 24 other European countries during the same period (1991–2001). Inpatient and specialized outpatient diagnoses of cardiovascular disease (CVD), cancer, and psychiatric disorders were obtained from the Swedish National Patient Register and the Swedish Cancer Register, and mortality data from the Swedish Cause of Death Register. Adjusting for individual-level data on sociodemographic characteristics and emigration country smoking prevalence, we used Cox regressions to contrast risks of health outcomes for migrants of the Balkan wars and other European migrants. During an average of 12.26 years of follow-up, being a migrant of the Balkan wars was associated with an elevated risk of being diagnosed with CVD (HR 1.39, 95% CI 1.34–1.43, p < 0.001) and dying from CVD (HR 1.45, 95% CI 1.29–1.62, p < 0.001), as well as being diagnosed with cancer (HR 1.16, 95% CI 1.08–1.24, p < 0.001) and dying from cancer (HR 1.27, 95% CI 1.15–1.41, p < 0.001), compared to other European migrants. Being a migrant of the Balkan wars was also associated with a greater overall risk of being diagnosed with a psychiatric disorder (HR 1.19, 95% CI 1.14–1.23, p < 0.001), particularly post-traumatic stress disorder (HR 9.33, 95% CI 7.96–10.94, p < 0.001), while being associated with a reduced risk of suicide (HR 0.68, 95% CI 0.48–0.96, p = 0.030) and suicide attempt (HR 0.57, 95% CI 0.51–0.65, p < 0.001). Later time period of migration and not having any first-degree relatives in Sweden at the time of immigration were associated with greater increases in risk of CVD and psychiatric disorders. Limitations of the study included lack of individual-level information on health status and behaviors of migrants at the time of immigration.

    Conclusions

    Our findings indicate that migrants of the Balkan wars faced considerably elevated risks of major diseases and mortality in their first decade in Sweden compared to other European migrants. War migrants without family members in Sweden or with more recent immigration may be particularly vulnerable to adverse health outcomes. Results underscore that persons displaced by war are a vulnerable group in need of long-term health surveillance for psychiatric disorders and somatic disease.

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  • 15.
    Björkenstam, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden.;Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Community Hlth Sci, Los Angeles, CA 90095 USA.;Univ Calif Los Angeles, Calif Ctr Populat Res, Los Angeles, CA 90095 USA.
    Helgesson, Magnus
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden..
    Amin, Ridwanul
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden..
    Lange, Theis
    Univ Copenhagen, Sect Biostat, Copenhagen, Denmark.;Peking Univ, Ctr Stat Sci, Beijing, Peoples R China..
    Mittendorfer-Rutz, Ellenor
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, S-17177 Stockholm, Sweden..
    Mental disorders and suicidal behavior in refugees and Swedish-born individuals: is the association affected by work disability?2020In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 55, no 8, p. 1061-1071Article in journal (Refereed)
    Abstract [en]

    Background

    Among potential pathways to suicidal behavior in individuals with mental disorders (MD), work disability (WD) may play an important role. We examined the role of WD in the relationship between MD and suicidal behavior in Swedish-born individuals and refugees.

    Methods

    The study cohort consisted of 4,195,058 individuals aged 16–64, residing in Sweden in 2004–2005, whereof 163,160 refugees were followed during 2006–2013 with respect to suicidal behavior. Risk estimates were calculated as hazard ratios (HR) with 95% confidence intervals (CI). The reference groups comprised individuals with neither MD nor WD. WD factors (sickness absence (SA) and disability pension (DP)) were explored as potential modifiers and mediators.

    Results

    In both Swedish-born and refugees, SA and DP were associated with an elevated risk of suicide attempt regardless of MD. In refugees, HRs for suicide attempt in long-term SA ranged from 2.96 (95% CI: 2.14–4.09) (no MD) to 6.23 (95% CI: 3.21–12.08) (MD). Similar associations were observed in Swedish-born. Elevated suicide attempt risks were also observed in DP. In Swedish-born individuals, there was a synergy effect between MD, and SA and DP regarding suicidal behavior. Both SA and DP were found to mediate the studied associations in Swedish-born, but not in refugees.

    Conclusion

    There is an effect modification and a mediating effect between mental disorders and WD for subsequent suicidal behavior in Swedish-born individuals. Also for refugees without MD, WD is a risk factor for subsequent suicidal behavior. Particularly for Swedish-born individuals with MD, information on WD is vital in a clinical suicide risk assessment.

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  • 16.
    Björkenstam, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden.
    Helgesson, Magnus
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden..
    Norredam, Marie
    Univ Copenhagen, Res Ctr Migrat Ethnic & Hlth MESU, Dept Publ Hlth, Sect Hlth Serv Res, Copenhagen K, Denmark.;Univ Hosp Hvidovre, Dept Infect Dis, Sect Immigrant Med, Copenhagen, Denmark..
    Sijbrandij, Marit
    Vrije Univ, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands..
    de Montgomery, Christopher Jamil
    Univ Copenhagen, Res Ctr Migrat Ethnic & Hlth MESU, Dept Publ Hlth, Sect Hlth Serv Res, Copenhagen K, Denmark..
    Mittendorfer-Rutz, Ellenor
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden..
    Common mental disorders among young refugees in Sweden: The role of education and duration of residency2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 270, p. 189-197Article in journal (Refereed)
    Abstract [en]

    Background: Studies investigating risks of common mental disorders (CMDs) in refugee youth are sparse. The current study examined health care use due to CMDs in unaccompanied and accompanied refugee youth and Swedish-born, and the role of education and residency duration.

    Methods: This longitudinal cohort study included 743,671 individuals (whereof 33,501 refugees) between 19 and 25 years, residing in Sweden in 2009. Refugees were classified as unaccompanied/accompanied. Risk estimates of CMDs, measured as health care use and antidepressant treatment, between 2010 and 2016 were calculated as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Highest attained education in 2009, and residency duration were examined as potential modifiers.

    Results: Compared to Swedish-born youth, refugees had a lower risk of treated major depressive and anxiety disorders (aHR): 0.73 (95% CI 0.68-0.78) and 0.74 (95% CI 0.70-0.79) respectively), but a higher risk for posttraumatic stress disorders (PTSD). Compared to Swedish-born, unaccompanied had an 8-fold elevated risk for PTSD (aHR: 8.40, 95% CI 6.16-11.47) and accompanied refugees had a nearly 3-fold risk of PTSD (aHR: 2.78, 95% CI 2.29-3.37). Rates of PTSD decreased with years spent in Sweden. The risk of CMDs decreased with increasing education.

    Limitations: The study lacked information on pre-migration factors. There may further be a potential misclassification of untreated CMDs.

    Conclusion: Refugees had a lower risk of treated depressive and anxiety disorders but a higher risk for PTSD. In refugees, the rates of anxiety disorders increased slightly over time whereas the rates of PTSD decreased. Last, low education was an important predictor for CMDs.

  • 17.
    Björkenstam, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden.;Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Community Hlth Sci, Los Angeles, CA USA.;Univ Calif Los Angeles, Calif Ctr Populat Res, Los Angeles, CA USA..
    Pierce, Matthias
    Univ Manchester, Sch Hlth Sci, Ctr Womens Mental Hlth, Manchester, Lancs, England..
    Björkenstam, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Dalman, Christina
    Karolinska Inst, Dept Publ Hlth Sci, Div Publ Hlth Epidemiol, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Kosidou, Kyriaki
    Karolinska Inst, Dept Publ Hlth Sci, Div Publ Hlth Epidemiol, Stockholm, Sweden.;Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm, Sweden..
    Attention De ficit/Hyperactivity Disorder and risk for non-affective psychotic disorder: The role of ADHD medication and comorbidity, and sibling comparison2020In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 218, p. 124-130Article in journal (Refereed)
    Abstract [en]

    Attention Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder in childhood. It is unclear whether ADHD increases the risk of non-affective psychotic disorder (NAPD). The study included a matched cohort, drawn from all born in Sweden 1987–1991 (n = 548,852). ADHD was defined as ICD diagnosis and/or prescription of ADHD medication. We distinguished between stimulants and non-stimulants, and usage duration (<1 year, 1–2 years and ≥2 years). We calculated odds ratios (OR) with 95% confidence intervals (CI) for NAPD, adjusted for confounders, comorbid autism spectrum disorder (ASD) and substance abuse. ADHD cases were also compared to their unaffected full siblings. We analyzed 18,139 ADHD cases and 72,437 sex and birth year matched controls. NAPD was more common in cases than controls (2.7 and 0.4%, respectively). After adjustment for confounders, ADHD cases had markedly high risk for NAPD (OR: 6.99; 95% CI 6.03–8.10), which attenuated further after adjustment for ASD and substance abuse (OR: 2.57; 95% CI 2.09–3.16). Utilization of ADHD medication increased the risk for NAPD (ORs for change in odds of NAPD for every 5 extra prescriptions of stimulants 1.06 (95% CI 1.02–1.10) and, non-stimulants 1.15 (95% CI 1.01–1.30)). There was no association between usage length of medication and risk for NAPD. The risk was higher in individuals with ADHD than their unaffected siblings (OR: 2.95 (95% CI 2.07–4.20)). Overall, ADHD was associated with elevated risk for NAPD, which is not entirely explained by shared familial factors. The clinical severity leading to medical treatment may also increase NAPD risk.

  • 18.
    Björkstrand, Johannes
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Psychology, Lund University, Allhelgona Kyrkogata 14M, 223 50, Lund, Sweden.
    Ågren, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Frick, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Hjorth, Olof
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Furmark, Tomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Fredrikson, Mats
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
    Åhs, Fredrik
    Department of Psychology and Social Work, Mid Sweden University, Kunskapens väg 1, Östersund, Sweden.
    Decrease in amygdala activity during repeated exposure to spider images predicts avoidance behavior in spider fearful individuals2020In: Translational Psychiatry, E-ISSN 2158-3188, Vol. 10, no 1, article id 292Article in journal (Refereed)
    Abstract [en]

    Spider phobia is characterized by exaggerated fear of situations where spiders could be present, resulting in avoidance of such situations and compromised quality of life. An important component in psychological treatment of spider phobia is exposure to phobic situations that reduces avoidance behaviors. At the neural level, amygdala responses to phobic material are elevated, but normalizes following exposure treatment. To what extent amygdala activity decreases during a session of repeated phobic stimulation, and whether activity decrease is related to subsequent avoidance is not well studied. We hypothesized reduced amygdala activity during the course of repeated exposure to spider pictures, and that the degree of reduction would predict subsequent avoidance of spider pictures. To test our hypothesis, functional magnetic resonance imaging was performed in 45 individuals with spider fear during repeated exposure to spider pictures. Results showed that repeated exposure to spider stimuli attenuated amygdala reactivity and individual differences in activity reductions predicted subsequent avoidance behavior to spider pictures in an incentive-conflict task, with larger attenuations predicting less avoidance. At 6-month follow up, initial reductions in amygdala activation still predicted avoidance. This result demonstrates that reduction in amygdala responses is related to clinically meaningful outcomes in human anxiety, and suggests that within-session reductions in amygdala responses could be an important mechanism explaining the clinical effects of exposure therapy.

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  • 19. Bodlund, O.
    et al.
    Kullgren, G.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Lindstrom, E.
    von Knorring, L.
    Axis V--Global Assessment of Functioning Scale. Evaluation of a self-report version1994In: Acta Psychiatr Scand, ISSN 0001-690X Print 0001-690X Linking, Vol. 90, no 5Article in journal (Refereed)
    Abstract [en]

    The present study examines a self-report version of the Global Assessment of Functioning Scale according to Axis V (GAF self-report). The sample (n = 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48-86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self-report overall at r = 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: -4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self-report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self-report version as a complement, Axis V could be more frequently used in future clinical practice and research.

  • 20.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Hyland, Philip
    Department of Psychology, Maynooth University, Kildare, Ireland.
    Roberts, Neil P.
    Cardiff & Vale University Health Board, Cardiff, United Kingdom; UK School of Medicine, Cardiff University, Cardiff, United Kingdom.
    Bisson, Jonathan I.
    UK School of Medicine, Cardiff University, Cardiff, United Kingdom.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample2019In: European Journal of Psychotraumatology, ISSN 2000-8198, E-ISSN 2000-8066, Vol. 10, no 1, article id 1665617Article in journal (Refereed)
    Abstract [en]

    Background: The recently published ICD-11 includes substantial changes to the diagnosis of posttraumatic stress disorder (PTSD) and introduces the diagnosis of Complex PTSD (CPTSD). The International Trauma Interview (ITI) has been developed for clinicians to assess these new diagnoses but has not yet been evaluated.

    Objectives: To evaluate the psychometric properties of the Swedish translation of the ITI by examining the interrater agreement, latent structure, internal consistency, and convergent and discriminant validity.

    Methods: In a prospective study, 186 adults who had experienced a potentially traumatic event were assessed with the ITI and answered questionnaires for symptoms of posttraumatic stress, other psychiatric disorders, functional disability, and quality of life (QoL).

    Results: The diagnostic rate was 16% for PTSD and 6% for CPTSD. Interrater agreement was satisfactory (α = .76), and confirmatory factor analysis indicated that a two-factor second-20 order model consistent with the ICD-11 model of CPTSD provided acceptable fit to the data. Composite reliability analysis demonstrated that the ITI possessed acceptable internal reliability, and associations with measures of other psychiatric disorders, insomnia, functional disability, and QoL supported the concurrent validity of the ITI.

    Conclusion: Swedish ITI shows promise as a clinician-administered instrument to assess and diagnose ICD-11 PTSD and CPTSD.

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  • 21.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Sveen, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Psychometric Properties of the PTSD Checklist for DSM-5 (PCL-5) in parents to children with burns.2015Conference paper (Refereed)
    Abstract [en]

    Introduction Symptoms of post-traumatic stress disorder (PTSD) is a common problem among parents of children with burns. However, there is a paucity of evaluated screening tools for this population. The aim was to evaluate the psychometric properties of the PTSD Checklist (PCL), which is recently revised in accordance to the Diagnostic and statistical manual of mental disorders, 5th ed.  

    Methods The participating parents (N= 62, mean age= 38) completed self-report questionnaires 0.8-5.6 years after their child’s burn. Measures were the PCL-5 (consisting of four subscales; Intrusion, Avoidance, Negative alterations in cognitions and mood, and Arousal and reactivity), the Impact of Event Scale-Revised (with three subscales; Intrusion, Avoidance and Hyperarousal) and the Perceived Stress Scale. The children had a TBSA burned ranging from 1 to 31 % and were 0.1-15.0 years of age at injury.

    Results The average PCL-5 scores were low to moderate and indicated that no parent was above the recommended preliminary cut off of 38 for PTSD. Cronbach’s alpha values were acceptable and varied between 0.56 and 0.77 for the four PCL-5 subscales and mean inter-item correlations ranged from 0.22 to 0.73. The PCL-5 subscales were positively correlated with the corresponding IES-R subscales as well as the total PSS score (p<.05). There were no associations between the PCL-5 and  burn severity (TBSA, TBSA-FT, and LOS), time since injury, child age or gender, or parent gender. 

    Conclusion In conclusion, the PCL-5 had high internal consistency and evaluation of concurrent validity suggested moderate associations with other measures of traumatic stress and perceived stress as expected. The moderate associations with other measures of stress is to be expected, taking into account the slightly different constructs targeted by the three measures in this study. This first study suggests that the PCL-5 is a psychometrically sound instrument that deserves further evaluation as a screening tool for parents of children with burns.

  • 22.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Psychometric Properties of the Swedish Version of the PTSD Checklist for DSM-5 (PCL-5): Sensitivity, Specificity, Diagnostic Accuracy and Structural Validity in a Mixed Trauma Sample2020In: Article in journal (Refereed)
  • 23.
    Breedh, Julia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Comasco: Neuropsychopharmacology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Comasco, Erika
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Comasco: Neuropsychopharmacology.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Hypothalamic-pituitary-adrenal axis responsiveness, startle response, and sensorimotor gating in late pregnancy2019In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 106, p. 1-8Article in journal (Refereed)
    Abstract [en]

    During pregnancy, the hypothalamic-pituitary-adrenal (HPA) axis, the main regulator of the stress response, undergoes dramatic changes. The acoustic startle response (ASR) and the prepulse inhibition (PPI) of the startle response are neurophysiological research tools and objective measures of an individual's response to an emotional context or stressor. The ASR and PPI are influenced by psychiatric diseases characterized by anxiety symptoms and are sensitive to cortisol. Hence, the ASR and the PPI can be used to investigate the effects of pregnancy-induced endocrine changes and their contribution to affective disorders. The present study sought to investigate the association between measures of HPA-axis responsiveness, startle reactivity and sensorimotor gating during pregnancy that to date remains unknown. The eye-blink component of the ASR, and its prepulse inhibition, were measured in 107 late third trimester pregnant women. Saliva samples were collected to assess the cortisol awakening response (CAR), a measure of HPA-axis activity. Blood was sampled to measure serum levels of cortisol, cortisone and the cortisone to cortisol ratio. Ongoing anxiety disorders, sleep duration, smoking, and age were considered as potential confounders in the statistical analyses. CAR reactivity, measured as area under the curve (AUC) increase and above baseline, was positively associated with baseline startle magnitude [Cohen's d = 0.27; F (1, 105) = 4.99; p = 0.028, and Cohen's d = 0.30; F (1, 105) = 6.25; p = 0.014, respectively] as well as PPI at 86 dB [Cohen's d = 0.29; F (1, 105) = 5.93; p = 0.017; and Cohen's d = 0.34; F (1, 105) = 8.38; p = 0.005, respectively]. The observed positive correlation between startle magnitude in pregnant women and greater increase in cortisol during the awakening response may be interpreted as heightened neurophysiological reactivity, likely associated with dysregulation of the stress system.

  • 24.
    Brenner, Philip
    et al.
    Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Brandt, Lena
    Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Li, Gang
    Janssen Res & Dev LLC, Titusville, NJ USA.
    DiBernardo, Allitia
    Janssen Res & Dev LLC, Titusville, NJ USA.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Reutfors, Johan
    Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Substance use disorders and risk for treatment resistant depression: a population-based, nested case-control study2020In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 4, p. 768-777Article in journal (Refereed)
    Abstract [en]

    Background and aims: Treatment-resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD.

    Design: Nested case-control study.

    Setting: Nation-wide governmental health-care registers in Sweden.

    Cases and controls: Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121 669) from 2006 to 2014. Of these, 15 631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio-demographic data with five controls with depression.

    Measurements: Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio-demographic covariates.

    Findings: Having any SUD during, or <= 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [<= 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70-2.05]. Increased risks for TRD were found <= 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88-2.99), opioids (aOR = 2.02; 1.48-2.75), alcohol (aOR = 1.77; CI = 1.59-1.98) and combined substance use (aOR = 2.31; 1.87-2.99).

    Conclusions: Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression.

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  • 25.
    Brenner, Philip
    et al.
    Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Brandt, Lena
    Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Li, Gang
    Janssen Res & Dev LLC, Titusville, NJ USA.
    DiBernardo, Allitia
    Janssen Res & Dev LLC, Titusville, NJ USA.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Reutfors, Johan
    Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Treatment-resistant depression as risk factor for substance use disorders: a nation-wide register-based cohort study2019In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 114, no 7, p. 1274-1282Article in journal (Refereed)
    Abstract [en]

    Background and aims Treatment-resistant depression (TRD) is common among patients with major depressive disorder (MDD). MDD may increase the risk for developing substance use disorders (SUD). The aim of this study was to investigate the risk for developing SUD among patients with TRD compared with other depressed patients.

    Design Observational cohort study.

    Setting Nation-wide governmental health registers in Sweden.

    Participants All patients aged 18-69 years with an MDD diagnosis in specialized health care who had received at least one antidepressant prescription during 2006-14 were identified. Patients with at least three treatment trials within a single depressive episode were classified with TRD.

    Measurements Patients with TRD were compared with the whole MDD cohort regarding risk for obtaining a SUD diagnosis or medication using survival analyses adjusted for socio-demographics and comorbidities.

    Findings Of 121 669 MDD patients, 13% were classified with TRD. Among the patients without any history of SUD, patients with TRD had a risk increase for any SUD both ≤ 1 and > 1 year after antidepressant initiation [> 1 year hazard ratio (HR) = 1.4; 95% confidence interval (CI) = 1.3-1.5]. Risks were elevated for the subcategories of opioid (HR = 1.9, 95% CI = 1.4-2.5) and sedative SUD (HR = 2.7, 95% CI = 2.2-3.2). Patients with a history of SUD had a risk increase for any SUD ≤ 1 year after start of treatment (HR = 1.2, 95% CI = 1.1-1.4), and both ≤ 1 year and > 1 year for sedative (> 1 year HR = 2.0, 95% CI = 1.3-3.0) and multiple substance SUD (HR = 1.9, 95% CI = 1.4-2.5).

    Conclusions Patients with treatment-resistant depression may be at greater risk for substance use disorders compared with other patients with major depressive disorder. Patterns may differ for patients with and without a history of substance use disorders, and for different categories of substance use disorder.

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  • 26.
    Bränn, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Karolinska Institutet, Stockholm, Sweden.
    White, Richard A.
    Norwegian Institute of Public Health, Oslo, Norway.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Edvinsson, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Kamali-Moghaddam, Masood
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular tools. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Cunningham, Janet L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Inflammatory markers in women with postpartum depressive symptoms2020In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547, Vol. 98, no 7, p. 1309-1321Article in journal (Refereed)
    Abstract [en]

    Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

  • 27.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Fogelberg, Jonathan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Gabrielsson, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Lindberg, Mikaela
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) - A pilot testing of the tool.2020In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 41, no 6, p. 790-803Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the test-retest reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) developed to measure nursing staff perceived behaviours and barriers for promotion of everyday activities in nursing home residents.

    METHOD: Nursing staff completed the MAINtAIN(S) questionnaire on two occasions at 3-week intervals. Relative reliability, absolute reliability and internal consistency with Cronbach's alpha were calculated.

    RESULTS: The test--retest reliability of MAINtAIN(S)-behaviours subscales ranged from ICC2. = 0.78--0.91 and MAINtAIN(S)-barriers subscales from ICC2.1 = 0.60--0.84. Cronbach's alpha varied between 0.60 and 0.91 for the different subscales. The MAINtAIN(S) inventory shows acceptable reliability and internal consistency. MAINtAIN(S) seems to be a promising tool for identifying behaviours and barriers in promoting everyday activities in nursing home residents and can be used to develop ward specific interventions for promotion of daily physical activity level in the care of older adults.

  • 28.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Huddinge, Sweden.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Identifying the Needs of Family Members in Burn Care: Nurses' Different Approaches2019In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 40, no 3, p. 336-340Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore how nurses in burn care identify family members' needs of support and what support the nurses offer. Family members are an important source of short- and long-term support for burn survivors. Being a family member in burn specific as well as general care can be challenging in several ways. Nurses are recognized as well as positioned in the team for assessing and providing such support; however, little is known about how this is done. This is an explorative study with a qualitative descriptive design. Fourteen semistructured interviews with registered nurses working in national burn centers were recorded digitally, transcribed verbatim, and analyzed using Systematic text condensation. The analysis resulted in four themes reflecting different approaches to assess the needs of family members: Active, Emotional, Passive, and Rejective Approach. Nurses in this study demonstrated different approaches to assessing needs in family members; it is possible that these differences may affect what support family members receive. Therefore, the importance of theoretical education, professional views, and local ward culture should be highlighted in ongoing work in improving care within burn care as well as similar health care contexts.

  • 29.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sylvén, Sara M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Wahlström Eriksson, Helena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Centre for Gender Research.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Breastfeeding as a balancing act: pregnant Swedish women’s voices on breastfeeding2020In: International Breastfeeding Journal, E-ISSN 1746-4358, Vol. 15, article id 16Article in journal (Refereed)
    Abstract [en]

    Background: Breastfeeding provides health benefits to both women and children. The rationale behind an individual woman's decision to breastfeed or not can depend on several factors, either independently or in combination. The aim of the current study was to explore attitudes towards breastfeeding among pregnant women in Sweden who intend to breastfeed.

    Methods: Eleven mothers-to-be, one of whom had previous breastfeeding experience, participated in the study. The women were interviewed either by telephone or face-to-face during late pregnancy, with the aim of exploring their attitudes towards breastfeeding. A semi-structured interview-guide was used, and the transcripts of the interviews were analyzed using thematic analysis. The social ecological model of health is the theory-based framework underpinning this study. The model provides a comprehensive approach to understanding the factors that influence breastfeeding intention.

    Results: When interviewed during pregnancy, women described breastfeeding as a balancing act between societal norms and personal desires. The women perceived a societal pressure to breastfeed, however it was accompanied by boundaries and mixed messages. This perceived pressure was balanced by their own knowledge of breastfeeding, in particular their knowledge of other women's experience of breastfeeding. When envisioning their future breastfeeding, the women made uncertain and preliminary plans, and negotiated the benefits and drawbacks of breastfeeding. There was a wish for individual breastfeeding support and information.

    Conclusions: Pregnant Swedish women perceive their future breastfeeding as a balancing act between societal norms and personal desires. These findings suggest that while discussing breastfeeding during pregnancy, it could be of interest to collect information from pregnant women on their knowledge of breastfeeding and from where they have gained this knowledge, since stories from family and friends may make them question their own capacity to breastfeed. A thorough review of the woman's experiences and attitudes of breastfeeding is important in order to offer the best evidence-based breastfeeding support.

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  • 30.
    Chen, Lingjing
    et al.
    Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Björkenstam, Emma
    Karolinska Institutet.
    Rahman, Syed
    Karolinska Institutet.
    Gustafsson, Klas
    Karolinska Institutet.
    Taipale, Heidi
    Karolinska Institutet.
    Tanskanen, Antti
    Karolinska Institutet.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Helgesson, Magnus
    Karolinska Institutet.
    Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood.2022In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 26, no 5, p. 723-734, article id 10870547211025605Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden.

    METHOD: In total, 9718 individuals diagnosed with incident ADHD in young adult age (19-29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders.

    RESULTS: Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39-1.71); low educational level (HR = 1.97; 95%CI 1.60-2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35-2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17-2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66-2.80), autism (HR = 1.87; 95%CI 1.42-2.46), anxiety (HR = 1.34; 95%CI 1.22-1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women.

    CONCLUSION: Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.

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  • 31.
    Cheng, Siwei
    et al.
    NYU, Sociol, New York, NY 10003 USA..
    Kosidou, Kyriaki
    Karolinska Inst, Ctr Epidemiol & Community Med Reg Stockholm, Stockholm, Sweden.;Karolinska Inst, Dept Global Hlth, Stockholm, Sweden..
    Burström, Bo
    Karolinska Inst, Dept Publ Hlth Sci, Social Med, Stockholm, Sweden..
    Björkenstam, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Pebley, Anne R.
    Karolinska Inst, Stockholm, Sweden..
    Björkenstam, Emma
    Karolinska Inst, Dept Clin Neurosci, Epidemiol, Stockholm, Sweden..
    Precarious Childhoods: Childhood Family Income Volatility and Mental Health in Early Adulthood2020In: Social Forces, ISSN 0037-7732, E-ISSN 1534-7605, Vol. 99, no 2, p. 672-699Article in journal (Refereed)
    Abstract [en]

    The rise of income volatility in western countries has been extensively documented in the literature, but empirical research has just started to examine how childhood exposure to family income volatility affects subsequent wellbeing. This study takes advantage of several nation-wide, population registers from Sweden with linkages within and across generations to examine the intergenerational impact of childhood family income volatility on psychiatric disorders in early adulthood. In addition to the population-average effects, we also examine the heterogeneity in the impact of family income volatility for families at the top, bottom, and middle of the family income distribution. Our results suggest that after controlling for a set of family- and child-level characteristics, childhood family income volatility has a negative effect on mental wellbeing, and this finding is consistent across a range of psychiatric outcomes. Furthermore, we show that while children from low-income families exhibit the greatest likelihood of psychiatric disorder, children from families in the middle of the income distribution experience the greatest negative impact of income volatility.

  • 32.
    Clapham, Eric
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ, Dept Neurosci, Psychiat, Ing 10,Van 3, SE-75185 Uppsala, Sweden;Karolinska Inst, Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Dept Med Solna, Stockholm, Sweden.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala Univ, Dept Neurosci, Psychiat, Ing 10,Van 3, SE-75185 Uppsala, Sweden;Karolinska Inst, Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Dept Med Solna, Stockholm, Sweden.
    Brandt, Lena
    Karolinska Inst, Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Dept Med Solna, Stockholm, Sweden.
    Jonsson, Erik G.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Univ Oslo, KG Jebsen Ctr Psychosis Res, NORMENT, Inst Clin Med,Psychiat Sect, Oslo, Norway.
    Bahmanyar, Shahram
    Karolinska Inst, Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Dept Med Solna, Stockholm, Sweden.
    Ekbom, Anders
    Karolinska Inst, Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Dept Med Solna, Stockholm, Sweden.
    Osby, Urban
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden.
    Reutfors, Johan
    Karolinska Inst, Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Dept Med Solna, Stockholm, Sweden.
    Suicide Ideation and Behavior as Risk Factors for Subsequent Suicide in Schizophrenia: A Nested Case-Control Study2019In: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 49, no 4, p. 996-1005Article in journal (Refereed)
    Abstract [en]

    Objective To investigate suicide ideation and behavior as risk factors for suicide in schizophrenia during varying time periods. Method Cases were 84 patients who died by suicide within 5 years from diagnosis in a source population of patients discharged for the first time from psychiatric hospitals in Stockholm County, Sweden, with a schizophrenia spectrum diagnosis. One control was individually matched with each suicide case. Data were retrieved from clinical records in a blind fashion. Thoughts of death, thoughts of suicide, suicide plan, and suicide attempt during varying time periods were investigated as risk factors for subsequent completed suicide. Results In adjusted analyses, thoughts of suicide, suicide plan, and suicide attempt were significantly associated with subsequent completed suicide in the following year. The highest suicide risk was found within a year following suicide attempt (adjusted OR 9.9, 95% confidence interval 2.5-39.0). The association between suicide ideation and behavior and subsequent suicide declined over time. Conclusions Several types of suicide ideation and behavior were associated with suicide, and the association was stronger for suicidal behavior. The clinical significance of suicidal communication appears highest during the following month or/and year. Many suicides occurred without recorded short-term suicidal communication.

  • 33.
    Clapham, Eric
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Karolinska Inst, Dept Med Solna, Solna, Sweden.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Karolinska Inst, Dept Med Solna, Solna, Sweden.
    Reutfors, J.
    Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Karolinska Inst, Dept Med Solna, Solna, Sweden.
    Svensson, T.
    Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Karolinska Inst, Dept Med Solna, Solna, Sweden.
    Ramcharran, D.
    Janssen Global Res & Dev Epidemiol, Titusville, NJ USA.
    Qiu, H.
    Janssen Global Res & Dev Epidemiol, Titusville, NJ USA.
    Kileer, H.
    Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Karolinska Inst, Dept Med Solna, Solna, Sweden.
    Bahmanyar, S.
    Karolinska Univ Hosp, Ctr Pharmacoepidemiol CPE, Karolinska Inst, Dept Med Solna, Solna, Sweden.
    Exposure to risperidone versus other antipsychotics and risk of osteoporosis-related fractures: a population-based study2020In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 141, no 1, p. 74-83Article in journal (Refereed)
    Abstract [en]

    Objective Antipsychotics may increase serum prolactin, which has particularly been observed with risperidone. Further, hyperprolactinemia has been linked to osteoporosis-related fractures. Therefore, we investigated fracture risk in a nationwide cohort exposed to antipsychotics. Methods Swedish registers were used to identify adults with two consecutive dispensations of risperidone (n = 38 211), other atypical antipsychotics not including paliperidone (n = 60 691), or typical antipsychotics (n = 17 445) within three months between 2006 and 2013. An osteoporosis-related fracture was defined as a non-open hip/femur fracture in primary analyses. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Risperidone users were on average older (mean age of 68, 44, and 63 years for risperidone, other atypical antipsychotics, and typical antipsychotics respectively). Compared with other atypical antipsychotics, there was no association between risperidone and osteoporosis-related fractures in the overall (HR = 1.04, CI: 0.91-1.19) or age-stratified analyses. A significantly increased risk of typical antipsychotics (HR = 1.24, CI: 1.07-1.45) compared with other atypical antipsychotics remained for ages >45 years. Conclusion Risperidone does not appear to be associated with an increased risk of osteoporosis-related fracture compared with other atypical antipsychotic agents as a group. For typical antipsychotics, a moderately elevated risk of hip fractures was noted compared with other atypical antipsychotics, possibly because of residual confounding.

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  • 34.
    Costache, Mădălina Elena
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Frick, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Månsson, Kristoffer
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, United Kingdom; Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.
    Engman, Jonas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Faria, Vanda
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Center for Pain and The Brain, Department of Anesthesiology, Harvard Medical School, Boston Children’s Hospital, Perioperative and Pain Medicine, Boston, MA, United States of America; Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany.
    Hjorth, Olof
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Hoppe, Johanna M.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Gingnell, Malin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Björkstrand, Johannes
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Psychology, Lund University, Lund, Sweden.
    Rosén, Jörgen
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Alaie, Iman
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Åhs, Fredrik
    Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden.
    Linnman, Clas
    Harvard Med Sch, Spaulding Rehabil Hosp, Boston, MA 02115 USA.
    Wahlstedt, Kurt
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Tillfors, Maria
    Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden .
    Marteinsdottir, Ina
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden .
    Fredrikson, Mats
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Furmark, Tomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Higher- and lower-order personality traits and cluster subtypes in social anxiety disorder2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 4, article id e0232187Article in journal (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD) can come in different forms, presenting problems for diagnostic classification. Here, we examined personality traits in a large sample of patients (N = 265) diagnosed with SAD in comparison to healthy controls (N = 164) by use of the Revised NEO Personality Inventory (NEO-PI-R) and Karolinska Scales of Personality (KSP). In addition, we identified subtypes of SAD based on cluster analysis of the NEO-PI-R Big Five personality dimensions. Significant group differences in personality traits between patients and controls were noted on all Big Five dimensions except agreeableness. Group differences were further noted on most lower-order facets of NEO-PI-R, and nearly all KSP variables. A logistic regression analysis showed, however, that only neuroticism and extraversion remained significant independent predictors of patient/control group when controlling for the effects of the other Big Five dimensions. Also, only neuroticism and extraversion yielded large effect sizes when SAD patients were compared to Swedish normative data for the NEO-PI-R. A two-step cluster analysis resulted in three separate clusters labelled Prototypical (33%), Introvert-Conscientious (29%), and Instable-Open (38%) SAD. Individuals in the Prototypical cluster deviated most on the Big Five dimensions and they were at the most severe end in profile analyses of social anxiety, self-rated fear during public speaking, trait anxiety, and anxiety-related KSP variables. While additional studies are needed to determine if personality subtypes in SAD differ in etiological and treatment-related factors, the present results demonstrate considerable personality heterogeneity in socially anxious individuals, further underscoring that SAD is a multidimensional disorder.

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  • 35.
    Cunningham, Janet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Bramstång, Ludvig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Singh, Abhijeet
    Swedish Univ Agr Sci, BioCentrum, Dept Mol Sci, Uppsala, Sweden..
    Jayarathna, Shishanthi
    Swedish Univ Agr Sci, BioCentrum, Dept Mol Sci, Uppsala, Sweden..
    Rasmusson, Annica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Moazzami, Ali
    Swedish Univ Agr Sci, BioCentrum, Dept Mol Sci, Uppsala, Sweden..
    Mueller, Bettina
    Swedish Univ Agr Sci, BioCentrum, Dept Mol Sci, Uppsala, Sweden..
    Impact of time and temperature on gut microbiota and SCFA composition in stool samples2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 8, article id e0236944Article in journal (Refereed)
    Abstract [en]

    Gut dysbiosis has been implicated in the pathophysiology of a growing number of non-communicable diseases. High through-put sequencing technologies and short chain fatty acid (SCFA) profiling enables surveying of the composition and function of the gut microbiota and provide key insights into host-microbiome interactions. However, a methodological problem with analyzing stool samples is that samples are treated and stored differently prior to submission for analysis potentially influencing the composition of the microbiota and its metabolites. In the present study, we simulated the sample acquisition of a large-scale study, in which stool samples were stored for up to two days in the fridge or at room temperature before being handed over to the hospital. To assess the influence of time and temperature on the microbial community and on SCFA composition in a controlled experimental setting, the stool samples of 10 individuals were exposed to room and fridge temperatures for 24 and 48 hours, respectively, and analyzed using 16S rRNA gene amplicon sequencing, qPCR and nuclear magnetic resonance spectroscopy. To best of our knowledge, this is the first study to investigate the influence of storage time and temperature on the absolute abundance of methanogens, and ofLactobacillus reuteri. The results indicate that values obtained for methanogens,L.reuteriand total bacteria are still representative even after storage for up to 48 hours at RT (20 degrees C) or 4 degrees C. The overall microbial composition and structure appeared to be influenced more by laboratory errors introduced during sample processing than by the actual effects of temperature and time. Although microbial activity was demonstrated by elevated SCFA at both 4 degrees C and RT, SCFAs ratios were more stable over the different conditions and may be considered as long as samples are come from similar storage conditions.

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  • 36.
    de Montgomery, Christopher Jamil
    et al.
    Univ Copenhagen, Danish Res Ctr Migrat Ethnic & Hlth, Dept Publ Hlth, Copenhagen K, Denmark.;Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Norredam, Marie
    Univ Copenhagen, Danish Res Ctr Migrat Ethnic & Hlth, Dept Publ Hlth, Copenhagen K, Denmark.;Univ Hosp Hvidovre, Dept Infect Dis, Sect Immigrant Med, Copenhagen, Denmark..
    Krasnik, Allan
    Univ Copenhagen, Danish Res Ctr Migrat Ethnic & Hlth, Dept Publ Hlth, Copenhagen K, Denmark..
    Petersen, Jorgen Holm
    Univ Copenhagen, Dept Biostat, Copenhagen, Denmark..
    Bjorkenstam, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden..
    Berg, Lisa
    Stockholm Univ, Ctr Hlth Equ Studies, Stockholm, Sweden..
    Hjern, Anders
    Stockholm Univ, Ctr Hlth Equ Studies, Stockholm, Sweden..
    Sijbrandij, Marit
    Vrije Univ Amsterdam, Collaborating Ctr Res & Disseminat Psychol Interv, Amsterdam Publ Hlth Res Inst, Dept Clin Neuro & Dev Psychol,WHO, Amsterdam, Netherlands..
    Klimek, Peter
    Med Univ Vienna, CeMSIIS, Sect Sci Complex Syst, Vienna, Austria.;Complex Sci Hub Vienna, Vienna, Austria..
    Mittendorfer-Rutz, Ellenor
    Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Stockholm, Sweden.;Med Univ Vienna, CeMSIIS, Sect Sci Complex Syst, Vienna, Austria..
    Labour market marginalisation in young refugees and their majority peers in Denmark and Sweden: The role of common mental disorders and secondary school completion2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263450Article in journal (Refereed)
    Abstract [en]

    Background Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions. Methods Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012-2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics. Results The risk of marginalisation was 2.1-2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77-85% of associations eliminated). Conclusions The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.

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  • 37.
    Deogan, Charlotte
    et al.
    Publ Hlth Agcy Sweden, Solna, Sweden; Karolinska Inst, Div Global Hlth, Dept Publ Hlth Sci, Stockholm, Sweden..
    Jacobsson, Elin
    Publ Hlth Agcy Sweden, Solna, Sweden..
    Mannheimer, Louise
    Publ Hlth Agcy Sweden, Solna, Sweden; Karolinska Inst, Div Learning Informat Management & Eth, Dept Publ Hlth Sci, Stockholm, Sweden..
    Björkenstam, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Publ Hlth Agcy Sweden, Solna, Sweden..
    Meeting sexual partners online and associations with sexual risk behaviors in the Swedish population2020In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 17, no 11, p. 2141-2147Article in journal (Refereed)
    Abstract [en]

    Background: Online arenas may facilitate sexual encounters. However, to what extent finding sexual partners online is associated with sexual risk behavior and sexual health outcomes is still not fully explored. Methods: A stratified randomized population based study on sexual and reproductive health and rights of 50,000 Swedes was conducted in 2017. The final sample consisted of 14,537 women and men aged 16-84 years. We identified sexual health factors associated with finding sexual partners online and estimated prevalences thereof. Results: Having used the internet to meet sexual partners was reported by 11% (95% confidence interval: 10.1-12.3) of men and 7% (95% confidence interval: 6.0-7.4) of women and was most common among men aged 30-44 years (13.7%). After adjustment, those reporting a non-heterosexual identity were most likely to meet sexual partners online. Meeting sexual partners online was also associated with reporting several sexual risk behaviors: condomless sex with temporary partner during the past 12 months, adjusted odds ratio (AOR): 5.1 (3.8-6.8) for women and AOR: 6.0 (4.5-7.9) for men, and having had a test for sexually transmitted infections (STIs) generated a 4-fold AOR for both sexes, STI diagnosis showed a 2-fold AOR, ever having paid or given other compensation for sex AOR: 4.8 (2.7-8.8) for women and AOR: 4.2 (2.9-6.1) for men as well as ever having received money or other compensation for sex AOR: 4.0 (1.3-11.9) for women and AOR: 6.0 (2.4-15.1) for men. Clinical translation: Meeting sexual partners online was associated with sexual risk behaviors, which is of importance in tailoring sexual health interventions and STI/HIV-control activities. Strengths and limitations: Few studies of online sexual behaviors are based on population-based surveys of the general population with results stratified by sexual identity. However, the use of lifetime prevalence of ever having used the internet, smartphone, or app to meet sexual partners has limitations. Conclusion: Meeting sexual partners online was associated with sexual risk behaviors in a randomized sample of the Swedish population, which is of importance to tailoring sexual health interventions. Copyright (C) 2020, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.

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  • 38.
    Ekselius, Lisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Cervenka: Psychiatry.
    Lindström, E
    von Knorring, L
    Bodlund, O
    Kullgren, G
    Personality disorders in DSM-III-R as categorical or dimensional.1993In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 88, no 3, p. 183-7Article in journal (Refereed)
    Abstract [en]

    Despite the atheoretical approach of the DSM-III-R, the personality disorders have their roots in specific theoretical schools. Due to clinical tradition, analogies with Axis I and the tradition in psychiatry and medicine, the personality disorders are presented as categories although there is more empirical support for a dimensional approach. This study attempted to determine whether the separate personality disorders meet Kendell's criteria for distinct entities, i.e., bimodality with distinct points of rarity. None of the personality disorders met t