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Purpose: The study aimed to (1) explore nursing staff attitudes towards evidence-based practice in conjunction with implementation of Steps Towards Recovery, and (2) describe nurses' and nurse managers' experiences of working with Steps Towards Recovery, as an example of evidence-based practice.

Materials and methods: The study was carried out in two parts. Part 1 incorporated quantitative questionnaire data using descriptive, non-parametric statistical analyses. Part 2 incorporated qualitative data, from both individual and focus group interviews, using qualitative content analysis and focus group data analysis.

Results: In part 1, positive attitudes were reported. Openness to evidence-based practice was significantly higher after implementation. In part 2, the nursing programme was found to be seen as an important contribution to nursing in psychiatric in-patient care. Evidence-based practice was seen as important but insufficiently used.

Conclusion: Integrating results from nursing research into daily nursing work is described as challenging in psychiatric in-patient care. There is a need to illuminate the gap between theory and practice to achieve evidence-based nursing. Nurses' professional role and responsibility for the development and improvement of nursing are crucial in doing so and must be addressed in nursing education, by nurses themselves, as well as by managers at all levels of health care.

Background: A small proportion of patients account for a disproportionate use of emergency healthcare services and exhibit an increased mortality. This group includes individuals with different conditions and risk-taking behaviors. Among them are persons diagnosed with personality disorders, who are particularly susceptible to injuries and intoxications-factors that contribute to an increased risk of premature death, especially from unnatural causes.. In this study in women with a personality disorder diagnosis, we hypothesized that the number of inpatient episodes due to injuries or intoxications would be independently related to the mortality risk for both natural and unnatural causes.

Methods: A cohort of all women who received a personality disorder diagnosis in the Swedish National Patient Register during the years 1997-2015 (n = 44,221) was followed up until December 31, 2015. All inpatient treatment periods with diagnoses of injuries or intoxications were documented. Information on all deaths was obtained from The Swedish Cause of Death Register.

Results: Multivariable Cox proportional hazards regressions, adjusted for relevant confounders revealed that the number of inpatient care episodes due to injuries or intoxications was independently related to later all-cause mortality, as well as mortality from unnatural and natural causes, and suicidal actions.

Conclusions: The results motivate particular attention to women with recurrent injuries or intoxications with an assessment of the need for non-emergent measures to decrease the risk of early death, including suicide.

Background

This study aimed to examine: (a) characteristics associated with long-term opioid use and (b) characteristics associated with problematic opioid use, here defined as prescription opioid use disorder (P-OUD), in patients referred to specialised pain care.

Methods

This cross-sectional study utilised baseline data from a clinical chronic pain cohort. Eligible participants included adults > 18 years old, not undergoing cancer treatment, had pain > 3 months, and had been referred to a specialised pain care centre in Sweden. Bivariate logistic regression and multivariable logistic regression with forward selection were used to examine the associations between biopsychosocial variables and either long-term opioid use or P-OUD.

Results

Of the 339 patients included, 194 (57%) were using opioids, 159 (47%) had long-term opioid use (> 90 days), and 34 (21% of those with long-term opioid use) had P-OUD. Longer pain duration, unemployment, more pain catastrophising, lower health-related quality of life, and worse balance increased the likelihood of long-term opioid use. Long-term use of high doses was associated with a greater prevalence of psychiatric and cognitive-behavioural problems compared to long-term use at low to moderate doses. Long-term opioid use, younger age, trauma exposure, more pain catastrophising, and fear of movement increased the likelihood of P-OUD.

Conclusions

Our results demonstrate the importance of identifying and treating salient factors that may sustain both the pain condition and long-term opioid use. Many of the biopsychosocial variables associated with long-term opioid use and P-OUD can be addressed within interdisciplinary pain management and rehabilitation programmes.

Significance

This study is part of the U-PAIN cohort study on a clinical sample from a highly specialised pain centre in Sweden. It is based on a deep and thorough characterisation of patients referred to the clinic to evaluate risks and benefits of opioid therapy in chronic pain. It adds valuable information on the complexity of opioid therapy in chronic pain; the results highlight the need for interdisciplinary multimodal evaluation and treatment.

Background: This study aimed to examine: (a) characteristics associated with long-term opioid use and (b) characteristics associated with problematic opioid use, here defined as prescription opioid use disorder (P-OUD), in patients referred to specialised pain care.

Methods: This cross-sectional study utilised baseline data from a clinical chronic pain cohort. Eligible participants included adults > 18 years old, not undergoing cancer treatment, had pain > 3 months, and had been referred to a specialised pain care centre in Sweden. Bivariate logistic regression and multivariable logistic regression with forward selection were used to examine the associations between biopsychosocial variables and either long-term opioid use or P-OUD.

Results: Of the 339 patients included, 194 (57%) were using opioids, 159 (47%) had long-term opioid use (> 90 days), and 34 (21% of those with long-term opioid use) had P-OUD. Longer pain duration, unemployment, more pain catastrophising, lower health-related quality of life, and worse balance increased the likelihood of long-term opioid use. Long-term use of high doses was associated with a greater prevalence of psychiatric and cognitive-behavioural problems compared to long-term use at low to moderate doses. Long-term opioid use, younger age, trauma exposure, more pain catastrophising, and fear of movement increased the likelihood of P-OUD.

Conclusions: Our results demonstrate the importance of identifying and treating salient factors that may sustain both the pain condition and long-term opioid use. Many of the biopsychosocial variables associated with long-term opioid use and P-OUD can be addressed within interdisciplinary pain management and rehabilitation programmes.

Background

Insecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses.

Methods

K-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD.

Results

Three distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses.

Conclusions

The three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Background: The Swedish Universities Scales of Personality (SSP) is a personality measurement tool with a short test battery of high psychometric quality, previously not availiable in Japanese.

Methods: We translated the SSP into Japanese and administered it to 103 Japanese nationals. For 11 of the 13 SSP scales in the Japanese version of the SSP (SSP-J11), the Cronbach’s alpha ranged from 0.50 to 0.82 with good internal scale reliability.

Results: A principal factor analysis replicated the previous work by identifying the same three principal dimensions of Neuroticism, Aggression, and Extraversion factors.

Conclusion: The resulting three-factor SSP-J11 shows acceptable reliability and should provide informative insights about personality traits in research and clinical practice in a Japanese context.

Importance  Individuals with attention-deficit/hyperactivity disorder (ADHD) often have comorbid psychiatric conditions. Relatively little is known about how specific ADHD medications are associated with overall treatment outcomes among these patients.

Objective  To investigate the association of the use of specific ADHD medications with hospitalization outcomes and work disability among adolescents and adults with ADHD.

Design, Setting, and Participants  This nationwide register-based cohort study identified individuals (aged 16-65 years) with ADHD from Swedish nationwide registers of inpatient health care, specialized outpatient health care, sickness absence, and disability pension during the years 2006 to 2021. Data analysis was performed from November 2022 to August 2023.

Exposure  Use of specific ADHD medications.

Main Outcomes and Measures  The main outcome measure was psychiatric hospitalization, and secondary outcomes were suicide attempt and/or death by suicide, nonpsychiatric hospitalization, and work disability (ie, sickness absence or disability pension). The risk of outcomes between use vs nonuse periods of ADHD medications was compared in a within-individual design, where a person acts as their own control, and was analyzed with stratified Cox models.

Results  A total of 221 714 persons with ADHD were included in the study cohort (mean [SD] age, 25.0 [11.2] years; 120 968 male individuals [54.6%]). Methylphenidate was the most commonly used ADHD medication (151 837 individuals [68.5%]), followed by lisdexamphetamine (78 106 individuals [35.2%]) during the follow-up (mean [SD], 7.0 [4.7] years). The following medications were associated with a decreased risk of psychiatric hospitalization: amphetamine (adjusted hazard ratio [aHR], 0.74; 95% CI, 0.61-0.90), lisdexamphetamine (aHR, 0.80; 95% CI, 0.78-0.82), ADHD drug polytherapy (aHR, 0.85; 95% CI, 0.82-0.88), dexamphetamine (aHR, 0.88; 95% CI, 0.83-0.94), and methylphenidate (aHR, 0.93; 95% CI, 0.92-0.95). No associations were found for modafinil, atomoxetine, clonidine, and guanfacine. Decreased risk of suicidal behavior was associated with the use of dexamphetamine (aHR, 0.69; 95% CI, 0.53-0.89), lisdexamphetamine (aHR, 0.76; 95% CI, 0.68-0.84), and methylphenidate (aHR, 0.92; 95% CI, 0.86-0.98). None of the medications was associated with increased risk of nonpsychiatric hospitalization; instead, use of amphetamine, lisdexamphetamine, polytherapy, dexamphetamine, methylphenidate, and atomoxetine were associated with decreased risk of nonpsychiatric hospitalization. The results regarding work disability were significant only for the use of atomoxetine (aHR, 0.89; 95% CI, 0.82-0.97), especially among adolescents and young adults aged 16 to 29 years, (aHR, 0.82; 95% CI, 0.73-0.92).

Conclusions and Relevance  In this nationwide cohort study of adolescents and adults with ADHD, the use of ADHD medication was associated with fewer hospitalizations for both psychiatric and nonpsychiatric morbidity and lower suicidal behavior.

OBJECTIVE: This study aimed to explore factors influencing functioning in psychiatric outpatients, both separately and in combination. The primary objectives were to determine predictors of functioning, assess their significance in a combined analysis, and quantify their collective predictive power.

METHOD: A sample of 137 psychiatric outpatients diagnosed with bipolar disorder, borderline personality disorder, or attention deficit hyperactivity disorder (ADHD) participated in this cross-sectional study, undergoing semi-structured diagnostic interviews for psychiatric and personality disorders. Participants also completed assessments of current functioning, personality traits (temperament and character), attachment style, and childhood trauma. Linear regression models were employed to analyse the relationships between these factors and level of functioning.

RESULTS: The majority of temperament and character traits and attachment dimensions, as well as having a personality disorder, predicted impaired functioning, but comorbidity and childhood trauma did not. When all variables were taken into account in a multiple regression analysis, only the temperament and character traits Harm Avoidance and Self-directedness remained significantly predictive (p = .006 and .003, respectively). These two factors explain about one-third of the variance.

CONCLUSIONS: Personality traits-more specifically, the temperament trait Harm Avoidance and the character trait Self-directedness-are strong predictors of functioning among psychiatric outpatients. Interestingly, when accounting for these factors, traditionally associated variables, such as attachment, comorbidity, and childhood trauma, lost their significance as predictors. These findings underscore the pivotal role of specific personality traits in understanding and predicting the functioning of psychiatric patients.

The aims were to investigate patterns of labour market integration following an adult diagnosis of attention-deficit/hyperactivity disorder (ADHD) and its relation to sociodemographic factors and comorbid disorders.MethodsMultiple Swedish nationwide registers were used to identify 8045 individuals, aged 20-29, with an incident diagnosis of ADHD 2006-2011. Labour market integration was conceptualized according to the core-peripheral model as a continuum from a strong (core) to a weak (peripheral) connection to the labour market. Sequence analyses categorized clusters of labour market integration, from 1 year before to 5 years after their ADHD diagnosis for individuals diagnosed with ADHD and a matched control group without ADHD. Multinomial logistic regression computed odds ratios (ORs) with 95% confidence intervals (CIs) between sociodemographic factors and comorbid disorders and the identified clusters. ResultsAbout one-fourth of the young adults diagnosed with ADHD belonged to clusters characterized by a transition to a mainly peripheral labour market position, which was approximately four-times higher compared to controls without ADHD. Foremost, those living in small cities/villages (OR 1.9; CI 1.5-2.2), those having comorbid autism-spectrum disorder (OR 13.7; CI 6.8-27.5) or schizophrenia/psychoses (OR 7.8; CI 3.8-15.9) were associated with a transition towards a peripheral labour market position throughout the study period. Those with a high educational level (OR 0.1; CI 0.1-0.1), and men (OR 0.7; CI 0.6-0.8) were less likely to have a peripheral labour market position. ConclusionsYoung adults diagnosed with ADHD are four-times more likely to be in the peripheral labour market position compared to those without ADHD. To increase labour market participation, special attention is warranted to those with low educational level, those living outside big cities and those with comorbid mental disorders.

Objectives This study aimed to examine the psychometric properties of a Swedish version of the Medical Outcomes Study Social Support Survey (MOS-SSS).

Methods Standard forward-backward translation was used. A cross-sectional survey was conducted among treatment seeking individuals with chronic pain included in a clinical cohort. Internal consistency was measured with Cronbach’s α, test-retest reliability was examined with intraclass correlation, confirmatory factor analyses was used for examining factor structure, and correlations between the MOS-SSS and selected health validity measures were used for testing concurrent validity hypotheses.

Results 182 participants were included in the study. Internal consistency measured with Cronbach’s alpha was acceptable for all subscales and for the total support index of the MOS-SSS. Test-retest reliability was moderate – good for the different subscales, and was good for the overall support index. The original four factor model of the MOS-SSS was confirmed, and the concurrent validity hypotheses were also confirmed; however, the associations were weaker than expected.

Conclusions The Swedish version of the MOS-SSS was found psychometrically sound and offers a systematic assessment of social support in specialized pain care.