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  • 1.
    Alexandersson, Kristina
    et al.
    Karolinska Institutet.
    Lumikukka, Tuula
    Karolinska universitetssjukhuset, Huddinge.
    Tinghög, Petter
    Karolinska Institutet.
    Åkerlund, Kerstin
    Karolinska universitetssjukhuset, Solna.
    Att uppmärksamma barn till svårt sjuka patienter på en neurologisk klinik - utvärdering av implementering av rutiner och arbetssätt2017Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, E-ISSN 2000-4192, Vol. 94, nr 4, s. 485-495Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Barn till allvarligt somatiskt sjuka föräldrar löper en förhöjd risk för egen psykisk ohälsa. Här presenteras resultat från utvärderingen av implementering av rutiner och arbetssätt som syftade till att förbättra arbetet med att identifiera, informera samt stödja minderåriga barn till patienter på en neurologisk klinik. Fyra delstudier genomfördes. Resultaten indikerar att trots betydande insatser för att säkerställa att kliniken lever upp till sina lagstadgade uppgifter, fanns en stor förbättringspotential. Hela 80% av patienter med minderåriga barn hade inte fått information om sina barns rätt till stöd och 40% hade inte tillräckligt stöd för att utöva sin föräldraroll. Samtidigt noterades en tydlig ökning i andelen personal på kliniken som hade kunskap om sin skyldighet att erbjuda information, råd och stöd. 

  • 2.
    Amin, M. Ridwanul
    et al.
    Karolinska Institutet.
    Helgesson, M.
    Karolinska Institutet.
    Runeson, B.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen.
    Mehlum, L.
    National Centre for Suicide Research and Prevention, Oslo, Norway.
    Holmes, E.
    Karolinska Institutet.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    The risk of suicidal behaviour in refugees and other immigrants to Sweden2018Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, nr Suppl. 4, s. 191-191Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Amin, R.
    et al.
    Karolinska Institutet, Sweden.
    Mittendorfer-Rutz, E.
    Karolinska Institutet, Sweden.
    Mehlum, L.
    University of Oslo, Norway.
    Runeson, B.
    Karolinska Institutet, Sweden.
    Helgesson, M.
    Karolinska Institutet, Sweden.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet, Sweden.
    Björkenstam, E.
    Karolinska Institutet, Sweden.
    Holmes, E. A.
    Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Qin, P.
    University of Oslo, Norway.
    Does country of resettlement influence the risk of suicide in refugees?: A case-control study in Sweden and Norway2021Ingår i: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 2045-7979, Vol. 30, artikel-id e62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. We aimed to investigate (1) the risk of suicide in refugees resident in Sweden and Norway, in general, and according to their sex, age, region/country of birth and duration of residence, compared with the risk of suicide in the respective majority host population; (2) if factors related to socio-demographics, labour market marginalisation (LMM) and healthcare use might explain the risk of suicide in refugees differently in host countries. Methods Using a nested case-control design, each case who died by suicide between the age of 18 and 64 years during 1998 and 2018 (17 572 and 9443 cases in Sweden and Norway, respectively) was matched with up to 20 controls from the general population, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Separate models were controlled for factors related to socio-demographics, previous LMM and healthcare use. Analyses were also stratified by sex and age groups, by refugees' region/country of birth and duration of residence in the host country. Results The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI 0.5-0.6) and 0.3 (95% CI 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age except for younger refugees aged 18-24 who did not have a statistically significant relative difference in suicide risk than their respective host country peers. Factors related to socio-demographics, LMM and healthcare use had only a marginal influence on the studied associations in both countries. Conclusions Refugees in Sweden and Norway had almost similar suicide mortality advantages compared with the Swedish-born and Norwegian-born population, respectively. These findings may suggest that resiliency and culture/religion-bound attitudes towards suicidal behaviour in refugees could be more influential for their suicide risk after resettlement than other post-migration environmental and structural factors in the host country.

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  • 4.
    Amin, Ridwanul
    et al.
    Karolinska Institutet.
    Helgesson, Magnus
    Karolinska Institutet.
    Runeson, Bo
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen.
    Mehlum, Lars
    University of Oslo, Oslo, Norway.
    Qin, Ping
    University of Oslo, Oslo, Norway.
    Holmes, Emily A
    Karolinska Institutet / Uppsala universitet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study2021Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 51, nr 2, s. 254-263Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations.

    METHODS: Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors.

    RESULTS: In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods.

    CONCLUSIONS: Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.

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  • 5.
    Amin, Ridwanul
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet.
    Rahman, Syed
    Department of Clinical Neuroscience, Karolinska Institutet.
    Helgesson, Magnus
    Department of Clinical Neuroscience, Karolinska Institutet.
    Björkenstam, Emma
    Department of Clinical Neuroscience, Karolinska Institutet.
    Runeson, Bo
    Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen.
    Mehlum, Lars
    National Centre for Suicide Research and Prevention, University of Oslo.
    Qin, Ping
    National Centre for Suicide Research and Prevention, University of Oslo.
    Mittendorfer-Rutz, Ellenor
    Department of Clinical Neuroscience, Karolinska Institutet.
    Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study2021Ingår i: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 20, nr 1, artikel-id 131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.

    METHODS: All 20-64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009-2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi2-tests and multinomial logistic regression.

    RESULTS: Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A 'low increasing' group comprised 5.9% of refugees (60-260 annual DDDs before and 510-685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110-190 DDDs) and high (630-765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees' trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.

    CONCLUSIONS: Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.

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  • 6.
    Amin, Ridwanul
    et al.
    Karolinska Institutet.
    Rahman, Syed
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen.
    Helgesson, Magnus
    Karolinska Institutet.
    Runeson, Bo
    S.t Göran's Hospital, Karolinska Institutet, Stockholm County Council.
    Björkenstam, Emma
    Karolinska Institutet.
    Qin, Ping
    University of Oslo, Oslo, Norway.
    Mehlum, Lars
    University of Oslo, Oslo, Norway.
    Holmes, Emily A
    Karolinska Institutet; Uppsala University.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Healthcare use before and after suicide attempt in refugees and Swedish-born individuals2021Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, nr 2, s. 325-338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: There is a lack of research on whether healthcare use before and after a suicide attempt differs between refugees and the host population. We aimed to investigate if the patterns of specialised (inpatient and specialised outpatient) psychiatric and somatic healthcare use, 3 years before and after a suicide attempt, differ between refugees and the Swedish-born individuals in Sweden. Additionally, we aimed to explore if specialised healthcare use differed among refugee suicide attempters according to their sex, age, education or receipt of disability pension.

    METHODS: All refugees and Swedish-born individuals, 20-64 years of age, treated for suicide attempt in specialised healthcare during 2004-2013 (n = 85,771 suicide attempters, of which 4.5% refugees) were followed 3 years before and after (Y - 3 to Y + 3) the index suicide attempt (t0) regarding their specialised healthcare use. Annual adjusted prevalence with 95% confidence intervals (CIs) of specialised healthcare use were assessed by generalized estimating equations (GEE). Additionally, in analyses among the refugees, GEE models were stratified by sex, age, educational level and disability pension.

    RESULTS: Compared to Swedish-born, refugees had lower prevalence rates of psychiatric and somatic healthcare use during the observation period. During Y + 1, 25% (95% CI 23-28%) refugees and 30% (95% CI 29-30%) Swedish-born used inpatient psychiatric healthcare. Among refugees, a higher specialised healthcare use was observed in disability pension recipients than non-recipients.

    CONCLUSION: Refugees used less specialised healthcare, before and after a suicide attempt, relative to the Swedish-born. Strengthened cultural competence among healthcare professionals and better health literacy among the refugees may improve healthcare access in refugees.

  • 7.
    Arwidson, Charlotta
    et al.
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet, Sweden.
    Holmgren, Jessica
    Mälardalen Universit, Sweden.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet, Sweden.
    Eriksson, Henrik
    University West, Sweden.
    Gottberg, Kristina
    Karolinska Institutet, Sweden.
    (Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden2024Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 24, nr 1, artikel-id 622Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The COVID-19 pandemic has made visible the scale of health disparities in society, highlighting how the distribution of infection and deaths differs between population subgroups within countries. Asylum seekers represent a potentially vulnerable group; early in the pandemic, concerns were raised about their housing situation, usually involving overcrowded, camp-like accommodations, and the effects of COVID-19 in relation to this. Hence, this study aimed to explore asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers. Methods: In this qualitative study, 14 semi-structured interviews were conducted with asylum seekers at two accommodation centers in Sweden. Participants represented a diverse group of asylum seekers in regard to age, educational background, and gender. Data were analyzed using qualitative content analysis. Results: Experiences related to COVID-19 were highly dependent on the living situation at the accommodation centers and the experience of feeling unsafe in shared spaces. This was enhanced by the experiences of a challenging mix of COVID-19 messages where different understandings of COVID-19 and related measures existed, together with a feeling of loss of control and safety in shared rooms. Additionally, participants felt more isolated from the outside society and missed prior social activities. Adding to this experience of isolation was an increasing mistrust regarding the authorities' pandemic response. Conclusion: This study highlights the importance of understanding the specific challenges and vulnerabilities of asylum seekers at accommodation centers during the pandemic, shaped by their housing situation and legal status. The findings underscore the need for context-specific support, holistic disease prevention approaches, and tailored health communication strategies using diverse formats. Additionally, the findings emphasize the crucial need to identify and mobilize existing community resources in planning and implementing pandemic control measures. Furthermore, the study emphasizes governmental responsibility in providing secure housing, and to address long-term vulnerabilities beyond pandemics.

  • 8.
    Björkenstam, B.
    et al.
    University of California Los Angeles, Los Angeles, CA USA / Karolinska Institutet / Stockholms universitet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet.
    Cochran, S.
    University of California Los Angeles, Los Angeles, CA USA.
    Andersson, G.
    University of California, Los Angeles, USA.
    Alexanderson, K.
    University of California, Los Angeles, USA / Karolinska Institutet.
    Bränström, R.
    Karolinska Institutet.
    Is work disability more common among same-sex than different-sex married people?2016Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr Suppl. 1, s. 305-Artikel i tidskrift (Övrigt vetenskapligt)
  • 9.
    Björkenstam, Charlotte
    et al.
    Division of Insurance Medicine, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Wiberg, Michael
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Heterogeneity of sickness absence and disability pension trajectories among individuals with MS2015Ingår i: Multiple Sclerosis Journal, Experimental, Translational and Clinical, E-ISSN 2055-2173, Vol. 1, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The variability of progression of multiple sclerosis (MS) suggests that MS is a heterogeneous entity.

    Objective The objective of this article is to determine whether sickness absence (SA) and disability pension (DP) could be used to identify groups of patients with different progression courses.

    Methods We analyzed mean-annual net months of SA/DP, five years prior to MS diagnosis, until the year of diagnosis, and five years after for 3543 individuals diagnosed 2003–2006, by modeling trajectory subgroups.

    Results Five different groups were identified, revealing substantial heterogeneity among MS patients. Before diagnosis, 74% had a flat trajectory, while the remaining had a sharply increasing degree of SA/DP. After diagnosis, 95% had a flat or marginally increasing trajectory, although at various SA/disability pension (DP) levels, whereas a small group of 5% had decreasing SA/DP. A majority had few or no SA/DP months throughout the 11-year study period. Higher age and a lower educational level were associated with an unfavorable trajectory (p values <0.01).

    Conclusions There’s a considerable heterogeneity of MS progression in terms of SA/DP. Compared with other measures of disability, sickness-absence and disability pension offer a continuous variable that can be assigned to every individual for each time period without missing data. To what extent the SA/DP measure reflects classical MS outcome-measures as well as how correlated it is with co-morbidities and working-conditions needs to be investigated further.

  • 10.
    Björkenstam, Charlotte
    et al.
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Brenner, Philip
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Jokinen, Jussi
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Is disability pension a risk indicator for future need of psychiatric healthcare or suicidal behavior among MS patients- a nationwide register study in Sweden?2015Ingår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 15, nr 1, s. 1-8, artikel-id 286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they also carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups.

    METHOD: A prospective population-based cohort study with six-year follow-up (2005-2010), including 11 346 MS patients who in 2004 were aged 16-64 and lived in Sweden. Incidence rate ratios (IRR) with 95 % confidence intervals (CI) were calculated.

    RESULTS: MS patients on DP had a modestly higher risk of requiring psychiatric healthcare, IRR: 1.36 (95 % CI: 1.18-1.58). MS patients with previous psychiatric healthcare had a higher IRR for both psychiatric healthcare and suicidal behavior; 2.32 (2.18-2.47) and 1.91 (1.59-2.30), respectively. DP moderated the association between sex and psychiatric healthcare, where women on DP displayed higher risk than men, X(2) 4.74 (p = 0.03).

    CONCLUSION: The findings suggest that losing one's role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians.

  • 11.
    Brenner, Philip
    et al.
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Björkenstam, Charlotte
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Jokinen, Jussi
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients: a population-based register study2014Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 9, nr 8, artikel-id e104165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension.

    METHODS: This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome.

    RESULTS: Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33).

    CONCLUSION: Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.

  • 12.
    Brenner, Philip
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet; Center for Psychiatry Research, Karolinska Universitetssjukhuset.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Jokinen, Jussi
    Department of Clinical Neuroscience, Karolinska Institutet; Center for Psychiatry Research, Karolinska Universitetssjukhuset; Department of Clinical Sciences, Umeå University.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    Prescribed psychiatric medication among multiple sclerosis patients before and after disability pension: a register study with matched controls.2016Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 51, nr 7, s. 1047-1054Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Many multiple sclerosis (MS) patients of working ages have psychiatric comorbidity, and 60 % are on disability pension (DP). It is unknown how DP is associated with MS patients' mental health. The objective of this study was to investigate the association between prescriptions of psychiatric medication and time before and after receiving full-time DP in MS patients compared with matched controls.

    METHODS: Nationwide Swedish registers were used to identify 3836 MS patients who were granted DP in 2000-2012 and 19,180 DP controls matched on socio-demographic variables by propensity scores. Patients and controls were organized in groups by year granted DP. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated for being prescribed selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or sleeping agents in 2006.

    RESULTS: Both patients and controls, who were not yet on DP in the study year of 2006, had lower OR compared with those who were granted DP in the same year. The OR increased when being closer to DP. MS patients, who had been granted DP 5-6 years earlier, had a higher risk for prescription of benzodiazepines (OR 1.72; 95 % CI 1.16-2.57) than controls (OR 1.14; 95 % CI 1.14-1.18). These patients also had a higher risk for SSRI prescription when compared directly with controls (OR 1.76; 95 % CI 1.44-2.15).

    CONCLUSIONS: MS patients have substantially higher odds ratios for being prescribed psychiatric drugs after DP than other disability pensioners. Further research on the association of DP with the mental health of MS patients is warranted.

  • 13.
    Bränström, Richard
    et al.
    Yale School of Public Health, New Haven, USA / Karolinska Institutet.
    Hatzenbuehler, Mark L
    Columbia University, New York, USA.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Pachankis, John E
    Yale School of Public Health, New Haven, USA.
    Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings2018Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, nr 6, s. 591-599Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Sweden to examine whether psychiatric outpatient treatment for various diagnoses and antidepressant medication usage are greater in sexual minority individuals compared to their siblings. A longitudinal cohort study design was used with a representative random population-based sample in Stockholm, Sweden. Registry-based health record data on all specialized outpatient health care visits and prescription drug use was linked to a sample of 1154 sexual minority individuals from the Stockholm Public Health Cohort and their siblings. The main outcomes were treatment due to psychiatric diagnoses retrieved from nationwide registry-based health records. In analyses accounting for dependency between siblings, gay men/lesbians had a greater likelihood of being treated for mood disorder [adjusted odds ratio (AOR) 1.77; 99% confidence intervals (CI) 1.00, 3.16] and being prescribed antidepressants (AOR 1.51; 99% CI 1.10, 2.07) compared to their siblings. Further, bisexual individuals had a greater likelihood of any outpatient psychiatric treatment (AOR 1.69; 99% CI 1.17, 2.45) and being prescribed antidepressants (AOR 1.48; 99% CI 1.07, 2.05) as well as a greater likelihood of being treated for a mood disorder (AOR 1.98; 99% CI 1.33, 2.95) compared to their siblings. No difference in anxiety or substance use disorder treatment was found between any sexual minority subgroup and their siblings. The potential role of familial confounding in psychiatric disorder treatment was not supported for more than half of the outcomes that were examined. Results suggest that sexual minority individuals are significantly more likely to be treated for certain psychiatric disorders compared to their siblings. Future research is needed to understand mechanisms other than familial factors that might cause the substantial treatment differences based on sexual orientation reported here.

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  • 14.
    Bygren, Lars Olov
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet; Department of Community Medicine and Rehabilitation, University of Umeå.
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet.
    Carstensen, John
    Department of Medical and Health Sciences, University of Linköping.
    Edvinsson, Sören
    The Demographic Database, University of Umeå.
    Kaati, Gunnar
    Department of Biosciences and Nutrition, Karolinska Institutet.
    Pembrey, Marcus E
    Institute of Child Health, University College London, UK.
    Sjöström, Michael
    Department of Biosciences and Nutrition, Karolinska Institutet.
    Change in paternal grandmothers' early food supply influenced cardiovascular mortality of the female grandchildren.2014Ingår i: BMC Genetics, E-ISSN 1471-2156, Vol. 15, artikel-id 12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This study investigated whether large fluctuations in food availability during grandparents' early development influenced grandchildren's cardiovascular mortality. We reported earlier that changes in availability of food - from good to poor or from poor to good - during intrauterine development was followed by a double risk of sudden death as an adult, and that mortality rate can be associated with ancestors' childhood availability of food. We have now studied transgenerational responses (TGR) to sharp differences of harvest between two consecutive years' for ancestors of 317 people in Överkalix, Sweden.

    RESULTS: The confidence intervals were very wide but we found a striking TGR. There was no response in cardiovascular mortality in the grandchild from sharp changes of early exposure, experienced by three of the four grandparents (maternal grandparents and paternal grandfathers). If, however, the paternal grandmother up to puberty lived through a sharp change in food supply from one year to next, her sons' daughters had an excess risk for cardiovascular mortality (HR 2.69, 95% confidence interval 1.05-6.92). Selection or learning and imitation are unlikely explanations. X-linked epigenetic inheritance via spermatozoa seemed to be plausible, with the transmission, limited to being through the father, possibly explained by the sex differences in meiosis.

    CONCLUSION: The shock of change in food availability seems to give specific transgenerational responses.

  • 15.
    Chruzander, Charlotte
    et al.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Ytterberg, Charlotte
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Widén Holmqvist, Lotta
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital; Division of Neuroscience, Department of Clinical Neuroscience.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Johansson, Sverker
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Longitudinal changes in sickness absence and disability pension, and associations between disability pension and disease-specific and contextual factors and functioning, in people with multiple sclerosis.2016Ingår i: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 367, s. 319-325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Even though it is well known that disability due to MS is highly associated with employment status, the long-term longitudinal perspective on sickness absence and disability pension over the MS trajectory is lacking. In addition, further knowledge of risk factors for future disability pension is needed.

    OBJECTIVES: To explore long-term longitudinal changes in the prevalence of sickness absence and disability pension in people with MS (PwMS), as well as to explore associations between disease-specific factors, contextual factors and functioning, and the outcome of future full-time disability pension.

    METHODS: A prospective, population-based survival cohort study, with a nine year follow-up, including 114 PwMS was conducted by combining face-to-face collected data and register-based data.

    RESULTS: The prevalence of full-time disability pension increased from 20% to 50%, however 24% of the PwMS had no disability pension at all at end of follow-up. Sex, age, disease severity and impaired manual dexterity were associated with future full-time disability pension.

    CONCLUSIONS: The large increase in prevalence of PwMS on full-time disability pension during the MS trajectory, calls for the development and implementation of evidence-based interventions, aiming at keeping PwMS in the work force. Modifiable factors, such as manual dexterity should be targeted in such interventions.

  • 16.
    Di Thiene, Domitilla
    et al.
    Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    La Torre, Giuseppe
    Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Suicide among first-generation and second-generation immigrants in Sweden: association with labour market marginalisation and morbidity.2014Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, nr 5, s. 467-473Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in the second generation seems higher. The aim of this study was to investigate to what extent suicide risk in first-generation and second-generation (both parents born abroad) and intermediate-generation (only one parent born abroad) immigrants compared with natives is associated with sociodemographic factors, labour market marginalisation and morbidity.

    METHODS: A prospective population-based cohort study of 4 034 728 individuals aged 16-50 years was followed from 2005 to 2010. HRs for suicide were calculated for first-generation, intermediate-generation and second-generation immigrants compared with natives. Analyses were controlled for sociodemographic factors, morbidity and labour market marginalisation.

    RESULTS: The HR of suicide was significantly lower in first-generation immigrants (HR 0.83 CI 0.76 to 0.91), and higher in second-generation (HR 1.32, CI 1.15 to 1.52) and intermediate-generation immigrants (HR 1.20, CI 1.08 to 1.33) in comparison to natives. The excess risk was explained by differences in sociodemographics, morbidity and labour market marginalisation. In the fully adjusted models, a higher HR remained only for the Nordic second generation (HR 1.29, CI 1.09 to 1.52). There were no sex differences in HRs.

    CONCLUSIONS: The risk of suicide was shown to be lower in the first generation and higher in the second generation compared with natives. The higher HR in the Nordic second generation was not explained by differences in sociodemographics, labour market marginalisation and morbidity. Further research is warranted to investigate factors underlying this excess risk.

  • 17.
    Dorner, T E
    et al.
    Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
    Alexanderson, K
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Svedberg, P
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Tinghög, Petter
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Ropponen, A
    Finnish Institute of Occupational Health, Topeliuksenkatu, Helsinki, Finland.
    Mittendorfer-Rutz, E
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden.2016Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).

    METHOD: All 4 823 069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].

    RESULTS: HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70).

    CONCLUSIONS: Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

  • 18.
    Ernstsson, Olivia
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet; Department of Clinical Neuroscience, Karolinska Institutet.
    Gyllensten, Hanna
    Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet; The Swedish Red Cross University College.
    Friberg, Emilie
    Department of Clinical Neuroscience, Karolinska Institutet.
    Norlund, Anders
    Department of Clinical Neuroscience, Karolinska Institutet.
    Cost of Illness of Multiple Sclerosis: A Systematic Review2016Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 7, artikel-id e0159129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices.

    MATERIAL AND METHOD: A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used.

    RESULTS: The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups.

    CONCLUSION: The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.

  • 19.
    Ernstsson, Olivia
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Burström, Kristina
    Karolinska Institutet / Stockholm County Council.
    The External Validity of Mapping MSIS-29 on EQ-5D Among Individuals With Multiple Sclerosis in Sweden2017Ingår i: Medical Decision Making Policy & Practice, ISSN 2381-4683, Vol. 2, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mapping can be performed to predict utility values from condition-specific measures when preference-based measures are absent. A previously developed algorithm that predicts EQ-5D-3L index values from the Multiple Sclerosis Impact Scale (MSIS-29) has not yet been externally validated. Aim: To examine the external validity of a previously developed mapping algorithm by testing the accuracy of predicting EQ-5D-3L index values from MSIS-29 among multiple sclerosis (MS) patients in Sweden. Methods: Cross-sectional individual-level data were collected from population-based Swedish registers between 2011 and 2014. Health-related quality of life was assessed through MSIS-29 and EQ-5D-3L at one point in time among 767 individuals with known disability level of MS. A previously developed mapping algorithm was applied to predict EQ-5D index values from MSIS-29 items, and the predictive accuracy was assessed through mean absolute error and root mean square error. Results: When applying the algorithm, the predicted mean EQ-5D-3L index value was 0.77 compared to the observed mean index value of 0.75. Prediction error was higher for individuals reporting EQ-5D values <0.5 compared to individuals reporting EQ-5D values ≥0.5. Mean absolute error (0.12) and root mean square error (0.18) were smaller or equal to the prediction errors found in the original mapping study. Conclusion: The mapping algorithm had similar predictive accuracy in the two independent samples although results showed that the highest predictive performance was found in groups with better health. Varied predictive accuracy in subgroups is consistent with previous studies and strategies to deal with this are warranted.

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  • 20.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki, Finland: Department of Public Health, University of Helsinki, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kjeldgård, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Contribution of comorbid conditions to the association between diabetes and disability pensions: a population-based nationwide cohort study2016Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, nr 3, s. 209-216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Using Swedish population-based register data, we examined the extent to which comorbid conditions contribute to the risk of disability pension among people with diabetes.

    METHODS: We carried out Cox proportional hazard analyses with comorbid conditions as time-dependent covariates among 14 198 people with newly diagnosed diabetes in 2006, and 39 204 people free from diabetes during the follow-up from 2007-2010. The average follow-up times were 46 and 48 months for those with and without diabetes, respectively.

    RESULTS: For those with diabetes only, the incidence of all-cause disability pension was 9.5 per 1000 person-years. The highest incidence of disability pension were for those with: diabetes and depression (23.6); diabetes and musculoskeletal disorder (30.6), and those with diabetes and more than one comorbid condition (36.5). The incidence rate was 5.8 for those without diabetes. Diabetes was associated with a 2.30 times [95% confidence interval (95% CI) 2.09-2.54] higher risk of disability pension (adjusted for sociodemographic factors). This association attenuated by 41% after further adjustment for comorbid chronic conditions. While diabetes was a risk factor for disability pension due to musculoskeletal disorders and diseases of the circulatory system, even after accounting for the above-mentioned conditions, the association between disability pension due to mental disorders and diabetes was diluted after adjustment for mental disorders.

    CONCLUSIONS: Although diabetes is an independent risk factor for disability pension, comorbid conditions contribute to this risk to a large degree.

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  • 21.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Kjeldgard, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine,Department of Clinical Neuroscience, Karolinska Institutet.
    Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden.2015Ingår i: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 105, nr 6, s. e22-e29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis.

    METHODS: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009.

    RESULTS: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability.

    CONCLUSIONS: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

  • 22.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Kjeldgård, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden2015Ingår i: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 105, nr 6, s. e22-e29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis.

    METHODS: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009.

    RESULTS: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability.

    CONCLUSIONS: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

  • 23.
    Garoff, Ferdinand
    et al.
    Faculty of Medicine/Psychology, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Suvisaari, Jaana
    National Institute for Health and Welfare, Helsinki, Finland.
    Lilja, Eero
    National Institute for Health and Welfare, Helsinki, Finland.
    Castaneda, Anu E.
    Faculty of Medicine/Psychology, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland.
    Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies2021Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 31, nr 3, s. 493-498Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Most refugees and other forced migrants have experienced potentially traumatic events (PTEs). Torture and other traumatic experiences, as well as various daily stressors, impact the mental health and psychosocial well-being of war-affected populations.

    METHODS: The study includes two population-based samples of Iranian and Iraqi men living in Finland and Sweden. The Finnish Migrant Health and Well-being Study (Maamu) was conducted in 2010-2012. The Linköping study was conducted in Sweden in 2005. In both samples, health and well-being measures, social and economic outcomes as well as health service utilization were reported.

    RESULTS: The final sample for analysis consisted of two groups of males of Iranian or Iraqi origin: 278 residents in Finland and 267 residents in Sweden. Both groups were subdivided according to the reported PTEs: Torture survivors; Other PTEs; No PTEs. Migrants that reported PTEs, torture survivors in particular, had significantly poorer social and health outcomes. Torture survivors also reported lower trust and confidence in authorities and public service providers, as well as more loneliness, social isolation and experiences of discrimination.

    CONCLUSIONS: Torture and other PTEs prevalent in refugee and migrant populations create a wide-ranging and long-term impact in terms of increased risk of various types of adverse social and health conditions. Early identification through systematic and effective screening should be the first step in guiding migrants and refugees suffering from experiences of torture and other PTEs to flexible, multidisciplinary services.

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  • 24.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet / Karolinska University Hospital.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden2018Ingår i: Multiple Sclerosis Journal, Experimental, Translational and Clinical, E-ISSN 2055-2173, Vol. 4, nr 3, artikel-id 2055217318783352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

    Objectives: To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21-64 years of age.

    Methods: Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

    Results: Among 8906 multiple sclerosis patients, EDSS 0.0-3.5 and 7.0-9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

    Conclusion: Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

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  • 25.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet; University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet; Karolinska University Hospital.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden2019Ingår i: Multiple Sclerosis Journal, Experimental, Translational and Clinical, E-ISSN 2055-2173, Vol. 5, nr 2, artikel-id 2055217319858383Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

    Objectives

    To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21–64 years of age.

    Methods

    Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

    Results

    Among 8906 multiple sclerosis patients, EDSS 0.0–3.5 and 7.0–9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

    Conclusion

    Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

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  • 26.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / Göteborgs universitet, Sahlgrenska universitetssjukhuset.
    Wiberg, M.
    Karolinska Institutet / Försäkringskassan.
    Alexanderson, K.
    Karolinska Institutet.
    Friberg, E.
    Karolinska Institutet.
    Hillert, J.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    Comparing indirect costs of multiple sclerosis in three different years: A population-based study2016Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr Suppl. 1, s. 29-Artikel i tidskrift (Övrigt vetenskapligt)
  • 27.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Comparing costs of illness of multiple sclerosis in three different years: A population-based study2018Ingår i: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, nr 4, s. 520-528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Little is known about changes in the costs of illness (COI) among multiple sclerosis (MS) patients during recent years.

    OBJECTIVES: To compare the COI among MS patients and matched controls in 2006, 2009, and 2012, respectively, indicating the costs attributable to the MS disease.

    METHODS: Three cross-sectional datasets were analyzed, including all MS patients in Sweden aged 20-60 years and five matched controls for each of them. The analyses were based on 10,531 MS patients and 52,655 matched controls for 2006, 11,722 and 58,610 individuals for 2009, and 12,789 and 63,945 for 2012. Nationwide registers, including prescription drug use, specialized healthcare, sick leave, and disability pension, were linked to estimate the prevalence-based COI.

    RESULTS: Adjusted for inflation, the average difference in COI between MS patients and matched controls were Swedish Krona (SEK) 243,751 (95% confidence interval: SEK 239,171-248,331) in 2006, SEK 238,971 (SEK 234,516-243,426) in 2009, and SEK 225,923 (SEK 221,630-230,218) in 2012. The difference in indirect costs were SEK 170,502 (SEK 166,478-174,525) in 2006, SEK 158,839 (SEK 154,953-162,726) in 2009, and SEK 141,280 (SEK 137,601-144,960) in 2012.

    CONCLUSION: The inflation-adjusted COI of MS patients was lower in 2012 than in 2006, in particular regarding indirect costs.

  • 28.
    Gyllensten, Hanna
    et al.
    Karolinska institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska institutet.
    Hillert, Jan
    Karolinska institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet.
    How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group2016Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 6, nr 11, artikel-id e012731Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We compared work disability of patients with multiple sclerosis (MS) from 5 years before with 5 years after diagnosis, with that of matched controls, and analysed whether progression in work disability among patients with MS was associated with sociodemography.

    DESIGN: Population-based cohort study.

    SETTING: The adult Swedish general population.

    PARTICIPANTS: Residents aged 24-57 diagnosed with MS (n=3685) in 2003-2006 and 18 425 matched controls without MS.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Annual net days of sickness absence (SA) and disability pension (DP), used as a proxy for work disability, followed from 5 years before to 5 years after diagnosis (ie, T-5-T+5). For patients with MS, regression was used to identify sociodemographic factors related to progression in work disability.

    RESULTS: Work disability of patients with MS increased gradually between T-5 and T-1 (mean: 46-82 days) followed by a sharp increase (T+1, 142 days), after which only a marginal increase was observed (T+5, 149 days). The matched controls had less work disability, slightly increasing during the period to a maximum of ∼40 days. Men with MS had a sharper increase in work disability before diagnosis. High educational level was associated with less progression in work disability before and around diagnosis.

    CONCLUSIONS: Patients with MS had more work disability days also 5 years before diagnosis. Several sociodemographic variables were associated with the absolute level and the progression in SA and DP.

  • 29.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Norlund, Anders
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Ernstsson, Olivia
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age2018Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 19, nr 3, s. 435-446Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) causes work disability and healthcare resource use, but little is known about the distribution of the associated costs to society.

    OBJECTIVES: We estimated the cost of illness (COI) of working-aged individuals with MS, from the societal perspective, overall and in different groups.

    METHODS: A population-based study was conducted, using data linked from several nationwide registers, on 14,077 individuals with MS, aged 20-64 years and living in Sweden. Prevalence-based direct and indirect costs in 2010 were calculated, including costs for prescription drug use, specialized healthcare, sick leave, and disability pension.

    RESULTS: The estimated COI of all the MS patients were SEK 3950 million, of which 75% were indirect costs. MS was the main diagnosis for resource use, causing 38% of healthcare costs and 67% of indirect costs. The distribution of costs was skewed, in which less than 25% of the patients accounted for half the total COI.

    CONCLUSIONS: Indirect costs contributed to approximately 75% of the estimated overall COI of MS patients of working age in Sweden. MS was the main diagnosis for more than half of the estimated COI in this patient group. Further studies are needed to gain knowledge on development of costs over time during the MS disease course.

  • 30.
    Helgesson, Magnus
    et al.
    Uppsala universitet / Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet.
    Niederkrotenthaler, T.
    Medical Univiversity Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    Labour-market marginalisation after a mental diagnosis among natives and immigrants living in Sweden2016Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, nr Suppl. 1, s. 38-Artikel i tidskrift (Övrigt vetenskapligt)
  • 31.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet.
    Niederkrotenthaler, Thomas
    Medical University Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, nr 1, artikel-id 593Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants.

    METHODS: The study comprised 1,753,544 individuals, aged 20-35 years, and resident in Sweden 2004. They were followed 2005-2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001-2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment.

    RESULTS: Individuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4-6.8) than Western immigrants (4.8; 4.4-5.2) and non-Western immigrants (4.8; 4.4-5.1), slightly higher risk estimates for sickness absence (2.1;2.1-2.2) than Western (1.9;1.8-2.1), and non-Western (1.9;1.7-2.0) immigrants but lower risk estimates for unemployment (1.4;1.3-1.4) than Western (1.8;1.7-1.9) and non-Western immigrants (2.0;1.9-2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment.

    CONCLUSIONS: Mental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.

  • 32.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Rahman, Syed
    Karolinska Institutet.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Trajectories of work disability and unemployment among young adults with common mental disorders2018Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 18, artikel-id 1228Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19-30years with an incident diagnosis of a CMD in year 2007 (n=7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n=7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n=1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n=2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n=665) followed increasing or constant high levels of work disability and 21 % (n=1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n=4546, 63%) or unemployment (n=2745, 38%), compared to the level of constant low work disability (n=6158, 85%) and unemployment (n=3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R-difference(2)=0.02-0.05, p<0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.

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  • 33.
    Hinas, Elin
    et al.
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Nilsson, Kerstin
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Tinghög, Petter
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Mittendorfer Rutz, Ellenor
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Alexanderson, Kristina
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Prediktion av fortsatt sjukfrånvaro bland personer sjukskrivna i depressiv episod respektive i artros2015Rapport (Övrigt vetenskapligt)
  • 34.
    Hiyoshi, Ayako
    et al.
    Örebro Univeristy, Sweden; Stockholm University, Sweden.
    Alexanderson, Kristina
    Karolinska Institutet, Sweden.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet, Sweden.
    Cao, Yang
    Örebro University, Sweden; Karolinska Institutet, Sweden.
    Fall, Katja
    Örebro University, Sweden; Karolinska Institutet, Sweden.
    Montgomery, Scott
    Örebro University, Sweden; Karolinska Institutet, Sweden; University College London, UK.
    Future sick leave, disability pension, and unemployment among patients with cancer after returning to work: Swedish register‐based matched prospective cohort study2024Ingår i: Cancer, ISSN 0008-543X, E-ISSN 1097-0142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Despite increasing numbers of working-age cancer survivors, evidence on their future work-related circumstances is limited. This study examined their future sick leave, disability pension, and unemployment benefits compared to matched cancer-free individuals.

    Methods: A matched cohort study was conducted using nationwide Swedish registers. In total, 94,411 individuals aged 25 to 59 years when diagnosed with incident cancer in 2001–2012 and who returned to work after cancer were compared with their matched cancer-free individuals (N = 354,814). Follow-up started from the year before cancer diagnosis and continued up to 14 years. Generalized estimating equations were used to calculate incidence rate ratios (IRR) and odds ratios for the difference between cancer survivors and matched cancer-free individuals.

    Results: Compared with cancer-free individuals, cancer survivors had six times higher sick-leave days per year after cancer (IRR 6.25 [95% CI, 5.97–6.54] for men; IRR, 5.51 [5.39–5.64] for women). This higher number of sick-leave days declined over time but a two-fold difference persisted. An approximate 1.5 times higher risk of receiving disability pension remained during follow-up. The unemployment days tended to be lower for cancer survivors (IRR, 0.84 [0.75–0.94] for men; IRR, 0.91 [0.86–0.96] for women). Risk of sick leave and disability pension was higher among those with leukemia, colorectal, and breast cancer than skin and genitourinary cancers.

    Conclusions: Cancer survivors who returned to work experienced a high and persisting sick leave and disability pension for over a decade. Prolonged receipt of a high amount of benefits may have long-term adverse impacts on financial circumstances; more knowledge to promote the environment that encourages returning to and remaining in work is needed.

  • 35.
    Hällström, Tore
    et al.
    NEUROTEC, Section of Psychiatry, Karolinska Institutet.
    Damström Thakker, Kerstin
    Stockholm Center of Public Health, Department of Alcohol and Drug Prevention.
    Forsell, Yvonne
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet.
    Lundberg, Ingvar
    National Institute for Working Life, Department for Work and Health.
    Tinghög, Petter
    The PART Study: A Population Based Study of Mental Health in the Stockholm County: Study Design. Phase l (1998-2000)2003Rapport (Övrigt vetenskapligt)
  • 36.
    Kavaliunas, Andrius
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Olsson, Tomas
    Karolinska Institutet / Karolinska University Hospital.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet / Karolinska University Hospital.
    Karrenbauer, Virginija Danylaite
    Karolinska Institutet /Karolinska University Hospital.
    Cognitive function predicts work disability among multiple sclerosis patients2019Ingår i: Multiple Sclerosis Journal, Experimental, Translational and Clinical, E-ISSN 2055-2173, Vol. 5, nr 1, artikel-id 2055217318822134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted.

    Objective: To determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test.

    Methods: A register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability.

    Results: After one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02).

    Conclusion: Cognitive function is to a high extent associated with multiple sclerosis patients' future work disability, even after adjusting for other factors.

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  • 37.
    Kavaliunas, Andrius
    et al.
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet.
    Glaser, Anna
    Karolinska Institutet.
    Gyllensten, Hanna
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Earnings and Financial Compensation from Social Security Systems Correlate Strongly with Disability for Multiple Sclerosis Patients2015Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 10, nr 12, artikel-id e0145435Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) patients earn lower incomes and receive higher benefits. However, there is limited knowledge of how this is correlated with their disability.

    OBJECTIVE: To elucidate sources and levels of income among MS patients with different disability, assessed with the Expanded Disability Status Scale.

    METHODS: A total of 7929 MS patients aged 21-64 years and living in Sweden in 2010 were identified for this cross-sectional study. Descriptive statistics, logistic and truncated linear regression models were used to estimate differences between MS patients regarding earnings, disability pension, sickness absence, disability allowance, unemployment compensation, and social assistance.

    RESULTS: The average level of earnings was ten times lower and the average level of health- related benefits was four times higher when comparing MS patients with severe and mild disability. MS patients with severe disability had on average SEK 166,931 less annual income from earnings and SEK 54,534 more income from benefits compared to those with mild disability. The combined average income for MS patients was 35% lower when comparing patients in the same groups. The adjusted risk ratio for having earnings among MS patients with severe disability compared to the patients with mild disability was 0.33 (95% CI 0.29-0.39), while the risk ratio for having benefits was 1.93 (95% CI 1.90-1.94).

    CONCLUSIONS: Disease progression affects the financial situation of MS patients considerably. Correlations between higher disability and patient income were observed, suggesting that earnings and benefits could be used as measures of MS progression and proxies of disability.

  • 38.
    Lallukka, Tea
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Helsinki, Finland .
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Kjeldgård, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    The joint contribution of diabetes and work disability to premature death during working age: a population-based study in Sweden.2016Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, nr 6, s. 580-586Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age.

    METHODS: We used prospective population-based register data of 25-59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003-2010. Net days of sickness absence and disability pension in 2005-2006 were examined; the follow-up time for mortality was 2007-2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions.

    RESULTS: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0-16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4-7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8-4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up.

    CONCLUSIONS: DIABETES AND WORK DISABILITY JOINTLY INCREASE THE RISK OF DEATH DURING WORKING AGE DIABETES WITH LONG-TERM WORK DISABILITY IS ASSOCIATED WITH THE HIGHEST RISK OF PREMATURE DEATH, WHICH HIGHLIGHTS THE IMPORTANCE OF THEIR PREVENTION AND EARLY DETECTION.

  • 39.
    Lallukka, Tea
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Finland.
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Red Cross University College, Stockholm, Sweden.
    Kjeldgård, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The joint contribution of diabetes and work disability to premature death during working age: a population-based study in Sweden2016Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, nr 6, s. 580-586Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age.

    METHODS: We used prospective population-based register data of 25-59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003-2010. Net days of sickness absence and disability pension in 2005-2006 were examined; the follow-up time for mortality was 2007-2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions.

    RESULTS: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0-16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4-7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8-4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up.

  • 40.
    Lundin, Andreas
    et al.
    Karolinska Institutet / Stockholm County Council.
    Åhs, Jill
    Karolinska Institutet.
    Åsbring, Nina
    Stockholm County Council.
    Kosidou, Kyriaki
    Karolinska Institutet / Stockholm County Council.
    Dal, Henrik
    Karolinska Institutet / Stockholm County Council.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Dalman, Christina
    Karolinska Institutet / Stockholm County Council.
    Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study2017Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, nr 3, s. 171-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.

    AIMS: This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.

    METHODS: This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.

    RESULTS: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC = 0.86, GHQ index AUC = 0.83), and between individuals with current disorder from healthy controls (Likert index AUC = 0.90, GHQ index AUC = 0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity = 81.7 and specificity = 85.4), and for the Likert index ≥14 (sensitivity = 85.5 and specificity = 83.2).

    CONCLUSIONS: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.

  • 41.
    Malm, Andreas
    et al.
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet / The Swedish Red Cross Treatment Center for Persons Affected by War and Torture.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Narusyte, Jurgita
    Karolinska Institutet.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden2020Ingår i: Conflict and Health, E-ISSN 1752-1505, Vol. 14, artikel-id 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.

    Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.

    Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

  • 42.
    Murley, C.
    et al.
    Karolinska Institutet, Sweden.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen.
    Karampampa, K.
    Karolinska Institutet, Sweden.
    Hillert, J.
    Karolinska Institutet, Sweden.
    Alexanderson, K.
    Karolinska Institutet Sweden.
    Friberg, E.
    Karolinska Institutet Sweden.
    Patterns Of Working Life Sequences Among People Recently Diagnosed With MS In Sweden: A Nationwide Register-Based Longitudinal Cohort Study2020Ingår i: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 23, s. S637-S637Artikel i tidskrift (Övrigt vetenskapligt)
  • 43.
    Murley, C.
    et al.
    Karolinska Institutet.
    Wiberg, M.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Swedish Red Cross Univ Coll, Dept Hlth Sci, Stockholm, Sweden..
    Alexanderson, Kristina
    Karolinska Institutet.
    Palmer, E.
    Uppsala University.
    Hillert, J.
    Karolinska Institutet.
    Stenbeck, M.
    Karolinska Institutet.
    Friberg, E.
    Karolinska Institutet.
    Earnings among people with multiple sclerosis in Sweden, by education and occupation2019Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr Supplement 4, s. 68-Artikel i tidskrift (Övrigt vetenskapligt)
  • 44.
    Murley, Chantelle
    et al.
    Karolinska Institutet.
    Mogard, Olof
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Karampampa, Korinna
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group2018Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 8, nr 5, artikel-id e020392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden.

    DESIGN: Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis).

    SETTING: Swedish working-age population with microdata linked from two nationwide registers.

    PARTICIPANTS: Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth).

    PRIMARY AND SECONDARY OUTCOME MEASURES: DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits.

    RESULTS: We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis.

    CONCLUSIONS: The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the disease progresses, although thorough investigation with future studies of modern cohorts are required.

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  • 45.
    Murley, Chantelle
    et al.
    Karolinska Institutet, Sweden.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet, Sweden.
    Alexanderson, Kristina
    Karolinska Institutet, Sweden.
    Hillert, Jan
    Karolinska Institutet, Sweden.
    Friberg, Emilie
    Karolinska Institutet, Sweden.
    Karampampa, Korinna
    Karolinska Institutet, Sweden.
    Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group2021Ingår i: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 39, s. 835-851Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses.

    OBJECTIVE: The objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group.

    METHODS: We conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010-12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y-4) to 4 years (Y+4) after the year of diagnosis (Y0). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models.

    RESULTS: People with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y-4 were 216 EUR (95% confidence interval 58-374) and 1540 EUR (95% confidence interval 848-2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses.

    CONCLUSIONS: Excess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time.

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  • 46.
    Murley, Chantelle
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet.
    Karampampa, Korinna
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Types of working-life sequences among people recently diagnosed with multiple sclerosis in Sweden: a nationwide register-based cohort study2020Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 12, artikel-id e039228Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To explore sequences of annual states of activity and sickness absence (SA) or disability pension (DP) (SA/DP) among working-aged people with multiple sclerosis (PwMS) as well as characteristics associated with the identified types of working-life sequences.

    DESIGN: Nationwide Swedish register-based cohort study from 1 year prior to 5 years after the year of multiple sclerosis (MS) diagnosis.

    SETTING: Sweden.

    PARTICIPANTS: PwMS diagnosed in 2008-2011 when aged 20-55 (n=2652, 69.9% women).

    PRIMARY AND SECONDARY OUTCOME MEASURES: Individual-level sequences spanning 7 years were constructed with annual states regarding activity (income from paid work, student allowances, parental leave or unemployment compensation) and/or SA/DP. Types of working-life sequences were identified among the individuals' sequences using hierarchical cluster analysis with optimal matching dissimilarity measures.

    RESULTS: Six types of working-life sequences were identified. The largest cluster, Stable High Activity, represented 48.4% of the cohort. Other types were: Stable High SA/DP (14.5%); Other (4.5%); and three types with mixed activity and varying SA/DP regarding the number of days/year and timing (32.6%). Characteristics of the different identified types of sequences were subsequently investigated. All types of sequences had lower odds for university education (OR range: 0.18-0.72) compared with Stable High Activity. Increasingly higher odds of having anxiety/depression compared with Stable High Activity were observed across the types of sequences, by increasing proportions of SA/DP. Stable High SA/DP sequences were less likely than Stable High Activity to be prescribed MS drugs in the MS diagnosis year (OR 0.61; 95% CI 0.47 to 0.78). All types of sequences had higher disposable income in the final study year than the first, except for Stable High SA/DP sequences (Swedish Krona 4669, 95% CI -1892 to 11 230).

    CONCLUSIONS: Diversity in working life was influenced by sociodemographic and clinical characteristics resulting in different activity and SA/DP patterns across the six identified types of working-life sequences.

  • 47.
    Murley, Chantelle
    et al.
    Karolinska Institutet, Sweden.
    Tinghög, Petter
    Röda Korsets Högskola, Hälsovetenskapliga institutionen. Karolinska Institutet, Sweden.
    Teni, Fitsum Sebsibe
    Karolinska Institutet, Sweden.
    Machado, Alejandra
    Karolinska Institutet, Sweden.
    Alexanderson, Kristina
    Karolinska Institutet, Sweden.
    Hillert, Jan
    Karolinska Institutet, Sweden.
    Karampampa, Korinna
    Karolinska Institutet, Sweden.
    Friberg, Emilie
    Karolinska Institutet, Sweden.
    Excess costs of multiple sclerosis: a register-based study in Sweden2023Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 24, s. 1357-1371Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objective: Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to their MS, including primary healthcare.

    Methods: An observational study was conducted of the 2806 working-aged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS. Register-based resource use was quantified for 2018. Annual healthcare costs (primary, specialised outpatient, and inpatient healthcare visits along with prescribed drugs) and productivity losses (operationalised by sickness absence and disability pension days) were quantified using bottom-up costing. The costs of people with MS were compared with those of the references using independent t-tests with bootstrapped 95% confidence intervals (CIs) to isolate the excess costs of MS from the mean difference.

    Results: The mean annual excess costs of MS for healthcare were €7381 (95% CI 6991–7816) per person with MS with disease-modifying therapies as the largest component (€4262, 95% CI 4026–4497). There was a mean annual excess cost for primary healthcare of €695 (95% CI 585–832) per person with MS, comprising 9.4% of the excess healthcare costs of MS. The mean annual excess costs of MS for productivity losses were €13,173 (95% CI 12,325–14,019) per person with MS, predominately from disability pension (79.3%).

    Conclusions: The socioeconomic burden of MS in Sweden from healthcare consumption and productivity losses was quantified, updating knowledge on the cost structure of the substantial excess costs of MS.

  • 48.
    Niederkrotenthaler, Thomas
    et al.
    Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria.
    Tinghög, Petter
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Alexanderson, Kristina
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Dahlin, Marie
    Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research.
    Wang, Mo
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Beckman, Karin
    Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research.
    Gould, Madeleine
    Columbia University, NYS Psychiatric Institute, New York, USA.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Future risk of labour market marginalization in young suicide attempters: a population-based prospective cohort study2014Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, nr 5, s. 1520-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Research on future labour market marginalization following suicide attempt at young age is scarce. We investigated the effects of suicide attempts on three labour market outcomes: unemployment, sickness absence and disability pension.

    METHODS: We conducted a prospective cohort study based on register linkage of 1,613,816 individuals who in 1994 were 16-30 years old and lived in Sweden. Suicide attempters treated in inpatient care during the 3 years preceding study entry, i.e. 1992-94 (N=5649) were compared with the general population of the same age without suicide attempt between 1973 and 2010 (n=1,608,167). Hazard ratios (HRs) for long-term unemployment (>180 days), sickness absence (>90 days) and disability pension in 1995-2010 were calculated by Cox regression models, adjusted for a number of parental and individual risk markers, and stratified for previous psychiatric inpatient care not due to suicide attempt.

    RESULTS: The risks for unemployment [HR 1.58; 95% confidence interval (CI) 1.52-1.64], sickness absence (HR 2.16; 2.08-2.24) and disability pension (HR 4.57; 4.34-4.81) were considerably increased among suicide attempters. There was a dose-response relationship between number of suicide attempts and the risk of disability pension, for individuals both with or without previous psychiatric hospitalizations not due to suicide attempts. No such relationship was present with regard to unemployment.

    CONCLUSIONS: This study highlights the strong association of suicide attempts with future marginalization from the labour market, particularly for outcomes that are based on a medical assessment. Studies that focus only on unemployment may largely underestimate the true detrimental impact of suicide attempt on labour market marginalization.

  • 49.
    Niederkrotenthaler, Thomas
    et al.
    Medical University Vienna, Center for Public Health, Institute of Social Medicine, Suicide Research Unit, Vienna, Austria.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Goldman-Mellor, Sidra
    University of California, Merced, USA.
    Wilcox, Holly C
    Johns Hopkins School of Medicine, Baltimore, USA.
    Gould, Madelyn
    Columbia University, NYS Psychiatric Institute, New York, USA.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters2016Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 1, s. 1-15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization.

    METHODS: Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16-30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992-1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995-2010 were calculated with Cox regression.

    RESULTS: Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9).

    CONCLUSIONS: As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.

  • 50.
    Okenwa-Emegwa, Leah
    et al.
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    Paillard-Borg, Stéphanie
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    Tinghög, Petter
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    Saboonchi, Fredrik
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa.
    von Strauss, Eva
    Röda Korsets Högskola, Avdelningen Medicin och Folkhälsa. Swedish Red Cross University College.
    A global workspace is the emerging reality for future public health workforce2017Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, E-ISSN 2000-4192, Vol. 94, nr 3, s. 132-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is an urgent need to train public health professionals at undergraduate level who can face global challenges that are due to longstanding conflicts, increasing number of displaced people, natural disasters, and growing inequalities between and within countries. Future public health professionals will lead activities ranging from national and international community planning, strategic work geared towards integration of migrants and crisis management of refugees, and humanitarian services. Consequently, the need for public health professionals with deep and wide theoretical and practical competencies in global contexts has become most relevant. In response to this need, The Swedish Red Cross University College has created such a programme leading to a Bachelor degree in Public Health Science, specialization Global Health.

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