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  • 5251.
    Ängarne-Lindberg, Teresia
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Grown-up children of divorce: Experiences and health2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The comprehensive purpose of the thesis was to study the health and experiences, with a main focus on mental health, of a group of grown-up children of divorced parents in comparison to a group of persons without this experience. Mental health, experienced life events, narratives of divorce related experiences and personal resources were therefore examined in a group of young adults (age 22-33 years) whose parents divorced 15 years before the start of the first three studies. In addition to this, the presence of a child/adolescent and/or an adult psychiatric record and ten years of diagnosed physical health visits in the same but extended group (age 21-38 years) was examined 20 years after parental divorce. The outcomes of these examinations were compared with the outcomes of a group with married parents still living together, matched with the divorce group on age gender and living area. The results showed no major differences in mental health between the divorce and the non-divorce group, with the exception of women age 22-27 showing poorer mental health than the others in the study. Personal resources in this case SOC (Sense of Coherence) followed the same pattern, with no significant differences between the divorce and the non-divorce group, but with women age 22-27 showing lower SOC. The experiences/narratives told by the divorce group fell into one of two categories: one disappointment, the other contentment, with the first indicating non-optimal chances for adjustment to parental divorce and the other good. The run-through of psychiatric records showed no significant differences between the number of persons in need of adult psychiatric care in the divorce and the non-divorce group. A significant difference was present, however, in child- and adolescent psychiatric care pointing to a larger need for psychiatric care in the divorce group, a need most pronounced among girls. As concerned the number of diagnosed physical health care visits, only small differences between the groups were found. The main conclusion of the study was that experience of parental divorce in childhood is not found for a majority to be an experience determining poorer mental or somatic health in young adulthood.

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  • 5252.
    Ängarne-Lindberg, Teresia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Psychiatric and somatic health in relation to expereince of parental divorce in childhood2012In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 58, no 1, p. 16-25Article in journal (Refereed)
    Abstract [en]

    Background: The outcome of studies about experience of parental divorce and effects on mental and physical health differs in result possibly caused by the use of different questionnaires and instruments, varying length of time since the divorce and divergent drop-off of participants.

    Aims: To study the presence of psychiatric records and number of diagnosed somatic and mental health care visits in a group of young adults with childhood experience of parental divorce in comparison to a group without this experience.

    Methods: The presence of a record at the public psychiatric clinics and ten years of administrative health care data (somatic and mental) was checked for both groups.

    Results: Significantly more persons from the divorce group occurred in child and adolescent psychiatric care, most pronounced women. However, no significant difference between the groups in number of persons seeking adult psychiatry, or in number of psychiatric consultations was present. Experience of parental divorce was not either found to be an indicator of larger somatic health problems.

    Conclusion: Experience of parental divorce in childhood is not an indicator of adult psychiatric or somatic need of care.

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  • 5253.
    Ängarne-Lindberg, Teresia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry .
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry .
    Sense of coherence in young adults with and without childhood experience of parental divorceManuscript (preprint) (Other academic)
    Abstract [en]

    Aim: A number of studies show variability in children’s response to parental divorce. The intent of the present study was to look at personal resources as one possible factor explaining differences in mental health among young adults with childhood experience of parental divorce. This factor is examined by also taking into account the effect of traumatic experiences other than the possibly traumatic parental divorce. Method:  A group of persons with childhood experience of parental divorce (divorce group) was compared to a group without this experience, a non-divorce group consisting of persons of the same gender and age and living in the same locations as those in the divorce group. Personal resources were defined in this study as “Sense of Coherence” (SOC) measured with SOC-29, and mental health was assessed by the SCL-90 index General Severity Index (GSI). Traumatic life events were accounted for by using Life Incidence of Traumatic Events (LITE). Results: The results showed a significant connection between a strong SOC-29 and good mental health SCL-90/GSI, but no significant connection between SOC-29 and LITE, and the same pattern was seen in both the divorce and the non-divorce group. Conclusion: Personal resources measured as strong sense of coherence seem to be important in retaining a good mental health and the capacity to deal with life incidences such as parental divorce.

    .                                                                                                                           

  • 5254.
    Ängarne-Lindberg, Teresia
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Young adults with childhood experience of parental divorce: Disappointment and contentment2009In: Journal of Divorce and Remarriage, ISSN 1050-2556, E-ISSN 1540-4811, Vol. 50, no 3, p. 172-184Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to use in-depth interviews to identify and describe experiences of parental divorce among adult children whose parents divorced 15 years earlier. Ten out of 76 interviews were recorded and transcribed verbatim, and data were analyzed using qualitative content analysis. Two categories of experiences were identified: disappointment and contentment. Two subcategories of disappointment were distinguished: disappointment toward mother, father, or both, and disappointment with relatives and other surrounding persons. Four subcategories of contentment were distinguished: contentment in the belief that the members of the original family received a good or even better life after the divorce, contentment with how the divorce was handled by the parents, contentment and inner strength as a part of the child's own personality, and contentment with receiving adequate help during and after the parental divorce.

  • 5255.
    Åberg, Katarina
    et al.
    Mittuniversitetet, Institutionen för Socialt Arbete.
    Grönberg, Annika
    Mittuniversitetet, Institutionen för Socialt Arbete.
    Persson, Christina
    Mittuniversitetet, Institutionen för Socialt Arbete.
    Gerdner, Arne
    Mittuniversitetet, Institutionen för socialt arbete.
    Psykosociala behandlingsinslag i svenska metadonprogram: värdering ur patientperspektiv2001In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 18, no 5-6, p. 444-460Article in journal (Refereed)
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  • 5256.
    Ågren, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Univ Gävle, Dept Occupat Hlth Psychol & Sports Sci, Gävle, Sweden..
    Motilla Hoppe, Johanna
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Extensive functional connectivity between brain areas implicated in mental imagery production and phobic fear during both emotional and neutral mental imagery2024In: Behavioural Brain Research, ISSN 0166-4328, E-ISSN 1872-7549, Vol. 462, article id 114893Article in journal (Refereed)
    Abstract [en]

    Mental imagery is used by most people in their day-to-day cognition, for example, in planning, daydreaming, or remembering. Importantly, mental imagery has a powerful influence on emotion and is critically involved in many mental disorders. Thus, understanding the link between mental imagery and emotion is of clinical interest. For example, exposure therapy can be successfully conducted using mental imagery of fear-provoking stimuli, i.e., imaginal exposure. In this vein, accumulating evidence shows that mental imagery of a fearful stimulus produces a similar physiological and neural response as actual perception of the stimulus. Alas, knowledge of the neural processes underlying the link between mental imagery and emotion is limited. Functional magnetic resonance imaging data from a previous study on imaginal exposure (N = 30) was used to examine the functional connectivity during the production of phobic and neutral mental imagery. Regions of interest were selected from meta-analyses on brain regions consistently recruited during mental imagery production and phobic fear, respectively. Results showed that these regions were positively correlated during both phobic and neutral mental imagery production. Very few differences in functional connectivity between phobic and neutral imagery were found. Specifically, weaker functional connectivity between the supplemental motor area and a region including parts of the left insula and inferior frontal gyrus was observed during phobic (vs neutral) imagery. In conclusion, our findings suggest that brain regions previously implicated in mental imagery production and phobic fear are highly interconnected during the production of both phobic and neutral imagery.

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  • 5257.
    Åhlander, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Strömbäck, Maria
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Sandlund, Jonas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Arctic Research Centre at Umeå University.
    Living (dys)regulated and alienated young masculinity: young men's embodied experiences of mental disorders and suicidality2023In: Counselling and Psychotherapy Research, ISSN 1473-3145, E-ISSN 1746-1405, Vol. 23, no 4, p. 893-905Article in journal (Refereed)
    Abstract [en]

    Introduction: Mental disorders, such as depression and anxiety with interlinked suicidality, are the leading cause of health-related disability among young men. Knowledge of the interaction between emotional, bodily, social and gendered mental health processes in young men is limited and therefore needed.

    Aim: This study aimed to explore young men's lived embodied experiences of mental disorders and suicidality, and to conceptualise these by integrating affective–emotional, physiological, social and gendered processes.

    Methods: Semistructured individual interviews were conducted with 13 young men who had sought professional help for mental disorders and suicidality. Grounded theory (GT) was used with a social constructivist perspective.

    Results: The results comprise one core category - Living (dys)regulated and alienated young masculinity - with related categories “battling with the emotional body,” “suffering in social silence” and “balancing embodied darkness and distress.” The GT illustrates how young men navigate and manage their embodied and emotional suffering in a context of “regulative” masculine and social norms alongside insufficient social support.

    Conclusion: Our results suggest that young men's lived embodied experiences of mental disorders and suicidality can be understood as a dynamic process of internal and external “(dys)regulation and alienation.” The generated GT provides a broad tentative explanation model, contributing to theory development, and serves as a basis for gender-sensitive interventions - in both psychotherapy and physiotherapy - integrating body, mind and the social context.

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  • 5258.
    Åhlin, Julia K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Jansson-Fröjmark, Markus
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Job demands, control and social support as predictors of trajectories of depressive symptoms2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 535-543Article in journal (Refereed)
    Abstract [en]

    Background: Job demands, job control and social support have been associated with depressive symptoms. However, it is unknown how these work characteristics are associated with different trajectories of depressive symptoms, which this study aimed to examine. Methods: We included 6679 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who completed biennial questionnaires in 2006-2016. Group-based trajectory models identified groups with similar development of depressive symptoms. Multinomial logistic regression estimated associations between baseline demands, control, social support and trajectories of depressive symptoms. Results: We identified six depression trajectories with varying severity and stability across four measurements. High job demands and low social support, but not low control, were associated with higher probability of belonging to subsequent trajectories with higher symptom level compared to very low symptom level. Adjusted risk ratios ranged from 1.26, 95% CI = 1.06-1.51 (low symptom trajectory) to 2.51, 95% CI = 1.43-4.41 (persistent severe symptom trajectory). Results also indicated that onset of high demands, low control and low social support increases depressive symptoms over time. Limitations: The results were based on self-reported data and all individuals did not have complete data in all waves. Conclusions: The results indicated that especially perceptions of high job demands and low social support are associated with higher or increasing levels of depressive symptoms over time. This support the supposition that high job demands, and low social support may have long-term consequences for depressive symptoms and that interventions targeting job demands and social support may contribute to a more favourable course of depression.

  • 5259.
    Åhs, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Michelgård Palmquist, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Pissiota, Anna
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Appel, Lieuwe
    Frans, Örjan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Liberzon, Israel
    Furmark, Tomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Fredrikson, Mats
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Arousal modulation of memory and amygdala-parahippocampal connectivity: A PET-psychophysiology study in specific phobia2011In: Psychophysiology, ISSN 0048-5772, E-ISSN 1469-8986, Vol. 48, no 11, p. 1463-1469Article in journal (Refereed)
    Abstract [en]

    Phobic fear is accompanied by intense bodily responses modulated by the amygdala. An amygdala moderated psychophysiological measure related to arousal is electrodermal activity. We evaluated the contributions of electrodermal activity to amygdala-parahippocampal regional cerebral blood flow (rCBF) during phobic memory encoding in subjects with spider or snake phobia. Recognition memory was increased for phobia-related slides and covaried with rCBF in the amygdala and the parahippocampal gyrus. The covariation between parahippocampal rCBF and recognition was related to electrodermal activity suggesting that parahippocampal memory processes were associated with sympathetic activity. Electrodermal activity further mediated the amygdala effect on parahippocampal activity. Memory encoding during phobic fear therefore seems contingent on amygdala's influence on arousal and parahippocampal activity.

  • 5260.
    Åhs, Jill
    et al.
    Swedish Red Cross University, Department of Health Sciences. Karolinska Institutet, Sweden.
    Lundin, A.
    Karolinska Institutet, Sweden.
    Carvajal Aguirre, L.
    UNICEF, USA.
    Stevanovic, D.
    Clinic for Neurology and Psychiatry for Children and Youth, Serbia.
    The Revised Children’s Anxiety and Depression Scale: Analyses for a Very Brief Scale Based on Multi-Country Data2019Conference paper (Other academic)
  • 5261.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Orsini, Nicola
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Do sleep, stress, and illness explain daily variations in fatigue?: A prospective study2014In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 76, no 4, p. 280-285Article in journal (Refereed)
    Abstract [en]

    Objective: Fatigue is related to a number of serious diseases, as well as to general well-being. It is also a major cause of sickness absence and use of health facilities. Still, the determinants of variations in fatigue are little investigated. The purpose of present study was to investigate the relationships between the daily variations of fatigue with sleep during the previous night, stress or disease symptoms during the same day - across 42 consecutive days of normal life. Methods: 50 individuals participated and gave diary reports and used an actigraph across the 42 days. The data was analyzed using a multilevel approach with mixed model regression. Results: The analyses showed that the day-to-day variation in fatigue was related to (poor) sleep quality (p < .001) and (reduced) sleep duration (p < .01) the previous night, as well as to higher stress (p < .05), and to the occurrence of a cold or fever (p < .001) during the same day as the fatigue rating. Fatigue was also strongly related to poorer subjective health (p < .001) and sleepiness (p < .001) during the same day. Conclusion: The results indicate that prior sleep (and sleepiness) as well as stress and illness are consistently connected to how fatigue is experienced during normal living conditions.

  • 5262. Åkerstedt, Torbjörn
    et al.
    Knutsson, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational Medicine.
    Westerholm, P
    Theorell, Töres
    Alfredsson, Lars
    Kecklund, G
    Mental fatigue, work and sleep2004In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 57, no 5, p. 427-433Article in journal (Refereed)
    Abstract [en]

    Objective: The study examined the multivariate relationship between mental fatigue and different work-related (work load, work hours) and background/life style factors, as well as disturbed sleep.

    Methods: A total of 5720 healthy employed men and women living in the greater Stockholm area participated in a questionnaire study on cardiovascular risk factors. The data were analysed using a multiple logistic regression analysis with self-rated fatigue as the dependent variable.

    Results: Fatigue was predicted by disturbed sleep (4.31; 3.50-5.45, high immersion in work (4.17; 2.93-5.94), high work demands (2.39; 1.54-3.69), social support, being a female, being a supervisor and high age. Shift work, work hours (including overtime) and influence at work did not become significant predictors. With control for work demands a high number of work hours was associated with lower fatigue.

    Conclusion: Disturbed sleep is an important predictor of fatigue, apparently stronger than previously well-established predictors such as work load, female gender, lack of exercise, etc. (C) 2004 Elsevier Inc. All rights reserved.

  • 5263.
    Åkesdotter, Cecilia
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics. Karolinska Inst, Clin Neurosci, Stockholm, Sweden.
    Kenttä, Göran
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics. Univ Ottawa, Sch Human Kinet, Ottawa, ON, Canada.
    Eloranta, Sandra
    Karolinska Inst, Dept Med Clin Epidemiol, Stockholm, Sweden.
    Håkansson, Anders
    Lund Univ, Fac Med, Dept Clin Sci Lund, Psychiat, Lund, Sweden; Clin Sports & Mental Hlth Unit, Malmö, Sweden.
    Franck, Johan
    Karolinska Inst, Clin Neurosci, Stockholm, Sweden.
    Prevalence and comorbidity of psychiatric disorders among treatment-seeking elite athletes and high-performance coaches2022In: BMJ Open Sport & Exercise Medicine, ISSN 2398-9459, Vol. 8, no 1, article id e001264Article in journal (Refereed)
    Abstract [en]

    Objectives Few studies have evaluated the prevalence of psychiatric disorders among treatment-seeking elite athletes (EA) or high-performance coaches (HPC) in psychiatric outpatient settings. Methods Descriptive overview of EA and HPC with psychiatric disorders at two publicly funded psychiatric outpatient treatment clinics in Stockholm and Malmo, Sweden. Co-occurring psychiatric disorders were illustrated using Venn diagrams for EA and HPC, and male and female EA separately, among patients from the Stockholm clinic (SC) that used standardised diagnostic interviews. Results Overall, most patients were EA (n=221) compared with HPC (n=34). The mean age was 23.5 (+/- 5.9) years for EA and 42.8 (+/- 8.8) for HPC. Anxiety disorders were most common at the SC in EA and HPC (69% vs 91%, respectively). Stress-related disorders were found in 72% of HPC compared with 25% of EA. Affective disorders were found in 51% of EA and 52% of HPC. Eating disorders were common among EA (26%), especially females (37%). Substance use disorders were found in 17% of HPC. Comorbidity was generally common between affective and anxiety disorders. Conclusion Stress and adjustment disorders were found in nearly three of the four HPC compared with one in four EA. Eating disorders were prevalent in around one in four athletes and about one in six HPC had a substance use disorder.

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  • 5264.
    Åmlid, Håkon Olav
    et al.
    TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Carlsson, Jan
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Bjørnestad, Jone
    TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; Department of Psychiatry, District General Hospital of Førde, Førde, Norway.
    Joa, Inge
    TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Institute of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
    Hegelstad, Wenche Ten Velden
    TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
    We need to talk: a qualitative inquiry into pathways to care for young men at ultra-high risk for psychosis2024In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 15, article id 1282432Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: It is known from the literature that men are slower to seek help and staying engaged in mental health care compared to women. Seeing that in psychosis, men more often than women have insidious onsets but also a more malign illness course, it is important to find ways to improve timely help-seeking. The aim of this study was to explore barriers and facilitators for help-seeking in young male persons struggling with early signs of psychosis.

    METHODS: Qualitative interviews with nine young men who suffer from a first episode of psychosis or psychosis risk symptoms.

    RESULTS: Male stereotypical ideals, significant others, and knowledge of symptoms and where to get help as well characteristics of symptom trajectories appeared to be important determinants of help-seeking behavior.

    DISCUSSION: Interviews indicated that help-seeking in the participants was delayed first, because of reluctancy to disclose distress and second, because significant others were unable to accurately recognize symptoms. Information, awareness, and easy access to care remain important in early detection and intervention in psychosis and psychosis risk. However, more emphasis should be placed on de-stigmatizing mental health problems in men and aiming information specifically at them.

  • 5265.
    Ångström, Anna-Karin
    et al.
    Örebro University, School of Medical Sciences.
    Andersson, Anneli
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Garcia-Argibay, Miguel
    Örebro University, School of Medical Sciences.
    Chang, Zheng
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    D’Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA.
    Tuvblad, Catherine
    Örebro University, School of Behavioural, Social and Legal Sciences. Department of Psychology, University of Southern California, Los Angeles, California, USA.
    Ghirardi, Laura
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; MediNeos Observational Research ‐ IQVIA, Data Management & Statistics, Modena, Italy.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Criminal convictions in males and females diagnosed with attention deficit hyperactivity disorder: A Swedish national registry study2024In: JCPP Advances, E-ISSN 2692-9384, Vol. 4, no 1, article id e12217Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) face an elevated risk of criminal convictions compared to those without ADHD. However, understanding this link involves considering sex differences, coexisting psychiatric conditions, and unmeasured familial factors. This study aimed to explore the connection between ADHD and criminal convictions (both violent and non-violent) in males and females, while also assessing the impact of comorbid psychiatric disorders and familial factors.

    Methods: Using Swedish national registers, we identified individuals born between 1986 and 1997 (635,391 males and 600,548 females). ADHD was defined through clinical diagnosis and prescribed medications, while criminal convictions were determined based on Swedish lower court records. Unmeasured familial factors were accounted for using a sibling design approach.

    Results: Findings revealed that individuals with ADHD had a notably higher absolute and relative risk of both violent and non-violent criminal convictions compared to those without ADHD. While criminal convictions were more frequent among males with ADHD, females with ADHD exhibited higher relative risks (HR violent 10.50, non-violent 4.04) than their male counterparts (HR violent 6.03, non-violent 3.57). Additionally, lower socioeconomic status (SES) in individuals with ADHD was associated with increased relative risks for criminal convictions compared to individuals with ADHD who had higher SES. Adjusting for childhood and internalizing psychiatric disorders partially attenuated these associations, while substance use disorders (SUD) substantially attenuated them. SUD also contributed to an elevated absolute risk of criminal convictions in both male and female individuals with ADHD. Accounting for unmeasured shared familial factors slightly reduced the estimates, but the association between ADHD and criminal convictions persisted.

    Conclusion: In conclusion, ADHD remains a potent independent risk factor for criminal convictions, with varying effects based on gender. This underscores the importance of tailored crime prevention strategies and early interventions for individuals with ADHD, especially when comorbid SUD is present.

  • 5266.
    Åsberg Johnels, Jakob
    et al.
    Univ Gothenburg, Gillberg Neuropsychiat Ctr, Gothenburg, Sweden..
    Yngvesson, Paul
    Univ Gothenburg, Gillberg Neuropsychiat Ctr, Gothenburg, Sweden..
    Billstedt, Eva
    Univ Gothenburg, Gillberg Neuropsychiat Ctr, Gothenburg, Sweden..
    Gillberg, Christopher
    Univ Gothenburg, Gillberg Neuropsychiat Ctr, Gothenburg, Sweden..
    Halldner, Linda
    Umeå Univ, Dept Clin Sci Child & Adolescent Psychiat, Umeå, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Rastam, Maria
    Univ Gothenburg, Gillberg Neuropsychiat Ctr, Gothenburg, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Gustafsson, Peik
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Norén Selinus, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Ctr Psychiat Res, Stockholm, Sweden.;Swedish Sch Sport & Hlth Sci, Stockholm, Sweden..
    Lichtenstein, Paul
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Hellner, Clara
    Univ Gothenburg, Ctr Eth Law & Mental Hlth, Gothenburg, Sweden..
    Anckarsater, Henrik
    Univ Gothenburg, Ctr Eth Law & Mental Hlth, Gothenburg, Sweden..
    Lundstrom, Sebastian
    Univ Gothenburg, Gillberg Neuropsychiat Ctr, Gothenburg, Sweden.;Univ Gothenburg, Ctr Eth Law & Mental Hlth, Gothenburg, Sweden..
    The relationship between intelligence and global adaptive functioning in young people with or without neurodevelopmental disorders2021In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 303, article id 114076Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown an association between IQ and adaptive global functioning, i.e. how well a person is functioning in different domains of life. However, it is unclear to what extent such an association applies in children with neurodevelopmental disorders (NDDs). The study group consisted of 550 population-screened children assessed with the K-SADS, WISC-IV, and the C-GAS. Approximately half of the sample had been diagnosed with one or several NDDs (ADHD, autism, language disorder and tic disorder). A factorial ANOVA with IQ level and the presence of NDD was conducted, with C-GAS score as the dependent variable. Results revealed a significant interaction effect between IQ-group and NDD-status. In the non-NDD group (49% girls), higher IQ scores were clearly linked with better global adaptive functioning. Among children with NDDs (35% girls), however, higher IQ scores were not clearly associated with better functioning. Thus, the association between IQ and adaptive functioning were found to differ depending on the presence of NDD. These results have implications for the interpretation of IQ test results in neurodevelopmental assessments and point towards the importance of providing support based on an assessment of needs and functioning rather than scores from IQ tests.

  • 5267.
    Åsberg Johnels, Jakob
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Yngvesson, Paul
    University of Gothenburg, Gothenburg, Sweden.
    Billstedt, Eva
    University of Gothenburg, Gothenburg, Sweden.
    Gillberg, Christopher
    University of Gothenburg, Gothenburg, Sweden.
    Halldner, Linda
    Umeå University, Sweden; Karolinska Institute, Sweden.
    Råstam, Maria
    University of Gothenburg, Gothenburg, Sweden; Lund University, Lund, Sweden.
    Gustafsson, Peik
    Lund University, Lund, Sweden.
    Selinus, Eva Noren
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Hellner, Clara
    University of Gothenburg, Gothenburg, Sweden.
    Anckarsäter, Henrik
    University of Gothenburg, Gothenburg, Sweden.
    Lundström, Sebastian
    University of Gothenburg, Gothenburg, Sweden.
    The relationship between intelligence and global adaptive functioning in young people with or without neurodevelopmental disorders.2021In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 303, article id 114076Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown an association between IQ and adaptive global functioning, i.e. how well a person is functioning in different domains of life. However, it is unclear to what extent such an association applies in children with neurodevelopmental disorders (NDDs). The study group consisted of 550 population-screened children assessed with the K-SADS, WISC-IV, and the C-GAS. Approximately half of the sample had been diagnosed with one or several NDDs (ADHD, autism, language disorder and tic disorder). A factorial ANOVA with IQ level and the presence of NDD was conducted, with C-GAS score as the dependent variable. Results revealed a significant interaction effect between IQ-group and NDD-status. In the non-NDD group (49% girls), higher IQ scores were clearly linked with better global adaptive functioning. Among children with NDDs (35% girls), however, higher IQ scores were not clearly associated with better functioning. Thus, the association between IQ and adaptive functioning were found to differ depending on the presence of NDD. These results have implications for the interpretation of IQ test results in neurodevelopmental assessments and point towards the importance of providing support based on an assessment of needs and functioning rather than scores from IQ tests.

  • 5268.
    åsberg Johnels, Jakob
    et al.
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    Yngvesson, Paul
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    Billstedt, Eva
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    Gillberg, Christopher
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    Halldner, Linda
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Råstam, Maria
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Gustafsson, Peik
    Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Selinus, Eva Norén
    Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden; Centre for Psychiatry Research, Stockholm, Sweden; The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hellner, Clara
    Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden.
    Anckarsäter, Henrik
    Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden.
    Lundström, Sebastian
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden.
    The relationship between intelligence and global adaptive functioning in young people with or without neurodevelopmental disorders2021In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 303, article id 114076Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown an association between IQ and adaptive global functioning, i.e. how well a person is functioning in different domains of life. However, it is unclear to what extent such an association applies in children with neurodevelopmental disorders (NDDs). The study group consisted of 550 population-screened children assessed with the K-SADS, WISC-IV, and the C-GAS. Approximately half of the sample had been diagnosed with one or several NDDs (ADHD, autism, language disorder and tic disorder). A factorial ANOVA with IQ level and the presence of NDD was conducted, with C-GAS score as the dependent variable. Results revealed a significant interaction effect between IQ-group and NDD-status. In the non-NDD group (49% girls), higher IQ scores were clearly linked with better global adaptive functioning. Among children with NDDs (35% girls), however, higher IQ scores were not clearly associated with better functioning. Thus, the association between IQ and adaptive functioning were found to differ depending on the presence of NDD. These results have implications for the interpretation of IQ test results in neurodevelopmental assessments and point towards the importance of providing support based on an assessment of needs and functioning rather than scores from IQ tests.

  • 5269.
    Åsberg, Katarina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Karolinska Inst, Sweden.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Effects of a single session low-threshold digital intervention for procrastination behaviors among university students (Focus): Findings from a randomized controlled trial2024In: Internet Interventions, ISSN 2214-7829, Vol. 36, article id 100741Article in journal (Refereed)
    Abstract [en]

    Introduction: Procrastination behaviors are common among university students, and have been found to be associated with stress, symptoms of depression, anxiety, and poorer academic performance. There is a need for interventions that can reach students at scale, and therefore this study aimed to estimate the effects of a single session low-threshold digital intervention (Focus) for procrastination behaviors among university students in Sweden. Methods and analysis: A two-arm, parallel groups (1:1), single blind randomized controlled trial was conducted between February 8 to April 26, 2023. The study used email to invite university students across Sweden to participate in the trial. Both the intervention and the control group were invited to assess their current procrastination behaviors using the Pure Procrastination Scale (PPS). The intervention group immediately received feedback and behavior change advice by means of an interactive website, while the control group was shown their total PPS score without any further feedback. Students were included in the study if they scored 20 points or more on the PPS. Our primary outcome was procrastination behavior measured at 2 months post-randomization. Analyses were conducted using multilevel regression models estimated with Bayesian inference. Results: A total of 2209 participants (intervention: 1109, control: 1100) were randomized. The average age of participants was 26.4 years (SD = 7.8) and 65 % were women (n = 1442). The mean PPS score at baseline was 35.6 points (of a maximum of 60). Primary outcome data were available for 45 % (n = 498) of the intervention group and 55 % (n = 601) of the control group. The evidence suggested no marked difference between groups regarding any of the outcomes, although there was weak evidence of lower physical activity in the intervention group. Qualitative findings from open-ended responses uncovered a variety of views on procrastination and perceived problems that may follow. Those not feeling supported by Focus explained having troubles adopting the advice given and converting their intentions into action without more continuous support. Conclusions: Access to a single session of feedback and behavior change advice by means of an interactive website did not produce differential self-reported procrastination among university students who took the opportunity to self-assess their behaviors. The findings are limited by assessment reactivity due to screening at baseline and attrition to follow-up.

  • 5270.
    Åslund, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Depression and Antisocial Behaviour in Adolescents: Influence of Social Status, Shaming, and Gene-Environment Interaction2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis investigated (1) social status and shaming experiences in relation to aggressive behaviour and depression, and (2) gene-environment interactions between two genetic polymorphisms related to the serotonergic system – MAOA-VNTR and 5HTTLPR – and experiences of maltreatment in relation to delinquent behaviour and depression among adolescents.

    The four included studies are based on questionnaire data from the Survey of Adolescent Life in Vestmanland 2006 (SALVe-2006). A total of 5396 students in 9th (15-16 years old) grade of elementary school and 2nd (17-18 years old) grade of high school comprised the target population. The students in 2nd grade of high school also provided a saliva sample for gene extraction.

    There were strong associations between shaming experiences and both aggressive behaviour and depression. In addition, individuals who reported many shaming experiences and had either low or high social status had increased risks of physical aggression or depression, whereas medium social status seemed to have a protective effect.

    Gene-environment interactions were found between experiences of maltreatment and the MAOA-VNTR in relation to delinquent behaviour. Moreover, the direction of the gene-environment interaction differed depending on sex: boys with the short (S) variant of the MAOA-VNTR, in contrast to girls with the long (LL) variant, had the highest risk of delinquency in combination with maltreatment.

    Gene-environment interactions were also found between experiences of maltreatment and the 5HTTLPR in relation to depression among girls. The girls that were homozygous for the S allele (SS) had the highest risk of depression in combination with maltreatment. Among boys however, no gene-environment interaction was found between the 5HTTLPR and maltreatment in relation to depression.

    In conclusion, it is important to consider both genetic effects, and psychosocial factors such as social status, shaming experiences, and experiences of maltreatment when investigating different aspects of health and behaviour among adolescents.

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  • 5271.
    Åslund, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Starrin, Bengt
    Sjöberg, Rickard L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Shaming experiences and the association between adolescent depression and psychosocial risk factors2007In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 16, no 5, p. 298-304Article in journal (Refereed)
    Abstract [en]

    Objective  To investigate whether psychosocial risk factors such as parental separation, parental unemployment and experiences of sexual abuse are associated with adolescent depression, and whether shaming experiences (defined as experiences of being degraded, or ridiculed by others) may account for such an association. Method  A total of 5048 Swedish adolescents answered the Survey of Adolescent Life in Vestmanland 2004 (SALVe—2004) during classhours. The survey included questions about depressive symptoms, parental separation, parental unemployment and experiences of sexual abuse. Results  The psychosocial risk factors studied were all associated with depression, but several of these associations became non-significant when a factor for shaming experiences was entered into the models. The explained variance for depression furthermore increased from approximately 4–7% to 17–20% when shame was included. Conclusion  Shaming experiences may mediate part of the association between psychosocial risk factors and depression. These findings may have important implications for the understanding of psychotherapeutic treatment of the effects of risk factors in depressed patients.

  • 5272.
    Åslund, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Nordquist, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Pharmacology.
    Comasco, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Pharmacology.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Oreland, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Pharmacology.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Maltreatment, MAOA, and delinquency: Sex differences in gene-environment interaction in a large population-based cohort of adolescents2011In: Behavior Genetics, ISSN 0001-8244, E-ISSN 1573-3297, Vol. 41, no 2, p. 262-272Article in journal (Refereed)
    Abstract [en]

    The present study investigated a possible interaction between a functional polymorphism in the MAOA gene promoter (MAOA-VNTR) and childhood maltreatment in the prediction of adolescent male and female delinquency. A cohort of 1 825 high school students, 17-18 years old, completed an anonymous questionnaire during class hours which included questions on childhood maltreatment, sexual abuse, and delinquency. Saliva samples were collected for DNA isolation, and analyzed for the MAOA-VNTR polymorphism.

    Self-reported maltreatment was a strong risk factor for adolescent delinquent behavior. The MAOA genotype also showed a significant main effect when controlled for maltreatment. Boys with a short variant and girls with one or two long variants of the polymorphism showed a higher risk for delinquency when exposed to maltreatment. Our results confirm previous findings of an interaction between the MAOA-VNTR polymorphism and self-reported maltreatment. Results for boys and girls differ according to MAOA-VNTR genotype and direction of phenotypic expression.

  • 5273.
    Åslund, Li
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Jernelöv, Susanna
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Serlachius, Eva
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Child and Adolescent Psychiatry, Department of Clinical Sciences, Faculty of Medicine, Lund University, Sweden; Child and Adolescent Psychiatry, Region Skåne, Sweden.
    Vigerland, Sarah
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Wicksell, Rikard K
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Pain Clinic, Capio St Göran Hospital, Sweden.
    Henje Blom, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Lekander, Mats
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Stress Research Institute, Stockholm University, Sweden.
    Internet-delivered cognitive behavioral therapy for adolescents with insomnia: Feasibility and preliminary efficacy2023In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is common in adolescents. This study evaluated feasibility and preliminary efficacy of a six-week internet-delivered cognitive-behavioral therapy for insomnia (ICBT-I) in adolescents.

    Methods: In this uncontrolled pilot study, participants (n = 27, 78% female) completed assessments pre- and post intervention. Data on recruitment, adherence to treatment, treatment activity, satisfaction and credibility was collected to assess feasibility. Self-reported insomnia symptoms, sleep parameters as well as depression, anxiety and daytime function were also assessed.

    Results: Participants showed good adherence to treatment and found the intervention overall credible and satisfactory. From pre- to post-assessment, statistically significant improvements were found for insomnia symptoms (p <.001; d = 1.02), sleep onset latency (p <.001; d =.39), wake after sleep onset (p =.001; d =.34), sleep efficiency (p <.001; d =.5) and depression (p =.01, d =.37). Changes in scores of total sleep time, generalized anxiety, daytime sleepiness and functional disability were not significant.

    Conclusions: The present study indicates that ICBT-I is well accepted by adolescents, that insomnia symptoms and sleep parameters can improve following the intervention, and that co-morbid symptoms of depression can be reduced. Due to the limited sample size and the uncontrolled design, the suggested results need to be replicated in well-powered controlled clinical trials.

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  • 5274. Åslund, Li
    et al.
    Jernelöv, Susanna
    Serlachius, Eva
    Vigerland, Sarah
    Wicksell, Rikard K.
    Henje, Eva
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Internet-delivered cognitive behavioral therapy for adolescents with insomnia: Feasibility and preliminary efficacy2024In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 29, no 3, p. 1159-1173Article in journal (Refereed)
    Abstract [en]

    Background Insomnia is common in adolescents. This study evaluated feasibility and preliminary efficacy of a six-week internet-delivered cognitive-behavioral therapy for insomnia (ICBT-I) in adolescents.

    Methods In this uncontrolled pilot study, participants (n = 27, 78% female) completed assessments pre- and post intervention. Data on recruitment, adherence to treatment, treatment activity, satisfaction and credibility was collected to assess feasibility. Self-reported insomnia symptoms, sleep parameters as well as depression, anxiety and daytime function were also assessed.

    Results Participants showed good adherence to treatment and found the intervention overall credible and satisfactory. From pre- to post-assessment, statistically significant improvements were found for insomnia symptoms (p < .001; d = 1.02), sleep onset latency (p < .001; d = .39), wake after sleep onset (p = .001; d = .34), sleep efficiency (p < .001; d = .5) and depression (p = .01, d = .37). Changes in scores of total sleep time, generalized anxiety, daytime sleepiness and functional disability were not significant.

    Conclusions The present study indicates that ICBT-I is well accepted by adolescents, that insomnia symptoms and sleep parameters can improve following the intervention, and that co-morbid symptoms of depression can be reduced. Due to the limited sample size and the uncontrolled design, the suggested results need to be replicated in well-powered controlled clinical trials.

  • 5275.
    Åslund, Lie
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, CAP Research Centre, Sweden.
    Andreasson, Anna
    Stress Research Institute, Stockholm University, Sweden.
    Lekander, Mats
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Stress Research Institute, Stockholm University, Sweden.
    Henje, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Dennhag, Inga
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Disturbed sleep and patterns of psychiatric symptoms and function in a school-based sample of adolescents2023In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 28, no 4, p. 1524-1535Article in journal (Refereed)
    Abstract [en]

    Background: Sleep problems are common in adolescence and often related to psychopathology and impaired functioning. However, most studies have used summative scores, and little is known about how adolescents with disrupted sleep perceive their specific symptoms and dysfunctions. This study explored differences in levels of psychiatric symptoms and functional ability between Swedish adolescents with and without self-reported disturbed sleep in a school-based sample.

    Methods: Swedish adolescents (n = 618, mean age 15.7+/-1.9yrs) answered the PROMIS pediatric measures for fatigue, anxiety, depression, pain interference, anger, physical activity and peer and family relationships. Logistic regression analyses were performed to assess differences between respondents with and without disturbed sleep.

    Results: Disturbed sleep was associated with higher levels of symptoms of fatigue, anxiety, depression, anger and pain interference, as well as lower functional abilities in terms of physical activity and peer- and family relationships. Adolescents reporting disturbed sleep generally displayed a pattern of impaired executive functioning, internal emotional distress and school- and sleep related worry and dysfunction, as compared to physical disability, aggressive behavior, stress and generalized worry.

    Conclusions: The present study adds to the understanding of how disturbed sleep and specific psychiatric symptoms and functional ability are interrelated, which may also have clinical implications.

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  • 5276. Åslund, Lie
    et al.
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Stockholm, Sweden.
    Henje, Eva
    Dennhag, Inga
    Disturbed sleep and patterns of psychiatric symptoms and function in a school-based sample of adolescents2023In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 28, no 4, p. 1524-1535Article in journal (Refereed)
    Abstract [en]

    Background Sleep problems are common in adolescence and often related to psychopathology and impaired functioning. However, most studies have used summative scores, and little is known about how adolescents with disrupted sleep perceive their specific symptoms and dysfunctions. This study explored differences in levels of psychiatric symptoms and functional ability between Swedish adolescents with and without self-reported disturbed sleep in a school-based sample.

    Methods Swedish adolescents (n = 618, mean age 15.7+/-1.9yrs) answered the PROMIS pediatric measures for fatigue, anxiety, depression, pain interference, anger, physical activity and peer and family relationships. Logistic regression analyses were performed to assess differences between respondents with and without disturbed sleep.

    Results Disturbed sleep was associated with higher levels of symptoms of fatigue, anxiety, depression, anger and pain interference, as well as lower functional abilities in terms of physical activity and peer- and family relationships. Adolescents reporting disturbed sleep generally displayed a pattern of impaired executive functioning, internal emotional distress and school- and sleep related worry and dysfunction, as compared to physical disability, aggressive behavior, stress and generalized worry.

    Conclusions The present study adds to the understanding of how disturbed sleep and specific psychiatric symptoms and functional ability are interrelated, which may also have clinical implications.

  • 5277. Åslund, Lie
    et al.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Kanstrup, Marie
    Lekander, Mats
    Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis2018In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 14, no 11, p. 1937-1947Article, review/survey (Refereed)
    Abstract [en]

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

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

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

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

  • 5278. Åslund, Lie
    et al.
    Lekander, Mats
    Wicksell, Rikard K.
    Henje Blom, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Jernelöv, Susanna
    Cognitive-behavioral therapy for insomnia in adolescents with comorbid psychiatric disorders: A clinical pilot study2020In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 25, no 4, p. 958-971Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is common in adolescents and often comorbid with psychiatric disorders. This study evaluated changes in insomnia, sleep, and comorbid symptoms following cognitive-behavioral therapy for insomnia (CBT-I) in adolescents with comorbid psychiatric disorders and chronic pain.

    Methods: In this non-controlled clinical pilot study, participants (n = 23, 78% female) were recruited from adolescent psychiatry and pediatric pain clinics. Assessments of self-reported insomnia, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency and depression, anxiety, functional disability, and pain intensity were completed at pre- and post-intervention and 3 months follow-up.

    Results: From pre- to post-intervention, statistically significant improvements were found for insomnia symptoms (p < .001; d = 1.63), sleep onset latency (p < .001; d = 1.04), wake after sleep onset (p < .001; d = 0.38), total sleep time (p = .015; d = 0.22), sleep efficiency (p < .001; d = 1.00), depression (p < .001; d = 0.87), and anxiety (p = .001; d = 0.31). Only eight participants reported data at follow-up with maintained improvements for all measures.

    Conclusion: This study provides support that insomnia symptoms and sleep can improve following CBT-I delivered in a clinical setting and that co-occurring psychiatric symptoms can be reduced. The results should be interpreted with caution due to the uncontrolled conditions and limited sample size. Well-powered clinical trials are needed to validate the suggested effects.

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  • 5279. Åslund, Lie
    et al.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Wicksell, Rikard K.
    Henje, Eva
    Jernelöv, Susanna
    Cognitive-behavioral therapy for insomnia in adolescents with comorbid psychiatric disorders: A clinical pilot study2020In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 25, no 4, p. 958-971Article in journal (Refereed)
    Abstract [en]

    Background: Insomnia is common in adolescents and often comorbid with psychiatric disorders. This study evaluated changes in insomnia, sleep, and comorbid symptoms following cognitive-behavioral therapy for insomnia (CBT-I) in adolescents with comorbid psychiatric disorders and chronic pain. Methods: In this non-controlled clinical pilot study, participants (n = 23, 78% female) were recruited from adolescent psychiatry and pediatric pain clinics. Assessments of self-reported insomnia, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency and depression, anxiety, functional disability, and pain intensity were completed at pre- and post-intervention and 3 months follow-up. Results: From pre- to post-intervention, statistically significant improvements were found for insomnia symptoms (p < .001;d = 1.63), sleep onset latency (p < .001;d = 1.04), wake after sleep onset (p < .001;d = 0.38), total sleep time (p = .015;d = 0.22), sleep efficiency (p < .001;d = 1.00), depression (p < .001;d = 0.87), and anxiety (p = .001;d = 0.31). Only eight participants reported data at follow-up with maintained improvements for all measures. Conclusion: This study provides support that insomnia symptoms and sleep can improve following CBT-I delivered in a clinical setting and that co-occurring psychiatric symptoms can be reduced. The results should be interpreted with caution due to the uncontrolled conditions and limited sample size. Well-powered clinical trials are needed to validate the suggested effects.

  • 5280. Åström, Jenny
    et al.
    Holmström, Linda
    Karshikoff, Bianka
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska Institutet, Sweden; Macquarie University, Australia.
    Kemani, Mike K.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Karolinska University Hospital, Sweden.
    Evaluating the construct validity and internal consistency of the Sickness Questionnaire in a Swedish sample of adults with longstanding pain2022In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 22, no 1, p. 88-96Article in journal (Refereed)
    Abstract [en]

    Objectives: Low-grade inflammation is a possible contributing factor in the development and persistence of chronic primary pain syndromes. Related to inflammatory activity is sickness behavior, a set of behavioral responses including increased pain sensitivity, fatigue, malaise, fever, loss of appetite, as well as depressive behavior and anhedonia. To capture these behavioral responses and their relation to longstanding pain, psychometrically sound self-report questionnaires are needed. The Sickness Questionnaire (SicknessQ) was developed to assess self-reported sickness behavior based on studies on acute immune activation while maintaining relevance for persistent conditions. The aim of the current study was to evaluate aspects of the validity and reliability of the SicknessQ in a Swedish sample of persons with longstanding pain.

    Methods: Aspects of construct validity were evaluated by means of performing a confirmatory factor analysis (CFA) (testing structural validity) and by relevant hypothesis testing i.e., that ratings of sickness behavior in combination with other related factors (e.g., depression and anxiety) would be significantly related to ratings of avoidance. Reliability was evaluated by means of analyzing the internal consistency of items.

    Results: Following the CFA, a non-significant Chi-Square test (chi(2) [32, N=190] = 42.95, p=0.094) indicated perfect model fit. Also, the relative fit indices supported adequate model fit (CFI = 0.978; TLI = 0.969; RMSEA = 0.0430). Sickness behavior (p<0.0001), depression (p<0.05) and pain duration (p<0.05) significantly contributed to the regression model, explaining 45% of the total variance in avoidance. Internal consistency was adequate, as indicated by a Cronbach's alpha value of 0.82 for the entire questionnaire.

    Conclusions: Results indicate that the SicknessQ has adequate structural validity as well as adequate internal consistency, and is significantly associated with avoidance. The SicknessQ appears to have utility as a self-report questionnaire to assess symptoms of sickness behavior for adults with longstanding pain.

  • 5281.
    Åström, Monica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Depression after stroke1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population.

    Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke.

    The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation.

    Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

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  • 5282.
    Åström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Major depression in stroke patients: A 3-year longitudinal study1993In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, no 7, p. 976-982Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.

  • 5283.
    Åström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Åström, T.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Life before and after Stroke: Living Conditions and Life Satisfaction in Relation to a General Elderly Population1992In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 2, no 1, p. 28-34Article in journal (Refereed)
    Abstract [en]

    Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.

  • 5284.
    Ögren, Kenneth
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Portrayals of lobotomy in American and Swedish media2013In: Literature, neurology and neuroscience: neurological and psychiatric disorders / [ed] Stanley Finger, François Boller and Anne Stiles, Amsterdam: Elsevier , 2013, p. 201-217Chapter in book (Refereed)
    Abstract [en]

    Psychosurgery has a long history dating back to the 1880s when Gottlieb Burckhardt performed focal cerebral cortical excisions on the brains of six patients diagnosed with schizophrenia. His operations were vividly contested by the medical community of the time. In 1936, when Walter J. Freeman and James W. Watts performed their initial prefrontal lobotomies in the United States, they were met with some professional opposition from superintendents, who would not provide them with patients for the operation. However, Freeman and Watts managed to cope well with the opponents. In newspapers and magazines, the curiosity for lobotomy was obvious. Freeman was instrumental in the way he promoted lobotomy, and he evoked the interest of the press and the journalists for this new surgical treatment on mental illness, something that he regarded as a medico-historical breakthrough. In this chapter, the portrayal of lobotomy in American and Swedish newspapers and magazines is explored and analyzed. How did journalists write about lobotomy for the public in the years spanning 1936 to 1959, a period in which the American and Swedish presses appeared inclined to describe the positive effects of lobotomy, while neglecting the negative and fatal consequences of the operation. There are not only similarities but also interesting differences between the Swedish and the American articles depicting lobotomy. The media can be a powerful factor in the construction of “facts,” which can significantly affect decisions made by people about their health issues. 

  • 5285.
    Ögren, Kenneth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Department of culture and media studies.
    Psychosurgery in Sweden 1944 - 1958: the practice, the professional and media discourse2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context.

    Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden.

    • Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors.

    • Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959.

    • Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality.

    Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals.

    Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate.

    Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%).

    Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy.

    Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations.

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  • 5286.
    Ögren, Kenneth
    Umeå University, Faculty of Arts, Culture and Media. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The surgical offensives against mental disorder: psychosurgery in Sweden 1944-19582005Licentiate thesis, comprehensive summary (Other academic)
  • 5287.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Culture and Media.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 19582007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 5, p. 355-362Article in journal (Refereed)
    Abstract [en]

    This retrospective survey aims at describing patients subjected to prefrontal lobotomies and the general treatment conditions at Umedalen State Mental Hospital during the period 1947–1958. Data collected from psychiatric and surgical medical records was analysed using quantitative and qualitative content analysis. A total of 771 patients subjected to lobotomy during the years 1947–1958 were identified. From these, a sample of 105 patients was selected for the purpose of obtaining detailed data on socio-economic status, diagnosis, symptomatology, other psychiatric treatments applied before the pre-frontal lobotomy operation, time spent in hospital before operation, praxis of consent and mortality. The diagnosis of schizophrenia was found in 84% of the 771 lobotomized patients. The post-operative mortality was 7.4% (57 deaths), with the highest rate in 1949 (17%). The mean age of the patient at the time of operation was 44.8 years for females and 39.5 years for male patients. The average length of pre-operative time in hospital for females was 10.7 years and for males 3.5 years. It remains unclear why this mental hospital conducted the lobotomy operation to such a comparatively great extent. Factors such as overcrowding of wards and its status as a modern mental hospital may have contributed.

  • 5288.
    Ögren, Kenneth
    et al.
    Umeå universitet, Institutionen för kultur- och medievetenskaper.
    Sjöström, Stefan
    Umeå universitet, Institutionen för socialt arbete.
    Bengtsson, Nils-Olof
    Lobotomins okända historia: kvinnor, barn och idioter opererades2000In: Läkartidningen, Vol. 97, no 30-31, p. 3395-3398Article in journal (Other academic)
  • 5289.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Sjöström, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Bengtsson, Nils-Olof
    Lobotomins okända historia: kvinnor, barn och idioter opererades2000In: Läkartidningen, Vol. 97, no 30-31, p. 3395-3398Article in journal (Other academic)
  • 5290.
    Ögren, Kenneth
    et al.
    Institutionen för Kultur Och Medier, Umeå Universitet, Sweden.
    Sjöström, Stefan
    Luleå University of Technology.
    Bengtsson, Nils-Olof
    Onkologiska Kliniken, Norrlands Universitetssjukhus, Sweden.
    Lobotomins okända historia: Kvinnor, barn och idioter opererades: [The unknown history of lobotomy: Women, children and idiots were lobotomized]2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, no 30/31, p. 3395-3398Article in journal (Other academic)
    Abstract [en]

    The history of prefrontal lobotomy is an interesting example of medicine regarding as useful a treatment method which present-day consensus evaluates in a contrary fashion. A pilot study of archives from the Swedish state mental hospital Umedalen shows that the frequency of lobotomies as well as postoperative mortality were higher than what has earlier been assumed. The majority of the 704 patients who underwent lobotomy at Umedalen hospital were women. One unexpected finding concerns the numbers of mentally retarded patients and children who were subjected to lobotomy. Case records and other documents from the hospital archives indicate that the operation was performed largely for the benefit of the hospital rather than the patient, with an eye to engendering calm and order on the unruly wards.

  • 5291.
    Öhlund, Louise
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Forskningsenheten Sunderbyn.
    Factors affecting the pharmacological treatment of bipolar disorder2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: In patients with bipolar disorder, long-term treatment with mood-stabilisers is often required to prevent manic and depressive episodes. At present, our knowledge remains limited regarding factors that influence the outcomes of mood-stabiliser treatment.

    Lithium is a first-line treatment of bipolar disorder, thought to be superior regarding the prevention of acute relapse, self-harm and suicide. But despite its therapeutic superiority, patients may find lithium difficult to take long-term. The reasons why patients discontinue lithium treatment remain largely unknown. Neither do we know whether lithium is equally effective in patients with bipolar I and bipolar II disorder. Finally, there is only little evidence on how patients with a dual diagnosis of bipolar disorder and adult attention-deficit hyperactivity disorder (ADHD) should be treated. In this patient group, central stimulant treatment may be of benefit, as long as mood-stabilisers are given simultaneously to prevent manic relapses. However, there are no studies that have explored the impact of central stimulants on suicidal and non-suicidal self-injurious behaviour in patients with such a dual diagnosis.

    Aim: The overall aim of this thesis was to study three factors that may modify treatment outcomes in patients with bipolar disorder or schizoaffective disorder; (1) adherence to lithium and reasons for lithium discontinuation, (2) impact of lithium discontinuation on clinical course in different bipolar disorder subtypes, and (3) impact of central stimulants on suicidal and non-suicidal self-injurious behaviour in patients with a dual diagnosis of bipolar disorder and ADHD.

    Method shared by all studies: All three studies were part of LiSIE (Lithium – Study into Effects and Side Effects), a retrospective cohort study in the regions of Norrbotten and Västerbotten, exploring effects and side-effects of lithium and other mood-stabilisers.  For our studies, we identified 1566 individuals who had been diagnosed with bipolar disorder or schizoaffective disorder. Study II and III are based on 1564 patients due to consent withdrawal in one patient and diagnosis reassessment in another. For the respective study included in this thesis, we extracted routine clinical data from the medical records.

    Study I identified and assessed the reasons for lithium discontinuation in 468 patients with bipolar disorder or schizoaffective disorder in relation to (a) type of underlying disorder, bipolar I or schizoaffective disorder versus bipolar II or other bipolar disorder, (b) gender, and (c) person taking the initiative to discontinue lithium (doctor or patient).

    Study II applied a mirror-image design to examine the clinical course and need for hospital admissions in 194 patients with either bipolar I or schizoaffective disorder or bipolar II or other bipolar disorder within two years before and after lithium discontinuation.

    Study III assessed occurrence of suicidal or non-suicidal self-injurious behaviour in 206 patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD. This study also used a mirror-image design, comparing the number of suicide attempts and non-suicidal self-injury events within six months and two years before and after central stimulant initiation.

    Results: Study I: More than half of all patients discontinued lithium at some point. Lithium discontinuation mainly occurred because of adverse effects. More patients with bipolar II or other bipolar disorder than patients with bipolar I or schizoaffective disorder discontinued lithium because of a perceived lack of effect. Men were more likely to discontinue lithium when feeling well. They were also less likely to consult with a doctor prior discontinuation.

    Study II: The number of hospital admissions and bed-days doubled after lithium discontinuation. This increase was exclusively attributable to patients with bipolar I or schizoaffective disorder. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood-stabiliser at the time of lithium discontinuation led to more admissions.

    Study III: In patients with a dual diagnosis of bipolar or schizoaffective disorder and ADHD, central stimulant treatment reduced the number of suicide attempts and non-suicidal self-injury events. There was no increase in number of hospital admissions.

    Conclusion: Lithium discontinuation in patients with bipolar disorder or schizoaffective disorder is common and mainly occurs because of adverse effects. It is important that patients who may benefit from lithium can continue their treatment. Therefore, clinicians should discuss and manage potential adverse effects of lithium treatment with patients before initiation and continuously during treatment. Particularly men may require proactive follow-up since they may be more likely to discontinue their treatment without consulting a doctor.

    Lithium discontinuation in patients with bipolar I or schizoaffective disorder comes at a cost of deteriorated mental health and increased hospital utilisation. In patients with bipolar II or other bipolar disorder, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admissions. The higher relapse risk in patients with bipolar I or schizoaffective disorder points towards a need to apply a higher threshold for lithium discontinuation in this group.

    In patients with both bipolar disorder and ADHD, addition of central stimulant treatment may reduce the risk of suicide attempts and non-suicidal self-injury events. This suggests that central stimulants can be safely given in this patient group, as long mood-stabiliser treatment are given concomitantly.

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  • 5292.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Lieber, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Trainee editorial: psychiatry should be taught from day one in medical school2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S3-S4Article in journal (Other academic)
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  • 5293.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Bergqvist, M.
    Oja, S.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychiatric hospital utilisation following lithium discontinuation in patients with bipolar I or II disorder: A mirror-image study based on the lisie retrospective cohort2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, p. S79-S79, article id O011Article in journal (Other academic)
  • 5294.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Bergqvist, Malin
    Oja, Sofia
    Lundqvist, Robert
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Clinical course and need for hospital admission after lithium discontinuation in patients with bipolar disorder type I or II: mirror-image study based on the LiSIE retrospective cohort2019In: BJPsych Open, E-ISSN 2056-4724, Vol. 5, no 6, article id e101Article in journal (Refereed)
    Abstract [en]

    Background: Currently, the evidence for lithium as a maintenance treatment for bipolar disorder type II (BD-II) remains limited. Guidelines commonly extrapolate recommendations for BD-II from available evidence for bipolar disorder type I (BD-I). Comparing the impact of lithium discontinuation is one way of assessing effectiveness in both groups.

    Aims: To compare the impact of lithium discontinuation on hospital admissions and self-harm in patients with BD-I or schizoaffective disorder (SZD) and patients with BD-II or other bipolar disorder.

    Method: Mirror-image study, examining hospital admissions within 2 years before and after lithium discontinuation in both patient groups. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of bipolar disorder as compared with other mood stabilisers.

    Results: For the whole sample, the mean number of admissions/patient/review period doubled from 0.44 to 0.95 (P<0.001) after lithium discontinuation. The mean number of bed days/patient/review period doubled from 11 to 22 (P = 0.025). This increase in admissions and bed days was exclusively attributable to patients with BD-I/SZD. Not having consulted with a doctor prior to lithium discontinuation or no treatment with an alternative mood stabiliser at the time of lithium discontinuation led to more admissions.

    Conclusions: The higher relapse risk in patients with BD-I/SZD suggests a higher threshold for discontinuing lithium than for patients with BD-II/other bipolar disorder. In patients with BD-II/other bipolar disorder, however, judged on the impact of discontinuation alone, lithium did not appear to prevent more severe depressive episodes requiring hospital admission.

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  • 5295.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Self-injurious behaviour in patients with bipolar disorder and attention deficit hyperactivity disorder after central stimulant start: a retrospective study based on the lisie cohort2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, no S1, p. S79-S80, article id O012Article in journal (Other academic)
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  • 5296.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Forskningsenheten Sunderbyn.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Forskningsenheten Sunderbyn.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Forskningsenheten Sunderbyn.
    Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort2020In: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 10, p. 1-19Article in journal (Refereed)
    Abstract [en]

    Background: Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events.

    Methods: A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers.

    Results: Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events (p = 0.013) and numbers of events experienced (p = 0.004). These effects were preserved 2 years after CS initiation.

    Conclusions: CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.

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  • 5297.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Oja, Sofia
    Bergqvist, Malin
    Lundqvist, Robert
    Research and Innovation Unit, Luleå, Norrbotten Region, Sweden.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Hospital – Psychiatry, 97180 Luleå, Sweden.
    Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study2018In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 18, article id 37Article in journal (Refereed)
    Abstract [en]

    Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

    Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

    Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

    Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

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  • 5298.
    Öjebrandt, Johan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ungdomars självupplevda uppfattning av etiologin till depression – en kvalitativ studie2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 5299.
    Öst, Lars-Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Bergen, Norway.
    Enebrink, Pia
    Finnes, Anna
    Ghaderi, Ata
    Havnen, Audun
    Kvale, Gerd
    Salomonsson, Sigrid
    Wergeland, Gro Janne
    Cognitive Behavior Therapy for Adult Anxiety Disorders in Routine Clinical Care: A Systematic Review and Meta-Analysis2023In: Clinical psychology, ISSN 0969-5893, E-ISSN 1468-2850, Vol. 30, no 3, p. 272-290Article, review/survey (Refereed)
    Abstract [en]

    Cognitive-behavioral therapy (CBT) has received strong research support for anxiety disorders such as panic disorder, agoraphobia, social anxiety disorder, and generalized anxiety disorder. However, less is known about how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis were conducted of CBT for these anxiety disorders in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for the same disorders. Sixty-six studies were included, comprising 6,113 participants. Large within-group effect sizes (ESs; Hedges’s g) were detected for anxiety measures at posttreatment (1.09) and follow-up (1.39), as well as for the secondary outcome of depression measures (0.80 at both assessment points). Attrition rate across the disorders was 15.9%. The benchmarking analysis showed that effectiveness studies had very similar ES (1.09) as efficacy studies (1.07) at posttreatment and at follow-up (1.39 vs. 1.30), and there were no significant differences in remission rates. Thus, the outcomes of effectiveness studies for these anxiety disorders are comparable with the results obtained in efficacy studies.

  • 5300.
    Öst, Lars-Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
    Enebrink, Pia
    Finnes, Anna
    Ghaderi, Ata
    Havnen, Audun
    Kvale, Gerd
    Salomonsson, Sigrid
    Wergeland, Gro Janne
    Cognitive behavior therapy for adult depressive disorders in routine clinical care: A systematic review and meta-analysis2023In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 331, p. 322-333Article, review/survey (Refereed)
    Abstract [en]

    Background: Different cognitive behavioral therapies (CBT) have strong research support for treatment of adult depressive disorders (DD). Given the scarcity of knowledge about the performance of CBT in routine clinical care, a systematic review and meta-analysis of CBT for adults with DD treated in this context was conducted.

    Methods: Published studies until the end of September 2022, were systematically searched in Ovid MEDLINE, Embase OVID, and PsycINFO. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for DD.

    Results: Twenty-eight studies, comprising 3734 participants, were included. Large within-group effect sizes (ES) were obtained for DD-severity at post-treatment, and follow-up, on average 8 months post-treatment. Benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.51 vs. 1.71) and follow-up (1.71 vs. 1.85). Remission rates were also very similar; effectiveness studies 44 % and 46 %, efficacy studies 45 % and 46 %, at post-treatment and follow-up, respectively.

    Limitations: Only studies published in English-language peer-reviewed journals were included and the use of pre-post ES in the meta-analyses could contribute to biased outcomes.

    Conclusions: CBT for DD is an effective treatment when delivered in routine clinical care and the outcomes of effectiveness studies for DD are comparable to the effects obtained in efficacy studies.

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