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Holländare, F., Tillfors, M., Nordenskjöld, A. & Björk, T. (2020). Are quantity and content of psychiatric interventions associated with suicide? A case-control study of a Swedish sample. BMC Psychiatry, 20(1), Article ID 13.
Open this publication in new window or tab >>Are quantity and content of psychiatric interventions associated with suicide? A case-control study of a Swedish sample
2020 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 20, no 1, article id 13Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Research is required to identify those psychiatric interventions with a protective effect against suicide. The overarching aim of the current study was to examine whether completed suicide in psychiatric patients in a Swedish population was associated with the quantity and nature of previous medical and psychosocial treatment interventions.

METHODS: This retrospective case-control study (n = 308) compared a group of deceased psychiatric patients with matched controls. For every case of suicide, a control was found within psychiatry that matched according to sex, age, and primary psychiatric diagnosis. A stepwise forward logistic regression model with suicide as the dependent outcome variable was used.

RESULTS: Receiving pharmacotherapy combined with psychotherapy [OR: 0.44 (95% CI: 0.226-0.876), p = 0.019] and a higher number of outpatient visits in psychiatry [OR: 0.99 (95% CI: 0.982-0.999), p = 0.028] were negatively associated with suicide. These associations were still significant after controlling for previous serious suicide attempts and somatic comorbidity.

CONCLUSIONS: Frequent visits and pharmacotherapy combined with psychotherapy seem to be important for preventing suicide in psychiatric patients. The reasons for not receiving such therapy are important issues for further study.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Case-control, Psychiatric interventions, Psychiatry, Suicide, Suicide prevention
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-78963 (URN)10.1186/s12888-019-2421-z (DOI)000513703100004 ()31918712 (PubMedID)2-s2.0-85077722358 (Scopus ID)
Note

Funding Agencies:

Foundation for Medical Research 'Nyckelfonden' at the University Hospital of Örebro, Sweden  OLL-621651

Region Örebro County Research Committee  OLL-483691

Örebro University

Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2020-03-04Bibliographically approved
Cato, V., Holländare, F., Nordenskjöld, A. & Sellin Jönsson, T. (2019). Association between benzodiazepines and suicide risk: a matched case-control study. BMC Psychiatry, 19(1), Article ID 317.
Open this publication in new window or tab >>Association between benzodiazepines and suicide risk: a matched case-control study
2019 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, no 1, article id 317Article in journal (Refereed) Published
Abstract [en]

Background: It is unclear whether benzodiazepines increase the risk of suicide. The aim of this study was to test the hypothesis that benzodiazepines are associated with an increased risk of suicide, by comparing psychopharmacological interventions between psychiatric patients who committed suicide and a group of matched controls.

Methods: The case group comprised 154 psychiatric patients (101 men, 53 women; age range: 13-96 years) who had committed suicide in orebro County, Sweden. Control psychiatric patients matched by age, sex, and main psychiatric diagnosis were selected for each case. Binary logistic regression was used to calculate odds ratios in unadjusted and adjusted models.

Results: Benzodiazepine prescriptions were more common among cases than controls (65/154 [42.2%] versus 43/154 [27.9%], p = 0.009, odds ratio: 1.89 [95% CI: 1.17-3.03]). This association remained significant in a model adjusted for previous suicide attempts and somatic hospitalizations (odds ratio: 1.83 [95% CI: 1.06-3.14]). No statistically significant differences were seen between the groups in the use of any other subtype of psychopharmaceutical agent.

Conclusions: These data indicate that benzodiazepine use may increase the risk of suicide. However, this study is limited by the potential for indication bias.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Suicide, Benzodiazepine, Psychopharmaceuticals, Case control
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-77909 (URN)10.1186/s12888-019-2312-3 (DOI)000493085000003 ()31655565 (PubMedID)2-s2.0-85074147378 (Scopus ID)
Note

Funding Agencies:

Foundation for Medical Research 'Nyckelfonden' at the University hospital, Örebro County, Sweden  OLL-621651

Örebro County Council Research Committee, Sweden  OLL-483691

Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2019-11-15Bibliographically approved
Rytterström, P., Lindeborg, M., Korhonen, S. & Björk, T. (2019). Finding the Silent Message: Nurses’ Experiences of Non-Verbal Communication Preceding a Suicide. Psychology, 10(1), 1-18
Open this publication in new window or tab >>Finding the Silent Message: Nurses’ Experiences of Non-Verbal Communication Preceding a Suicide
2019 (English)In: Psychology, ISSN 2152-7180, E-ISSN 2152-7199, Vol. 10, no 1, p. 1-18Article in journal (Refereed) Published
Abstract [en]

Suicidal individuals often communicate their intention to commit suicide, but not necessarily verbally. Psychiatric nurses play a central role in the care of patients exhibiting suicidal behaviour or thoughts. Thus, the aim of this study was to explore nurses’ experiences of the indirect messages about forthcoming suicide from patients’ everyday life before they committed suicide. A qualitative design was used with a phenomenological hermeneutical approach. Seven nurses working in specialist psychiatric care were interviewed about their experience of the phenomenon communication about suicide. Results show how the nurses noticed changes in patients just before they committed suicide. These changes included rapid improvement, disguise of real feelings, and unreceptiveness to further treatment or encouragements. The nurses also described patients becoming aware of painful life conditions of losing hope and confidence in the future and experiencing feelings of powerlessness or an inability to influence the situation. Their last moments were characterised by a greater preoccupation with thoughts about death and finding ways to express farewells. This manifested itself in practical preparations and expressing gratitude to people, which was understood by the nurses as a way of saying goodbye. This study shows that it is possible for skilled staff to develop an understanding of a suicidal patient’s internal state and to recognise the non-verbal messages of someone who later committed suicide. The knowledge of how patients prepare and act before suicide could be used to complement a structural suicide risk assessment.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2019
Keywords
Phenomenological Hermeneutics, Preparations for Suicide, Suicide Communication, Risk Assessment, Psychiatric Nursing
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-73683 (URN)10.4236/psych.2019.101001 (DOI)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Schückher, F., Sellin Jönsson, T., Engström, I. & Berglund, K. (2019). History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder. BMC Women's Health, 19(1), Article ID 159.
Open this publication in new window or tab >>History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder
2019 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 19, no 1, article id 159Article in journal (Refereed) Published
Abstract [en]

Background: To examine the relationship between treatment outcome, as measured according to change in alcohol consumption, and a history of childhood abuse (emotional, physical, sexual) in socially stable women undergoing treatment for alcohol use disorder (AUD).

Methods: Participants were assessed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview at the beginning of treatment (n = 75), end of treatment (n = 59) and 12 month follow-up after treatment (n = 57). Self-report data on alcohol consumption were obtained at all three time-points using the Alcohol Habits Inventory-Revised 2. Self-report data on childhood maltreatment were obtained at the beginning of treatment using the Childhood Trauma Questionnaire-short form. Study outcomes were changes in alcohol consumption (grams of pure alcohol per week), risk-drinking and reported abstinence.

Results: Of the 75 women enrolled, 38 (50.7%) reported a history of childhood abuse and the rest did not. Both groups showed a significant improvement in all three outcomes at the end of treatment and at 12-month follow-up. At the end of treatment, a significant inter-group difference was found for reported abstinence (non-abused group, 39.3% vs abused, 12.9%; p < 0.05). At 12-month follow-up, significant inter-group differences were observed for all treatment outcomes, with superior outcomes being found for the non-abused group, including a higher proportion of women with reported abstinence (55.6% vs 13.3%; p < 0.01).

Conclusion: The present findings suggest that an evaluation of a possible history of childhood abuse is warranted in all women seeking treatment for AUD, irrespective of social stability. In terms of clinical practice, the results suggest that additional interventions may be warranted in this population.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Adult women, Alcohol use disorder, Childhood abuse, Treatment outcome
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-79099 (URN)10.1186/s12905-019-0857-4 (DOI)000502718200002 ()31830964 (PubMedID)2-s2.0-85076488310 (Scopus ID)
Note

Funding Agency:

University Health Care Research Center, Region Örebro County, Sweden

Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-15Bibliographically approved
Schückher, F., Sellin, T., Fahlke, C. & Engström, I. (2018). The Impact of Childhood Maltreatment on Age of Onset of Alcohol Use Disorder in Women. European Addiction Research, 24(6), 278-285
Open this publication in new window or tab >>The Impact of Childhood Maltreatment on Age of Onset of Alcohol Use Disorder in Women
2018 (English)In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, no 6, p. 278-285Article in journal (Refereed) Published
Abstract [en]

It is unclear whether exposure to childhood maltreatment is associated with the age of onset of alcohol use disorder (AUD). A group of socially stable women with AUD seeking treatment (n = 75) were interviewed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview. They also filled out the Childhood Trauma Questionnaire-short form. Emotional abuse, sexual abuse and multiple childhood traumas were found to be associated with earlier onset of AUD. Multivariable linear regression analysis showed that independent predictors for an earlier onset of AUD were exposure to emotional abuse (beta = -7.44, SE = 2.83, adjusted p = 0.010) and mother's alcohol/substance problems (beta = -7.87, SE = 3.45, adjusted p = 0.026). These variables explained 18.9% of the variance of age of onset of AUD. These findings highlight a need for increased clinical attention to AUD subgroups who have experienced childhood maltreatment, especially emotional abuse, as well as a need for including support in the patient's own parental role in the treatment.

Place, publisher, year, edition, pages
S. Karger, 2018
Keywords
Age of onset, Alcohol use disorder, Childhood maltreatment, Mother’s alcohol/substance problems
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-72004 (URN)10.1159/000494766 (DOI)000456650200002 ()30448841 (PubMedID)2-s2.0-85057010272 (Scopus ID)
Note

Funding Agency:

University Health Care Research Center, Region Örebro County, Sweden

Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-13Bibliographically approved
Schückher, F., Sellin, T., Fahlke, C. & Engström, I. (2018). The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment. In: : . Paper presented at 2018 Annual Meeting, American Psychiatric Association, New York, NY, USA, 5-9 May, 2018.
Open this publication in new window or tab >>The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Substance Abuse
Identifiers
urn:nbn:se:oru:diva-73847 (URN)
Conference
2018 Annual Meeting, American Psychiatric Association, New York, NY, USA, 5-9 May, 2018
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-04-17Bibliographically approved
Pettersen, G., Wallin, K. & Björk, T. (2016). How do males recover from eating disorders?: An interview study. BMJ Open, 6(8), Article ID e010760.
Open this publication in new window or tab >>How do males recover from eating disorders?: An interview study
2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 8, article id e010760Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of the current study is to investigate what males experience as helpful in their recovery process from eating disorders (ED).

Methods: Qualitative in-depth interviews within a phenomenological approach, and using content analysis to excavate overarching text themes.

Setting: Norway and Sweden.

Participants: Included were 15 males with an age range from 19 to 52 years. Duration of illness varied between 3 and 25 years of experience with anorexia nervosa (n=10), bulimia nervosa (n=4) or ED not otherwise specified (n=1).

Results: The content analysis revealed four main categories, that is, 'the need for a change', 'a commitment to leave the eating disorder behind', 'interpersonal changes' and 'searching for a life without an eating disorder'. These categories comprise features like motivation to change, gaining structure in eating situations, a re-learning of personal and interpersonal skills as well as accepting losses and starting a reorientation of identity and meaning. We noted a rather goal-oriented approach to help seeking and a variation in how the males engaged their social network in resolving the challenges associated with the recovery process. Still, the overall nature of the recovery process highly accords with what has been reported for women.

Discussion: A clinical implication from our findings is that symptom relief is important to facilitate good circles of improvement, but that the nature of the recovery process would require a wider perspective in treatment. Clinicians may also be informed about challenges related to an instrumental approach to help seeking reported in this study.

Place, publisher, year, edition, pages
London, United Kingdom: BMJ Publishing Group Ltd, 2016
National Category
Psychiatry General Practice
Identifiers
urn:nbn:se:oru:diva-51668 (URN)10.1136/bmjopen-2015-010760 (DOI)000382336700116 ()27515747 (PubMedID)
Available from: 2016-08-17 Created: 2016-08-16 Last updated: 2018-01-10Bibliographically approved
Björk, T. (2016). Smak på livet igen!. Randi Förlag
Open this publication in new window or tab >>Smak på livet igen!
2016 (English)Book (Refereed)
Place, publisher, year, edition, pages
Randi Förlag, 2016. p. 42
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-81951 (URN)9789163908279 (ISBN)
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-19Bibliographically approved
Wallin, K., Pettersen, G., Björk, T. & Råstam, M. (2014). A Qualitative Study of Males' Perceptions about Causes of Eating Disorder. Psychology, 5(15), 1813-1820
Open this publication in new window or tab >>A Qualitative Study of Males' Perceptions about Causes of Eating Disorder
2014 (English)In: Psychology, ISSN 2152-7180, Vol. 5, no 15, p. 1813-1820Article in journal (Refereed) Published
Abstract [en]

Our knowledge about males’ perceptions about causes of eating disorder is very limited, but can be useful in the treatment planning for males. The aim of this study was to describe how male former patients perceived causes of onset of their eating disorder. Fifteen males previously treated for eating disorders and now considering themselves as recovered where interviewed at ages 19 - 52. All interviews were recorded and analyzed qualitatively using a phenomenographic approach. Three categories of perceived causes of onset of eating disorders were found. The first category: self-dissatisfaction, was presented with three conceptions: “High achievements and demands”, “Body-dissatisfaction” and “Low self-esteem”. The second category: family environment, comprised the two conceptions: “Difficulty in family interaction and communication” and “Excessive expectations from family members”. The third category was stressful events outside the family, and consisted of the three conceptions: “Bullying, bad situation at school”, “Moving to new places/separation from friends” and “Societal ideals”. Males’ perceptions of causes of onset of their eating disorder were in many aspects similar to those earlier described for women. In treatment, it is important that the clinicians show a sincere interest in perceived causes, since it may facilitate a good working alliance with the patient.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2014
Keywords
Eating Disorders, Males, Causes, Qualitative
National Category
Psychiatry Psychology
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-44483 (URN)10.4236/psych.2014.515187 (DOI)
Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2017-10-18Bibliographically approved
Cohn, L., Björk, T., Lember, R., Wallin, K. & Pettersson, G. (2014). Male Experiences of Life After Recovery From an Eating Disorder (1ed.). In: Leigh Cohn, Raymond Lemberg (Ed.), Current Findings on Males with Eating Disorders: (pp. 185-194). Routledge
Open this publication in new window or tab >>Male Experiences of Life After Recovery From an Eating Disorder
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2014 (English)In: Current Findings on Males with Eating Disorders / [ed] Leigh Cohn, Raymond Lemberg, Routledge, 2014, 1, p. 185-194Chapter in book (Refereed)
Place, publisher, year, edition, pages
Routledge, 2014 Edition: 1
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-81949 (URN)978-0-415-83590-9 (ISBN)
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-19Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-5030-6353

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