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Holländare, FredrikORCID iD iconorcid.org/0000-0001-9500-7763
Publications (10 of 22) Show all publications
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)31918712 (PubMedID)
Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2020-01-14Bibliographically 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
Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F. & Engström, I. (2018). Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology. Behavioural and Cognitive Psychotherapy, 46(6), 726-737
Open this publication in new window or tab >>Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
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2018 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 46, no 6, p. 726-737Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator.

AIMS: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment.

METHOD: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators.

RESULTS: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up.

DISCUSSION: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.

Place, publisher, year, edition, pages
Cambridge University Press, 2018
Keywords
Cognitive behavioural therapy, depression, group psychotherapy, insomnia, randomized controlled trial, statistical mediation
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-67316 (URN)10.1017/S1352465818000395 (DOI)000444683800006 ()29898793 (PubMedID)2-s2.0-85048765370 (Scopus ID)
Note

Funding Agencies:

Stiftelsen Professor Bror Gadelius Minnesfond  

Psykiatrifonden  

Research Committee of Region Örebro County, Sweden

Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-10-01Bibliographically approved
Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F. & Engström, I. (2017). How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology. International Journal of Cognitive Therapy, 10(4), 304-329
Open this publication in new window or tab >>How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology
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2017 (English)In: International Journal of Cognitive Therapy, ISSN 1937-1209, E-ISSN 1937-1217, Vol. 10, no 4, p. 304-329Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to gain a greater understanding of the five cognitive processes from the cognitive model of insomnia, negative automatic thoughts, and time in bed as outcomes and potential mediators of cognitive behavioral therapy for insomnia (CBT-I), in a sample with insomnia and depressive symptomatology. Sixty-four participants were randomized to receive either CBT-I or an active control (relaxation training: RT) in groups during four biweekly sessions. Insomnia, depressive severity, and the potential processes of change were measured pre-, mid-, and post-treatment. CBT-I was associated with greater reductions of dysfunctional beliefs about sleep, sleep-related safety behaviors, and time in bed compared to RT. Mid-treatment dysfunctional beliefs about sleep was the only process that mediated between CBT-I and outcomes on insomnia and depressive severity, respectively. The relationships were reciprocal. Dysfunctional beliefs about sleep may be a transdiagnostic process of both insomnia and depression.

Place, publisher, year, edition, pages
Guilford Publications, 2017
Keywords
Cognitive behavioral therapy, depression, dysfunctional beliefs, insomnia, mediation
National Category
Psychiatry Psychology (excluding Applied Psychology)
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-64742 (URN)10.1521/ijct.2017.10.4.304 (DOI)000423606400003 ()2-s2.0-85039558365 (Scopus ID)
Note

Funding Agencies:

Psykiatrifonden  

Research Committee of Region Örebro County, Sweden

Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-02-23Bibliographically approved
Forsell, E., Bendix, M., Holländare, F., von Schultz, B. S., Nasiell, J., Blomdahl-Wetterholm, M., . . . Kaldo, V. (2017). Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial. Journal of Affective Disorders, 221, 56-64
Open this publication in new window or tab >>Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial
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2017 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 221, p. 56-64Article in journal (Refereed) Published
Abstract [en]

Major depression occurs in 5-10% of pregnancies and is associated with many negative effects for mother and child, yet treatment options are scarce. To our knowledge, this is the first published randomised controlled trial on Internet delivered Cognitive Behavior Therapy (ICBT) for this group.

Objective: To test the efficacy of a pregnancy adapted version of an existing 10-week ICBT-program for depression as well as assessing acceptability and adherence.

Design: Randomised controlled trial.

Setting: Online and telephone.

Population or sample: Self-referred pregnant women (gestational week 10-28 at intake) currently suffering from major depressive disorder.

Methods: 42 pregnant women (gestational week 12-28) with major depression were randomised to either treatment as usual (TAU) provided at their antenatal clinic or to ICBT as an add-on to usual care.

Main outcome measures: The primary outcome was depressive symptoms measured with the Montgomery-Asberg depression rating scale-self report (MADRS-S). The Edinburgh Postnatal Depression Scale and measures of anxiety and sleep were used. Credibility, satisfaction, adherence and utilization were also assessed.

Results: The ICBT group had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g = 1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) (RR = 0.36; p = 0.004). Measures of treatment credibility, satisfaction, utilization, and adherence were comparable to implemented ICBT for depression.

Limitations: Small sample size and no long-term evaluation.

Conclusion: Pregnancy adapted ICBT for antenatal depression is feasible, acceptable and efficacious. These results need to be replicated in larger trials to validate these promising findings.

Place, publisher, year, edition, pages
Amsterdam, Netherlands: Elsevier, 2017
Keywords
Depression, Pregnancy, Cognitive behavior therapy, Internet, Antenatal depression, Psychotherapy, Perinatal mental health, ehealth, Online
National Category
Neurology Psychiatry
Identifiers
urn:nbn:se:oru:diva-59416 (URN)10.1016/j.jad.2017.06.013 (DOI)000406464200009 ()28628768 (PubMedID)2-s2.0-85020791703 (Scopus ID)
Funder
Swedish Research Council, DNR 521-2012-3466
Note

Funding Agencies:

Karolinska Institutet  

Stockholm City Council  

Umeå University  

Västerbotten County Council (ALF) 

Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2018-08-05Bibliographically approved
Wurm, M., Klein Strandberg, E., Lorenz, C., Tillfors, M., Buhrman, M., Holländare, F. & Boersma, K. (2017). Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet Interventions, 10, 54-64
Open this publication in new window or tab >>Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study
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2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 54-64Article in journal (Refereed) Published
Abstract [en]

In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimaltreatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarchingaim of this study was to test an internet delivered therapist guided transdiagnostic treatment withtelephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of EmotionalDisorders was used as an intervention for pain patients with residual pain problems and comorbid emotionalproblems after having received a multimodal pain rehabilitation. The study used a replicated AB single caseexperimental design (N =5; 3 females). Outcome measures were depressive and general anxiety symptoms, painintensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) andpatient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety forthree participants and a decrease of depression for four participants. Decreases were small and did not alwaysreach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two outof four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnosticcriteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patientsatisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support maybe a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, theeffects are unclear. The gap between high patient satisfaction and small changes in symptomatology should beexplored further.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Internet delivered treatment; pain; transdiagnostic; emotional comorbidity; single case
National Category
Other Medical Sciences not elsewhere specified
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-62356 (URN)10.1016/j.invent.2017.10.004 (DOI)000457134100008 ()2-s2.0-85032807121 (Scopus ID)
Projects
SÅS
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2019-02-13Bibliographically approved
Edlund, S., Wurm, M., Holländare, F., Linton, S. J., Fruzzetti, A. E. & Tillfors, M. (2017). Pain patients´ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity and treatment outcome. Scandinavian Journal of Pain, 17, 77-86
Open this publication in new window or tab >>Pain patients´ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity and treatment outcome
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2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 77-86Article in journal (Refereed) Published
Abstract [en]

Background and aims: Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients’ perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients’ perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored.

Methods: A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored.

Results: Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment.

Conclusions: Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. Implications In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference.

Place, publisher, year, edition, pages
Walter de Gruyter, 2017
Keywords
Chronic pain; Communication; Validation; Invalidation; Treatment outcome
National Category
Psychology Neurology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-59104 (URN)10.1016/j.sjpain.2017.07.007 (DOI)000419851500012 ()28850377 (PubMedID)2-s2.0-85026788123 (Scopus ID)
Note

Funding Agency:

Regional Research Council (Regionala Forskningsradet, RFR) 

Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2018-08-01Bibliographically approved
Sellin, T., Holländare, F. & Tillfors, M. (2017). Psychiatric ward consumption before suicide: A case-control study. European psychiatry, 41, S295-S296, Article ID EW0559.
Open this publication in new window or tab >>Psychiatric ward consumption before suicide: A case-control study
2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, p. S295-S296, article id EW0559Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-58971 (URN)10.1016/j.eurpsy.2017.02.173 (DOI)000404952200871 ()
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2018-09-04Bibliographically approved
Wurm, M., Klein Strandberg, E., Lorenz, C., Buhrman, M., Holländare, F., Tillfors, M. & Boersma, K. (2016). Chronic pain and emotional problems: A replicated single case study of an internet based therapist guided treatment based on CBT principles and the Unified Protocol of transdiagnostic treatments. In: : . Paper presented at 8th World Congress of Behavioural and Cognitive Therapies (WCBCT 2016), Melbourne, Australia, June 22-25, 2016.
Open this publication in new window or tab >>Chronic pain and emotional problems: A replicated single case study of an internet based therapist guided treatment based on CBT principles and the Unified Protocol of transdiagnostic treatments
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2016 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-54748 (URN)
Conference
8th World Congress of Behavioural and Cognitive Therapies (WCBCT 2016), Melbourne, Australia, June 22-25, 2016
Available from: 2017-01-17 Created: 2017-01-17 Last updated: 2017-10-18Bibliographically approved
Holländare, F., Gustafsson, S. A., Berglind, M., Grape, F., Carlbring, P., Andersson, G., . . . Tillfors, M. (2016). Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms. Internet Interventions, 3, 1-7
Open this publication in new window or tab >>Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms
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2016 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 3, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common "therapist behaviours" and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment framework, informed about module content, emphasised the importance of patient responsibility, confronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirming correlated significantly (r=.42, p=.005) with improvement in depressive symptoms at post-treatment and after two years (r=.39, p=.014). Encouraging was associated with outcome directly after treatment (r=.52, p=.001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r=.44, p=.003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Cognitive behaviour therapy; Depression; Internet; Patient adherence; Therapist behaviour
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-48064 (URN)10.1016/j.invent.2015.11.002 (DOI)2-s2.0-84948951087 (Scopus ID)
Available from: 2016-02-06 Created: 2016-02-06 Last updated: 2018-07-10Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-9500-7763

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