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  • 1.
    Andersson, G.
    et al.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Veilord, A.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Svedling, L.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Andersson, F.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Sleman, O.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Mauritzson, L.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Sarkohi, A.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Claesson, E.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Zetterqvist, V.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Lamminen, M.
    Redakliniken, Linköping, Sweden.
    Eriksson, T.
    Redakliniken, Linköping, Sweden.
    Carlbring, P.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 151, no 3, p. 986-994Article in journal (Refereed)
    Abstract [en]

    Background: Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up.

    Method: Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n =33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended.

    Results: Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. Results on the self-rated version of the Montgomery-Asberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post treatment showed a Cohen's d=1.46, with a similar large effect at 3-year follow-up, d=1.78. For the group CBT the corresponding within group effects were d =0.99 and d=1.34, respectively.

    Limitations: The study was small with two active treatments and there was no placebo or credible control condition.

    Conclusions: Guided ICBT is at least as effective as group based CBT and long-term effects can be sustained up to 3 years after treatment.

  • 2.
    Forsell, Erik
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bendix, Marie
    Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden.
    Holländare, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    von Schultz, Barbara Szymanska
    Department of Children and Women, Karolinska University Hospital, Huddinge, Sweden.
    Nasiell, Josefine
    Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.
    Blomdahl-Wetterholm, Margareta
    Stockholms Läns Sjuvårdsområde (SLSO), Psychiatry Southwest, Stockholm, Sweden.
    Eriksson, Caroline
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Kvarned, Sara
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    van der Linden, Johanna Lindau
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Söderberg, Elin
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Jokinen, Jussi
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden.
    Wide, Katarina
    Department of Clinical Science, Intervention and Technology (CLINTEC), Department of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, Viktor
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 221, p. 56-64Article in journal (Refereed)
    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.

  • 3.
    Hedman, E.
    et al.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, B.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, V.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    El Alaoui, S.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Kraepelien, M.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Andersson, E.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Rück, C.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Svanborg, C.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Andersson, G.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Lindefors, N.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Sweden.
    Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care2014In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 155, no 1, p. 49-58Article in journal (Refereed)
    Abstract [en]

    Background: Efficacy of guided Internet-based cognitive behaviour therapy (ICBT) for depression has been demonstrated in several randomised controlled trials. Knowledge on the effectiveness of the treatment, i.e. how it works when delivered within routine care, is however scarce. The aim of this study was to investigate the effectiveness of ICBT for depression.

    Methods: We conducted a cohort study investigating all patients (N =1203) who had received guided ICBT for depression between 2007 and 2013 in a routine care setting at an outpatient psychiatric clinic providing Internet-based treatment The primary outcome measure was the Montgomery Asberg Depression Rating Scale-Self rated (MADRS-S).

    Results: Patients made large improvements from pre-treatment assessments to post-treatment on the primary outcome (effect size d on the MADRS-S = 1.27, 99% CI, 1.14-1.39). Participants were significantly improved in terms of suicidal ideation and sleep difficulties improvements were sustained at 6-month follow-up.

    Limitations: Attrition was rather large at 6-month follow-up. However, additional data was collected through telephone interviews with dropouts and advanced statistical models indicated that missing data did not bias the findings.

    Conclusions: ICBT for depression can be highly effective when delivered within the context of routine psychiatric care. This study suggests that the effect sizes are at least as high when the treatment is delivered in routine psychiatric care by qualified staff as when delivered in a controlled trial setting.

  • 4.
    Hiyoshi, Ayako
    et al.
    Örebro University, School of Medical Sciences.
    Sabet, Julia A.
    Örebro University, School of Medical Sciences.
    Sjöqvist, Hugo
    Örebro University, Örebro University School of Business.
    Melinder, Carren
    Örebro University, School of Medical Sciences.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK .
    Precursors in adolescence of adult-onset bipolar disorder2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 218, p. 353-358Article in journal (Refereed)
    Abstract [en]

    Background: Although the estimated contribution of genetic factors is high in bipolar disorder, environmental factors may also play a role. This Swedish register-based cohort study of men examined if physical and psychological characteristics in late adolescence, including factors previously linked with bipolar disorder (body mass index, asthma and allergy), are associated with subsequent bipolar disorder in adulthood. Unipolar depression and anxiety are analysed as additional outcomes to identify bipolar disorder-specific associations.

    Methods: A total of 213,693 men born between 1952 and 1956, who participated in compulsory military conscription assessments in late adolescence were followed up to 2009, excluding men with any psychiatric diagnoses at baseline. Cox regression estimated risk of bipolar disorder, depression and anxiety in adulthood associated with body mass index, asthma, allergy, muscular strength stress resilience and cognitive function in adolescence.

    Results: BMI, asthma and allergy were not associated with bipolar disorder. Higher grip strength, cognitive function and stress resilience were associated with a reduced risk of bipolar disorder and the other disease outcomes.

    Limitations: The sample consisted only of men; even though the characteristics in adolescence pre-dated disease onset, they may have been the consequence of prodromal disease.

    Conclusions: Associations with body mass index and asthma found by previous studies may be consequences of bipolar disorder or its treatment rather than risk factors. Inverse associations with all the outcome diagnoses for stress resilience, muscular strength and cognitive function may reflect general risks for these psychiatric disorders or intermediary factors.

  • 5.
    Kronsell, Alexander
    et al.
    Psykiatri Nordväst, Stockholm County Council. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council. Centrum för psykiatriforskning, Stockholm, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences.
    Tiger, Mikael
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
    Less memory complaints with reduced stimulus dose during electroconvulsive therapy for depression2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 259, p. 296-301Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for depression, but there is risk of cognitive adverse events. This risk has been partially attributed to electrical charge, thus the optimal electrical stimulus dose is still under discussion. The aim of this study was to evaluate how the risk of subjective memory worsening was changed after lowering stimulus dose during ECT for patients with major depression.

    METHOD: A retrospective register-based intervention study of the effects of reduced electrical charges for patients receiving ECT for depression was conducted. The primary outcome was subjective memory worsening and the secondary outcome change in effect on depressive symptoms.

    RESULTS: A total of 154 patients were enrolled in the study (High dosage group: n = 57; Lower dosage group: n = 97). Subjective memory worsening after ECT occurred in 44% of patients in the high dosage group and in 25% of patients in the lower dosage group(p = 0.014). There was no significant between-group difference in the anti-depressive effect of ECT.

    LIMITATIONS: The study was register-based and the two groups were not randomized. A large portion of patients were initially excluded due to missing data in the register. The study lacks a long-term follow up.

    CONCLUSION: After implementing a change of treatment protocol, that lowered ECT stimulus doses from high to moderate, the occurrence of subjective memory worsening was significantly reduced without compromising treatment results.

  • 6.
    Ludvigsson, Jonas F.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Reutfors, Johan
    Ösby, Urban
    Ekbom, Anders
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Coeliac disease and risk of mood disorders: a general population-based cohort study2007In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 99, no 1, p. 117-126Article in journal (Other academic)
    Abstract [en]

    Background

    Earlier research has indicated a positive association between coeliac disease (CD) and some mental disorders. Studies on CD and depression have inconsistent findings and we know of no study of CD and the risk of bipolar disorder (BD).

    Methods

    We used Cox regression to investigate the risk of subsequent mood disorders (MD); depression and BD in 13,776 individuals with CD and 66,815 age- and sex-matched reference individuals in a general population-based cohort study in Sweden. We also studied the association between prior MD and CD through conditional logistic regression.

    Results

    CD was associated with an increased risk of subsequent depression (Hazard ratio (HR)=1.8; 95% CI=1.6–2.2; p<0.001, based on 181 positive events in individuals with CD and 529 positive events in reference individuals). CD was not associated with subsequent BD (HR=1.1; 95% CI=0.7–1.7; p=0.779, based on 22 and 99 positive events). Individuals with prior depression (OR=2.3; 95% CI=2.0–2.8; p<0.001) or prior BD (OR=1.7; 95% CI=1.2–2.3; p=0.001) were at increased risk of a subsequent diagnosis of CD.

    Limitations

    Study participants with CD and MD may have more severe disease than the average patient with these disorders since they were identified through a hospital-based register.

    Conclusions

    CD is positively associated with subsequent depression. The risk increase for CD in individuals with prior depression and BD may be due to screening for CD among those with MD.

  • 7.
    Mazzer, Kelly
    et al.
    Örebro University, School of Law, Psychology and Social Work. Centre for Health and Medical Psychology.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work. Centre for Health and Medical Psychology.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work. Centre for Health and Medical Psychology.
    A longitudinal view of rumination, poor sleep and psychological distress in adolescents2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 245, p. 686-696Article in journal (Refereed)
    Abstract [en]

    Background: Given the high prevalence and negative impact of psychological problems during adolescence, examining transdiagnostic factors that may have scope to positively influence a variety of psychological problems is imperative. The main purpose of this study was to investigate the longitudinal relationship between rumination and psychological distress and whether sleep mediated this relationship over a 2 year period.

    Methods: Participants were 1620 high school students in the 7th and 8th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2014, 2015 and 2016. Rumination and psychological distress were self-reported, and sleep duration was calculated from reported bed-times, wake-times and sleep onset latencies.

    Results: Sleep duration declined with age, whereas rumination and psychological distress increased. Rumination was predictive of future psychological distress and distress at a given time was predictive of concurrent rumination. Sleep duration did not consistently mediate the reciprocal relationships between rumination and psychological distress over time.

    Limitations: Stronger longitudinal associations may have been obtained by using smaller measurement intervals or further delineation of outcome constructs.

    Conclusions: Reducing rumination, rather than targeting sleep patterns, may work towards preventing the development of a number of psychological problems and is a strategy anticipated to function across disorders to improve young people's mental wellbeing.

  • 8.
    Popiolek, Katarzyna
    et al.
    Örebro University, School of Medical Sciences.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Elvin, Tove
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Landen, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Rehospitalization and suicide following electroconvulsive therapy for bipolar depression: A population-based register study2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 226, p. 146-154Article in journal (Refereed)
    Abstract [en]

    Background: Electroconvulsive therapy (ECT) is effective in bipolar depression, but relapse is common. The aim of the study was (i) to identify prognostic factors (ii) and to determine the impact of pharmacological approaches on the risk for rehospitalization or suicide.

    Methods: This register study analyzed data from individuals treated with inpatient ECT for bipolar depression. Subjects were identified using the Swedish National Patient Register between 2011 and 2014 and the Swedish National Quality Register for ECT. Other national registers provided data on psychopharmacotherapy, socio-demographic factors, and causes of death. The endpoint was the composite of rehospitalization for any psychiatric disorder, suicide attempt or completed suicide (RoS). Cox regression was used to calculate hazard ratios in univariate and multivariate models.

    Results: Data from 1255 patients were analyzed. The mean period of follow-up was 346 days.

    A total of 29%, 41%, and 52% of patients reached RoS at 3, 6, and 12 months post-discharge. A history of multiple psychiatric admissions, lower age, and post-discharge treatment with antipsychotics or benzodiazepines was associated with RoS.

    Limitations: Indication bias may have affected the results.

    Conclusions: A history of multiple hospital admissions and lower age are key predictors of the composite of rehospitalization or suicide in patients treated with ECT for bipolar depression. Lithium might be effective. By contrast, antipsychotics and benzodiazepines were associated with increased risk, but possibly this finding was influenced by indication bias.

  • 9.
    Rundgren, Sara
    et al.
    School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Båve, Ullvi
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
    Landén, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Faculty of Health Sciences, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 258-264Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies.

    AIMS: The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period.

    MATERIALS AND METHODS: Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7).

    RESULTS: 185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response.

    LIMITATIONS: There was no control group without ECT treatment.

    CONCLUSION: The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

  • 10.
    Rådmark, L.
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Magnusson Hanson, L. L.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK.
    Bojner Horwitz, E.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Music, Pedagogy and Society, Royal College of Music, Stockholm, Sweden.
    Osika, W.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden.
    Mind and body exercises (MBE), prescribed antidepressant medication, physical exercise and depressive symptoms: a longitudinal study2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 265, p. 185-192Article in journal (Refereed)
    Abstract [en]

    AIMS: Earlier studies show that participation in mind and body exercises (MBE) is cross-sectionally associated with high levels of depressive symptoms and antidepressants. This study investigates the longitudinal interrelationship between depressive symptoms, MBE and antidepressants.

    METHODS: 3269 men and 4318 women aged 24-74 years participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Measures of MBE practice and depressive symptoms were drawn from the SLOSH questionnaire, data on prescription drugs were obtained from the Swedish Prescribed Drug Register. Structural Equation Modeling (SEM) was used to analyze temporal relationships.

    RESULTS: Both MBE practice and antidepressants in 2012 was associated with higher levels of depressive symptoms two years later. Depressive symptoms in turn were associated with higher levels of later MBE practice and antidepressants. These relationships seemed to be explained by confounding by indication and were of higher magnitude for antidepressants than for MBE.

    CONCLUSION: Overall, SEM analysis shows that MBE and antidepressant treatment were both bi-directionally associated with depressive symptoms over time. Part of the explanation is likely to be confounding by indication: those with symptoms of depression more likely to undertake treatment, and MBE alone may be more common among those with less severe depression. The results clarify some of our findings from earlier studies and give some important, new information on what people are doing to manage depressive symptoms on a societal level, regarding self-care, medication, and the combination of both.

  • 11.
    Sevilla-Cermeño, Laura
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
    Isomura, Kayoko
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Psychology Division, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Vilaplana-Pérez, Alba
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Departament de Personalitat, Avaluació i Tractaments Psicològics, Universitat de València, Spain.
    Lahera, Guillermo
    Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
    Mataix-Cols, David
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Fernández de la Cruz, Lorena
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Insomnia in obsessive-compulsive disorder: A Swedish population-based cohort study2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 266, p. 413-416Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between specific psychiatric disorders and insomnia is well established, but the prevalence of insomnia in obsessive-compulsive disorder (OCD) is unknown. This population-based study examined the prevalence of insomnia in patients with OCD compared to unaffected individuals from the general population and to their unaffected full siblings, and evaluated the contribution of psychiatric comorbidities to this association.

    METHODS: Individuals diagnosed with OCD (31,856) were identified from a cohort of 13,017,902 individuals living in Sweden anytime during 1973 and 2013. Logistic regression analyses were used to investigate the odds of insomnia in individuals with OCD, compared to the general population and their unaffected full siblings. Sensitivity analyses were performed in subgroups from which all individuals with comorbid psychiatric conditions were excluded, one at a time.

    RESULTS: Individuals with OCD had almost 7-fold increased odds of receiving an insomnia diagnosis or being dispensed a drug with specific indication for insomnia, compared to unaffected individuals from the general population (42.2% vs. 11.0%, respectively; OR=6.92 [95% CI, 6.76-7.08]). Familiar factors shared with siblings and comorbid conditions did not fully explain this association, but when individuals with comorbid depression and anxiety disorders were excluded, the odds of insomnia were significantly reduced (OR=4.97 [95% CI, 4.81-5.14] and OR=4.51 [95% CI, 4.33-4.69], respectively).

    LIMITATIONS: Due to the intrinsic coverage issues of the registers, results may not be generalizable to milder forms of the disorder and to individuals who do not seek help.

    CONCLUSIONS: Insomnia should be systematically evaluated and managed in individuals with OCD, particularly in those with comorbid anxiety and depression.

  • 12.
    Ssegonja, Richard
    et al.
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Alaie, Iman
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Sampaio, Filipa
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Centre.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Sarkadi, Anna
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden; Murdoch Children's Research Institute, Melbourne, Australia.
    Langenskiöld, Sophie
    Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    von Knorring, Anne-Liis
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Bohman, Hannes
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden.
    Jonsson, Ulf
    Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Pediatric Neuropsychiatry Unit, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Feldman, Inna
    Department of Public Health and Caring Sciences, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden.
    Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study2019In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

    METHODS: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

    RESULTS: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

    LIMITATIONS: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

    CONCLUSIONS: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

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