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  • 1.
    Bergh, Andreas
    et al.
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Englund, Anna-Lena
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Englund, Tomas
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Engström, Karin
    Stockholms universitet, Stockholm, Sweden.
    Prevention and promotion programs in Swedish schools as an answer to what?: An analysis of national policy texts2013Konferensbidrag (Refereegranskat)
  • 2.
    Bergh, Andreas
    et al.
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Englund, Anna-Lena
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Englund, Tomas
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Engström, Karin
    Stockholms universitet, Stockholm, Sweden.
    Värdepremisser i främjande och förebyggande program i skolan: rapport från forskningsprojektet En värdefull skola2013Rapport (Refereegranskat)
  • 3.
    Björk, Tabita
    et al.
    Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    Skårberg, Kurt
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Eating disorders and anabolic androgenic steroids in males: similarities and differences in self-image and psychiatric symptoms2013Ingår i: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 8, nr 30, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use.

    Aim: The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.

    Methods: This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List.

    Results: The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image.

    Conclusions: The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.

  • 4.
    Blomqvist, Suzanne
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Interprofessional psychiatric teams: is multidimensionality evident in treatment conferences?2012Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 26, nr 4, s. 289-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.

  • 5. Eckerdal, Gunnar
    et al.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Kristoffersson, Ulf
    Löfmark, Rurik
    Sallin, Karl
    Thulesius, Hans
    Bengtsson, Håkan
    Johnsson, Lars-Åke
    Etisk argumentation och klinisk verklighet kan med fördel förenas2007Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, nr 28-29, s. 2097-2098Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 6. Eckerdal, Gunnar
    et al.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Lynöe, Niels
    Löfmark, Rurik
    Sallin, Karl
    Respektera patientens rätt avstå från livsuppehållande behandling: nya riktlinjer från Svenska Läkaresällskapets delegation för medicinsk etik2007Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, nr 41, s. 2969-2971Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Delegationen för medicinsk etik framhåller patientens rätt

    • att avstå från potentiellt livsförlängande behandling

    • att i osäkra fall få livsuppehållande behandling tills

    det är uppenbart att den inte kan gagna patienten

    • att i alla situationer få adekvat symtomlindring.

    Det är speciellt angeläget att i dessa situationer dokumentera beslut och beslutsunderlag i patientens journal

  • 7.
    Elinder, Göran
    et al.
    Department of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Anders
    Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, Umeå, Sweden; The National Board of Forensic Medicine, Linköping, Sweden.
    Hallberg, Boubou
    Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics and Neonatology, Karolinska University Hospital, Stockholm, Sweden.
    Lynøe, Niels
    Medical Ethics, Karolinska Institutet, Stockholm, Sweden.
    Sundgren, Pia Maly
    Diagnostic Radiology, Lund University, Lund, Sweden; Department of Neuroradiology, Skåne University Hospital, Lund, Sweden.
    Rosén, Måns
    Health Technology Assessment, Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för medicinska vetenskaper. Child and Adolecent Psychiatry, University Health Care Research Center.
    Erlandsson, Björn-Erik
    Medical Technology, Royal Institute of Technology, Stockholm, Sweden.
    Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking2018Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr S472, s. 3-23Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:

    • There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).
    • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).

    Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

  • 8.
    Englund, Anna-Lena
    et al.
    Örebro universitet, Akademin för humaniora, utbildning och samhällsvetenskap.
    Englund, Tomas
    Örebro universitet, Akademin för humaniora, utbildning och samhällsvetenskap.
    Engström, Karin
    Örebro universitet, Akademin för humaniora, utbildning och samhällsvetenskap.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Värdegrunden reducerad till metod2009Ingår i: Pedagogiska magasinet, ISSN 1401-3320, Vol. 13, nr 4, s. 18-21Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Det behövs en etisk vändning i diskussionen om främjande och förebyggande program. Alltför stort intresse riktas mot frågan om evidens och effektivitet och alltför lite intresse riktas mot värdefrågorna. Vad innebäör det för lärarens professionalism om manualstyrda aktiviteter ersätter samtal och samspel?

  • 9.
    Englund, Tomas
    et al.
    Örebro universitet, Akademin för humaniora, utbildning och samhällsvetenskap.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Behaviorismens återkomst i svensk skola: exemplet Skol-Komet2011Ingår i: Pedagogiska Magasinet, ISSN 1401-3320, Vol. 15, nr 2, s. 14-17Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Englund, Tomas
    et al.
    Örebro universitet, Akademin för humaniora, utbildning och samhällsvetenskap.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Skol-Komet står för en instrumentell syn på relationer2011Ingår i: Pedagogiska Magasinet, ISSN 1401-3320, Vol. 15, nr 4, s. 72-73Artikel i tidskrift (Övrigt vetenskapligt)
  • 11.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Adolescents' perception of coercive treatment: conclusions and clinical implications2007Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 7, nr Suppl 1, s. S108-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe aim of the study was to describe how involuntarily and voluntarily admitted adolescents talk about their experiences from child and adolescent psychiatric care with special focus on coercion, participation and dialogue.

    MethodsTwenty-one adolescents, ten involuntarily and eleven voluntarily admitted, were interviewed in-depth. The transcriptions were analyzed based on theories on participation and human dialogue.

    ResultsThe adolescents' experiences of coercion show a wide variation that didn't correspond very well with the formal situation. Coercion was experienced in many ways and was also valued quite differently with respect to the impact of the treatment in their lives. The adolescents' experience of participation in the planning of the treatment was very sparse. The requirements for participation of patients in Swedish law were seldom met, according to the adolescents. The adolescents' experiences of dialogue with the staff also varied considerably. Examples will be given from different experiences during the presentation.

    Conclusion Coercion is, from a subjective perspective, a concept with many meanings. The correspondence between formal coercion and experienced coercion is quite weak. Adolescents seldom feel genuinely engaged in the planning of their own treatment, despite legal requirements. Trustful and reciprocal relations were sometimes to be found in their stories. This seems difficult, but not impossible, to reach even under coercive circumstances.

  • 12.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Apathetic children: a phenomenological interpretation of a psychiatric epidemic in Sweden2008Konferensbidrag (Refereegranskat)
    Abstract [en]

    Purpose: Since 2001, over four hundred children and adolescents in Sweden, who all have been asylum seekers, have developed a psychiatric syndrome with more or less complete loss of mental and physical functions. These children have been called “apathetic”. This epidemic has led to considerable interest, both in Sweden and abroad. The media debate about this epidemic has mostly centred on the possibilities of simulation or parental forcing of their children. The psychiatric debate has centred mostly on different diagnostic possibilities. There has also been an extensive ethical debate both among professionals and on the public arena. Not much interest has been paid to the syndrome from a phenomenological perspective.

    Method: I will in this paper present the key case that I was summoned by the Swedish government to examine. This is the case of Makram, 11 years of age, who had been in an almost persistent apathetic state since one and a half year. The case will be interpreted using thoughts from Karl Jaspers and Martin Heidegger.

    Results: The life experience of Makram will be discussed in terms of a total withdrawal from the world, which is interpreted as a solution to lift off an all too heavy burden within the family. The process into apathy will be discussed in relation to psychiatric and philosophical concepts like withdrawal and stupor. My discussion will centre on possible interpretations from a phenomenological perspective based on interviews with patients.

    Conclusion: The key interpretation will be that this is a syndrome characterized by a withdrawal from being in the communal world and stay in a private world until circumstances have changed enough to elicit a longing for coming back to the real world.

  • 13.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Apathetic children from a phenomenological perspective2007Konferensbidrag (Refereegranskat)
  • 14.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Psykiatriskt forskningscentrum, Örebro universitet, Örebro, Sverige.
    Barn- och ungdomspsykiatri2011Ingår i: Pediatrik / [ed] Christian Moëll & Jan Gustavsson, Stockholm: Liber, 2011, 1, s. 537-555Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 15.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Psykiatriskt forskningscentrum, Örebro.
    Diagnostik och differentialdiagnostik2013Ingår i: Från apati till aktivitet: Teori och behandling av flyktingbarn med svår psykisk ohälsa / [ed] Henry Ascher & Anders Hjern, Lund: Studentlitteratur AB, 2013, 1, s. 117-136Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 16.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Ethical reflections on organ donation from children2011Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, nr 9, s. 1172-1174Artikel i tidskrift (Refereegranskat)
  • 17.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Etik, erfarenhet och evidens2013Ingår i: Palliativ vård: Begrepp och perspektiv i teori och praktik / [ed] Birgitta Andershed, Britt-Marie Ternestedt, Cecilia Håkanson, Lund: Studentlitteratur AB, 2013, 1, s. 151-162Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 18.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Etik, erfarenhet och evidens: hur ska man se på psykiatrin?2008Ingår i: Tidskriften för svensk psykiatri, ISSN 1653-8579, nr 2, s. 32-35Artikel i tidskrift (Övrigt vetenskapligt)
  • 19.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Hur kan psykiatrisk tvångsvård motiveras ur ett etiskt perspektiv?2007Konferensbidrag (Refereegranskat)
  • 20.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Justifications of coercion: are decisions of coercive care psychiatric or ethical?2008Konferensbidrag (Refereegranskat)
    Abstract [en]

    Questions on coercion in psychiatric care have long been controversial themes for psychiatry. Health care is usually based on the patient’s wish for help whereas psychiatric care to a large extent is based on the decisions of others, first and foremost by psychiatrists. Due to the reduction of beds in psychiatric care, an increasing proportion of beds are used for committed patients. This makes the questions even more relevant, despite a decrease in absolute numbers.

    The legal prerequisites for coercive care are based only on psychiatric criteria, which points to a notion of fact-based rationality, whereas ethical reasons for coercion at best may be implicit. This paper is based on an ongoing study of coercive care in child and adolescent psychiatry, where the files and the certificates for all committed patients during one year in Sweden are analyzed with respect to given reasons for decisions of coercive care. The core question is whether ethical reasons are present and if so, what ethical values are judged to be at risk in different clinical situations.

    This paper advocates a stronger emphasis on ethical questions in discussions of the use of coercion in psychiatry. We advocate an open discussion of which fundamental values may be at stake in such instances and the ethical reasons involved in making these judgments. The need for a transparent deliberative process involving all parties to the coercion is emphasized.

  • 21.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Medical decision making with adolescents: cultural differences and communicative prerequisites2007Konferensbidrag (Refereegranskat)
  • 22.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Människa och läkare2008Ingår i: Svensk psykiatri, ISSN 1653-8579, nr 4, s. 37-37Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 23.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Normalitet i psykiatrin2008Konferensbidrag (Refereegranskat)
  • 24.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Om normalitet i psykiatriska sammanhang2008Konferensbidrag (Refereegranskat)
    Abstract [sv]

    Inom psykiatrin ställs ofta medicinsk-filosofiska frågor på sin spets. Även om inte psykiatrin är artskild från andra medicinska specialiteter, så blir frågor om ontologiska och epistemologiska grundantaganden tydligare och mer avgörande i det kliniska handlandet.

    En grundfråga är hur psykiatrins kompetensområde och kunskapsanspråk kan avgränsas. I praktiska termer kan det uttryckas som; vilka patienter kan räkna med att få hjälp i den psykiatriska vården? Vad är psykiatrins område? Det brukar uttryckas i termer av psykisk sjukdom eller allvarlig psykisk störning eller liknande begrepp, som kan förefalla tydliga, men som vid varje försök till definition visar sig vara tämligen undanglidande.

    DSM-systemet har konstruerats så att diagnoser definieras med explicita operationaliserade kriterier, där målet är att alla som använder systemet ska vara överens om en diagnos oavsett teoretisk tillhörighet, kulturell kontext eller liknande.

    Det finns emellertid ett grundkriterium i hela DSM-systemet, som lyfter fram frågan om symtomens påverkan på funktioner i livet. Detta grundkriterium benämns ”kliniskt signifikant lidande”. Själva begreppet visar sig dock innehålla ett grundantagande om att det är läkaren som definierar om ett sådant lidande föreligger; därav termen ”kliniskt signifikant”. Frågan om vad som är ett ”lidande” kvarstår emellertid odefinierat.

    Låt mig ge några historiska och aktuella exempel på försök till avgränsningar av psykisk sjukdom. Dessa kan förhoppningsvis fungera som ”fallbeskrivningar” att diskutera under symposiet.

    1. Homosexualitet

    Homosexualitet var klassificerat som en psykisk sjukdom/störning fram till 1973, då det försvann i det amerikanska DSM-systemet. Tillvägagångssättet med vilket detta skedde ger oss emellertid intressant information om hur diagnoser ges legitimitet eller ej.

    Det finns ett antal diagnoser i DSM-IV som kallas ”sexuella funktionsstörningar” eller ”sexuella avvikelser”. I den förstnämnda gruppen återfinns exempelvis impotens och vaginism. I den senare gruppen återfinns exempelvis exhibitionism, pedofili eller sadism/masochism. Det var i denna grupp som tidigare också homosexualitet förekom.

    På grund av samhälleliga diskussioner under slutet av 1960- och början av 1970-talet så kom rimligheten av att betrakta homosexualitet som en diagnos att ifrågasättas. Till slut kom denna diskussion att leda fram till att man inom American Psychiatric Association (som konstruerar DSM-systemet) röstade om homosexualitet skulle vara kvar i DSM-systemet eller ej. Med knapp majoritet röstades för att stryka denna diagnos.

    Detta leder till frågor om vem som definierar vad som är sjukt och inte sjukt. Det leder också till frågor om vilka kriterier som kan användas som grund för en sådan definition. Medicinska kriterier är väl rimligt, men här finns det också andra kriterier som kan anföras i en sådan diskussion.

    Man kan också jämföra med när någon astronomi-sammanslutning häromåret röstade för att Pluto inte längre ansågs vara en planet eller Kyrkomötets i Nicea beslut medelst omröstning om kvinnan har en själ eller ej.

    2. Social fobi

    Social fobi kan fungera som ett exempel på den viktiga distinktionen mellan grad och art. Denna diagnos har, ivrigt understött av läkemedelsindustrin, på senare år ökat i användning, ofta med läkemedel som första behandlingsalternativ. Det är ställt utom allt tvivel att det finns personer som har svår ångest i specifika sociala situationer som blir till ett betydande funktionshinder i det dagliga livet.

    Frågan gäller då närmast om detta är en sjukdom i den meningen att det går att distinkt avgränsa den från ”normal” blyghet, eller om det snarare är en gradfråga, det vill säga att alla människor kan uppleva obehag i speciella situationer men vissa mer än andra.

    Om det snarare är en ”graddiagnos” än en ”artdiagnos” uppstår frågan om vem som har tolkningsföreträdet. Hur kan läkaren med bibehållen medicinsk förankring beakta personens egen beskrivning av sitt lidande. Med andra ord; hur fastställer läkaren om det föreligger ett ”kliniskt signifikant lidande”?

    En annan frågeställning är vilka konsekvenser det har i ett prioriteringsperspektiv om patienten ges hela tolkningsföreträdet.

    3. ADHD

    Debatten om ADHD/DAMP har varit mer intensiv i Sverige än någon annanstans i världen. Även här är det tämligen okontroversiellt att påstå att det finns barn med svårigheter när det gäller uppmärksamhet, koncentration och motorik. Att de barn med betydande svårigheter inom dessa områden kan behöver stöd och hjälp på olika sätt är därmed också uppenbart.

    Det uppstår emellertid problem när sjukvården anmodas att ställa diagnos på barn i syfte att detta krävs för att skolan ska kunna sätta in erforderliga insatser. Här uppstår en situation där läkaren utsätts för påtryckningar från andra myndigheter och/eller föräldrar att ställa en diagnos som kanske inte anses medicinskt motiverad men där omsorgen om barnet och dess rätt till insatser leder till ett problematiskt handlande.

    Hur ska vi finna ett språk och ett tolkningssystem som innebär att diagnosen inte får den stora betydelse som den har i dag?

  • 25.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Psykiatri - en specialitet om hjärnan eller om människan?2008Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 43, s. 3057-3057Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 26.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Psykiatriska aspekter på avbrytande av livsuppehållande behandling2007Konferensbidrag (Refereegranskat)
  • 27.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    The "Forced to help" study: study design, methods and epidemiological data2007Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 7, nr Suppl 1, s. S 104-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The aim of the study was to examine coercive treatment in Swedish child and adolescent psychiatry from different scientific perspectives. The study was done in a multidisciplinary group comprised of researchers and PhD-students from child and adolescent psychiatry, law, philosophy, education and sociology. In this presentation, the design of the study will be presented and also some preliminary epidemiological data.

    Methods Epidemiological data from the period 2000 – 2004 was collected from all clinics in Sweden. Hospital records concerning all involuntarily admitted persons less than 18 years of age during one year were also collected from all clinics in Sweden.

    Results We found a tendency towards more coercive care during recent years. At least 150 children and adolescents were involuntarily admitted annually. The variation between counties was considerable. In some counties, adolescents on coercive treatment were treated together with adults. Girls were involuntarily admitted twice as often as boys. The most frequent diagnoses were psychosis, anorexia nervosa, self-destructive behavior and drug abuse.

    Conclusion Coercive treatment seems to be more frequent in recent years, but the variation is large between different counties. Contrary to adults, girls are more frequently treated involuntarily than boys. Further analysis of data is necessary to get a more comprehensive picture of the reasons for coercion of under aged persons.

  • 28.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Tvingad till hjälp: ett forskningsprojekt om tvång i svensk barn- och ungdomspsykiatri2007Konferensbidrag (Refereegranskat)
  • 29.
    Engström, Ingemar
    Örebro universitet, Hälsovetenskapliga institutionen.
    Vad har vi lärt oss av de apatiska flyktingbarnen?2007Konferensbidrag (Refereegranskat)
  • 30.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    VBM - ett nödvändigt komplement till EBM2008Ingår i: SLS aktuellt, ISSN 1650-8203, Vol. 8, nr 2, s. 4-4Artikel i tidskrift (Övrigt vetenskapligt)
  • 31.
    Engström, Ingemar
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Universitetssjukvårdens forskningscent­rum (UFC), Region Örebro County, Örebro, Sweden.
    Bengtsson, Saskia
    Mobila geriatriska teamet, Länssjukhuset Ryhov, Jönköping, Sweden.
    Vården börjar alltid med mötet2017Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr 42, artikel-id ERRMArtikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Patient care always starts with an encounter Being a doctor is essentially a moral enterprise and all kinds of care begin with the encounter with the patient. This encounter occurs at the intersection of the patient's need for assistance and the doctor's professional knowledge. The meeting can be characterised by paternalism, autonomy or participation. It is important to regard the patient as a person and explore his or her perceptions, apprehensions and expectations early in the meeting. All decisions in medicine rely on both facts and values. It is, therefore, important that both the doctor's and the patient's values and preferences are out in the open. The medical encounter is always asymmetrical, which necessitates that the power perspective be acknowledged.

  • 32.
    Engström, Ingemar
    et al.
    Örebro universitet, Hälsoakademin.
    Lynöe, Niels
    Karolinska Institutet, Stockholm, Sweden.
    Patientens och sjukvårdens värderingar2012Ingår i: Professionell utveckling inom läkaryrket / [ed] Sven Olov Andersson et al, Stockholm: Liber, 2012, 1, s. 27-52Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 33.
    Engström, Ingemar
    et al.
    Psykiatriskt forskningscentrum, Örebro, Sweden.
    Lynøe, Niels
    Centrum för hälso-och sjukvårdsetik, Karolinska institutet, Stockholm, Sweden.
    Tio myter att avliva om medicinsk etik2010Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 40, s. 2419-21Artikel i tidskrift (Refereegranskat)
  • 34.
    Hedberg, Charlotte
    et al.
    Kvartersakuten Surbrunnsgatan, Centre for Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Centre for Psychiatric Research, Örebro, Sweden.
    Vickhoff, Renee
    Kärråkra vårdcentral, Eslöv, Sweden.
    Lynöe, Niels
    Centre for Healthcare Ethics, Karolinska Institute, Stockholm, Sweden.
    Can evidence-based medicine become counter-productive?2010Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, nr 5, s. 553-4Artikel i tidskrift (Refereegranskat)
  • 35.
    Hermansson, Liselotte
    et al.
    Örebro University Hospital, Örebro, Sweden; Karolinska Institute, Stockholm, Sweden.
    Eliasson, A. C.
    Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för klinisk medicin.
    Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand2005Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, nr 4, s. 479-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.

    METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.

    RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.

    CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.

  • 36.
    Holländare, Fredrik
    et al.
    Örebro universitet, Hälsoakademin.
    Andersson, Gerhard
    Dept Clin Neurosci, Sect Internet Psychiat, Karolinska Inst, Stockholm, Sweden; Linköping Univ, Linköping, Sweden.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients2010Ingår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 12, nr 5, artikel-id e49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes. However, many clinicians do not use self-report measures systematically in their clinical practice. Internet-based questionnaires could facilitate administration, but the psychometric properties of the online version of an instrument should be explored before implementation. The recommendation from the International Test Commission is to test the psychometric properties of each questionnaire separately.

    Objective: Our objective was to compare the psychometric properties of paper-and-pencil versions and Internet versions of two questionnaires measuring depressive symptoms.

    Methods: The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden. Participants completed the Beck Depression Inventory (BDI-II) and the Montgomery- Åsberg Depression Rating Scale—Self-rated (MADRS-S), both on paper and on the Internet. The order was randomized to control for order effects. Symptom severity in the sample ranged from mild to severe depressive symptoms.

    Results: Psychometric properties of the two administration formats were mostly equivalent. The internal consistency was similar for the Internet and paper versions, and significant correlations were found between the formats for both MADRS-S (r= .84) and the BDI-II (r= .89). Differences between paper and Internet total scores were not statistically significant for either questionnaire nor for the MADRS-S question dealing with suicidality (item 9) when analyzed separately. The score on the BDI-II question about suicidality (item 9) was significantly lower when administered via the Internet compared with the paper score, but the difference was small (effect size, Cohen’s [d] = 0.14). There were significant main effects for order of administration on both questionnaires and significant interaction effects between format and order. This should not, however, pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made.

    Conclusions: The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinically meaningful way. The full BDI-II also seems to retain its properties when transferred; however, the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study. The use of online questionnaires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save resources.

  • 37.
    Holländare, Fredrik
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Psychiatric Research Center, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Anthony, Susanne A.
    School of Law, Psychology & Social Work, Örebro University, Örebro, Sweden.
    Randestad, Mia
    School of Law, Psychology & Social Work, Örebro University, Örebro, Sweden.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Carlbring, Per
    Stockholm Univ, Dept Psychology, Stockholm, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Two-year outcome of internet-based relapse prevention for partially remitted depression2013Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, nr 11, s. 719-722Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95% = 2.5-24.9) and in the control group it was 60.9% (CI 95% = 44.8-77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression. (C) 2013 Elsevier Ltd. All rights reserved.

  • 38.
    Holländare, Fredrik
    et al.
    Örebro universitet, Hälsoakademin.
    Askerlund, Anna-Maria
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Nieminen, Anna
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Can the BDI-II and MADRS-S be transferred to online use without affecting their psychometric properties?2008Ingår i: Electronic Journal of Applied Psychology, Vol. 4, nr 2, s. 63-65Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Internet has brought new possibilities to psychological assessment. Although there are several advantages to online assessment, there are also challenges. The aim of this study is to test the psychometric equivalence of the traditional paper versions and Internet adapted versions of the BDI-II and the MADRS-S. The 71 participants were recruited at a university campus, and filled out the BDI-II and MADRS-S on both Internet and paper. They were randomized to complete either the Internet versions or the paper versions first, and then complete the other version on the next day. For both the BDI-II and the MADRS-S the Chronbach’s alpha levels were similar in the two mediums of administration. No significant differences were found between the paper versions and the Internet versions and the scores from the two differing mediums correlated highly for both questionnaires. Therefore, it was concluded that the psychometric properties of the BDI-II and the MADRS-S remained unchanged after transformation to online use.

  • 39.
    Holländare, Fredrik
    et al.
    Örebro universitet, Hälsoakademin.
    Johnsson, Susanne
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Randestad, Mia
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Carlbring, Per
    Umeå universitet, Umeå, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Linköping, Sweden.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Randomized trial of Internet-based relapse prevention for partially remitted depression2011Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, nr 4, s. 285-294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:

    To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment.

    Method:

    Seventy-one women and 13 men (N= 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later.

    Results:

    Significantly fewer participants in the CBT group experienced relapse (4⁄38 or 10.5%) compared with those in the control group (14⁄37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up.

    Conclusion:

    Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

  • 40.
    Humble, Mats B.
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Psychiatric Research Centre, Örebro, Sweden.
    Uvnäs-Moberg, Kerstin
    Swedish University of Agricultural Sciences, Skara, Sweden .
    Engström, Ingemar
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Bejerot, Susanne
    Karolinska Institutet, Stockholm, Sweden.
    Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment: a placebo controlled study2013Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 13, s. 344-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The drug treatments of choice for obsessive-compulsive disorder (OCD) are serotonin reuptake inhibitors (SRIs). However, a correlation between the neuropeptide oxytocin in cerebrospinal fluid and the severity of OCD has previously been shown, and oxytocin and serotonin are interconnected within the brain. Few studies have investigated whether SRIs have any effect on oxytocin; thus, our aim was to explore the possibility that oxytocinergic mechanisms contribute to the anti-obsessive effect of SRIs.

    Method: In a randomized, double-blind trial, comparing SRIs (clomipramine and paroxetine) with placebo in 36 adults with OCD (characterized for subtypes), plasma oxytocin was measured with radioimmunoassay after plasma extraction, at baseline, after 1 week, and after 4 weeks of treatment, and related to baseline severity and clinical response after 12 weeks, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

    Results: Baseline oxytocin levels correlated positively with baseline Y-BOCS ratings, but only among the future SRI responders. Patients with early onset of OCD had higher baseline oxytocin. During treatment, plasma oxytocin did not differ between SRI and placebo treatment. In SRI responders, plasma oxytocin first decreased and then increased; in non-responders (to SRI as well as to placebo), the reverse was the case. After 4 weeks, treatment responders had attained higher oxytocin levels compared to non-responders. The intra-individual range (i.e. the variability) of plasma oxytocin between measurements was the measure that best differentiated responders from non-responders. This range was higher in responders than non-responders, and lower in patients with autistic traits.

    Conclusions: SRIs have highly variable effects on plasma oxytocin between individuals. The associations between baseline oxytocin and OCD severity and between oxytocin changes and treatment response support the notions that oxytocin is involved in OCD pathophysiology, and that the anti-obsessive effects of SRIs are partly exerted through oxytocinergic mechanisms.

  • 41.
    Hylén, Ulrika
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center.
    Engström, Ingemar
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center.
    Engström, Karin
    School of Culture and Education, Södertörn University, Stockholm, Sweden.
    Pelto-Piri, Veikko
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Providing Good Care in the Shadow of Violence: An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden2019Ingår i: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, nr 2, s. 148-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.

  • 42.
    Kjellin, Lars
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Engström, Ingemar
    Örebro universitet, Institutionen för klinisk medicin.
    Tvångsvård av barn och ungdomar saknar enhetlig, nationell praxis: enkätstudie visar på stora regionala variationer2006Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, nr 42, s. 3162-3164Artikel i tidskrift (Refereegranskat)
  • 43.
    Kjellin, Lars
    et al.
    Region Örebro län. Psykiatriskt forskningscentrum, Örebro University Hospital, Örebro, Sweden.
    Thorsen, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Backström, Jan
    Psykiatrisk akut- och heldygnsvård, Region Örebro län, Karlskoga, Sverige.
    Wadefjord, Anna
    Psykiatriskt forskningscentrum, Örebro University Hospital, Örebro, Sweden.
    Engström, Ingemar
    Region Örebro län. Psykiatriskt forskningscentrum, Örebro University Hospital, Örebro, Sweden.
    Etik och moralisk stress diskuteras sällan i psykiatrin2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 4, s. 150-3Artikel i tidskrift (Refereegranskat)
  • 44. Lundstedt, G.
    et al.
    Edlund, B.
    Engström, Ingemar
    Örebro universitet, Institutionen för klinisk medicin.
    Thurfjell, B.
    Marcus, C.
    Eating disorder traits in obese children and adolescents2006Ingår i: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 11, nr 1, s. 45-50Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to investigate the prevalence of eating disorder (ED) traits among obese children and adolescents. The Swedish version of the Eating Disorder Inventory for Children, consisting of 11 subscales, was administered to 150 obese patients during an extensive investigation of causes and risk factors in obesity at the Karolinska University Hospital at Huddinge. Patients aged 17-18 years (N=24) had a mean body mass index (BMI) of 40.7, SD 5.31, and patients aged 8-16 (N=126) had a mean body mass index standard deviation score (BMI SDS) of 6.18, SD 1.69. These patients were compared with 201 girls with a diagnosed ED from the COEAT project and with a control group of schoolchildren. The comparison between obese girls and boys showed that adolescent obese girls scored higher than obese boys on Drive for Thinness, Bulimia and Body Dissatisfaction. They also scored higher on Ineffectiveness, Interoceptive Awareness and Impulse Regulation. Obese girls were close to the girls with an ED on six of the subscales. Obese boys had a lower score of Asceticism than boys in the control group. The conclusion is that psychological traits associated with disordered eating appear among obese patients, particularly among the girls. However, these patients rarely satisfy any diagnostic criteria for ED during childhood or adolescence. Since obesity treatment currently assumes rational behavior, i.e. no EDs, it is important to discover ED traits at an early age in order to adapt treatment accordingly.

  • 45. Lynöe, Niels
    et al.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Löfmark, Rurik
    Från läkarpaternalism till patientautonomi2009Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 52, s. 3500-3502Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Patientens ställning har stärkts, och ett paternalistiskt bemötande är inte längre gångbart.

    Att respektera en patients autonomi innebär att både respektera patients beslut och stärka och bevara patientens beslutsförmåga.

    Läkare förväntas i dag re­spektera en beslutskapabel patients autonomi beträffande rätten att tacka nej till erbjuden utredning och behandling.

    På samma sätt som läkare bör respektera patienters autonomi bör patienter re­spek­tera läkares professionella autonomi, som baseras på vetenskap och beprövad erfarenhet.

    Vetenskap och beprövad erfarenhet inbegriper både fakta- och värderingsaspekter, och i en etisk analys bör man förtydliga båda aspekterna.

  • 46. Lynöe, Niels
    et al.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Löfmark, Rurik
    Sallin, Karl
    Uggla, Charlotta
    Thulesius, Hans
    Goda förebilder och tid för reflektion saknas: enkätstudie om medicinsk etik i läkarutbildningen2007Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, nr 9, s. 676-678Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Cirka tre fjärdedelar av läkarstuderande har varit i kontakt med goda förebilder, och drygt hälften har varit i kontakt med dåliga. En tiondel av läkarstuderande har enbart varit i kontakt med dåliga förebilder. Mindre än 40 procent har varit med om att läkare/lärare lyft fram etiska problem, och fler har erfarenhet av att läkare/lärare enbart ger sin egen bedömning utan att ge utrymme för diskussion. Det förefaller vara riskabelt att enbart förlita sig på att läkare/lärare fungerar som goda förebilder och att etikdiskussionen är integrerad i den kliniska undervisningen. För att utveckla ett etiskt förhållningssätt bör undervisningen i medicinsk etik kompletteras med kunskaper i den etiska grammatiken.

  • 47.
    Lynøe, Niels
    et al.
    Centrum för hälso-och sjukvårdsetik, Karolinska institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Juth, Niklas
    Centrum för hälso-och sjukvårdsetik, Karolinska institutet, Stockholm, Sweden.
    Dödshjälp bakom okunskapens slöja2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, nr 24, s. 1020-1020, artikel-id EZ4TArtikel i tidskrift (Refereegranskat)
  • 48.
    Neander, Kerstin
    et al.
    Örebro universitet, Hälsoakademin.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Parents' assessment of parent-child interaction interventions: a longitudinal study in 101 families2009Ingår i: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, Vol. 3, nr 1, s. 8-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The aim of the study was to describe families with small children who participated in parent-child interaction interventions at four centres in Sweden, and to examine long term and short term changes regarding the parents' experience of parental stress, parental attachment patterns, the parents' mental health and life satisfaction, the parents' social support and the children's problems.

    Methods

    In this longitudinal study a consecutive sample of 101 families (94 mothers and 54 fathers) with 118 children (median age 3 years) was assessed, using self-reports, at the outset of the treatment (T1), six months later (T2) and 18 months after the beginning of treatment (T3). Analysis of the observed differences was carried out using Wilcoxon's Signed-Rank test and Cohen's d.

    Results

    The results from commencement of treatment showed that the parents had considerable problems in all areas examined. At the outset of treatment (T1) the mothers showed a higher level of problem load than the fathers on almost all scales. In the families where the children's problems have also been measured (children from the age of four) it appeared that they had problems of a nature and degree otherwise found in psychiatric populations. We found a clear general trend towards a positive development from T1 to T2 and this development was also reinforced from T2 to T3. Aggression in the child was one of the most common causes for contact. There were few undesired or unplanned interruptions of the treatment, and the attrition from the study was low.

    Conclusion

    This study has shown that it is possible to reach mothers as well as fathers with parenting problems and to create an intervention program with very low dropout levels – which is of special importance for families with small children displaying aggressive behaviour. The parents taking part in this study showed clear improvement trends after six months and this development was reinforced a year later. This study suggests the necessity of clinical development and future research concerning the role of fathers in parent-child interaction interventions.

  • 49.
    Neander, Kerstin
    et al.
    Örebro universitet, Hälsoakademin.
    Kling, Anna-Maria
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Fathers' involvement in parent-child interaction interventions: a prospective, naturalistic studyManuskript (preprint) (Övrigt vetenskapligt)
  • 50.
    Nilsson, Karin
    et al.
    Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
    Engström, Ingemar
    Örebro universitet, Hälsoakademin.
    Hagglöf, Bruno
    Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
    Family Climate And Recovery In Adolescent Onset Eating Disorders: a prospective study2012Ingår i: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 20, nr 1, s. e96-e102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This prospective study investigated the self-assessed family climate of adolescent patients and their parents during treatment of and recovery from eating disorders.

    Method: One hundred two girls aged 13-17 years with eating disorders, answered the self-report Family Climate Scale (FCS) and Eating Disorders Inventory for Children at initial assessment and after 18 and 36 months. The FCS was also answered by their parents at the same time points.

    Results: Self-assessed family climate and eating disorder symptoms were similar for recovered (R) and nonrecovered (NR) adolescents at initial assessment and at 18 months. At 36 months, FCS Closeness was higher for R, and FCS Distance was lower for R compared with NR. Parents of R adolescents had higher scores on FCS Closeness and lower scores on FCS Chaos compared with parents of NR adolescents at the 36-month follow-up.

    Conclusion: Self-reported family climate was associated with recovery. Changes in eating disorder symptoms preceded changes in family climate. Copyright (C) 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

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