Nordic Journal of Psychiatry最新文献

Purpose: Young adults (18-25 years) have the highest prevalence of psychiatric disorders of any age group. This qualitative study aims to gain perspectives on individual change and recovery, and the influence of psychiatric care, 20 years after being treated as young adults.

Methods: Semi-structured interviews were conducted at 20-year follow-up with 18 participants from the original 'Young Adult' study in Uppsala, Sweden from 2002/2003. All interviews were audio-recorded and transcribed. The data were analysed using inductive thematic analysis.

Results: The analysis resulted in three themes: Personal recovery, Communication and participation in psychiatric care, and Organization of psychiatric care. Personal recovery included subthemes: Acceptance of vulnerability, Maturity, and Social stigma. Communication and participation in psychiatric care included subthemes: Personal approach, and Individually-adapted care and individual responsibility. Organization of psychiatric care included subthemes: Availability of health care, Resources, and Diagnostics and treatment.

Conclusions: Personal recovery for young adults included social changes, comparison with peers, being between dependence and independence, and stigma. Acceptance of vulnerability and maturity helped to increase stability. Communication, participation and the organization of psychiatric care were described within the framework of patient-centred care, with an emphasis on an empathetic approach and the availability of psychiatric care. These findings offer clinically relevant insights into how psychiatric services can support long-term recovery.

Purpose: Discharge from a psychiatric hospital is associated with an elevated risk of suicide. Previous studies have linked a higher number of psychiatric admissions to suicide risk. However, findings are mixed, and the association between admission frequency and suicide risk remains unclear. This study aimed to investigate whether frequent psychiatric admissions and the persistence of readmission patterns serve as risk factors for suicide.

Methods: This prospective total cohort study included all patients consecutively admitted to the psychiatric acute ward at Haukeland University Hospital in Bergen, Norway, between 2005 and 2014 (N = 7000). The cohort was divided into independent groups according to the number of admissions per year and the persistence of this pattern. Demographic and clinical data were collected at each admission. Patients were followed for up to 19 years by linking the cohort to the Norwegian Cause of Death Registry. Cox and competing risk regression analyses were applied to investigate the association between the frequency of admissions and the risk of suicide.

Results: There was an approximately threefold (AHR = 2.91) increase in the risk of suicide in patients with five or more admissions on average per utilisation year, when adjusted for gender, suicidal ideation, self-harm and diagnosis. The risk was particularly high (AHR = 5.93) immediately after the last discharge.

Conclusions: These findings might assist the identification of a subgroup of individuals at particular risk of suicide within a population of hospitalised psychiatric patients.

Purpose: The purpose of this review is to review the current literature on the relationship between somatization and emotional processes in different cultures.

Materials and methods: This study used a narrative approach by reviewing the existing theoretical and empirical literature on the subject. No specific inclusion or exclusion criteria were used; relevant publications were identified by searching academic databases and bibliographies.

Results: The findings generally indicate that somatization is a multidimensional phenomenon influenced by culturally differing emotion regulation styles. Differences in the recognition and expression of emotions across cultures may shape how individuals perceive and report somatic symptoms. In collectivist societies, the tendency to avoid direct expression of emotions may lead to more frequent expressions of emotional distress through physical symptoms. Furthermore, the existing literature's focus on East-West comparisons results in an underrepresentation of cultures located between these two extremes, such as Turkey.

Conclusion: Understanding somatization requires a joint consideration of both cultures and individual emotion regulation capacity.

Purpose: COVID-19 challenged health care personnel from spring 2020 to the introduction of vaccines. This prospective cohort study evaluated the psychological impact of cumulated exposure to COVID-19 frontline work and COVID-19-related potentially traumatic events (PTEs) on all hospital personnel.

Materials and methods: PTEs, posttraumatic stress disorder (PTSD) symptoms, psychological distress, insomnia, anxiety and depression symptoms were assessed with screening tools monthly during the first year and later bimonthly in this study among HUS Helsinki University Hospital personnel who participated in this study. The initial number of participants was N = 4910 (19% of the hospital personnel), 85% of whom reparticipated in some of the 16 follow ups and N = 1128 at 24 months (last follow up).

Results: The most important PTE before PTSD symptoms was strong anxiety due to fear of one's own or a close one's infection (odds ratio, OR 2.39, 95% confidence interval, CI 1.92-2.98), followed by exceptionally disturbing or distressing pandemic work assignments (OR 1.69, 95% CI 1.41-2.02). Frontline work and direct exposure to pandemic patients alone did not statistically significantly increase PTSD risk (OR 1.05, 95% CI 0.89-1.23). Accumulation of PTEs (OR 1.07 per PTE, 95% CI 1.03-1.12) and prolonged frontline work (OR 1.05, 95% CI 1.01-1.10) over time were risk factors for psychological distress.

Conclusions: Accumulated exposures to PTEs and frontline work constitute an additional risk of distress and stress-related disorders. The subjective nature of the most prominent risk, PTE (fear of infections), suggests that workplace interventions and emotional support might prevent distress during a pandemic.

Background: Workplace violence towards healthcare workers is increasing worldwide, with significant consequences for the healthcare worker, healthcare organization, and the quality of care. Healthcare workers in psychiatric inpatient units are particularly exposed, as the frequency and severity of violence is high. This study aimed to examine the prevalence of workplace violence towards healthcare workers in psychiatric inpatient units in Norway and the rate of formal reporting of such incidents.

Materials and methods: A cross-sectional, questionnaire-based survey was conducted among healthcare workers across ten psychiatric inpatient units in Norway. The survey investigated the 12-month prevalence of workplace violence towards healthcare workers and the extent of formal reporting by type and severity.

Results: A total of 237 (36%) healthcare workers completed the questionnaire. The overall 12-month prevalence of workplace violence from patients was 93%, with 91% of respondents reported being exposed to threats and 80% to violence. The median formal reporting rate was 7% (IQR 0-50) for threats, 40% (IQR 1-69) for violence without injury, and 70% (IQR 20-100) for violence resulting in injury. Formal reporting was generally regarded as important and not perceived as a professional defeat, but it was not seen as leading to change.

Conclusions: This study confirmed a high prevalence of workplace violence in Norwegian psychiatric inpatient units, with the majority of incidents not formally reported.

Background: Substance use disorders (SUD) are prevalent among forensic psychiatric patients and contribute to a complex mental and somatic health burden. While barriers to healthcare access are well documented, little is known about how individuals with comorbid SUD use general practitioner (GP) and acute somatic hospital services before entering forensic psychiatric treatment.

Aims: To examine the association between SUD and use of GP and acute outpatient hospital services.

Methods: We identified all individuals with a forensic psychiatric measure initiated in 2021-2022 from the Danish National Patient Register. SUD was defined as any ICD-10 F1 diagnosis, excluding acute intoxication, recorded during 2013-2017. Outcomes were GP consultations and acute outpatient hospital contacts during 2018. Associations were examined using negative binomial regression adjusted for age, sex, region, and prior-year service use.

Results: The cohort included 829 patients (39% with SUD). Almost all had ≥1 GP contact in 2018 (90% vs 89%). SUD was not associated with GP utilization (adjusted IRR = 0.99, 95% CI: 0.88-1.12). Acute outpatient contacts were more frequent among patients with SUD (45% vs 32%), with higher rates (IRR = 1.43, 95% CI: 1.04-1.97), attenuating after adjustment for prior-year use (aIRR = 1.28, 95% CI: 0.97-1.68).

Conclusions: Forensic psychiatric patients with SUD had greater use of acute outpatient hospital services, but similar GP utilization, compared with those without SUD, suggesting reliance on crisis-driven rather than preventive care.

‌methods: ‌ NHANES 2013-2018 cohort data were analyzed. DII scores were calculated from 24-hour dietary recalls; depression was assessed via Patient Health Questionnaire-9 (PHQ-9). Logistic regression and restricted cubic spline (RCS) analyses examined DII-depression associations. Cox regression and Kaplan-Meier curves evaluated mortality risks.

‌results: ‌ A total of 12,521 participants were finally included in the final analysis. Logistic regression and RCS analyses revealed a dose-response relationship between higher DII and depression risk (p < 0.001). Over 6.82-year median follow-up, depression was independently associated with increased all-cause mortality (HR:1.42, 95% CI:1.11-1.82), particularly in adults age <60 (HR:3.01, 95% CI: 1.94-4.65), BMI < 25 kg/m² (HR:2.40, 95% CI: 1.58-3.65), and nonsmokers (HR:2.61, 95% CI: 1.77-3.85). Each unit DII increase raised all-cause mortality by 7% (HR:1.07, 95% CI:1.02-1.12) and cardiovascular diseases (CVD) mortality by 12% (HR:1.12, 95% CI:1.02-1.22), with stronger effects in those with BMI ≥ 25 (HR:1.11,95% CI:1.05-1.18) and smokers (HR:1.14,95% CI:1.05-1.23). No significant DII-depression interaction on mortality was found.

‌conclusion: ‌ A higher DII score was associated with increased depression risk in U.S. adults. Depression and high DII scores elevated all-cause mortality, but these impacts varied with age, BMI, or smoking status. These findings highlight nutrition-mental health links for targeted prevention.

Purpose: This study is the first to examine the prevalence of metabolic syndrome (MetS) and its four components (hypertension, dyslipidaemia, dysglycaemia and obesity) in a population of trauma-affected refugees. We also examined whether MetS was associated with age, sex and medication use.

Materials and methods: Data were collected from a cohort of refugees with PTSD who participated in a randomised controlled trial (RCT) at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The cohort comprised 110 men and 109 women (mean age = 44 years, SD = 10.4) predominantly from the Middle East, with additional representation from Asia, Africa, and Eastern Europe. MetS was defined according to the Danish medical handbook (fasting glucose was substituted with HbA1c) and Chi-square tests were utilised to examine associations between MetS and age, sex and use of antidepressants and antipsychotics.

Results: Among the 219 participants, the prevalence of MetS was 34.7% with additional 16.0% potentially having MetS. MetS was significantly associated with antidepressant use (p < 0.001), antipsychotic use (p = 0.003), and older age (p < 0.001), but not with sex (p = 0.10). Dyslipidaemia was the most prevalent MetS component (57.5%) and was significantly overrepresented in males (73.8%) compared to females (41.1%) (p < 0.001).

Conclusions: In a cohort of refugees with PTSD, the prevalence of MetS was elevated and associated with older age, and the use of antidepressants and antipsychotics. Among the four MetS components, dyslipidaemia was particularly prevalent in men, highlighting the need for targeted interventions.

Purpose: Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for major depressive disorder (MDD). MDD is a heterogeneous condition with subtypes, including atypical depression (AD). The effectiveness of rTMS for AD remains unknown. In this study, we investigated the effects of rTMS in patients with AD compared to those with MDD in a clinical setting.

Materials and methods: A total of 103 patients with uni- or bipolar depressive episodes, treated with rTMS at the Uppsala Brain Stimulation Unit between April 2017 and October 2023, were included. Participants were categorized as AD (Quick Inventory of Depressive Symptomatology Self Report items 4, 7, and 9 ≥ 3) or MDD. The primary outcomes were response and remission rates based on the total score of Montgomery and Åsberg Depression Rating Scale self-report (MADRS-S). Response was defined as a 50% reduction of the total MADRS-S score and remission as MADRS-S < 10.

Results: Depressive symptoms significantly decreased after rTMS in the whole sample, with the mean MADRS-S score reduced from 34 to 25. The AD group had consistently lower scores on MADRS-S. No significant differences were observed in symptom reduction, response, or remission rates between AD and MDD groups. Response and remission rates were 12.6% and 2.9% for the whole sample, although reasons for treatment termination could not be assessed.

Conclusions: rTMS does not appear to yield specific benefits for AD. Observed response and remission rates were lower than previously reported, highlighting the need for more reports of the actual effectiveness of rTMS.

Purpose: In Sweden, in the wake of deinstitutionalization, in 1995 the responsibility for support regarding accommodation, employment, and an active everyday life for persons with severe mental illness (SMI) became a matter for the municipality's social services. The overall aim of this study was to investigate whether there are differences in functioning and needs among older adults (65+) with severe mental illness (SMI) when divided into Psychosis and Non‑Psychosis groups.

Materials and methods: Data was collected from 5 surveys, and data from national registers. A group of older adults with SMI, with a history of long-term stays in mental hospitals, was identified and divided into two groups: Psychosis diagnosis (N = 222) and Non-Psychotic diagnosis (N = 253).

Results: The level of functioning was significantly lower in the Psychosis group, but at the same time, long periods of institutionalization, regardless of diagnosis category, also contributed to lower functioning scores. Diagnostic group did not explain differences in the proportion of unsatisfied needs; however, the length of institutionalization did.

Conclusions: Although there were diagnostic group differences in functioning, there were no diagnostic group differences in unmet needs, suggesting that social services were responding to individuals' actual level of functioning. In line with the studies by Barton and by Goffman, it can be argued that the long periods of institutionalization were the most decisive factors influencing functional levels.