Nordic Journal of Psychiatry最新文献

Background: Social capital theory is predominantly built around social networks, relationships, and functions of society. Social capital dimensions have been found to be inversely associated with depressive symptoms. This study aimed to investigate the association between cognitive and structural dimensions of social capital and depressive symptoms (outcome variable) at an epidemiological level.

Methods: Social capital consisted of cognitive (actual support, emotional support and generalized trust) and structural (taking care of family members) dimensions. Depressive symptoms were calculated using the Hopkins Symptoms Checklist- 15. Data used was derived from the Northern Finland Birth Cohort 1966, utilizing a sample of 46-year-old participants (N = 6522). The study used cross-sectional design. Binary logistic regression analyses were used to explore the association between these dimensions of social capital and depressive symptoms after adjusting for gender, education level, and marital status.

Results: Cognitive social capital variables were associated with depressive symptoms: those who received 'not at all' emotional or actual support from their partners were significantly more likely to exhibit depressive symptoms (odd ratios (OR) being 2.04 (95% CI = 1.57, 2.65) and 2.29 (95% CI = 1.76, 2.98), respectively) than those whose partners supported them a lot/quite a lot. Furthermore, those having extra low generalized trust had over 7-fold (OR = 7.55, 95% CI= 5.42, 10.53) increased risk of exhibiting depressive symptoms. Structural social capital was not associated with depressive symptoms.

Conclusions: A significant association between cognitive social capital and depressive symptoms was found, suggesting that social capital may play a significant role in the trajectory of depressive symptoms.

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in adolescence resulting in functional impairment that often persist to adulthood. Girls seem to be diagnosed with ADHD later in life than boys and more often have a comorbid major depressive disorder (MDD). It has been suggested that comorbidity with MDD can interfere with early identification of ADHD.

Aims: The aim of the study was to investigate the diagnostic delay for boys and girls with ADHD in child and adolescent outpatient settings as well the interference of self-reported symptoms of MDD.

Methods: Adolescent psychiatric outpatients were assessed with DSRS-A Screener (version of Depression Self-Rating Scale for Adolescents) at intake. Diagnostic delay for ADHD was estimated with Kaplan-Meier survival curve with separated analysis for boys/girls and for negative/positive MDD screening. Cox regression analysis was used to examine the association of sex and MDD screening.

Results: Diagnostic delay for N = 252 (41% boys, mean age =15.23 years) was 3.5 years, 1.4 for boys and 4.9 for girls (p = 0.004). Positive MDD screening was associated with prolonged diagnostic delay (from 1.4 to 4.9 years p = 0.002), which in separated analyses was statistically significant only for girls from 1.8 to 4.9 years (p = 0.018). In Cox regression male sex was associated with decreased diagnostic delay (p = 0.023) while positive MDD screening with prolonged diagnostic delay (p = 0.015).

Conclusions: The diagnostic delay of ADHD was more than three times longer for girls. Co-occurring symptoms of MDD prolonged diagnostic delay significantly only for girls.

Background: Many reports associate particular phases of the human reproductive cycle with psychiatric symptoms including depression, although details of associations of morbidity of depressive, bipolar, and anxiety disorders with pre-, peri-, and post-menopausal phases require further clarification. This naturalistic study evaluated the timing of onset and morbidity of mood and anxiety disorders in women during these menopausal phases.

Methods: Women (N = 928) with a primary diagnosis of BD type I or II (BD1 or BD2), major depressive disorder (MDD) or an anxiety disorder were clinically evaluated after menopause to determine the onset of affective illness during the pre, peri-, or post-menopausal phases. Psychometric scales were used to assess affective illness and multivariable regression modeling was used to compare menopausal phases.

Results: Many descriptive and clinical measures differed significantly with illnesses starting in the three menstrual phases. Women with onset of affective illness in the perimenopause phase spent 1.33 more time ill than those starting in the premenopausal phase and 1.46 more time ill than women with postmenopausal onset, with corresponding differences in illness episodes/year as well as suicidal risks.

Conclusions: Study findings are consistent with the view that onset in the peri-menopausal phase may be associated with an excess of affective morbidity in both MDD and BD and that the post-menopausal phase may involve less morbidity.

Background: Mental health problems are increasing among children and adolescents. Parents play a pivotal role in care, and intervention programmes have been introduced directed towards children with mild to moderate mental health problems. Due to long waiting times for specialised psychiatric care, such programmes could serve as means to ease the burden on mental health clinics for children 6-14 years. The aim of this study was to evaluate parents' assessments of the quality of care of an intervention programme and associations with the children's physical and mental health after treatment.

Methods: Parents' assessment of the quality of care was investigated through a questionnaire. Outcome variables were parents' perceptions of the children's physical and mental health after treatment. Explanatory variables were background factors, care organisation and the content of care.

Findings: 31% of the parents assessed their child's physical health as less than good, and 46% their child's mental health as less than good, after treatment. Long waiting times (OR 2.50; 1.17-5.30), parents' ability to have private conversations with the therapist (OR 0.45; 0.22-0.94), and deficiencies in the content of care were associated with less good physical health after treatment. Less good mental health after treatment was associated with older age of children (OR 2.01; 1.01-3.99) and deficiencies in care content.

Conclusion: Age of the child, long waiting time, and perceived deficiencies in the content of care were associated with less physical and mental well-being of the child after the intervention. These findings call for improvement of care.

Introduction: Personality disorder (PD) diagnoses, especially borderline PD, are overrepresented among individuals seeking medical gender reassignment (GR), but their impact on progression to or discontinuation of GR is unclear. This may differ between adults and adolescents due to ongoing personality development in youth.

Materials and methods: This register-based follow-up study examined 3665 individuals referred to Finnish gender identity services between 1996 and 2019. Data on specialist-level psychiatric treatments from 1994 to 2022 were obtained from the National Care Register for Health Care. The study assessed associations between PD diagnoses (any, and specifically borderline PD) and outcomes related to medical GR, including treatment initiation and discontinuation. Analyses accounted for age group (adolescents vs. adults), transition direction, and non-PD psychiatric comorbidities.

Results: Subjects with a PD diagnosis were significantly less likely to initiate GR than were those without a PD (33% vs. 46.1%, p < .001). However, among those who began GR, presence of PD did not appear to increase the likelihood of discontinuation. These findings held equally for across both adolescents and adults. Similar results were found for borderline PD specifically.

Conclusions: Personality disorders may be linked to challenges in forming a stable gender identity, potentially reducing the likelihood of initiating medical GR. However, once treatment begins, PD does not appear to increase the risk of discontinuation.

Background: Insomnia is common in psychiatric populations. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for chronic insomnia. However, patients with mental disorders often experience a variety of sleep problems, including delayed sleep phase beyond insomnia. To address this, a Danish sleep and circadian intervention with six individual sessions combining CBT-I with chronotherapeutic methods was initiated in 2019.

Aim: To evaluate the effect of the transdiagnostic sleep and circadian intervention on sleep quality and insomnia severity and to identify diagnostic characteristics of patients who responded well compared to those with less favorable outcomes.

Method: Data on patients' subjective sleep quality and perceived insomnia severity, assessed before and after the intervention, were extracted from clinical notes. Additionally, demographic data and diagnostic information were collected.

Results: A total of 248 patients completed the transdiagnostic sleep and circadian intervention. We found a statistically significant reduction in insomnia severity, particularly in those diagnosed with bipolar affective disorder and unipolar depression. We also saw a statistically significant improvement in sleep quality and the largest change over time was found in patients with attention-deficit hyperactivity disorder.

Conclusion: This quality assurance study showed that a transdiagnostic sleep and circadian intervention - comprising six individual sessions delivered by an interdisciplinary team following a short sleep course and peer-to-peer training - can effectively improve sleep in patients with long-lasting sleep problems.

Objective: To study the lifetime and point prevalence of eating disorders (ED) among mental health care providers and compare those working with patients with ED to those who work in other fields of psychiatry to examine whether the overrepresentation of ED among professionals seen in ED clinics are also true for professionals in other psychiatric outpatient clinics.

Methods: Digital questionnaires were sent out to professionals working with patients in psychiatric outpatient clinics in Sweden. The questionnaire included questions from the Mini International Neuropsychiatric Interview 7.0.1 and the Eating Disorder Examination Questionnaire 6.0. 173 respondents completed the questionnaire.

Results: The lifetime prevalence of ED among professionals in ED-clinics was 35.2% (women 41.9%, men 10.0%) and in non-ED clinics 24.4% (women 27.7%, men 16.1%). The point prevalence was 11.1 and 10.9% respectively.

Conclusions: The lifetime prevalence of any ED in the Swedish general population is 2-3.5%. Our results suggest a 10-fold higher prevalence among mental health care providers, regardless of if working with patients with ED or not. This result could have multiple explanations; such as an increased willingness to help others based on personal experience of ED or increased risk of developing ED when working with patients with ED. There is always a risk of reporting bias when conducting studies using digital questionnaires. The findings can have implications for the psychosocial work environment and health of employees as well as for the assessment and treatment of patients.

Introduction: This study is based on a development project among selected child and adult mental health services in Sweden. Its goal was quality enhancement by using a family approach. The Family Model (TFM) is a family-focused practice developed in Australia and implemented for several years. In accordance with trust-based research, experiences voiced by the family are investigated.

Aim: The aim of the study was to gain knowledge regarding the experiences of both youth and adult family members when using TFM under the supervision of child and adult mental health services.

Method: Eleven families were recruited and interviewed in focus groups or individually in a qualitative study based on principles of naturalistic inquiry.

Results: Family members found that the model provided them with the opportunity to deal preemptively with their issues. It worked well in conjunction with the mental health services they were being provided by giving them clear objectives. The presence of competent clinicians was considered essential for success.

Conclusion: The Family Model proved useful in mental health clinical practice in families with concurrent mental illness in youth and adults. Our findings may assist providers in developing a parallel family-focused practice that offers child and adult clinical services.

Purpose: To investigate the connections between young people's criminal behavior and involuntary psychiatric treatment.

Materials and methods: A registry-based follow-up study, using data of all Finnish individuals with first ever psychiatric inpatient treatment at ages 13-17 between 1996 and 2010 (n = 12,725). Information on inpatient treatment periods was extracted from the National Care Register for Health Care (HILMO) and data on criminality from the Register of Prosecutions, Sentences and Punishments maintained by Statistics Finland. The subjects were followed for 10 years after the end of the index hospital stay.

Results: A criminal background before the first hospital stay was about twice as common among those committed to hospital involuntarily and those detained in involuntary treatment. Both commitment and detainment were across diagnostic groups associated with later criminal behavior in general and violent criminality in particular. In analyses stratified by sex, involuntary treatment was associated with later criminality only among females.

Conclusions: Criminal behavior before admission to psychiatric treatment is a risk factor for the initiation and implementation of involuntary treatment, but the initiation and implementation of treatment through involuntary procedures are also independent predictors of later criminal behavior. In hospital care and subsequent interventions, supporting prosocial development should be a focus in addition to treating psychiatric symptoms.