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Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature294801
Source
BMJ Open. 2018 02 24; 8(2):e018323
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-24-2018
Author
Anders Prior
Mogens Vestergaard
Karen Kjær Larsen
Morten Fenger-Grøn
Author Affiliation
Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
Source
BMJ Open. 2018 02 24; 8(2):e018323
Date
02-24-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Distribution
Aged
Aged, 80 and over
Cohort Studies
Denmark - epidemiology
Female
Health Surveys
Humans
Life Style
Male
Mental Health Services - utilization
Middle Aged
Multimorbidity
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - utilization
Psychiatric Status Rating Scales
Psychotherapy
Psychotropic Drugs - therapeutic use
Regression Analysis
Sex Distribution
Socioeconomic Factors
Stress, Psychological - epidemiology - therapy
Abstract
Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity.
Population-based cohort study.
Primary healthcare in Denmark.
118?410 participants from the Danish National Health Survey 2010 followed for 1?year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.
General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.
Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95%?CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95%?CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95%?CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95%?CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95%?CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.
Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.
Notes
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PubMed ID
29478014 View in PubMed
Less detail

Attachment style among outpatients with substance use disorders in psychological treatment.

https://arctichealth.org/en/permalink/ahliterature298631
Source
Psychol Psychother. 2018 12; 91(4):490-508
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-2018
Author
Ylva Gidhagen
Rolf Holmqvist
Björn Philips
Author Affiliation
Department of Behavioural Sciences and Learning, Linköping University, Sweden.
Source
Psychol Psychother. 2018 12; 91(4):490-508
Date
12-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Female
Health Knowledge, Attitudes, Practice
Humans
Interpersonal Relations
Male
Middle Aged
Object Attachment
Outpatients - psychology
Psychotherapy - methods
Regression Analysis
Stress, Psychological
Substance-Related Disorders - psychology - therapy
Sweden
Young Adult
Abstract
To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment.
In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation.
An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end.
This study shows significant relations between patients' attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style.
We found among patients with SUD a strong relation between patients' attachment style and their psychological distress. Knowledge of the patient's attachment style may help the therapist to tailor the treatment to the patient's needs. A change from insecure to secure attachment style can be an important goal for a SUD treatment, as it may prevent the patient from using defence strategies involving substance use for regulating emotions and interpersonal relationships.
PubMed ID
29399945 View in PubMed
Less detail

Collaborative Assessment and Management of Suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature289518
Source
Trials. 2016 10 03; 17(1):481
Publication Type
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
10-03-2016
Author
Wenche Ryberg
Roar Fosse
Per Henrik Zahl
Inge Brorson
Paul Møller
Nils Inge Landrø
David Jobes
Author Affiliation
Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Lier, Norway. Wenche.ryberg@vestreviken.no.
Source
Trials. 2016 10 03; 17(1):481
Date
10-03-2016
Language
English
Publication Type
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Checklist
Clinical Protocols
Cognition
Cooperative Behavior
Humans
Interdisciplinary Communication
Mental health
Norway
Patient care team
Psychiatric Status Rating Scales
Psychotherapy - methods
Research Design
Risk factors
Suicidal ideation
Suicide - prevention & control - psychology
Surveys and Questionnaires
Time Factors
Treatment Outcome
Abstract
Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that appears promising to reduce suicidal ideation and suicidal cognition. CAMS has not previously been evaluated in a standard specialized mental health care setting for patients with suicidal problems in general. In this pragmatic randomized controlled trial (RCT) we will investigate if CAMS is more effective than treatment as usual (TAU) in reducing suicidal thoughts and behaviors. Effects will also be investigated on mental health and symptom relief in general and upon readmissions to inpatient units.
The study is a multicenter, observer-blinded, superiority, two-armed RCT which will include patients from four clinical departments at Vestre Viken Hospital Trust, Norway. We aim to include 100 patients with moderate to strong suicidal problems, as defined by a score of 13 or more on Beck's Scale for Suicide Ideation - Current. Patients are included regardless of diagnosis. Randomization will be performed using a stratified four-block procedure with treatment unit as the stratification variable. The duration of treatment will vary depending on patients' needs and clinical assessments. Patients are interviewed by research staff at four checkpoints: baseline, 2 weeks, 6 months, and 12 months. Central outcome measures are the Beck Scale for Suicide Ideation - Current, Outcome Questionnaire - 45, and Suicide Attempt Self-Injury Count.
This pragmatic trial is effectuated within the Public Health Care System in Norway, where patients have multiple problems and diagnoses and therapists have a high work load. Results from this trial are highly generalizable to a typical everyday clinical setting, and one should expect similar results if CAMS is implemented in the future as a standard component in specialized mental health care systems.
Open Science Framework: DOI 10.17605/OSF.IO/JHRM2 . Registered 5 July 2015. ClinicalTrials.gov: NCT02685943 . Registered on 8 February 2016.
Notes
Cites: Soc Psychiatry Psychiatr Epidemiol. 2012 Jan;47(1):1-9 PMID 21052623
Cites: Psychother Res. 2014;24(4):504-13 PMID 24188797
Cites: JAMA. 2005 Aug 3;294(5):563-70 PMID 16077050
Cites: Dan Med Bull. 2011 Aug;58(8):A4300 PMID 21827722
Cites: Psychiatr Serv. 2010 Jan;61(1):25-31 PMID 20044414
Cites: Psychotherapy (Chic). 2012 Mar;49(1):72-80 PMID 22369081
Cites: Depress Anxiety. 2011 Nov;28(11):963-72 PMID 21948348
Cites: J Clin Psychol. 2006 Feb;62(2):161-70 PMID 16342292
Cites: Psychol Assess. 2015 Dec;27(4):1171-81 PMID 25894705
Cites: Am J Psychother. 2012;66(3):227-42 PMID 23091884
Cites: Arch Gen Psychiatry. 1983 Mar;40(3):249-57 PMID 6830404
Cites: J Clin Epidemiol. 1999 Dec;52(12):1143-56 PMID 10580777
Cites: Psychol Med. 2003 Apr;33(3):395-405 PMID 12701661
Cites: J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57 PMID 9881538
Cites: Arch Gen Psychiatry. 2005 Apr;62(4):427-32 PMID 15809410
Cites: Am J Psychiatry. 2015 May;172(5):441-9 PMID 25677353
Cites: Behav Res Ther. 1997 Nov;35(11):1039-46 PMID 9431735
Cites: Lancet. 2005 Jan 1-7;365(9453):82-93 PMID 15639683
Cites: Eur Addict Res. 2005;11(1):22-31 PMID 15608468
Cites: Arch Gen Psychiatry. 2006 Jul;63(7):757-66 PMID 16818865
Cites: Suicide Life Threat Behav. 2009 Jun;39(3):307-20 PMID 19606922
Cites: Addiction. 1993 Jun;88(6):791-804 PMID 8329970
Cites: Addict Behav. 2012 Jan;37(1):36-41 PMID 21937169
Cites: Suicide Life Threat Behav. 2015 Jan 12;:null PMID 25581595
Cites: Suicide Life Threat Behav. 2012 Dec;42(6):640-53 PMID 22971238
Cites: Psychiatry Res. 2010 May 15;177(1-2):228-34 PMID 20178887
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Cites: Depress Anxiety. 2016 Jun;33(6):520-30 PMID 26854478
Cites: Trials. 2009 Jun 03;10:37 PMID 19493350
PubMed ID
27716298 View in PubMed
Less detail

Collaborative Assessment and Management of Suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: study protocol for a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature289676
Source
Trials. 2016 10 03; 17(1):481
Publication Type
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Date
10-03-2016
Author
Wenche Ryberg
Roar Fosse
Per Henrik Zahl
Inge Brorson
Paul Møller
Nils Inge Landrø
David Jobes
Author Affiliation
Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Lier, Norway. Wenche.ryberg@vestreviken.no.
Source
Trials. 2016 10 03; 17(1):481
Date
10-03-2016
Language
English
Publication Type
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Keywords
Checklist
Clinical Protocols
Cognition
Cooperative Behavior
Humans
Interdisciplinary Communication
Mental health
Norway
Patient care team
Psychiatric Status Rating Scales
Psychotherapy - methods
Research Design
Risk factors
Suicidal ideation
Suicide - prevention & control - psychology
Surveys and Questionnaires
Time Factors
Treatment Outcome
Abstract
Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic framework that appears promising to reduce suicidal ideation and suicidal cognition. CAMS has not previously been evaluated in a standard specialized mental health care setting for patients with suicidal problems in general. In this pragmatic randomized controlled trial (RCT) we will investigate if CAMS is more effective than treatment as usual (TAU) in reducing suicidal thoughts and behaviors. Effects will also be investigated on mental health and symptom relief in general and upon readmissions to inpatient units.
The study is a multicenter, observer-blinded, superiority, two-armed RCT which will include patients from four clinical departments at Vestre Viken Hospital Trust, Norway. We aim to include 100 patients with moderate to strong suicidal problems, as defined by a score of 13 or more on Beck's Scale for Suicide Ideation - Current. Patients are included regardless of diagnosis. Randomization will be performed using a stratified four-block procedure with treatment unit as the stratification variable. The duration of treatment will vary depending on patients' needs and clinical assessments. Patients are interviewed by research staff at four checkpoints: baseline, 2 weeks, 6 months, and 12 months. Central outcome measures are the Beck Scale for Suicide Ideation - Current, Outcome Questionnaire - 45, and Suicide Attempt Self-Injury Count.
This pragmatic trial is effectuated within the Public Health Care System in Norway, where patients have multiple problems and diagnoses and therapists have a high work load. Results from this trial are highly generalizable to a typical everyday clinical setting, and one should expect similar results if CAMS is implemented in the future as a standard component in specialized mental health care systems.
Open Science Framework: DOI 10.17605/OSF.IO/JHRM2 . Registered 5 July 2015. ClinicalTrials.gov: NCT02685943 . Registered on 8 February 2016.
Notes
Cites: Soc Psychiatry Psychiatr Epidemiol. 2012 Jan;47(1):1-9 PMID 21052623
Cites: Psychother Res. 2014;24(4):504-13 PMID 24188797
Cites: JAMA. 2005 Aug 3;294(5):563-70 PMID 16077050
Cites: Dan Med Bull. 2011 Aug;58(8):A4300 PMID 21827722
Cites: Psychiatr Serv. 2010 Jan;61(1):25-31 PMID 20044414
Cites: Psychotherapy (Chic). 2012 Mar;49(1):72-80 PMID 22369081
Cites: Depress Anxiety. 2011 Nov;28(11):963-72 PMID 21948348
Cites: J Clin Psychol. 2006 Feb;62(2):161-70 PMID 16342292
Cites: Psychol Assess. 2015 Dec;27(4):1171-81 PMID 25894705
Cites: Am J Psychother. 2012;66(3):227-42 PMID 23091884
Cites: Arch Gen Psychiatry. 1983 Mar;40(3):249-57 PMID 6830404
Cites: J Clin Epidemiol. 1999 Dec;52(12):1143-56 PMID 10580777
Cites: Psychol Med. 2003 Apr;33(3):395-405 PMID 12701661
Cites: J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57 PMID 9881538
Cites: Arch Gen Psychiatry. 2005 Apr;62(4):427-32 PMID 15809410
Cites: Am J Psychiatry. 2015 May;172(5):441-9 PMID 25677353
Cites: Behav Res Ther. 1997 Nov;35(11):1039-46 PMID 9431735
Cites: Lancet. 2005 Jan 1-7;365(9453):82-93 PMID 15639683
Cites: Eur Addict Res. 2005;11(1):22-31 PMID 15608468
Cites: Arch Gen Psychiatry. 2006 Jul;63(7):757-66 PMID 16818865
Cites: Suicide Life Threat Behav. 2009 Jun;39(3):307-20 PMID 19606922
Cites: Addiction. 1993 Jun;88(6):791-804 PMID 8329970
Cites: Addict Behav. 2012 Jan;37(1):36-41 PMID 21937169
Cites: Suicide Life Threat Behav. 2015 Jan 12;:null PMID 25581595
Cites: Suicide Life Threat Behav. 2012 Dec;42(6):640-53 PMID 22971238
Cites: Psychiatry Res. 2010 May 15;177(1-2):228-34 PMID 20178887
Cites: Ugeskr Laeger. 2008 Jan 14;170(3):149-53 PMID 18208732
Cites: BMJ. 2009 Jun 29;338:b2393 PMID 19564179
Cites: Bull Menninger Clin. 2009 Fall;73(4):339-54 PMID 20025428
Cites: J Psychol. 2005 Sep;139(5):439-57 PMID 16285214
Cites: Tidsskr Nor Laegeforen. 2015 Aug 25;135(15):1342-3 PMID 26315231
Cites: Trials. 2014 May 29;15:194 PMID 24885904
Cites: BMJ. 2008 Nov 11;337:a2390 PMID 19001484
Cites: Contemp Clin Trials. 2009 Jan;30(1):40-6 PMID 18718555
Cites: Suicide Life Threat Behav. 1999 Spring;29(1):1-9 PMID 10322616
Cites: Tidsskr Nor Laegeforen. 2014 Feb 25;134(4):394 PMID 24569736
Cites: Depress Anxiety. 2016 Jun;33(6):520-30 PMID 26854478
Cites: Trials. 2009 Jun 03;10:37 PMID 19493350
PubMed ID
27716298 View in PubMed
Less detail

Social differences in diagnosed depression among adolescents in a Swedish population based cohort.

https://arctichealth.org/en/permalink/ahliterature301347
Source
BMC Psychiatry. 2018 07 03; 18(1):216
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-03-2018
Author
Therese Wirback
Jette Möller
Jan-Olov Larsson
Karin Engström
Author Affiliation
Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1E, 113 65, Stockholm, Sweden. therese.wirback@ki.se.
Source
BMC Psychiatry. 2018 07 03; 18(1):216
Date
07-03-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adolescent Behavior - psychology
Child
Cohort Studies
Depression - economics - epidemiology - psychology
Educational Status
Female
Hierarchy, Social
Humans
Male
Parents - psychology
Population Surveillance - methods
Psychotherapy - economics - methods
Registries
Socioeconomic Factors
Sweden - epidemiology
Young Adult
Abstract
Population based research regarding social differences in diagnosed depression in adolescence is sparse. In this study unique material containing in-and outpatient data was used to determine if low social position in childhood increases the risk of diagnosed depression in adolescence. To further examine this association, gender differences and interactions were explored.
The study population was extracted from the Stockholm Youth Cohort (SYC), a register based cohort containing psychiatric care for all young people in Stockholm County and information about social position. For the purpose of this study, all in the SYC who turned 13 years old during 2001-2007, in total 169,262 adolescents, were followed up in 2005-2011 for diagnoses of depression until age 18. Associations were estimated with Cox regression models and presented as Hazard Ratios (HR).
The risk of diagnosed depression was higher for adolescents with parents with low education (HR?=?1.1, CI?=?1.0-1.2) and medium education (HR?=?1.1, CI?=?1.1-1.2) compared to high as well as for those with lower household income (for example, medium low, HR?=?1.2, CI?=?1.1-1.3) and for those with parents who received an unemployment benefit (HR?=?1.3, CI?=?1.2-1.4). No differences were found for those with the lowest household income compared to those with the highest level. Adolescents with parents born outside the Nordic countries had a lower risk of diagnosed depression (HR?=?0.7, CI?=?0.6-0.7). An interaction effect was found between gender and parental education.
Social differences were found but the magnitude was modest and gender differences small.
PubMed ID
29970041 View in PubMed
Less detail