Dissertations / Theses on the topic 'Mental illness – Epidemiology'

Polypharmacy is broadly defined as the administration of more than one medication in a single patient, with the most commonly used definition indicating the concurrent use of five or more medications. Polypharmacy occurs in most clinical settings, particularly inpatient settings and treatment settings for persons with chronic illness and the elderly. Reasons for receiving more than one medication include ineffective treatment with monotherapy, targeting specific but varied symptoms, treating two distinct but co-morbid illnesses, addressing unremitting symptoms, and treating extrapyramidal side effects. Research indicates that each medication added to the patient’s regimen increases the likelihood of an adverse outcome, as well as the risk of adverse drug reactions, drug-to-drug interactions, cumulative toxicity, medication errors, patient non-compliance, patient morbidity, and patient mortality. The current study seeks to investigate the rates of polypharmacy and related characteristics predictive of polypharmacy within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101), African American (40.1%, n=73), and Hispanic (2.2%, n=4), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). Of those currently taking medications, 99.2% have been prescribed more than one type of medication, with 93.1% of those individuals being prescribed four or more. Polypharmacy was observed in 91% of participants. Of those diagnosed with a mood or psychotic disorder, an average of 3.6 different types of psychotropic medications were prescribed. Co-morbidity of mental illness was predictive of polypharmacy trends, F(1,181)=5.28, p<.05. Additionally, individuals with at least one chronic illness also were subjected to polypharmacy practices, with rates increasing for those with more than one chronic illness. As a measure of onset and severity of symptoms, age at first hospitalization and age of onset of aggressive behaviors were measured, and, interestingly, both measures were predictive of polypharmacy within these patients, F(1, 181)=13.45, p<.01. Results indicate that perceived severity of symptomology, aggression, and complex health problems all contribute to polypharmacy practices among prescribing physicians. The high rates of polypharmacy observed are concerning because of the potential for increased aversive health outcomes. Understanding the predictive factors, rates, and trends of polypharmacy has valuable implications for the future treatment and rehabilitation of individuals residing in a forensic psychiatric setting.

(Truncated abstract) The aims of this thesis are: (i) To estimate the prevalence of psychiatric illness among persons with intellectual disability and, conversely, the prevalence of intellectual disability among persons with a psychiatric illness; (ii) To describe the disability and service utilisation profile of persons with conjoint disorder; (iii) To examine, in particular, intellectual disability co-occurring with schizophrenia; and (iv) To explore the role of hereditary and environmental (specifically obstetric) risk factors in the aetiology of (i) intellectual disability and (ii) intellectual disability co-occurring with psychiatric illness. This thesis has a special interest in the relationship between intellectual disability and schizophrenia. Where data and sample sizes permit, it explores that relationship at some depth and has included sections on the putative nature of the link between intellectual disability and schizophrenia in the introductory and discussion chapters. To realise its objectives, the thesis comprises a core study focusing on aims (i) – (iii) and a supplementary study whose focus is aim (iv). It also draws on work from an ancillary study completed prior to the period of candidacy...This thesis found that, overall, 31.7% of persons with an intellectual disability had a psychiatric illness; 1.8% of persons with a psychiatric illness had an intellectual disability. The rate of schizophrenia, but not bipolar disorder or unipolar major depression, was greatly increased among cases of conjoint disorder: depending on birth cohort, 3.7-5.2% of individuals with intellectual disability had co-occurring schizophrenia. Down syndrome was much less prevalent among conjoint disorder cases despite being the most predominant cause of intellectual disability while pervasive developmental disorder was over-represented. Persons with conjoint disorder had a more severe clinical profile including higher mortality rates than those with a single disability. The supplementary study confirmed the findings in the core body of work with respect to the extent of conjoint disorder, its severity, and its relationship with pervasive development disorder and Down syndrome. Moreover, the supplementary study and the ancillary influenza study indicated a role for neurodevelopmental insults including obstetric complications in the adverse neuropsychiatric outcomes, with timing of the insult a potentially critical element in defining the specific outcome. The supplementary study also added new information on familiality in intellectual disability. It found that, in addition to parental intellectual disability status and exposure to labour and delivery complications at birth, parental psychiatric status was an independent predictor of intellectual disability in offspring as well as a predictor of conjoint disorder. In conclusion, the facility to collect and integrate records held by separate State administrative health jurisdictions, and to analyse them within the one database has had a marked impact on the capacity for this thesis to estimate the prevalence of conjoint disorder among intellectually disabled and psychiatric populations, and to understand more about its clinical manifestations and aetiological underpinnings.

The purpose of this study was to examine the relative risk of psychiatric disorders occurring in patients diagnosed with neurological disorders. This study separately computed the relative risk ratios for identified psychiatric disorder (i.e., anxiety, mood disorders, somatization, schizophrenia, alcohol abuse, and antisocial personality disorder) on seven of the more common neurological disorders (i.e., brain tumor, closed head injury, stroke, dementia, multiple sclerosis, cerebral palsy, and Parkinson's disease). The six psychiatric disorders were chosen based on the epidemiological catchment area (ECA) research (Robins & Reigier 1991) and provided the control group of psychiatric disorders in the general population by which comparisons were made to the neurological care setting. The neurological disorders were included based on the frequency of referrals to a neuropsychological practice. Further, this study provided an overall relative risk ratio of psychiatric disorders for all seven neurological disorders considered together.Participants in this study included a sample of 367 consecutive referrals to a neurology practice in the Midwest. All of the 376 subjects were diagnosed with a neurological disorder. Two hundred forty-six of the subjects were diagnosed with a neurological disorder and no psychiatric disorder. One hundred twenty-one of the subjects were diagnosed with both a neurological and a psychiatric disorder. The MMPI2 was used in the assessment and diagnosis of psychiatric disorders. The control group, represented by the ECA study, was composed of 19,640 participants.Relative risk estimates were made using cross products ratio. Significance of the risk ratio was tested using Chi-square Continuity Correction values. Power analysis was conducted using Fisher's Exact Test.The results of the analysis suggested that patients with neurological disorders are more likely to present with psychiatric disorders compared to the general population. The overall relative risk for this study revealed that patients were 1.669 times more likely to have a comorbid psychiatric disorder following the diagnosis of a neurological disorder. Additionally, three individual disorders had relative risk ratios suggesting an increase in psychiatric disorders above the risk in the general population. These three conditions included stroke (RR = 3.038), dementia (RR = 2.762), and multiple sclerosis (RR = 3.617).
Department of Educational Psychology

Background: Co-occurring substance use disorders (SUDs) occur in as many as half to three quarters of patients with severe mental disorders such as schizophrenia and bipolar disorder, a phenomenon also described as dual diagnosis. Past research from high income countries have shown that the presence of co-occurring SUDs are associated with a number of demographic and clinical factors, including worse clinical outcomes. Although the clinical profile and negative impact on prognosis has been well characterised in research on dual diagnosis samples from high income countries, little is known in the low- and middle-income country (LAMIC) context about the prevalence and factors associated with SUDs in patients with SMI, its clinical identification and diagnosis, as well as factors associated with its treatment. Objectives: In part-I of the thesis I investigate the clinical epidemiology of dual diagnosis by determining the prevalence of substance use disorders (SUDs) and its association with various clinical and demographic factors in two datasets, the first dataset containing data from a homogeneous sample of Xhosa South African patients with schizophrenia and the second dataset with data from a clinically more heterogeneous sample of patients with major affective and non-affective psychotic disorders. In part-II of the thesis I determine the psychometric properties of two Xhosa language versions of brief substance screening instruments, the Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST version 3) and the Severity of Dependence Scale (SDS), against a gold standard diagnostic instrument, the Structured Clinical Interview for DSM-IV-TR Axis I disorders (SCID-I for DSM-IV). In part-III of the thesis I examine aspects in the pharmacotherapy of dual diagnosis, firstly the association between methamphetamine use and extra-pyramidal medication side-effects (EPS) in patients treated with antipsychotics, and second in a systematic review, the efficacy of risperidone versus other antipsychotics for people with a dual diagnosis. Methods: This thesis consists of secondary analyses of two datasets (datasets#1 and dataset#2) and a Cochrane systematic review of existing randomised trials. Dataset#1 contains data from case-control study with the original aim of investigating the genomics of schizophrenia in the South African Xhosa population. Dataset#2 contains data collected in a cross-sectional manner from 3 studies; one study that investigating the presentation and psychobiology of psychosis, another which was a pilot randomised controlled trial of a text message treatment partner intervention and a third which was a neuroimaging and electrophysiological study of psychotic disorders. Across dataset #1 and #2, demographic information, clinical variables and psychotic and substance use disorder diagnoses were determined using the SCID-I for DSM-IV. In addition, for dataset #2 (conducted in a multi-cultural and ethnic population) we recorded self-identified ethnicity. For self-identified ethnic groups, the terms “Coloured” “Black” and “Caucasian” and “Other” (Asian), were not intended to reify sociocultural constructs but were instead used to study ongoing health disparities. Psychosocial Axis-IV problems were determined using a checklist from the SCID-I and legal involvement was determined using the legal section of the Addiction Severity Index (ASI). Functioning was determined with the global assessment of function, or GAF scale. The ASSIST and SDS instruments were used in a study based on data from dataset #1 investigating the psychometric properties of these screening tools. In turn, I investigated the relationship between methamphetamine use and medication related extra-pyramidal side effects (EPS) in a heterogeneous sample of patients with major affective and non-affective psychotic disorders (from dataset #2). For this study the Simpson Angus Scale for Parkinsonism (SAS), the Barnes Akathisia Rating Scale (BARS) and the Abnormal Involuntary Movement Scale (AIMS) were used to measure EPS. For the first two objectives, logistic regression modelling was used to determine factors associated with having a cooccurring SUD. For the validation study of the Xhosa language versions of the ASSIST and SDS, I determined the internal consistency, concurrent validity, and discriminant validity of these instruments and compared the sensitivity, specificity and the receiver operating characteristics (ROC) for the ASSIST and SDS. Logistic and ROC regression was used for the comparison of ROC area-under-the-curves for ASSIST versus SDS and for determining the impact of co-variates on ROC respectively. In part III, I determined the association between methamphetamine use and the presence of EPS using logistic regression. Finally, I conducted a Cochrane systematic review of randomised trials after a comprehensive literature search of several databases and duplicate study selection and data extraction. Where possible outcomes were pooled, and meta-analyses conducted using random effects models. Primary outcomes were changes in substance use and mental state. Secondary outcomes included substance craving, subjective-wellbeing, adherence, adverse effects, study retention, quality of life and mortality. Study selection, data extraction and quality appraisals were independently conducted. Random-effects meta-analysis was conducted, and the Cochrane risk of bias and GRADE approach used to assess evidence quality. Results: In both datasets#1 and #2, consisting of a total sample size of N=1420 (dataset#1) and N=248 (dataset#2) we found a high prevalence of lifetime SUDs (47.8% and 55.6%) in patients with schizophrenia and major affective or non-affective psychosis, respectively. In multivariable logistic models younger age, male gender, and legal involvement were significantly associated with co-occurring SUDs. Multiple substances were often used together, and SUDs were significantly correlated with one another. Methamphetamine use disorders were significantly more prevalent in the Western Cape province of South Africa and ethnic differences were also apparent with Coloured participants significantly more likely to use methamphetamine compared to Black participants. In addition, we found significant associations between post-traumatic stress symptoms, anxiety symptoms and suicidality and alcohol use disorders. Inpatient status and higher levels of prior admissions were associated with cannabis and methamphetamine use disorders. In a sample of 351 participants from dataset#1 who completed either the ASSIST (N=190), SDS (N=299), or both (n=138), good internal reliability was obtained for both the ASSIST-TSI (total substance involvement score) (Cronbach α= 0.77) and SDS (Cronbach α=0.80). The ASSIST and SDS demonstrated good concurrent validity (rs= 0.50, p 3 years were significantly more likely to have EPS. We found a significant interaction effect between MA use disorders and standardised antipsychotic dose on the occurrence of EPS (ORadj = 1.01, 95% CI= 1.00-1.01, p=0.042). There were no significant associations with EPS with comorbid alcohol, cannabis, or methaqualone use disorders. In the Cochrane systematic review of randomised controlled trials involving risperidone versus other antipsychotics for dual diagnosis, we identified eight trials containing a total of 1073 participants with SMI and co-occurring SUD. Seven trials contributed useable data to the review. Risperidone was compared to clozapine, olanzapine, perphenazine, quetiapine and ziprasidone. Only one study contained data comparing risperidone with a first-generation antipsychotic (perphenazine). Quality of the included studies varied from low to very low. Outcome data were frequently missing and little, or no data was reported in most studies for craving, subjective-wellbeing, metabolic disturbances, global impression of illness severity, quality of life or mortality. For risperidone versus clozapine we found no clear differences between these two antipsychotics in the reduction of positive psychotic symptoms or reduction in cannabis use, improvement in subjective well-being, numbers discontinuing medication, extrapyramidal side-effects or leaving the study early. Clozapine was associated with lower levels of craving for cannabis. For risperidone versus olanzapine we found no clear differences in the reduction of positive psychotic symptoms, reduction in cannabis use, craving for cannabis, parkinsonism, or leaving the study early. For risperidone versus perphenazine, quetiapine and ziprasidone respectively, we found no clear differences in the number of participants leaving the study early. Conclusion: In the context of a dearth of research into dual diagnosis in LAMIC countries such as South Africa, this thesis contains a large-scale epidemiological investigation into substance use comorbidity in patients with schizophrenia and other psychotic disorders. In addition, for the first time we determine the psychometric properties and validity of the Xhosa language ASSIST and SDS and systematically investigate the relationship between methamphetamine use and extra-pyramidal side effects in people with psychotic disorders treated with antipsychotics. For the first time we also conduct a systematic review of the efficacy of risperidone compared to other antipsychotics for a number of primary and secondary outcomes. Our findings have a number of implications for clinicians and services planners. Firstly, SUDs occur in at least half of the people schizophrenia and other psychotic disorders. Accurate detection of SUDs is possible using brief screening tools such as the ASSIST and SDS. Some populations such a younger male population may need particular attention. Moreover, assessment of patients will need to include current and past legal involvement as well as careful assessment of associated comorbid anxiety, post-traumatic symptomology and suicide risk. In patients with co-occurring methamphetamine use disorders clinicians should regularly assess for the development of EPS and carefully titrate antipsychotic dosage from lower to higher doses to avoid EPS. Currently there is not sufficient high-quality evidence favouring the superiority of risperidone over any other antipsychotic in people with SMI and co-occurring SUDs. Results of ongoing trials are awaited, and future trials need to use consistent methodologies and adhere to CONSORT reporting guidelines.

The complexity of information produced since the 1980's on co-occurring severe mental illness and substance misuse makes it difficult for social workers to grasp the current state of the question. This is a new field of study, and much of the information is incomplete or contradictory. This review examines epidemiological studies carried out in North America. We identify the varied semantic and philosophical approaches to the question of dual diagnoses, and provide an overview of etiological theories, as well as of the theory and practice of treatment for these disorders. Emergent concepts of recovery are also discussed.
Major findings. epidemiological data vary, but all point to a widespread problem. The diversity of meaning and of etiological theories appears to be linked to the heterogeneity of this population. An integrated treatment strategy is the current modality of choice, despite outcomes that are only mildly encouraging; finally, there is consensus among consumers that recovery from a disease is possible even in the absence of a complete cure.
Research limitations and knowledge gaps are to be expected in a new field of study. Additional research is necessary to determine the extent and causes of these comorbidities. Social workers must become knowledgeable in this field and remain abreast of new developments in order to engage in evidenced-based practice. Greater education about comorbidities is necessary, as is an overarching policy response from all levels of government. The principal contribution of this master's thesis to the discipline of social work is to provide a general synthesis of knowledge in a domain that is highly medicalized in the literature.

Background: Preventing injuries among children and young people is a priority in England and worldwide; with injuries a leading cause of death, ill health and disability in children, and resulting in substantial costs to health services and society. Understanding the burden of injuries is important for health service planning and the prioritisation of preventative interventions to those at greatest risk. Despite this, estimating injury burden in England remains a challenge due to fragmented data collection systems and no national surveillance system. The recent linkage of a large primary care research database, the Clinical Practice Research Datalink (CPRD), to hospitalisation and mortality data, offers a new opportunity to study the epidemiology of injuries and provide more complete estimates of injury incidence. Mental illnesses are the commonest morbidity women experience during pregnancy and the postnatal period, and are associated with several child health outcomes. The impact of maternal mental illnesses on the occurrence of childhood injuries is underexplored; with existing studies giving mixed findings, focusing upon depression alone and relying on maternal reporting of injury occurrences. Existing studies suggesting an association between maternal perinatal depression and childhood injuries have not considered the role of ongoing maternal depression after the postnatal period, and whether observed associations could be explained by biases in the reporting of injuries by mothers, or the recording of injuries by clinicians. Methods: Three large routinely-collected datasets from England, the CPRD, Hospital Episode Statistics (HES), and Office for National Statistics (ONS) mortality data, were used to conduct a series of studies. 1. The epidemiology of injuries among children and young people. A cohort of 1,928,681 individuals aged 0-24 years old from England who had linked CPRD, HES and ONS mortality data was used to describe the epidemiology of three common injuries (poisonings, fractures, burns). Time-based algorithms were developed to identify incident injury events, distinguishing between repeat records for the same injury, and those for a new event. Injury incidence rates and adjusted incidence rate ratios (aIRR) were estimated by age, sex, calendar year and socioeconomic deprivation. The recording of injury mechanisms and intent were examined for the three data sources. 2. Maternal mental illnesses during pregnancy and the child’s first five years of life. A cohort of 207,048 mother-child pairs from England who had linked CPRD and HES data, with children born 1998-2013, was used to define episodes of maternal depression and/or anxiety (termed ‘depression/anxiety’) using diagnostic, prescription and hospitalisation records. Incidence rates of maternal depression/anxiety were described over the child’s first five years of life. 3. Maternal perinatal depression and injuries in children aged 0-4 years old. A cohort study of 207,048 mother-child pairs compared incidence rates and adjusted incidence rate ratios of child poisonings, fractures, and burns among children whose mothers had experienced perinatal depression with those who had not. To assess how the association between perinatal depression and child injury was affected by subsequent exposure to maternal depression, adjusted incidence rate ratios were compared for mothers whose depression continued beyond or recurred after the postnatal period, with mothers in whom it did not. Analyses were repeated for a group of serious injuries where injury ascertainment was more likely to be complete. 4. Association between episodes of maternal depression/anxiety and rates of child injuries. Two analyses, a traditional cohort analysis (a between person design) and a self-controlled case series (SCCS) analysis (a within person design where individuals act as their own controls), were used to compare incidence rates of child injuries during episodes of maternal depression/anxiety with periods when mothers had no evidence of depression/anxiety in their medical record. These two methods were compared as they account for confounding by different means. Results: 1. The epidemiology of injuries among children and young people. For the period 2001-2011, incidence rates of poisonings, fractures and burns were 41.9 per 10,000 person-years (PY) (95%CI 41.3-42.5), 185.5 (95%CI 184.6-186.4) and 34.6 (95%CI 34.2-35.0), respectively among the cohort of 0-24 year olds. Of the injury events identified in linked CPRD-HES-ONS mortality data, 18,065 (51%) poisonings, 117,102 (75%) fractures, and 26,276 (91%) burns were only recorded in primary care data (CPRD). Injury mechanism and intent recording was high within hospitalisation and mortality data (80-100%), but low in primary care data (2-4% of burns and fractures). Age patterns of injury incidence varied by injury type, with peaks at age 2 (69.4/10,000 PY) and 18 (76.0/10,000 PY) for poisonings, age 13 for fractures (310.1/10,000 PY) and age 1 for burns (113.1/10,000 PY). Over time, fracture incidence rates increased, whereas poisoning rates increased only among 15-24 year olds and burns incidence reduced. Poisoning and burn incidence rates increased with deprivation, with the steepest socioeconomic gradient between most and least deprived quintiles for poisonings (aIRR 2.20, 95%CI 2.07-2.34). 2. Maternal mental illnesses during pregnancy and the child’s first five years of life. 4,210 (2.0%) mothers had antenatal depression, 20,486 (9.9%) had postnatal depression, and 7,413 (3.6%) had both. Between the child’s birth and fifth birthday, 54,702 (26.4%) children were exposed to one or more episode of maternal depression/anxiety, with incidence rates of maternal depression, depression with anxiety and anxiety alone 6.92/100 PY (95%CI 6.86-6.98), 1.30 (95%CI 1.27-1.33) and 1.83 (95%CI 1.80-1.86), respectively. 3. Maternal perinatal depression and injuries in children aged 0-4 years old. Among 207,048 children, 2,614 poisonings, 6,088 fractures and 4,201 burns occurred during follow-up. Children whose mothers had perinatal depression had higher injury rates than children who were unexposed, with associations strongest for poisonings. Compared to those unexposed, poisoning rates were 74% higher among children exposed to antenatal depression (aIRR 1.74, 95%CI 1.39-2.18), 55% higher for postnatal depression (aIRR 1.55, 95%CI 1.39-1.72) and 89% higher for children exposed to both (aIRR 1.89, 95%CI 1.61-2.23). Children also exposed to maternal depression when aged 1-4 years old tended to have higher poisoning, fracture and burn rates than children only exposed to perinatal depression. Significant associations persisted when analyses were restricted to serious fractures and burns. 4. Association between episodes of maternal depression/anxiety and rates of child injuries. In the traditional cohort analysis, child poisoning rates were increased during episodes of maternal depression (aIRR 1.52, 95%CI 1.31-1.76), depression with anxiety (aIRR 2.30, 95%CI 1.93-2.75) and anxiety alone (aIRR 1.63, 95%CI 1.09-2.43). Similarly, rates of burns (aIRR 1.53, 95%CI 1.29-1.81) and fractures (aIRR 1.24, 95%CI 1.06-1.44) were greatest during episodes of maternal depression with anxiety. No association was seen between maternal depression/anxiety and serious child injuries. The study populations for the SCCS analyses consisted of 2,502, 5,836, 4,051 and 909 children who had experienced a poisoning, fracture, burn or serious injury, respectively. For children who experienced a poisoning or burn, poisoning (aIRR 1.48, 95%CI 1.19-1.85) and burn (aIRR 1.29, 95%CI 1.07-1.55) rates were only increased during periods when the mother had depression compared to periods when the mother had no evidence of depression/anxiety in their medical record. No significant differences in fracture or serious injury rates were seen during depression/anxiety episodes compared to unexposed periods. Conclusion and implications: It is essential to use linked primary care, hospitalisation and mortality data to estimate injury burden, as many injury events are only captured within a single data source. Linked routinely-collected data may offer an affordable mechanism for injury surveillance; although is limited by poor recording of injury mechanism and intent within primary care data.
Differing injury patterns according to age and injury type reflect differences in underlying injury mechanisms, highlighting the importance of tailored preventative interventions across the life course. Inequalities in injury occurrences support the targeting of preventative interventions to those living in the most deprived areas. Future work includes extending this research to other injury types and incorporating emergency department data when this becomes available.

The overarching aim of this dissertation is to use health services research methods to address three problems in behavioral health services. This dissertation seeks to address the knowledge gaps in behavioral health services through the generation of evidence intended to support evidence-based practices (EBP). Previous work has examined epidemiology of behavioral health disorders in the ED, but they have not attempted to examine disorders by the cause of injury. Chapter 2 examines the epidemiology of psychiatric disorders among adults who seek care in the emergency department (ED) by cause of injury. Data from a national hospital discharge survey was analyzed using logistic and multinomial regression. Estimates are given as average marginal effects (AME) to simplify the interpretation and application. Intentionally-caused injury and undetermined cause of injury are significantly associated with psychiatric disorders. Patients with undetermined cause of injury were more likely to be diagnosed with anxiety disorders, depressed mood, and psychoses relative to patients with unintentional injuries Since there are several treatment options for obsessive-compulsive disorder (OCD), including cognitive behavioral therapy (CBT), serotonin reuptake inhibitors (SRIs), and combinations of these, a comparison of treatment effects denominated in dollars is helpful when comparing risks and benefits. Chapter 3 builds on previous randomized control trials of treatments for OCD in children and adolescents by ranks the cost-benefits of first-line treatments. The analysis aggregates treatment effects from published trials in meta-analytic framework and a Monte Carlo simulation of 100,000 hypothetic children and adolescents to derive ranked cost-benefit. Treatments strategies starting with CBT, but not CBT and SRIs concurrently, were the most cost-beneficial. The relationship between cost-sharing and utilization of behavioral health services has been studied in the aggregate, but there has been little work examining the relationship by disorder and treatment modality. The aim of Chapter 4 is to examine the association between cost-sharing and utilization of psychotherapy and adherence to pharmacotherapy among insured adults with OCD. This chapter utilizes the Truven MarketScan Commercial Claims and Encounters dataset to perform zero-inflated negative binomial regression and logistic regression analyses. Increased cost-sharing was significantly, negatively associated with psychotherapy intensity and dose, but not associated with SRI adherence. This dissertation examined three different research questions to address gaps in the behavioral health services research. The findings of these chapters have implications for patients, clinicians, insurers, and policymakers. The results can be used to improve aspects of cost, quality, access, and efficiency of behavioral health services.

Children with chronic physical illness have twice the risk of psychosocial maladjustment as healthy children. One specific aspect of mental functioning is abnormal eating attitudes, hypothesized to be an early stage of an eating disorder. To date, there has been no study of the association of a variety of physical chronic illnesses with a specific psychiatric syndrome in a diagnostically heterogeneous population, comparing chronically ill children with healthy children. This study examined the association between chronic illness and eating attitudes in a population of school children from Western Quebec. A checklist of chronic medical conditions was added to the parent questionnaire in order to determine presence of chronic illness. There were two objectives of this thesis. The first objective was to determine whether chronic illness was associated with eating attitudes in children as measured by the Eating Attitudes Test. The second study objective was to determine whether there was a meaningful group difference in othcr psychometric scores of depression, family functioning and stress between children with a chronic illness and children without a chronic illness. (Abstract shortened by UMI.)

Objectives: This study sought to determine the relationship between combat experience and mental health outcomes. The study sought to determine whether age was a significant factor in poor mental health outcomes. Methods: Multiple logistic regression (n = 195,048) and multiple linear regression (n = 264,154) were performed on the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. Veteran status and a host of demographic and health status questions were analyzed in relation to diagnosis of anxiety or depressive disorder (multiple logistic regression) and to number of days poor mental health (multiple linear regression). Results: Diagnosis of anxiety or depression was not found to be associated with veteran status. Among both veterans and non-veterans, diagnosis was associated with age Conclusions: Contrary to expectations, veteran status was found to be a protective factor for poor mental health outcomes in this analysis. Younger age was found to be associated with poor mental health outcomes, but was an equal association in both veterans and non-veterans, suggesting that mental health outcomes have not been worsened by recent changes in combat characteristics. Denial of mental health status, stoicism within the military community, and limitations of the survey are proposed to explain the unexpected outcome of this analysis.

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A cross-sectional population-based study was conducted to identify the prevalence of common mental disorders (CMD) and verify its association with chronic illnesses and the declared number of chronic conditions. The Self-Report Questionnaire (SRQ-20) was applied in a multi-stage random sample of 1276 adults aged 40 and older. Socio-demographic, behavioral and health-related variables were also obtained with a structured questionnaire. The CMD prevalence was 30.2%. Lower educational level and social class and the group 46- 55 years old were associated with psychiatric morbidity. Each chronic illness was associated with CMD. However, a stronger association was found between CMD and the declared number of chronic conditions, with a prevalence ratio of 4.67 (IC95%: 3.19 6.83) for five or more declared conditions. The present work emphasizes the importance of CMD in chronically ill patients, particularly when a greater number of chronic conditions is declared.
Estudo transversal de base populacional foi conduzido tendo como objetivos avaliar a prevalência dos transtornos mentais comuns (TMC) e verificar sua associação com determinadas enfermidades crônicas e com o número de doenças crônicas relatadas pelo indivíduo. Para a avaliação de TMC, o Self-Report Questionnaire (SRQ-20) foi aplicado em 1276 adultos com 40 anos ou mais, identificados por meio de amostragem aleatória em múltiplos estágios. O ponto de corte utilizado foi de 6 ou mais pontos para homens e 8 ou mais pontos para as mulheres. Variáveis sócio-demográficas, comportamentais e relacionadas à saúde foram obtidas por meio de um questionário estruturado. Os TMC apresentaram uma prevalência de 30,2%, estando associados à baixa escolaridade e classe social, e à faixa etária de 46 a 65 anos. Todas as doenças crônicas pesquisadas mostraram-se associadas aos TMC, mesmo após ajuste para as demais variáveis. Entretanto, o número de enfermidades apresentadas pelo indivíduo teve maior importância do que cada uma delas individualmente, com uma razão de prevalência (RP) de 4,67 com intervalo de confiança de 95% (IC95%) de 3,19 6,83 para cinco ou mais doenças relatadas. O presente estudo realça a importância de se atentar para os transtornos mentais em indivíduos com enfermidades crônicas, principalmente naqueles que se apresentam com um grande número de doenças.

Introduktion: I Sverige beräknas 25 procent i åldersgruppen 16–29 år lida av någon form av psykisk ohälsa följt av 20 procent i åldersgruppen 30–44 år (Folkhälsomyndigheten, 2019d). Enligt United Nations Development Programme (UNDP) (u.å.b) så är covid-19 pandemin den största hälsokrisen i vår tid och många av de välkända riskfaktorerna för psykisk ohälsa, så som stress, ensamhet och oro, kan bli allt mer förekommande. Syfte: Studien syftar till att inhämta information kring vilket samband det finns mellan covid-19 pandemin och psykisk ohälsa i åldersgruppen 18–44 år i Sverige. Metod: En kvantitativ tvärsnittsstudie som inhämtat data genom en webbenkät där ett bekvämlighetsurval har använts. Enkäten besvarades av 157 respondenter av båda könen i åldrarna 18–44 år och resultaten analyserades med hjälp av en deskriptiv analys, korstabeller samt chi-två tester. Resultat: Resultaten visar att en ökning med 7,1 procent har skett bland de som uppger att de upplever psykiska besvär dagligen/några gånger i veckan innan pandemin (19,7 procent) jämfört med under pandemin (26,8 procent). Vidare uppger 52,2 procent av respondenterna att deras psykiska mående har försämrats till följd av pandemin. Slutsats: Den här studien visar på att det psykiska måendet kan ha försämrats till följd av covid-19 pandemin bland respondenterna. Då ett bekvämlighetsurval har använts så är studiens resultat ej generaliserbara till resterande befolkningen i åldersgruppen 18–44 år. Vidare studier inom ämnet som inkluderar fler deltagare kan vara nödvändiga för planering av framtida arbete för att förbättra den psykiska hälsan i denna åldersgrupp under och efter pandemin.
Introduction: It is estimated that 25 percent of youth between the ages 16-29 and 20 percent of the population between the ages 30-44 in Sweden suffer from some sort of mental illness (Folkhälsomyndigheten, 2019d). The covid-19 pandemic is the biggest health crisis of our time and many of the well known risk factors in mental illness, such as stress, loneliness and anxiety could be on the rise, according to the United Nations Development Programme (UNDP) (u.å.b). Aim: The purpose of the study is to collect information around the connection of the covid-19 pandemic and mental illness in the age span 18-44 in Sweden. Methods: A quantitative cross-sectional study that has collected data through an online survey where a convenience sample has been used. The survey was answered by 157 respondents of both sexes between the ages 18-44 and the result was analyzed with the help of descriptive analysis, cross tables and chi-square tests. Results: The result shows that there has been an increase of 7,1 percent amongst respondents that experience mental problems daily/a few times a week before the pandemic (19,7 percent) compared to the time during the pandemic (26,8 percent). Furthermore, 52,2 percent state that their mental well-being has worsened as a result of the pandemic. Conclusion: This study shows that the mental well-being of the respondents may have been worsened as a result of the covid-19 pandemic. The result of the study is not generalizable amongst the population of Sweden in the age span 18 to 44, as a convenience sample has been used. Further studies in the field that include more respondents may be necessary in the planning of future work of improving the mental health of those age group during and after the pandemic.

Två utbredda folkhälsosjukdomar är övervikt och psykisk ohälsa. Följderna av övervikt kan vara sjukdomar som till exempel diabetes, hjärt- och kärlsjukdomar olika cancerdiagnoser och även psykiatriska sjukdomar. Riskfaktorerna för att drabbas av övervikt eller fetma är onyttig kost och fysisk inaktivitet. Syftet med studien är att undersöka faktorer associerade med fetma och psykisk sjukdom som komorbiditet hos kvinnor. Vald metod är en litteraturstudie. Författaren har utfört en systematisk litteraturgranskning av vetenskapliga artiklar. Resultatet beskriver att faktorer som socioekonomisk status och etnisk bakgrund kan associeras med övervikt eller fetma och depression och ångest. Studien påvisar att det är behövligt att vid en intervention som syftar till att individer ska minska i vikt även tar hänsyn till att främja psykisk hälsa och inte utsätter en individ för känslor av skam och skuld.
Two prevalent public health diseases are obesity and mental illness. Obesity and overweight are associated with diseases such as diabetes, cardiovascular disease, various cancer diagnoses and even psychiatric illness. The risk factors for being overweight or obese are unhealthy diets and physical inactivity.The purpose of this study is to investigate factors associated with obesity and mental illness such as comorbidity in women.The chosen method is a literature study. The author has performed a systematic literature review of scientific articles.The result describes that factors such as socioeconomic status and ethnic background can be associated with overweight or obesity and depression and anxiety.The study shows that it is necessary in an intervention that aims to reduce the weight of individuals also take into account the promotion of mental health and does not expose an individual to feelings of shame and guilt.

Bakgrund: Hedersrelaterat våld och förtryck är en angelägen folkhälsofråga innebärande negativa konsekvenser för berörda individer inklusive barn och unga. En förekommande form av hedersförtryck är barn och tonåringar som inte får välja sin framtida partner. Det kan medföra oskuldskrav samt kontroll av familjen med målet att äkta en partner som kan bidra till ökad socioekonomisk status. Kontrollen möjliggör därtill negativa hälsokonsekvenser för individen. Forskning belyser att hedersrelaterat våld och förtryck kan innefatta barnmisshandel och psykisk ohälsa för utsatta barn och unga. Utsatthet för våld och förtryck i hemmet kan även leda till utsatthet för mobbning då individen på grund av sina hemförhållanden kan uppfattas som annorlunda enligt skolkamrater. Syfte: Syftet med studien var att undersöka sambandet mellan hedersförtryck och polyviktimisering, psykisk ohälsa samt mobbning bland tonåringar i Sverige. Metod: Studien baseras på tvärsnittsdata från en nationell kartläggning om våld mot barn från år 2016 där sammantaget 4741 elever från årskurs 9 på högstadiet och årskurs 2 på gymnasiet deltog. För att besvara studiens syfte med tillhörande frågeställningar tillämpades korsanalyser samt logistiska regressionsanalyser. Vidare tillämpades även multivariata logistiska regressionsanalyser justerat för kön, ekonomi, ålder, boendesituation och funktionsnedsättning. Resultat: Resultatet redovisade att hedersförtryck hade ett statistiskt signifikant samband med polyviktimisering, psykisk ohälsa samt att vara utsatt för mobbning. De justerade analyserna redovisade att hedersförtryck ökade sannolikheten för polyviktimisering (aOR 10.2, CI 5.6 – 18.4), psykisk ohälsa såsom självskadebeteende (aOR 1.9, CI 1.1 – 3.2), suicidförsök (aOR 2.4, CI 1.3 – 4.7) samt utsatthet för mobbning (aOR 2.4, CI 1.5 – 4.1). Konklusion: Studiens resultat bekräftar att hedersförtryck kan öka sannolikheten för våldsutsatthet samt negativa hälsokonsekvenser inkluderat dödligt utfall bland tonåringar. Detta understryker vikten av förebyggande arbete för hedersförtryckta barn och unga samt att de får anpassad hjälp och stöd av professionella utövare i olika samhällsarenor.
Background: Honor related violence and oppression is a significant societal subject in the field of public health sciences resulting in negative consequences for children and adolescences. One form of honor oppression is children and adolescences unable to choose their future partner. This can derive claim of virginity and control from the family with the aim to marry a partner who can contribute to increased socioeconomic status. The emphasized control results in multiple negative health-consequences for the individual. Previous research implies that honor related violence and oppression can be related to child abuse and mental illness among children and adolescences. Exposure to violence and oppression from home can also be related to exposure for bullying where the individual because of her home conditions may be perceived as different from her school-peers. Objective: The aim of the study was to investigate the correlation between honor oppression and poly-victimization, mental illness and bullying among Swedish adolescences. Method: The study is based on cross-sectional data derived from a national survey about violence against children from year 2016 included 4741 students from year 9 in elementary school and the second year of high-school in total. Cross-sectional and logistical regression analyses where applied to answer the aim of the study with included research questions. Furthermore, multivariate logistical regression analyses adjusted for gender, economy, age, residential-situation and disability were practiced. Results: The results showed that honor oppression had a statistically significant correlation to poly-victimization, mental illness and exposure to bullying. The adjusted analyses presented that honor-oppression increased the probability for poly-victimization (aOR 10.2, CI 5.6 – 18.4), mental illness such as self-harm (aOR 1.9, CI 1.1 – 3.2), suicidal attempt (aOR 2.4, CI 1.3 – 4.7) and exposure to bullying (aOR 2.4, CI 1.5 – 4.1). Conclusions: The results of the study confirmed that honor oppression can increase the possibility for exposure to violence and negative health consequences included lethal outcomes for adolescences. This emphasizes the importance of prevention concerning honor- oppressed children and adolescences where they can get adapted help and support from professional practices in different societal arenas.

Inledning: Globalt sett beräknas det att en av fyra familjer har minst en medlem med psykisk störning och de anhöriga är ofta de som är de främsta vårdarna. En majoritet av personer med psykisk sjukdom är eller kommer att bli föräldrar. Forskning visar på ett starkt samband mellan psykisk sjukdom hos föräldrarna och psykisk ohälsa hos barn. Syfte: Att identifiera riskfaktorer respektive friskfaktorer som uppträder hos barn som växer upp med en psykiskt sjuk förälder. Metod: En litteraturstudie där 15 artiklar både kvantitativa och kvalitativa ingick. Analysering av artiklarna har skett enligt en tematisk analysmetod. Resultat: Barn till föräldrar med psykisk sjukdom utgör en högriskgrupp för att själva utveckla beteendemässiga, känslomässiga och psykiatriska problem. Det finns ett starkt samband mellan förälderns psykiska sjukdom och stigmatisering samt bristande skolgång. Skyddande faktorer inbegriper stöd, kunskap om förälderns tillstånd, en aktiv coping strategi och en familjefokuserad vård, vilket kan öka familjens och barnens resiliens. Diskussion: Det finns stora behov av tidiga insatser för att stödja barn. Många gånger missas barnen då fokus på vården enbart är riktad till den psykiskt sjuka föräldern. Studien visar att stöd och information till barnen inte är implementerat eller är bristfällig i många fall.
Introduction: Globally, it is estimated that one in four families has at least one family member with a mental disorder and relatives are often the primary caregivers. A majority of people with mental illness are or will be parents. Research shows a significant association between parental mental illness and mental illness in children. Purpose: The purpose of this systematic literature review was to identify the risk factors and the protective factors of the health of children living with a mentally ill parent. Method: A literature study involving 15 articles both quantitative and qualitative. Analysis of the articles has been done according to a thematic analysis method. Result: Children of parents with mental illness constitute a high-risk group for developing problems such as behavioural, emotional and psychiatric disorders. There is a strong relation between the parent's mental illness and stigmatization as well as lack of school attendance. Protective factors include social support, knowledge of the parent's illness, having an active coping strategy and a family-focused care that can enhance the family and children's resilience. Discussion: There is a great need of early efforts and interventions to support children. Many times, the focus from health care is only on the mentally ill parent and many children's needs are missed. This study shows that support and information to the children in many cases is not implemented or inadequate.

Introduktion: Bipolär sjukdom är en av flera olika psykiatriska diagnoser som bidrar till en psykisk ohälsa. Bipolär sjukdom kännetecknas av manier och depressioner som kan bli så allvarliga att det kan behövas vård på sjukhus. Bemötandet och omhändertagandet mellan vårdpersonal och personer med bipolär sjukdom är därför särskild viktig för att säkerställa att personer med bipolär sjukdom får den vård de behöver. Syfte: Syftet med denna litteraturstudie är att undersöka personers erfarenheter av vårdpersonals bemötande och omhändertagande vid bipolär sjukdom inom både öppen- och slutenvård. Metod: En strukturerad litteraturstudie har använts, där kvalitativa artiklar har studerats och analyserats. Resultat: Tio vetenskapliga artiklar inkluderades för analys och resulterade i fem olika teman enligt följande: vikten av att vårdpersonal lyssnar på personer med bipolär sjukdom, tidsbrist som hinder i omhändertagandet och bemötandet, vikten av stöd och förståelse från vårdpersonalen, behov av information för personer med bipolär sjukdom och behov av personcentrerad vård till personer med bipolär sjukdom. Slutsats: Denna studie för med sig kunskap inom olika aspekter som anses viktiga vid både bemötande och omhändertagandet för personer med bipolär sjukdom. Studiens resultat kan stödja vårdpersonalens bemötande respektive omhändertagande till personer med bipolär sjukdom.
Introduction: Bipolar disorder is one of many other psychiatric diagnoses which contributes to mental illness. Bipolar disorder is characterized by mania and depressions that can become so severe that hospitalizing might be needed. The care and treatment between health professionals and people with bipolar disorder are therefore particularly important to ensure that people with bipolar disorder receive the care they need. Purpose: The aim of this literature review was to investigate people’s experiences from health professionals for care and treatment of bipolar disorder in both open and closed care. Method: A structured literature study has been used, where qualitative articles have been studied and analyzed. Results: Ten scientific articles were included for analysis and resulted in five different themes as follows: the importance of health professionals listening to people with bipolar disorder, lack of time as an obstacle to care and treatment, the importance of support and understanding from health professionals, the need of information for people with bipolar disorder and the need of person-centered care for people with bipolar disorder. Conclusion: This study brings knowledge in various aspects that are considered important in both care and treatment for people with bipolar disorder. The results of this study can support health professionals care and treatment for people with bipolar disorder.

Bakgrund: Distriktssköterskan triagerar dagligen patienter med psykisk ohälsa i primärvården. Psykisk ohälsa är mångfacetterat och till viss del tabubelagt i samhället. Detta kräver att distriktssköterskan har god kännedom om psykisk ohälsa och hur den kan uttrycka sig hos olika patienter. Distriktssköterskan behöver även ha ett holistiskt synsätt med personcentrerad vård i fokus. Syfte: Syftet med studien var att belysa distriktssköterskans erfarenheter av triagering av patienter med psykisk ohälsa inom primärvården. Metod: En kvalitativ intervjustudie med åtta distriktssköterskor/sjuksköterskor verksamma i primärvården. Analysmetoden var kvalitativ innehållsanalys. Resultat: Resultatet var tre kategorier och tio underkategorier. De tre kategorierna var: Brister i utbildning, Utmaningar vid triagering samt Brister i samverkan. Resultatet visade att distriktssköterskan behöver ha mer kunskap om psykisk ohälsa samt ha de förutsättningar som krävs för att genomföra en bra triagering såsom stödverktyg och trygghet i dialog om självmordstankar hos patienten. Distriktssköterskan behöver vara medveten om somatisering och dess påverkan i triageringen. Samarbetet mellan primärvården och öppen psykiatriska mottagningen behöver förbättras. Konklusion: För att triagering av psykisk ohälsa ska bli bättre behöver distriktssköterskan erhålla mer utbildning av psykisk ohälsa. Där har både arbetsgivare och utbildningsansvariga ett ansvar att påverka möjligheterna till triagering av psykisk ohälsa i primärvården. Distriktssköterskan behöver även ha stödverktyg för att säkerhetsställa likvärdig triagering av psykisk ohälsa i primärvården.
Background: The district nurse triage daily patients with mental illness in primary care. Mental illness is multifaceted and to some extent taboo in society. This requires that the district nurse has a good knowledge of mental illness and how it can express itself in different patients. The district nurse also needs to take a holistic approach with person-centred care in focus. Aim: The aim was the district nurse experiences with triage of patients with mental illness in primary care. Method: A qualitative research approach based on interviews with eight district nurse/nurse active in primary care. Qualitative content analysis. Result: The result was three categories and ten subcategories. The three categories were: Deficiencies in education, Challenges in triage and Deficiencies in collaboration. The results showed that the district nurse needs to have more knowledge about mental illness and have the conditions required to carry out a good triage, such as support tools and security in dialogue about suicidal thoughts in the patient. The district nurse needs to be aware of somatization and its impact on triage. The collaboration between primary care and the open psychiatric clinic needs to be improved. Conclusion: In order for triage of mental illness to improve, the district nurse needs to receive more training in mental illness. There, both employers and education managers have a responsibility to influence the opportunities for triage of mental illness in primary care. The district nurse also needs support tools to ensure equivalent triage of mental illness in primary care.

Abstract Björklund, M. (2017). Is the use of Instagram a new self-harm behaviour? A cross-sectional study of Instagram users’ reflections. Bachelor thesis in Public Health Science. Department of Occupational and Public Health Science. Faculty of Health and Occupational Studies. University of Gävle, Sweden.   The aim of the study was to investigate the use of Instagram among Swedish internet users. A further aim was to investigate whether there was an association between the increased use of Instagram and mental health. The method used was a cross-sectional study with questionnaires. Both quantitative and qualitative questions were included in the survey, which were presented as descriptive statistics as well as thematic analysis with quotes. The selection was a convenience selection and snowball selection, where the surveys were disseminated via the author Facebook. The result showed that the majority used Instagram several times a day and many of them were found to be in the risk group of mental illness. Many users found that the images exposed in Instagram contributed to comparisons between themselves and the photos resulting in body dissatisfaction. The conclusion was that the use of Instagram several times a day was associated with a decreased level of well-being. The majority of the Instagram users compared themselves with other people and more thought of their appearance, when they were exposed to the images in Instagram.
Idag använder ca 55 % av Sveriges befolkning i åldrarna 12–55 år tjänsten Instagram. De senaste åren har användandet ökat med 12 % varje år. Under år 2016 har den psykiska ohälsan i Sverige ökat kraftigt, särskilt i åldersgruppen 16–29 år. Denna grupp är också stora användare av Instagram. Tidigare studier visar att exponeringen av bilder bidrar till att de exponerade jämför sig med andra, vill förändra sig själva och funderar mer över sitt utseende. Dessa beteenden kan också bidra till diagnoser som depression och ätstörningar och bli en typ av ett självskadebeteende.   Syftet med studien var att undersöka hur användandet av Instagram ser ut bland svenska internetanvändare. Ytterligare ett syfte var att undersöka om det finns en association mellan det ökade Instagram-användandet och den psykiska hälsan.   Metoden som används var en tvärsnittsstudie med enkäter, med både kvantitativa och kvalitativa frågor. Detta presenterades som beskrivande statistik samt tematisk analys med citat. Urvalet var ett bekvämlighetsurval och snöbollsurval, där enkäterna delades ut via författarens Facebook.   Resultatet visade att många använde Instagram flera gånger om dagen och många av dem visade sig vara i riskgruppen för att drabbas av psykisk ohälsa. Många upplevde att bilderna man exponeras för på Instagram bidrar till att man jämför sig själv vilket skapar ett missnöje med den egna kroppen. Det fanns ett samband mellan att använda Instagram flera gånger per dag och att uppleva missnöjdhet, osäkerhet, att inte räcka till, samt att man jämförde sig med andra och tänkte mer på sitt utseende. Slutsatsen blev att det som använder Instagram flera gånger per dag upplever ett minskat psykiskt välbefinnande och är i riskgruppen för att drabbas av psykisk ohälsa. Många användare av Instagram jämförde sig med andra och tänkte mer på sitt utseende när de exponerades för bilder på Instagram.

Introduktion: Psykisk ohälsa hos barn och ungdomar fortsätter att öka och har blivit ett stort samhällsproblem och den höga sjukdomsbördan medför att psykisk ohälsa räknas som en folksjukdom. Covid-19 pandemin har medfört en försämring av den psykiska hälsan till följd av förändrade levnadsvanor på grund av restriktionerna för att minska smittspridningen och konsekvenserna kan påverka individer i flera år framåt. Syfte: Syftet med denna litteraturstudie är att identifiera vilka riskfaktorer som påverkar barn och ungdomars psykiska hälsa negativt under covid-19 pandemin. Metod: Denna studie är en tematisk litteraturstudie och artiklar har framtagits med hjälp av databaserna Academic Search Premier, CINAHL, Directory of Open Accsess Journals, MEDLINE EBSCO, PubMed och SpringerLink. Resultat: Fyra riskfaktorer identifierades ”fysisk inaktivitet”, ”ökad skärmtid”, ”våld i hemmet/föräldrars alkoholmissbruk” samt ”isolation/social distansering”. Även socioekonomiska faktorer utmärkte sig som betydande för psykisk ohälsa samt att flickor var särskilt utsatta för psykisk ohälsa under pandemin. Slutsats: Covid-19 pandemin har påverkat barn och ungdomars psykiska hälsa negativt, restriktionerna har medfört att smittspridningen minskat, dock till en bekostnad av en ökad psykisk ohälsa. Fler studier på ämnet behövs för att utforska vilka ytterligare konsekvenser covid-19 pandemin har fått på folkhälsan då forskningsområdet är relativt outforskat.
Introduction: Mental illness in children and adolescents continues to increase and has become a major societal problem. The prevalence and high burden makes mental illness apublic health disease. The covid-19 pandemic has led to deterioration in mental health due to changes in lifestyles due to restrictions to reduce the spread of infection. Consequences of these restrictions can affect individuals for years to come. Aim: The aim of this study was to identify risk factors that have a negative impact on children and adolescent's mental health during the covid-19 pandemics. Methods: This study was a thematic literature study and articles has been selected from the databases Academic Search Premier, CINAHL, Directory of Open Accsess Journals, MEDLINE EBSCO, PubMed och SpringerLink. Conclusion: The covid-19 has had a negative effect on the mental health of children and adolescents and covid-19 restrictions have led to a reduction in the spread of the infection but at the expense of increased mental illness. More studies on the subject are needed to explore the additional consequences

Tidigare studier har visat på att i varje missbrukares liv, finns cirka fem anhöriga som riskerar att utveckla medberoende. Riskfaktorerna associerade med medberoende påverkar därför förekomsten av psykiska ohälsa och ökar risken för att utveckla andra sjukdomar såsom depression, ångest och känslomässiga problem. Syftet med studien var att undersöka hur medberoende i nära relationer kan utveckla självdestruktivt beteende och psykisk ohälsa. Med hjälp av en kvalitativ metod och intervjuer som datainsamlingsmetod blev syftet med denna studie genomförd. Studien grundades på semistrukturerade intervjuer där totalt sex informanter deltog. Resultatet i studien visade på liknande resultat genom alla intervjuer, såsom förekomsten av psykiska sjukdomar, självdestruktivt beteende och vikten av introjektiv identifikation. Dessa tre kategorier kompletterar varandra i den skrivna ordningen. Resultatet tyder på att det kan vara så att den medberoende inte kan utveckla psykisk ohälsa utan fenomenet introjektiv identifikation och självdestruktivt beteende. För att det ska utvecklas någon form av psykisk ohälsa skulle den medberoende personen behöva utveckla ett självdestruktivt beteende, och resultatet tyder på att det inte är möjligt utan introjektiv identifiering i kontexten nära relationer. Dock med hjälp av anknytningsteorin och coping-strategin, visade slutsatsen att inte alla medberoende utvecklade psykisk ohälsa. Förekomsten av psykisk ohälsa påverkas av individens tidiga anknytningsmönster och copingförmåga. Studien ledde till slutsatsen att psykisk ohälsa är ett stort problem bland individer med medberoende. Medberoende är inte fastställt som en sjukdom, trots att risken för att eventuellt utveckla psykisk ohälsa finns. Trots de följdsjukdomar som medberoende medför är det ingen prioritering inom folkhälsopolitiken.
Previous studies have shown that in every drug addicted person’s life there is about five relatives which risks developing co-dependency. Therefore, the riskfactors affect the relative’s mental health and increase the risk of developing other illnesses such as depression, anxiety and emotional issues. The aim of the study was to investigate how co-dependency in close relationships can develop self-destructive behavior and mental illness. With the use of a qualitative method and interviews as a data collecting method, the aim for this study became fulfilled. The study was based on semi-structured interviews, performed by six participants. The results showed similar outcomes for all interviews, such as the prevalence for mental illness, self-destructive behaviour and the importance of introjective identification. These three categories complement each other in the order written. The results indicates that a co-dependent individual could not, without the phenomenon introjective identification and self-destructive behaviour acquire mental illness. However in order to acquire some kind of mental illness the co-dependent person would have to develop self-destructive behaviour, and the results showed that it is not possible without introjective identification in the context of a close relationship. Although, with the use of attachment theory and coping-strategy, the conclusion showed that not every co-dependent developed mental illness. The prevalence of illnesses was affected by the individuals early life attachment-pattern and coping skills. The study led to a conclusion that mental illness is a big issue among co-dependent individuals. Co-dependency is not a determined as a disease, despite the risk of possibly developing mental illness. It is still not a prioritization among public health authorities.

Syftet med studien var att undersöka unga vuxna somaliers uppfattningar om psykisk ohälsa och hur de ser på att söka stöd och hjälp från omgivningen. Metoden som har använts är kvalitativ metod och data har samlats in genom semistrukturerade intervjuer. Studiens intervjupersoner var unga vuxna med somalisk bakgrund vilka var mellan 19 till 29 år varav tre var kvinnor och tre var män. Studiens analys gjordes med hjälp av en kvalitativ manifest innehållsanalys. Resultatet av studien visar att unga vuxna somaliers uppfattning om psykisk ohälsa ser olika ut och att det är ett svårdefinierat begrepp. Unga vuxna somalier upplever även att det inte går att prata öppet om psykisk ohälsa med omgivningen, särskilt bland familjen. Uppfattning om stöd och hjälp är att det undviks, religionen har även stor betydelse och samtidigt finns det kunskapsbrist gällande var de kan söka hjälp och stöd för psykiska besvär.
The purpose of the study was to explore Somali young adults’ perception of mental illness and how they look on seeking support and help from people in the surrounding environment. The method that has been used is a qualitative method using semi-structured interviews. The participants in the interviews were young adults with a Somali ethnic background. There were three men and women and their ages vary between 19 to 29 years old. The analysis was done using a qualitative manifest content analysis. The result of the study shows that young adults Somalis’ perception of mental illness looked different and difficult to define. Young adult Somalis also feel that it is not possible to talk openly about mental illness with people in their surroundings, especially with members of the family. Their perception of support and help is that it is avoided, religion plays a major role among it and there is a lack of knowledge regarding where they can seek help and support for mental illness.

Introduktion: Den psykiska ohälsan bland unga vuxna har ökat under de senaste tio åren och är en av Sveriges största folkhälsoutmaningar. Globalt sett är 322 miljoner människor drabbade av depression och 264 miljoner är drabbade av ångestsjukdom. Ett delmål bland de globala hållbarhetsmålen är att den mentala hälsan skall beaktas och främjas med preventiva insatser. Ytterligare ett steg för att uppnå en god och jämlik hälsa är den av Sverige antagna Vision e-hälsa 2025 som innebär att Sverige skall bli världsledande i att tillvarata möjligheterna med digitalisering. Informations- och kommunikationsteknologin [IKT] och sociala medier ökar möjligheten till interaktion, oberoende av tid och rum. Syfte: Att beskriva hälsofrämjande effekter som sociala medier och IKT-verktyg kan ha för att minska den psykiska ohälsan bland unga vuxna. Metod: En strukturerad litteraturstudie baserad på 20 vetenskapliga originalartiklar som inhämtats från databaserna Pubmed och Cinahl. Artiklarna har analyserats med en tematisk analys. Resultat: Sex teman med främjande effekt på den psykiska hälsan urskildes och grupperades i tre kategorier. Kategorierna var kunskapsutveckling, psykologiska aspekter och användbara verktyg. Teman var personlig utveckling och förändring, ökad kunskap och förmåga, trygghet och anonymitet, motivation och engagemang, social tillhörighet och socialt stöd samt lättillgänglighet och användarvänlighet. Slutsats: Resultatet visar att det finns hälsofrämjande effekter inom det digitala området. Teknikanvändningen kan bidra till implementering av digitala hälsofrämjande insatser i syfte att minska den mentala ohälsan hos unga vuxna. Dock  finns lite forskning inom området och fler studier behövs för att få full effekt av digitaliseringens möjligheter.
Introduction: The mental ill-health of young adults has increased over the past ten years and is one of Sweden's largest public health challenges. Globally, 322 million people are suffering from depression and 264 million are suffering from anxiety disorder. One of the global sustainability goals is that mental health must be considered and promoted with preventive measures. Another step to achieve good and equal health is Vision e-health 2025, in which Sweden is aiming to become a world leader in utilizing the opportunities of digitalisation. Information and communication technology [ICT] and social media increase the possibility of interaction, regardless of time and space. Aim: To describe health-promoting effects that social media and ICT tools can have to alliviate the mental ill-health of young adults. Method: A structured literature study based on 20 scientific original articles obtained from the PubMed and CINAHL databases. The articles have been analyzed with a thematic analysis. Results: Six themes with a promoting effect on mental health were identified and grouped into three categories. The categories were knowledge development, psychological aspects, and useful tools. The themes were personal development and change, increased knowledge and ability, security and anonymity, motivation and engagement, social belonging, and social support, as well as easy accessibility and user-friendliness. Conclusion: The result shows that health-promoting effects are evident in the digital field. The use of technology can contribute to the implementation of digital health promotion efforts aimed at alleviating the mental ill-health of young adults. However, research in the field is limited and more studies are needed to achieve the full effect of the opportunities of digitisation.

Studien byggde på associationen mellan att de som främst använde sociala medier, målgruppen unga kvinnor i åldrarna 16 till 25 år, även var den samhällsgrupp som dominerade i psykisk ohälsa. Forskning kring varför målgruppen lider av psykisk ohälsa mer än andra samhällsgrupper är bristande. Det är samtidigt känt att ungas uppväxtmiljö spelar en betydande roll för deras psykiska hälsa. Sociala medier inkluderas inte som en sådan miljö, trots att unga kvinnor idag spenderar minst 3 timmar där dagligen. Detta motiverade studiens syfte, att undersöka unga kvinnors upplevelser kring sociala medier som uppväxtmiljö i relation till sin identitet och hälsa. Kvalitativ metod möjliggjorde insamling av material genom semistrukturerade intervjuer i fokusgrupper. Studiens resultat fann att unga kvinnor upplever sociala medier som en miljö lika verklighetstrogen som andra fysiskt anknutna uppväxtmiljöer. Studiens resultat redogör även för upplevelser av psykisk ohälsa i samband med sociala medier, men att en hög självkänsla fungerar som en skyddande faktor. Konklusionen redogör för om det finns bestämningsfaktorer för hälsa på sociala medier, bör dessa kunna betraktas som påverkbara förutsatt att de upptäcks och dokumenteras. Därför föreslås framtida hälsoarbete med fokus på säker navigering för unga på sociala medier. Konklusionen påvisar vikten av att folkhälsovetenskapens forskning fortgår i linje med den rådande samhällsutvecklingen som i studien förstås som digitaliserad, detta för att inte missa värdefull kunskap kring vad som leder eller avbryter kurs mot psykisk ohälsa.
The study’s background was based on the association between those who mainly used social media, young women between the ages of 16 and 25, were also the group that dominated in mental illness. Current research on why young women suffers from mental illness more than others is inadequate. Although, it is well-known that environments that young people integrates with growing up plays a significant role in youths mental health. Despite that young women spend at least 3 hours there daily, social media is not included as such environment. This motivated the study's purpose, to investigate young women's experiences about social media as an emerging environment in relation to their identity and health. Qualitative methodology enabled the collection of material through semistructured interviews in focus groups. The study found that young women perceive social media as an environment as realistic as any other environments they interact with growing up. The results of the study also describe the experiences of mental illness associated with social media, but that a high self-esteem serves as a protective factor. The conclusion explains whether there are determinants of health on social media, these should be considered as impactable provided they are discovered and documented. Therefore, future health work is proposed focusing on safe navigation for young people on social media. The conclusion demonstrates the importance of public health science research continuing in line with current social development, which in the study is understood to be digitized, in order not to lose valuable knowledge about what leads or interrupts courses against mental illness.

Inledning: Den psykiska ohälsoutvecklingen bland barn och unga är idag ett allvarligt folkhälsoproblem. Evidens påvisar att den existentiella hälsan har betydelse för psykisk hälsa och välbefinnande. Snacka om livet (SOL) är ett projekt som utformats för att främja barn och ungas existentiella hälsa. Ett fortsatt arbete med projektet är beroende av att det skapas förutsättningar för områdets implementering och att politiken och beslutsfattare prioriterar området. Syfte: Att undersöka upplevelsen av den existentiella hälsan inom Skånes kommunala och regionala sektorsövergripande folkhälsoarbete i främjandet av barn och ungas psykiska hälsa. Metod: Studien hade en kvalitativ ansats med tio deltagare med ledande befattning inom kommun och region. Informanterna selekterades utifrån ett strategiskt urval. Intervjuerna genomfördes med semistrukturerad metod och med ett genomgående etiskt beaktande. Empirin analyserades utifrån kvalitativ innehållsanalys. Resultat: I resultatet framkom att området är nytt, viktigt och aktuellt i relation till den psykiska ohälsan bland barn och unga. Begreppet upplevdes i viss mån komplext och tabubelagt men beskrevs även ha stora vinster för individ och samhälle. Den existentiella hälsan uppfattades kunna stärka och rusta barn och unga. En förutsättning för områdets implementering menades bland annat vara att begreppet inkluderas i folkhälsoarbetet. Konklusion: Studien har kunnat bidra med ytterligare evidens och kunskap till detta relativt nya och outforskade område. Den existentiella hälsan är en resurs i såväl det förebyggande som främjande folkhälsoarbetet. Studien har identifierat att health literacy kan vara ett viktigt verktyg för områdets integrering inom folkhälsan. Begreppet behöver tydliggöras, medvetandegöras och få utrymme i det folkhälsovetenskapliga perspektivet.
Introduction: The development of mental illness among children and adolescents is a serious public health problem today. Evidence shows that spiritual health is important for mental health and well-being. Snacka om livet (SOL) is a project designed to promote the existential health of children and adolescents. Continued work on the project depends on creating the conditions for the area’s implementation and on policymakers prioritizing the area. Purpose: To investigate the experience of existential health within Skåne's municipal and regional cross-sectoral public health work in the promotion of children and young people's mental health. Methods: The study had a qualitative approach with ten participants with senior positions within the municipality and region. The informants were selected based on a strategic selection. The interviews were conducted with a semi-structured method and with thorough ethical considerations. The empirics were analyzed based on qualitative content analysis. Results: The results showed that the area is new, important and of current interest in relation to mental illness among children and adolescents. The concept was to some extent perceived as complex and taboo but was also described as having great benefits for individuals and society. Spiritual health was perceived to strengthen and equip children and adolescents. A prerequisite for the area’s implementation was meant, among other things, to include the concept in public health work. Conclusion: The study has been able to contribute additional evidence and knowledge to this relatively new and unexplored area. Spiritual health is a resource in both prevention and promotion of public health work. The study has identified that health literacy can be an important tool for the area's integration into public health. The concept needs to be clarified, made aware and given space in the public health perspective.

This research into Chronic Fatigue Syndrome (CFS) presents the results of 60 first-person psycho-phenomenological interviews with 30 New Zealand women. The participants were recruited from the Canterbury and Wellington regions, 10 had recovered. Taking a non-dual, non-reductive embodied approach, the phenomenological data was analysed semiotically, using a graph-theoretical cluster analysis to elucidate the large number of resulting categories, and interpreted through the enactive approach to cognitive science. The initial result of the analysis is a comprehensive exploration of the experience of CFS which develops subject-specific categories of experience and explores the relation of the illness to universal categories of experience, including self, ‘energy’, action, and being-able-to-do. Transformations of the self surrounding being-able-to-do and not-being-able-to-do were shown to elucidate the illness process. It is proposed that the concept ‘energy’ in the participants’ discourse is equivalent to the Mahayana Buddhist concept of ‘contact’. This characterises CFS as a breakdown of contact. Narrative content from the recovered interviewees reflects a reestablishment of contact. The hypothesis that CFS is a disorder of action is investigated in detail. A general model for the phenomenology and functional architecture of action is proposed. This model is a recursive loop involving felt meaning, contact, action, and perception and appears to be phenomenologically supported. It is proposed that the CFS illness process is a dynamical decompensation of the subject’s action loop caused by a breakdown in the process of contact. On this basis, a new interpretation of neurological findings in relation to CFS becomes possible. A neurological phenomenon that correlates with the illness and involves a brain region that has a similar structure to the action model’s recursive loop is identified in previous research results and compared with the action model and the results of this research. This correspondence may identify the brain regions involved in the illness process, which may provide an objective diagnostic test for the condition and approaches to treatment. The implications of this model for cognitive science and CFS should be investigated through neurophenomenological research since the model stands to shed considerable light on the nature of consciousness, contact and agency. Phenomenologically based treatments are proposed, along with suggestions for future research on CFS. The research may clarify the diagnostic criteria for CFS and guide management and treatment programmes, particularly multidimensional and interdisciplinary approaches. Category theory is proposed as a foundation for a mathematisation of phenomenology.

Thesis (Ph. D.)--Florida State University, 2006.
Advisor: R. Jay Turner, Florida State University, College of Social Sciences, Dept. of Sociology. Title and description from dissertation home page (viewed Sept. 22, 2006). Document formatted into pages; contains viii, 97 pages. Includes bibliographical references.

In recent years, food addiction has become a popular construct believed to have serious behavioral, emotional and physical consequences. However, its scientific validity is still under investigation. This dissertation evaluated whether food addiction is a valid mental disorder, substance-related disorder, and addiction in three parts. Part 1 reviewed the phenomenological, animal and neurological evidence to assess whether food addiction has face validity and conducted a systematic literature review of studies estimating the prevalence, validating measures, and/or assessing correlates of human food addiction to evaluate construct validity. Part 2 used two community-based convenience samples to assess whether operationalized measures of food addiction are reliable and valid. Part 3 used two large cohorts of nurses to evaluate whether food addiction is associated with potentially positively reinforcing nutrients, food items and food groups. The literature review established that food addiction has face validity, and to some degree, construct validity. The first analytic paper found that the internal and test-retest reliabilities of both scales were moderate to good, and the shorter Modified Yale Food Addiction Scale compared with the original Yale Food Addiction Scale had good sensitivity and negative predictive value. The second analytic paper found strong positive associations between food addiction and consumption of fats and sodium, non-sweet fatty foods, diet foods, and some salty and sweet foods, no association with most starchy and salty food items, and an inverse association with fruits and vegetables. It also found unexpected strong inverse associations between sugar and food addiction, contradicting the popular “sugar addiction” hypothesis. Prospective analyses should reexamine these findings to eliminate potential reverse causation bias. Taken together, this dissertation supported food addiction as a valid mental disorder, substance-related disorder and addiction, although some findings contradicted a priori hypotheses, and gaps in the literature remain.

The biomedical conceptualisation of “depression” as a disease entity stems from biological science rooted in a 17th century paradigm, and is an inappropriately positivist idea which discounts individual agency, disregards social context underscored in the descriptive epidemiology, fails to accommodate inter-subjectivity and process, medicalizes suffering, and serves a managed care model of health administration. A qualitative study using in-depth interviews was undertaken to elicit perspectives from individuals who had lived experience of biomedical (pharmacological) treatment for affective distress and who self-reported having attained satisfactory recovery. Thematic analysis of interview data clustered around three main categories: (1) multifactorial conceptual understandings; (2) context pertinent to the experience of distress and recovery – including a variety of stressors – and (3) trajectories of recovery from acute distress to negotiation of ambivalence toward treatment, enlisting of supports, and reclaiming of agency. Relationships with service providers marked by trust, empathy, and hope were valued as primary difference-makers.
May 2017

Epidemiological trends in mental disorders are shown against a background governed by medical aid health policy. The study quantitatively analyzed a dataset of mental disorders for South Africa’s leading medical aid scheme. South Africa’s leading medical aid scheme has been in operation for almost three decades. This degree of longevity allows for a reliable longitudinal analysis of diagnostic trends. Through consent of the Scheme, a database was provided, which lists mental disorder diagnoses over seven years from 2008 to mid-way through 2015. Data from this source were analyzed and interpreted. Data fields provided and made use of from the raw medical scheme database are: Date of admission (Year, Month); Patient gender; Database population per year; Patient diagnosis (DEG Description); Total per DEG Description. Each diagnosis (mental disorder) is presented in the following ways: 1. Bar charts showing the volume of specific mental illnesses each year. 2. Bar charts showing fluctuations of occurrence of a specific mental illness over time. 3. Frequency of specific mental illnesses over time, relative to the entire database population. 4. Male:Female ratio per mental disorder. 5. Female Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015).v 6. Male Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015). 7. Total number of patients per mental disorder across time (2008 – 2015). 8. Frequency polygons showing the fluctuation of a selected mental disorder over time as compared to other selected mental disorders. It is found that there are changes in prevalence rates of mental disorders over time and that these fluctuations are attributed to an economic factor within medical aid scheme cost-driven policy. The effect of cost-driven policy is that members diagnosed with a mental disorder may not be granted provision of adequate treatment because diagnosis is in part, determined by economic structures. Costs for mental illness treatment programmes are curtailed by keeping patient numbers significantly low, by radically over-diagnosing certain mental illnesses treated with comparably cheaper pharmaceuticals or by drastically curbing time spent in a mental health facility. Some members of the medical aid scheme have been deliberately misdiagnosed. Alternatively, those, correctly diagnosed, do not receive the treatment required of such an illness. The scenario then is of thousands of mentally ill people, who are not treated effectively. Members continue to pay fees, paying under the illusion that medical cover ensures effective treatment
Psychology
M.A. Psychology

Introduktion: De senaste åren har användning av sociala medier ökat kraftigt hos ungdomar. 92 procent av alla 13 till 16 åringar använder idag sociala medier där de vanligaste medierna är Facebook, Instagram och Snapchat. Något annat som ökar i samma takt som sociala medier är psykisk ohälsa hos ungdomar. Syfte: Syftet med denna litteraturstudie är att undersöka huruvida ungdomar och unga vuxnas (13-24 år) användande av sociala medier har några effekter på deras psykiska hälsa och välbefinnande. Metod: Metoden är en litteraturstudie där 21 vetenskapliga artiklar har analyserats för att besvara frågeställningarna. Resultat: Sociala medier visade sig både  ha en negativ och en positiv effekt på unga människor. Psykologiska konsekvenser kunde påvisas och förklaras genom såväl hur sociala medier används, hur ofta de används och olika medierande variabler. Den starkaste medieringen visades vara FoMO, rädslan över att råka missa något om man inte ständigt kollar igenom sina sociala medier. Social medier påvisades även vara ett hälsofrämjande verktyg om de används med måtta, individen utvecklar då dels sin kommunikationsförmåga och stärker sitt sociala umgänge och stöd. Slutsats: Sociala medier har såväl positiva som negativa effekter på den psykiska hälsan. Däremot blir slutsatsen i denna litteraturstudie att de negativa effekterna överväger och att sociala medier således bör användas med mer varsamhet och eftertanke.
Introduction: In recent years, the use of social media has increased significantly in young people. 92 percent of all 13 to 16-year-olds today use social media where the most common media are Facebook, Instagram and Snapchat. Something else that increases at the same rate as social media is mental illness in young people. Aim: The purpose of this literature study is to investigate whether adolescents and young adults (age 13-24) use of social media has any effects on their mental health and well-being. Method: The method is a literature study in which 21 peer reviewed articles have been analyzed to answer the questions. Result: Social media proved to have both a negative and a positive effect on young people. Psychological consequences could be demonstrated and explained by how social media are used, how often they are used and different mediating variables. The strongest mediation was shown to be FoMO, the fear of missing something out if not constantly checking through their social media. Social media was also shown to be a health-promoting tool if used in moderation, as the individual then develops his or her communication skills and strengthens the social interaction and support. Conclusion: Social media have both positive and negative effects on mental health. However, the conclusion in this literature study is that the negative effects outdo the positive effects, and social media should therefore be used with more caution and reflection.