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Mikkelsen TJ, Agerskov H, Jensen DM, Stenager E, Rothmann MJ. Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study. J Clin Nurs 2024; 33:1862-1874. [PMID: 38356190 DOI: 10.1111/jocn.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIM To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care. DESIGN The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews. METHODS Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. RESULTS Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment. CONCLUSION Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. IMPLICATIONS FOR PATIENT CARE The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.
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Affiliation(s)
- Tanja Juhl Mikkelsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
| | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Psychiatric Research Unit, Aabenraa, Department of Regional Health Services Research, University of Southern Denmark, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Jakobsen SG, Andersen PT, Lauritsen J, Larsen CP, Stenager E, Christiansen E. Opening the black box of registration practice for self-harm and suicide attempts in emergency departments: a qualitative study. BMC Prim Care 2024; 25:139. [PMID: 38678191 PMCID: PMC11055235 DOI: 10.1186/s12875-024-02393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The World Health Organization has called for improved surveillance of self-harm and suicide attempts worldwide to benefit suicide prevention programs. International comparisons of registrations are lacking, however, and there is a need for systematically collected, high-quality data across countries. The current study investigated healthcare professionals' perceptions of registration practices and their suggestions for ensuring high-quality registration of self-harm and suicide attempts. METHODS Qualitative interviews (N = 20) were conducted among medical secretaries, medical doctors, nurses, and registration advisers from psychiatric and somatic emergency departments in all regions of Denmark between September 2022 and March 2023. Content analysis was performed using NVivo. RESULTS Despite great efforts to standardize and assure the quality of registration in Denmark, almost all the healthcare professionals perceived registration practice as inconsistent and unreliable. Codes are often misclassified or unused due to insufficient time, non-standardized training, or insufficient information. The interview informants suggested that coding guidelines should be simplified and made more visible, alongside technical solutions in the electronic health record system. CONCLUSION The study findings resulted in eight overall recommendations for clinical practice that aim at improving the registration of patients presenting with self-harm or suicide attempts. This would be expected to help improve surveillance and prevention programs.
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Affiliation(s)
- Sarah Grube Jakobsen
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark.
- Centre for Suicide Research, Bangs Boder 28-30, st. th, Odense, 5000, Denmark.
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Department of Clinical Medicine, Unit of Orthopaedic Surgery, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Christina Petrea Larsen
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark
- Centre for Suicide Research, Bangs Boder 28-30, st. th, Odense, 5000, Denmark
| | - Elsebeth Stenager
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark
| | - Erik Christiansen
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark
- Centre for Suicide Research, Bangs Boder 28-30, st. th, Odense, 5000, Denmark
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Sandahl M, Lassen AT, Stenager E, Østervang C. Pathways and transitions for patients admitted to an emergency department after self-harming events. Int J Ment Health Nurs 2024. [PMID: 38500171 DOI: 10.1111/inm.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
The frequency of people presented in emergency departments (EDs) after self-harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self-harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self-harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self-harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self-harming event and (3) a system of chaos. Patients admitted to the ED after self-harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self-harm patients and so provides chaotic patient pathways. There is a need for improved cross-sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow-up care between those involved in the patient's pathway and care.
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Affiliation(s)
- Malene Sandahl
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Mental Health Research Unit, Children and Adult Psychiatry, Region of South Denmark, Aabenraa, Denmark
- Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Guala MM, Bikic A, Bul K, Clinton D, Mejdal A, Nielsen HN, Stenager E, Søgaard Nielsen A. "Maze Out": a study protocol for a randomised controlled trial using a mix methods approach exploring the potential and examining the effectiveness of a serious game in the treatment of eating disorders. J Eat Disord 2024; 12:35. [PMID: 38429839 PMCID: PMC10908122 DOI: 10.1186/s40337-024-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Eating Disorders (ED) are severe and costly mental health disorders. The effects of existing treatment approaches are limited and there is a need to develop novel interventions, including digital strategies that can increase engagement and effectiveness. Maze Out is a new serious game coproduced by patients and ED therapists, which allows patients to "play" with the reality of an ED and reflect on associated challenges. OBJECTIVES The present study has two main objectives: (1) to evaluate the effectiveness of adding Maze Out to treatment as usual (TAU) in a randomised controlled trial (RCT); and (2) to examine in depth the potential of Maze Out by examining how it is perceived and used in the context of an RCT. METHODS Participants will be recruited from mental health care services, endocrinology departments or Community Centres offering treatment for ED. Patients suffering from ED (N = 94) will be randomised to either TAU or TAU plus Maze Out. Primary outcome will be measured in terms of changes in self-efficacy, measured by a 5-item self-efficacy questionnaire (5-item SE_ED). Secondary outcome measures will include feelings of ineffectiveness and self-image, as measured by Eating Disorder Inventory, version 3 (EDI-3), Brief INSPIRE-O and Structural Analysis of Social Behaviour Intrex Questionnaire (SAS-B). Data will be collected at baseline (enrolment in the study), and subsequently 8 and 15 weeks after inclusion. Experiences of playing Maze Out will be examined in a sub-sample of participants, utilising both quantitative user analytics and qualitative interview data of patients, interview data of significant others, and healthcare professionals to explore the possible impact of Maze Out on disorder insight, communication patterns between patients and therapists and understanding of their disorder. DISCUSSION To our knowledge Maze Out is the first serious game coproduced by patients and therapists. It is a novel and theoretically grounded intervention that may significantly contribute to the healing process of ED. If found effective, the potential for wide-spread impact and scalability is considerable. Trial registration ClinicalTrials.gov NCT05621018.
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Affiliation(s)
- Maria Mercedes Guala
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark.
| | - Aida Bikic
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Kim Bul
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics (MEB), Centre for Eating Disorders Innovation (CEDI), Karolinska Institute, Stockholm, Sweden
| | - Anna Mejdal
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Helene Nygaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
| | - Elsebeth Stenager
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
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Iachina M, Ljungdalh P, Nørgård BM, Garvik O, Stenager E, Schiøttz-Christensen B. Psychiatric disorders, diagnosed in psychiatric clinics, in patients with back pain: A cohort study. Scand J Public Health 2023; 51:1153-1160. [PMID: 35674239 DOI: 10.1177/14034948221100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Aims: The aim of this study was to evaluate whether patients with a non-specific back pain disorder are more likely to be diagnosed with a psychiatric disorder than patients with a specific back pain disorder (such as a herniated disc or inflammatory back disorder). Methods: This was a retrospective cohort study using Danish registries. Results: Our study population included 24,518 patients younger than 61 years and 12,274 patients older than 61 years. In both subpopulations, 60% had a non-specific back pain diagnosis (BPD). In the younger subpopulation, 2.1% of the patients with a non-specific BPD and 1.3% of the patients with a specific BPD had a psychiatric diagnosis within one year of their BPD. In the older subpopulation, 0.6% of patients had a psychiatric diagnosis in both BPD groups. The most frequent psychiatric diagnoses were stress-related disorders. In the younger subpopulation, patients with non-specific back pain had a higher risk of being diagnosed with a psychiatric disorder than patients with specific back pain (adjusted odds ratio 1.56, 95% confidence interval 1.25-1.94). The type of BPD had no effect on the risk of having a psychiatric diagnosis among older patients. Conclusions: Patients with a non-specific back pain disorder younger than 61 years were more likely to be diagnosed with a psychiatric disorder than patients with a specific back pain disorder. We recommend that spine specialists pay special attention to patients younger than 61 years with a back pain disorder to prevent them from developing a psychiatric disorder.
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Affiliation(s)
- Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, University of Southern Denmark, Denmark
| | - Pernille Ljungdalh
- Spine Centre of Southern Denmark, University Hospital Lillebaelt, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, University of Southern Denmark, Denmark
| | - Olav Garvik
- Center for Clinical Epidemiology, Odense University Hospital and Research Unit of Clinical Epidemiology, University of Southern Denmark, Denmark
| | - Elsebeth Stenager
- Psychiatric Research Unit, Aabenraa, Department of Regional Health Services Research, University of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, University Hospital Lillebaelt, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
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Jakobsen SG, Larsen CP, Stenager E, Christiansen E. Risk of repeated suicide attempt after redeeming prescriptions for antidepressants: a register-based study in Denmark. Psychol Med 2023; 53:5510-5517. [PMID: 36043363 DOI: 10.1017/s0033291722002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It remains unclear how SSRIs and other antidepressants are associated with the risk of repeated suicide attempts. We aimed to analyse the association between redeemed antidepressant prescriptions and the risk of repeated suicide attempts, hypothesising that antidepressant treatment is associated with increased risk of repeated suicide attempts. METHODS The study was based on Danish register data and a validated cohort of 1842 suicide attempts. We used three Cox regression models (crude, adjusted and propensity score matched) to analyse the data; these models included both static and dynamic time-dependent factors. RESULTS 1842 individuals attempted suicide in the study period, with a total of 210 repeated attempts. Individuals redeeming antidepressant prescriptions were more likely to repeat a suicide attempt. All crude models showed all antidepressants to be significant risk factors (HR around 1.39), whereas all adjusted models showed all antidepressants to be insignificant risk factors. CONCLUSION We found no significant increased risk of repeated suicide attempts in individuals redeeming a prescription for any antidepressant (or only SSRIs) when considering the individuals' baseline risk of repetition. This study is based on validated suicide attempts, register data, and strong epidemiology designs, but it still has some limitations, and the results should be replicated and confirmed in other studies.
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Affiliation(s)
- Sarah Grube Jakobsen
- Centre for Suicide Research, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - Erik Christiansen
- Centre for Suicide Research, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Unit for Psychiatric Research, Department of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
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Jakobsen SG, Nielsen T, Larsen CP, Andersen PT, Lauritsen J, Stenager E, Christiansen E. Definitions and incidence rates of self-harm and suicide attempts in Europe: A scoping review. J Psychiatr Res 2023; 164:28-36. [PMID: 37311401 DOI: 10.1016/j.jpsychires.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe. METHODS A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area. RESULTS A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches. CONCLUSION The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.
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Affiliation(s)
- Sarah Grube Jakobsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark.
| | - Torben Nielsen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Christina Petrea Larsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Accident Analysis Group, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
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Svensson BA, Bredtoft J, Stenager E, Larsen PV, Skøt L, Sibbersen C, Mellentin AI. Mentalization-oriented psychodynamic group therapy for patients with personality disorders: a naturalistic prospective cohort study. Nord J Psychiatry 2023; 77:147-157. [PMID: 35510757 DOI: 10.1080/08039488.2022.2067898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Patients with personality disorders (PDs) are often treated with non-manualized psychodynamic group therapy (PDT) lasting for several years. Non-manualized PDT often combines a variety of therapeutic approaches from different PDT traditions, including mentalization-based therapy. Currently, little is known about the effect of this long-term, costly treatment. This study investigated the extent to which patients with different PDs benefit from mentalization-oriented PDT as it is implemented in clinical practice in terms of symptom severity, interpersonal problems, and general functioning. METHODS The design was a naturalistic, prospective cohort study. Seventy-five consecutive PD patients were assessed before treatment with the Symptom Checklist-90 Revised (SCL-90-R) as the primary outcome measure and the Inventory of Interpersonal Problems (IIP) and Global Assessment of Functioning (GAF) as secondary outcome measures. The sample was repeatedly assessed every 12 months for up to 36 months. Paired t-tests were applied to examine the effectiveness of the intervention. RESULTS Among completers (n = 42; 56%), improvement was observed on the SCL-90-R: Global Severity Index (mean change = -0.45 [95% CI = -0.72, -0.19]; Cohen's d = -0.55), Positive Symptom Distress Index (-0.40 [-0.63, -0.17]; -0.56); Positive Symptoms Total (-10.70 [-17.31, -4.09]; -0.52). Secondary outcomes also improved: IIP-total (mean change = -0.50 [95%CI = -0.74, -0.25]; Cohen's d = -0.66); GAF-Functioning (8.79 [6.32, 11.27]; 1.15); and GAF-Symptoms (10.67 [8.09, 13.25]; 1.34). CONCLUSIONS Completers improved on symptom severity, interpersonal problems, and general functioning, with within-group effect sizes ranging from medium to large. Approximately half the sample dropped out, suggesting that mentalization-oriented PDT spanning several years may be unrealistic for many patients with PD. Significant outcomesThere are no clear guidelines for psychological interventions targeting personality disorders (PDs), and currently eclectic and non-manualized psychodynamic approaches lasting for up to 3 years are prevailing in some clinical practices.Although this treatment approach may have an effect on compliant patients, the high drop-out rate indicates that it may not be suitable for a large proportion of PD patients since it requires long-term commitment. Furthermore, it is difficult to identify the content of the non-manualized psychodynamic therapy and what helps the patients.More specific clinical guidelines emphasizing the application of evidence-based treatments or at least manualized treatments are warranted for the treatment of emotionally unstable PDs and other PDs. LimitationsThe naturalistic study design, without any control group, limits conclusions about mechanisms of action of the intervention.Since the intervention was not manualized, it is unknown exactly which treatment was actually administered, which reduces external validity.The outcomes are based on completer data of a relatively small sample size with high drop-out rate.
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Affiliation(s)
- Bo Anton Svensson
- Department of Psychiatry, Region of Southern Denmark, Aabenraa, Denmark
| | - Jacob Bredtoft
- Department of Psychiatry, Region of Southern Denmark, Sønderborg, Denmark
| | - Elsebeth Stenager
- Unit of Psychiatric Research, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Pia Veldt Larsen
- Mental Health Services at the Region of Southern Denmark, Odense C, Denmark
| | - Lotte Skøt
- Unit of Psychiatric Research, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Christensen TN, Wallstrøm IG, Stenager E, Hellström L, Bojesen AB, Nordentoft M, Eplov LF. 30-Month Follow-Up of Individual Placement and Support (IPS) and Cognitive Remediation for People with Severe Mental Illness: Results from a Randomized Clinical Trial. Psychiatry J 2023; 2023:2789891. [PMID: 37151719 PMCID: PMC10162865 DOI: 10.1155/2023/2789891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/27/2022] [Accepted: 03/21/2023] [Indexed: 05/09/2023]
Abstract
Background The individual placement and support (IPS) model for persons with severe mental illness has proven to be more effective than traditional vocational approaches in improving competitive work over 18 months. In this study, the longer-term effects of IPS over 30 months were investigated in a Danish setting. Method In a randomized clinical trial, we compared the effects of IPS, IPS enhanced with cognitive remediation and work-related social skills training (IPSE), and service as usual (SAU). At three locations in Denmark, 720 patients with serious mental illnesses were randomly assigned to the three groups. Competitive employment, education, and hospital admissions were tracked for 30 months using Danish national registers. Results The beneficial effects of IPS on competitive employment and education at the 18-month follow-up were sustained over the 30-month follow-up period. Participants receiving IPS or IPSE were more likely to obtain competitive employment or education than those who received service as usual (IPS 65%, IPSE 65%, SAU 53%, p = 0.006), and they worked on average more weeks competitively (IPS 25 weeks, IPSE 21 weeks, SAU 17 weeks; IPS vs. SAU p = 0.004 and IPSE vs. SAU p = 0.007). Moreover, participants in the two IPS groups had fewer outpatient visits during the 30-month follow-up. However, this was only statistically significant when comparing IPSE with SAU p = 0.017. Conclusion In conclusion, IPS and IPS enhanced with cognitive remediation and work-related skills training demonstrated that the vocational effects of the interventions are retrained over 30 months in a Danish context.
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Affiliation(s)
- Thomas Nordahl Christensen
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Iben Gammelgård Wallstrøm
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lone Hellström
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Bo Bojesen
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
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Conway PM, Erlangsen A, Grynderup MB, Clausen T, Rugulies R, Bjorner JB, Burr H, Francioli L, Garde AH, Hansen ÅM, Hanson LM, Kirchheiner-Rasmussen J, Kristensen TS, Mikkelsen EG, Stenager E, Thorsen SV, Villadsen E, Høgh A. Workplace bullying and risk of suicide and suicide attempts: A register-based prospective cohort study of 98 330 participants in Denmark. Scand J Work Environ Health 2022; 48:425-434. [PMID: 35648097 PMCID: PMC9888442 DOI: 10.5271/sjweh.4034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure. METHODS Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity. RESULTS The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women. CONCLUSIONS The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.
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Affiliation(s)
- Paul Maurice Conway
- Department of Psychology, University of Copenhagen, Denmark,
Correspondence to: Paul Maurice Conway, Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark. [E-mail: ]
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark,Copenhagen Research Centre for Mental Health, Capital Region of Denmark, Copenhagen, Denmark,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | | | - Thomas Clausen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Reiner Rugulies
- Department of Psychology, University of Copenhagen, Denmark,National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Optum Patient Insights, Lincoln, RI, USA
| | - Hermann Burr
- Department of Work and Health, Federal Institute for Occupational Safety and Health BAuA, Berlin, Germany
| | | | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- National Research Centre for the Working Environment, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Elsebeth Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ebbe Villadsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Annie Høgh
- Department of Psychology, University of Copenhagen, Denmark
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Stryhn L, Larsen MB, Mejldal A, Sibbersen C, Nielsen DG, Nielsen B, Nielsen AS, Stenager E, Mellentin AI. Relapse prevention for alcohol use disorders: combined acamprosate and cue exposure therapy as aftercare. Nord J Psychiatry 2022; 76:394-402. [PMID: 34622734 DOI: 10.1080/08039488.2021.1985169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Many patients with alcohol use disorders are challenged by cravings leading to repeated relapses. Both cue exposure therapy (CET) and acamprosate target alcohol cravings and are often combined (CET + acamprosate). The main aim of this study was to investigate whether aftercare treatment consisting of CET combined with acamprosate is equivalent to (A) CET as monotherapy, (B) aftercare as usual (AAU) as monotherapy or (C) AAU combined with acamprosate. METHODS Patients were randomized to receive either CET with urge-specific coping skills (USCS) as aftercare or AAU. Acamprosate prescription data were extracted from patient case records. Alcohol consumption, cravings, and USCS were assessed at pre-aftercare, post-aftercare, and 6-month follow-up. RESULTS Overall, patients increased their alcohol consumption during and following aftercare treatment, thereby relapsing despite any treatment. However, CET + acamprosate achieved greater abstinence compared to AAU + acamprosate at follow-up (p=.047). CET + acamprosate also reduced number of drinking days (p=.020) and number of days with excessive drinking (p=.020) at post-aftercare, when compared to AAU monotherapy. CET monotherapy increased sensible drinking at post-aftercare compared to AAU monotherapy (p=.045) and AAU + acamprosate (p=.047). Only CET monotherapy showed improvement in cravings, when compared to AAU at follow-up (mean urge level: p=.032; peak urge level: p=.014). CONCLUSION The study showed that CET both as monotherapy and combined with acamprosate was superior to AAU monotherapy and AAU + acamprosate in reducing alcohol consumption. Only CET + acamprosate was capable of reducing alcohol consumption in the longer term, indicating that anti-craving medication may not impede CET from exerting an effect on alcohol consumption. Trial registration: ClinicalTrials.gov ID: NCT02298751 (24/11-2014).
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Affiliation(s)
- Lene Stryhn
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Psychiatric Research Academy, Odense, Denmark
| | - Mathias Bach Larsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Psychiatric Research Academy, Odense, Denmark
| | - Anna Mejldal
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Christian Sibbersen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Grüner Nielsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
| | - Angelina Isabella Mellentin
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
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12
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Stryhn L, Mejldal A, Guala M, Støving R, Stenager E, Skøt L, Mellentin A. Comorbid alcohol and cannabis use disorders increase mortality in patients with eating disorders. Eur Psychiatry 2022. [PMCID: PMC9567466 DOI: 10.1192/j.eurpsy.2022.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Alcohol and cannabis use disorders are the most frequent comorbid substance use disorders (SUDs) among patients with eating disorders (EDs). EDs and SUDs involving alcohol and cannabis are independently associated with excess mortality. Objectives To investigate the impact of comorbid alcohol use disorder (AUD) and cannabis use disorder (CUD) on mortality in anorexia nervosa (AN), bulimia nervosa (BN), and unspecified eating disorder (USED) compared with matched control subjects. Methods This retrospective cohort study was conducted using Danish nationwide registers. The risk of mortality among ED patients with/without AUD and/or CUD was compared to matched control subjects with/without AUD and/or CUD using hazard ratios (HRs). Results Of the 20,759 included ED patients, 4.7% and 4.3% had AUD and CUD, respectively. The corresponding figures for the 83,036 control subjects were 1.0% (AUD) and 1.3% (CUD). ED patients without SUDs exhibited an increased risk of mortality compared to control subjects without SUDs (adjusted HR 2.9, P<.001). Mortality risk was higher among ED patients with AUD (adjusted HR 11.8, P<.001) or CUD (adjusted HR 4.6, P<.001) compared to control subjects without AUD/CUD. In addition, patients with AN, BN, and USED, who had comorbid AUD and/or CUD, exhibited an elevated risk of mortality compared to control subjects without AUD/CUD (AN: adjusted HR 11.3, P<.001; BN: adjusted HR 5.9, P<.001; USED: adjusted HR 10.9, P<.001). Conclusions Comorbid AUD and/or CUD increase mortality risk in patients with EDs. In order to reduce mortality in ED patients, prevention and treatment of AUD and CUD is important. Disclosure No significant relationships.
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Hansen T, Waldorff F, Andersen K, Stenager E. Homebased screening for cognitive impairment due to dementia. Eur Psychiatry 2022. [PMCID: PMC9566945 DOI: 10.1192/j.eurpsy.2022.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Dementia develops slowly and insidiously and causes cognitive impairment. The diagnosis is pivotal for relevant treatment and care. However, 50,000 people are estimated to have undiagnosed dementia in Denmark, while 36,000 are diagnosed. The municipalities offers a home visit to the population at the ages of 75 and 80 years to assess the need of care and prevent sickness. These home visits are well established and might offer an unused opportunity to detect cognitive impairment and dementia. Objectives To assess impaired cognition at home visits in order to initiate clinical examination for dementia. Methods A feasibility study with the use of Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q) (sensitivity 0.92, specificity 0.97) at home visits. It is expected to include 1000 participants without a dementia diagnosis at the ages of 75 and 80 years. Participants will be included in a period of 12 moths (in the year of 2022), in a number of municipalities. If the screening for cognitive impairment is positive, the participant is motivated for clinical examination at the general practitioner. Follow-up through registers and general practitioners. Results Preliminary results will be presented at the conference. Conclusions Assessment of cognition might give an opportunity to start medication and social support early in the elderly with impaired cognition and undiagnosed dementia. Disclosure No significant relationships.
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Jakobsen S, Christiansen E, Andersen P, Lauritsen J, Stenager E. Incidence rates of suicide attempts and self-harm in Europe. What can we learn? A systematic review and meta-analysis. Eur Psychiatry 2022. [PMCID: PMC9567207 DOI: 10.1192/j.eurpsy.2022.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Definitions used for suicide attempts and self-harm have been discussed for many years and is used differently in European countries, sometimes even interchangeably. Therefore, it is difficult to compare relevant rates across nations.
Objectives
This study aims at estimating the rate of suicide attempts and self-harm in chosen European countries in the more recent years when distinguishing between applied definitions.
Methods
A systematic search for relevant articles published between 2010-2020 will be performed in databases such as PubMed, Embase, PsycINFO, and Web of Science. Only articles in English or Danish will be included. Data will be collected for all age groups above 15 years of age. The prevalence of suicide attempts and self-harm will be calculated by a random effect model. Subgroup analyses will be performed to compare the rates according to age.
Results
from the performed systematic review and meta-study will be presented at the conference.
Conclusions
The conclusion will be presented when results have been analysed.
Disclosure
No significant relationships.
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Borg J, Stenager E, Wang Y, Svendstrup Christensen L, Goos R, Lund Henriksen F. Cardiac arrest survivors – Psychiatric comorbidity and cognitive impairment. Eur Psychiatry 2022. [PMCID: PMC9568054 DOI: 10.1192/j.eurpsy.2022.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
In 2019 there were 1,760 patients in Denmark’s hospitals who experienced cardiac arrest (IHCA patients = In Hospital Cardiac Arrest patients). Of these patients about 70% survived. There is only limited knowledge about the mental and cognitive state of cardiac arrest survivors. However, it seems, that cardiac arrest survivors, perform mentally and cognitively worse compared to the background population. The mental and cognitive difficulties can lead to reduced quality of life for both those affected and their relatives.
Objectives
Because the above-mentioned area has limited knowledge, further studies are needed to shed more light into the problem.
Methods
To find out if the patients can be included in the study, the patient journals will be studied. After that there will be performed an interview-survey-based study, in which IHCA patients’ possible symptoms of depression, anxiety, PTSD and suicide risk, the patients’ quality of life and any cognitive disorder, shortly after and three months after cardiac arrest, will be examined. The study will also, if possible, focus on the patients’ relatives and on the eventual difficulties they may experience in the aftermath of a relative surviving a cardiac arrest. The above-mentioned will be done using already existing relevant psychiatric and neuropsychological examination tools. In relation to the patients’ relatives, however, a separate survey tool, that has been developed, will be used.
Results
It is an ongoing study. Results are expected in 2023.
Conclusions
In the long run the study hopefully can contribute to establishing relevant help, counseling and rehabilitation for the patients and relatives affected.
Disclosure
No significant relationships.
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Mellentin AI, Skøt L, Guala MM, Støving RK, Ascone L, Stenager E, Mejldal A. Does receiving an eating disorder diagnosis increase the risk of a subsequent alcohol use disorder? A Danish nationwide register-based cohort study. Addiction 2022; 117:354-367. [PMID: 34251067 DOI: 10.1111/add.15639] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/01/2020] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM No large-scale, longitudinal clinical study has examined whether patients with different types of eating disorders (ED) have an increased risk of a subsequent alcohol use disorder (AUD). This study aimed to assess the ongoing risk of receiving a diagnosis of AUD following a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED). DESIGN Retrospective cohort study. SETTING Danish nationwide registries, January 1994 to December 2018. PARTICIPANTS A total of 20 759 ED patients and 83 036 controls were followed from the date of first ED diagnosis (index date) until the date of first AUD diagnosis, death, emigration, or the end of the study. Controls were selected in a 1:4 ratio and matched on month and year of birth, gender and ethnicity. MEASUREMENTS We obtained data on ED (AN, BN, USED; exposure) and AUD (abuse/dependence; outcome) diagnoses as well as sociodemographics and other psychiatric diagnoses. Time to AUD was generated from the index date. Risk of AUD after the index date was assessed among those without a prior AUD diagnosis while adjusting for sociodemographics and prior psychiatric diagnoses. FINDINGS Compared with controls, an increased relative risk of AUD after the index date was observed in AN patients throughout the study lasting 15 + years (adjusted hazard ratios [HRs] ranging from 2.49 [99% CI = 1.46, 4.25] to 6.83 [2.84, 16.41]), in BN patients during the first year of follow-up and from 2 years onward (2.72 [1.66, 4.44] to 17.44 [6.01, 50.63]), and in USED patients during the first year and 2-15 years of follow-up (2.52 [1.54, 4.14] to 14.17 [5.86, 34.27]). In all three groups, estimates were highest during the first year, particularly among BN patients. CONCLUSIONS Patients with anorexia nervosa, bulimia nervosa, or unspecified eating disorders appear to have an increased ongoing risk of receiving a diagnosis of alcohol use disorder following their first eating disorder diagnosis compared with controls.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense C, Denmark.,Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Maria Mercedes Guala
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Eating Disorders, Odense University Hospital, Odense C, Denmark
| | - René Klinkby Støving
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Eating Disorders, Odense University Hospital, Odense C, Denmark.,Research Unit for Medical Endocrinology, Institute of Clinical Research, University of South Denmark, Odense C, Denmark
| | - Leonie Ascone
- Neuroplasticity Research Group, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Regional Health Services Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Anna Mejldal
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Mellentin AI, Mejldal A, Guala MM, Støving RK, Eriksen LS, Stenager E, Skøt L. The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study. Am J Psychiatry 2022; 179:46-57. [PMID: 34974750 DOI: 10.1176/appi.ajp.2021.21030274] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research is lacking on the contribution of different types of substance use disorders (SUDs) to excess mortality across the full spectrum of eating disorders. The authors assessed the association of alcohol use disorders and other SUDs with mortality in anorexia nervosa, bulimia nervosa, and unspecified eating disorder compared with matched control subjects. METHODS A retrospective cohort study was conducted using Danish nationwide registers. The study included 20,759 patients with eating disorders and 83,036 matched control subjects. Hazard ratios were calculated to compare all-cause mortality risk between eating disorder patients and control subjects both with and without a lifetime SUD diagnosis (abuse or dependence of alcohol, cannabis, or hard drugs). RESULTS For patients with each type of eating disorder, a higher risk of all-cause mortality was observed relative to control subjects without SUDs among those who abused alcohol and/or cannabis (adjusted hazard ratios for the anorexia nervosa, bulimia nervosa, and unspecified eating disorder patients, respectively, were 11.28 [95% CI=7.01, 18.16], 5.86 [95% CI=3.37, 10.1], and 10.86 [95% CI=6.74, 17.50]), or hard drugs alone or in combination with alcohol and/or cannabis (adjusted hazard ratios, respectively, were 22.34 [95% CI=15.13, 33.00], 11.43 [95% CI=7.14, 18.28], and 15.53 [95% CI=10.15, 23.78]), than in those without SUDs (adjusted hazard ratios, respectively, were 3.21 [95% CI=2.43, 4.23], 1.24 [95% CI=0.88, 1.77], and 4.75 [95% CI=3.57, 6.31]). Control subjects with SUDs also exhibited an elevated risk of all-cause mortality relative to control subjects without SUDs, although to a much lesser extent than eating disorder patients with SUDs. CONCLUSIONS SUDs have an additive effect on excess mortality in patients with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Anna Mejldal
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Maria Mercedes Guala
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - René Klinkby Støving
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lene Stryhn Eriksen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
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Hellström L, Pedersen P, Christensen TN, Wallstroem IG, Bojesen AB, Stenager E, Bejerholm U, van Busschbach J, Michon H, Mueser KT, Reme SE, White S, Eplov LF. Vocational Outcomes of the Individual Placement and Support Model in Subgroups of Diagnoses, Substance Abuse, and Forensic Conditions: A Systematic Review and Analysis of Pooled Original Data. J Occup Rehabil 2021; 31:699-710. [PMID: 33661452 DOI: 10.1007/s10926-021-09960-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate the effect of Individual Placement and Support (IPS) according to diagnoses of schizophrenia, bipolar disorder, major depression, substance use disorders, or forensic psychiatric conditions. METHODS A systematic search of the literature was conducted in June 2017 and repeated in December 2020. The systematic review included 13 studies. Analyses of pooled original data were based on the six studies providing data (n = 1594). No studies on forensic psychiatric conditions were eligible. Hours and weeks worked were analyzed using linear regression. Employment, and time to employment was analyzed using logistic regression, and cox-regression, respectively. RESULTS The effects on hours and weeks in employment after 18 months were comparable for participants with schizophrenia, and bipolar disorder but only statistically significant for participants with schizophrenia compared to services as usual (SAU) (EMD 109.1 h (95% CI 60.5-157.7), 6.1 weeks (95% CI 3.9-8.4)). The effect was also significant for participants with any drug use disorder (121.2 h (95% CI 23.6-218.7), 6.8 weeks (95% CI 1.8-11.8)). Participants with schizophrenia, bipolar disorder, and any drug use disorder had higher odds of being competitively employed (OR 2.1 (95% CI 1.6-2.7); 2.4 (95% CI 1.3-4.4); 3.0 (95% CI 1.5-5.8)) and returned to work faster than SAU (HR 2.1 (95% CI 1.6-2.6); 1.8 (95% CI 1.1-3.1); 3.0 (95% CI 1.6-5.7)). No statistically significant effects were found regarding depression. CONCLUSIONS IPS was effective regarding schizophrenia, bipolar disorder, and substance use disorder; however, the effect on hours, and weeks worked was not statistically significant regarding bipolar disorder. For people with depression the impact of IPS remains inconclusive. Non-significant results may be due to lack of power. TRIAL REGISTRATION PROSPERO protocol nr. CRD42017060524.
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Affiliation(s)
- Lone Hellström
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
| | - Pernille Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Thomas Nordahl Christensen
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
- Institute of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Iben Gammelgaard Wallstroem
- Research Unit of Mental Health, Odense, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Bojesen
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Aabenraa, Institute of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | | | - Jooske van Busschbach
- University Medical Center Groningen, Groningen, Netherlands
- University Center of Psychiatry, Groningen, Netherlands
- Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | | | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, USA
| | | | - Sarah White
- Population Health Research Institute St George's, University of London, London, UK
| | - Lene Falgaard Eplov
- CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark
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Mellentin AI, Mejldal A, Guala MM, Støving RK, Eriksen LS, Stenager E, Skøt L. The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study. Am J Psychiatry 2021:appiajp21030274. [PMID: 34698521 DOI: 10.1176/appi.ajp.21030274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research is lacking on the contribution of different types of substance use disorders (SUDs) to excess mortality across the full spectrum of eating disorders. The authors assessed the association of alcohol use disorders and other SUDs with mortality in anorexia nervosa, bulimia nervosa, and unspecified eating disorder compared with matched control subjects. METHODS A retrospective cohort study was conducted using Danish nationwide registers. The study included 20,759 patients with eating disorders and 83,036 matched control subjects. Hazard ratios were calculated to compare all-cause mortality risk between eating disorder patients and control subjects both with and without a lifetime SUD diagnosis (abuse or dependence of alcohol, cannabis, or hard drugs). RESULTS For patients with each type of eating disorder, a higher risk of all-cause mortality was observed relative to control subjects without SUDs among those who abused alcohol and/or cannabis (adjusted hazard ratios for the anorexia nervosa, bulimia nervosa, and unspecified eating disorder patients, respectively, were 11.28 [95% CI=7.01, 18.16], 5.86 [95% CI=3.37, 10.1], and 10.86 [95% CI=6.74, 17.50]), or hard drugs alone or in combination with alcohol and/or cannabis (adjusted hazard ratios, respectively, were 22.34 [95% CI=15.13, 33.00], 11.43 [95% CI=7.14, 18.28], and 15.53 [95% CI=10.15, 23.78]), than in those without SUDs (adjusted hazard ratios, respectively, were 3.21 [95% CI=2.43, 4.23], 1.24 [95% CI=0.88, 1.77], and 4.75 [95% CI=3.57, 6.31]). Control subjects with SUDs also exhibited an elevated risk of all-cause mortality relative to control subjects without SUDs, although to a much lesser extent than eating disorder patients with SUDs. CONCLUSIONS SUDs have an additive effect on excess mortality in patients with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Anna Mejldal
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Maria Mercedes Guala
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - René Klinkby Støving
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lene Stryhn Eriksen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
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Kha TV, Stenager E, Hoang H, Bruun-Plesner K, Fuglsang KS, Søgaard la Cour B, Handberg G, Vaegter HB. Preliminary validity and test-retest reliability of two depression questionnaires compared with a diagnostic interview in 99 patients with chronic pain seeking specialist pain treatment. Scand J Pain 2021; 20:717-726. [PMID: 32706755 DOI: 10.1515/sjpain-2020-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/08/2020] [Indexed: 01/14/2023]
Abstract
Objectives Depression symptomatology is highly prevalent in patients with chronic pain, but accurate identification of major depression may be challenged due to time constraints and diagnostic interviews are therefore not routinely performed in clinical practice. Assessment of depression may be facilitated through the use of full-length depression screening questionnaires with acceptable construct validity and test-retest reliability. However, as previously indicated screening questionnaires may overestimate depression in patients with chronic pain, possibly due to overlapping symptoms. However, the failure to screen for depression may raise a concern for missing relevant cases with depression. The objectives of this study were to (1) quantify the validity of the 9-items Patient-Health Questionnaire (PHQ9) and the Major Depression Inventory (MDI) compared with a diagnostic interview in patients with chronic pain seeking specialist pain treatment, and (2) assess the relative test-retest reliability of PHQ9 and MDI over two weeks. Methods Responses to the PHQ9 and MDI were compared with a Present-State-Examination (PSE) interview in 99 patients with chronic pain referred to interdisciplinary pain treatment. PHQ9 and MDI were completed twice over two weeks. Construct validity were assessed with the area under the curve (AUC) analysis, and performance characteristics derived from 2 × 2 contingency tables in which scores on the screening questionnaires were dichotomized and compared with the classification of clinical depression based on the diagnostic interview. Relative test-retest reliability was assessed with intraclass correlation coefficients (ICC). Results Based on the PSE interview, the prevalence of depression was 22.2%, and according to the PHQ9 and MDI questionnaires the prevalence was 26.3 and 34.3%, respectively. Compared with the diagnostic PSE, the PHQ9 and MDI questionnaires had areas under the curve of 0.83 and 0.88, respectively. Both questionnaires had high negative predictive values (PHQ9: cut-off of 11; MDI: cut-off of 26), but low positive predictive values for all possible scores. ICC values were excellent. Conclusions The PHQ9 and MDI questionnaires reliably identified chronic pain patients unlikely to have clinical depression, but showed limited validity identifying patients with clinical depression. These preliminary results may have clinical implications in depression screening in patients with chronic pain seeking specialist pain treatment. Clinicians in a specialty care pain clinic can use these screening questionnaires to identify patients without depression, but caution should be used when positive cases are identified by PHQ9 or MDI due to the risk of false positives.
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Affiliation(s)
- Thuy Vy Kha
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit in Mental Health, Åbenrå, Department of Regional Health Services, University of Southern Denmark, Odense, Denmark.,Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Huong Hoang
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - Karin Bruun-Plesner
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
| | | | | | - Gitte Handberg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
| | - Henrik Bjarke Vaegter
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Pain Research Group, Pain Center, Odense University Hospital, Odense, Denmark
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21
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Wallstroem IG, Pedersen P, Christensen TN, Hellström L, Bojesen AB, Stenager E, White S, Mueser KT, Bejerholm U, van Busschbach JT, Michon H, Eplov LF. A Systematic Review of Individual Placement and Support, Employment, and Personal and Clinical Recovery. Psychiatr Serv 2021; 72:1040-1047. [PMID: 33940948 DOI: 10.1176/appi.ps.202000070] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this review was to assess associations between Individual Placement and Support (IPS), employment, and personal and clinical recovery among persons with severe mental illness at 18-month follow-up. METHODS A systematic literature search identified randomized controlled trials (RCTs) comparing IPS with services as usual. Outcomes were self-esteem, empowerment, quality of life, symptoms of depression, negative or psychotic symptoms, anxiety, and level of functioning. A total of six RCTs reported data suitable for meta-analyses, and pooled original data from five studies were also analyzed. RESULTS Meta-analyses and analyses of pooled original data indicated that receipt of the IPS intervention alone did not improve any of the recovery outcomes. Participants who worked during the study period, whether or not they were IPS participants, experienced improved negative symptoms, compared with those who did not work (standardized mean difference [SMD]=-0.41, 95% confidence interval [CI]=-0.56, -0.26). For participants who worked, whether or not they were IPS participants, improvements were also found in level of functioning and quality of life (SMD=0.59, 95% CI=0.42, 0.77 and SMD=0.34, 95% CI=0.14, 0.54, respectively). CONCLUSIONS Employment was associated with improvements in negative symptoms, level of functioning, and quality of life.
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Affiliation(s)
- Iben Gammelgaard Wallstroem
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Pernille Pedersen
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Thomas Nordahl Christensen
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Lone Hellström
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Anders Bo Bojesen
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Elsebeth Stenager
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Sarah White
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Kim T Mueser
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Ulrika Bejerholm
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Jooske Tanna van Busschbach
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Harry Michon
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
| | - Lene Falgaard Eplov
- Research Unit of Mental Health and Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Wallstroem); DEFACTUM, Central Denmark Region, and Department of Public Health, Aarhus University, Aarhus, Denmark (Pedersen); Copenhagen Research Center for Mental Health, Copenhagen (Christensen, Hellström, Bojesen, Eplov); Institute of Health and Medical Sciences, University of Copenhagen (Christensen); Research Unit of Mental Health, Aabenraa, Denmark, and Department of Regional Health Services, University of Southern Denmark, Odense, Denmark (Stenager); Population Health Research Institute, St. George's University of London, London (White); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Department of Health Sciences, Lund University, Lund, Sweden (Bejerholm); University Medical Center Groningen, and University Center of Psychiatry, University of Groningen, Groningen, Netherlands (van Busschbach); Movisie and Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht (Michon)
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22
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Petersen B, Stenager E, Mogensen CB, Erlangsen A. Response to letter regarding Tobacco smoking. J Intern Med 2020; 288:607. [PMID: 32367596 DOI: 10.1111/joim.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- B Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, University of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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23
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Thrue C, Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Time matters: Early-phase multiple sclerosis is accompanied by considerable impairments across multiple domains. Mult Scler 2020; 27:1477-1485. [DOI: 10.1177/1352458520936231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Impairments across multiple domains are a disabling consequence of multiple sclerosis (MS). Originating from preventive medical strategies, the “time matters”-perspective has become a focal point when treating MS. In particular, early detection of physical and cognitive deficits, along with deficits in patient-reported outcomes seems crucial to further optimize both pharmacological and non-pharmacological MS treatment strategies. Therefore, this topical review investigates the level of impairments across multiple domains (physical function, cognitive function, and patient-reported outcomes) in the early stage of MS (⩽5 years since diagnosis, including clinically isolated syndrome (CIS)), when compared to matched healthy controls. Even at early disease stages, studies show impairments corresponding to 8%–34% and small-to-large numerical effect sizes (0.35–2.85) in MS/CIS patients across domains. This evidence call for early screening programs along with early interventions targeting the multiple impaired domains. This further highlights the importance of preventive initiatives preserving and/or restoring physical and cognitive reserve capacity if possible.
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Affiliation(s)
- C Thrue
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - M Riemenschneider
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - LG Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
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24
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Abstract
OBJECTIVE To assess the association between specific heart diseases and suicide. DESIGN Nationwide retrospective cohort study. PARTICIPANTS A total of 7 298 002 individuals (3 640 632 males and 3 657 370 females) aged ≥15 years and living in Denmark during 1980-2016. MAIN OUTCOME MEASURES Incidence rate ratios (IRR) with 95% confidence intervals. In multivariate analysis, we adjust for sex, period, age group, living status, income level, Charlson Comorbidity Index, psychiatric disorders prior to heart disease and self-harm prior to heart disease. RESULTS Excess suicide rate ratios were found for following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was noted during the first 6 months after the diagnosis of heart failure (IRR: 2.38; 95% CI: 2.04-2.79); acute myocardial infarction (IRR: 2.24; 95% CI: 1.89-2.66); atrial fibrillation and flutter (IRR: 2.70; 95% CI: 2.30-3.18); and angina pectoris (IRR: 1.83; 95% CI: 1.53-2.19) when compared to later. CONCLUSION Several specific disorders were found to be associated with elevated rates of suicide. Additionally, we found temporal associations with higher suicide rates in the first time after diagnosis. Our results underscore the importance of being attentive towards psychological distress in individuals with heart disease.
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Affiliation(s)
- B D Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University of Southern Denmark, University Hospital of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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Hoang H, Stenager E, Stenager E. The Risk of Depression and Anxiety in the Post-diagnostic Period of Multiple Sclerosis Measured by Screening Instruments and Structured Interviews. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.2252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveTo examine the risk of depression and anxiety in MS patients in the post-diagnostic period by using clinical screening instruments and a diagnostic structured clinical interview.MethodA population of 134 MS patients was examined for the risk of depression and anxiety in the post-diagnostic period of MS using the clinical screening instruments Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Within six weeks of diagnosis, patients with cut-off > 12 for BDI and > 7 for HADS were offered a clinical structured interview using the Schedules for Clinical Assessment in Neuropsychiatry/SCAN Version 2.1.ResultsThe prevalence of depressive symptoms and depression in the post-diagnostic period of MS was 49.2% when using the screening instruments, but only 15.2% when using the SCAN interview. For anxiety, the prevalence was 3.4% for both the screening instruments and the SCAN interview in the post-diagnostic period of MS.ConclusionMS patients have a risk of depression and anxiety in the post-diagnostic period of MS, but it is crucial to consider which tools to use in a clinical setting to investigate depression and anxiety in MS patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Abstract
IMPORTANCE Neurological disorders have been linked to suicide, but the risk across a broad spectrum of neurological disorders remains to be assessed. OBJECTIVES To examine whether people with neurological disorders die by suicide more often than other people and to assess for temporal associations. DESIGN, SETTING, AND PARTICIPANTS Nationwide, retrospective cohort study on all persons 15 years or older living in Denmark, from 1980 through 2016 (N = 7 300 395). EXPOSURES Medical contact for head injury, stroke, epilepsy, polyneuropathy, diseases of myoneural junction, Parkinson disease, multiple sclerosis, central nervous system infections, meningitis, encephalitis, amyotrophic lateral sclerosis, Huntington disease, dementia, intellectual disability, and other brain diseases from 1977 through 2016 (n = 1 248 252). MAIN OUTCOMES AND MEASURES Death by suicide during 1980-2016. Adjusted incidence rate ratio (IRRs) were estimated using Poisson regressions, adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and self-harm. RESULTS Of the more than 7.3 million individuals observed over 161 935 233 person-years (49.1% males), 35 483 died by suicide (median duration of follow-up, 23.6 years; interquartile range, 10.0-37.0 years; mean age, 51.9 years; SD, 17.9 years). Of those, 77.4% were males, and 14.7% (n = 5141) were diagnosed with a neurological disorder, equivalent to a suicide rate of 44.0 per 100 000 person-years compared with 20.1 per 100 000 person-years among individuals not diagnosed with a neurological disorder. People diagnosed with a neurological disorder had an adjusted IRR of 1.8 (95% CI, 1.7-1.8) compared with those not diagnosed. The excess adjusted IRRs were 4.9 (95% CI, 3.5-6.9) for amyotrophic lateral sclerosis, 4.9 (95% CI, 3.1-7.7) for Huntington disease, 2.2 (95% CI, 1.9-2.6) for multiple sclerosis, 1.7 (95% CI, 1.6-1.7) for head injury, 1.3 (95% CI, 1.2-1.3) for stroke, and 1.7 (95% CI, 1.6-1.8) for epilepsy. The association varied according to time since diagnosis with an adjusted IRR for 1 to 3 months of 3.1 (95% CI, 2.7-3.6) and for 10 or more years, 1.5 (95% CI, 1.4 to 1.6, P < .001). Compared with those who were not diagnosed with a neurological disorder, those with dementia had a lower overall adjusted IRR of 0.8 (95% CI, 0.7-0.9), which was elevated during the first month after diagnosis to 3.0 (95% CI, 1.9-4.6; P < .001). The absolute risk of suicide for people with Huntington disease was 1.6% (95% CI, 1.0%-2.5%). CONCLUSIONS AND RELEVANCE In Denmark from 1980 through 2016, there was a significantly higher rate of suicide among those with a diagnosed neurological disorder than persons not diagnosed with a neurological disorder. However, the absolute risk difference was small.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Focused Research Unit, Department of Psychiatry, University Hospital of the Region of Southern Denmark, Aabenraa
- Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Egon Stenager
- MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Hospital of Southern Jutland, Sønderborg, Denmark
- Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense
- Focused Research Unit, Center Sønderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Yeates Conwell
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, New York
| | | | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warnerford Hospital, Oxford, United Kingdom
| | - Michael Eriksen Benros
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elsebeth Stenager
- Focused Research Unit, Department of Psychiatry, University Hospital of the Region of Southern Denmark, Aabenraa
- Department of Regional Health Research, University of Southern Denmark, Odense
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Christensen TN, Wallstrøm IG, Stenager E, Bojesen AB, Gluud C, Nordentoft M, Eplov LF. Effects of Individual Placement and Support Supplemented With Cognitive Remediation and Work-Focused Social Skills Training for People With Severe Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:1232-1240. [PMID: 31483451 PMCID: PMC6727676 DOI: 10.1001/jamapsychiatry.2019.2291] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Individual placement and support (IPS) seems to be an effective vocational intervention for people with severe mental illness, but its effects have not yet been shown in the Danish welfare model. Also, effects may be enhanced by adding cognitive remediation and work-focused social skills training (IPS with enhancements [IPSE]). OBJECTIVES To investigate the effects of IPS vs IPSE vs service as usual (SAU) on a population of individuals with severe mental illness in Denmark. DESIGN, SETTING, AND PARTICIPANTS This was an investigator-initiated, 3-group, parallel, assessor-blinded randomized clinical trial that used early-intervention teams or community mental health services in 3 Danish cities to recruit participants with severe mental illness. Participants were randomly assigned to receive IPS, IPSE, or SAU from November 2012 to February 2016, and follow-up continued until August 2017. INTERVENTIONS Participants allocated to the IPS intervention received vocational support per the principles of the IPS model. Participants in the IPSE arm received cognitive remediation and social skills training in addition to IPS. The group receiving SAU received vocational rehabilitation at the Danish job centers. MAIN OUTCOMES AND MEASURES The primary outcome was the number of hours in competitive employment or education during the 18-month follow-up. Secondary outcomes included intergroup differences in employment or education at any point during follow-up; time to employment or education; and cognitive and social functioning, self-esteem, and self-efficacy. RESULTS Of the 720 included participants (mean [SD] age, 32.8 [9.9] years; 276 [38.3%] women), 243 received IPS, 238 received IPSE, and 239 received SAU. Most participants (551 [76.5%]) were diagnosed with a schizophrenia spectrum disorder. During the 18-month follow-up, the IPSE group worked or studied a mean (SD) of 488.1 (735.6) hours, compared with 340.8 (573.8) hours in the group receiving SAU (success-rate difference [SRD], 0.151 [95% CI, 0.01-0.295]; P = .016). The mean (SD) in the IPS group was 411 (656.9) (SRD, 0.127 [95% CI, -0.017 to 0.276]; P = .004). There was no difference between IPS and IPSE in any vocational outcomes, and the 3 groups showed no differences in any nonvocational outcomes, except that the IPS and IPSE groups were more satisfied with the services received than the group receiving SAU (IPS vs SAU: SRD, 0.310 [95% CI, 0.167-0.445]); IPSE vs SAU: SRD, 0.341 [95% CI, 0.187-0.478]). CONCLUSIONS AND RELEVANCE Compared with SAU, IPS and IPSE seem to be viable routes to increase employment and education rates in people with severe mental illness in Denmark, but no additional effects were observed by enhancing IPS. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01722344.
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Affiliation(s)
| | - Iben Gammelgård Wallstrøm
- Research Unit of Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit Psychiatry, Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
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Saied M, Vasarhelyi CC, Mamoi S, Stenager E, Stenager E, Stone J, Binzer MN. [Diagnostics and treatment of functional dizziness in accordance with the new ICD-11 criteria]. Ugeskr Laeger 2019; 181:V04190245. [PMID: 31791463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Persistent postural-perceptual dizziness (PPPD) is a new diagnosis for functional chronic dizziness and included in the new International Classification of Diseases (ICD)-11. The new criteria are positive, specific and make it easier to identify and study functional chronic dizziness. PPPD is a condition triggered by vestibular-, neurological- or psychological conditions. This review examines the symptoms, pathophysiology and treatment of PPPD.
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Bruun H, Huniche L, Stenager E, Mogensen CB, Pedersen R. Hospital ethics reflection groups: a learning and development resource for clinical practice. BMC Med Ethics 2019; 20:75. [PMID: 31651308 PMCID: PMC6813973 DOI: 10.1186/s12910-019-0415-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background An ethics reflection group (ERG) is one of a number of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the significance of ERGs in psychiatric and general hospital departments in Denmark. Methods This is a qualitative action research study, including systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Short written descriptions of the ethical challenges presented in the ERGs also informed the analysis of significance. Results A recurring ethical challenge for clinicians, in a total of 63 cases described and assessed in 3 ethical reflection groups, is to strike a balance between respect for patient autonomy, paternalistic responsibility, professional responsibilities and institutional values. Both in psychiatric and general hospital departments, the study participants report a positive impact of ERG, which can be divided into three categories: 1) Significance for patients, 2) Significance for clinicians, and 3) Significance for ward managers. In wards characterized by short-time patient admissions, the cases assessed were retrospective and the beneficiaries of improved dialogue mainly future patients rather than the patients discussed in the specific ethical challenge presented. In wards with longer admissions, the patients concerned also benefitted from the dialogue in the ERG. Conclusion This study indicates a positive significance and impact of ERGs; constituting an interdisciplinary learning resource for clinicians, creating significance for themselves, the ward managers and the organization. By introducing specific examples, this study indicates that ERGs have significance for the patients discussed in the specific ethical challenge, but mostly indirectly through learning among clinicians and development of clinical practice. More research is needed to further investigate the impact of ERGs seen from the perspectives of patients and relatives.
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Affiliation(s)
- H Bruun
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - L Huniche
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - E Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - C B Mogensen
- Focused Research Unit in Emergency Medicine, Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - R Pedersen
- Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Mellentin AI, Nielsen B, Nielsen AS, Yu F, Mejldal A, Nielsen DG, Stenager E. A Mobile Phone App Featuring Cue Exposure Therapy As Aftercare for Alcohol Use Disorders: An Investigator-Blinded Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e13793. [PMID: 31420960 PMCID: PMC6716334 DOI: 10.2196/13793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 12/04/2022] Open
Abstract
Background Cue exposure therapy (CET) is a psychological approach developed to prepare individuals with alcohol use disorder (AUD) for confronting alcohol and associated stimuli in real life. CET has shown promise when treating AUD in group sessions, but it is unknown whether progressing from group sessions to using a mobile phone app is an effective delivery pathway. Objective The objectives of this study were to investigate (1) whether CET as aftercare would increase the effectiveness of primary treatment with cognitive behavior therapy, and (2) whether CET delivered through a mobile phone app would be similarly effective to CET via group sessions. Methods A total of 164 individuals with AUD were randomized to one of three groups: CET as group aftercare (CET group), CET as fully automated mobile phone app aftercare (CET app), or aftercare as usual. Study outcomes were assessed face-to-face at preaftercare, postaftercare, and again at 6 months after aftercare treatment. Generalized mixed models were used to compare the trajectories of the groups over time on drinking, cravings, and use of urge-specific coping skills (USCS). Results In all, 153 of 164 individuals (93%) completed assessments both at posttreatment and 6-month follow-up assessments. No differences in the trajectories of predicted means were found between the experimental groups (CET group and app) compared with aftercare as usual on drinking and craving outcomes over time. Both CET group (predicted mean difference 5.99, SE 2.59, z=2.31, P=.02) and the CET app (predicted mean difference 4.90, SE 2.26, z=2.31, P=.02) showed increased use of USCS compared to aftercare as usual at posttreatment, but this effect was reduced at the 6-month follow-up. No differences were detected between the two experimental CET groups on any outcomes. Conclusions CET with USCS delivered as aftercare either via group sessions or a mobile phone app did not increase the effectiveness of primary treatment. This suggests that CET with USCS may not be an effective psychological approach for the aftercare of individuals treated for AUD. Trial Registration ClinicalTrials.gov NCT02298751; https://clinicaltrials.gov/ct2/show/NCT02298751
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark.,Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - Bent Nielsen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark.,Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark
| | - Fei Yu
- Technology Entrepreneurship and Innovation section, Mads Clausen Institute, University of Southern Denmark, Sønderborg, Denmark
| | - Anna Mejldal
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark
| | - Dorthe Grüner Nielsen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark
| | - Elsebeth Stenager
- Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense Center, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
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Bruun H, Pedersen R, Stenager E, Mogensen CB, Huniche L. Implementing ethics reflection groups in hospitals: an action research study evaluating barriers and promotors. BMC Med Ethics 2019; 20:49. [PMID: 31311525 PMCID: PMC6636139 DOI: 10.1186/s12910-019-0387-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background An ethics reflection group (ERG) is one of a range of ethics support services developed to better handle ethical challenges in healthcare. The aim of this article is to evaluate the implementation process of interdisciplinary ERGs in psychiatric and general hospital departments in Denmark. To our knowledge, this is the first study of ERG implementation to include both psychiatric and general hospital departments. Methods The implementation and evaluation strategies are inspired by action research, using a qualitative approach and systematic text condensation of 28 individual interviews and 4 focus groups with clinicians, ethics facilitators and ward managers. Results The implementation process was influenced by both structural factors and factors related to clinicians having different values, interests and experiences. Structural barriers and promotors in the process to implement ERG included the following sub-categories: Organizational factors, recruitment and training of ethics facilitators, the deliberation model, planning and recruitment of participants to the ERGs, the support of the ward managers and the project group. Barriers and promotors found among clinicians included the following sub-categories: Expectations and pre-understandings of ERGs, understandings of a physician’s job, challenges experienced by ethics facilitators. At the end of the study, when it was decided that the ERGs should be continued, the implementation strategies were remodeled by the participants to meet new challenges. Conclusion The study of ERG implementation identified important structural and professional barriers and promotors that are likely to be relevant to anyone wanting to implement ethics support services across various types of healthcare services.
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Affiliation(s)
- Henriette Bruun
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark.
| | - Reidar Pedersen
- Center for medical Ethics, Institute of Health and Society, University of Oslo, Kirkevejen 166, 0450, Oslo, Norway
| | - Elsebeth Stenager
- Focused Research Unit in Psychiatry, Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark
| | - Christian Backer Mogensen
- Focused Research Unit in Emergency Medicine Institute for Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000, Odense C, Denmark
| | - Lotte Huniche
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Pankiewicz-Dulacz M, Stenager E, Chen M, Stenager EN. Risk factors of major infections in schizophrenia. A nationwide Danish register study. J Psychosom Res 2019; 121:60-67. [PMID: 31023486 DOI: 10.1016/j.jpsychores.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Risk of infections is elevated in patients with schizophrenia. Predicting their occurrence is essential, as infections in this group of patients are associated with prolonged hospital admission and increased mortality. The objective of the current investigation was to identify the potential risk factors of major infection after diagnosis with schizophrenia. METHODS This national prospective observational cohort study included 7788 people with schizophrenia born in Denmark between 1975 and 1990. Socio-demographic, psychiatric and health related data were obtained from Danish national registers. The Cox regression model was used for data analyses. Crude and adjusted hazard ratios (HRs) with 95% confidence intervals (95%CIs) are presented. RESULTS The most significant risk factors associated with the development of major infections included young age, female gender, medical comorbidity and substance abuse. A history of treatment with antipsychotics preceding the diagnosis was negatively associated with such morbidity. CONCLUSION This study reports several factors that might increase the risk of infections in individuals with schizophrenia. Early intervention towards infections should be considered in the subpopulation of schizophrenia patients who are at increased risk of infections.
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Affiliation(s)
- M Pankiewicz-Dulacz
- The Focused Research Unit of Psychiatry, Department of Psychiatry, Aabenraa, Denmark; University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark.
| | - E Stenager
- University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark; The Focused Research Group of Neurology, Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark.
| | - M Chen
- University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark; Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark.
| | - E N Stenager
- The Focused Research Unit of Psychiatry, Department of Psychiatry, Aabenraa, Denmark; University of Southern Denmark, Winsløwparken 19.3, Odense C-DK 5000, Department of Regional Health Research, Faculty of Health Sciences, Denmark.
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Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI. Prevalence of depressive disorder among patients with fibromyalgia: Systematic review and meta-analysis. J Affect Disord 2019; 245:1098-1105. [PMID: 30699852 DOI: 10.1016/j.jad.2018.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/16/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is acknowledged that fibromyalgia (FM) as a medical (rheumatological) disorder and major depressive disorder (MDD) as a mental disorder often co-occurs, but the inconsistency is prevailing at study-level and no overall estimate of the co-occurrence exist. AIMS This systematic review and meta-analysis aimed to estimate the overall point- and life-time prevalence of MDD among FM patients based on structured clinical interviews (SCI); and to estimate the point-prevalence of MDD among FM patients based on screening symptom scales (SSS). METHOD The electronical databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO were searched for papers that reported on prevalence of MDD among FM patients. Eligible studies were included in a random effects meta-analysis pooling the prevalence of depression. RESULTS The literature search identified 11 eligible studies for the meta-analysis. For SCI, the overall pooled point-prevalence (PP) was 25% (95% CI 19 to 31%), and life-time prevalence (LP) was 65% (95% CI 59 to 71%). When estimating the PP with self-administered SSS the overall pooled PP was 45% (95% CI 32 to 59%), and a single clinician-administered SSS yielded a PP of 23% (95% CI 10 to 41%). There was low inconsistency for the SCI and high inconsistency for the SSS. CONCLUSION One fourth of all FM patients had MDD, and more than half experienced MDD during their life-time according to clinician-administered instruments. Prevalence of MDD was almost twice as high when using self-administered symptom scales and may be likely to overestimate the co-occurrence.
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Affiliation(s)
- J S Løge-Hagen
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A Sæle
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - C Juhl
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - P Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark
| | - E Stenager
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark; Psychiatric Research Unit, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - A I Mellentin
- Psychiatric Research Unit, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
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Pankiewicz-Dulacz M, Stenager E, Chen M, Stenager E. Incidence Rates and Risk of Hospital Registered Infections among Schizophrenia Patients before and after Onset of Illness: A Population-Based Nationwide Register Study. J Clin Med 2018; 7:jcm7120485. [PMID: 30486356 PMCID: PMC6306855 DOI: 10.3390/jcm7120485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/16/2018] [Accepted: 11/23/2018] [Indexed: 02/06/2023] Open
Abstract
Infections in schizophrenia patients are associated with an increased premature mortality. However, our knowledge about the burden of infections in schizophrenia is scarce. The aims of this study were to (1) determine the prevalence of clinically important hospital registered infections in the period of five years prior to and five years after the diagnosis, (2) estimate the risk of infections before and after the schizophrenia diagnosis and, (3) evaluate the impact of comorbidity on the risk of infections in schizophrenia. Using combined data from Danish national registers, we sampled a cohort of all persons born in Denmark in the period 1975⁻1990 and obtained health-related records from 1995⁻2013. Occurrence patterns and the risk of infections were measured as annual incidence rates and incidence rates ratios, estimated using Poisson models. Medical conditions from the Charlson Index were considered as a measure of comorbidity. The analyses showed that schizophrenia patients had a significantly elevated risk of almost all types of hospital registered infections during the period of the study when compared to the controls. Comorbidity increased rates of infections by 176%. The results suggest that the risk of infections is elevated in the schizophrenia population and physical illness is an important risk factor.
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Affiliation(s)
- Monika Pankiewicz-Dulacz
- Focused Research Unit of Psychiatry, Department of Psychiatry, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark.
- The Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19.3, 5000 Odense, Denmark.
| | - Egon Stenager
- The Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19.3, 5000 Odense, Denmark.
- Focused Research Group of Neurology, Department of Neurology, Hospital of Southern Jutland, Sønderborg, 6200 Aabenraa, Denmark.
| | - Ming Chen
- The Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19.3, 5000 Odense, Denmark.
- Department of Clinical Microbiology, Hospital of Southern Jutland, 6400 Soenderborg, Denmark.
| | - Elsebeth Stenager
- Focused Research Unit of Psychiatry, Department of Psychiatry, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark.
- The Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19.3, 5000 Odense, Denmark.
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Bruun H, Lystbaek SG, Stenager E, Huniche L, Pedersen R. Ethical challenges assessed in the clinical ethics Committee of Psychiatry in the region of Southern Denmark in 2010-2015: a qualitative content analyses. BMC Med Ethics 2018; 19:62. [PMID: 29914461 PMCID: PMC6006832 DOI: 10.1186/s12910-018-0308-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. Methods A qualitative content analysis of 55 written case-reports from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. Results The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. Conclusions This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately.
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Affiliation(s)
- H Bruun
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark.
| | - S G Lystbaek
- Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark
| | - E Stenager
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Psychiatric hospitals, the Region of Southern Denmark, Toldbodgade 45, 5000, Odense, Denmark
| | - L Huniche
- User Perspectives, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - R Pedersen
- Center for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Affiliation(s)
- N. Asgari
- Department of Regional Health Research; University of Southern Denmark; Odense Denmark
- Department of Molecular Medicine; University of Southern Denmark; Odense Denmark
| | - S. T. Lillevang
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - H. P. B. Skejoe
- Department of Radiology; Aleris-Hamlet Hospital; Copenhagen Denmark
| | - M. Falah
- Department of Neurology; Regionhospital Holstebro; Holstebro Denmark
| | - E. Stenager
- Department of Regional Health Research; University of Southern Denmark; Odense Denmark
- Department of Neurology; Sonderborg Denmark
| | - K. O. Kyvik
- OPEN; Odense Patient data Explorative Network; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
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Højlund M, Høgh L, Bojesen AB, Munk-Jørgensen P, Stenager E. Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward. Int J Soc Psychiatry 2018; 64:258-265. [PMID: 29480051 DOI: 10.1177/0020764018760650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy. AIM To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint. METHODS Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward. RESULTS Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (β) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted β: .05, 95% confidence interval (CI): -0.20 to 0.31), total dose of benzodiazepines (adjusted β: -.13, 95%CI: -.42 to 0.16) nor total amount of both drugs (adjusted β: .00, 95%CI: -.26 to 0.21) increased after implementation. CONCLUSION Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.
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Affiliation(s)
- Mikkel Højlund
- 1 Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark.,2 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lene Høgh
- 1 Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark
| | - Anders Bo Bojesen
- 1 Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark
| | - Povl Munk-Jørgensen
- 3 Department of Psychiatry Odense, Mental Health Services Region of Southern Denmark, Odense, Denmark.,4 Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- 1 Department of Psychiatry Aabenraa, Mental Health Services Region of Southern Denmark, Aabenraa, Denmark.,2 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Hansen AS, Mikkelsen MB, Stenager E, Stenager E, Binzer M, Stone J. [Functional neurological symptoms and the positive diagnostic process]. Ugeskr Laeger 2018; 180:V08170594. [PMID: 29717704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Functional neurological symptoms are common in neurology and general medical practice. Functional neurological symptoms refer to neurological symptoms, which are not explained by a defined disease. The most common are functional weakness and non-epileptic seizures. Psychiatric models have dominated the classification, aetiology and treatment, limiting the neurologist's role to making the diagnosis by excluding disease and pronouncing the symptoms to be psychogenic. In this review, we outline the possibility of a positive diagnostic process, which can be the first step of treatment.
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Abstract
This article reports a case study of the illness career and identity work of patients who have had medically unexplained symptoms for many years with a particular emphasis on their interactions with a specialized and standardized health care system. Patients with medically unexplained symptoms often experience being met with mistrust and feel their identity threatened as a consequence of being illegitimately ill. There is a strong tendency in health care towards assessment thorough standardized so-called assessment packages. The study used a case study approach. Ethnographic fieldwork was carried out and several types of data were sampled through theoretical sampling, resulting in data from and about a sample of 13 patients, from which two patients were selected as cases. The study showed that a standardized health care system characterized by a tendency towards narrow diagnostic assessment with limited time can lead to a diagnostic limbo and that patients and health care professionals keep on searching for legitimate explanations for the patients' still unexplained symptoms. Consequently the patients were left in a constant identity negotiation.
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Affiliation(s)
- Camilla Blach Rossen
- Research Unit of Mental Health, Odense, Institute of Regional Health Services, University of Southern Denmark & Neurological Research Unit, Sønderborg, DenmarkElective Surgery Center, Silkeborg Regional Hospital, Denmark
| | - Niels Buus
- The University of Sydney, Australia; University of Southern Denmark, Denmark
| | - Elsebeth Stenager
- Institute of Regional Health Research, University of Southern Denmark, Denmark; Focused research Unit in Psychiatry, Åbenrå and Department of Psychiatry, Odense, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Denmark; MS-clinic of Southern Jutland and Focused research Unit in Neurology, Hospital of Southern Jutland, Sønderborg, Denmark
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Langeskov-Christensen D, Feys P, Baert I, Riemenschneider M, Stenager E, Dalgas U. Performed and perceived walking ability in relation to the Expanded Disability Status Scale in persons with multiple sclerosis. J Neurol Sci 2017; 382:131-136. [DOI: 10.1016/j.jns.2017.09.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/06/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
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Søndergård S, Vaegter HB, Erlangsen A, Stenager E. Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care: A register linkage cohort study. Eur J Pain 2017; 22:346-354. [PMID: 28971547 DOI: 10.1002/ejp.1124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Prevalence rates of mental disorders in patients with chronic pain vary and may be overestimated when assessed by screening instruments only. Objectives were to estimate the 10-year prevalence of different mental disorders diagnosed by psychiatrists in patients with chronic pain compared with the Danish general population. METHODS Patients (n = 7197) consulted in the interdisciplinary Pain Clinic South at Odense University Hospital, Denmark, from 2005 to 2015 were included. Data from the Pain Clinic were linked to the Danish National Patient Register-Psychiatry and the Danish Civil Registration System. Age and gender standardized prevalence ratios (SPR) were calculated. RESULTS In all, 17.8% of patients with chronic pain had been diagnosed with a mental disorder. The most frequent diagnoses were adjustment disorders (subcategory of anxiety disorders) (8.9%), depression (6.1%), personality disorders (3.8%), and substance abuse disorders (3.5%). Women and men with chronic pain had higher rates of anxiety disorders (SPR 3.1; 95% CI 2.9-3.4) and depression (SPR 2.5; 95% CI 2.3-2.8), whereas men had higher rates of substance abuse disorders (SPR 1.6; 95% CI 1.3-1.9) than found for the general population. CONCLUSIONS Although depression and anxiety were noted more frequently among patients with chronic pain than the general population, prevalence rates were lower than previously reported. The most frequent diagnoses were adjustment disorders. SIGNIFICANCE Prevalence rates of anxiety and depression diagnosed by psychiatrists in patients with chronic pain were found to be lower than previous findings using screening instruments. Adjustment disorders were the most frequent disorders diagnosed, as this study is the first to investigate.
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Affiliation(s)
- S Søndergård
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark
| | - H B Vaegter
- Pain Research Group, Pain Centre South, Odense University Hospital, Denmark.,Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - A Erlangsen
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark.,Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Denmark.,Department of Mental Health, Bloomberg Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - E Stenager
- Research Unit in Mental Health, Institute for Regional Health Services, University of Southern Denmark, Aabenraa, Denmark
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Andersen C, Kolmos A, Andersen K, Sippel V, Stenager E. Applying sensory modulation to mental health inpatient care to reduce seclusion and restraint: a case control study. Nord J Psychiatry 2017; 71:525-528. [PMID: 28719249 DOI: 10.1080/08039488.2017.1346142] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach that is associated with reduced rates of seclusion and restraint in mental healthcare, but there is need for more research in this area. AIMS Using SM to reduce restraint and seclusion in inpatient mental health care. METHODS The study included two similar psychiatric units where one unit implemented SM and one unit served as the control group. In the very beginning of the study, a staff-training program in the use of SM including assessment tools and intervention strategies was established. Data on restraint and forced medicine were sampled post the course of the year of implementation and compared with the control group. RESULTS The use of belts decreased with 38% compared to the control group. The use of forced medication decreased with 46% compared to the control group. Altogether the use of physical restraint and forced medication decreased significantly with 42% (p < .05). CONCLUSIONS Implementing a SM approach in mental healthcare facilities has a significant effect on the reduction of restraint and seclusion. As a part of the implementation, staff training and education in SM are crucial.
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Affiliation(s)
- Charlotte Andersen
- a Psychiatric Research Unit, Institute of Regional Health Service, University of Southern Denmark , Odense , Denmark
| | - Anne Kolmos
- a Psychiatric Research Unit, Institute of Regional Health Service, University of Southern Denmark , Odense , Denmark
| | - Kjeld Andersen
- b Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | | | - Elsebeth Stenager
- a Psychiatric Research Unit, Institute of Regional Health Service, University of Southern Denmark , Odense , Denmark
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Gammelgaard I, Christensen TN, Eplov LF, Jensen SB, Stenager E, Petersen KS. 'I have potential': Experiences of recovery in the individual placement and support intervention. Int J Soc Psychiatry 2017; 63:400-406. [PMID: 28545319 DOI: 10.1177/0020764017708801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The individual placement and support (IPS) intervention supports persons with severe mental illness in achieving competitive employment. Although the IPS intervention is labelled a recovery-oriented intervention, little is known about how participants experience IPS to influence recovery. The aim was to investigate how IPS and employment influence recovery in persons with severe mental illness. MATERIAL A qualitative phenomenological hermeneutic study of experiences of 12 participants in IPS. DISCUSSION AND CONCLUSION IPS and competitive work have an impact on personal recovery, may influence work functioning and decrease depressive symptoms, but do not seem to have an impact on psychotic symptoms.
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Affiliation(s)
- Iben Gammelgaard
- 1 Research Unit of Mental Health, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas N Christensen
- 2 Institute of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,3 Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Lene F Eplov
- 3 Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Sofie B Jensen
- 2 Institute of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,3 Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Elsebeth Stenager
- 4 Research Unit of Mental Health, Institute of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Kirsten S Petersen
- 5 Department of Health Science and Technology, Faculty of Health Sciences, Aalborg University, Aalborg, Denmark
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Gammelgaard I, Stenager E, Eplov L, Petersen K. Personal experiences of recovery facilitated by participation in an individual placement and support intervention. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionIndividual placement and support (IPS) is an evidence-based intervention where IPS consultants support people with severe mental illness in achieving competitive employment. IPS is a recovery-oriented intervention, but vast evidence regarding its ability to influence recovery-oriented outcomes challenges this position.AimTo investigate how an IPS-intervention influences the personal recovery process in people with severe mental illness.MethodA qualitative phenomenological study including interview of 12 participants in an IPS-intervention. Analysis was made using a four-step phenomenological analysis method.ResultsIPS contributed to personal recovery in a number of ways: The IPS consultants’ ability to create an equal, acknowledging and safe relationship where participants’ needs were taking into consideration in the search and support for job or education was found valuable. In combination with employment, the role of the IPS consultant contributed to normalization and stabilisation of participants’ daily lives, changed their behaviours and beliefs about maintaining new achievements, personal goals and dreams.ConclusionIndividual placement and support provides opportunities to gain personal goals and contributes to stabilisation and normalization of participants’ daily lives. This study supports the notion that the individual placement and support positively influences personal recovery in people with severe mental illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Mellentin AI, Stenager E, Nielsen B, Nielsen AS, Yu F. A Smarter Pathway for Delivering Cue Exposure Therapy? The Design and Development of a Smartphone App Targeting Alcohol Use Disorder. JMIR Mhealth Uhealth 2017; 5:e5. [PMID: 28137701 PMCID: PMC5306612 DOI: 10.2196/mhealth.6500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the number of alcohol-related treatments in app stores is proliferating, none of them are based on a psychological framework and supported by empirical evidence. Cue exposure treatment (CET) with urge-specific coping skills (USCS) is often used in Danish treatment settings. It is an evidence-based psychological approach that focuses on promoting "confrontation with alcohol cues" as a means of reducing urges and the likelihood of relapse. OBJECTIVE The objective of this study was to describe the design and development of a CET-based smartphone app; an innovative delivery pathway for treating alcohol use disorder (AUD). METHODS The treatment is based on Monty and coworkers' manual for CET with USCS (2002). It was created by a multidisciplinary team of psychiatrists, psychologists, programmers, and graphic designers as well as patients with AUD. A database was developed for the purpose of registering and monitoring training activities. A final version of the CET app and database was developed after several user tests. RESULTS The final version of the CET app includes an introduction, 4 sessions featuring USCS, 8 alcohol exposure videos promoting the use of one of the USCS, and a results component providing an overview of training activities and potential progress. Real-time urges are measured before, during, and after exposure to alcohol cues and are registered in the app together with other training activity variables. Data packages are continuously sent in encrypted form to an external database and will be merged with other data (in an internal database) in the future. CONCLUSIONS The CET smartphone app is currently being tested at a large-scale, randomized controlled trial with the aim of clarifying whether it can be classified as an evidence-based treatment solution. The app has the potential to augment the reach of psychological treatment for AUD.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit of Clinical Alcohol Research, Unit of Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - Elsebeth Stenager
- Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - Bent Nielsen
- Unit of Clinical Alcohol Research, Unit of Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Unit of Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Fei Yu
- Technology Entrepreneurship and Innovation section, Mads Clausen Institute, University of Southern Denmark, Soenderborg, Denmark
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Andersen AD, Binzer M, Stenager E, Gramsbergen JB. Cerebrospinal fluid biomarkers for Parkinson's disease - a systematic review. Acta Neurol Scand 2017; 135:34-56. [PMID: 26991855 DOI: 10.1111/ane.12590] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/14/2022]
Abstract
Diagnosis of Parkinson's disease (PD) relies on clinical history and physical examination, but misdiagnosis is common in early stages. Identification of biomarkers for PD may allow early and more precise diagnosis and monitoring of dopamine replacement strategies and disease modifying treatments. Developments in analytical chemistry allow the detection of large numbers of molecules in plasma or cerebrospinal fluid, associated with the pathophysiology or pathogenesis of PD. This systematic review includes cerebrospinal fluid biomarker studies focusing on different disease pathways: oxidative stress, neuroinflammation, lysosomal dysfunction and proteins involved in PD and other neurodegenerative disorders, focusing on four clinical domains: their ability to (1) distinguish PD from healthy subjects and other neurodegenerative disorders as well as their relation to (2) disease duration after initial diagnosis, (3) severity of disease (motor symptoms) and (4) cognitive dysfunction. Oligomeric alpha-synuclein might be helpful in the separation of PD from controls. Through metabolomics, changes in purine and tryptophan metabolism have been discovered in patients with PD. Neurofilament light chain (NfL) has a significant role in distinguishing PD from other neurodegenerative diseases. Several oxidative stress markers are related to disease severity, with the antioxidant urate also having a prognostic value in terms of disease severity. Increased levels of amyloid and tau-proteins correlate with cognitive decline and may have prognostic value for cognitive deficits in PD. In the future, larger longitudinal studies, corroborating previous research on viable biomarker candidates or using metabolomics identifying a vast amount of potential biomarkers, could be a good approach.
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Affiliation(s)
- A. D. Andersen
- Department of Neurology; Hospital of Southern Jutland; Sønderborg Denmark
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Neurology; Hospital of Southern Jutland; Sønderborg Denmark
| | - M. Binzer
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Neurology; Hospital of Southern Jutland; Sønderborg Denmark
| | - E. Stenager
- Institute of Regional Health Research; University of Southern Denmark; Odense Denmark
- Focused Research Group in Neurology; Hospital of Southern Jutland; Sønderborg Denmark
- The Multiple Sclerosis Clinic of Southern Jutland; (Vejle, Sonderborg, Esbjerg) Denmark
| | - J. B. Gramsbergen
- Institute of Molecular Medicine, Neurobiological Research; University of Southern Denmark; Odense Denmark
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Birkbak J, Stuart EA, Lind BD, Qin P, Stenager E, Larsen KJ, Wang AG, Nielsen AC, Pedersen CM, Winsløv JH, Langhoff C, Mühlmann C, Nordentoft M, Erlangsen A. Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Psychol Med 2016; 46:3419-3427. [PMID: 27654845 DOI: 10.1017/s0033291716001872] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death. METHOD In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period. RESULTS At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37-0.79], alcohol-related causes (0.63, 95% CI 0.50-0.80) and other diseases and medical conditions (0.61, 95% CI 0.49-0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5-448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2-210.5) for alcohol-related causes and 96.8 (95% CI 69.1-161.8) for other diseases and medical conditions. CONCLUSIONS Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.
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Affiliation(s)
- J Birkbak
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - E A Stuart
- Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA
| | - B D Lind
- Department of Psychiatry,Clinic of Suicide Prevention and Treatment for Adults,Region of Southern Denmark,Denmark
| | - P Qin
- National Centre for Suicide Research and Prevention, University of Oslo,Oslo,Norway
| | - E Stenager
- Psychiatric Research Unit,Aabenraa,University of Southern Denmark,Odense,Denmark
| | - K J Larsen
- Department of Child and Adolescent Psychiatry,Clinic of Suicide Prevention and Treatment for Children and Adolescents,Region of Southern Denmark,Denmark
| | - A G Wang
- Competence Centre for Suicide Prevention,Amager,Capital Region of Denmark,Denmark
| | - A C Nielsen
- Competence Centre for Suicide Prevention,Copenhagen,Capital Region of Denmark,Denmark
| | - C M Pedersen
- Clinic for Suicide Prevention, Aarhus University Hospital Risskov,Aarhus,Central Denmark Region,Denmark
| | - J-H Winsløv
- Unit for Suicide Prevention,Aalborg University Hospital,North Denmark Region,Denmark
| | - C Langhoff
- Clinic for Suicide Prevention,Herning,Central Denmark Region,Denmark
| | - C Mühlmann
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - M Nordentoft
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
| | - A Erlangsen
- Research Unit,Mental Health Centre Copenhagen,University of Copenhagen,Capital Region of Denmark,Denmark
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Jensen HB, Nielsen JL, Ravnborg M, Dalgas U, Aagaard P, Stenager E. Effect of slow release-Fampridine on muscle strength, rate of force development, functional capacity and cognitive function in an enriched population of MS patients. A randomized, double blind, placebo controlled study. Mult Scler Relat Disord 2016; 10:137-144. [PMID: 27919481 DOI: 10.1016/j.msard.2016.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 06/25/2016] [Accepted: 07/27/2016] [Indexed: 11/16/2022]
Abstract
DESIGN This study was conducted as a randomized, double blind, placebo-controlled parallel group trial preceded by open label enrichment phase. OBJECTIVES The objectives of this study were 1) to examine the effect of SR-Fampridine treatment on muscle strength in terms of maximal voluntary contraction (MVC) and rate of force development (RFD) of the lower extremities and 2) to replicate previously published data on the effect of slow release-Fampridine (SR-Fampridine) on the functional capacity of the lower limbs, the upper limb and cognitive function, in persons with multiple sclerosis (pwMS). METHODS Previously identified responders to SR-Fampridine were randomized to SR- Fampridine or placebo treatment for four weeks. On days 0 and 26-28 participants underwent testing by isokinetic dynamometry, Nine Hole Peg Test (9-HPT), Symbol Digit Modalities Test (SDMT), Six Spot Step Test (SSST), Timed 25 Foot Walk Test (T25FW) and 5-Times Sit-to-Stand (5-STS). RESULTS A statistical significant effect of SR-Fampridine on MVC was demonstrated during knee extension, knee flexion and hip flexion of the weakest leg, as well as on RFD during knee extension and knee flexion of the weakest leg. Furthermore, a significant effect of SR-Fampridine on T25FW, SSST and 5-STS was demonstrated. CONCLUSION Gold standard dynamometry assessment of muscle strength showed improved MVC and RFD in persons with MS treated with SR-Fampridine compared to placebo. Furthermore, previous findings on the effects of SR-Fampridine on functional capacity of the lower limbs were replicated. ClinicalTrials.gov identifier: NCT01656148.
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Affiliation(s)
- H B Jensen
- Institute of Regional Health Research, University of Southern Denmark, Denmark; MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Sønderborg Hospital, Denmark.
| | - J L Nielsen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - M Ravnborg
- Department of Neurology, Odense University Hospital, Denmark
| | - U Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Denmark
| | - P Aagaard
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - E Stenager
- Institute of Regional Health Research, University of Southern Denmark, Denmark; MS-clinic of Southern Jutland (Sønderborg, Vejle, Esbjerg), Department of Neurology, Sønderborg Hospital, Denmark
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Hansen T, Skytthe A, Stenager E, Petersen HC, Brønnum-Hansen H, Kyvik KO. Concordance for multiple sclerosis in Danish twins: an update of a nationwide study. Mult Scler 2016; 11:504-10. [PMID: 16193885 DOI: 10.1191/1352458505ms1220oa] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The occurrence of multiple sclerosis (MS) in twins has not previously been studied in complete nationwide data sets. The existence of almost complete MS and twin registries in Denmark ensures that essentially unbiased samples of MS cases among twins can be obtained. In this population-based study, virtually all Danish MS cases among twins born before 1983 with onset of MS after 1948 and diagnosis before 1 January 1997 were identified. Of 13 286 MS cases, 178 were twins and, of these 164 twin pairs were discordant and seven were concordant. We found significantly higher proband-wise concordance among monozygotic twins than dizygotic twins, with estimated proband-wise concordances of 24% (95% confidence interval (CI): 5-39%) for monozygotic and 3% (95% CI: 0-8%) for dizygotic twins. Thus, a monozygotic twin whose co-twin has MS has a 24% risk of developing the disease, while the corresponding risk for a dizygotic twin is only 3%. Our results largely confirm previously published concordance estimates and indicate that genetic factors are of importance in susceptibility to MS.
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Affiliation(s)
- T Hansen
- Department of Epidemiology and Biostatistics, National Institute of Public Health, Oster Farimagsgade 5, DK-1399 København K, Denmark.
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Mellentin AI, Nielsen B, Nielsen AS, Yu F, Stenager E. A randomized controlled study of exposure therapy as aftercare for alcohol use disorder: study protocol. BMC Psychiatry 2016; 16:112. [PMID: 27098817 PMCID: PMC4839102 DOI: 10.1186/s12888-016-0795-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 03/31/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is well documented that individuals with Alcohol Use Disorder (AUD) respond well during evidence-based psychological treatment, but also that a large proportion relapses when discharged from treatment and confronted with alcohol in real life. Cue Exposure Treatment (CET) focuses on exposing individuals to alcohol cues in order to reduce cravings as well as the likelihood of relapse. The aims of the study are: 1) to investigate whether CET aftercare delivered via a smartphone or in group sessions increases the effect of Cognitive Behavioural Treatment in groups of alcohol dependent individuals; 2) to investigate whether CET as a smartphone application is as or more effective than CET group therapy, and 3) to investigate whether CET as a smartphone application is more cost-effective than CET group aftercare and Aftercare as Usual. DESIGN AND METHODS The study will be implemented as an investigator-blinded randomized controlled trial. A total of 300 consecutively enrolled alcohol use disorder individuals recruited from an alcohol outpatient clinic will be randomized into one of the three following aftercare groups after concluding primary treatment: (1) CET as a smartphone application; (2) CET as group therapy, and (3) Aftercare as Usual. It is hypothesized that the two experimental groups will achieve better treatment outcomes compared to the control group (3). DISCUSSION Individuals in the CET groups are given the opportunity to practise coping strategies during exposure to alcohol stimuli before being unavoidably confronted with alcohol and associated stimuli in real life. Thus, CET may help prevent patients from relapsing after concluding treatment, and in the long term. Moreover, the CET application has the potential to improve AUD treatment and continuing care by offering psychological treatment whenever and wherever the patient finds it convenient. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02298751 Registration date: 6 November 2014.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark. .,Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Unit of Psychiatric Research, University of Southern Denmark, Sdr. Boulevard 29, 5000, Odense, Denmark.
| | - Bent Nielsen
- Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark ,Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - Fei Yu
- Innovation and Business Research Unit, Mads Clausen Institutet, University of Southern Denmark, Sønderborg, Denmark
| | - Elsebeth Stenager
- Unit of Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
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