Håkan Källmén

Novel biochemical markers of psychosocial stress in women

Background Prolonged psychosocial stress is a condition assessed through self-reports. Here we aimed to identify biochemical markers for screening and early intervention in women. Methods Plasma concentrations of interleukin (IL) 1-α, IL1-β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-γ (INF-γ), tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), thyroid stimulating hormone (TSH), total tri-iodothyronine (TT3), total thyroxine (TT4), prolactin, and testosterone were measured in: 195 women on long-term sick-leave for a stress-related affective disorder, 45 women at risk for professional burnout, and 84 healthy women. Results We found significantly increased levels of MCP-1, VEGF and EGF in women exposed to prolonged psychosocial stress. Statistical analysis indicates that they independently associate with a significant risk for being classified as ill. Conclusions MCP-1, EGF, and VEGF are potential markers for screening and early intervention in women under prolonged psychosocial stress.

A Test of the Validity of the Motivational Interviewing Treatment Integrity Code

To evaluate the Swedish version of the Motivational Interviewing Treatment Code (MITI), MITI coding was applied to tape‐recorded counseling sessions. Construct validity was assessed using factor analysis on 120 MITI‐coded sessions. Discriminant validity was assessed by comparing MITI coding of motivational interviewing (MI) sessions with information‐ and advice‐giving sessions as well as by comparing MI‐trained practitioners with untrained practitioners. A principal‐axis factoring analysis yielded some evidence for MITI construct validity. MITI differentiated between practitioners with different levels of MI training as well as between MI practitioners and advice‐giving counselors, thus supporting discriminant validity. MITI may be used as a training tool together with supervision to confirm and enhance MI practice in clinical settings. MITI can also serve as a tool for evaluating MI integrity in clinical research.

Coding Counsellor Behaviour in Motivational Interviewing Sessions: Inter‐Rater Reliability for the Swedish Motivational Interviewing Treatment Integrity Code (MITI)

The aim of this study was to evaluate inter‐rater reliability when using the Swedish version of the Motivational Interviewing Treatment Code (MITI) as an adjunct to MI training, clinical practice and research. Coders were trained to use the MITI for scoring taped sessions. The 4‐month basic training had a duration of 39 hours. Following training, 60 audio‐taped live interviews were randomly assigned for MITI coding. Mean intra‐class correlation (ICC) coefficients were calculated for 7 coders across all pairs of coders. Cronbachs alpha was calculated to estimate the covariance between each pair across their common interviews. Six months later, a second inter‐rater reliability test was performed, when 5 coders coded the same 15 randomly selected tapes. At the second reliability testing the mean ICC was 0.81 and the mean Cronbachs alpha was 0.96. However, the ICC varied for different sub‐variables of the MITI, ranging from 0.42 empathy to 0.79 for number of Closed questions. In conclusion, MITI shows promising potential to be a reliable tool to confirm and enhance MI training as well as practice in clinical settings and in evaluating MI integrity in clinical MI research. However, coder assessment of empathy and MI‐spirit, “global” variables, requires further refinement.

Alcohol habits in Sweden during 1997–2005 measured with the AUDIT

This study aimed to describe changes in Swedish alcohol habits during a period of “harmonization” with European Union alcohol policy. Three random samples collected during the years 1997 (n=997), 2001 (n=893) and 2005 (n=914) were compared. Alcohol habits and hazardous consumption was measured with the AUDIT (Alcohol Use Disorders Identification Test) distributed to the respondents by post. Results were somewhat diverse, but significant changes in alcohol habits occurred among two subgroups of the population: for women and the age group between 28 and 60 years, AUDIT scores peaked in 2001. The results are discussed in relation to the changes made in Swedish alcohol policy during the investigation period.

Are irrational beliefs and depressive mood more common among problem gamblers than non-gamblers? A survey study of Swedish problem gamblers and controls.

This study tests the hypothesis that problem gamblers are more prone to have irrational beliefs and depressed mood than non-gamblers. Irrational beliefs refer to fallacious opinions about probabilities. Gamblers like to believe that chance games (i.e., roulette and lottery) can be controlled and that the outcome of such games is dependent on the patterns of previous outcomes. The empirical material consists of responses to a survey that 302 individuals have answered. Half of the respondents were deemed to be problem gamblers. The results showed that compared to the controls, the problem gamblers were more inclined to show illusion of control due to their skill and reported more depressive mood. The results are discussed in terms of difficulties to know the “hen and the egg” regarding depressive mood, and in terms of intermittent reinforcement to continue gambling.

Alcohol Habits in Sweden during 1997–2009 with Particular Focus on 2005 and 2009, Assessed with the AUDIT: A Repeated Cross-Sectional Study

Aim: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. Methods: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. Design: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. Results: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61–71 years old and decreased among men 61–71 years old. Younger men and women 17–27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. Conclusions: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

Single-Session Motivational Interviewing for Drug Detoxification Inpatients: Effects on Self-Efficacy, Stages of Change and Substance Use

Thirty-five inpatients at a Stockholm hospital drug user detoxification unit received single-session Motivational Interviewing (MI) between 2006 and 2008. At baseline and after 3 months, they were compared to a semirandomized control group of 52 patients with treatment as usual. In the MI group, self-efficacy increased regarding abstention in connection with positive feelings, appreciation of positive drug effects increased, and participants tended to transition toward preparation/action stages of change. Despite implementation challenges, the study demonstrates the feasibility and effectiveness of single-session MI delivery in the inpatient drug detoxification setting and suggests paths for future research on delivery of single-session MI.

Life satisfaction in patients with long-term non-malignant pain–relation to demographic factors and pain intensity

Purpose. Life satisfaction can be defined as a measure of a patients perception of the difference between his reality and his needs or wants. Here we compare life satisfaction in patients with long-term pain to a reference group sampled from the normal population, and relate the results to pain intensity and to demographic factors. Method. Questionnaires containing the Life satisfaction (LiSat-11) checklist, a visual analogue scale (VAS) for pain, and questions on demographic background. Results. The prevalence of responders with low level of life satisfaction was larger among the patients than in the reference group. In particular, patients born outside Northern Europe scored significantly lower than patients born in Northern Europe in many of the LiSat-11 domains. Pain intensity did not correlate well to the level of life satisfaction, except for weak negative correlations to satisfaction with physical health and with financial situation. Conclusion. Long-term pain is strongly associated with low life satisfaction. In order to increase life satisfaction, interventions related to social factors seem to be important.

Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT

Background: Alcohol habits in Sweden, assessed as sales and estimates of unrecorded consumption, have changed since joining the EU. Earlier studies using the Alcohol Use Disorders Identification Test (AUDIT) showed that reported consumption is consistent with sales data, which makes it possible to assess consumption according to sex and age. Aims: This study reports the changes in alcohol habits between 2009 and 2014, a period starting a couple of years after Sweden joined the EU. Method: The AUDIT was sent to a random sample of the Swedish population aged between 17 and 80 years old. Results: No statistically significant changes were shown in six age and sex groups. Conclusions: Alcohol habits have stabilised in Sweden but on a higher consumption level than before.

Adults with mild to moderate depression exhibit more alcohol related problems compared to the general adult population: a cross sectional study

BackgroundAlcohol use has been shown to interfere with treatment for depression, but consumption habits are not routinely screened in primary care. To date, few studies have compared the alcohol consumption habits of patients with depression to the general population. The purpose of this study was to compare alcohol habits in adults diagnosed with depression in primary care to the general adult population in Sweden.MethodsNine hundred fourty six patients diagnosed with mild to moderate depression, without a primary substance use disorder, in primary care settings located across Sweden completed the Alcohol Use Disorders Identification Test (AUDIT). Consumptions habits and alcohol related problems in the depressed sample were compared to those in the general adult population (n = 663). Analyses were stratified by gender and age.ResultsRatings of alcohol problems and measures of hazardous drinking and binge drinking were significantly higher among patients seeking treatment for depression in primary care compared to the general population. Male patients scored higher on the AUDIT total and AUDIT-C (consumption) subscale than men in the general population. Compared to younger adults (aged 17–27) older depressed adults (aged 28–50 and 51–71) exhibited higher rates of consumption and problems related to alcohol.ConclusionsCompared to the general adult population, consumption and problems related to alcohol use were substantially higher among patients with mild to moderate depression in primary care. Routine screening of alcohol use in primary care is recommended for patients presenting with depression.