L. M. Johansson

Sense of coherence and lack of control in relation to outcome after orthopaedic injuries

This study aimed to investigate whether sense of coherence (SOC) and lack of control are related to outcome after moderate orthopaedic injuries. One hundred and eleven patients with orthopaedic injuries were included. The patients were followed up 1 year after the injury (physical examination, Disability Raring Index (DRI), Visual Analogue Scale, Becks Depression Inventory and SF-36). At a minimum of 2 years after the injury, the patients filled out a questionnaire, which included three SOC questions and one question about sense of lack of control. The results showed that a low sense of coherence, sense of having less control over ones life, and signs of depression were associated with an increased risk of having a less good clinical and functional outcome 1 year after the injury (odds ratios varied between 2 and 11). We conclude that these factors seem to be predictive of the outcome and should be taken into consideration when designing rehabilitation programs for injured patients.

Ethnicity, social factors, illness and suicide: a follow‐up study of a random sample of the Swedish population

The aim of this longitudinal study was to determine the influence of ethnicity, social factors and self‐reported long‐term somatic and psychiatric illness on suicide in a random sample of the Swedish population. The study is based on face‐to‐face interviews conducted between 1979 and 1985 with a random sample of the Swedish population consisting of 47 762 Swedish‐born subjects and 4407 individuals born elsewhere. The sample has been followed via register data concerning cases of suicide (suicides and undetermined deaths) until 31 December 1993. In total, 102 males and 46 females committed suicide prior to this date. Living alone and self‐reported somatic illness with impaired health status were very strong risk factors for suicide, with risk ratios of 2.15 (CI, 1.51–3.05) and 1.80 (1.19–2.72), respectively. Ethnicity, defined as being born outside Sweden, had a risk ratio of 1.87 (1.18–2.97) in a model controlled for sex and age. However, this risk decreased with increasing age in the final model. Furthermore, an increased risk of suicide was found among female subjects living in rented flats and among male subjects irrespective of form of tenure, as well as among residents of large urban areas. Respondents with a self‐reported long‐term psychiatric illness with impaired health status also had a high risk of suicide, which decreased with increasing age. The main finding of this study is that somatic diseases and psychiatric disorders, which are known risk factors for suicide, may be revealed in surveys conducted by interviewers without medical training. Thus self‐reported psychiatric and somatic illness appear to have a good potential for predicting suicide, even if the prevalence of psychiatric disorders is to some extent underestimated.

Are sociodemographic factors and year of delivery associated with hospital admission for postpartum psychosis? A study of 500 000 first-time mothers

Objective:  To examine the association between first hospital admissions due to postpartum psychosis and the explanatory variables age, educational level, marital status and year of delivery.

Obstetric complications and postpartum psychosis: a follow-up study of 1.1 million first-time mothers between 1975 and 2003 in Sweden

Objective:  The severity of postpartum psychosis calls for further research on the association between obstetric variables and this psychiatric disorder.

Immigration, moving house and psychiatric admissions

This study was designed to elucidate psychiatric admission rates for native Swedes and foreign‐born individuals during the period 1991–1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in‐patient care had been reduced. Tests of differences between Swedes and foreign‐born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign‐born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign‐born males under 55 years of age and foreign‐born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign‐born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign‐born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness.

Neighborhood socioeconomic environment and risk of postpartum psychosis

SummaryObjective: To examine the hypothesized association between the neighborhood socioeconomic environment and postpartum psychosis, after adjustment for individual sociodemographic characteristics.Method: All Swedish women aged 20–44 years who became first-time mothers from 1 January 1986 to 30 September 1998 (N = 485,199) were followed for first hospital admissions due to postpartum psychosis. Neighborhood income was divided into three groups according to the proportions of individuals with low income in the neighborhood. Cox regression was used to estimate hazard ratios for postpartum psychosis.Results: Women living in the poorest neighborhoods exhibited a significantly higher risk of first hospital admissions due to postpartum psychosis than women living in the richest neighborhoods, HR = 1.49 (95% CI = 1.15–2.91, p = 0.002).Conclusion: Decision makers and health care workers should be aware that living in a poor neighborhood socioeconomic environment might contribute to the development of postpartum psychosis.

The influence of ethnicity and social and demographic factors on Swedish suicide rates

The aim of this follow-up study, based on individual data, was to analyse the influence of ethnicity and other demographic and social factors on suicide rates between 1986 and 1989 for the Swedish population according to the 1985 census. The data were analysed by sex and age using a Poisson regression model. During the study period there were 8,310 cases of suicide and undetermined death. The main finding in this study was that ethnicity, defined as being foreign-born, was a significant risk factor for suicide in both sexes and in all age groups except for males aged 30 to 49 years. Not being married was a significant risk factor in all age groups for both males and females. Form of tenure, i.e. living in rented flats, was a significant risk factor for suicide in middle-aged males and females, while overcrowding was a risk factor for middle-aged males and for the over 50s of both sexes. As ethnicity, defined as foreign-born, was an important variable related to suicide, the association between different ethnic groups and suicide will be evaluated in forthcoming studies.