Lars Wahlström

Different types of exposure to the 2004 tsunami are associated with different levels of psychological distress and posttraumatic stress.

The impact of traumatic exposure on psychological distress and posttraumatic stress was investigated at 14 months through self-report in 1,505 Swedish tourists who survived the 2004 Indian Ocean Tsunami. Exposure, differentiated in single and multiple types, was associated with different levels of impaired mental health measured by General Health Questionnaire (GHQ) and Impact of Event Scale-Revised (IES-R). Additionally, having sole exposure to subjective life threat brought about specific psychological effects. Some demographic factors are associated with outcome on either the GHQ or the IES-R. Identifying specific types of exposure of disaster survivors may be a way to identify individuals who could be screened for psychological ill health at a later point in time.

Psychological distress and sick leave in Swedish survivors of the 2004 tsunami: a comparison with a population sample.

Disaster studies of the effects of trauma exposure on subsequent psychological health have seldom used population comparisons. A total of 1463 tsunami survivors from Stockholm were categorized according to type of exposure, and compared on measures of General Health Questionnaire and sick leave, with a matched population-based sample of 12,045 individuals from the same region. Data from the survivor group were obtained through a postal questionnaire 14 months postdisaster. Data from the population sample were collected in the same year. In comparison to the population sample, levels of sick leave ranged from higher in multiply exposed groups to lower in the least exposed group. For psychological distress, levels in multiply and moderately exposed groups were higher, and in lower exposed groups comparable. The use of a population comparison resulted in a support of recent research showing a relative resiliency of survivors exposed during disaster to potential trauma of lesser severity.

Diabetes and psychiatric illness in the total population of Stockholm

OBJECTIVE Concomitant psychiatric disorders in people with diabetes affect morbidity and mortality. We aimed to study psychiatric morbidity in people with diabetes and the general population using administrative health care data in Stockholm County. METHODS The study population included all living persons who resided in Stockholm County, Sweden, on January 1, 2011 (N=2,058,408). Subjects with a diagnosis of diabetes were identified with data from all consultations in primary health care, specialist outpatient care and inpatient care during the time span 2009-2013. As outcome, information was obtained on all consultations due to any psychiatric diagnosis as well as, specifically, schizophrenia, bipolar disorders, depression, and anxiety disorders, in 2011-2013. Analyses were performed by age group and gender. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) for women and men with diabetes, using individuals without diabetes as referents, were calculated. RESULTS Age-adjusted OR for all psychiatric diagnoses among people with diabetes was 1.296 (95% CI 1.267-1.326) for women and 1.399 (95% CI 1.368-1.432) for men. The greatest excess risk was found for schizophrenia, with OR 3.439 (95% CI 3.057-3.868) in women and 2.787 (95% CI 2.514-3.089) in men, with ORs between 1.276 (95% CI 1.227-1.327) and 1.714 (95% CI 1.540-1.905) for the remaining diagnoses. CONCLUSION The prevalence of psychiatric disorders is elevated in people with diabetes, which calls for preventive action to be taken to minimize suffering and costs to society.

Psychiatric comorbidities in patients with hypertension--a study of registered diagnoses 2009-2013 in the total population in Stockholm County, Sweden.

Objective: The objective of this study was to investigate the prevalence of concomitant hypertension and psychiatric disorders in the general population, using administrative healthcare data in Stockholm County. Design and method: The study population, included all living persons who resided in Stockholm County 1 January 2011 (N = 2 058 408). Individuals with a diagnosis of hypertension were identified with data from all consultations in primary care, specialized outpatient care, and inpatient care 2009–2013. As outcome, data were obtained on all consultations because of certain psychiatric diagnoses between 2011 and 2013, including specifically depression, anxiety disorders, bipolar disorder, and schizophrenia. Age-adjusted odd ratios (ORs) with 95% confidence intervals (95% CI) were calculated for men and women with and without hypertension, with individuals without hypertension as referents. Results: The age-adjusted ORs for depression in persons with hypertension were 1.293 (95% CI 1.256–1.331,) for men and 1.036 (95% CI 1.013–1.058) for women. The age-adjusted ORs for anxiety in persons with hypertension were 1.279 (95% CI 1.238–1.322) for men and 1.050 (95% CI 1.024–1.076) for women. The OR for bipolar disease were 0.904 (95% CI 0.826–0.990) for men and 0.709 (95% CI 0.656–0.767) for women. For schizophrenia, the ORs were 0.568 (95% CI 0.511–0.632) for men and 0.537 (95% CI 0.478–0.603) for women. Conclusion: Increased awareness of the risk of depression and anxiety among hypertensive patients is needed to combat hypertension, its complications, and psychiatric suffering in the population. Hypertension is probably underdiagnosed and neglected in individuals with severe psychiatric disorders. We warrant efforts to integrate psychiatric and hypertensive care.

Childhood life events and psychological symptoms in adult survivors of the 2004 tsunami

Background: Negative life events in childhood have an adverse influence on adult psychological health, and increase vulnerability to subsequent potential traumas. It remains unclear whether this is also true in the case of disasters. Aim: This study investigates whether the experience of negative life events in childhood and adolescence was associated with psychological symptoms in groups of Swedish survivors with different types of exposure to the tsunami. Methods: 1505 survivors from Stockholm responded to a questionnaire on psychological distress, which was sent by post 14 months after the 2004 Indian Ocean tsunami. Psychological distress was measured by General Health Questionnaire-12 and suicidal ideation, and post-traumatic stress was measured by Impact of Event Scale—Revised. Life events prior to age 16 were collected and categorized under the indices accident, violence, loss and interpersonal events. Exposure to the tsunami was categorized in different types, and controlled for in the analyses. Results: With the adjustment for confounders, significant odds ratios were found for all indices on at least one outcome measure, despite the powerful effect of the tsunami. We could not discern any distinct difference in the distribution of the tendency to report the different outcomes depending on types of prior life events. Conclusions: The implication of the study is that, for adult survivors of disaster, the reporting of adverse life events from childhood may influence future decisions regarding therapy.

Support, opinion of support and psychological health among survivors of a natural disaster

Background: Although formal intervention after disasters is recommended, the evidence base for this is weak. Satisfaction with support after disasters is seldom investigated and the relation to psychological symptoms is unknown. Aims: To investigate whether dissatisfaction with social and formalized support are associated with post-disaster psychological symptoms. Methods: A total of 1,505 Swedish survivors of the 2004 Indian Ocean tsunami responded to a questionnaire 14 months after the disaster, including the General Health Questionnaire-12, the Impact of Events Scale – Revised, the Crisis Support Scale, and questions concerning the reception and appraisal of social and formalized support from health care, psychological services and insurance agencies. Disaster exposure and background factors were controlled for in the analyses. Results: Reception of formalized support, but not social support, was associated with both psychological distress and post-traumatic stress. Dissatisfaction with social but not formalized support, with the exception of support from insurance agencies, was associated with psychological distress. Conclusions: Social support and formalized support should be differentiated in future studies in order to improve preventive intervention efforts after disasters. The reporting of dissatisfaction with social support merits special attention, since this may indicate increased risk for psychological symptoms.

Depression or anxiety and all-cause mortality in adults with atrial fibrillation – A cohort study in Swedish primary care

Abstract Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting. Methods The study population included adults (n = 12 283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored. Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR = 1.28, 95% CI 1.08–1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients. Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice.

Longitudinal course of physical and psychological symptoms after a natural disaster

Background After disaster, physical symptoms are common although seldom recognized due to lack of knowledge of the course of symptoms and relation to more studied psychological symptoms. Objective This study aimed to investigate the change in the reporting of different physical symptoms after a disaster, including possible factors for change, and whether psychological symptoms predict physical symptoms reporting at a later point in time. Method A longitudinal study of citizens of Stockholm who survived the 2004 Indian Ocean tsunami. A total of 1,101 participants completed questionnaires on somatic symptoms, general distress, posttraumatic stress, exposure, and demographic details 14 months and 3 years after the disaster. Physical symptoms occurring daily or weekly during the last year were investigated in four symptom indices: neurological, cardiorespiratory, gastrointestinal, and musculoskeletal. We used generalized estimating equations (GEE) analysis to determine odds ratios for a change in symptoms, and pathway analysis to predict the influence of psychological symptoms on physical symptoms. Results There was a general decrease of reporting in all physical symptom indices except the musculoskeletal symptom index. The change in the neurological symptom index showed the strongest association with exposure, and for women. General distress and posttraumatic stress at 14 months postdisaster predicted physical symptoms at 3 years. Conclusion Physical symptoms were predicted by psychological symptoms at an earlier time point, but in a considerable proportion of respondents, physical symptoms existed independently from psychological symptoms. Physicians should be observant on the possible connection of particular pseudoneurological symptoms with prior adversities.

Towards a Swedish identity in consultation-liaison (CL) psychiatry and psychosomatics – Re-foundation of the Swedish Association of CL Psychiatry

Towards a Swedish identity in consultation-liaison (CL) psychiatry and psychosomatics - Re-foundation of the Swedish Association of CL Psychiatry

Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm

Background Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions. Methods Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013–2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated. Results Girls at the ages 13–17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5–12 years (0.11%), and girls 0–4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008–0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5–12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 0–17 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0–17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18–) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18–) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1). Conclusions Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.