Niclas Kaiser

Depression and anxiety in the reindeer-herding Sami population of Sweden

Objectives. The objective of this study was to investigate symptoms and predicting factors of depression and anxiety among reindeer-herding Sami in Sweden. Study design. A total of 319 reindeer-herding Sami (168 men, 151 women) were compared with urban and rural reference populations comprising 1,393 persons (662 men, 731 women). Methods. A cross-sectional questionnaire study on mental health, which included the Hospital Anxiety and Depression Scale (HADS). Data were analysed with regard to population, gender, age group, education and work-related stress. Results. The Sami population disclosed higher mean values for both depression and anxiety than the reference groups, with Sami men reporting the highest rates. Work-related stress was associated with anxiety and depression in the Sami group. Conclusions. By comparing Sami men and women with reference groups of men and women living in urban and rural areas in northern Sweden, this study identified that reindeer-herding Sami men require special attention with regard to mental health problems.

Hazardous Drinking and Drinking Patterns Among the Reindeer-Herding Sami Population in Sweden

The objective of this study was to investigate hazardous drinking among reindeer-herding Sami in Sweden. A cross-sectional questionnaire study was conducted in 2007, which included the Alcohol Use Disorder Identification Test. A total of 319 reindeer-herding Sami were compared with urban and rural reference populations of 1,393 persons. Data were analyzed with regard to population, gender, age group, education, anxiety, depression, and work-related stress. The Sami population did not report a higher prevalence of hazardous drinking compared with the reference groups; however, subgroups of Sami men with symptoms of depression were revealed as at risk, in contrast to Sami women who were not found to be at risk at all. Limitations of the study are discussed.

We are like lemmings: making sense of the cultural meaning(s) of suicide among the indigenous Sami in Sweden.

Background Suicide is a widespread problem among indigenous people residing in the circumpolar Arctic. Though the situation among the indigenous Sami in northern Scandinavia is better than among some other indigenous people, suicide is still regarded as a major public health issue. To adapt prevention strategies that are culturally attuned one must understand how suicide is understood within context. That is, the cultural meaning(s) of suicide. Objective To explore and make sense of the cultural meaning(s) of suicide among Sami in Sweden. Design Open-ended focus group discussions (FGDs) on the topic “suicide among Sami” were carried out in 5 Sami communities in Sweden, with in total 22 strategically selected Sami participants. FGDs were recorded, transcribed verbatim and analyzed through employing content analysis. Results From the FGDs 4 themes emerged including “The Sami are fighting for their culture and the herders are in the middle of the fight,” “Suicide as a consequence of Sami losing (or having lost) their identity,” “A wildfire in the Sami world” and “Difficult to get help as a Sami.” Conclusions Findings indicate that Sami in Sweden make sense of suicide in relation to power and identity within a threatened Sami cultural context. Suicide is then understood as an act that takes place and makes sense to others when a Sami no longer has the power to maintain a Sami identity, resulting in being disconnected from the Sami world and placed in an existential void where suicide is a solution. The findings are useful in development of culturally attuned suicide prevention among Sami in Sweden.

Experiences of being a young male Sami reindeer herder: a qualitative study in perspective of mental health

Objectives To explore experiences of what it is to be a young male Sami reindeer herder in Sweden, a group with previously known stigma and specific health issues, and to understand experiences in perspective of mental health. Methods A qualitative content analysis was employed. Data were collected by in-depth interviews with 15 strategically selected reindeer herders aged 18–35 years old. Results The analysis resulted in 5 sub-themes: (a) being “inside” or “outside” is a question of identity; (b) a paradox between being free/bound; (c) an experience of various threats and a feeling of powerlessness; (d) specific norms for how a “real” reindeer herder should be; and (e) the different impacts and meanings of relations. The overarching theme is summarized thus: being a young reindeer herder means so many (impossible) dreams and conditions. Overall, the experience of the informants was that being a reindeer herder is a privileged position that also implies many impossibilities and unjust adversities they have no control over, and that there is nothing they can do but “bite the bullet or be a failure.” Conclusions Knowledge about this groups experiences can be used to understand difficulties faced by young reindeer herders and its consequences regarding mental health problems. This also implies a need for a broader perspective when discussing future interventions aimed at preventing mental health problems in this group.

Developing an authentic sex: Deconstructing developmental–psychological discourses of transgenderism in a clinical setting

The paper is based on a broader study of the use of discourses of transgenderism among sex-reassignment evaluators in Sweden. In this paper we explore how a developmental–psychological discourse was reproduced by the evaluators in their discursive negotiations of transsexualism. We found that maturity and authenticity are two key concepts that illuminate how the developmental–psychological discourse both clashes with and works together with a medical–pathological discourse of transgenderism. The developmental–psychological discourse can help to produce a definition of transgenderism that is more diverse regarding male/female dichotomies. This in turn can create a wider range of possible subject positions for patients who are seeking help. The developmental–psychological discourse also imposes additional limitations regarding the subject positions available to transgender persons through a demand for maturity and for having gone through all of the steps in the expected identity development process. The developmental–psychological repertoire casts transgenderism as an identity crisis.

Psychiatrists' experiences of suicide assessment

BackgroundClinical guidelines for suicide prevention often stress the identification of risk and protective factors as well as the evaluation of suicidal intent. However, we know very little about what psychiatrists actually do when they make these assessments. The aim was to investigate psychiatrists’ own accounts of suicide assessment consultations, with a focus on their behaviors, attitudes and emotions.MethodSemi-structured in depth interviews were carried out with a purposive selection of 15 psychiatrists.ResultsThematic analysis revealed three main themes: understanding the patient in a precarious situation, understanding one’s own reactions, and understanding how the doctor-patient relationship impacted on risk assessment and management decisions. Emotional contact and credibility issues were common subthemes that arose when the respondents talked about trying to understand the patient. The psychiatrists stressed the semi-intuitive nature of their assessments. Problems related to the use of risk factor assessments and rating scales were apparent. Assessment consultations could evoke physical and emotional symptoms of anxiety, and concerns about responsibility could lead to repressive management decisions. In situations of mutual trust, however, the assessment consultation could kick-start a therapeutic process.ConclusionThis study highlights psychiatrists’ experiences in clinical suicide assessment situations. Findings have implications for professional development as well as for service delivery.

Learning psychology as a challenging process towards development as well as "studies as usual": a thematic analysis of medical students' reflective writing.

Reflective writing in medical training has been shown to be most effective when combined with some form of personal meeting or dialog. During a course in medical psychology for medical students, reflective texts were followed up by an individual personal talk with a teacher from the course. Thematic analysis of the texts revealed four separate sub-themes: 1) the course has enabled me and the class to develop, which is good albeit arduous; 2) understanding myself is a resource in understanding people as well as knowing psychology; 3) the course provided me with new, purely intellectual skills as well as eye-openers; and 4) the receiving teacher is an integral part of my reflective writing. The main theme, capturing the students’ writing process, concluded that students perceive the course as “Learning psychology as a challenging process towards development” as well as “studies as usual”. Ethical, psychological, and pedagogical aspects are discussed in the paper.