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  • 1.
    Björkdahl, A
    et al.
    Karolinska institutet.
    Nyberg, U
    Karolinska institutet.
    Runeson, B
    Karolinska institutet.
    Omérov, Pernilla
    Karolinska institutet.
    The development of the Suicidal Patient Observation Chart (SPOC): Delphi study2011In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 18, no 6, p. 558-561Article in journal (Refereed)
    Abstract [en]

    Constant observation is a method used to insure the safety of suicidal inpatients. It involves structure and control as well as flexibility and the development of a relationship between the observer and the patient. It has been found that important observations may go unnoticed by the observer or fail to be communicated to the multidisciplinary team because of a lack of sufficient training and systematic documentation. We therefore conducted a Delphi survey to collect opinions on what would be important to observe during constant observation of suicidal patients. A panel of experienced clinicians, service users and researchers reached consensus on 37 of 40 observation items (92%). Of these, 28 were rated as the most important. As a result, we developed a form for systematic observer documentation in clinical practice, the Suicidal Patient Observation Chart. The Suicidal Patient Observation Chart includes the 28 items and covers 24 separate observation periods.

  • 2.
    Bullington, Jennifer
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Söderlund, Mona
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Bos Sparén, Elisabeth
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Kneck, Åsa
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Omérov, Pernilla
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Cronqvist, Agneta
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Communication skills in nursing: A phenomenologically-based communication training approach2019In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 9, p. 136-141Article in journal (Refereed)
    Abstract [en]

    The aim of this article is to present a communication skills training curriculum for nursing students, based upon phenomenology. Research shows that nurses have difficulty prioritizing dialogue with patients, due to lack of time, organizational and cultural factors. Like other health care professionals, nurses may also have difficulties communicating with patients due to personal fears and shortcomings. The communication training curriculum based upon phenomenology aims at systematically training students to stay focused upon patients' and relatives' narratives, allowing them to reflect upon and better understand their current situation. This approach to communication is applicable in any clinical situation where it important to provide space for the patients' experiences. The philosophical principles guiding the training are presented here as well as the practical steps in the program. Finally, the approach is compared to other common communication methods used in nursing (motivational interviewing, caring conversations, empathy training). The authors hope that the article will highlight the nurses’ role as dialogue partner as well as emphasize the importance of communication skills training in nursing education. This approach can be refined, tested and modified in future research and may serve as an inspirational model for creating a generic communicative competence for nurses.

  • 3.
    Eckerström, Joachim
    et al.
    Karolinska institutet; Röda Korsets högskola; Norra Stockholms psykiatri, Stockholms läns sjukvårdsområde, Region Stockholm.
    Allenius, Emelie
    Norra Stockholms psykiatri, Stockholms läns sjukvårdsområde, Region Stockholm.
    Helleman, Marjolein
    Nederländerna.
    Flyckt, Lena
    Karolinska institutet.
    Perseius, Kent-Inge
    Karolinska institutet; Röda Korsets högskola.
    Omérov, Pernilla
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Brief admission (BA) for patients with emotional instability and self-harm: nurses' perspectives - person-centred care in clinical practice.2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, p. 1-13, article id 1667133Article in journal (Refereed)
    Abstract [en]

    Purpose: Emotional instability and self-harm pose major problems for society and health care. There are effective interventions in outpatient care, but when patients need inpatient care, nurses often struggle meeting their patient's needs. Brief admission (BA) is a newly implemented crisis intervention and novel form of inpatient care. The aim of this study is to describe nurses' experiences working with BA related to patients with emotional instability and self-harm.

    Methods: Eight nurses were interviewed according to a semi-structured interview guide. The data was analysed using qualitative content analysis.

    Results: Four main categories emerged regarding nurses' experiences with BA: provides security and continuity, fosters caring relationships, shifts focus towards patient's health and empowers the patient. The nurse's role shifted from "handling problems" to establishing caring relationships with a focus on the person's health and possibilities for recovering instead of psychiatric symptoms.

    Conclusions: Previous studies on patients' perspective of BA describe positive experiences such as increased autonomy and participation in the healthcare process. This study supports those findings, albeit from the perspective of nurses. Our findings suggest that BA may reduce work-related stress experienced by nurses while caring for persons with emotional instability and self-harm. BA may also support nurses in their ability to provide more meaningful and constructive psychiatric inpatient care.

  • 4.
    Larsson Omerov, Pernilla
    Ersta Sköndal University College, Department of Health Care Sciences.
    Parents who have lost a son or daughter through suicide: towards improved care and restored psychological health2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Parents that have lost a son or daughter through suicide are at risk of developing psychological morbidity that may become long-lasting and even life-threatening. Despite this the aftermath of a suicidal loss is yet to be carefully studied. One reason for the lack of studies is that trauma-related surveys may be hindered when the risks of asking participants are overestimated and the benefits not considered. Another reason is methodological difficulties. The goal of our studies is to provide knowledge that may be used to improve the professional care of suicide-bereaved parents. This thesis describes the first steps towards the goal.

    Methods We developed hypotheses, questionnaires and an ethical protocol in a qualitative preparatory study with 46 suicide-bereaved parents (paper I). In a population-based survey we then collected data from parents who lost a child (15 to 30 years of age) to suicide, two to five years earlier. In all, 666 of 915 (73%) bereaved and 508 of 666 (74%) non-bereaved (matched 2:1) parents participated.

    Results We found that 633 (95%) of the bereaved parents thought the study was valuable and that 604 (91%) would recommend another parent to participate. Among the bereaved 334 (50%) reported being positively affected by their participation, whereas 70 (11%) reported being temporary negatively affected (most referring to sadness). The bereaved parents’ need for sharing their experiences regarding the suicide of their child was widely expressed and 639 (96%) thought the healthcare should contact parents bereaved through suicide to offer information and support (paper II). In all, 167 (25%) of the bereaved parents were currently taking antidepressants or were moderate-to severely depressed according to PHQ-9 versus 35 (9%) of the non-bereaved (RR 2.7). Fourteen percent of the bereaved reported they had had psychological morbidity more than 10 years earlier, versus 14% among the non-bereaved (RR 1.0). The highest levels of current psychological morbidity were found among the group of bereaved parents with psychological premorbidity (paper III). Of the bereaved parents 460 had (69%) viewed the body at a formal setting, among these parents 430 of 446 (96%) answered “no” to the question “Do you regret that you viewed your child after the death”. Among the parents that had not viewed 99 of 159 (62%) answered “no” to the question “Do you wish that you had viewed your child after the death” (paper IV).

    Conclusions We found that most parents perceived the research participation as something positive and that the contact was welcomed. Bereavement was associated with high prevalence of psychological morbidity two to five years after the loss. We found no difference in prevalence of premorbidity between the bereaved and the non-bereaved parents. The significant minority that had premorbidity before the loss did however report the highest levels of current psychological morbidity. By and large everyone that had viewed their deceased child in a formal setting did not regret the viewing. Of equal importance, more than half of those who did not view the body did not wish that they had.

  • 5.
    Larsson (Omerov), Pernilla
    et al.
    Karolinska institutet.
    Nilsson, Sonia
    Runeson, Bo
    Gustafsson, Barbro
    Psychiatric nursing care of suicidal patients described by the Sympathy-Acceptance-Understanding-Competence model for confirming nursing2007In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 21, no 4, p. 222-232Article in journal (Refereed)
    Abstract [en]

    Our aim was to describe psychiatric nursing care of suicidal patients from an action-theoretical and confirmatory perspective using the Sympathy-Acceptance-Understanding-Competence (SAUC) model for confirming nursing. Twenty-nine nurses were interviewed and asked to answer a questionnaire. The interview results showed that the nurses' care consisted of 83% of person support, 16% of self-support, and less than 1% of self-perspective support. However, the questionnaire responses showed that the nurses regarded all levels of support as equally important. Theoretical frameworks, such as the SAUC model, facilitate descriptions of nursing and may be used to improve the care of suicidal patients by making it deliberate and possible to evaluate.

  • 6.
    Nyberg, Tommy
    et al.
    Karolinska instituet.
    Hed Myrberg, Ida
    Karolinska institutet.
    Omerov, Pernilla
    Ersta Sköndal University College, Department of Health Care Sciences.
    Steineck, Gunnar
    Karolinska instituet & Sahlgrenska akademin Göteborgs universitet.
    Nyberg, Ullakarin
    Karolinska institutet.
    Depression among Parents Two to Six Years Following the Loss of a Child by Suicide: A Novel Prediction Model2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 10, article id e0164091Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parents who lose a child by suicide have elevated risks of depression. No clinical prediction tools exist to identify which suicide-bereaved parents will be particularly vulnerable; we aimed to create a prediction model for long-term depression for this purpose.

    METHOD: During 2009 and 2010 we collected data using a nationwide study-specific questionnaire among parents in Sweden who had lost a child aged 15-30 by suicide in years 2004-2007. Current depression was assessed with the Patient Health Questionnaire (PHQ-9) and a single question on antidepressant use. We considered 26 potential predictors assumed clinically assessable at the time of loss, including socio-economics, relationship status, history of psychological stress and morbidity, and suicide-related circumstances. We developed a novel prediction model using logistic regression with all subsets selection and stratified cross-validation. The model was assessed for classification performance and calibration, overall and stratified by time since loss.

    RESULTS: In total 666/915 (73%) participated. The model showed acceptable classification performance (adjusted area under the curve [AUC] = 0.720, 95% confidence interval [CI] 0.673-0.766), but performed classification best for those at shortest time since loss. Agreement between model-predicted and observed risks was fair, but with a tendency for underestimation and overestimation for individuals with shortest and longest time since loss, respectively. The identified predictors include female sex (odds ratio [OR] = 1.84); sick-leave (OR = 2.81) or unemployment (OR = 1.64); psychological premorbidity debuting during the last 10 years, before loss (OR = 3.64), or more than 10 years ago (OR = 4.96); suicide in biological relatives (OR = 1.54); with non-legal guardianship during the child's upbringing (OR = 0.48); and non-biological parenthood (OR = 0.22) found as protective.

    CONCLUSIONS: Our prediction model shows promising internal validity, but should be externally validated before application. Psychological premorbidity seems to be a prominent predictor of long-term depression among suicide-bereaved parents, and thus important for healthcare providers to assess.

  • 7.
    Omerov, Pernilla
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Craftman, Åsa G
    Sophiahemmet högskola.
    Mattsson, Elisabet
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences. Uppsala universitet.
    Klarare, Anna
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences. Uppsala universitet.
    Homeless persons' experiences of health- and social care: A systematic integrative review.2019In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524Article in journal (Refereed)
    Abstract [en]

    Homelessness is associated with high risks of morbidity and premature death. Many interventions aimed to improve physical and mental health exist, but do not reach the population of persons experiencing homelessness. Despite the widely reported unmet healthcare needs, more information about the barriers and facilitators that affect access to care for persons experiencing homelessness is needed. A systematic integrative review was performed to explore experiences and needs of health- and social care for persons experiencing homelessness. The following databases were searched: AMED, ASSIA, Academic Search Complete, CINAHL, Cochrane library, Nursing and Allied Database, PsycInfo, PubMed, Scopus and Web of Science Core Collection. Twenty-two studies met the inclusion criteria of empirical studies with adult persons experiencing homelessness, English language, and published 2008-2018. Fifty percent of the studies were of qualitative and quantitative design, respectively. Most studies (73%) were conducted in the United States (n=11) and Canada (n=5). The analysis resulted in three themes Unmet basic human needs, Interpersonal dimensions of access to care, and Structural and organizational aspects to meet needs. The findings highlight that persons in homelessness often must prioritize provision for basic human needs, such as finding shelter and food, over getting health- and social care. Bureaucracy and rigid opening hours, as well as discrimination and stigma, hinder these persons' access to health- and social care.

  • 8.
    Omerov, Pernilla
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
    Pettersen, Rossana
    Karolinska institutet.
    Titelman, David
    Karolinska institutet.
    Nyberg, Tommy
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska institutet.
    Dyregrov, Atle
    Norge.
    Nyberg, Ullakarin
    Karolinska institutet.
    Encountering the Body at the Site of the Suicide: A Population-Based Survey in Sweden.2017In: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 47, no 1, p. 38-47Article in journal (Refereed)
    Abstract [en]

    Encountering the body of a child who died by suicide at the site of death is believed to be especially harmful for bereaved parents. We investigated the association between encountering the body at the site of the suicide and psychological distress in 666 suicide-bereaved parents. Parents who had encountered their child's body at the site of the suicide (n = 147) did not have a higher risk of nightmares (relative risk [RR] 0.95, 95% confidence interval [CI] 0.67-1.35), intrusive memories (RR 0.97, 95% CI 0.84-1.13), avoidance of thoughts (RR 0.97, 95% CI 0.74-1.27), avoidance of places or things (RR 0.91, 95% CI 0.66-1.25), anxiety (RR 0.93, 95% CI 0.64-1.33), or depression (RR 0.94, 95% CI 0.63-1.42) compared with parents who had not encountered the body (n = 512). Our results suggest that losing a child by suicide is sufficiently disastrous by itself to elicit posttraumatic responses or psychiatric morbidity whether or not the parent has encountered the deceased child at the site of death.

  • 9.
    Omerov, Pernilla
    et al.
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska institutet; Sahlgrenska akademin Göteborgs universitet.
    Dyregrov, Kari
    The Center for Crisis Psychology, Bergen, Norway; The Norwegian Institute of Public Health, Oslo, Norway .
    Runeson, Bo
    Karolinska institutet.
    Nyberg, Ullakarin
    Karolinska institutet.
    The ethics of doing nothing. Suicide-bereavement and research: ethical and methodological considerations2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 16, p. 3409-3420Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Valuable trauma-related research may be hindered when the risks of asking participants about traumatic events are not carefully weighed against the benefits of their participation in the research. Method The overall aim of our population-based survey was to improve the professional care of suicide-bereaved parents by identifying aspects of care that would be amenable to change. The study population included 666 suicide-bereaved and 377 matched (2:1) non-bereaved parents. In this article we describe the parents' perceptions of their contacts with us as well as their participation in the survey. We also present our ethical-protocol for epidemiological surveys in the aftermath of a traumatic loss.

    RESULTS: We were able to contact 1410 of the 1423 eligible parents; eight of these parents expressed resentment towards the contact. Several participants and non-participants described their psychological suffering and received help because of the contact. A total of 666 suicide-bereaved and 377 non-bereaved parents returned the questionnaire. Just two out of the 1043 answered that they might, in the long term, be negatively affected by participation in the study; one was bereaved, the other was not. A significant minority of the parents reported being temporarily negatively affected at the end of their participation, most of them referring to feelings of sadness and painful memories. In parallel, positive experiences were widely expressed and most parents found the study valuable.

    CONCLUSIONS: Our findings suggest, given that the study design is ethically sound, that suicide-bereaved parents should be included in research since the benefits clearly outweigh the risks.

  • 10.
    Omerov, Pernilla
    et al.
    Karolinska Institutet.
    Steineck, Gunnar
    Karolinska Institutet; Sahlgrenska akademin Göteborgs universitet.
    Nyberg, Tommy
    Sahlgrenska akademin Göteborgs universitet.
    Runeson, Bo
    Karolinska Institutet.
    Nyberg, Ullakarin
    Karolinska Institutet.
    Psychological morbidity among suicide-bereaved and non-bereaved parents: a nationwide population survey2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 8, article id e003108Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine how psychological premorbidity affects the risk of depression in parents who lost a child through suicide.

    DESIGN: Population-based survey.

    SETTING: Sweden, between 2009 and 2010.

    PARTICIPANTS: All parents who lost a child, age 15-30, through suicide between 2004 and 2007 according to National population registries. Non-bereaved parents matched for age, sex, living area, marital status, number of children.

    EXCLUSION CRITERIA: born outside a Nordic country, not Swedish speaking, contact details missing. Participants: 666 of 915 (73%) suicide-bereaved and 377 of 508 (74%) non-bereaved parents.

    MAIN OUTCOME MEASURES: Depression measured by the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) and study-specific questions to assess psychological premorbidity and experience of the child's presuicidal morbidity.

    RESULTS: In all, 94 (14%) suicide-bereaved and 51 (14%) non-bereaved parents (relative risk 1.0; 95% CI 0.8 to 1.4) had received their first treatment for psychological problems or had been given a psychiatric diagnosis more than 10 years earlier. The prevalence of moderate-to-severe depression was 115 (18%) in suicide-bereaved versus 28 (7%) in non-bereaved parents (RR 2.3; 95% CI 1.6 to 3.5). For those without psychological premorbidity, the relative risk was 2.3 (95% CI 1.4 to 3.6). 339 (51%) suicide-bereaved parents expressed worry over the child's psychological health during the month preceding the suicide and 259 (39%) had anticipated the suicide.

    CONCLUSIONS: In parents who lost a child through suicide in Sweden we did not find a higher prevalence of long-term psychological premorbidity than among parents who had not lost a child; the more than twofold risk of depression among the bereaved can probably be explained by the suicide and the stressful time preceding the suicide.

  • 11.
    Omerov, Pernilla
    et al.
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska institutet & Sahlgrenska akademin, Göteborgs universitet.
    Nyberg, Tommy
    Karolinska institutet.
    Runeson, Bo
    Karolinska institutet.
    Nyberg, Ullakarin
    Karolinska institutet.
    Viewing the body after bereavement due to suicide: a population-based survey in Sweden2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 7, p. 1-9, article id e101799Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research on the assumed, positive and negative, psychological effects of viewing the body after a suicide loss is sparse. We hypothesized that suicide-bereaved parents that viewed their childs body in a formal setting seldom regretted the experience, and that viewing the body was associated with lower levels of psychological morbidity two to five years after the loss.

    METHODS AND FINDINGS: We identified 915 suicide-bereaved parents by linkage of nationwide population-based registries and collected data by a questionnaire. The outcome measures included the Patient Health Questionnaire (PHQ-9). In total, 666 (73%) parents participated. Of the 460 parents (69%) that viewed the body, 96% answered that they did not regret the experience. The viewing was associated with a higher risk of reliving the child's death through nightmares (RR 1.61, 95% CI 1.13 to 2.32) and intrusive memories (RR 1.20, 95% CI 1.04 to 1.38), but not with anxiety (RR 1.02, 95% CI 0.74 to 1.40) and depression (RR 1.25, 95% CI 0.85 to 1.83). One limitation of our study is that we lack data on the informants' personality and coping strategies.

    CONCLUSIONS: In this Swedish population-based survey of suicide-bereaved parents, we found that by and large everyone that had viewed their deceased child in a formal setting did not report regretting the viewing when asked two to five years after the loss. Our findings suggest that most bereaved parents are capable of deciding if they want to view the body or not. Officials may assist by giving careful information about the child's appearance and other details concerning the viewing, thus facilitating mental preparation for the bereaved person. This is the first large-scale study on the effects of viewing the body after a suicide and additional studies are needed before clinical recommendations can be made.

  • 12.
    Omerov, Pernilla
    et al.
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska institutet; Sahlgrenska akademin Göteborgs universitet.
    Runeson, Bo
    Karolinska institutet.
    Christensson, Anna
    Karolinska institutet.
    Kreicbergs, Ulrika
    Sophiahemmet Högskola, Karolinska institutet.
    Pettersén, Rossana
    Karolinska institutet.
    Rubenson, Birgitta
    Karolinska institutet.
    Skoogh, Johanna
    Sahlgrenska akademin Göteborgs universitet.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Nyberg, Ullakarin
    Karolinska institutet.
    Preparatory studies to a population-based survey of suicide-bereaved parents in Sweden2013In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 34, no 3, p. 200-210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need for evidence-based guidelines on how professionals should act following a suicide. In an effort to provide empiric knowledge, we designed a nationwide population-based study including suicide-bereaved parents.

    AIM: To describe the process from creating hypotheses through interviews to the development of a population-based questionnaire.

    METHOD: We used interviews, qualitative analysis and various means of validation to create a study-specific questionnaire to be used in a nonselected nationwide population of suicide-bereaved parents and a control population of nonbereaved (N = 2:1). The Swedish Register of Causes of Death and the Multigeneration Register were used to identify eligible individuals. All presumptive participants received a letter of invitation followed by a personal contact.

    RESULTS: We developed a questionnaire covering the participants' perception of participation, their daily living, psychological morbidity, professional actions, and other experiences in immediate connection to the time before and after the suicide. Almost three out of four parents (bereaved = 666, nonbereaved = 377) responded to the questionnaire.

    CONCLUSIONS: By involving parents early in the research process we were able to create a questionnaire that generated a high participation rate in a nationwide population-based study that might help us to answer our hypotheses about bereavement after suicide.

  • 13.
    Omerov, Pernilla
    et al.
    Ersta Sköndal Bräcke University College, Department of Health Care Sciences.
    Titelman, David
    Karolinska institutet.
    Nyberg, Ullakarin
    Karolinska institutet.
    Population-Based Surveys That Include Suicide-Bereaved Family Members: Ethical and Methodological Considerations2018In: Sage Research MethodsArticle in journal (Refereed)
    Abstract [en]

    Parents who have lost a son or daughter to suicide are at risk of developing psychological ill-health that may become long-lasting and even life-threatening. Despite this risk, the aftermath of a suicidal loss is yet to be carefully studied. Reasons for the lack of such studies may be that the dangers of approaching surviving relatives are exaggerated and trauma-related inquiries avoided. Another obstacle may be methodological difficulties. An overriding goal of the studies considered here was to provide knowledge that may be used to improve the professional care of suicide-bereaved parents. We describe how we planned and implemented a population-based survey with a continuous focus on ethical and methodological considerations throughout the research process.

  • 14.
    Pettersen, Rossana
    et al.
    Karolinska institutet.
    Omerov, Pernilla
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska institutet, Göteborgs universitet.
    Dyregrov, Atle
    Norge.
    Titelman, David
    Karolinska institutet.
    Dyregrov, Kari
    Norge.
    Nyberg, Ullakarin
    Karolinska institutet.
    Suicide-Bereaved Siblings' Perception of Health Services.2014In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683, Vol. 39, no 6, p. 323-331Article in journal (Refereed)
    Abstract [en]

    We investigated suicide-bereaved siblings' reported reasons for seeking or not seeking professional support, their reported satisfaction when receiving it, and their recommendations to health services when meeting suicide-bereaved siblings. Using qualitative content analysis of 18 interviews with suicide-bereaved siblings, we found that the perception of health services as being helpful was influenced by both the participants' and by the deceased siblings' experiences with health services. We conclude that own and the deceased sibling's unmet needs may generate negative attitudes towards health services, which reduces the likelihood of seeking professional help as well as medication acceptance in some cases.

  • 15.
    Pettersen, Rossana
    et al.
    Karolinska institutet.
    Omerov, Pernilla
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska sjukhuset, Göteborgs universitet.
    Titelman, David
    Karolinska institutet.
    Dyregrov, Atle
    Norge.
    Nyberg, Tommy
    Karolinska institutet.
    Nyberg, Ullakarin
    Karolinska institutet.
    Lack of Trust in the Health-Care System After Losing a Child to Suicide: A Nationwide Population Survey2015In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 36, no 3, p. 161-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Lack of trust in the health-care system after losing a child to suicide may prevent bereaved parents from seeking professional treatment when needed, thus diminishing their chances of recovery.

    AIMS: This is the first large study to aim at evaluating the incidence of lack of trust in the health-care system and associated variables in suicide-bereaved parents.

    METHOD: This nationwide population-based survey included 569 parents who lost a child to suicide 2-5 years earlier and a matched comparison group of 326 nonbereaved parents. Using a study-specific questionnaire, we asked bereaved and nonbereaved parents if they trusted the health-care system and measured psychological and background variables.

    RESULTS: Prevalence of lack of trust in the health-care system differed between the bereaved (46.5%) and the nonbereaved parents (18.3%), giving a relative risk of 2.5 (95% CI = 2.0-3.3). After multivariable modeling, high scores of depression, living in big cities, and being single were identified as variables associated with lack of trust in suicide-bereaved parents.

    CONCLUSION: Suicide-bereaved parents show lack of trust in the health-care system. We present possible effect modifiers that may be considered in professional interventions aiming at influencing suicide-bereaved parents' level of trust.

  • 16.
    Skoogh, Johanna
    et al.
    Göteborgs universitet.
    Ylitalo, N
    Göteborgs universitet.
    Larsson Omeróv, Pernilla
    Karolinska institutet.
    Hauksdóttir, A
    Karolinska institutet.
    Nyberg, U
    Karolinska institutet.
    Wilderäng, U
    Göteborgs universitet.
    Johansson, B
    Göteborgs universitet.
    Gatz, M
    University of Southern California, Karolinska institutet.
    Steineck, Gunnar
    Göteborgs universitet, Karolinska institutet.
    'A no means no': Measuring depression using a single-item question versus Hospital Anxiety and Depression Scale (HADS-D).2010In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 21, no 9, p. 1905-1909Article in journal (Refereed)
    Abstract [en]

    Background: Depression often develops undetected; to make treatment possible, a single-item screening question may be useful.

    Patients and methods: We attempted to compare the accuracy of the single-item question 'Are you depressed?' with the seven-item Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) among 1192 Swedish testicular cancer survivors.

    Results: We obtained information from 974 men (82%). Fifty-nine men (6%) answered 'Yes' to the question 'Are you depressed?' while 118 (12%) answered 'I don't know' and 794 (82%) answered 'No'. Among the 794 men who answered 'No' to the question 'Are you depressed?', 790 (99.5%) were not considered as depressed according to HADS-D 11+. Of those answering 'Yes', 34% (20/59) were identified as depressed according to the same cut-off. Sensitivity of 'Yes' compared with HADS-D > or =11 was 61%, rising to 88% when 'Yes' and 'I don't know' were combined.

    Conclusion: In a population of men with a prevalence of depression similar to that of the normal population, almost none of those responding 'No' to the written question 'Are you depressed?' were depressed according to HADS-D > or =11. Adding the category 'I don't know' increases sensitivity in detecting depression.

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