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Malm, A., Tinghög, P., Narusyte, J. & Saboonchi, F. (2020). The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden. Conflict and Health, 14, Article ID 2.
Open this publication in new window or tab >>The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden
2020 (English)In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 14, article id 2Article in journal (Refereed) Published
Abstract [en]

Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.

Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.

Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Assessment, Confirmatory factor analysis, Construct validity, Exploratory factor analysis, Mental health, Post-migration stress, Refugee, Scale development, Syria
National Category
Psychiatry
Identifiers
urn:nbn:se:rkh:diva-3130 (URN)10.1186/s13031-019-0246-5 (DOI)31921332 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016–07194
Available from: 2020-01-24 Created: 2020-01-24 Last updated: 2020-01-24Bibliographically approved
Kavaliunas, A., Tinghög, P., Friberg, E., Olsson, T., Alexanderson, K., Hillert, J. & Karrenbauer, V. D. (2019). Cognitive function predicts work disability among multiple sclerosis patients. Multiple sclerosis journal - experimental, translational and clinical, 5(1), Article ID 2055217318822134.
Open this publication in new window or tab >>Cognitive function predicts work disability among multiple sclerosis patients
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2019 (English)In: Multiple sclerosis journal - experimental, translational and clinical, ISSN 2055-2173, Vol. 5, no 1, article id 2055217318822134Article in journal (Refereed) Published
Abstract [en]

Background: In multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted.

Objective: To determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test.

Methods: A register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability.

Results: After one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02).

Conclusion: Cognitive function is to a high extent associated with multiple sclerosis patients' future work disability, even after adjusting for other factors.

Keywords
Multiple sclerosis, cognition, employment, prognosis, socioeconomic factors, work
National Category
General Practice
Identifiers
urn:nbn:se:rkh:diva-2750 (URN)10.1177/2055217318822134 (DOI)30729025 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-27Bibliographically approved
Gyllensten, H., Kavaliunas, A., Murley, C., Alexanderson, K., Hillert, J., Tinghög, P. & Friberg, E. (2019). Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden. Multiple Sclerosis Journal Experimental, Translational and Clinical, 5(2), Article ID 2055217319858383.
Open this publication in new window or tab >>Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden
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2019 (English)In: Multiple Sclerosis Journal Experimental, Translational and Clinical, ISSN 2055-2173, Vol. 5, no 2, article id 2055217319858383Article in journal (Refereed) Published
Abstract [en]

Background

Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

Objectives

To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21–64 years of age.

Methods

Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

Results

Among 8906 multiple sclerosis patients, EDSS 0.0–3.5 and 7.0–9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

Conclusion

Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

Keywords
Multiple sclerosis, cost of illness, healthcare costs, registries, sick leave, health-related quality of life, disability evaluation, disease progression
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3013 (URN)10.1177/2055217319858383 (DOI)31285832 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Wiberg, M., Murley, C., Tinghög, P., Alexanderson, K., Palmer, E., Hillert, J., . . . Friberg, E. (2019). Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time.. BMJ Open, 9(7), Article ID e024836.
Open this publication in new window or tab >>Earnings among people with multiple sclerosis compared to references, in total and by educational level and type of occupation: a population-based cohort study at different points in time.
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e024836Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate earnings among people with multiple sclerosis (PwMS) before and after MS diagnosis compared with people without MS, and if identified differences were associated with educational levels and types of occupations. Furthermore, to assess the proportions on sickness absence (SA) and disability pension (DP) in both groups.

DESIGN: Population-based longitudinal cohort study, 10 years before until 5 years after MS diagnosis.

SETTING: Working-age population using microdata linked from nationwide Swedish registers.

PARTICIPANTS: Residents in Sweden in 2004 aged 30-54 years with MS diagnosed in 2003-2006 (n=2553), and references without MS (n=7584) randomly selected by stratified matching.

OUTCOME MEASURES: Quartiles of earnings were calculated for each study year prior to and following the MS diagnosis. Mean earnings, by educational level and type of occupation, before and after diagnosis were compared using t-tests. Tobit regressions investigated the associations of earnings with individual characteristics. The proportions on SA and/or DP, by educational level and type of occupation, for the diagnosis year and 5 years later were compared.

RESULTS: Differences in earnings between PwMS and references were observed beginning 1 year before diagnosis, and increased thereafter. PwMS had lower mean earnings for the diagnosis year (difference=SEK 28 000, p<0.05), and 5 years after diagnosis, this difference had more than doubled (p<0.05). These differences remained after including educational level and type of occupation. Overall, the earnings of PwMS with university education and/or more qualified occupations were most like their reference peers. The proportions on SA and DP were higher among PwMS than the references.

CONCLUSIONS: The results suggest that the PwMS' earnings are lower than the references' beginning shortly before MS diagnosis, with this gap increasing thereafter. Besides SA and DP, the results indicate that educational level and type of occupation are influential determinants of the large heterogeneity of PwMS' earnings.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
disability pension, earnings, multiple sclerosis, sick leave, social insurance, work
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:rkh:diva-3003 (URN)10.1136/bmjopen-2018-024836 (DOI)31300492 (PubMedID)
Available from: 2019-08-06 Created: 2019-08-06 Last updated: 2019-08-06Bibliographically approved
Murley, C., Wiberg, M., Tinghög, P., Alexanderson, K., Palmer, E., Hillert, J., . . . Friberg, E. (2019). Earnings among people with multiple sclerosis in Sweden, by education and occupation. Paper presented at 12th European Public Health Conference, Marseille, France, November 20-23, 2019.. European Journal of Public Health, 29(Supplement 4), 68
Open this publication in new window or tab >>Earnings among people with multiple sclerosis in Sweden, by education and occupation
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2019 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no Supplement 4, p. 68-Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
heterogeneity, educational status, multiple sclerosis, peer group, pensions, diagnosis, disability, illness, earnings
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3136 (URN)10.1093/eurpub/ckz185.169 (DOI)
Conference
12th European Public Health Conference, Marseille, France, November 20-23, 2019.
Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-02-14Bibliographically approved
Okenwa-Emegwa, L., Saboonchi, F., Mittendorfer-Rutz, E., Helgesson, M. & Tinghög, P. (2019). Prevalence and predictors of low future expectations among Syrian refugees resettled in Sweden. Heliyon, 5(10), Article ID e02554.
Open this publication in new window or tab >>Prevalence and predictors of low future expectations among Syrian refugees resettled in Sweden
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2019 (English)In: Heliyon, ISSN 2405-8440, Vol. 5, no 10, article id e02554Article in journal (Refereed) Published
Abstract [en]

Background Future Expectation is important for motivation and wellbeing, however drastic life events such as in refugee situations may result in low expectations. This study aims to investigate the prevalence and determinants of low future expectations among Syrian refugees resettled in Sweden. Methods A random sample of 1215 Syrian refugees resettled in Sweden responded to questionnaire. Weighted analyses and adjusted relative risks were conducted to determine the prevalences and predictors of low future expectations. Synergy index was calculated for low social support and depression in relation to low expectations. Results The prevalences of low future expectations for labour market, social and economic intergration were 10.9%, 13.4% and 14.1% respectively. Longer stay in Sweden, being older, low social support and depression were associated with low future expectations. The simultaneous presence of depression and low social support had a synergistic effect on low social expectation. Discussions Understanding and addressing factors related to low future expectations among refugees may be useful for facilitating their labour market, social and economic integration.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Psychology, Sociology, Expectations, Migration, Social support, Depression, Refugee, Labour market, Asylum, Syria, Sweden, Synergy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3067 (URN)10.1016/j.heliyon.2019.e02554 (DOI)31692714 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Red Cross
Available from: 2019-11-08 Created: 2019-11-08 Last updated: 2020-01-30Bibliographically approved
Amin, R., Helgesson, M., Runeson, B., Tinghög, P., Mehlum, L., Qin, P., . . . Mittendorfer-Rutz, E. (2019). Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study. Psychological Medicine, 1-10
Open this publication in new window or tab >>Suicide attempt and suicide in refugees in Sweden - a nationwide population-based cohort study
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2019 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Despite a reported high rate of mental disorders in refugees, scientific knowledge on their risk of suicide attempt and suicide is scarce. We aimed to investigate (1) the risk of suicide attempt and suicide in refugees in Sweden, according to their country of birth, compared with Swedish-born individuals and (2) to what extent time period effects, socio-demographics, labour market marginalisation (LMM) and morbidity explain these associations.

METHODS: Three cohorts comprising the entire population of Sweden, 16-64 years at 31 December 1999, 2004 and 2009 (around 5 million each, of which 3.3-5.0% refugees), were followed for 4 years each through register linkage. Additionally, the 2004 cohort was followed for 9 years, to allow analyses by refugees' country of birth. Crude and multivariate hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. The multivariate models were adjusted for socio-demographic, LMM and morbidity factors.

RESULTS: In multivariate analyses, HRs regarding suicide attempt and suicide in refugees, compared with Swedish-born, ranged from 0.38-1.25 and 0.16-1.20 according to country of birth, respectively. Results were either non-significant or showed lower risks for refugees. Exceptions were refugees from Iran (HR 1.25; 95% CI 1.14-1.41) for suicide attempt. The risk for suicide attempt in refugees compared with the Swedish-born diminished slightly across time periods.

CONCLUSIONS: Refugees seem to be protected from suicide attempt and suicide relative to Swedish-born, which calls for more studies to disentangle underlying risk and protective factors.

Place, publisher, year, edition, pages
Cambridge University Press, 2019
Keywords
Labour market marginalisation, migration, refugees, sick leave, suicide, suicide attempt
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-3123 (URN)10.1017/S0033291719003167 (DOI)31858922 (PubMedID)
Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-01-07Bibliographically approved
Gyllensten, H., Wiberg, M., Alexanderson, K., Friberg, E., Hillert, J. & Tinghög, P. (2018). Comparing costs of illness of multiple sclerosis in three different years: A population-based study. Multiple Sclerosis, 24(4), 520-528
Open this publication in new window or tab >>Comparing costs of illness of multiple sclerosis in three different years: A population-based study
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2018 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, no 4, p. 520-528Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Little is known about changes in the costs of illness (COI) among multiple sclerosis (MS) patients during recent years.

OBJECTIVES: To compare the COI among MS patients and matched controls in 2006, 2009, and 2012, respectively, indicating the costs attributable to the MS disease.

METHODS: Three cross-sectional datasets were analyzed, including all MS patients in Sweden aged 20-60 years and five matched controls for each of them. The analyses were based on 10,531 MS patients and 52,655 matched controls for 2006, 11,722 and 58,610 individuals for 2009, and 12,789 and 63,945 for 2012. Nationwide registers, including prescription drug use, specialized healthcare, sick leave, and disability pension, were linked to estimate the prevalence-based COI.

RESULTS: Adjusted for inflation, the average difference in COI between MS patients and matched controls were Swedish Krona (SEK) 243,751 (95% confidence interval: SEK 239,171-248,331) in 2006, SEK 238,971 (SEK 234,516-243,426) in 2009, and SEK 225,923 (SEK 221,630-230,218) in 2012. The difference in indirect costs were SEK 170,502 (SEK 166,478-174,525) in 2006, SEK 158,839 (SEK 154,953-162,726) in 2009, and SEK 141,280 (SEK 137,601-144,960) in 2012.

CONCLUSION: The inflation-adjusted COI of MS patients was lower in 2012 than in 2006, in particular regarding indirect costs.

Keywords
Multiple sclerosis, cost of illness, drug costs, healthcare costs, registries, sick leave, time trends
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2355 (URN)10.1177/1352458517702549 (DOI)28367678 (PubMedID)
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2019-09-26Bibliographically approved
Gyllensten, H., Kavaliunas, A., Alexanderson, K., Hillert, J., Tinghög, P. & Friberg, E. (2018). Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden. Multiple sclerosis journal - experimental, translational and clinical, 4(3), Article ID 2055217318783352.
Open this publication in new window or tab >>Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden
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2018 (English)In: Multiple sclerosis journal - experimental, translational and clinical, E-ISSN 2055-2173, Vol. 4, no 3, article id 2055217318783352Article in journal (Refereed) Published
Abstract [en]

Background: Population-based estimates of costs of illness and health-related quality of life, by disability levels among people with multiple sclerosis, are lacking.

Objectives: To estimate the annual costs of illness and health-related quality of life, by disability levels, among multiple sclerosis patients, 21-64 years of age.

Methods: Microdata from Swedish nationwide registers were linked to estimate the prevalence-based costs of illness in 2013, including direct costs (prescription drug use and specialised healthcare) and indirect costs (calculated using sick leave and disability pension), and health-related quality of life (estimated from the EQ-5D). Disability level was measured by the Expanded Disability Status Scale (EDSS).

Results: Among 8906 multiple sclerosis patients, EDSS 0.0-3.5 and 7.0-9.5 were associated with mean indirect costs of SEK 117,609 and 461,357, respectively, whereas direct costs were similar between the categories (SEK 117,423 and 102,714, respectively). Prescription drug costs represented 40% of the costs of illness among multiple sclerosis patients with low EDSS, while among patients with high EDSS more than 80% were indirect costs. Among the 1684 individuals who had reported both EQ-5D and EDSS, the lowest health-related quality of life scores were found among those with a high EDSS.

Conclusion: Among people with multiple sclerosis, we confirmed higher costs and lower health-related quality of life in higher disability levels, in particular high indirect costs.

Keywords
Multiple sclerosis, cost of illness, disability evaluation, disease progression, health-related quality of life, healthcare costs, registries, sick leave
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2611 (URN)10.1177/2055217318783352 (DOI)30090640 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1762
Available from: 2018-08-30 Created: 2018-08-30 Last updated: 2018-09-03Bibliographically approved
Gyllensten, H., Wiberg, M., Alexanderson, K., Norlund, A., Friberg, E., Hillert, J., . . . Tinghög, P. (2018). Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age. European Journal of Health Economics, 19(3), 435-446
Open this publication in new window or tab >>Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age
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2018 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 19, no 3, p. 435-446Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Multiple sclerosis (MS) causes work disability and healthcare resource use, but little is known about the distribution of the associated costs to society.

OBJECTIVES: We estimated the cost of illness (COI) of working-aged individuals with MS, from the societal perspective, overall and in different groups.

METHODS: A population-based study was conducted, using data linked from several nationwide registers, on 14,077 individuals with MS, aged 20-64 years and living in Sweden. Prevalence-based direct and indirect costs in 2010 were calculated, including costs for prescription drug use, specialized healthcare, sick leave, and disability pension.

RESULTS: The estimated COI of all the MS patients were SEK 3950 million, of which 75% were indirect costs. MS was the main diagnosis for resource use, causing 38% of healthcare costs and 67% of indirect costs. The distribution of costs was skewed, in which less than 25% of the patients accounted for half the total COI.

CONCLUSIONS: Indirect costs contributed to approximately 75% of the estimated overall COI of MS patients of working age in Sweden. MS was the main diagnosis for more than half of the estimated COI in this patient group. Further studies are needed to gain knowledge on development of costs over time during the MS disease course.

Keywords
Cost of Illness, Multiple sclerosis, Registries, Sick leave, Socioeconomic factors, Third-party payers
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-2514 (URN)10.1007/s10198-017-0894-6 (DOI)28488184 (PubMedID)
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2018-08-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6138-6427

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