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  • 1.
    Alexandersson, Kristina
    et al.
    Karolinska Institutet.
    Lumikukka, Tuula
    Karolinska universitetssjukhuset, Huddinge.
    Tinghög, Petter
    Karolinska Institutet.
    Åkerlund, Kerstin
    Karolinska universitetssjukhuset, Solna.
    Att uppmärksamma barn till svårt sjuka patienter på en neurologisk klinik - utvärdering av implementering av rutiner och arbetssätt2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 4, p. 485-495Article in journal (Refereed)
    Abstract [sv]

    Barn till allvarligt somatiskt sjuka föräldrar löper en förhöjd risk för egen psykisk ohälsa. Här presenteras resultat från utvärderingen av implementering av rutiner och arbetssätt som syftade till att förbättra arbetet med att identifiera, informera samt stödja minderåriga barn till patienter på en neurologisk klinik. Fyra delstudier genomfördes. Resultaten indikerar att trots betydande insatser för att säkerställa att kliniken lever upp till sina lagstadgade uppgifter, fanns en stor förbättringspotential. Hela 80% av patienter med minderåriga barn hade inte fått information om sina barns rätt till stöd och 40% hade inte tillräckligt stöd för att utöva sin föräldraroll. Samtidigt noterades en tydlig ökning i andelen personal på kliniken som hade kunskap om sin skyldighet att erbjuda information, råd och stöd. 

  • 2.
    Amin, M. Ridwanul
    et al.
    Karolinska Institutet.
    Helgesson, M.
    Karolinska Institutet.
    Runeson, B.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Mehlum, L.
    National Centre for Suicide Research and Prevention, Oslo, Norway.
    Holmes, E.
    Karolinska Institutet.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    The risk of suicidal behaviour in refugees and other immigrants to Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 191-191Article in journal (Other academic)
  • 3.
    Björkenstam, B.
    et al.
    University of California Los Angeles, Los Angeles, CA USA / Karolinska Institutet / Stockholms universitet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Cochran, S.
    University of California Los Angeles, Los Angeles, CA USA.
    Andersson, G.
    University of California, Los Angeles, USA.
    Alexanderson, K.
    University of California, Los Angeles, USA / Karolinska Institutet.
    Bränström, R.
    Karolinska Institutet.
    Is work disability more common among same-sex than different-sex married people?2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 305-Article in journal (Other academic)
  • 4.
    Björkenstam, Charlotte
    et al.
    Division of Insurance Medicine, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Wiberg, Michael
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Heterogeneity of sickness absence and disability pension trajectories among individuals with MS2015In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 1, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Background The variability of progression of multiple sclerosis (MS) suggests that MS is a heterogeneous entity.

    Objective The objective of this article is to determine whether sickness absence (SA) and disability pension (DP) could be used to identify groups of patients with different progression courses.

    Methods We analyzed mean-annual net months of SA/DP, five years prior to MS diagnosis, until the year of diagnosis, and five years after for 3543 individuals diagnosed 2003–2006, by modeling trajectory subgroups.

    Results Five different groups were identified, revealing substantial heterogeneity among MS patients. Before diagnosis, 74% had a flat trajectory, while the remaining had a sharply increasing degree of SA/DP. After diagnosis, 95% had a flat or marginally increasing trajectory, although at various SA/disability pension (DP) levels, whereas a small group of 5% had decreasing SA/DP. A majority had few or no SA/DP months throughout the 11-year study period. Higher age and a lower educational level were associated with an unfavorable trajectory (p values <0.01).

    Conclusions There’s a considerable heterogeneity of MS progression in terms of SA/DP. Compared with other measures of disability, sickness-absence and disability pension offer a continuous variable that can be assigned to every individual for each time period without missing data. To what extent the SA/DP measure reflects classical MS outcome-measures as well as how correlated it is with co-morbidities and working-conditions needs to be investigated further.

  • 5.
    Björkenstam, Charlotte
    et al.
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Brenner, Philip
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Jokinen, Jussi
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Is disability pension a risk indicator for future need of psychiatric healthcare or suicidal behavior among MS patients- a nationwide register study in Sweden?2015In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 15, no 1, p. 1-8, article id 286Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mental disorders and suicidal behavior are common in patients with multiple sclerosis (MS), they also carry a higher risk of disability pension (DP). Our aim was to investigate if DP and other factors are associated with psychiatric disorders and suicidal behavior among MS patients, and whether DP is a stronger risk indicator among certain groups.

    METHOD: A prospective population-based cohort study with six-year follow-up (2005-2010), including 11 346 MS patients who in 2004 were aged 16-64 and lived in Sweden. Incidence rate ratios (IRR) with 95 % confidence intervals (CI) were calculated.

    RESULTS: MS patients on DP had a modestly higher risk of requiring psychiatric healthcare, IRR: 1.36 (95 % CI: 1.18-1.58). MS patients with previous psychiatric healthcare had a higher IRR for both psychiatric healthcare and suicidal behavior; 2.32 (2.18-2.47) and 1.91 (1.59-2.30), respectively. DP moderated the association between sex and psychiatric healthcare, where women on DP displayed higher risk than men, X(2) 4.74 (p = 0.03).

    CONCLUSION: The findings suggest that losing one's role in work life aggravates rather than alleviates the burden of MS, as MS patients on DP seem to have a higher need for psychiatric healthcare, especially among women; which calls for extra awareness among clinicians.

  • 6.
    Brenner, Philip
    et al.
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Björkenstam, Charlotte
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Jokinen, Jussi
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients: a population-based register study2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 8, article id e104165Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension.

    METHODS: This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome.

    RESULTS: Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33).

    CONCLUSION: Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.

  • 7.
    Brenner, Philip
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet; Center for Psychiatry Research, Karolinska Universitetssjukhuset.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Jokinen, Jussi
    Department of Clinical Neuroscience, Karolinska Institutet; Center for Psychiatry Research, Karolinska Universitetssjukhuset; Department of Clinical Sciences, Umeå University.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Prescribed psychiatric medication among multiple sclerosis patients before and after disability pension: a register study with matched controls.2016In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 51, no 7, p. 1047-1054Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many multiple sclerosis (MS) patients of working ages have psychiatric comorbidity, and 60 % are on disability pension (DP). It is unknown how DP is associated with MS patients' mental health. The objective of this study was to investigate the association between prescriptions of psychiatric medication and time before and after receiving full-time DP in MS patients compared with matched controls.

    METHODS: Nationwide Swedish registers were used to identify 3836 MS patients who were granted DP in 2000-2012 and 19,180 DP controls matched on socio-demographic variables by propensity scores. Patients and controls were organized in groups by year granted DP. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated for being prescribed selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, or sleeping agents in 2006.

    RESULTS: Both patients and controls, who were not yet on DP in the study year of 2006, had lower OR compared with those who were granted DP in the same year. The OR increased when being closer to DP. MS patients, who had been granted DP 5-6 years earlier, had a higher risk for prescription of benzodiazepines (OR 1.72; 95 % CI 1.16-2.57) than controls (OR 1.14; 95 % CI 1.14-1.18). These patients also had a higher risk for SSRI prescription when compared directly with controls (OR 1.76; 95 % CI 1.44-2.15).

    CONCLUSIONS: MS patients have substantially higher odds ratios for being prescribed psychiatric drugs after DP than other disability pensioners. Further research on the association of DP with the mental health of MS patients is warranted.

  • 8.
    Bränström, Richard
    et al.
    Yale School of Public Health, New Haven, USA / Karolinska Institutet.
    Hatzenbuehler, Mark L
    Columbia University, New York, USA.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Pachankis, John E
    Yale School of Public Health, New Haven, USA.
    Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 6, p. 591-599Article in journal (Refereed)
    Abstract [en]

    In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Sweden to examine whether psychiatric outpatient treatment for various diagnoses and antidepressant medication usage are greater in sexual minority individuals compared to their siblings. A longitudinal cohort study design was used with a representative random population-based sample in Stockholm, Sweden. Registry-based health record data on all specialized outpatient health care visits and prescription drug use was linked to a sample of 1154 sexual minority individuals from the Stockholm Public Health Cohort and their siblings. The main outcomes were treatment due to psychiatric diagnoses retrieved from nationwide registry-based health records. In analyses accounting for dependency between siblings, gay men/lesbians had a greater likelihood of being treated for mood disorder [adjusted odds ratio (AOR) 1.77; 99% confidence intervals (CI) 1.00, 3.16] and being prescribed antidepressants (AOR 1.51; 99% CI 1.10, 2.07) compared to their siblings. Further, bisexual individuals had a greater likelihood of any outpatient psychiatric treatment (AOR 1.69; 99% CI 1.17, 2.45) and being prescribed antidepressants (AOR 1.48; 99% CI 1.07, 2.05) as well as a greater likelihood of being treated for a mood disorder (AOR 1.98; 99% CI 1.33, 2.95) compared to their siblings. No difference in anxiety or substance use disorder treatment was found between any sexual minority subgroup and their siblings. The potential role of familial confounding in psychiatric disorder treatment was not supported for more than half of the outcomes that were examined. Results suggest that sexual minority individuals are significantly more likely to be treated for certain psychiatric disorders compared to their siblings. Future research is needed to understand mechanisms other than familial factors that might cause the substantial treatment differences based on sexual orientation reported here.

  • 9.
    Bygren, Lars Olov
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet; Department of Community Medicine and Rehabilitation, University of Umeå.
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet.
    Carstensen, John
    Department of Medical and Health Sciences, University of Linköping.
    Edvinsson, Sören
    The Demographic Database, University of Umeå.
    Kaati, Gunnar
    Department of Biosciences and Nutrition, Karolinska Institutet.
    Pembrey, Marcus E
    Institute of Child Health, University College London, UK.
    Sjöström, Michael
    Department of Biosciences and Nutrition, Karolinska Institutet.
    Change in paternal grandmothers' early food supply influenced cardiovascular mortality of the female grandchildren.2014In: BMC Genetics, ISSN 1471-2156, E-ISSN 1471-2156, Vol. 15, article id 12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study investigated whether large fluctuations in food availability during grandparents' early development influenced grandchildren's cardiovascular mortality. We reported earlier that changes in availability of food - from good to poor or from poor to good - during intrauterine development was followed by a double risk of sudden death as an adult, and that mortality rate can be associated with ancestors' childhood availability of food. We have now studied transgenerational responses (TGR) to sharp differences of harvest between two consecutive years' for ancestors of 317 people in Överkalix, Sweden.

    RESULTS: The confidence intervals were very wide but we found a striking TGR. There was no response in cardiovascular mortality in the grandchild from sharp changes of early exposure, experienced by three of the four grandparents (maternal grandparents and paternal grandfathers). If, however, the paternal grandmother up to puberty lived through a sharp change in food supply from one year to next, her sons' daughters had an excess risk for cardiovascular mortality (HR 2.69, 95% confidence interval 1.05-6.92). Selection or learning and imitation are unlikely explanations. X-linked epigenetic inheritance via spermatozoa seemed to be plausible, with the transmission, limited to being through the father, possibly explained by the sex differences in meiosis.

    CONCLUSION: The shock of change in food availability seems to give specific transgenerational responses.

  • 10.
    Chruzander, Charlotte
    et al.
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Ytterberg, Charlotte
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Widén Holmqvist, Lotta
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital; Division of Neuroscience, Department of Clinical Neuroscience.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Hillert, Jan
    Division of Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet.
    Johansson, Sverker
    Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet; Department of Physiotherapy, Karolinska University Hospital.
    Longitudinal changes in sickness absence and disability pension, and associations between disability pension and disease-specific and contextual factors and functioning, in people with multiple sclerosis.2016In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 367, p. 319-325Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Even though it is well known that disability due to MS is highly associated with employment status, the long-term longitudinal perspective on sickness absence and disability pension over the MS trajectory is lacking. In addition, further knowledge of risk factors for future disability pension is needed.

    OBJECTIVES: To explore long-term longitudinal changes in the prevalence of sickness absence and disability pension in people with MS (PwMS), as well as to explore associations between disease-specific factors, contextual factors and functioning, and the outcome of future full-time disability pension.

    METHODS: A prospective, population-based survival cohort study, with a nine year follow-up, including 114 PwMS was conducted by combining face-to-face collected data and register-based data.

    RESULTS: The prevalence of full-time disability pension increased from 20% to 50%, however 24% of the PwMS had no disability pension at all at end of follow-up. Sex, age, disease severity and impaired manual dexterity were associated with future full-time disability pension.

    CONCLUSIONS: The large increase in prevalence of PwMS on full-time disability pension during the MS trajectory, calls for the development and implementation of evidence-based interventions, aiming at keeping PwMS in the work force. Modifiable factors, such as manual dexterity should be targeted in such interventions.

  • 11.
    Di Thiene, Domitilla
    et al.
    Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    La Torre, Giuseppe
    Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Suicide among first-generation and second-generation immigrants in Sweden: association with labour market marginalisation and morbidity.2014In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 5, p. 467-473Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous research suggests that first-generation immigrants have a lower suicide risk than those both born in Sweden and with both parents born in Sweden (natives), while the suicide risk in the second generation seems higher. The aim of this study was to investigate to what extent suicide risk in first-generation and second-generation (both parents born abroad) and intermediate-generation (only one parent born abroad) immigrants compared with natives is associated with sociodemographic factors, labour market marginalisation and morbidity.

    METHODS: A prospective population-based cohort study of 4 034 728 individuals aged 16-50 years was followed from 2005 to 2010. HRs for suicide were calculated for first-generation, intermediate-generation and second-generation immigrants compared with natives. Analyses were controlled for sociodemographic factors, morbidity and labour market marginalisation.

    RESULTS: The HR of suicide was significantly lower in first-generation immigrants (HR 0.83 CI 0.76 to 0.91), and higher in second-generation (HR 1.32, CI 1.15 to 1.52) and intermediate-generation immigrants (HR 1.20, CI 1.08 to 1.33) in comparison to natives. The excess risk was explained by differences in sociodemographics, morbidity and labour market marginalisation. In the fully adjusted models, a higher HR remained only for the Nordic second generation (HR 1.29, CI 1.09 to 1.52). There were no sex differences in HRs.

    CONCLUSIONS: The risk of suicide was shown to be lower in the first generation and higher in the second generation compared with natives. The higher HR in the Nordic second generation was not explained by differences in sociodemographics, labour market marginalisation and morbidity. Further research is warranted to investigate factors underlying this excess risk.

  • 12.
    Dorner, T E
    et al.
    Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
    Alexanderson, K
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Svedberg, P
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Tinghög, Petter
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Ropponen, A
    Finnish Institute of Occupational Health, Topeliuksenkatu, Helsinki, Finland.
    Mittendorfer-Rutz, E
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden.2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).

    METHOD: All 4 823 069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].

    RESULTS: HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70).

    CONCLUSIONS: Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

  • 13.
    Ernstsson, Olivia
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet; Department of Clinical Neuroscience, Karolinska Institutet.
    Gyllensten, Hanna
    Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    Department of Clinical Neuroscience, Karolinska Institutet; The Swedish Red Cross University College.
    Friberg, Emilie
    Department of Clinical Neuroscience, Karolinska Institutet.
    Norlund, Anders
    Department of Clinical Neuroscience, Karolinska Institutet.
    Cost of Illness of Multiple Sclerosis: A Systematic Review2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 7, article id e0159129Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cost-of-illness (COI) studies of Multiple Sclerosis (MS) are vital components for describing the economic burden of MS, and are frequently used in model studies of interventions of MS. We conducted a systematic review of studies estimating the COI of MS, to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices.

    MATERIAL AND METHOD: A literature search on studies published in English on COI of MS was performed in PubMed for the period January 1969 to January 2014, resulting in 1,326 publications. A mapping of studies using a bottom-up approach or top-down approach, respectively, was conducted for the 48 studies assessed as relevant. In a second analysis, the cost estimates were compared between the 29 studies that used a societal perspective on costs, human capital approach for indirect costs, presenting number of patients included, time-period studied, and year of price level used.

    RESULTS: The mapping showed that bottom-up studies and prevalence approaches were most common. The cost ratios between different severity levels within studies were relatively stable, to the ratio of 1 to 2 to 3 for disability level categories. Drugs were the main cost drivers for MS-patients with low disease severity, representing 29% to 82% of all costs in this patient group, while the main cost components for groups with more advanced MS symptoms were production losses due to MS and informal care, together representing 17% to 67% of costs in those groups.

    CONCLUSION: The bottom-up method and prevalence approach dominated in studies of COI of MS. Our findings show that there are difficulties in comparing absolute costs across studies, nevertheless, the relative costs expressed as cost ratios, comparing different severity levels, showed higher resemblance. Costs of drugs were main cost drivers for less severe MS and informal care and production losses for the most severe MS.

  • 14.
    Ernstsson, Olivia
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Burström, Kristina
    Karolinska Institutet / Stockholm County Council.
    The External Validity of Mapping MSIS-29 on EQ-5D Among Individuals With Multiple Sclerosis in Sweden2017In: Medical Decision Making Policy & Practice, ISSN 2381-4683, Vol. 2, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Mapping can be performed to predict utility values from condition-specific measures when preference-based measures are absent. A previously developed algorithm that predicts EQ-5D-3L index values from the Multiple Sclerosis Impact Scale (MSIS-29) has not yet been externally validated. Aim: To examine the external validity of a previously developed mapping algorithm by testing the accuracy of predicting EQ-5D-3L index values from MSIS-29 among multiple sclerosis (MS) patients in Sweden. Methods: Cross-sectional individual-level data were collected from population-based Swedish registers between 2011 and 2014. Health-related quality of life was assessed through MSIS-29 and EQ-5D-3L at one point in time among 767 individuals with known disability level of MS. A previously developed mapping algorithm was applied to predict EQ-5D index values from MSIS-29 items, and the predictive accuracy was assessed through mean absolute error and root mean square error. Results: When applying the algorithm, the predicted mean EQ-5D-3L index value was 0.77 compared to the observed mean index value of 0.75. Prediction error was higher for individuals reporting EQ-5D values <0.5 compared to individuals reporting EQ-5D values ≥0.5. Mean absolute error (0.12) and root mean square error (0.18) were smaller or equal to the prediction errors found in the original mapping study. Conclusion: The mapping algorithm had similar predictive accuracy in the two independent samples although results showed that the highest predictive performance was found in groups with better health. Varied predictive accuracy in subgroups is consistent with previous studies and strategies to deal with this are warranted.

  • 15.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
    Tinghög, Petter
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Kjeldgard, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine,Department of Clinical Neuroscience, Karolinska Institutet.
    Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden.2015In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 105, no 6, p. e22-e29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis.

    METHODS: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009.

    RESULTS: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability.

    CONCLUSIONS: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

  • 16.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet / Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs and quality of life by disability among people with multiple sclerosis: a register-based study in Sweden2018In: Multiple sclerosis journal - experimental, translational and clinical, E-ISSN 2055-2173, Vol. 4, no 3, article id 2055217318783352Article in journal (Refereed)
    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.

  • 17.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet; University of Gothenburg.
    Kavaliunas, Andrius
    Karolinska Institutet.
    Murley, Chantelle
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet; Karolinska University Hospital.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Costs of illness progression for different multiple sclerosis phenotypes: a population-based study in Sweden2019In: Multiple Sclerosis Journal Experimental, Translational and Clinical, ISSN 2055-2173, Vol. 5, no 2, article id 2055217319858383Article in journal (Refereed)
    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.

  • 18.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / Göteborgs universitet, Sahlgrenska universitetssjukhuset.
    Wiberg, M.
    Karolinska Institutet / Försäkringskassan.
    Alexanderson, K.
    Karolinska Institutet.
    Friberg, E.
    Karolinska Institutet.
    Hillert, J.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Comparing indirect costs of multiple sclerosis in three different years: A population-based study2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 29-Article in journal (Other academic)
  • 19.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Comparing costs of illness of multiple sclerosis in three different years: A population-based study2018In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, no 4, p. 520-528Article in journal (Refereed)
    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.

  • 20.
    Gyllensten, Hanna
    et al.
    Karolinska institutet / Sahlgrenska Academy, University of Gothenburg.
    Wiberg, Michael
    Karolinska institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska institutet.
    Hillert, Jan
    Karolinska institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    How does work disability of patients with MS develop before and after diagnosis? A nationwide cohort study with a reference group2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e012731Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We compared work disability of patients with multiple sclerosis (MS) from 5 years before with 5 years after diagnosis, with that of matched controls, and analysed whether progression in work disability among patients with MS was associated with sociodemography.

    DESIGN: Population-based cohort study.

    SETTING: The adult Swedish general population.

    PARTICIPANTS: Residents aged 24-57 diagnosed with MS (n=3685) in 2003-2006 and 18 425 matched controls without MS.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Annual net days of sickness absence (SA) and disability pension (DP), used as a proxy for work disability, followed from 5 years before to 5 years after diagnosis (ie, T-5-T+5). For patients with MS, regression was used to identify sociodemographic factors related to progression in work disability.

    RESULTS: Work disability of patients with MS increased gradually between T-5 and T-1 (mean: 46-82 days) followed by a sharp increase (T+1, 142 days), after which only a marginal increase was observed (T+5, 149 days). The matched controls had less work disability, slightly increasing during the period to a maximum of ∼40 days. Men with MS had a sharper increase in work disability before diagnosis. High educational level was associated with less progression in work disability before and around diagnosis.

    CONCLUSIONS: Patients with MS had more work disability days also 5 years before diagnosis. Several sociodemographic variables were associated with the absolute level and the progression in SA and DP.

  • 21.
    Gyllensten, Hanna
    et al.
    Karolinska Institutet / University of Gothenburg.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Alexanderson, Kristina
    Karolinska Institutet.
    Norlund, Anders
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Ernstsson, Olivia
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Costs of illness of multiple sclerosis in Sweden: a population-based register study of people of working age2018In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 19, no 3, p. 435-446Article in journal (Refereed)
    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.

  • 22.
    Helgesson, Magnus
    et al.
    Uppsala universitet / Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Niederkrotenthaler, T.
    Medical Univiversity Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    Labour-market marginalisation after a mental diagnosis among natives and immigrants living in Sweden2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 38-Article in journal (Other academic)
  • 23.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Niederkrotenthaler, Thomas
    Medical University Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, no 1, article id 593Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim was to investigate the associations between mental disorders and three different measures of labour-market marginalisation, and differences between native Swedes and immigrants.

    METHODS: The study comprised 1,753,544 individuals, aged 20-35 years, and resident in Sweden 2004. They were followed 2005-2011 with regard to disability pension, sickness absence (≥90 days) and unemployment (≥180 days). Immigrants were born in Western countries (Nordic countries, EU, Europe outside EU or North-America/Oceania), or in non-Western countries (Africa, Asia or South-America). Mental disorders were grouped into seven subgroups based on a record of in- or specialised outpatient health care 2001-2004. Hazard ratios (HRs) with 95% confidence intervals (CIs) were computed by Cox regression models with both fixed and time-dependent covariates and competing risks. We also performed stratified analyses with regard to labour-market attachment.

    RESULTS: Individuals with mental disorders had a seven times higher risk of disability pension, a two times higher risk of sickness absence, and a 20% higher risk of unemployment than individuals without mental disorders. Individuals with personality disorders and schizophrenia/non-affective psychoses had highest risk estimates for having disability pension and long-term sickness absence, while the risk estimates of long-term unemployment were similar among all subgroups of mental disorders. Among persons with mental disorders, native Swedes had higher risk estimates for disability pension (HR:6.6; 95%CI:6.4-6.8) than Western immigrants (4.8; 4.4-5.2) and non-Western immigrants (4.8; 4.4-5.1), slightly higher risk estimates for sickness absence (2.1;2.1-2.2) than Western (1.9;1.8-2.1), and non-Western (1.9;1.7-2.0) immigrants but lower risk estimates for unemployment (1.4;1.3-1.4) than Western (1.8;1.7-1.9) and non-Western immigrants (2.0;1.9-2.1). There were similar risk estimates among sub-regions within both Western and non-Western countries. Stratification by labour-market attachment showed that the risk estimates for immigrants were lower the more distant individuals were from gainful employment.

    CONCLUSIONS: Mental disorders were associated with all three measures of labour-market marginalisation, strongest with subsequent disability pension. Native Swedes had higher risk estimates for both disability pension and sickness absence, but lower risk estimates for unemployment than immigrants. Previous labour-market attachment explained a great part of the association between immigrant status and subsequent labour-market marginalisation.

  • 24.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Rahman, Syed
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Trajectories of work disability and unemployment among young adults with common mental disorders2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1228Article in journal (Refereed)
    Abstract [en]

    BackgroundLabour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.MethodsThe study was based on Swedish registers and consisted of all individuals 19-30years with an incident diagnosis of a CMD in year 2007 (n=7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n=7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.ResultsTwenty-six percent (n=1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n=2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n=665) followed increasing or constant high levels of work disability and 21 % (n=1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n=4546, 63%) or unemployment (n=2745, 38%), compared to the level of constant low work disability (n=6158, 85%) and unemployment (n=3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R-difference(2)=0.02-0.05, p<0.001).ConclusionsA large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.

  • 25.
    Hinas, Elin
    et al.
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Nilsson, Kerstin
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Tinghög, Petter
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Mittendorfer Rutz, Ellenor
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Alexanderson, Kristina
    Sektionen för försäkringsmedicin, Karolinska Institutet.
    Prediktion av fortsatt sjukfrånvaro bland personer sjukskrivna i depressiv episod respektive i artros2015Report (Other academic)
  • 26.
    Hällström, Tore
    et al.
    NEUROTEC, Section of Psychiatry, Karolinska Institutet.
    Damström Thakker, Kerstin
    Stockholm Center of Public Health, Department of Alcohol and Drug Prevention.
    Forsell, Yvonne
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet.
    Lundberg, Ingvar
    National Institute for Working Life, Department for Work and Health.
    Tinghög, Petter
    The PART Study: A Population Based Study of Mental Health in the Stockholm County: Study Design. Phase l (1998-2000)2003Report (Other academic)
  • 27.
    Kavaliunas, Andrius
    et al.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Olsson, Tomas
    Karolinska Institutet / Karolinska University Hospital.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet / Karolinska University Hospital.
    Karrenbauer, Virginija Danylaite
    Karolinska Institutet /Karolinska University Hospital.
    Cognitive function predicts work disability among multiple sclerosis patients2019In: Multiple sclerosis journal - experimental, translational and clinical, ISSN 2055-2173, Vol. 5, no 1, article id 2055217318822134Article in journal (Refereed)
    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.

  • 28.
    Kavaliunas, Andrius
    et al.
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet / Swedish Social Insurance Agency.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Glaser, Anna
    Karolinska Institutet.
    Gyllensten, Hanna
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Hillert, Jan
    Karolinska Institutet.
    Earnings and Financial Compensation from Social Security Systems Correlate Strongly with Disability for Multiple Sclerosis Patients2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 12, article id e0145435Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) patients earn lower incomes and receive higher benefits. However, there is limited knowledge of how this is correlated with their disability.

    OBJECTIVE: To elucidate sources and levels of income among MS patients with different disability, assessed with the Expanded Disability Status Scale.

    METHODS: A total of 7929 MS patients aged 21-64 years and living in Sweden in 2010 were identified for this cross-sectional study. Descriptive statistics, logistic and truncated linear regression models were used to estimate differences between MS patients regarding earnings, disability pension, sickness absence, disability allowance, unemployment compensation, and social assistance.

    RESULTS: The average level of earnings was ten times lower and the average level of health- related benefits was four times higher when comparing MS patients with severe and mild disability. MS patients with severe disability had on average SEK 166,931 less annual income from earnings and SEK 54,534 more income from benefits compared to those with mild disability. The combined average income for MS patients was 35% lower when comparing patients in the same groups. The adjusted risk ratio for having earnings among MS patients with severe disability compared to the patients with mild disability was 0.33 (95% CI 0.29-0.39), while the risk ratio for having benefits was 1.93 (95% CI 1.90-1.94).

    CONCLUSIONS: Disease progression affects the financial situation of MS patients considerably. Correlations between higher disability and patient income were observed, suggesting that earnings and benefits could be used as measures of MS progression and proxies of disability.

  • 29.
    Lallukka, Tea
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Helsinki, Finland .
    Ervasti, Jenni
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Kjeldgård, Linnea
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    The joint contribution of diabetes and work disability to premature death during working age: a population-based study in Sweden.2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 6, p. 580-586Article in journal (Refereed)
    Abstract [en]

    AIMS: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age.

    METHODS: We used prospective population-based register data of 25-59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003-2010. Net days of sickness absence and disability pension in 2005-2006 were examined; the follow-up time for mortality was 2007-2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions.

    RESULTS: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0-16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4-7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8-4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up.

    CONCLUSIONS: DIABETES AND WORK DISABILITY JOINTLY INCREASE THE RISK OF DEATH DURING WORKING AGE DIABETES WITH LONG-TERM WORK DISABILITY IS ASSOCIATED WITH THE HIGHEST RISK OF PREMATURE DEATH, WHICH HIGHLIGHTS THE IMPORTANCE OF THEIR PREVENTION AND EARLY DETECTION.

  • 30.
    Lundin, Andreas
    et al.
    Karolinska Institutet / Stockholm County Council.
    Åhs, Jill
    Karolinska Institutet.
    Åsbring, Nina
    Stockholm County Council.
    Kosidou, Kyriaki
    Karolinska Institutet / Stockholm County Council.
    Dal, Henrik
    Karolinska Institutet / Stockholm County Council.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Dalman, Christina
    Karolinska Institutet / Stockholm County Council.
    Discriminant validity of the 12-item version of the general health questionnaire in a Swedish case-control study2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 3, p. 171-179Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 12-item version of the General Health Questionnaire (GHQ-12) is widely used as a proxy for Affective Disorders in public health surveys, although the cut-off points for distress vary considerably between studies. The agreement between the GHQ-12 score and having a clinical disorder in the study population is usually unknown.

    AIMS: This study aimed to assess the criterion validity and to determine the sensitivity and specificity of the GHQ-12 in the Swedish population.

    METHODS: This study used 556 patient cases surveyed in specialized psychiatric care outpatient age- and sex-matched with 556 controls from the Stockholm Health Survey. Criterion validity for two scoring methods of GHQ-12 was tested using Receiver Operating Characteristics (ROC) analyses with Area Under the Curve (AUC) as a measure of agreement. Reference standard was (1) specialized psychiatric care and (2) current depression, anxiety or adjustment disorder.

    RESULTS: Both the Likert and Standard GHQ-12 scoring method discriminated excellently between individuals using specialized psychiatric services and healthy controls (Likert index AUC = 0.86, GHQ index AUC = 0.83), and between individuals with current disorder from healthy controls (Likert index AUC = 0.90, GHQ index AUC = 0.88). The best cut-off point for the GHQ index was ≥4 (sensitivity = 81.7 and specificity = 85.4), and for the Likert index ≥14 (sensitivity = 85.5 and specificity = 83.2).

    CONCLUSIONS: The GHQ-12 has excellent discriminant validity and is well suited as a non-specific measure of affective disorders in public mental health surveys.

  • 31.
    Murley, Chantelle
    et al.
    Karolinska Institutet.
    Mogard, Olof
    Karolinska Institutet.
    Wiberg, Michael
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Karampampa, Korinna
    Karolinska Institutet.
    Friberg, Emilie
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 5, article id e020392Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden.

    DESIGN: Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis).

    SETTING: Swedish working-age population with microdata linked from two nationwide registers.

    PARTICIPANTS: Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth).

    PRIMARY AND SECONDARY OUTCOME MEASURES: DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits.

    RESULTS: We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis.

    CONCLUSIONS: The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the disease progresses, although thorough investigation with future studies of modern cohorts are required.

  • 32.
    Niederkrotenthaler, Thomas
    et al.
    Medical University Vienna, Center for Public Health, Institute of Social Medicine, Vienna, Austria.
    Tinghög, Petter
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Alexanderson, Kristina
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Dahlin, Marie
    Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research.
    Wang, Mo
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Beckman, Karin
    Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatric Research.
    Gould, Madeleine
    Columbia University, NYS Psychiatric Institute, New York, USA.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Future risk of labour market marginalization in young suicide attempters: a population-based prospective cohort study2014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 5, p. 1520-30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research on future labour market marginalization following suicide attempt at young age is scarce. We investigated the effects of suicide attempts on three labour market outcomes: unemployment, sickness absence and disability pension.

    METHODS: We conducted a prospective cohort study based on register linkage of 1,613,816 individuals who in 1994 were 16-30 years old and lived in Sweden. Suicide attempters treated in inpatient care during the 3 years preceding study entry, i.e. 1992-94 (N=5649) were compared with the general population of the same age without suicide attempt between 1973 and 2010 (n=1,608,167). Hazard ratios (HRs) for long-term unemployment (>180 days), sickness absence (>90 days) and disability pension in 1995-2010 were calculated by Cox regression models, adjusted for a number of parental and individual risk markers, and stratified for previous psychiatric inpatient care not due to suicide attempt.

    RESULTS: The risks for unemployment [HR 1.58; 95% confidence interval (CI) 1.52-1.64], sickness absence (HR 2.16; 2.08-2.24) and disability pension (HR 4.57; 4.34-4.81) were considerably increased among suicide attempters. There was a dose-response relationship between number of suicide attempts and the risk of disability pension, for individuals both with or without previous psychiatric hospitalizations not due to suicide attempts. No such relationship was present with regard to unemployment.

    CONCLUSIONS: This study highlights the strong association of suicide attempts with future marginalization from the labour market, particularly for outcomes that are based on a medical assessment. Studies that focus only on unemployment may largely underestimate the true detrimental impact of suicide attempt on labour market marginalization.

  • 33.
    Niederkrotenthaler, Thomas
    et al.
    Medical University Vienna, Center for Public Health, Institute of Social Medicine, Suicide Research Unit, Vienna, Austria.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Goldman-Mellor, Sidra
    University of California, Merced, USA.
    Wilcox, Holly C
    Johns Hopkins School of Medicine, Baltimore, USA.
    Gould, Madelyn
    Columbia University, NYS Psychiatric Institute, New York, USA.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, p. 1-15Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization.

    METHODS: Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16-30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992-1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995-2010 were calculated with Cox regression.

    RESULTS: Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9).

    CONCLUSIONS: As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.

  • 34.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine. Swedish Red Cross University College.
    A global workspace is the emerging reality for future public health workforce2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 132-140Article in journal (Refereed)
    Abstract [en]

    There is an urgent need to train public health professionals at undergraduate level who can face global challenges that are due to longstanding conflicts, increasing number of displaced people, natural disasters, and growing inequalities between and within countries. Future public health professionals will lead activities ranging from national and international community planning, strategic work geared towards integration of migrants and crisis management of refugees, and humanitarian services. Consequently, the need for public health professionals with deep and wide theoretical and practical competencies in global contexts has become most relevant. In response to this need, The Swedish Red Cross University College has created such a programme leading to a Bachelor degree in Public Health Science, specialization Global Health.

  • 35.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Paillard-Borg, Stéphanie
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    von Strauss, Eva
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Framtidens hälsovetare verkar på en global arena.2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 318-326Article in journal (Refereed)
    Abstract [sv]

    Det föreligger ett akut behov att utbilda folkhälsovetare på grundnivå och som kan möta de globala utmaningarna. Hälsoutmaningarna förändras i takt med långvariga konflikter, människor på flykt, stora katastrofer och en ökande ojämlikhet mellan och inom länder, i en omvärld som är i ständig rörelse. Dagens och morgondagens folkhälsovetare ska kunna arbeta med olika aktörer på skilda arenor; med hälso- och sjukdomsprevention kommunalt, regionalt, nationellt (regering, myndigheter) och internationellt (europeiskt och globalt). Det innefattar även integrationsarbete, internationellt biståndsarbete och humanitärt arbete. Behovet av professionella folkhälsovetare med breda och djupa teoretiska och praktiska kompetenser i globala sammanhang har därför blivit högst relevant. Därför agerar nu Röda Korsets Högskola och startar ett folkhälsovetenskapligt program på kandidatnivå med global inriktning.

  • 36.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Högskolan i Gävle.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Högskolan i Gävle.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska institutet.
    Depression and Low Labour Market and Social Expectations among Resettled Syrian Refugees in Sweden: Leah Okenwa Emegwa2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 3Article in journal (Other academic)
    Abstract [en]

    Background

    Large numbers of refugees have come to Europe in search of safety. For non-refugee migrants, expectations and the extent to which they are met are shown to be integral components of adaptation and wellbeing. This study aims to explore the prevalence of low expectations for labour market, economic and social integration among Syrian refugees recently resettled in Sweden and whether depression is associated with these expectations.

    Methods

    A random sample of 1215 Syrian refuges of working age recently resettled in Sweden responded to a questionnaire in Arabic. Expectations were assessed by three items developed for this study. Average item score of >1.80 on the depressive symptoms in Hopkins Symptom Checklist indicated depression. Logistic regressions adjusted for demographic factors and social support were conducted. Weighted data was used to produce socio-demographically representative prevalence rates and odds ratios (ORs). Robust standard errors were used to obtain 95% confidence intervals for all estimates.

    Results

    Prevalence of low economic, social and labour market expectations were 14.1% (95% CI 12.0-16.1), 13.4% (11.3-15.4) and 10.9% (9.1-12.6) respectively. Approximately 40.2% (36.9-43.3) of the participants had depression. Those with depression were about four times more likely to have low economic expectations (OR 3.89, 95% CI 2.66-5.92), three times more likely to have low social (OR 3.1, 2.30-5.24), and labour market (OR 2.83, 1.90-4.47) expectations.

    Conclusions

    Low expectations, while not widespread, exist among Syrian refugees in Sweden. Notable proportions had depression which was also significantly associated with low expectations. The association between depression and low expectations in keys areas necessary for adaptation and wellbeing in a new land, indicates the need to address mental health issues in current societal level efforts aimed at boosting labour market participation and social inclusion.

    Key messages:

    • Notable proportions of Syrian refugees in Sweden have low expectations in domains vital for adaptation and wellbeing in a new land. Depression is significantly associated with low expectations.

    • Low expectation among Syrian refugees in domains vital for adaptation and wellbeing and the association with depression indicate need to address mental health in social and labour market interventions.

  • 37.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Department of occupational and public health, faculty of health and occupational studies, University of Gävle, Sweden..
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Prevalence and predictors of violence among Syrian refugee women resettled in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 156-Article in journal (Other academic)
    Abstract [en]

    Background Refugee women are at more risk of a continuum of violence, pre, during and post flight. After resettlement, increased family conflicts are likely, due to shifts in gender roles and changing family structures. Prevalence estimates, however, remain scarce especially for Syrian refugee women in Europe. Given that exposure to violence is a substantial risk factor for ill health and poor adaptation, this study aims to estimate the prevalence of violence in different phases of flight and associated sociodemographic factors. Methods The study is based on a random sample of 452 Syrian refugee women resettled in Sweden. Exposure to violence was operationalised as having been a victim of torture, physical or sexual violence, pre and during flight; witnessing violence was operationalised as experiencing war at close quarters, witnessing physical violence, or forced separation from loved ones, pre and during flight; family conflicts was operationalised as experiencing distressing conflicts in the family since resettlement. Descriptive analysis were conducted to estimate prevalence and logistic regression to assess associations. Weighted data produced socio-demographically representative estimates. Robust standard errors were used to obtain 95% confidence intervals for all estimates. Results About 25.1% (95% 20.9 – 29.4) of the women were exposed to violence preflight, 7.8% (95% 5.2 – 10.4) were victims during flight. Up to 93.3% (95% 90.7 – 95.9) witnessed violence preflight, 67.2% (95% 62.6 – 71.8) during flight. About 34.2% (95% 29.7 – 38.7) are experiencing distressing family conflicts.Logistic regressions showed no significant difference after controlling for age, education and marital status. Conclusions The magnitude of violence and ongoing family conflicts calls for a closer look at the plight of refugee women.Violence is widespread and not specific to any sociodemographic group, an important finding for healthcare and public health workforce to take note of. 

  • 38.
    Omar, Faisal
    et al.
    Department of Medical and Health Sciences, Linköping University.
    Tinghög, Gustav
    Department of Medical and Health Sciences, Linköping University.
    Tinghög, Petter
    Department of Medical and Health Sciences, Linköping University.
    Carlsson, Per
    Department of Medical and Health Sciences, Linköping University.
    Attitudes towards priority-setting and rationing in healthcare: an exploratory survey of Swedish medical students2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 2, p. 122-130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Healthcare priority-setting is inextricably linked to the challenge of providing publicly funded healthcare within a limited budget, which may result in difficult and potentially controversial rationing decisions. Despite priority-setting's increasing prominence in policy and academic discussion, it is still unclear what the level of understanding and acceptance of priority-setting is at different levels of health care.

    AIMS: The aim of this study is threefold. First we wish to explore the level of familiarity with different aspects of priority-setting among graduating medical students. Secondly, to gauge their acceptance of both established and proposed Swedish priority-setting principles. Finally to elucidate their attitudes towards healthcare rationing and the role of different actors in decision making, with a particular interest in comparing the attitudes of medical students with data from the literature examining the attitudes among primary care patients in Sweden.

    METHODS: A cross-sectional survey containing 14 multiple choice items about priority-setting in healthcare was distributed to the graduating medical class at Linkoöping University. The response rate was 92% (43/47).

    RESULTS: Less than half of respondents have encountered the notion of open priority-setting, and the majority believed it to be somewhat or very unclear. There is a high degree of awareness and agreement with the established ethical principles for priority-setting in Swedish health care; however respondents are inconsistent in their application of the cost-effectiveness principle. A larger proportion of respondents were more favourable to physicians and other health personnel being responsible for rationing decisions as opposed to politicians.

    CONCLUSIONS: Future discussion about priority-setting in medical education should be contextualized within an explicit and open process. There is a need to adequately clarify the role of the cost-effectiveness principle in priority-setting. Medical students seem to acknowledge the need for rationing in healthcare to a greater extent when compared with previous results from Swedish primary care patients.

  • 39.
    Omar, Faisal
    et al.
    Department of Medical and Health Sciences , Linköping University.
    Tinghög, Petter
    Department of Medical and Health Sciences , Linköping University.
    Tinghög, Gustav
    Department of Medical and Health Sciences , Linköping University.
    Welin, Stellan
    Department of Medical and Health Sciences , Linköping University.
    Transplant tourism and compensated kidney donation: A survey of opinions amongst Swedish medical students2010In: International Journal of Health Promotion & Education, Vol. 48, no 4, p. 100-106Article in journal (Refereed)
  • 40.
    Pembrey, Marcus
    et al.
    School of Social & Community Medicine, University of Bristol, Bristol, UK; UCL Institute of Child Health, London, UK.
    Saffery, Richard
    Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
    Bygren, Lars Olov
    Department of Biosciences and Rehabilitation, Karolinska Institutet; Department of Community Medicine and Rehabilitation, Umeå University.
    Network in Epigenetic Epidemiology,
    Human transgenerational responses to early-life experience: potential impact on development, health and biomedical research2014In: Journal of Medical Genetics, ISSN 0022-2593, E-ISSN 1468-6244, Vol. 51, no 9, p. 563-572Article, review/survey (Refereed)
    Abstract [en]

    Mammalian experiments provide clear evidence of male line transgenerational effects on health and development from paternal or ancestral early-life exposures such as diet or stress. The few human observational studies to date suggest (male line) transgenerational effects exist that cannot easily be attributed to cultural and/or genetic inheritance. Here we summarise relevant studies, drawing attention to exposure sensitive periods in early life and sex differences in transmission and offspring outcomes. Thus, variation, or changes, in the parental/ancestral environment may influence phenotypic variation for better or worse in the next generation(s), and so contribute to common, non-communicable disease risk including sex differences. We argue that life-course epidemiology should be reframed to include exposures from previous generations, keeping an open mind as to the mechanisms that transmit this information to offspring. Finally, we discuss animal experiments, including the role of epigenetic inheritance and non-coding RNAs, in terms of what lessons can be learnt for designing and interpreting human studies. This review was developed initially as a position paper by the multidisciplinary Network in Epigenetic Epidemiology to encourage transgenerational research in human cohorts.

  • 41.
    Rahman, S
    et al.
    Karolinska institutet.
    Mittendorfer-Rutz, E
    Karolinska institutet.
    Alexanderson, K
    Karolinska institutet.
    Jokinen, J
    Karolinska institutet / Umeå universitet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Disability pension due to common mental disorders and healthcare use before and after policy changes; a nationwide study2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 90-96Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite common mental disorders (CMDs) being a main reason for preterm exit from the labour market, there is limited knowledge regarding healthcare use around the time of being granted disability pension (DP) due to CMD. The aim was to study specialized healthcare use before and after being granted DP due to CMD and whether these trajectories differed before and after changes in DP granting criteria in Sweden in 2008.

    METHODS: Included individuals lived in Sweden, aged 19-64 years with incident DP due to CMD before (wave 1, 2005-06, n = 24 298) or after (wave 2, 2009-10, n = 4056) the changes in 2008. Healthcare trajectories during a 7-year window were assessed by generalized estimating equations. Between- and within-wave differences were examined by interaction models.

    RESULTS: Psychiatric healthcare increased until the year preceding DP and declined thereafter, with one exception; such outpatient care kept increasing in wave 1 following DP. In the year preceding DP, 4.6 and 19.2% of the individuals in wave 1 had psychiatric in- and specialized outpatient care, respectively, compared with 7.9 and 46.6% in wave 2. No clear pattern was observed regarding somatic healthcare. The slopes of the different DP waves differed mainly during DP granting years (1 year prior to 1 year after), showing a sharper decline in wave 2.

    CONCLUSION: Transition to DP due to CMD seems to be associated with changes in psychiatric healthcare use, with higher rates in the year preceding DP. Outpatient healthcare patterns somewhat differed among those granted DP after stricter rules were introduced.

  • 42.
    Sigvardsdotter, Erika
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine.
    Malm, Andreas
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet / Swedish Red Cross Treatment Center for Persons Affected by War and Torture.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Vaez, Marjan
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Refugee trauma measurement: a review of existing checklists2016In: Public Health Reviews, ISSN 0301-0422, E-ISSN 2107-6952, Vol. 37, article id 10Article, review/survey (Refereed)
    Abstract [en]

    Studies have shown that a high proportion of refugees have been subjected to potentially traumatic experiences (PTEs). PTEs, including torture, are powerful predictors of mental ill health. This paper reports a review of refugee trauma history self-report measures used in population studies.

    Methods

    A review of existing instruments and checklists, up to September 2015, was performed.

    Results

    The types of measures for refugee trauma history vary from semi-structured interviews and medical records to extensive multi-item trauma-checklists. The Harvard Trauma Questionnaire (HTQ) was the most commonly used instrument for measuring trauma history among refugee populations. Few checklists included PTEs during the flight.

    Conclusion

    Trauma history checklists are often used as a tool to control for background variables when studying refugees’ mental health and have mostly been developed in clinical or semi-clinical settings. There is a need for acceptable, reliable and valid brief checklists for measuring trauma in refugees, for the purpose of performing larger scale population studies.

  • 43.
    Sigvardsdotter, Erika
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Nilsson, Henrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet / Swedish Red Cross Center for Persons Affected by War and Torture.
    Malm, Andreas
    The Swedish Red Cross University College, Department of Health Sciences. Swedish Red Cross Center for Persons Affected by War and Torture.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Gottvall, Maria
    The Swedish Red Cross University College, Department of Health Sciences. Uppsala University.
    Vaez, Marjan
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC)-A Brief Checklist for Survey Studies2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 10, article id 1175Article in journal (Refereed)
    Abstract [en]

    A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for survey studies.

    METHODS: A pool of 232 items was generated based on pre-existing instruments. Conceptualization, item selection and item refinement was conducted based on existing literature and in collaboration with experts. Ten cognitive interviews using a Think Aloud Protocol (TAP) were performed in a clinical setting, and field testing of the proposed checklist was performed in a total sample of n = 137 asylum seekers from Syria.

    RESULTS: The proposed refugee trauma history checklist (RTHC) consists of 2 × 8 items, concerning PTEs that occurred before and during the respondents' flight, respectively. Results show low item non-response and adequate psychometric properties Conclusion: RTHC is a usable tool for providing self-report data on refugee trauma history surveys of community samples. The core set of included events can be augmented and slight modifications can be applied to RTHC for use also in other refugee populations and settings.

  • 44.
    Sjölund, Sara
    et al.
    Karolinska Institutet.
    Hinas, E.
    Karolinska Institutet.
    Nilsson, K.
    Karolinska Institutet.
    Alexanderson, K.
    Karolinska Institutet.
    Bottai, M.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Predicting long-term sick leave among sick listed due to depressive episode, a Swedish cohort study2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no Suppl. 1, p. 38-Article in journal (Other academic)
  • 45.
    Tegern, Gunilla
    et al.
    Linköpings universitet, Institutionen för tema, Tema Barn. Linköpings universitet, Filosofiska fakulteten..
    Tinghög, Petter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten..
    Flodmark, Olof
    Institutionen för klinisk neurovetenskap, Karolinska institutet, Stockholm..
    Om att förebygga skakvåld mot små barn: Redovisning och utvärdering av et försöksverksamhet med ett preventionsprogram2012Report (Other academic)
  • 46.
    Tinghög, Gustav
    et al.
    Linkoping Univ, Dept Management & Engn.
    Andersson, David
    Linkoping Univ, Dept Management & Engn.
    Tinghög, Petter
    Karolinska Inst, Div Insurance Med.
    Lyttkens, Carl Hampus
    Lund Univ, Swedish Med Res Council.
    Horizontal inequality in rationing by waiting lists2014In: International Journal of Health Services, ISSN 0020-7314, E-ISSN 1541-4469, Vol. 44, no 1, p. 169-84Article in journal (Refereed)
    Abstract [en]

    The objective of this article was to investigate the existence of horizontal inequality in access to care for six categories of elective surgery in a publicly funded system, when care is rationed through waiting lists. Administrative waiting time data on all elective surgeries (n = 4,634) performed in Ostergötland, Sweden, in 2007 were linked to national registers containing variables on socioeconomic indicators. Using multiple regression, we tested five hypotheses reflecting that more resourceful groups receive priority when rationing by waiting lists. Low disposable household income predicted longer waiting times for orthopedic surgery (27%, p < 0.01) and general surgery (34%, p < 0.05). However, no significant differences on the basis of ethnicity and gender were detected. A particularly noteworthy finding was that disposable household income appeared to be an increasingly influential factor when the waiting times were longer. Our findings reveal horizontal inequalities in access to elective surgeries, but only to a limited extent. Whether this is good or bad depends on one's moral inclination. From a policymaker's perspective, it is nevertheless important to recognize that horizontal inequalities arise even though care is not rationed through ability to pay.

  • 47.
    Tinghög, Mimmi Eriksson
    et al.
    Social Centre for Research on Alcohol and Drugs (SoRAD), Stockholm University; Department of Criminology, Stockholm University, Stockholm.
    Tinghög, Petter
    Division of Insurance Medicine, Karolinska Institutet.
    Preventing alcohol problems and improving drinking habits among employees: an evaluation of alcohol education.2016In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 53, no 2, p. 421-428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In a municipality in Sweden there was a concern about the high alcohol consumption among its residents. An alcohol education program was provided to all those employed by the municipality.

    OBJECTIVE: To investigate whether a day-long alcohol education program provided to all employed by a Swedish municipality had an effect on alcohol consumption among employees and specifically among employees with low and higher levels of consumption respectively.

    METHODS: A quasi-experimental evaluation using pre-test and post-test questionnaires was performed. The municipality's employees were divided in one intervention group (n: 124) and one control group (n: 139). ANOVA with repeated measures was performed on AUDIT-score and on three separate AUDIT-items: frequency of drinking, frequency of binge drinking, and typical amount consumed per drinking occasion.

    RESULTS: No significant effect on alcohol consumption was identified for the intervention group as a whole. Stratified analyses showed the intervention had a significant effect on reducing the frequency of binge drinking among those with the highest consumption.

    CONCLUSIONS: Compared to many other studies on alcohol education, some results on behaviour were found when performing stratified analyses. The employees with the highest alcohol consumption, although not labelled high consumers, reduced the frequency of binge drinking. It is difficult to speculate whether these results can be generalized to other working populations. The results have to be compared with more direct methods of reaching risk consumers, such as screening and brief interventions. Knowledge about alcohol and the associated risks of alcohol consumption might facilitate the willingness to seek help sooner.

  • 48. Tinghög, Petter
    Livsvillkorens effekter på hälsan2009In: I & M (Invandrare & Minoriteter), ISSN 1404-6857, no 4, p. 42-44Article in journal (Other academic)
    Abstract [sv]

    Orsakerna till psykisk (o)hälsa bland invandrare utgör en komplex väv och skiljer sig mellan olika grupper och individer. Men att sociala och ekonomiska villkor har en stor betydelse för hälsan tycks gälla över lag.

  • 49.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences.
    Mental ill-health, trauma and adverse post-migratory experiences among refugees from Syria in Sweden2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no S3, p. 49-50Article in journal (Other academic)
  • 50.
    Tinghög, Petter
    Department of Medical and Health Sciences, Linköping University.
    Migration, Stress and Mental Ill Health: Post-migration Factors and Experiences in the Swedish Context2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This predominantly empirical dissertation deals with how socio-economic living conditions and immigrant-specific factors can be linked to immigrants’ mental ill health. It is also explored how cultural representations can affect stress and whether mental ill health is expressed differently among immigrants from Iraq and Iran than among individuals of Nordic origin. Moreover, a conceptual analysis is conducted, where a phenomenological conceptualisation of stress is outlined with a special focus on how this stress approach can be related to culture and migration.

    The empirical material consists of eleven in-depth interviews with Iraqi and Iranian immigrant women and two population-based surveys.

    The main findings of this thesis suggest as follows: 1) Mental ill health is more common among foreign-born than among native-born Swedes and can to a great extent be attributed to their poorer socio-economic living conditions. 2) Immigrants’ mental health is independently associated with different types of factors, such as traumatic episodes, socio-cultural adaptation level and socioeconomic living conditions. 3) The self-reporting mental health instruments, HSCL-25 and WHO (ten) Wellbeing Index, produce scores that are comparable between Scandinavians and immigrants of Middle Eastern descent. 4) Nonuniversal representations that can be found in Iraq and Iran can amplify, or even be necessary ingredients in certain types of stressful experiences among immigrant women from these countries. 5) The distinctions between universal and non-universal stress, and between immigrant/minority and non-immigrant/nonminority stress appear to be crucial for an adequate comprehension of immigrants’ stressful experiences.

12 1 - 50 of 65
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