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  • 1.
    Bränström, Richard
    et al.
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Petersson, Lena-Marie
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Saboonchi, Fredrik
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Wennman-Larsen, Agneta
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet; Sophiahemmet University.
    Alexanderson, Kristina
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Physical activity following a breast cancer diagnosis: Implications for self-rated health and cancer-related symptoms.2015In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 19, no 6, p. 680-685Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Studies have consistently shown an association between physical activity and increased health and well-being after a cancer diagnosis. Nevertheless, large proportions of breast cancer survivors do not meet recommended levels of physical activity. The aim of this study was to describe physical activity levels during the first two years after being diagnosed with breast cancer, and to explore the predictive ability of physical inactivity on longer-term self-rated health, physical symptoms, and psychological distress.

    METHOD: Study participants were women recently having had a first breast cancer surgery at one of the three main hospitals in Stockholm between 2007 and 2009. A total of 726 women were included and responded to six questionnaire assessments during the 24 months following diagnosis.

    RESULTS: Less than one third of the participants were sufficiently physically active at baseline. Physical activity decreased after surgery, increased at 8 month follow-up, and subsequently decreased slightly during the subsequent follow-up period. Physical inactivity was related to reduced health, increased symptoms such as pain, depression, and anxiety.

    CONCLUSION: This study provides additional support for the beneficial consequences of being physically active after a breast cancer diagnosis and highlights a potential target for intervention. This study provides additional support showing that being physically active even at a very low level seems to result in health benefits. Physical activity should be encouraged among patients treated for breast cancer.

  • 2.
    Gottvall, Maria
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Uppsala University.
    Sjölund, Sara
    The Swedish Red Cross University College, Department of Health Sciences.
    Arwidson, Charlotta
    The Swedish Red Cross University College, Department of Health Sciences.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Instiutet.
    Health-related quality of life among Syrian refugees resettled in Sweden2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649Article in journal (Refereed)
    Abstract [en]

    Purpose The main purpose of this study was to assess health-related quality of life (HRQoL) among Syrian refugees resettled in Sweden. Further, we wanted to investigate whether sex, age, education, area of residence, cohabitation and social support were associated with HRQoL in this population. Methods This is a cross-sectional study including 1215 Syrian refugees from a randomly selected sample frame resettled in Sweden between the years 2011 and 2013. HRQoL was measured by the EQ-5D-5L descriptive system, and EQ-5D-5L index values were calculated. Associations between sex, age, education, area of residence, cohabitation, social support and EQ-5D-5L were investigated using multiple linear regression analysis. Results Depression/anxiety was the most commonly (61.9%) reported EQ-5D-5L problem among the group of Syrian refugees. The mean EQ-5D-5L index value was found to be 0.754. Male sex, younger age, cohabitation and social support were found associated with a higher EQ-5D-5L index score. Conclusions Our results concerning long-lasting health problems among the study population indicate that there is a profound need for policies and interventions promoting refugees' health. Our results also show that social support, a modifiable factor, is relevant to refugees' overall health, pointing to the importance of public health interventions and policies targeting the facilitation, mobilization and enhancing of refugees' social support.

  • 3.
    Gottvall, Maria
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Uppsala University.
    Vaez, Marjan
    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.
    Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden2019In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 19, no 1, article id 28Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender.

    METHODS: Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework.

    RESULTS: Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern.

    CONCLUSION: The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.

  • 4.
    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)
  • 5.
    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.

  • 6.
    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.

  • 7.
    Helgesson, Magnus
    et al.
    Karolinska Institutet.
    Wang, Mo
    Karolinska Institutet.
    Niederkrotenthaler, Thomas
    Medical University of Vienna, Vienna, Austria.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 5, p. 407-415Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.

    Methods: All non-pensioned individuals aged 19-60 years who were resident in Sweden on 31 December 2009 were included (n= 4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010-2013.

    Results: Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.

    Conclusion: Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

  • 8.
    Jaghult, Susanna
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Saboonchi, Fredrik
    Red Cross University College of Nursing.
    Moller, Jette
    Karolinska Institute, Department of Public Health Sciences, Division of Public Health Epidemiology.
    Johansson, Unn-Britt
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Wredling, Regina
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Kapraali, Marjo
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Stress as a Trigger for Relapses in IBD: A Case-Crossover Study2013In: Gastroenterology Research, ISSN 1918-2805, E-ISSN 1918-2813, Vol. 6, no 1, p. 10-16Article in journal (Refereed)
    Abstract [en]

    Background: It is important to identify factors that influence the risk of relapses in inflammatory bowel disease. Few studies have been conducted and with limited methodology. This prospective case-crossover study, aims to examine whether perceived stress has a short-term acute effect, namely whether it acts as a trigger, on the risk of relapse in inflammatory bowel disease. 

    Methods: Sixty patients with inflammatory bowel disease and in remission were included. The case-crossover design was employed, which is an epidemiological design developed to study  triggers for acute events and diseases. To collect information regarding symptoms and potential trigger factors, such as perceived stress, a structured diary was  constructed. The participants were instructed to fill in the diary daily during six months. Fifty patients completed the study.

    Results: The analysis showed an effect for high level of perceived stress. Being exposed to “quite a lot”  of stress, yield an increase in risk for relapse during the forthcoming day (OR  = 4.8, 95% CI 1.09 -  21.10). No statistically increased risk for lower levels of perceived stress was found, although elevated effect estimates were found for “some” stress.

    Conclusion: This study supports earlier findings regarding perceived stress as an important factor in triggering relapses in IBD. However, this is the first case-crossover study performed to explore the trigger risk of stress in this population. Further investigations with larger patient samples are needed to confirm the findings.

  • 9.
    Janczewska, I.
    et al.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Kapraali, M.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Saboonchi, Fredrik
    Sophiahemmet University College, Stockholm.
    Nekzada, Q.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Wessulv, Å.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Khoshkar, J.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Marouf, F.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Gorsetman, J.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Risberg, D.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Lissing, M.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Wirström, G.
    Division of Medicine, Ersta Hospital, Stockholm.
    Sandstedt, B.
    Karolinska Institutet, Department of Pathology, Danderyd Hospital, Stockholm.
    Clinical application of the multigene analysis test in discriminating between ulcerative colitis and Crohn’s disease: A retrospective study2012In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 47, no 2, p. 162-169Article in journal (Refereed)
    Abstract [en]

    Methods.The newly described – multigene analysis test(DiBiCol) identifying 7 inflammatory bowel disease (IBD)-specific genes incolonic mucosal biopsy differentiating between ulcerative colitis (UC) and Crohn's disease (CD) with active inflammation – is a new addition to existingmethods with a higher stated sensitivity and specificity. Method biopsymaterial from 78 patients with a complicated course diagnosed as most probably UC in 38, CD in 18 and inflammatory bowel disease unclassified (IBDU) in 22 were investigated by DiBiCol. Results. DiBiCol showed a pattern consistent with CD in 13 patients with UC and led to change of diagnosis in 3 patients and a strong suggestion of CD in 8 patients. A total of 2 patients remained as UC. DiBiCol showed a pattern of UC in 4 patients of 18 with CD leading to a changing of diagnosis to UC in 3 patients, but the fourth remained as CD. In 22 patients with IBDU DiBiCol showed a pattern consistent with UC in 7 cases and with CD in 13 cases. A new evaluation 1 year after the DiBiCol allowed the assessment of clinical diagnosis in 10 patients confirmed in 9 of 10 patients by DiBiCol. In patients with acute flare of colitis the clinical diagnosis corresponded in 10 of 12 UC and in 5 of 6 CD cases. Summary. Adoptingthe DiBiCol test led to a change of the primary diagnosis in a significant number of patients with the initial diagnosis of UC and CD and suggested aclinically probable diagnosis in most of the patients with IBDU and in those with an acute flare of colitis.

  • 10.
    Jäghult, Susanna
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Medicine, SE-182 88 Stockholm.
    Saboonchi, Fredrik
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Medicine, SE-182 88 Stockholm.
    Johansson, Unn-Britt
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Medicine, SE-182 88 Stockholm.
    Wredling, Regina
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Medicine, SE-182 88 Stockholm.
    Kapraali, Marjo
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Medicine, SE-182 88 Stockholm.
    Factor structures of the Swedish Version of the RFIPC: Investigating the Validity of Measurements of IBD Patients’ Worries and Concerns2010In: Gastroenterology Research, ISSN 1918-2805, Vol. 3, no 5, p. 191-200Article in journal (Refereed)
    Abstract [en]

    Background: Worries and concerns of patients with IBD comprise an important negative factor in their HRQOL. The Rating Form of Inflammatory Bowel Disease Patient Concerns (RFIPC) was developed to describe the nature and degree of the worries and concerns of IBD patients. In the original version, the specific issues of worries are divided into four separate factors. These factors provide useful information about HRQOL and the kind of worries and concerns which are most important to the patient. However, the Swedish version of the RFIPC is often scored using a single sum score, implying that all the specific issues of worries stem from a single general worry factor. The aim of this study was to validate the factor structure of the Swedish version of the RFIPC. Methods: A sample consisting of 195 patients with IBD filled out the RFIPC. Confirmatory factor analysis was performed to examine fit of three hypothesized models of factor structure. Spearman’s correlation and Mann-Whitney analysis were used to follow up the results. Results: The single-factor model displayed poor fit indices. The four-factor model marked substantive improvement, but still remains inadequate. The final four-factor model permitting correlated error terms between some items displayed the most adequate fit. Conclusions: The factorial structure of the RFIPC, as suggested in the original version, was able to be replicated with a slight modification in the Swedish version. The separate factors identified in this structure provide more detailed information about the worries and concerns of IBD patients as these components of worries are different related to HRQOL and general health.

  • 11.
    Jäghult, Susanna
    et al.
    Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital.
    Saboonchi, Fredrik
    Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Johansson, Unn-Britt
    Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Wredling, Regina
    Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Kapraali, Marjo
    Division of Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Identifying predictors of low health-related quality of life among patients with inflammatory bowel disease: comparison between Crohn's disease and ulcerative colitis with disease duration2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, ISSN 0962-1067, Vol. 20, no 11/12, p. 1578-1587Article in journal (Refereed)
    Abstract [en]

    To identify predictors of low health-related quality of life among patients with inflammatory bowel disease and make a comparison between Crohn's disease and ulcerative colitis with disease duration. Studies have shown that patients with inflammatory bowel disease rate their health-related quality of life lower, as compared with a general population. Survey. In this study, 197 patients in remission were included and divided into a Crohn's disease group and an ulcerative colitis group. Each group was also divided into separate groups whether the patients had short disease duration or long disease duration. Generic instruments, combined with disease-specific questionnaires, were used for measuring health-related quality of life. The analysis showed a non-significant effect for diagnosis, but a significant effect for disease duration showing that the patients with short disease duration had lower scores of health-related quality of life compared with patients with long disease duration. A significant interaction between diagnosis and disease duration was also revealed. Patients with longer disease duration experienced a better health-related quality of life than patients with short disease duration. Patients with Crohn's disease and short disease duration have the lowest health-related quality of life and are in greatest need of education and support. It is important to identify which patients' are in the greatest need of education and support.

  • 12.
    Lauffs, Monica
    et al.
    Sophiahemmet University College, Stockholm.
    Ponzer, Sari
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm.
    Saboonchi, Fredrik
    Sophiahemmet University College, Stockholm.
    Lonka, Kirsti
    Research Centre for Educational Psychology, Department of Applied Educational Sciences, University of Helsinki, Helsinki, Finland.
    Hylin, Uffe
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm.
    Mattiasson, Anne-Cathrine
    Department of Clinical Sciences, Karolinska Institute at Danderyd Hospital, Division of Surgery, Stockholm.
    Cross-cultural adaptation of the Swedish version of Readiness for Interprofessional Learning Scale (RIPLS)2008In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, ISSN 0308-0110, Vol. 42, no 4, p. 405-411Article in journal (Refereed)
    Abstract [en]

    Context  Interprofessional learning activities in health care are being gradually introduced on an international basis and therefore cross-cultural and internationally collaborative research into the outcomes of these activities is needed. Hence, it is necessary not only to translate research instruments into the language of the culture in which they are to be used, but also to adapt them culturally if they are to fulfil the testing purposes for which they are intended. It is also necessary to test a translated instrument in order to ensure that it retains its intended psychometric properties.

    Methods  In the present study, the Readiness for Interprofessional Learning Scale (RIPLS) was adapted for use in a Swedish student population. Cross-cultural adaptation was performed according to recommended guidelines. The Swedish version was tested on a group of students from various health care professions (n = 214). Cronbach’s alpha coefficient was adopted to ensure internal consistency.

    Results  Minor discrepancies during the different translation processes were identified and corrected. Confirmatory factor analysis suggests that the model had an acceptable fit, implying that the factor structure of the scale did not undergo any significant changes by being subjected to translation. The psychometric qualities of the instrument were comparable with those of the English-language version.

    Conclusions  This study presents the cross-cultural adaptation of the RIPLS and demonstrates that its subscale Teamwork and Collaboration is the only reliable subscale. The other 2 subscales (Professional Identity, and Roles and Responsibilities) probably require further scrutiny and development, at least in the Swedish population.

  • 13.
    Lundh, Lars-Gunnar
    et al.
    Sleep Disorders Unit, Department of Psychiatry, University Hospital, Uppsala.
    Broman, Jan-Erik
    Sleep Disorders Unit, Department of Psychiatry, University Hospital, Uppsala.
    Hetta, Jerker
    Sleep Disorders Unit, Department of Psychiatry, University Hospital, Uppsala.
    Saboonchi, Fredrik
    Sleep Disorders Unit, Department of Psychiatry, University Hospital, Uppsala.
    Perfectionism and Insomnia1994In: Scandinavian Journal of Behaviour Therapy, ISSN 0284-5717, ISSN 0284-5717, Vol. 23, no 1, p. 3-18Article in journal (Refereed)
    Abstract [en]

    The relationship between perfectionism and insomnia was studied by means of a shortened version of Frost et al's (1990) Multidimensional Perfectionism Scale (MPS-20). In the first study, an age- and sex-stratified sample of 383 randomly selected individuals from Uppsala, Sweden answered the MPS-20 and a number of questions about their sleep. Within this normal sample, perfectionism correlated with degree of sleep problem, and with an increased concern over the adverse consequences of insufficient sleep. In the second study, the MPS-20 was administered to a consecutive series of 70 patients with persistent insomnia from a sleep disorders clinic. This group was found to have significantly higher scores than the normals on perfectionism, and especially on the subscales Concern over Mistakes and Personal Standards. Within the insomnia group, patients with a concomitant diagnosis of major depression differed from the non-depressed insomniacs by having higher scores on the subscale Doubts about Action. Although these studies show a correlation between perfectionism and insomnia, they do not demonstrate a causal relationship. It is hypothesized that perfectionism (high personal standards and high concern over mistakes) may serve as a predisposing factor for the development of persistent insomnia.

  • 14.
    Lundh, Lars-Gunnar
    et al.
    Department of Psychology, Lund University, Box 213, 221 00, Lund.
    Saboonchi, Fredrik
    H. M. Queen Sophia University College of Nursing, Stockholm.
    Wångby, Margit
    Department of Psychology, Lund University, Box 213, 221 00, Lund.
    The role of personal standards in clinically significant perfectionism: A person-oriented approach to the study of patterns of perfectionism2008In: Cognitive Therapy and Research, ISSN 0147-5916, E-ISSN 1573-2819, ISSN 0147-5916, Vol. 32, no 3, p. 333-350Article in journal (Refereed)
    Abstract [en]

    Clinically significant perfectionism is defined as patterns of perfectionism which are over-represented in clinical samples and under-represented in non-clinical samples. The present study contrasted two hypotheses about what characterizes clinically significant perfectionism: the two-factor theory and perfectionism/acceptance theory. First, a person-oriented approach by means of cluster analysis was used to identify typical patterns of perfectionism. These clusters were then cross-tabulated with two clinical samples (patients with social phobia and patients with panic disorder) and a non-clinical sample. The results showed that patterns of clinically significant perfectionism combined high Concern over Mistakes (CM) and Doubts about Action (DA) with high Personal Standards (PS) (and to a lesser extent also high Organization)––which is consistent with perfectionism/acceptance theory, but at odds with the two-factor theory. The results illustrate the value of a person-oriented methodological approach as a complement to the traditional variable-oriented approach.

  • 15.
    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.

  • 16.
    Löfvenmark, C
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Saboonchi, Fredrik
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Edner, M
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Billing, E
    Department of Medical Sciences, Uppsala University, Uppsala.
    Mattiasson, A.-C
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 1-2, p. 115-126Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  To evaluate the effect of a group-based multi-professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study.

    Background.  When a person is diagnosed with heart failure, the daily life of the family members is also affected.

    Design.  Randomised controlled trial.

    Methods.  A total of 128 family members were randomly assigned to participate in a multi-professional educational programme or a control group. Analysis of variance and regression analysis were used.

    Results.  There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R2 = 0·35) and depression (p = 0·021, R2 = 0·37). Younger family members were found to have a higher quality of life (p < 0·01).

    Conclusion.  Improved disease-related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members.

    Relevance to clinical practice.  Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.

  • 17.
    Lööf, H
    et al.
    Sophiahemmet University College, Stockholm.
    Johansson, U-B
    Sophiahemmet University College, Stockholm.
    Welin Henriksson, E
    Division of Nursing, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm.
    Lindblad, S
    Rheumatology Clinic, Karolinska University Hospital, Stockholm.
    Saboonchi, Fredrik
    Sophiahemmet University College, Stockholm.
    Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, p. 1643-1651Article in journal (Refereed)
    Abstract [en]

    Aim

    This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention.

    Background

    The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available.

    Method

    A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The ‘concurrent think aloud’ method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity.

    Results

    According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory.

    Conclusion

    Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may be useful in the management of chronic disease and can be addressed in nursing.

  • 18.
    Lööf, Helena
    et al.
    Sophiahemmet University, Stockholm, Sweden.
    Johansson, Unn-Britt
    Sophiahemmet University, Stockholm, Sweden.
    Welin Henriksson, Elisabet
    Karolinska Institutet, Division of Nursing, Department of Neurobiology and Rheumatology Unit, Karolinska Hospital, Stockholm, Sweden.
    Lindblad, Staffan
    Karolinska Institutet, Department of Learning Informatics, Management and Ethics, Stockholm, Sweden.
    Saboonchi, Fredrik
    Red Cross University College of Nursing.
    Pain and fatigue in adult patients with rheumatoid arthritis: Association with body awareness, demographic, disease-related, emotional and psychosocial factors2013In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 2, p. 293-300Article in journal (Refereed)
    Abstract [en]

    Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors. Method: Data were collected from a sample of patients with RA (n= 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 -80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied. Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.

  • 19.
    Manhica, Hélio
    et al.
    The Swedish Red Cross University College, Department of Health Sciences.
    Niemi, M.
    Karolinska Institutet.
    Gunnarsson, D.
    Södertörn University.
    Ståhle, G.
    Södertörn University.
    Larsson, Sofia
    The Swedish Red Cross University College.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Social participation, mental health in refugees and asylum seekers: A scoping review2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Suppl. 4, p. 482-482Article in journal (Other academic)
  • 20.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Elfstrom, Magnus L.
    Mälardalen University, Academy of Health, Care and Social Welfare, Eskilstuna/Västerås.
    Persson, Hans
    Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine.
    Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured2015In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, p. 239-248Article in journal (Refereed)
    Abstract [en]

    Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

    Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

    Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

    Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

  • 21.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet.
    Elfström, M. L.
    Mälardalen University.
    Persson, H.
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Implementation of coping effectiveness training in patients with chronic heart failure: participants evaluations indicate psychosocial benefits2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no S1, p. S10-S10Article in journal (Other academic)
  • 22.
    Nahlen Bose, Catarina
    et al.
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet / Sophiahemmet University.
    Elfström, Magnus L.
    Academy of Health, Care and Social Welfare, Mälardalen University.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
    Persson, Hans
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet.
    Saboonchi, Fredrik
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
    Patterns and the mediating role of avoidant coping style and illness perception on anxiety and depression in patients with chronic heart failure2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 704-713Article in journal (Refereed)
    Abstract [en]

    Introduction: Emotional distress in patients with chronic heart failure (CHF) predicts mortality, hospital readmission and quality of life. The patient's avoidant coping style and beliefs about the disease have been linked to emotional distress in CHF. However, the pattern and transmitting effects of these variables are indefinite.

    Aim: This study aimed to examine the links between and the potential mediating role of illness perceptions and avoidant coping style on depression and anxiety in patients with CHF.

    Method: Self-assessment data from 103 patients with CHF were subjected to path analysis in two hypothesised models. The outcome measures were coping styles, illness perception, anxiety and depression.

    Results: Avoidant coping had a direct adverse effect on anxiety and depression. The perception of symptom burden and personal control, significantly mediated the effect between avoidant coping and anxiety and depression.

    Conclusions: Avoidant coping style appears to influence not only emotional distress, but also a malignant symptom perception and low sense of control over the illness.

  • 23.
    Nahlen Bose, Catarina
    et al.
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Persson, Hans
    Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Björling, Gunilla
    The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital AB.
    Ljunggren, Gunnar
    Public Healthcare Services Committee Administration, Stockholm County Counsil; Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Medical Management Centre.
    Elfström, Magnus L.
    Mälardalen University, Academy of Health, Care and Social Welfare.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet; Department of Clinical Neuroscience, Division of Insurance Medicine, Administration.
    Evaluation of a Coping Effectiveness Training intervention in patients with chronic heart failure: a randomized controlled trial2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 537-548Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Impaired emotional well-being has detrimental effects on health outcomes in patients with chronic heart failure (CHF).AIMS:To evaluate a nurse-led Coping Effectiveness Training (CET) group intervention for patients with CHF. It was hypothesized that CET would increase emotional well-being (primary outcome) and health-related quality (HRQoL) of life and improve clinical outcomes. Furthermore, changes in appraisal and coping as mediators of the intervention effect were examined.

    METHODS: Participants were randomized to either control group (n=51) receiving standard health care or CET intervention group (n=52). Self-assessments of positive affect, negative affect, depression, anxiety, HRQoL, illness perception, coping strategies and social support were performed pre- and post-intervention and after six weeks, six months and 12 months. Time to death and hospitalizations were measured during the entire follow-up (median 35 months, interquartile range 11 months).

    RESULTS: No significant improvements for emotional well-being and HRQoL in the intervention group compared with the control group were found. After excluding patients with clinical anxiety and depression at baseline the intervention group had significantly lower negative affect (p = 0.022). There were no significant differences regarding cardiovascular events between the groups. The intervention group had greater sense of control over their illness in the short-term (p = 0.036).

    CONCLUSION: CET intervention was found to increase sense of control over the illness in the short term. Psychosocial support programmes, like CET, for patients with CHF is currently lacking evidence for implementing in clinical practice. However, the results provide a basis for future studies with a modified CET intervention design and increased study size.

  • 24.
    Nahlén, Catarina
    et al.
    Department of Cardiology Danderyd Hospital AB, S-182 88 Stockholm.
    Saboonchi, Fredrik
    Sophiahemmet University College, Stockholm.
    Coping, Sense of Coherence and the Dimensions of Affect in Patients with Chronic Heart Failure2010In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, ISSN 1474-5151, Vol. 9, no 2, p. 118-125Article in journal (Refereed)
    Abstract [en]

    Background: Living with chronic heart failure has an impact on several important dimensions of an individual's life. A patient's use of coping strategies may influence his or her health condition and emotional well-being.

    Aim: To investigate factors that may relate to the coping strategies used by individuals with chronic heart failure and how the coping strategies are associated with positive and negative affect.

    Methods: A cross-sectional research design was used. The participants provided demographic data and filled out three questionnaires: Sense of Coherence scale, Brief COPE and Positive Affect Negative Affect Schedule.

    Results: No differences in relation to coping strategies were found with regard to New York Heart Association class. Substance use was associated with gender and age. Sense of coherence was negatively associated with denial, behavioural disengagement, venting and self-blame, and positively associated with acceptance. It was found that avoidant coping positively and sense of coherence negatively, predicted negative affect. Problem focused coping positively predicted positive affect. Socially supported coping predicted both negative and positive affect.

    Conclusion: The present study found that the employment of different coping strategies and sense of coherence had an impact on affect and therefore also the emotional well-being among patients with chronic heart failure.

  • 25.
    Niemi, Maria
    et al.
    Karolinska Institutet.
    Manhica, Hélio
    Karolinska Institutet.
    Gunnarsson, David
    Södertörns högskola.
    Ståhle, Göran
    Södertörns högskola.
    Larsson, Sofia
    The Swedish Red Cross University College.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences.
    A Scoping Review and Conceptual Model of Social Participation and Mental Health among Refugees and Asylum Seekers2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 20, article id E4027Article in journal (Refereed)
    Abstract [en]

    Social participation plays a key role in the integration of refugees and asylum seekers into their host societies, and is also closely tied to the mental health of those populations. The aim of this scoping review was to study how the concept of social participation is described in empirical research, and how it is associated with mental health outcomes.

    METHODS: In total, 64 studies were identified through searches in PubMed, PsycInfo, and Sociological Abstracts. These studies describe various forms of social participation among refugees and asylum seekers, and 33 of them also addressed various forms of mental health outcomes.

    RESULTS: The identified studies described forms and conditions of social participation-both in the host country and transnationally-that could be synthesized into three broad dimensions: (1) Regulatory frameworks, conditions and initiatives; (2) Established societal organizations and social structures; and (3) Community organized groups. Each of these consisted of several sub-domains. The identified dimensions of social participation were also associated with psychosocial well-being and decreased psychological distress.

    CONCLUSIONS: There is a need for policies to enable and support the participation of refugees and asylum seekers in various dimensions of social structures in host societies. Social participation enhances resilience, re-establishes social lives, and acts as a protective factor against poor mental health outcomes.

  • 26.
    Nilsson, Marie I
    et al.
    Karolinska Institutet / Karolinska University Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Olsson, Mariann
    Karolinska Institutet.
    Wennman-Larsen, Agneta
    Karolinska Institutet / Sophiahemmet University.
    Petersson, Lena-Marie
    Karolinska Institutet .
    Changes in importance of work and vocational satisfaction during the 2 years after breast cancer surgery and factors associated with this2016In: Journal of cancer survivorship, ISSN 1932-2259, E-ISSN 1932-2267, Vol. 10, no 3, p. 564-572Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to investigate how women, during the 2 years following breast cancer surgery, rate importance of work and vocational satisfaction, and baseline factors associated with rating over time.

    METHODS: A prospective cohort study of 692 women aged 20-63 included about 4 weeks after a first breast cancer surgery. Register data on treatment and data from six repeated questionnaires during a 2-year follow-up (at baseline, 4, 8, 12, 18, 24 months) were used in two-way mixed repeated analysis of variance and mixed repeated measures analysis of covariance.

    RESULTS: The women rated importance of work (m = 3.74; sd 0.88) (maximum 5) and vocational satisfaction (m = 4.30; sd 1.38) (maximum 6) high during the 2 years. Women with planned chemotherapy rated lower vocational satisfaction and especially so at 4 months after inclusion (F 1, 498 = 8.20; p = 0.004). Higher age, better physical, and mental/social work ability at baseline influenced rating of vocational satisfaction. Supportive colleagues was an important covariate that significantly affected ratings of importance of work as well as vocational satisfaction, i.e., women with better support rated on average higher on these outcomes. The effect of chemotherapy disappeared after including the abovementioned baseline covariates.

    CONCLUSIONS: Women diagnosed with breast cancer in the following 2 years rate importance of work and vocational satisfaction high, which are associated to lower work ability and social support.

    IMPLICATIONS FOR CANCER SURVIVORS: Work is a very important aspect in life also after a cancer diagnosis, which has to be acknowledged when discussing treatment and rehabilitation plans with women with breast cancer. Furthermore, workplace support needs to be assessed as this is an influential factor.

  • 27.
    Nordhall, Ola
    et al.
    University of Gävle.
    Knez, Igor
    University of Gävle.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences.
    Predicting general mental health and exhaustion: the role of emotion and cognition components of personal and collective work-identity.2018In: Heliyon, ISSN 2405-8440, Vol. 4, no 8, article id e00735Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate relationships between emotion and cognition components of personal and collective work-identity and self-reported general mental health and exhaustion, in Swedish teachers (N = 768). In line with our predictions, we showed that the emotion component of personal work-identity and the cognition component of collective work-identity associated positively with general mental health and negatively with exhaustion. The reverse result was found, however, for the cognition component of personal work-identity and emotion component of collective work-identity. In general, all this indicates that person-work bonding might, to some degree, account for general mental health and exhaustion in employees. In particular, the findings suggest that general mental health and exhaustion may vary symmetrically across the: (1) Type of person-work bonding (personal vs. collective work-identity); and (2) Type of psychological component (emotion vs. cognition) involved in personal- and collective work-identity.

  • 28.
    Nymark, Carolin
    et al.
    Karolinska Institutet.
    Henriksson, Peter
    Karolinska Institutet.
    Mattiasson, Anne-Cathrine
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Kiessling, Anna
    Karolinska Institutet.
    Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 6, p. 512-520Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking.

    AIM: To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay.

    METHODS: A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis.

    RESULTS: The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay ( P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour.

    CONCLUSION: Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.

  • 29.
    Nymark, Carolin
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance medicine.
    Mattiasson, A-C
    Karolinska Institutet, Department of Neurobiology, Care Sciences and Society.
    Henriksson, P
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Kiessling, A
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Development and validation of an instrument to assess patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction: The PA-AMI questionnaire.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 3, p. 240-248Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions.

    AIM: The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction.

    METHODS: An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items.

    RESULTS: The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity CONCLUSIONS: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.

  • 30.
    Nürnberg Damström, D.
    et al.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm.
    Saboonchi, Fredrik
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Sackey, P. V.
    Institution of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm,.
    Björling, Gunilla
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    A preliminary validation of the Swedish version of the critical-care pain observation tool in adults2011In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, ISSN 0001-5172, Vol. 55, no 4, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background: Assessing pain in critically ill patients can be complicated, especially for those unable to communicate. A recently developed pain assessment tool, the Critical-Care Pain Observation Tool (CPOT), has been shown to be a reliable tool for pain assessment in the Intensive Care Unit (ICU). The aim of the study was to validate the Swedish version of the CPOT.

    Methods: Conscious and unconscious adults were observed during two procedures: one non-nociceptive procedure (NNP) (arm- and face wash) and one nociceptive procedure (NP) (turning). In total, there were 240 patient assessments pre-, per- and post-procedure performed by two independent staff members at rest, during and 15 min after the different procedures. Measures of interrater reliability, internal consistency and discriminant validity of the CPOT were obtained to examine the properties of the Swedish version of CPOT.

    Results: The results provide indications of good agreement between the independent raters (ICC=0.84). There was an adequate discriminant validity of the Swedish version of CPOT established by a significant peak for CPOT scores during the NP (per-procedure). There was also a consistent pattern of significant correlations between CPOT and the mean artery pressure (ρ=0.32–0.45).

    Conclusion: The Swedish version of the CPOT is a suitable instrument for assessing pain in critically ill adults. The overall reliability and validity measures converge with findings from previous studies of the CPOT, but in order to achieve enhanced generalizability of the CPOT, we encourage further evaluation of CPOT in broader groups of critically ill patients.

  • 31.
    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.

  • 32.
    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.

  • 33.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. University of Gävle.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Family conflict mediates the relationship between past violence and wellbeing among female refugees2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no Supplement_44, p. 408-Article in journal (Refereed)
    Abstract [en]

    Background: Past exposure to violence has been suggested to have a lasting effect on subjective well being (SWB). Similarly, family conflict is another known predictor of SWB. Research shows that refugee women exposed to gender based violence (GBV) before resettlement may also face post-resettlement family conflicts due to socio-cultural factors, changes in social network and migration-based shifting gender roles. This study examines the role of family conflict as a likely mediator between past exposure to violence and SWB among Syrian refugee women in Sweden.

    Methods: A total of 452 women out of a random sample of 1215 Syrian refugee women in Sweden responded to a questionnaire survey in Arabic. Variables include Past violence i.e. exposure to any of torture, physical or sexual violence preflight or during flight before arriving Sweden; Post-resettlement distressing family conflicts i.e. feeling disrespected or unimportant in the family or distressing conflicts; SWB was measured by WHO-5 wellbeing index. Maximum likelihood estimation with Robust standard errors and bias corrected bootstrapped 95% confidence intervals for all estimates.

    Results: Total effect of past violence on SWB was significant (Estimate = -6.63; CI = -12.73 - -0.46). Similarly, family conflicts were associated with decreased SWB (Estimate = -3.80; CI = -5.17 - -2.40), and past violence exposure increased family conflicts (Estimate = 0.57; 0.13 - 1.08). The total effect of violence exposure on decreased SWB was decomposed into a direct and an indirect effect (mediated via family conflicts). The indirect effect via family conflicts was significant (M = -2.19; C1 = -4.30 - 0.59), while decomposing rendered the direct effect non-significant (Estimate = -4.44, CI = -10.51 - 1.52).

    Conclusions: Post-resettlement distressing family conflicts mediate the effect of prior exposure to violence on reduced SWB among refugee women.

    Key messages: Past violence exposure reduces refugee women’s SWB via aggravated family conflicts implying the need for family targeted interventions to improve SWB of female refugees previously exposed to violence. Strategies to improve subjective wellbeing among female refugees should include screening for and addressing all forms of previous and ongoing GBV

  • 34.
    Okenwa-Emegwa, Leah
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. University of Gävle.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Mittendorfer-Rutz, E.
    Karolinska Institutet.
    Helgesson, M.
    Karolinska Institutet.
    Tinghög, Petter
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Prevalence and predictors of low future expectations among Syrian refugees resettled in Sweden2019In: Heliyon, ISSN 2405-8440, Vol. 5, no 10, article id e02554Article in journal (Refereed)
    Abstract [en]

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

  • 35.
    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.

  • 36.
    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. 

  • 37.
    Olt, Helen
    et al.
    Department of Neurobiology Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Jirwe, Maria
    Department of Neurobiology Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Saboonchi, Fredrik
    Red Cross University College of Nursing.
    Gerrish, Kate
    Department Nursing Research, School of Nursing and Midwifery, University of Sheffield.
    Emami, Azita
    University of Washington, School of Nursing and Biobehavioral Nursing and Health Systems, School of Nursing, Seattle; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
    Communication and equality in elderly care settings: Perceptions of first- and secondgeneration immigrant and native Swedish healthcare workers2014In: Diversity and equality in health and care, ISSN 2049-5471, E-ISSN 2049-548X, Vol. 11, no 2, p. 99-111Article in journal (Refereed)
    Abstract [en]

    An ethnically diverse healthcare workforce is considered beneficial to meeting the needs of an ethnically diverse population. In the UK and the USA, lack of equality and difficulties in communication between co-workers and patients from different ethnic backgrounds is problematic. Little is known about the ethnically diverse healthcare workforce in elderly care settings in Sweden. This paper compares native Swedish and first- and secondgeneration immigrant healthcare workers' perceptions of diversity in relation to equality and communication in elderly care settings. The study used a cross-sectional design with a survey administered by self-completed questionnaire. The Assess Awareness and Acceptance of Diversity in Healthcare Organizations questionnaire was distributed to healthcare workers in elderly care settings in one municipality in Sweden. Responses from 643 healthcare workers were analysed. A factor analysis was performed on 26 items in the questionnaire. Reliability analysis on the subscales was conducted using Cronbach's alpha. Differences between native and first- and second-generation immigrants were analysed using ANOVA followed by post-hoc tests. The results showed that first-generation immigrant and native Swedish healthcare workers had different views on equality and communication in four of the five subscales, namely care of elderly patients from different backgrounds, equality in the workplace, communication with diverse co-workers, and treatment by family and significant others from a different ethnic background. Second-generation immigrants held similar views to native Swedish healthcare workers on two factors, namely equality in the workplace and communication between co-workers from different backgrounds. There were no differences between the groups with regard to their views on self-awareness in collaboration with co-workers. Differences in the experiences of first- and secondgeneration healthcare workers should be acknowledged, rather than assuming that they share similar experiences as immigrants. Managers need to promote equality and effective communication among an ethnically diverse workforce.

  • 38.
    Petersson, Lena-Marie
    et al.
    Karolinska Institutet.
    Vaez, Marjan
    Karolinska Institutet.
    Nilsson, Marie I.
    Karolinska Institutet / Karolinska University Hospital.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet / Stockholm University.
    Alexanderson, Kristina
    Karolinska Institutet.
    Olsson, Mariann
    Karolinska Institutet.
    Wennman-Larsen, Agneta
    Karolinska Institutet / Sophiahemmet University.
    Sickness absence following breast cancer surgery: a two-year follow-up cohort study2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 715-724Article in journal (Refereed)
    Abstract [en]

    RATIONALE AND AIM: Most women of working ages with limited breast cancer (BC) have returned to work within the first year after diagnosis. However, little is known about what is happening during this year regarding sickness absence and return to work. Also, the knowledge is very limited about the occurrence of part-time sickness absence after BC diagnosis. Therefore, the aim of this study was to describe occurrence, extent and length of SA during a two-year follow-up after BC surgery and to analyse the association between being SA and type of cancer treatment.

    METHODS: In this prospective cohort study, 497 women responded to questionnaires about different aspects of sickness absence at six occasions during two years after primary BC surgery (at baseline and after 4, 8, 12, 18 and 24 months). Treatment information was obtained from the National breast cancer register. Multinomial logistic regression was used to calculate odds ratios (OR) for likelihood of being sickness absent more than once.

    RESULTS: Two-thirds of the women were sickness absent at baseline; this proportion decreased, especially during the first eight months. At 24 months, 13% were sickness absent. Of all women, 27% never reported sickness absence and 14% were sickness absent at most of the six survey times. At eight months, many had shifted from full- to part-time sickness absence. Women with chemotherapy and/or advanced BC surgery had higher ORs for being sickness absent at most of the follow-ups.

    CONCLUSIONS: Most women returned to work within the first eight months after BC surgery and of those sickness absent after that, most had been part-time sickness absent. Thus, it is important to differentiate between part- and full-time sickness absence in future studies. Special attention should be paid to the impact of chemotherapy and type of surgery on the likelihood of being sickness absent.

  • 39. Saboonchi, Fredrik
    Den skapande människans tolerans2012In: Tolerera: en antologi om intolerans och tolerans ur ett psykologiskt perspektiv / [ed] Jon Brunberg, Stockholm: Forum för levande historia , 2012, p. 17-37Chapter in book (Other (popular science, discussion, etc.))
  • 40.
    Saboonchi, Fredrik
    Stockholms universitet, Psykologiska institutionen.
    Perfectionsim: Conceptual, Emotional, Psychopathological, and Health-Related Implications2000Doctoral thesis, comprehensive summary (Other academic)
  • 41.
    Saboonchi, Fredrik
    et al.
    H.M. Queen Sophia University College of Nursing, Box 5605, 1114 86 Stockholm.
    Lundh, Lars-Gunnar
    Department of Social Science, Mid Sweden University, S-831 25 Östersund.
    Perfectionism, anger, somatic health, and positive affect2003In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, ISSN 0191-8869, Vol. 35, no 7, p. 1585-1599Article in journal (Refereed)
    Abstract [en]

    The associations between perfectionism, anger, somatic health, and positive affect were examined in 184 Swedish adults from a randomly selected population sample. Somewhat unexpectedly, trait anger was found to be associated with self-oriented perfectionism rather than with socially prescribed perfectionism. Both socially prescribed perfectionism and self-oriented perfectionism showed weak positive correlations with self-reported somatic complaints, particularly symptoms of tension and fatigue, and more clearly in women than in men, whereas other-oriented perfectionism appeared as a predictor of whether the participants were undergoing medical treatment or not. Finally, the results did not support the notion of self-oriented perfectionism representing a positive, adaptive dimension of perfectionism; on the contrary, this dimension was found to be negatively associated with positive affect.

  • 42.
    Saboonchi, Fredrik
    et al.
    Department of Psychology, Stockholm University, S-106 91, Stockholm.
    Lundh, Lars-Gunnar
    Department of Psychology, Stockholm University, S-106 91, Stockholm.
    Perfectionism, self-consciousness and anxiety1997In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, ISSN 0191-8869, Vol. 22, no 6, p. 921-928Article in journal (Refereed)
    Abstract [en]

    The relation between perfectionism, anxiety, and self-consciousness was studied in a normal sample. The perfectionism dimensions of Concern over Mistakes, Doubts about Action, and Socially Prescribed Perfectionism showed a pattern of correlations not only with measures of social anxiety, but also with measures of agoraphobic fears, and fears of bodily injury, death and illness. Public self-consciousness also correlated with various measures of anxiety, but these correlations disappeared when the relevant dimensions of perfectionism were controlled for. It is concluded that perfectionism is a more relevant construct in the study of anxiety than is public self-consciousness. The results are discussed in terms of possible causal relationships between perfectionism and anxiety.

  • 43.
    Saboonchi, Fredrik
    et al.
    Department of Psychology, Stockholm University, Stockholm, SE-106 91.
    Lundh, Lars-Gunnar
    Department of Psychology, Stockholm University, Stockholm, SE-106 91.
    State Perfectionism and its Relation to Trait Perfectionism, Type of Situation, Priming, and Being Observed1999In: Scandinavian Journal of Behaviour Therapy, ISSN 0284-5717, ISSN 0284-5717, Vol. 28, no 4, p. 154-166Article in journal (Refereed)
    Abstract [en]

    Perfectionism is normally viewed as a multidimensional personality trait. In the present experimental study, perfectionism was treated as a state in which transient changes were produced through manipulation of 2 factors: being observed by others and verbal priming. The experiment was carried out in 2 different situations: a social encounter situation and a problem-solving situation. Partial support for the hypothesis that both priming and observation cause elevated degrees of perfectionism was found in the social encounter situation. In the problem-solving situation, observation produced some effects, although partly in an unexpected direction. A significant interaction effect between priming and observation was found on estimating performance on a memory task in the problem-solving situation. The state approach to perfectionism and the stability of perfectionism across situations are discussed on the basis of the findings.

  • 44.
    Saboonchi, Fredrik
    et al.
    Department of Psychology, Stockholm University, 106 91 Stockholm.
    Lundh, Lars-Gunnar
    Department of Psychology, Stockholm University, 106 91 Stockholm.
    Öst, Lars-Göran
    Department of Psychology, Stockholm University, 106 91 Stockholm.
    Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia1999In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, ISSN 0005-7967, Vol. 37, no 9, p. 799-808Article in journal (Refereed)
    Abstract [en]

    Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921–928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.

  • 45.
    Saboonchi, Fredrik
    et al.
    Red Cross University College of Nursing. Stress Research Institute, University of Stockholm, Stockholm.
    Perski, Aleksander
    Stress Research Institute, University of Stockholm, Stockholm.
    Grossi, Giorgio
    Stress Research Institute, University of Stockholm, Stockholm.
    Validation of Karolinska Exhaustion Scale: psychometric properties of a measure of exhaustion syndrome2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 1010-1017Article in journal (Refereed)
    Abstract [en]

    Background

    The syndrome of exhaustion is currently a medical diagnosis in Sweden. The description of the syndrome largely corresponds to the suggested core component of burnout, that is exhaustion. Karolinska Exhaustion Scale (KES) has been constructed to provide specific assessment of exhaustion in clinical and research settings.

    Aim

    The purpose of the present study was to examine the psychometric properties of this scale in its original and revised versions by examining the factorial structure and measures of convergent and discriminant validity.

    Methods

    Data gathered from two independent samples (n1 = 358 & n2 = 403) consisting of patients diagnosed with ‘reaction to severe stress, and adjustment disorder’ were subjected to confirmatory factor analysis. The study's instruments were Karolinska Exhaustion Scale and Shirom Melam Burnout Measure. Correlation analyses were employed to follow up the established factorial structure of the scale. The study was ethically approved by Karolinska Institute regional ethic committee.

    Results

    The findings demonstrated adequate fit of the data to the measurement model provided by the revised version of KES Limitations: The main limitation of the present study is the lack of a gold standard of exhaustion for direct comparison with KES. (KES-26) and partially supported convergent validity and discriminant validity of the scale.

    Conclusion

    The demonstrated psychometric properties of KES-26 indicate sound construct validity for this scale encouraging use of this scale in assessment of exhaustion. The factorial structure of KES-26 may also be used to provide information concerning possible different clinical profiles.

  • 46.
    Saboonchi, Fredrik
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine. Karolinska Institutet.
    Petersson, Lena-Marie
    Karolinska Institutet.
    Alexanderson, Kristina
    Karolinska Institutet.
    Bränström, Richard
    Karolinska Institutet.
    Wennman-Larsen, Agneta
    Karolinska Institutet / Sophiahemmet.
    Expecting the best and being prepared for the worst: structure, profiles, and 2-year temporal stability of dispositional optimism in women with breast cancer2016In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 25, no 8, p. 957-963Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Dispositional optimism is viewed as a key personality resource for resiliency and has been linked to adjustment among women with breast cancer. The aim was to examine (a) the psychometric proprieties of Life Orientation Test-Revised (LOT-R), (b) the potential independence and co-occurrence of positive and negative dimensions of future outcome expectancies, (c) the longitudinal invariance of LOT-R and the temporal stability of dispositional optimism over 2 years following surgery, and (d) the predictive impact of optimism and pessimism on emotional distress among women with breast cancer.

    METHODS: Data from a prospective study (n = 750) of women with breast cancer were acquired shortly after surgery, and the women were followed up for 2 years. Assessments of LOT-R, Hospital Anxiety and Depression Scale, treatment-related, and demographic variables were subjected to structural equation modeling analysis.

    RESULTS: A bidimensional and temporarily invariant structure of LOT-R displayed acceptable fit indices. Three profiles of future expectancies consisting of optimists, pessimists, and ambiguous were identified. Temporal stability in optimism and pessimism over 2 years was established. Women with higher education displayed higher degrees of pessimism. Baseline dispositional optimism inversely predicted emotional distress at 2 years.

    CONCLUSIONS: The LOT-R should be approached as a bidimensional measure. Co-occurrence of optimism and pessimism may indicate a cautious defensive coping effort in women with breast cancer. The importance of systematic efforts to enhance optimism as well as the capacity to acknowledge both positive and negative future expectancies is emphasized. Copyright © 2015 John Wiley & Sons, Ltd.

  • 47.
    Saboonchi, Fredrik
    et al.
    Red Cross University College of Nursing. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Wennman-Larsen, Agneta
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden / Sophiahemmet University College, Stockholm, Sweden.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Swede.
    Brännström, Richard
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Vaez, Marjan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Changes in caseness of anxiety and depression in breast cancer patients during the first year following surgery: Patterns of transiency and severity of the distress response.2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 6, p. 598-604Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress.

    AIM: To examine the transiency of distress response in breast cancer patients by investigating the changes in clinical caseness of depression and anxiety during one year following surgery.

    METHODS: Data on the Hospital Anxiety and Depression Scale from a cohort of 715 women with breast cancer on three assessments within one year following breast surgery were subjected to Generalized Estimation Equation Analysis, McNemar's test, and logistic regression.

    RESULTS: There was a significant decrease in the proportions of anxiety cases from baseline (37.7%) to 4 months (26.7%) but no significant change from 4 to 12 months. Caseness in depression significantly increased from baseline (18.5%) to 4 months (21.5%) but decreased to 15.3% at 12 months. Only experience of major adverse life events contributed to 12 months caseness of anxiety and depression beyond baseline caseness.

    DISCUSSION: The average decrease in caseness of anxiety and depression a year following surgery lends support to the view of distress as a transient non-pathological response. A subgroup of patients, however, displayed enduring or recurrent severe distress indicating the presence of potential disorder. The findings emphasize the importance of screening and follow up monitoring of distress.

  • 48.
    Saboonchi, Fredrik
    et al.
    The Swedish Red Cross University College, Department of Public Health and Medicine. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Wennman-Larsen, Agneta
    Sophiahemmet University College.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Vaez, Marjan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Centre for Occupational and Environmental Medicine, Stockholm County Council.
    Trajectories of anxiety among women with breast cancer: A proxy for adjustment from acute to transitional survivorship.2015In: Journal of psychosocial oncology, ISSN 0734-7332, E-ISSN 1540-7586, Vol. 33, no 6, p. 603-619Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination.

    AIM: To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within two years following BC surgery.

    METHODS: Survey data from a two-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and analysis of variance.

    RESULTS: A piece wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified of which a High Stable anxiety class showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties.

    CONCLUSION: Our results support an emphasize on the transitional nature of the stage that follows the end of primary active treatment, and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

  • 49.
    Saboonchi, Fredrik
    et al.
    Red Cross University College of Nursing. Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet / Stress Research Institute, University of Stockholm.
    Wennman-Larsen, Agneta
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Petersson, Lena-Marie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet.
    Examination of the construct validity of the Swedish version of Hospital Anxiety and Depression Scale in breast cancer patients2013In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 22, no 10, p. 2849-2856Article in journal (Refereed)
    Abstract [en]

    Purpose

    To examine the construct validity of the Swedish version of Hospital Anxiety and Depression Scale (HAD) in women with breast cancer.

    Method

    Acquired data on HAD from 727 women who recently had breast cancer surgery, were aged 20–63 years and worked before diagnosis, and had no previous breast cancer (n = 725) were subjected to confirmatory factor analysis examining the viability of three hypothesized measurement models.

    Results

    The analysis showed adequate fit to the data for both bi-dimensional and three-factorial models of HAD. The single-factorial model, however, was shown to have inferior fit to the data. Substantive correlations were found between anxiety and depression in the bi-dimensional model, and negative affectivity and anxiety in the three-factorial model of HAD.

    Conclusions

    The findings support the utility of scoring procedure based on the original bi-dimensional model, but add indication of co-occurrence of anxiety and depression in this patient population. The discriminant validity of a third factor of negative affectivity in a three-factorial model, however, remains unclear.

  • 50.
    Sengoelge, Mathilde
    et al.
    The Swedish Red Cross University College. Karolinska Institutet.
    Johnson-Singh, Charisse M
    The Swedish Red Cross University College. Karolinska Institutet.
    Mittendorfer-Rutz, Ellenor
    Karolinska Institutet.
    Vaez, Marjan
    Karolinska Institutet.
    Saboonchi, Fredrik
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Identifying subgroups of refugees from Syria resettled in Sweden based on multiple trauma exposures: A latent class analysis of trauma history and mental health outcomes.2019In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 125, article id 109814Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes.

    METHODS: Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD.

    RESULTS: Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes.

    CONCLUSIONS: There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.

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