Peer-reviewed papers by Kristian Wahlbeck
The Lancet Psychiatry, 2025
Background
Clozapine is recommended by national and international guidelines for people with trea... more Background
Clozapine is recommended by national and international guidelines for people with treatment-resistant schizophrenia. However, available meta-analyses of randomised controlled trials have not shown superior efficacy of clozapine when compared with other second-generation antipsychotics, with heterogeneity identified between the original studies. We aimed to use individual patient data (IPD) to account for potential reasons of variability and to synthesise an adjusted estimate for the difference in efficacy between clozapine and other second-generation antipsychotics for treatment-resistant schizophrenia.
Methods
In this systematic review and IPD meta-analysis, we searched the Cochrane Schizophrenia Group's Study-Based Register from inception to Jan 24, 2024, and previous reviews for blinded randomised controlled trials comparing clozapine with other second-generation antipsychotics in participants with treatment-resistant schizophrenia. Trials were eligible if they included patients with treatment-resistant schizophrenia and had a duration of at least 6 weeks. IPD were requested from trial investigators. The primary outcome was change in overall schizophrenia symptoms as measured by the Positive and Negative Syndrome Scale (PANSS) between clozapine and other second-generation antipsychotics after 6-8 weeks of treatment. The effect size measure for the primary outcome was mean difference with 95% credible interval (CrI). We fitted a Bayesian random-effects IPD meta-regression model that included duration of illness, baseline severity, and sex as potential prognostic factors or treatment effect modifiers. Confidence in the evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). People with lived experience of mental illness were involved in this study. This study is registered with PROSPERO, CRD42021254986. Findings
We screened 13 876 references and included 19 studies with data for 1599 participants; IPD were available for 12 of 19 trials (n=1052; mean age 37•67 years [SD 11•24; range 10-66]; 348 [33•08%] women and 704 [66•92%] men). Data on ethnicity were not available. The estimated mean difference in change from baseline PANSS total score was-0•64 points (95% CrI-3•97 to 2•63; τ=2•68) in favour of other second-generation antipsychotics. Shorter duration of illness and higher baseline severity were prognostic factors associated with a larger reduction in symptoms, but neither those factors nor sex were found to modify the relative effect between clozapine and other second-generation antipsychotics. The confidence in the evidence was graded as very low.
Interpretation
This IPD meta-analysis found a small and uncertain advantage of other second-generation antipsychotics, mainly olanzapine and risperidone, and so did not provide evidence for superior efficacy of clozapine compared with other second-generation antipsychotics in treatment-resistant schizophrenia. It is limited by unavailability of IPD for some studies, uncaptured sources of variance, and uncertainty due to premature study discontinuation. Given the side-effects of clozapine, the observed uncertainty regarding clozapine's superiority warrants prudent use and further research.
![Research paper thumbnail of Att främja psykisk hälsa – ett centralt mål för folkhälsoarbetet [Mental health promotion is at the core of public health]](https://attachments.academia-assets.com/120685313/thumbnails/1.jpg)
Finska Läkaresällskapets Handlingar, 2024
Trots positiva trender i den fysiska folkhälsan har liknande framsteg inte setts i den psykiska h... more Trots positiva trender i den fysiska folkhälsan har liknande framsteg inte setts i den psykiska hälsan. Att främja den psykiska hälsan är därför ett centralt mål i det hälsofrämjande arbetet.
Grunden för den psykiska hälsan läggs i barndomen, och därför behövs främjande och förebyggande insatser för i synnerhet barn och unga. Tidiga insatser för att främja den psykiska hälsan är kostnadseffektiva, men genomförs inte i tillräckligt hög grad trots att investeringar i barns och föräldrars psykiska välbefinnande ger hög avkastning för samhället. Hälso- och sjukvården har en viktig roll i arbetet för bättre psykisk hälsa, men fler insatser för den psykiska folkhälsan behövs inom alla samhällssektorer. På individnivå kan alla träna sina färdigheter i psykisk hälsa, men den negativa trenden inom psykisk hälsa kräver även en välfärdsorienterad samhällspolitik.
International Archives of Occupational and Environmental Health, 2024
Objective:
To determine if and which types of organisational interventions conducted in small and... more Objective:
To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.
Methods:
Following PRISMA guidelines, we searched six scientifc databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.
Results:
We identifed 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifcations” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.
Conclusion:
Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.
Journal of Public Mental Health, 2023
Purpose
The purpose of this study is to systematically review how positive mental health literac... more Purpose
The purpose of this study is to systematically review how positive mental health literacy has been conceptualised and measured over the last 20 years. Positive mental health recognises the benefits of feeling good and functioning effectively. Developing clarity around conceptualisation and knowledge (or literacy) of what constitutes positive mental health is an area of continued development, and an important step in measuring the impact of mental health promotion.
Design/methodology/approach
A systematic review of literature was performed to investigate how positive mental health literacy has been conceptualised and measured over the last 20 years. Databases searched included EDS, Scopus, ERIC, PsycINFO, CINAHL and SocIndex with fulltext. Search terms relating to positive mental health were combined with proximity operators within four words denoting knowledge, competence or literacy.
Findings
A total of 464 records were assessed on title level, with six articles included for final review. The final studies included three measures assessing participants’ knowledge of positive mental health, some of which included more distal themes such as awareness of coping strategies and emotional awareness. One measure, the Mental Health Promoting Knowledge – 10, stood out as the most fitting measure of positive mental health literacy.
Research limitations/implications
Our review approaches an under reported area of study, highlighting an area in need for further development with a few limitations. When building the search strategy, care was taken to line it up with literacy around positive mental health and its synonyms. The word “mental health” without positive specification was omitted in the final search strategy, increasing the risk of it also omitting potential articles of interest.
Practical implications
Our findings therefore highlight a knowledge gap in relation to conceptualisations and measures of positive mental health literacy, unfolding an area for further development. A more harmonised understanding of what is meant by positive mental health is an important step towards clarifying the concept and facilitating future study of the topic. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Social implications
New ways of measuring positive mental health literacy can be a useful way to establish benefits of mental health promotion, taking a salutogenic approach to mental health.
Originality/value
These findings expose an apparent knowledge gap in relation to conceptualisations and measures of positive mental health literacy, highlighting an area in need for further development. Measures of positive mental health literacy could be an important indicator for mental health promotion.
PLOS One, 2022
Objectives: This systematic review assesses the scientific evidence regarding the effectiveness o... more Objectives: This systematic review assesses the scientific evidence regarding the effectiveness of organisational-level workplace mental health interventions on stress, burnout, non-clinical depressive and anxiety symptoms, and wellbeing in construction workers.
Methods: Eligibility criteria were randomized controlled trials(RCTs), clusterrandomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic SearchComplete, Psy-cInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO (CRD42020183640).
International Journal of Environmental Research and Public Health, 2022
Mental health is largely shaped by the daily environments in which people live their lives, with ... more Mental health is largely shaped by the daily environments in which people live their lives, with positive components of mental health emphasising the importance of feeling good and functioning effectively. Promoting mental health relies on broad-based actions over multiple sectors, which can be difficult to measure. Different types of Impact Assessment (IA) frameworks allow for a structured approach to evaluating policy actions on different levels. A systematic review was performed exploring existing IA frameworks relating to mental health and mental wellbeing and how they have been used. A total of 145 records were identified from the databases, from which 9 articles were included in the review, with a further 6 studies included via reference list and citation chaining. Five different mental-health-related IA frameworks were found to be implemented in a variety of settings, mostly in relation to evaluating community actions. A Narrative Synthesis summarised key themes from the 15 included articles. Findings highlight the need for participatory approaches in IA, which have the dual purpose of informing the IA evaluation and advocating for the need to include mental health in policy development. However, it is important to ensure that IA frameworks are user-friendly, designed to be used by laypeople in a variety of sectors and that IA frameworks are operational in terms of time and monetary resources.
International Journal of Environmental Research and Public Health, 2022
Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced ... more Background: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age.
Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables.
Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.
Journal of Community Psychology, 2022
The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital int... more The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital into an open site for mental health promotion. The current study uses qualitative methods to explore how the initiative may promote population mental health. The phenomenological study comprised of data from 7 focus group including 28 parti-cipants. Resulting data were thematically analysed to ar-ticulate how the initiative supports mental wellbeing indifferent ways. Mental health benefits were categorizedinto three themes; mental health value, civil values andcommon values which were comprised of nine subthemes;paradigm shift, social inclusion, personal meaning, re-generation, ambience, stigma, sustainability, democracyand environment. Mental health promotion emphasises theimpact of daily environments in which people live theirlives. Results from this study support the use of broadbased actions which promote different components ofmental wellbeing simultaneously. Psychiatric hospitals mayoffer historically meaningful sites for such actions.
Health Expectations, 2021
Background: Psychiatric rehospitalization is a complex phenomenon in need of more person-centred ... more Background: Psychiatric rehospitalization is a complex phenomenon in need of more person-centred approaches. The current paper aimed to explore how community-based actions and daily life influence mental health and rehospitalization.
Design, setting and participants: The qualitative study included focus group data from six European countries including 59 participants. Data were thematically ana-lysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health.
Results: Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (comple-menting services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning).
Discussion: Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal re-covery. By articulating the value of these facilitators, we highlight benefits of a per-son-centred and recovery-focused approach also within the context of psychiatric rehospitalization.
Conclusions: This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilita-tors, acknowledging the social determinants of mental health and personal recovery.
| 175CRESSWELL-SMITH ETaL.1 | BACKGROUNDThere is a growing interest in how the social, economic and physical environments may support mental health,1-5 with contemporary approaches placing increased focus on the social determinants and the importance providing opportunities for meaningful activities, reducing social exclusion and enhancing community connected-ness.6-9 A well-cited definition by the World Health Organisation (WHO) defines mental health as 'A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community',10 (p.1) underlining the importance of peoples’ everyday actions on men-tal health.Mental health can therefore be promoted both by health-care services and by community-based initiatives, which foster positive mental health, prevent mental disorders and should be included across all policy sectors.11-13 This approach is also endorsed by the WHO Optimal Mix of Services for Mental Health, which emphasizes the need for easily available and balanced mental health services,14while placing considerable emphasis on the value of community and self-care actions.15 Psychiatric rehospitalization is a complex phe-nomenon that has been reported to hamper the recovery process16and be unfavourable in terms of quality and cost of health care.17Psychiatric rehospitalization is a good example where comprehen-sive approaches may be beneficial.17–2 2 These approaches may also be incorporated prior to hospital discharge, for example ensuring access to meaningful activities, and engaging in signposting and planning for community life during the hospital stay.23-25 Such ap-proaches reflect a person-centred ethos where individuals' unique experiences are attended to in a holistic manner and highlight the need for organizing services, organizations, families and communi-ties accordingly.26,27Although a clear definition of person-centred approaches has not yet been formalized,28 it generally reflects health-care practices where the patients’ perspective and a focus on patient-reported out-comes are prioritized.29, 3 0 Person-centred approaches may include recovery-based thinking, which has its roots in service user–led contexts and has gained momentum also within mental health ser-vices.31 The recovery model redefines how we view mental health difficulties, nurturing empowerment and participation in society.32,33Personal recovery can be thought of as a highly subjective experi-ence around goals, relationships and skills that support a positive life with or without on-going mental health difficulties.34 Although not universally defined, the model acknowledges that mental health treatment may at times be necessary, but views it as one building block in the recovery process, which should also support 'everyday solutions to everyday problems'(Slade 2012).35,36The aim of the current paper was to explore how attention to community-based actions may support person-centred approaches in relation to psychiatric rehospitalization using qualitative data from the Comparative Effectiveness Research on Psychiatric Hospitalisation by Record Linkage of Large Administrative Data Sets (CEPHOS-LINK) project (www.cephos-link.org). Previous pa-pers from the project report on psychiatric rehospitalization using quantitative register-based methodology18 and explore meanings and experiences of the phenomenon qualitatively both in general terms24 and more specifically how it can be avoided.23 The current paper furthers this line of enquiry via a secondary analysis looking at how participants relate community-based actions and day-to-day activities to their mental health. By articulating what actions indi-viduals with experience of psychiatric rehospitalization themselves deem useful for their mental health, we not only illuminate these actions but also may promote the development of person-centred approaches in relation to psychiatric rehospitalization.2 | METHODSThe CEPHOS-LINK project studied psychiatric rehospitalization quantitatively and qualitatively in six different countries: Austria (At), Finland (Fin), Italy (It), Norway (Nor), Romania (Rom) and Slovenia (Sl). Ethical approval was sought from leading ethical committees in all participating countries, and informed consent was given by all participants who participated in the qualitative study. A focus group methodology was employed in order to gain insight into lived ex-perience of psychiatric rehospitalization. The reasoning behind this approach related to its suitability for generating insights into experi-ences, views and meanings through the process of shared discus-sion derived from both the individual and the groups.37 Furthermore, focus groups allow for exploring responses to questions not only in relation to the interview guide, but also in terms of digressions and Patient or public contribution: The current study included participants with ex-perience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study
Psychiatria Fennica, 2021
Mental health and substance abuse services (MHS) have gone through major changes throughout Weste... more Mental health and substance abuse services (MHS) have gone through major changes throughout Western countries. In searching for best practices, there is a need for benchmarking data on ways to allocate resources and organize services. In Finland, the closing of psychiatric hospitals during the last 50 years has partly led to transinstitutionalization to non-hospital residential services. We set out to study the provision of beds and personnel resources in non-hospital residential services in southern Finland, and whether the residential services' personnel resources and primary care orientation of services predict the total personnel costs of the MHS. We mapped the MHS with the European Service Mapping Schedule-Revised (ESMS-R). For the statistical analysis, we used the Spearman correlation and linear regression models. There were 333 non-hospital residential service beds per 100,000 adults and 119.5 full-time equivalent (FTE) personnel per 100,000 adults in the nonhospital residential services. The personnel resources in the hospital and non-hospital residential services were both significant predictors of total personnel costs. The association between non-hospital personnel and total personnel costs was not explained by sociodemographic indicators of the need for services. Of the personnel in the non-hospital residential services, 0.8% were physicians, 16.8% were nurses, 0.1% were psychologists, 0.6% were social workers and 82% were other professionals (mostly auxiliary nurses). Non-hospital residential services are a significant part of the MHS in Finland, and special attention should be paid to the coordination and the quality of care in these institutions.
Voluntary Sector Review, 2021
Civil society in general is widely recognised as having an important role in addressing the socia... more Civil society in general is widely recognised as having an important role in addressing the social determinants of health. Non-governmental organisations (NGOs) have a long history of mental health actions, ranging from mental health promotion and advocacy to volunteer work and service provision. An explicit focus on the social determinants of mental health is a more recent development. In this article we review relevant literature on NGO actions on key social determinants of mental health: family; friends and communities; education and skills; good work; money and resources; housing; and surroundings. Searching of relevant bibliographic databases was combined with searching for relevant grey literature to identify relevant evidence and practice on the work of NGOs in this field. We reflect on the inherent tensions involved in understanding the role of NGOs in taking action on the social determinants of mental health and the critical questions raised as a result. Our review highlights a lack of documented evidence of NGO actions, and underscores the significant untapped potential of civil society to contribute to the Mental Health in All Policies (MHiAP) agenda.
Aging & Mental Health, 2021
Objective: The aim of this study is to identify and appraise existing instruments to evaluate men... more Objective: The aim of this study is to identify and appraise existing instruments to evaluate mental well-being in old age.
Method: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell’Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL).
Conclusion: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.
![Research paper thumbnail of Itsemurhien ehkäisy ja itsemurhaa yrittäneen hoito [Treatment of suicidal patient and suicide prevention in health care]](https://attachments.academia-assets.com/105887754/thumbnails/1.jpg)
Duodecim, 2020
[In English below]
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveyde... more [In English below]
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveydenhuollossa on myös monitekijäistä kohdistuen prosessin eri vaiheisiin.
Itsemurhaa yrittäneet tulee somaattisen akuuttihoidon jälkeen arvioida psykiatrian erikoislääkärin tai psykiatriaan perehtyneen lääkärin johdolla. Itsemurhaa yrittänyt nuori kuuluu aina erikoissairaanhoidon arvioon.
Itsemurhaa yrittäneen kanssa on syytä käydä läpi koko itsemurhayritykseen johtanut tapahtumaketju. Itsemurha-ajatuksista kysyminen ei suurenna itsemurhan riskiä. Itsemurhaa yrittäneet kärsivät yleensä mielenterveyden häiriöistä ja päihdeongelmista.
Itsemurhayrityksen jälkeisen hoidon tulee olla aktiivista ja viiveetöntä. Sen intensiteetti perustuu huolelliseen tilannearvioon niin ajankohtaisesta itsetuhoisuudesta kuin akuuteista psykiatrisista ja psykososiaalisista tarpeista. Itsemurhaa yrittäneen psykiatrinen jatkohoito voidaan useimmiten toteuttaa psykiatrisessa avohoidossa. Psykiatrisen sairaalahoidon tarvetta arvioitaessa huomioidaan psykiatrisen häiriön vaikeusaste, erityisesti mahdollinen psykoottisuus, syvä toivottomuus tai tilan hallitsematon epävakaus, välitön itsemurhavaara ja mielenterveyslain mukaisen tahdosta riippumattoman hoidon tarve.
Itsetuhoisuuteen kohdennetut hoitointerventiot voivat merkittävästi pienentää itsemurhayrityksen uusimisen riskiä. Tutkittuja interventioita ovat kognitiivis-behavioraaliset itsetuhokäyttäytymisen ehkäisyyn suunnatut psykoterapiat, turvasuunnitelmainterventio, Linity/Assip-lyhytinterventiot ja dialektinen käyttäytymisterapia epävakaan persoonallisuuden yhteydessä.
Terveydenhuollossa on syytä kehittää itsemurhaa yrittäneiden arviointia ja lisätä tutkittujen interventioiden saatavuutta. Mielenterveyden häiriöt, sisältäen päihdehäiriöt, tulee hoitaa hyvin itsemurhayritysten ja itsemurhien ehkäisemiseksi.
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This guideline focuses on the assessment and treatment of suicidal patients and describes current knowledge on the prevention of suicides by health care interventions and in health care settings among youths, adults and the elderly. Comprehensive assessment and evidence -based interventions such as safety plan and CBT focused on suicidality are recommended. Easy accessible diverse evidence -based treatment of psychiatric disorders is essential, a majority of suicidal patients suffer from psychiatric disorders. Recommendations of pharmacological treatments with e.g. lithium, clozapine or ketamine relate to concurrent psychiatric disorders.
![Research paper thumbnail of Itsemurhaa yrittäneen psykiatrinen hoito -kysy, kuuntele ja hoida perussairaus [Psychiatric assessment of suicide attempters – ask, listen and ensure appropriate care]](https://attachments.academia-assets.com/66131955/thumbnails/1.jpg)
Lääkärilehti, Sep 18, 2020
• Suomi on kansainvälisesti verrattuna suurten itsemurhalukujen maa, vaikka viime vuosikymmeninä ... more • Suomi on kansainvälisesti verrattuna suurten itsemurhalukujen maa, vaikka viime vuosikymmeninä kuolemat ovat pääsääntöisesti vähentyneet.
• Itsetuhoinen käyttäytyminen liittyy useimmiten psykiatriseen sairauteen tai päihdeongelmiin.
• Itsemurhayrityksen jälkeen keskeisiä ovat strukturoitu psykiatrinen arvio, turvasuunnitelman tekeminen ja aktiivinen perussairauksien hoito.
• Lääkärin lakisääteiset velvoitteet ja läheisten tilanne tulee huomioida.
• Psykososiaalisia, muuhun hoitoon liitettäviä lyhyitä erillisinterventioita tutkitaan aktiivisesti
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This review focuses on the assessment and treatment of suicide attempters in line with the national evidence-based draft Current Care guideline on the assessment and treatment of suicidal patients. Internationally, Finland has been a country of high suicide rates, though during the last two decades the number of suicide deaths has greatly diminished. Among women the Finnish suicide rates are currently close to those of other Nordic countries and among men slightly higher. Suicide risk is elevated in some psychiatric disorders, especially major depression, bipolar disorder and schizophrenia. Thus, easily accessible evidence-based mental health services are part of effective suicide prevention in health care.
For suicide attempters, a psychiatric assessment is advised as soon as physical and cognitive recovery is sufficient to allow a comprehensive psychiatric examination. This includes careful assessment of psychiatric and substance-use disorders and their current treatment, risk and protective factors for a new suicide attempt, and current major life-events. In addition to other psychiatric treatment, use of a safety plan is recommended, and especially for adolescents it is important to include parents or close ones in preparation of the safety plan. Non-suicidal self-injury should be noted. Among the elderly, increasing limitations related to illnesses and ability to function, and loneliness need to be taken into account. Psychosocial interventions such as cognitive-behavioural therapy (CBT) focused on the suicide attempt are advised in addition to good clinical care of psychiatric disorders. Bereaved close ones and all those involved may need support after a suicide death. Psychosocial care and support is available through several providers including non-governmental organizations, and for some CBT-based psychosocial group interventions may be beneficial.
Duodecim, 2020
(English below)
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisill... more (English below)
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisillä esiintyviä mielenterveyden häiriöitä, jotka tulee tunnistaa kaikkialla terveydenhuollossa.
– Laajamittaisen järkyttävän tilanteen jälkeen niitä voi esiintyä runsaasti. Psykososiaalisen tuen ja palvelujen järjestämisellä ja aktiivisella seurannalla on merkitystä heti poikkeuksellisen järkyttävän tapahtuman jälkeen.
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The updated Current Care Guidelines for PTSD includes assessment and treatment of acute stress reaction (ASR), acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in all age groups. Psychosocial support and active monitoring are recommended after a potentially traumatic event. If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is effective, but evidence on other pharmacological options and on treatment combinations is limited. Specific groups, such as first responders, military and peacekeeping personnel may require tailored interventions.
Journal of Happiness Studies, 2020
The oldest-old population is increasing in Europe, and greater focus is placed on promoting menta... more The oldest-old population is increasing in Europe, and greater focus is placed on promoting mental well-being (MWB) in this population. The European Welfare Models and Mental Wellbeing in Final Years of Life project aims to develop a better understanding of how best to promote positive MWB in the oldest-old population. Using a resources approach, the present study aimed to provide empirical evidence about the structure of MWB in the 80 + year age group and to compare this with the structure of MWB in the old (65–79 years) and adult (18–64 years) population. Twenty-eight items reflecting a focus on positive aspects of MWB were selected from the European Social Survey data (24 countries). After application of an exploratory approach using Exploratory Structural Equation Modelling, five- and six-factor model solutions were found to be statistically appropriate, and the results are consistent with the most widely studied dimensions of MWB. Despite specific differences in the factor models and item loadings, evaluation of formal invariance showed that dimensions built in the same way are comparable across age groups. Although explorative and not conclusive, the results of this study contribute insights into the multidimensional structure of MWB in the oldest-old population and provide a starting point for further research on promoting MWB in the later stages of life.
Social Psychiatry and Psychiatric Epidemiology, 2019
Purpose The aims of our study are: to explore rehospitalization in mental health services across ... more Purpose The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. Methods The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single-and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. Results The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. Conclusions Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.
Health Policy, Jul 2019
Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality me... more Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperabil-ity of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30-and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in crosscountry comparisons.
![Research paper thumbnail of Potilaan paluu psykiatriseen sairaalahoitoon. Alueellinen esiintyvyys ja sen yhteys avohoitoon. [Regional psychiatric re-hospitalisation rates and their association with outpatient services]](https://attachments.academia-assets.com/58330530/thumbnails/1.jpg)
Suomen Lääkärilehti [Finnish Medical Journal], Jan 2019
[ENGLISH ABSTRACT BELOW]
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta j... more [ENGLISH ABSTRACT BELOW]
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta ja hoitojärjestelmästä. Selvitimme sairaalaan palaamisen esiintyvyyttä ja yhteyttä paluuta edeltävään avohoitoon sairaanhoitopiireittäin.
Menetelmät
Rekisteritutkimusaineisto kattaa 16 814 potilasta (18–97 v), jotka olivat psykiatrisista syistä osastohoidossa v. 2012. Heidän perusterveydenhuollon ja erikoissairaanhoidon käyttöään seurattiin 12 kk:n ajan uloskirjauksesta.
Tulokset
Potilaista 40 % palasi psykiatriseen sairaalahoitoon. Sairaanhoitopiirien erot olivat suuret (28–53 %). Terveydenhuollon avohoitokäynti viikon kuluessa uloskirjauksesta oli 51 %:lla potilaista (34–69 %). 8 %:lla ei ollut avohoitokäyntejä sairaalajakson jälkeen, ja heillä riski palata sairaalahoitoon oli suurin.
Päätelmät
Alueellinen vaihtelu paluussa sairaalaan voi selittyä osin hoidon järjestämisestä ja toteutumisesta uloskirjauksen jälkeen. Jo yksi avohoitokäynti liittyi merkitsevästi pienempään paluuriskiin. Sairaalaan palaavien osuus ja avohoito uloskirjauksen jälkeen kuvaavat palvelujärjestelmän laatua.
ENGLISH ABSTRACT
Background. Psychiatric re-hospitalisation is dependent on patient level factors as well as health system level factors. Low re-hospitalisation rates are often considered a positive quality indicator in terms of mental health services. This study sets out to investigate psychiatric re-hospitalisation and its predictors on hospital district level in Finland.
Methods. The register-based study consisted of nationwide data on 16,814 adult patients (18–97 years of age) hospitalised with a psychiatric diagnosis (ICD-10 categories F2–F6) for a minimum period of 24 hours in the year 2012. Health service use was followed for 12 months, starting from date of discharge. Data were obtained from the Care Register for Health Care (Hilmo) and the Register of Primary Health Care Visits (AvoHilmo). Specialised and primary care outpatient contacts were examined. Statistical analysis was performed as frequency analysis and logistic regression with re-hospitalisation as the dependent variable.
Results. A total of 40% of patients were re-hospitalised into psychiatric inpatient care within a year (re-hospitalisation rate varying between hospital districts from 28–53%). Altogether 51% of patients received an outpatient appointment within one week from hospital discharge, while 8% received no outpatient contact at all during the 12-month follow-up. Typically, those who received outpatient care had 2.3 visits per month. The rate of psychiatric re-hospitalisation was highest for those who received no outpatient contact at all.
Conclusions Regional differences in psychiatric re-hospitalisation rates can to some extent be explained by health service organisation. Health services should direct more attention to the early weeks following hospital discharge. Even one contact with outpatient services resulted in a decreased risk of re-hospitalisation. Low levels of unplanned psychiatric re-hospitalisation rates, together with a seamless transition to outpatient services following discharge are both promising health service quality indicators. These indicators could benefit from regular regional follow-up.
European Neuropsychopharmacology, 2019
As part of the Roamer project, we sought to have a picture of the available mental health researc... more As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis ®, On- Course ®and Meril® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced rec- ommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommenda- tions. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.
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Peer-reviewed papers by Kristian Wahlbeck
Clozapine is recommended by national and international guidelines for people with treatment-resistant schizophrenia. However, available meta-analyses of randomised controlled trials have not shown superior efficacy of clozapine when compared with other second-generation antipsychotics, with heterogeneity identified between the original studies. We aimed to use individual patient data (IPD) to account for potential reasons of variability and to synthesise an adjusted estimate for the difference in efficacy between clozapine and other second-generation antipsychotics for treatment-resistant schizophrenia.
Methods
In this systematic review and IPD meta-analysis, we searched the Cochrane Schizophrenia Group's Study-Based Register from inception to Jan 24, 2024, and previous reviews for blinded randomised controlled trials comparing clozapine with other second-generation antipsychotics in participants with treatment-resistant schizophrenia. Trials were eligible if they included patients with treatment-resistant schizophrenia and had a duration of at least 6 weeks. IPD were requested from trial investigators. The primary outcome was change in overall schizophrenia symptoms as measured by the Positive and Negative Syndrome Scale (PANSS) between clozapine and other second-generation antipsychotics after 6-8 weeks of treatment. The effect size measure for the primary outcome was mean difference with 95% credible interval (CrI). We fitted a Bayesian random-effects IPD meta-regression model that included duration of illness, baseline severity, and sex as potential prognostic factors or treatment effect modifiers. Confidence in the evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). People with lived experience of mental illness were involved in this study. This study is registered with PROSPERO, CRD42021254986. Findings
We screened 13 876 references and included 19 studies with data for 1599 participants; IPD were available for 12 of 19 trials (n=1052; mean age 37•67 years [SD 11•24; range 10-66]; 348 [33•08%] women and 704 [66•92%] men). Data on ethnicity were not available. The estimated mean difference in change from baseline PANSS total score was-0•64 points (95% CrI-3•97 to 2•63; τ=2•68) in favour of other second-generation antipsychotics. Shorter duration of illness and higher baseline severity were prognostic factors associated with a larger reduction in symptoms, but neither those factors nor sex were found to modify the relative effect between clozapine and other second-generation antipsychotics. The confidence in the evidence was graded as very low.
Interpretation
This IPD meta-analysis found a small and uncertain advantage of other second-generation antipsychotics, mainly olanzapine and risperidone, and so did not provide evidence for superior efficacy of clozapine compared with other second-generation antipsychotics in treatment-resistant schizophrenia. It is limited by unavailability of IPD for some studies, uncaptured sources of variance, and uncertainty due to premature study discontinuation. Given the side-effects of clozapine, the observed uncertainty regarding clozapine's superiority warrants prudent use and further research.
Grunden för den psykiska hälsan läggs i barndomen, och därför behövs främjande och förebyggande insatser för i synnerhet barn och unga. Tidiga insatser för att främja den psykiska hälsan är kostnadseffektiva, men genomförs inte i tillräckligt hög grad trots att investeringar i barns och föräldrars psykiska välbefinnande ger hög avkastning för samhället. Hälso- och sjukvården har en viktig roll i arbetet för bättre psykisk hälsa, men fler insatser för den psykiska folkhälsan behövs inom alla samhällssektorer. På individnivå kan alla träna sina färdigheter i psykisk hälsa, men den negativa trenden inom psykisk hälsa kräver även en välfärdsorienterad samhällspolitik.
To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.
Methods:
Following PRISMA guidelines, we searched six scientifc databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.
Results:
We identifed 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type “Job and task modifcations” and a moderate level of evidence for the types “Flexible work and scheduling” and “Changes in the physical work environment”. For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.
Conclusion:
Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.
The purpose of this study is to systematically review how positive mental health literacy has been conceptualised and measured over the last 20 years. Positive mental health recognises the benefits of feeling good and functioning effectively. Developing clarity around conceptualisation and knowledge (or literacy) of what constitutes positive mental health is an area of continued development, and an important step in measuring the impact of mental health promotion.
Design/methodology/approach
A systematic review of literature was performed to investigate how positive mental health literacy has been conceptualised and measured over the last 20 years. Databases searched included EDS, Scopus, ERIC, PsycINFO, CINAHL and SocIndex with fulltext. Search terms relating to positive mental health were combined with proximity operators within four words denoting knowledge, competence or literacy.
Findings
A total of 464 records were assessed on title level, with six articles included for final review. The final studies included three measures assessing participants’ knowledge of positive mental health, some of which included more distal themes such as awareness of coping strategies and emotional awareness. One measure, the Mental Health Promoting Knowledge – 10, stood out as the most fitting measure of positive mental health literacy.
Research limitations/implications
Our review approaches an under reported area of study, highlighting an area in need for further development with a few limitations. When building the search strategy, care was taken to line it up with literacy around positive mental health and its synonyms. The word “mental health” without positive specification was omitted in the final search strategy, increasing the risk of it also omitting potential articles of interest.
Practical implications
Our findings therefore highlight a knowledge gap in relation to conceptualisations and measures of positive mental health literacy, unfolding an area for further development. A more harmonised understanding of what is meant by positive mental health is an important step towards clarifying the concept and facilitating future study of the topic. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Social implications
New ways of measuring positive mental health literacy can be a useful way to establish benefits of mental health promotion, taking a salutogenic approach to mental health.
Originality/value
These findings expose an apparent knowledge gap in relation to conceptualisations and measures of positive mental health literacy, highlighting an area in need for further development. Measures of positive mental health literacy could be an important indicator for mental health promotion.
Methods: Eligibility criteria were randomized controlled trials(RCTs), clusterrandomized controlled trials (cRCTs), controlled or uncontrolled before- and after studies published in peer-reviewed journals between 2010 and May 2022 in five databases (Academic SearchComplete, Psy-cInfo, PubMed, Scopus and Web of Science). Outcomes were stress, burnout and non-clinical depression and anxiety symptoms, and wellbeing (primary) and workplace changes and sickness absenteeism (secondary). Quality appraisal was conducted using the QATQS scale, a narrative synthesis was applied. The protocol was published in PROSPERO (CRD42020183640).
Methods: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. Results: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables.
Conclusions: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.
Design, setting and participants: The qualitative study included focus group data from six European countries including 59 participants. Data were thematically ana-lysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health.
Results: Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (comple-menting services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning).
Discussion: Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal re-covery. By articulating the value of these facilitators, we highlight benefits of a per-son-centred and recovery-focused approach also within the context of psychiatric rehospitalization.
Conclusions: This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilita-tors, acknowledging the social determinants of mental health and personal recovery.
| 175CRESSWELL-SMITH ETaL.1 | BACKGROUNDThere is a growing interest in how the social, economic and physical environments may support mental health,1-5 with contemporary approaches placing increased focus on the social determinants and the importance providing opportunities for meaningful activities, reducing social exclusion and enhancing community connected-ness.6-9 A well-cited definition by the World Health Organisation (WHO) defines mental health as 'A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community',10 (p.1) underlining the importance of peoples’ everyday actions on men-tal health.Mental health can therefore be promoted both by health-care services and by community-based initiatives, which foster positive mental health, prevent mental disorders and should be included across all policy sectors.11-13 This approach is also endorsed by the WHO Optimal Mix of Services for Mental Health, which emphasizes the need for easily available and balanced mental health services,14while placing considerable emphasis on the value of community and self-care actions.15 Psychiatric rehospitalization is a complex phe-nomenon that has been reported to hamper the recovery process16and be unfavourable in terms of quality and cost of health care.17Psychiatric rehospitalization is a good example where comprehen-sive approaches may be beneficial.17–2 2 These approaches may also be incorporated prior to hospital discharge, for example ensuring access to meaningful activities, and engaging in signposting and planning for community life during the hospital stay.23-25 Such ap-proaches reflect a person-centred ethos where individuals' unique experiences are attended to in a holistic manner and highlight the need for organizing services, organizations, families and communi-ties accordingly.26,27Although a clear definition of person-centred approaches has not yet been formalized,28 it generally reflects health-care practices where the patients’ perspective and a focus on patient-reported out-comes are prioritized.29, 3 0 Person-centred approaches may include recovery-based thinking, which has its roots in service user–led contexts and has gained momentum also within mental health ser-vices.31 The recovery model redefines how we view mental health difficulties, nurturing empowerment and participation in society.32,33Personal recovery can be thought of as a highly subjective experi-ence around goals, relationships and skills that support a positive life with or without on-going mental health difficulties.34 Although not universally defined, the model acknowledges that mental health treatment may at times be necessary, but views it as one building block in the recovery process, which should also support 'everyday solutions to everyday problems'(Slade 2012).35,36The aim of the current paper was to explore how attention to community-based actions may support person-centred approaches in relation to psychiatric rehospitalization using qualitative data from the Comparative Effectiveness Research on Psychiatric Hospitalisation by Record Linkage of Large Administrative Data Sets (CEPHOS-LINK) project (www.cephos-link.org). Previous pa-pers from the project report on psychiatric rehospitalization using quantitative register-based methodology18 and explore meanings and experiences of the phenomenon qualitatively both in general terms24 and more specifically how it can be avoided.23 The current paper furthers this line of enquiry via a secondary analysis looking at how participants relate community-based actions and day-to-day activities to their mental health. By articulating what actions indi-viduals with experience of psychiatric rehospitalization themselves deem useful for their mental health, we not only illuminate these actions but also may promote the development of person-centred approaches in relation to psychiatric rehospitalization.2 | METHODSThe CEPHOS-LINK project studied psychiatric rehospitalization quantitatively and qualitatively in six different countries: Austria (At), Finland (Fin), Italy (It), Norway (Nor), Romania (Rom) and Slovenia (Sl). Ethical approval was sought from leading ethical committees in all participating countries, and informed consent was given by all participants who participated in the qualitative study. A focus group methodology was employed in order to gain insight into lived ex-perience of psychiatric rehospitalization. The reasoning behind this approach related to its suitability for generating insights into experi-ences, views and meanings through the process of shared discus-sion derived from both the individual and the groups.37 Furthermore, focus groups allow for exploring responses to questions not only in relation to the interview guide, but also in terms of digressions and Patient or public contribution: The current study included participants with ex-perience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study
Method: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell’Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL).
Conclusion: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.
Itsemurha on taustaltaan monitekijäinen prosessi. Itsemurhien ehkäisy terveydenhuollossa on myös monitekijäistä kohdistuen prosessin eri vaiheisiin.
Itsemurhaa yrittäneet tulee somaattisen akuuttihoidon jälkeen arvioida psykiatrian erikoislääkärin tai psykiatriaan perehtyneen lääkärin johdolla. Itsemurhaa yrittänyt nuori kuuluu aina erikoissairaanhoidon arvioon.
Itsemurhaa yrittäneen kanssa on syytä käydä läpi koko itsemurhayritykseen johtanut tapahtumaketju. Itsemurha-ajatuksista kysyminen ei suurenna itsemurhan riskiä. Itsemurhaa yrittäneet kärsivät yleensä mielenterveyden häiriöistä ja päihdeongelmista.
Itsemurhayrityksen jälkeisen hoidon tulee olla aktiivista ja viiveetöntä. Sen intensiteetti perustuu huolelliseen tilannearvioon niin ajankohtaisesta itsetuhoisuudesta kuin akuuteista psykiatrisista ja psykososiaalisista tarpeista. Itsemurhaa yrittäneen psykiatrinen jatkohoito voidaan useimmiten toteuttaa psykiatrisessa avohoidossa. Psykiatrisen sairaalahoidon tarvetta arvioitaessa huomioidaan psykiatrisen häiriön vaikeusaste, erityisesti mahdollinen psykoottisuus, syvä toivottomuus tai tilan hallitsematon epävakaus, välitön itsemurhavaara ja mielenterveyslain mukaisen tahdosta riippumattoman hoidon tarve.
Itsetuhoisuuteen kohdennetut hoitointerventiot voivat merkittävästi pienentää itsemurhayrityksen uusimisen riskiä. Tutkittuja interventioita ovat kognitiivis-behavioraaliset itsetuhokäyttäytymisen ehkäisyyn suunnatut psykoterapiat, turvasuunnitelmainterventio, Linity/Assip-lyhytinterventiot ja dialektinen käyttäytymisterapia epävakaan persoonallisuuden yhteydessä.
Terveydenhuollossa on syytä kehittää itsemurhaa yrittäneiden arviointia ja lisätä tutkittujen interventioiden saatavuutta. Mielenterveyden häiriöt, sisältäen päihdehäiriöt, tulee hoitaa hyvin itsemurhayritysten ja itsemurhien ehkäisemiseksi.
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This guideline focuses on the assessment and treatment of suicidal patients and describes current knowledge on the prevention of suicides by health care interventions and in health care settings among youths, adults and the elderly. Comprehensive assessment and evidence -based interventions such as safety plan and CBT focused on suicidality are recommended. Easy accessible diverse evidence -based treatment of psychiatric disorders is essential, a majority of suicidal patients suffer from psychiatric disorders. Recommendations of pharmacological treatments with e.g. lithium, clozapine or ketamine relate to concurrent psychiatric disorders.
• Itsetuhoinen käyttäytyminen liittyy useimmiten psykiatriseen sairauteen tai päihdeongelmiin.
• Itsemurhayrityksen jälkeen keskeisiä ovat strukturoitu psykiatrinen arvio, turvasuunnitelman tekeminen ja aktiivinen perussairauksien hoito.
• Lääkärin lakisääteiset velvoitteet ja läheisten tilanne tulee huomioida.
• Psykososiaalisia, muuhun hoitoon liitettäviä lyhyitä erillisinterventioita tutkitaan aktiivisesti
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This review focuses on the assessment and treatment of suicide attempters in line with the national evidence-based draft Current Care guideline on the assessment and treatment of suicidal patients. Internationally, Finland has been a country of high suicide rates, though during the last two decades the number of suicide deaths has greatly diminished. Among women the Finnish suicide rates are currently close to those of other Nordic countries and among men slightly higher. Suicide risk is elevated in some psychiatric disorders, especially major depression, bipolar disorder and schizophrenia. Thus, easily accessible evidence-based mental health services are part of effective suicide prevention in health care.
For suicide attempters, a psychiatric assessment is advised as soon as physical and cognitive recovery is sufficient to allow a comprehensive psychiatric examination. This includes careful assessment of psychiatric and substance-use disorders and their current treatment, risk and protective factors for a new suicide attempt, and current major life-events. In addition to other psychiatric treatment, use of a safety plan is recommended, and especially for adolescents it is important to include parents or close ones in preparation of the safety plan. Non-suicidal self-injury should be noted. Among the elderly, increasing limitations related to illnesses and ability to function, and loneliness need to be taken into account. Psychosocial interventions such as cognitive-behavioural therapy (CBT) focused on the suicide attempt are advised in addition to good clinical care of psychiatric disorders. Bereaved close ones and all those involved may need support after a suicide death. Psychosocial care and support is available through several providers including non-governmental organizations, and for some CBT-based psychosocial group interventions may be beneficial.
Traumaperäiset stressireaktiot ja -häiriöt ovat melko tavallisia, kaikenikäisillä esiintyviä mielenterveyden häiriöitä, jotka tulee tunnistaa kaikkialla terveydenhuollossa.
– Laajamittaisen järkyttävän tilanteen jälkeen niitä voi esiintyä runsaasti. Psykososiaalisen tuen ja palvelujen järjestämisellä ja aktiivisella seurannalla on merkitystä heti poikkeuksellisen järkyttävän tapahtuman jälkeen.
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The updated Current Care Guidelines for PTSD includes assessment and treatment of acute stress reaction (ASR), acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in all age groups. Psychosocial support and active monitoring are recommended after a potentially traumatic event. If symptoms require, short focused cognitive-behavioral psychotherapy can be used for ASD. Trauma-focused psychotherapeutic interventions are the first-line treatment for post-traumatic stress disorder (PTSD). Antidepressant medication is effective, but evidence on other pharmacological options and on treatment combinations is limited. Specific groups, such as first responders, military and peacekeeping personnel may require tailored interventions.
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta ja hoitojärjestelmästä. Selvitimme sairaalaan palaamisen esiintyvyyttä ja yhteyttä paluuta edeltävään avohoitoon sairaanhoitopiireittäin.
Menetelmät
Rekisteritutkimusaineisto kattaa 16 814 potilasta (18–97 v), jotka olivat psykiatrisista syistä osastohoidossa v. 2012. Heidän perusterveydenhuollon ja erikoissairaanhoidon käyttöään seurattiin 12 kk:n ajan uloskirjauksesta.
Tulokset
Potilaista 40 % palasi psykiatriseen sairaalahoitoon. Sairaanhoitopiirien erot olivat suuret (28–53 %). Terveydenhuollon avohoitokäynti viikon kuluessa uloskirjauksesta oli 51 %:lla potilaista (34–69 %). 8 %:lla ei ollut avohoitokäyntejä sairaalajakson jälkeen, ja heillä riski palata sairaalahoitoon oli suurin.
Päätelmät
Alueellinen vaihtelu paluussa sairaalaan voi selittyä osin hoidon järjestämisestä ja toteutumisesta uloskirjauksen jälkeen. Jo yksi avohoitokäynti liittyi merkitsevästi pienempään paluuriskiin. Sairaalaan palaavien osuus ja avohoito uloskirjauksen jälkeen kuvaavat palvelujärjestelmän laatua.
ENGLISH ABSTRACT
Background. Psychiatric re-hospitalisation is dependent on patient level factors as well as health system level factors. Low re-hospitalisation rates are often considered a positive quality indicator in terms of mental health services. This study sets out to investigate psychiatric re-hospitalisation and its predictors on hospital district level in Finland.
Methods. The register-based study consisted of nationwide data on 16,814 adult patients (18–97 years of age) hospitalised with a psychiatric diagnosis (ICD-10 categories F2–F6) for a minimum period of 24 hours in the year 2012. Health service use was followed for 12 months, starting from date of discharge. Data were obtained from the Care Register for Health Care (Hilmo) and the Register of Primary Health Care Visits (AvoHilmo). Specialised and primary care outpatient contacts were examined. Statistical analysis was performed as frequency analysis and logistic regression with re-hospitalisation as the dependent variable.
Results. A total of 40% of patients were re-hospitalised into psychiatric inpatient care within a year (re-hospitalisation rate varying between hospital districts from 28–53%). Altogether 51% of patients received an outpatient appointment within one week from hospital discharge, while 8% received no outpatient contact at all during the 12-month follow-up. Typically, those who received outpatient care had 2.3 visits per month. The rate of psychiatric re-hospitalisation was highest for those who received no outpatient contact at all.
Conclusions Regional differences in psychiatric re-hospitalisation rates can to some extent be explained by health service organisation. Health services should direct more attention to the early weeks following hospital discharge. Even one contact with outpatient services resulted in a decreased risk of re-hospitalisation. Low levels of unplanned psychiatric re-hospitalisation rates, together with a seamless transition to outpatient services following discharge are both promising health service quality indicators. These indicators could benefit from regular regional follow-up.