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B Runeson

Publications and source records attributed to B Runeson.

At least 19 recordsLinked to original sources
PubMed2007

Resource use and costs associated with patients treated for depression in primary care.

We investigated medical resource consumption, productivity loss and costs associated with patients treated with antidepressants for depression in primary care in Sweden. Patients on treatment for depression were followed naturalistically for six-months, and data on patients' characteristics, daily activity and resource-use were collected. The total cost per patient was estimated at euro 5,500 (95%CI euro 5,000-6,100) over six months in 2005 prices. Direct costs were estimated at euro 1,900 (euro 1,700-2,200), 35% of total costs, and indirect costs at euro 3,600 (euro 3,100-4,100), 65% of total costs. The cost for antidepressants represented only 4% of the total costs. We conclude that the burden of depression is high, both to the individual as well as to wider society, and there seems to be a particular need for therapies that have the potential to improve productivity in depressed patients.

Adolescent↗
PubMed2006

The mission is remission: health economic consequences of achieving full remission with antidepressant treatment for depression.

The aim of the present study was to determine the magnitude of the impact of treating depression to full remission on cost and health-related quality of life. In a naturalistic longitudinal survey recordings of resource use and quality of life were carried out among depressed patients treated with antidepressant therapy in 56 Swedish primary care clinics. We found that a total of 52% of the patients achieved full remission during the study period. Remitting patients had, on average, three outpatient visits less than non-remitting patients (p < 0.01), 22 fewer sick leave days (p = 0.01), which translated into a significantly lower total cost (Euro 2700) compared with non-remitting patients (p < 0.01). Health-related quality-of-life scores improved by 40% for remitting patients when compared with non-remitting ones (p < 0.01). We conclude that remission has a substantial health economic impact on patients treated for depression, which further strengthens the importance of aiming for full remission in the treatment of depression.

Adult↗
PubMed2003

Attitudes towards suicide and suicidal patients among medical students.

Medical students' attitudes towards suicide and suicidal patients were studied. The aim was also to determine whether attitudes differ between students in the beginning and end of studies. A questionnaire including own attitudes on death and suicide and psychosocial circumstances was filled in by 63% of first and final year students (306 of 485). The calculation included a factor analysis on items describing the attitudes to suicidal patients. Attitudes towards patients became influenced by the knowledge of mental disorders and by biological aspects of behaviour during the education. Final year students more often consider suicide to be an expression of psychiatric disease and thought that people trying to commit suicide were not responsible for their own actions. Thirty-four percent and 44% (ns) in the first and last years, respectively, reported suicidal ideas some time in their lives. Students with such a history of suicide thoughts were less optimistic about the possibility to help. Ongoing depressive/anxious symptoms were prevalent in 36/305 (12%) of students, but did not seem to affect their attitudes to patients. Female students had sought psychological/psychiatric help more often than males (26% and 10%, P < 0.01).

Adult↗
PubMed2002

Burden of illness and suicide in elderly people: case-control study.

OBJECTIVES: To study the association between physical illness and suicide in elderly people. DESIGN: Case-control with illness determined from interviews with relatives of people who committed suicide and with control participants and from medical records. SETTING: Gothenburg and two surrounding counties (210 703 people aged 65 years and over). PARTICIPANTS: Consecutive records of people who had committed suicide and had undergone forensic examination (46 men, 39 women) and living control participants from the tax register (84 men, 69 women). MAIN OUTCOME MEASURES: Physical illness rated in 13 organ systems according to the cumulative illness rating scale-geriatrics; serious physical illness (organ category score 3 or 4); overall score for burden of physical illness. RESULTS: Visual impairment (odds ratio 7.0, 95% confidence interval 2.3 to 21.4), neurological disorders (3.8, 1.5 to 9.4), and malignant disease (3.4, 1.2 to 9.8) were associated with increased risk for suicide. Serious physical illness in any organ category was an independent risk factor for suicide in the multivariate regression model (6.4, 2.0 to 20.0). When the sexes were analysed separately, serious physical illness was associated with suicide in men (4.2, 1.8 to 9.5) as was high burden of physical illness (2.8, 1.2 to 6.5). Such associations were not seen in women, possibly because of the small sample size. CONCLUSIONS: Visual impairment, neurological disorders, and malignant disease were independently associated with increased risk of suicide in elderly people. Serious physical illness may be a stronger risk factor for suicide in men than in women.

Aged↗
PubMed2001

Parasuicides without follow-up.

The aim of this project was to approach subjects who committed parasuicide but did not primarily receive or accept a recommendation for care through the regular routines after referral to a general hospital. Three hundred and twenty-nine consecutive parasuicides in 10- to 89-year-olds (162 men and 167 women) were studied. One hundred were subsequently hospitalized in the departments of psychiatry, 130 were followed up at outpatient facilities, and 96 left without any follow-up. A psychiatric liaison consultation was made in 57% of the total sample. The 96 subjects without follow-up were compared with the subjects who received follow-up. The sample was somewhat younger and included slightly more men. They were single in 54% and unemployed in 43% of the cases. According to the DSM-IV, 27% had a concurrent depression. According to the CAGE questions, 57% had indication of substance addiction. Fifty-four per cent had currently low global functioning, less than 50 points on the GAF. They had not been in contact with psychiatric care previously to the same extent as the others. About 34% of these who did not receive or rejected follow-up initially after a second approach agreed to follow-up when contacted by the project team, referring them to appropriate authorities such as social welfare offices, family counselling, or psychosocial staff within psychiatry or primary care. This may imply that the group delineated is at risk for eventual suicide and that the acceptance of follow-up should be interpreted as an indication that a substantial number needs help and can be successfully encountered by means of a case manager approach.

Adolescent↗
PubMed1999

Anabolic androgenic steroids and suicide.

Eight medicolegally examined cases of suicide, in 21- to 33-year-old males, with a history of current or discontinued use of anabolic androgenic steroids (AAS) are described, five of which were approached by means of systematic interviews with survivors. Five suicides were committed during current use of AAS, and two following 2 and 6 months of AAS withdrawal. In one case it was unclear whether the suicide was committed during current use or after recent discontinuation. In five cases family members had noted depressive symptoms associated with AAS withdrawal. After prolonged use, four persons had developed depressive syndromes. Two subjects exhibited hypomania-like symptoms during the time immediately preceding the suicide. Four subjects had recently committed acts of violence while using AAS. In some cases these acts exacerbated the subjects' problems in personal relationships or at work, which in turn seem to have precipitated the suicides. Only one of them had experienced suicidal ideation before starting to use AAS. In all cases examined by psychological autopsy, risk factors of suicidality likely to be independent of the use of AAS were present. In conclusion, this study presents data suggesting that psychiatric symptoms and conflicts resulting from long-term use of AAS may contribute to completed suicide in certain predisposed individuals.

Adult↗
PubMed1997

Contacts of suicide attempters with GPs prior to the event: a comparison between Stockholm and Bern.

The aim of this study was to investigate patterns of contact made with GPs by subjects in two cities prior to attempting suicide, in order to determine whether differences in the health care systems could be a possible factor influencing the help-seeking behaviour of people experiencing suicidal crises. Structured interviews were conducted with suicide attempters from geographically defined catchment areas in two countries with private and national health care systems, respectively. The subjects were suicide attempters, admitted consecutively, aged > or = 15 years and living either in Stockholm (n=202) or in Bern (n=66). Patients living in Bern had seen their GPs more regularly and more frequently throughout the year. There was an increase in the number of visits to the GP prior to the suicide attempt in both cities, but it was greater in Stockholm than in Bern. However, in Stockholm fewer patients who saw their GP in the week before the attempt talked about their suicidal thoughts. The differences in help-seeking behaviour between the two patient samples may be related to the higher number of practising GPs and a more personal and consistent patient-doctor relationship in Bern. It is possible that the private medical care system in Switzerland lowers the threshold enabling patients to talk to their GP about their suicidal plans. The results suggest that in both cities there is scope for improving communication of the suicidal patient with his or her doctor.

Adolescent↗
PubMed1996

Living conditions of female suicide attempters: a case-control study.

A total of 51 hospitalized female suicide attempters (17-64 years old) were interviewed according to a questionnaire used by Statistics Sweden, SCB (ULF 88:1) for investigation of living conditions. Control subjects from similar geographical areas included in the ULF investigation in 1988, and matched for age and nationality, were identified through the SCB (n = 153). Odds ratios (OR) and 95% confidence limits were estimated. Correlation coefficients were used to study the relative importance of specific factors. Not less than 26 items reached the level of statistical significance, but only four of them (mental disorder, use of anxiolytics, unemployment at some time during the last 5 years, and no professional work during the past year) showed a considerable excess risk (lower 95% CI limit for OR > 3). Physical illness was relevant as an independent factor. Although of secondary importance, hospitalization during the previous 3 months was also a characteristic of suicide attempters.

Adolescent↗
PubMed1994

Management of suicide attempters: what are the routines and the costs?

The services offered to a consecutive series of 97 suicide attempters (36 men and 61 women) at a general hospital were registered by a participating observer. All but one case were subjected to psychiatric consultation for suicide risk assessment, but only 34% were evaluated by a psychiatric specialist. Fifty-seven percent were admitted to psychiatric inpatient care. The length of inpatient care varied, the average duration was 5 days for men and 14 days for women. Repeaters were admitted more often than nonrepeaters. The short-term compliance was satisfactory. The direct cost for management was evaluated based on the detailed quantification of care provided for each subject. The care at the hospital equalled 6.4% of the total budget for psychiatric inpatient care.

Adolescent↗
PubMed1991

Borderline personality disorder in young Swedish suicides.

Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (ages 15 to 29 years) in an urban community were the subject of retrospective investigation through interviews with survivors and analyses of medical records. Classification in accordance with DSM-III-R showed a large proportion of axis II disorders. Borderline personality disorder (BPD) was found in 19 subjects (33%). When compared with subjects with other disorders, BPD subjects showed more antisocial traits and substance use disorders. Early parental absence, substance abuse in the homes, employment and financial problems, lack of a permanent residence, and sentence by court were also more frequent in BPD subjects.

Adolescent↗
PubMed1991

Ethical aspects of psychological autopsy.

Survivors of suicide victims are usually vulnerable to new traumatic experiences. Researchers who have used the method of psychological autopsy, including interviews with survivors, have paid little attention to ethical questions. The purpose of this article is to discuss such issues based on empirical data. Data and experiences from 3 studies of suicide among men (n = 271), women (n = 104) and youth (n = 58) are presented; the last 2 also include telephone follow-up by an independent researcher who measured the reactions of the interviewees to the main interviews. The ethical problems for 3 groups of agents (informants and other relatives, including the deceased; the researcher; and the research) are discussed according to 3 basic ethical principles (nonmaleficence, beneficence and respect for autonomy). Many of the interviewees still had signs of crisis reactions and thus constituted a vulnerable group. Nevertheless, drop-out was infrequent. Nor did we find any interviewee who was hurt by the interview, even if the possibility cannot be excluded in a few cases (less than 4%). Many of the interviewees seem to benefit from the interview. The interviews ought to be done by researchers prepared to meet people in crisis situations. The informants had different opinions on whether letter or telephone was the best method for first contact. Tape-recording was generally accepted. It seems to be possible and advisable to further change the design to better meet the needs of the interviewees, without violating the requirements of the researcher and the research.

Adaptation, Psychological↗
PubMed1991

Reactions of survivors of suicide victims to interviews.

Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (age 15-29 years) in an urban community were the subject of retrospective investigations by means of interviews with survivors. The outcome of the survivors' crisis reactions and the interviewees' capacity to participate in the interviews were evaluated. Two weeks after a main interview, a follow-up interview dealing with the interviewee's reactions to the investigation was performed. The cautious interview procedure seemed very acceptable to the survivors. An initial contact about 2 months after the suicide is recommended. Tape-recording was generally tolerated. There was a relationship between a satisfactory outcome of the crisis and good quality of the information given by the interviewee, but survivors in severe crisis may also cooperate well and give information with good trustworthiness and precision. An unsatisfactory crisis outcome was significantly more common in interview subjects with post-traumatic stress disorder according to DSM-III-R. Many interviewees benefit from the single interview.

Adaptation, Psychological↗
PubMed1990

Psychological autopsies: methods and ethics.

Essential knowledge on suicide is derived from studies that include interviews with survivors. In this paper, we discuss methodological and ethical issues pertaining to the interview method known as "psychological autopsy"; the discussion is based on our application of the method to three studies of suicides in Sweden and on a review of other investigations. Interviewing a survivor is a delicate matter, and the integrity of the deceased, the integrity and health of the informant, and the psychological strain on the interviewer must all be taken into consideration. The interviewer should have clinical experience in order to be prepared to deal with interviewees in grief. Contact by telephone, followed by an introductory letter, provides an opportunity to meet survivors in an empathic manner and has a low rejection rate. A 2- to 6-month interval between suicide and interview is recommended. The survivor's reactions to the interview should be evaluated in order to expand the empirical base for ethical considerations. Studies on the validity and reliability of the method are necessary.

Adaptation, Psychological↗
PubMed1990

Psychoactive substance use disorder in youth suicide.

Fifty-eight consecutive suicides committed between 1984 and 1987 by adolescents and young adults (age 15-29 years) from an urban community were the subject of retrospective investigations through interviews with survivors and analyses of registers and medical records. Psychoactive substance use disorder in accordance with DSM-III-R was present in 47% of the youth suicides investigated, predominantly as alcohol dependence. Substance use disorder often coexisted with a borderline personality disorder or schizophrenia. Secondary depression was a frequent final factor. Dependence had developed in all females and most males. The median duration of substance use was 9 years. Substance use preceded suicidal behaviour by two years. Exposure to parental substance misuse during childhood, early parental divorce and parasuicide in the family were more frequent among subjects with substance use disorder than among other subjects. The social situation was often characterized by unemployment and legal problems. Previous inpatient care was more common than among other subjects.

Adolescent↗
PubMed1989

Mental disorder in youth suicide. DSM-III-R Axes I and II.

A 3-year urban material of suicides in adolescents and young adults (age 15-29 years) was studied retrospectively by means of interviews with survivors (n = 58). Classification of mental disorders according to DSM-III-R showed that major depression was important as background to suicides in 41%, primary (22%) or secondary (19%) to other disorders. Adding major depression, depressive disorder, not otherwise specified, dysthymia and adjustment disorder with depressed mood gave a total of 64% depressive syndromes. Schizophrenia (14%) and borderline personality disorder (28%) constituted other relevant groups. Coexisting substance use disorder occurred in 47%. A majority of the subjects (72%) were known by psychiatric caregivers and 16% committed suicide during inpatient care.

Adjustment Disorders↗