Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress.

Introduction: The desire to have children and form a family is for many people central for life fulfilment and the desire does not differ by sexual orientation. Due a series of societal changes during the last decade, today we see a lesbian baby boom. Planned lesbian families are a relatively new group of patients and parents in reproductive health care, yet little is known about psychological wellbeing during the transition to parenthood in these families. Aim: The overall aim of this thesis was to fill a gap of knowledge about the psychological aspects of undergoing treatment with donated sperm, at the time of pregnancy and during early parenthood that affect lesbian couples forming a family. Method: This is a multicentre study comprising all 7 university clinics that perform gamete donation. The study includes lesbian couples undergoing treatment with donated sperm and heterosexual couples undergoing IVF treatment with their own gametes. Participants were recruited consecutively during 2005 and 2008. 165 lesbian couples and 151 heterosexual couples participated in the study. Participants responded questionnaires at three time points (T); time point 1 (T1) at the commencement of treatment, (T2) after the first round of treatment, around 2 month after T1 and (T3) 12-18 months after first treatment when a presumptive child had reached 1 year. Data was analysed with statistical methodology. Results: Lesbian couples reported an all over high satisfaction with relationship quality, good psychological wellbeing and low parenting stress. Heterosexual couples also reported good satisfaction with relationship quality, however somewhat lower than the lesbian couples. Parenting stress in the heterosexual couples was similar to the lesbian couples. A strong association was found between high relationship satisfaction and low parenting stress. Conclusions: Lesbian couples forming a family through sperm donation treatment are satisfied with their relationships, they report a good psychological health and experiences of low parenting stress. / <p>Name change: Paper 2, "Psychological health in lesbian and heterosexual couples undergoing assisted reproduction" in the list of papers has been changed to "Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study"</p>

Background: Alongside experiencing physical symptoms with no identifiable organic cause, patients with MUS commonly experience comorbid anxiety and depression. They also have high health utilisation costs, which has implications for the health service. Interventions which target these symptoms in a cost effective way need to be developed and evaluated. Objective: To develop and evaluate a self-help mindfulness-based stress reduction (MBSR) intervention for patients with medically unexplained symptoms (MUS). Methods: A systematic review of the literature was carried out to evaluate the effectiveness of MBSR for reducing psychological distress in people with MUS. Study 1 developed and evaluated a self-help MBSR intervention in a clinical setting. Fifteen participants were recruited from eight practice, however only five completed post-intervention measures. A combination of t-tests and descriptive statistics were used to compare changes in levels of psychological distress, quality of life, symptoms and mindfulness at post-intervention. Pearson‘s correlations were used to identify relationships between improvements in mindfulness and improvements in outcomes. Study 2, exploring the reasons for the difficulties recruiting participants to Study 1, was then carried out through questionnaires to GPs. Results: Though more evidence is needed, the systematic review found MBSR to have moderate effects on psychological distress, which are largely maintained or improved at follow-up. Study 1 found symptom frequency and levels of acceptance to have improved at post-intervention. Study 2 found that the main reasons for GPs not recruiting participants was that they were busy and found it difficult to prioritise given other demands. Conclusions: Evidence to date suggests that MBSR is an effective intervention for patients with MUS. Future studies may benefit from recruiting participants from relevant organisations or using alternative methods such as database searches. No firm conclusions can be made about the self-help MBSR intervention‘s efficacy due to the study‘s limitations, however changes seen in the completer group suggest that further research would be warranted.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Introduction: Following ST-elevation myocardial infarction (STEMI) and treatment with Primary Percutaneous Coronary Intervention (PPCI), some patients re-present with potential ischaemic heart disease (IHD) symptoms. Symptoms may be related to cardiac ischaemia, reduced psychological health or a comorbid condition, which share similar symptoms and may lead patients to seek help via acute services. The purpose of the study was to investigate the proportion of PPCI patients who re-presented to acute services due to potential IHD symptoms within 6 months of STEMI, and to explore associated factors. Methods: An explanatory mixed methods study was conducted. Quantitative data were collected at baseline and 6 months from consecutive patients attending two centres in Manchester. Variables were carefully considered based on a conceptual model for re-presentation. These included potential IHD symptom and psychological health assessments using self-report measures: the Seattle Angina Questionnaire (SAQ) and the Hospital and Anxiety and Depression Scale (HADS). Physiological health was measured using the Global Registry of Acute Coronary Events (GRACE) and the Charleson Comorbidity Index (CCI) at baseline. At 6 months re-presentation data were collected using patient records, a telephone interview and a self-report diary card. The experiences of some who re-presented (purposeful sampling) were explored through semi-structured interviews conducted at least 6 months following PPCI. Framework analysis was adopted to analyse data. Results: 202 PPCI patients returned baseline questionnaires [mean age 59.7 years (SD 13.9), 75.7% male]; 38 (18.8%; 95% CI 14.0% to 24.8%) participants re-presented due to potential IHD symptoms at 6 months; 16 (42.1%) re-presented due to a cardiac event and 22 (57.9%) did not receive a diagnosis. At both baseline and 6 months, mean HADS anxiety scores were higher for the re-presentation group compared to the non-representation group (baseline 9.5 vs 7.1, p=0.006; 6 months 9.4 vs 6.0, p<0.001). Angina symptoms were stable and infrequent at both time points for the groups. Multivariate regression modelling with the inclusion of predictors HADS anxiety, SAQ angina stability, SAQ angina frequency, GRACE and CCI, determined HADS anxiety as a predictor of re-presentation with an adjusted odds ratio of 1.12 (95% CI 1.03 to 1.22, p=0.008). The qualitative interviews with re-presenters included 25 participants (14 men, 27-79 years). Four themes were identified: fear of experiencing a further heart attack, uncertainty and inability to determine cause of symptoms, insufficient opportunity to validate self-construction of illness and difficulty adapting to life after a heart attack. Conclusion: Elevated levels of anxiety at baseline were predictive of re-presentation with potential IHD symptoms at 6 months. Factors such as shock at experiencing a heart attack, hypervigilance of symptoms and difficulty with symptom attribution appeared to play a role in raised anxiety levels for the re-presentation group. Findings suggested that changes are needed to cardiac rehabilitation and post-STEMI follow-up to address educational needs and psychological issues and changes in STEMI treatment.

No description available.

Entre 2003 et 2005, un programme de dépistage des maladies liées à l’amiante a été mis en place dans quatre régions françaises, constituant ensuite la cohorte ARDCO (Asbesto related Diseases Cohort). La cohorte ARDCO a été suivie entre 2007-2009 (étude ARDCO I) et entre 2011-2012 (étude ARDCO II). Cette thèse a été réalisée dans le cadre de l’étude ARDCO II et trois études ont été réalisées. Dans notre population d’étude, nous avons montré une amélioration de certaines connaissances sur le risque lié à l’amiante et au tabac par le biais d’une notice d’information. La prévalence globale des symptômes d’anxiété probable et de dépression probable a été respectivement estimée à 19,7% (n=435) et 9,9% (n=219). Les femmes présentaient significativement plus de symptômes anxieux et dépressifs que les hommes (respectivement 34,8% contre 19% et 18,5% contre 9,5%). Le risque de développer les symptômes anxieux et dépressifs était significativement associé à l’auto-évaluation de l’exposition à l’amiante, la perception du risque lié à l’amiante ainsi qu’à l’autoperception du risque de développer des pathologies liées à l’amiante. Une troisième étude a montré que les personnes présentant des symptômes d’anxiété probable ou de dépression probable utilisaient le plus souvent les stratégies de coping dites « maladaptatives » ; et que l’utilisation des stratégies de coping dépendait plus de la présence des symptômes anxieux ou dépressifs que de l’exposition à l’amiante. / A large-scale screening program for asbestos-related diseases was organised in four regions of France between October 2003 and December 2005. Asbestos Related Diseases Cohort was constituted and participants were followed up between 2007 and 2009 (ARDCO I study) and between 2011 and 2012 (ARDCO II study). This thesis was made from ARDCO II study and three studies have been conducted. Among the study participants, we found an improvement in knowledge about tobacco and asbestos-risk perception related to an information leaflet. The prevalence of symptoms of probable anxiety and depression was 19.7% (n=435) and 9.9% (n=219) respectively. Women had significantly more anxious and depressive symptoms than men (34.8 vs 19% and 18.5 vs 9.5, respectively). The risk of developing anxious and depressive symptoms was significantly associated to the intensity of asbestos-exposure self-evaluated and to the asbestos-risk perception. The participants with symptoms of probable anxiety or depression more frequently used “maladaptive” coping strategies and the use of the coping strategies depended specially of anxious and depressive symptoms rather than asbestos exposure.

Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Aims and Methods The overall aim was to evaluate methods of screening and assessment of distress, anxiety, and depression in cancer patients. Further, to evaluate effects of a psychosocial intervention and to explore changes of distress, anxiety, depression, and HRQoL during six months. Study I included 495 consecutive patients screened with the Hospital Anxiety and Depression Scale (HADS) at their first visit to an Oncology Department. Half of the patients with &gt;7 on any of HADS subscales received standard care (SCG), and half received a psychosocial intervention (IG). To compare HADS with a thorough clinical assessment (CA), Study II included 171 identified patients representing both sexes, &lt;65/≥65 years, and curative/palliative treatment intention. Results Screening with HADS identified anxiety or/and depression symptoms in 36% of the 495 patients. Thirty-six (43%) of 84 IG patients attended CA, resulting in support for 20 (24%) of them. There were no differences between SC and IG during follow-up, anxiety and depression decreased and HRQoL increased, although anxiety was still present and HRQoL impaired at six months. The Distress Thermometer (DT) ≥4 (sensitivity 87%, specificity 73%) is valid for screening of distress; its ability to measure changes over time is comparable to HADS. Of 319 patients screened with &lt;8 on both HADS subscales, 196 (80%) were stable non-cases with HRQoL comparable to that of the general population and 49 (20%) patients were unstable non-cases, with deteriorated anxiety, depression, and HRQoL. &gt;4 on HADS subscales may be useful for early detection of unstable non-cases. In Study II, HADS identified 49 (34%) and the CA 71 (49%) patients as having distress, anxiety or depression. CA identified more men and more young patients with distress than HADS did. Conclusion Screening and assessment identifies patients with persistent symptoms and increases access to CA and support. The DT may be used routinely in oncology care. When HADS is used, healthcare professionals should be aware of psychosocial problems perceived by patients but not covered by HADS. Most patients identified with distress seem to have resources to manage problems without needing additional support. Patients screened as non-cases indicate no need for re-assessment.

Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n=3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.