Childlessness and Psychological Well-Being in Midlife and Old Age

This entry reviews the literature on the relationship between parental status and psychological well-being in middle and old age. Psychological well-being is defined broadly, in order to capture the complexity of the costs and benefits of having children or not for well-being. This review focuses on indicators of positive and negative, cognitive, and affective well-being: life satisfaction, happiness, positive and negative effect, depression, and loneliness. Most studies define “parents” as the status of having living biological and/or adopted children and “childless” as the status of never having had such children. Yet, there is some variation and ambiguity in how studies have categorized stepchildren, adopted children, and parents who have outlived all of their children.Norges forskningsråd 299859acceptedVersio

Psychological stress in postural tachycardia syndrome: results of an online survey

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Postural orthostatic tachycardia syndrome (POTS) is a chronic condition in which patients show a marked increase in heart rate on standing, but also suffer from a range of additional symptoms, which may include fatigue and unrefreshing sleep. A well accepted 10-item survey instrument, the Perceived Stress Scale (PSS; Cohen, et al., 1983), was used to investigate the levels of psychological stress experienced by POTS patients. Methods Sixty Swedish patients diagnosed with POTS at a tertiary investigation center were contacted by mail and a link was provided to respondents who signed the informed consent form. A 64-item, on-line survey was developed in five sections. One of the sections consisted of the ten items of the PSS scale. As an example, item three asks: "In the last month, how often have you felt nervous and ‘stressed’?". A five-point Likert scale is used with possible responses ranging from "never" to "very often". This study employed a previously translated Swedish language version, which has been validated in a sample of 3,406 respondents and showed good internal reliability (α =.84) and normative data for a Swedish population (Nordin &amp; Nordin, 2013). Symptoms were measured using the orthostatic hypotension questionnaire (Kaufmann et al. 2012). Results Twenty-four POTS patients (22 female gender; mean age 35 years, SD = 8.4) completed the survey. The average age at onset of symptoms was 20 years and four months with patients waiting an average of nine years and five months for a POTS diagnosis. Scores for the PSS ranged from three to 35. The mean PSS score for this cohort was 19.38 (SD = 8.88). Fourteen respondents were in the moderate range for perceived stress (14 to 26), whilst five can be considered to have a low perception of stress and five a high perception. Patients with POTS had a statistically significant higher score for perceived stress (M = 19.38, SD = 8.88, p &lt; .01) than the general population of Sweden (M = 13.96, SD = 5.63). However, there was no correlation between perceptions of stress and symptom severity measured by the orthostatic hypotension questionnaire. Conclusions Swedish POTS patients have higher levels of perceived stress, similar to other disease states such as chronic pain and multiple sclerosis (Table 1). However, this survey found no correlation between perceptions of stress and symptom severity. </sec

Brief admission by self-referral as an add-on to usual care for individuals with self-harm at risk of suicide: cost-effectiveness and 4-year health-economic consequences after a Swedish randomized controlled trial

Background: Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. Materials and methods: BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. Results: Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. Conclusion: BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA

A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skane randomized controlled trial protocol (BASRCT)

BACKGROUND: Brief Admission is a crisis and risk management strategy in which self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder self-admit to hospital at times of increasing risk when other efforts to stay safe are failing. Standardized in the current randomized controlled trial, the intensity of Brief Admission Skane is implemented in durations of three days, with a maximum frequency of three times a month. Brief Admission is integrated into existing treatment plans in advance of crises to prevent reliance on general psychiatric admissions for risk management, as these may be lengthy, unstructured, and of uncertain therapeutic value. METHODS/DESIGN: The overall objective of the Brief Admission Skane randomized controlled trial is to determine if Brief Admission can replace general psychiatric admission for self-harming and suicidal individuals with complex mental illness at times of escalating risk. Other objectives of the study are to evaluate whether Brief Admission increases daily functioning and enhances coping, reduces psychiatric symptoms including frequency and severity of self-harm and suicidal behaviours. A final objective is to determine if Brief Admission is an effective crisis management model for this population. Participants are randomized at an individual level to either Brief Admission Skane plus Treatment as Usual or Treatment As Usual. Based on a priori power analyses, N = 124 participants will be recruited to the study. Data collection is in progress, and will continue until June 2018. All participant data are single-blinded and will be handled with intention-to-treat analysis. DISCUSSION: Based on the combined clinical experience of our international research group, the Brief Admission Skane randomized controlled trial upon which the current protocol is based represents the first initiative to standardize, implement and evaluate Brief Admission amongst self-harming and suicidal individuals, including those with borderline traits. Objectively measuring protocol fidelity and developing English-language Brief Admission study protocols and training materials are implementation and dissemination targets developed in order to facilitate adherent international export of Brief Admission Skane. TRIAL REGISTRATION: NCT02985047 . Registered November 25, 2016. Retrospectively registered