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Femårsuppföljning för tvångsvårdade kvinnor. Inverkan av psykiska problem på utfallet

Jansson, Irene LU (2010)
Abstract (Swedish)
Avhandlingen, som består av fyra delstudier, är en femårsuppföljning av kvinnliga missbrukare, som var tvångsomhändertagna på Lunden mellan januari 1997 och december 2000, och som genomgick en omfattande utredning. Klienterna har systematiskt utretts med psykologiska och neuropsykologiska test i samarbete med personal och Lundens psykiater. Test och skattningsskalor som använts är standardiserade jämte DOK- och ADAD-data. Syftet var att skapa ett underlag för bättre vårdplanering. Standardiseringen av utredningsmetoden har möjliggjort jämförelser mellan ett vårdtillfälle och förnyad vård. Jämförbarheten med andra narkomanmaterial utanför tvångsvården var viktig för att se i vad mån olika diagnoser motsvarar proportionerna i snarlika... (More)
Avhandlingen, som består av fyra delstudier, är en femårsuppföljning av kvinnliga missbrukare, som var tvångsomhändertagna på Lunden mellan januari 1997 och december 2000, och som genomgick en omfattande utredning. Klienterna har systematiskt utretts med psykologiska och neuropsykologiska test i samarbete med personal och Lundens psykiater. Test och skattningsskalor som använts är standardiserade jämte DOK- och ADAD-data. Syftet var att skapa ett underlag för bättre vårdplanering. Standardiseringen av utredningsmetoden har möjliggjort jämförelser mellan ett vårdtillfälle och förnyad vård. Jämförbarheten med andra narkomanmaterial utanför tvångsvården var viktig för att se i vad mån olika diagnoser motsvarar proportionerna i snarlika grupper av kvinnliga narkomaner. Samplet är ett representativt urval om 132 konsekutivt intagna och utredda klienter med 80 kvinnor från LVM och 52 från LVU är inkluderade. Övriga icke utredda kvinnor: 58 från LVM och 40 från LVU används i analysen som en jämförelsegrupp. Jämförbara data finns både från indexvårdtillfället och vid uppföljningen. Några patienter skrevs in på SiS-institution under uppföljningstiden och en del har fått annan vård. Uppföljningsprocenten i intervjustudien är hög, 109 personer (88%) räknat på dem som fortfarande levde och 83 procent medräknat dem som vi inte lyckats nå och räknar dem som möjliga återfall (intention-to-treat). Jämförelser över tid av diagnostiska data har kunnat göras på 109 som intervjuades vid uppföljningen. Detta ger en hög extern validitet i undersökningen. Avhandlingen redovisas i fyra delstudier:

Resultat: Studie I visade att sjukhusinläggning och kriminalitet nådde en topp runt tiden vid tvångsomhändertagandet för att med tiden sjunka. I gruppen kvinnor med en längre tids drogfrihet hade den psykiska och fysiska hälsan förbättrats liksom sociala förhållanden. Vid uppföljningen hade 42-48% varit drogfia ett år, 30-36% minst två år och 17% sedan utskrivningen. Det psykiska mående hade förbättrats bland klienter med en längre tids drogfrihet, liksom en sänkning av sjukhus-inläggningar och kriminalitet. Uppförandestörning och antisocial personlighets-störning var negativa prediktorer, vilket inte gällde borderline personlighetsstörning.

Studie II analyserade validiteten av självrapporterad kriminalitet med information från BRÅ´s dataregister. 106 kvinnor intervjuades om tillgreppsbrott, narkotikabrott, våldsbrott och fängelsedomar. Resultaten visar att självrapporterad data om kriminalitet stämmer ganska väl överens med officiell data, men att validiteten kan variera beroende på brottstyp. Stöld och narkotika brott och var något överrap-porterat, medan våldsrelaterad brottslighet var något underrapporterad.

Studie III visar att klienter med fler kriterier på personlighetsstörning förblev mer symptombelastade än dem med färre kriterier. Klienter med borderline personlig-hetsstörning hade en högre symptombelastning oavsett drogfrihet eller ej.

Studie IV undersökte inflytandet som drag av personlighetsstörning har på socialt fungerande som arbete, polisingripande och sjukhusinläggningar fem år efter index. 106 kvinnor utreddes med SCID II, SCL 90 (GSI) och TLFB. Vid uppföljningen hade äldre kvinnor i mindre omfattning arbete. Kvinnor med dependent- histrion och tvångsmässig och personlighetsstörning hade i större utsträckning arbetsmöjligheter vilket inte gällde klienter med undvikande- och uppförandestörning. Enbart uppför-andestörning hade ett förhöjt samband med arbetslöshet och att hamna i brotts-register. (Less)
Abstract
Aim: The study focus is a sample of women with drug dependence admitted to compulsory treatment according to the Swedish act of care for drug abusers (LVM, 1988:870) and according to the act of care for young persons (LVU, 1990:52). From a cohort consecutively admitted to residential treatment at Lunden between 1997 and 2000, a sample of 132 women was selected for a five year follow-up. They were evaluated at base-line using a structured assessment procedure including, psychiatric diagnoses (ICD-10; DSM-IV), personality disorders (DSM-IV) and tests of symptoms, personality patterns and neuropsychological problems. All participants provided written consent. The study was approved by the Ethical Committee of Lund University (LU 88-02; Dnr.... (More)
Aim: The study focus is a sample of women with drug dependence admitted to compulsory treatment according to the Swedish act of care for drug abusers (LVM, 1988:870) and according to the act of care for young persons (LVU, 1990:52). From a cohort consecutively admitted to residential treatment at Lunden between 1997 and 2000, a sample of 132 women was selected for a five year follow-up. They were evaluated at base-line using a structured assessment procedure including, psychiatric diagnoses (ICD-10; DSM-IV), personality disorders (DSM-IV) and tests of symptoms, personality patterns and neuropsychological problems. All participants provided written consent. The study was approved by the Ethical Committee of Lund University (LU 88-02; Dnr. 586/2005).

Method: 109 of 124 clients (88%), still alive, were interviewed face-to-face five years after the index admission. A triangulation approach was used with cross-section data like DOK, the tests used at base-line and process data like the Timeline-Follow-Back interview. Register data from causes of death and hospital admission registers from the EPC at the Swedish National Department of Health, and data on criminal sentences from the Council of Crime Prevention (BRÅ) were added, covering data for the entire cohort (n=230) from 11 years prior base-line admittance to 2006.

Results: Study I demonstrated that hospital admission and criminal patterns peaked around the time of the admission but decreased over time. The psychological and physical health of the sample, the social status of the women five years after discharge was improved in the group with a prolonged abstinence as well as for those having one year or more of abstinence. The levels of abstinence at follow-up were 42-48% for one year, 30-36% for two continuous years and 17% continously abstinent from discharge up to five years. Psychological improvement was found for all patients with longer periods of abstinence, as was a decrease of criminal sentences and hospital admissions. Conduct disorders and antisocial personality disorder were negative predictors. Borderline personality disorder was not.

Study II analyzed the validity of self-reported criminal behavior with databases of criminal offences and judical sanctions. Theft, drug offences and violence- and prison sentences were investigated for 106 women. The results imply that self-reported data of criminal behavior are comparable, though the validity of self-report may vary between types of criminal offences involvement. Data on theft and drug offence were slightly over reported while violence sentences were slightly under reported.

Study III showed that clients with more personality disorder features remained more symptomatic than those with fewer personality disorder features. Client with Borderline personality disorder features were more symptomatic independently of abstinence or not.

Study IV evaluated the influence of personality disorder features on social functioning like employment, arrest and hospitalization at follow-up. 106 were evaluated with SCID II, the SCL-90, (GSI) and the TLFB. At follow-up, older women were less likely to work. Obsessive-compulsive and dependent personality disorders were associated with increased chances of employment whereas conduct disorder features and avoidant personality disorder features were not. Conduct disorder features only were associated with unemployment and criminal justice record. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • docent Palmstierna, Tom, Karolinska institutet, Stockholm
organization
alternative title
Five years follow-up of women in compulsory treatment
publishing date
type
Thesis
publication status
published
subject
keywords
hospital admissions, criminal offences, psychiatric disorder, abstinence, women, drug dependence, Compulsive treatment
pages
251 pages
publisher
Lunds universitet, Institutionen för psykologi
defense location
Auditoriet Kulturen, Tegnérsplatsen i Lund
defense date
2010-04-16 10:15
ISBN
978-91-978718-2-2
language
Swedish
LU publication?
yes
id
7b6270c5-f87e-41b5-9bd1-6d34d7df5171 (old id 1578480)
date added to LUP
2010-03-26 10:57:32
date last changed
2016-09-19 08:45:14
@phdthesis{7b6270c5-f87e-41b5-9bd1-6d34d7df5171,
  abstract     = {Aim: The study focus is a sample of women with drug dependence admitted to compulsory treatment according to the Swedish act of care for drug abusers (LVM, 1988:870) and according to the act of care for young persons (LVU, 1990:52). From a cohort consecutively admitted to residential treatment at Lunden between 1997 and 2000, a sample of 132 women was selected for a five year follow-up. They were evaluated at base-line using a structured assessment procedure including, psychiatric diagnoses (ICD-10; DSM-IV), personality disorders (DSM-IV) and tests of symptoms, personality patterns and neuropsychological problems. All participants provided written consent. The study was approved by the Ethical Committee of Lund University (LU 88-02; Dnr. 586/2005).<br/><br>
Method: 109 of 124 clients (88%), still alive, were interviewed face-to-face five years after the index admission. A triangulation approach was used with cross-section data like DOK, the tests used at base-line and process data like the Timeline-Follow-Back interview. Register data from causes of death and hospital admission registers from the EPC at the Swedish National Department of Health, and data on criminal sentences from the Council of Crime Prevention (BRÅ) were added, covering data for the entire cohort (n=230) from 11 years prior base-line admittance to 2006. <br/><br>
Results: Study I demonstrated that hospital admission and criminal patterns peaked around the time of the admission but decreased over time. The psychological and physical health of the sample, the social status of the women five years after discharge was improved in the group with a prolonged abstinence as well as for those having one year or more of abstinence. The levels of abstinence at follow-up were 42-48% for one year, 30-36% for two continuous years and 17% continously abstinent from discharge up to five years. Psychological improvement was found for all patients with longer periods of abstinence, as was a decrease of criminal sentences and hospital admissions. Conduct disorders and antisocial personality disorder were negative predictors. Borderline personality disorder was not. <br/><br>
Study II analyzed the validity of self-reported criminal behavior with databases of criminal offences and judical sanctions. Theft, drug offences and violence- and prison sentences were investigated for 106 women. The results imply that self-reported data of criminal behavior are comparable, though the validity of self-report may vary between types of criminal offences involvement. Data on theft and drug offence were slightly over reported while violence sentences were slightly under reported.<br/><br>
Study III showed that clients with more personality disorder features remained more symptomatic than those with fewer personality disorder features. Client with Borderline personality disorder features were more symptomatic independently of abstinence or not. <br/><br>
Study IV evaluated the influence of personality disorder features on social functioning like employment, arrest and hospitalization at follow-up. 106 were evaluated with SCID II, the SCL-90, (GSI) and the TLFB. At follow-up, older women were less likely to work. Obsessive-compulsive and dependent personality disorders were associated with increased chances of employment whereas conduct disorder features and avoidant personality disorder features were not. Conduct disorder features only were associated with unemployment and criminal justice record.},
  author       = {Jansson, Irene},
  isbn         = {978-91-978718-2-2},
  keyword      = {hospital admissions,criminal offences,psychiatric disorder,abstinence,women,drug dependence,Compulsive treatment},
  language     = {swe},
  pages        = {251},
  publisher    = {Lunds universitet, Institutionen för psykologi},
  school       = {Lund University},
  title        = {Femårsuppföljning för tvångsvårdade kvinnor. Inverkan av psykiska problem på utfallet},
  year         = {2010},
}