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Accountability and psychiatric disorders: how do forensic psychiatric...
Höglund, Pontus; Levander, Sten; Anckarsäter, Henrik; Radovic, Susanna Journal article in International journal of law and psychiatry;6 : Elsevier (2009)	peer-reviewed scientific ARTICLE

Adolescent mental health and utilisation of psychiatric care : the ro...
Ivert, Anna-Karin : Malmö University, Faculty of Health and Society Malmö University Health and Society Doctoral Dissertations;1 (2013)	DOCTORAL THESIS

English abstract:

The studies included in this thesis aim to illustrate different aspects of mental health and the utilisation of psychiatric care among Swedish children and adolescents, with the overarching aim being to improve the existing knowledge on how the neighbourhood of residence and parental country of birth influence adolescents’ mental health and their pathways into and utilisation of psychiatric care. The first study investigates referral pathways to child and adolescent psychiatric clinics, directing a special focus at how these pathways differ on the basis of parental country of birth and neighbourhood of residence. The results show that parental country of birth plays an important role in how children and adolescents are referred to the child and adolescent psychiatric sector. Children and adolescents with Swedish-born parents appear more often to have been referred by their families, whereas by comparison with children and adolescents with Swedish-born parents, those with foreign-born parents had more often than been referred by someone outside the family, such as the social services or their school. Neighbourhood of residence was found to play a significant role in relation to family referrals; children and adolescents living in neighbourhoods with low levels of socioeconomic deprivation were more likely to have been referred by their families by comparison with those from more deprived neighbourhoods. The second study investigates how parental country of birth and individual gender are associated with the utilisation of psychiatric care. The findings from the study indicate that adolescents whose parents were born in middleor low-income countries present lower levels of psychiatric outpatient care utilisation than those with Swedish-born parents. Initially, no associations 7 were found between parental country of birth and inpatient care. Following adjustment for socio-demographic variables, it was found that adolescents whose parents were born in low-income countries were also less likely to utilise inpatient care. Girls were more likely to have utilised psychiatric care, but controlling for possible interactions revealed that this was true primarily for girls with parents born in Sweden or other high-income countries. In the third study, psychiatric care utilisation patterns are analysed in relation to the neighbourhood of residence. In part the aim was to investigate the validity of the neighbourhood when it comes to understanding variations in adolescents’ utilisation of psychiatric care, but the study also examines whether neighbourhood socioeconomic deprivation is associated with individual variations in the utilisation of psychiatric care. The results indicate that the neighbourhood of residence has little influence on the utilisation of psychiatric care, only 1.6 % of the variance was found at the neighbourhood level. No clear association between the neighbourhood level of socioeconomic deprivation and levels of psychiatric care utilisation was found in the study. The final study investigates how adolescents’ perceptions of the social characteristics of their neighbourhood are related to their self-reported mental health, while controlling for the socioeconomic structure of the neighbourhood. The results show that adolescents’ perceptions of their neighbourhood are associated with their self-reported mental health, particularly their perceptions of social disorder. However, these associations differ between girls and boys, and between adolescents with Swedish- and foreign-born parents. In conclusion, the results presented in the thesis show that parental country of birth is an important factor when it comes to understanding differences in referral patterns and in the utilisation of psychiatric care. However, the role of the neighbourhood of residence appears to be more complex.

15177 Ivert muep_ny(kappan).pdf (670.0Kb)

Flunitrazepam intake in male offenders
Dåderman, Anna; Edman, Gunnar; Wirsen Meurling, Ann; Levander, Sten; Kristiansson, Marianne Journal article in Nordic Journal of Psychiatry;2 : Informa Healthcare (2012)	peer-reviewed scientific ARTICLE

English abstract:

The abuse of flunitrazepam (FZ) compounds is worldwide, and several studies have reflected on the consequences with regard to violence, aggression and criminal lifestyle of FZ users. Criminals take high doses of FZ or some other benzodiazepines to "calm down" before the planned crime. There is support from earlier studies that most likely, all benzodiazepines may increase aggression in vulnerable males. Chronic intake of high doses of FZ increases aggression in male rats. Because psychopathy involves aggression, we have examined whether psychopathy as well as any of the four facets of the Psychopathy Checklist-Revised (PCL-R) (Interpersonal, Affective, Lifestyle and Antisocial) are related to different substance use disorders, with the focus on FZ. We have also examined the relationship between each PCL-R item and FZ use. Participants were 114 male offenders aged 14-35 years, all of whom were convicted for severe, predominantly violent, offences. Substance use, including FZ, was not more common in those who scored high in psychopathy. Use of FZ was more common in offenders who scored high in Facet 4 (Antisocial) of the PCL-R (odds ratio = 4.30, 95% CI 1.86-9.94). Only one of the PCL-R items, "Criminal versatility", was significantly associated with FZ use (odds ratio = 3.7). It may be concluded that intake of FZ has a specific relationship to only one of the facets and not to psychopathy per se. ; The findings have also important theoretical implications because Facet 4 is not a key factor of the construct of psychopathy. Clinical implications of the article: We have used the new two-factor and four-facet theoretical model of psychopathy in the young offender population, many of them with one or more substance use disorders. The present results suggest that antisocial behavior defined by Facet 4 (poor behavioral control, early behavior problems, juvenile delinquency, revocation of conditional release and criminal versatility) in the studied subjects is more typical for FZ users than it is for non-FZ users. This may have implications for assessment and treatment. Clinicians should be aware that criminals with high scores on Facet 4 have a more than fourfold odds of being a FZ user. This conclusion has an important clinical implication because FZ abuse is very common and is not always the focus of a forensic psychiatric assessment. ;

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Adolescent lifestyle risk by gender and ethnic background: Findings f...
Pauwels, Lieven; Svensson, Robert Journal article in European Journal of Criminology;1 : Sage Publications (2009)	peer-reviewed scientific ARTICLE

Adult onset offending in a Swedish female birth cohort
Andersson, Frida; Torstensson Levander, Marie Journal article in Journal of Criminal Justice;3 : Elsevier (2013)	peer-reviewed scientific ARTICLE

Analytical Criminology: A style of theorizing and analyzing themicro-...
Pauwels, Lieven; Ponsaers, Paul; Svensson, Robert Book chapter in Contemporary Issues in the Empirical Study of Crime : Maklu Publishing Governance of Security (GofS) Research Paper Series;1 (2009)	BOOK CHAPTER

A Life-Course Perspective on Girls' Criminality
Andersson, Frida; Levander, Sten; Torstensson Levander, Marie Book chapter in Girls at Risk. Swedish Longitudinal Research on Adjustment : Springer Advancing Responsible Adolescent Development; (2012)	BOOK CHAPTER