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Ioannou M, Wartenberg C, Greenbrook JTV, Larson T, Magnusson K, Schmitz L, Sjögren P, Stadig I, Szabó Z, Steingrimsson S. Sleep deprivation as treatment for depression: Systematic review and meta-analysis. Acta Psychiatr Scand 2021; 143:22-35. [PMID: 33145770 PMCID: PMC7839702 DOI: 10.1111/acps.13253] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To systematically review evidence on the efficacy and safety of sleep deprivation (SD) as a treatment option for patients with unipolar or bipolar depression. METHODS A systematic review according to PRISMA guidelines was conducted. The certainty of evidence was assessed using the GRADE approach. Controlled trials were included in efficacy analysis, case series for evaluating complications and qualitative studies for patients' experiences. RESULTS Eight controlled studies (368 patients), one qualitative study and seven case series (825 patients) were included. One week after treatment start, SD combined with standard treatment did not reduce depressive symptoms compared with standard treatment (standardized mean difference, SMD = -0.29, [95% confidence interval, CI: -0.84 to 0.25], p = 0.29). When excluding a study in elderly patients in a post hoc analysis, the difference was statistically significant (SMD = -0.54 ([95% CI: -0.86 to -0.22], p < 0.001)) but it diminished two weeks after treatment start. No superiority of SD was found compared with antidepressants, but SD may be superior to exercise in certain settings. It is uncertain whether SD affects quality of sleep, quality of life, everyday functioning or length of stay. Apart from switch to mania (ranging between 2.7% and 10.7%), no other serious complications were reported. CONCLUSION Sleep deprivation has been studied in a wide range of settings resulting in divergent results for the short-term efficacy on depressive symptoms. Post hoc analyses indicated that there may be a significant but transient effect in certain populations. Further studies should focus on identifying subgroups of responders as well as examining feasibility in routine clinical care.
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Affiliation(s)
- Michael Ioannou
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden,Institute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | | | - Josephine T. V. Greenbrook
- School of LawMason Institute for Medicine, Life Science and the LawUniversity of EdinburghEdinburghScotland,Department of the Life Context and Health PromotionInstitute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Tomas Larson
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden,Institute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kajsa Magnusson
- Region Västra GötalandMedical LibrarySahlgrenska University HospitalGothenburgSweden
| | - Linnea Schmitz
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden
| | | | - Ida Stadig
- Region Västra GötalandMedical LibrarySahlgrenska University HospitalGothenburgSweden
| | - Zoltán Szabó
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden
| | - Steinn Steingrimsson
- Region Västra GötalandPsykiatri AffektivaDepartment of PsychiatrySahlgrenska University HospitalGothenburgSweden,Institute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Greenbrook JTV, Reichenberg K. Medicolegal Alienation in Physicians Practising in Informal Clinics Servicing Undocumented Migrants. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Globally, undocumented migrants have relied on informal clinics for their healthcare services. Empirical explorations of physicians' moral, ethical, and legal consciousness surrounding practising within this context remain lacking. The present study sought to contribute to this gap.
Methods
Constructivist grounded theory was applied to qualitative interviews with 16 physicians working in informal humanitarian clinics in Sweden.
Results
Physicians' experiences were synthesised into three categories: Ambiguity in navigating illegality, due to awareness of vulnerabilities surrounding patient-safety and own involvement, whilst simultaneously feeling enriched through interactions in the clinic; Being exposed to patients' accounts of structural violence and social injustice; Experiencing isolation in practice, when discovering professional limitations and feeling severed from the conventional medical institution. In navigating the threshold between their societally commended role and structurally condemned undocumentedness, differing processes of alienation synthesised in physicians in medical, ethical, and legal terms; identified as a novel dimension of legal consciousness theory, a process coined medicolegal alienation.
Conclusions
The process of medicolegal alienation occurs when, functioning as arbiters of patients' rights within the conventional medical institution, questions surrounding undocumented migrants' deservingness force physicians into a position of moral, ethical, and professional dissonance. Struggling to dictate their own practice, they are propelled out into informal clinics, in search for congruence. Through this process, physicians become alienated from both their profession and from legality. Though able to navigate freely between the medical institution and humanitarian clinics, the burden of insight into the threshold between legal realms and the plight of the undocumented patient is heavily ambiguous, being both transformative and isolating.
Key messages
In navigating the threshold between their societally commended role and structurally condemned undocumentedness, differing processes of medical, ethical, and legal alienation synthesised in physicians. When undocumented migrants’ deservingness is questtioned, physicians are forced into a position of moral, ethical, and professional dissonance, giving rise to the process of medicolegal alienation.
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Affiliation(s)
- J T V Greenbrook
- Mason Institute for Medicine, Life Sciences, and the Law, School of Law, University of Edinburgh, Edinburgh, UK
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - K Reichenberg
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Närhälsan Region Västra Götaland, Gothenburg, Sweden
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Greenbrook JTV. Undocumented migrants’ right to health care: Physicians’ rejection of law in their gatekeeper roles. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Legal consciousness theory acknowledges the known gap between law in writing and law in its everyday practical application in society. Limited research has explored legal consciousness in medical contexts, and limited knowledge exists surrounding how the intrusion of law in medical authority impacts applied medical ethics. Conflicts between law and medical ethics can be saliently observed in Sweden, where current law forcibly places physicians in a gatekeeper role in satisfying undocumented migrants' right to health care access, relying on physicians' assessments of whether patients without legal residency status should be provided 'care that cannot be deferred'.
Methods
In this context, the present phenomenological study sought to explore how legal terminology is experienced, understood, and applied by physicians, contextualising the perceived meaning ascribed to the imposed gatekeeper role. Qualitative interviews were conducted with 42 physicians from five major Swedish hospitals, and analysed through the lens of legal consciousness theory.
Results
Participants actively rejected law by taking a firm, and often collective, stance against its intrusion in their work. Rejection of law was constructed through: rejecting legal hegemony and government imposed non-medical responsibilities; perceiving professional authority and medical ethics as empowering; considering repercussions of legal non-compliance unthreatening; believing increased legal knowledge would not influence their professions' foundational role.
Conclusions
The study produced novel findings, contributing to the limited body of work exploring legal consciousness in medicine. Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.
Key messages
Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.
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Affiliation(s)
- J T V Greenbrook
- Mason Institute for Medicine, Life Sciences and the Law, School of Law, University of Edinburgh, Edinburgh, UK
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Opperdoes M, Greenbrook JTV, Danielsson L, Elden H, Ascher H. Navigating contrasting liminalities: Women’s experience of childbearing while undocumented in Sweden. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pregnant women living as undocumented migrants navigate multiple and layered liminalities, exacerbating their vulnerability, and accenting ambiguity and uncertainty in their lives. Whilst previous research has addressed these women's interactions with healthcare institutions, the present study's aim was to explore their experiences of daily life during pregnancy and early motherhood, when living undocumented in Sweden.
Methods
A qualitative phenomenological study was conducted, where 13 women from 10 countries were interviewed; all undocumented, with a forced migration background. The anthropological theory of liminality was applied in furthering interpretations.
Results
The central theme of navigating the contrasting liminalities of celebrating pregnancy and early motherhood while immersed in the acute uncertainties of undocumentedness emerged, including two categories: (1) Embodying systemic injustice, with the subcategories living in the shadows of society to maintain personal safety, fearing the inability to satisfy basic needs in motherhood, and experience of dissonance when suspended in existence; (2) coping strategies for tackling daily life, with the subcategories: the importance of social relationships in satisfying needs and rights, striving for normality in the present, and dreaming of belonging to the fabric of the host society.
Conclusions
Pregnancy and early motherhood both exacerbated and countered the burden of undocumentedness. Daily life constituted a paradox, where undocumentedness resulted in being consumed by harsh living circumstances; driving fears of common spaces and services and uncertainty and unpredictability in meeting basic needs. Simultaneously, the universal and inherently human experiences of joy and longing that pregnancy can foster still emerged in little moments allowing it. Dreams of belonging were, however, thwarted by exclusion, being continuously and forcibly confined to inhabiting the liminal space on society's threshold.
Key messages
Pregnancy and early motherhood both acutely exacerbate and counter the burden of undocumentedness, rendering navigating daily life heavily paradoxical. Undocumentedness results in being consumed by harsh living circumstances; simultaneously, the universal and inherently human experiences of joy and longing that pregnancy can foster still emerge.
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Affiliation(s)
- M Opperdoes
- Knowledge Centre for Sexual Health, Närhälsan Region Västra Götaland, Gothenburg, Sweden
- Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J T V Greenbrook
- Mason Institute for Medicine, Life Sciences and the Law, School of Law, University of Edinburgh, Edinburgh, Sweden
- Department of Life Context and Health Promotion, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L Danielsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research Unit, Angered Hospital, Angered, Sweden
| | - H Elden
- Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Ascher
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research Unit, Angered Hospital, Angered, Sweden
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Dencker A, Bergqvist L, Berg M, Greenbrook JTV, Nilsson C, Lundgren I. Measuring women's experiences of decision-making and aspects of midwifery support: a confirmatory factor analysis of the revised Childbirth Experience Questionnaire. BMC Pregnancy Childbirth 2020; 20:199. [PMID: 32252679 PMCID: PMC7137445 DOI: 10.1186/s12884-020-02869-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Women’s experiences of labour and birth can have both short- and long-term effects on their physical and psychological health. The original Swedish version of the Childbirth Experience Questionnaire (CEQ) has shown to have good psychometric quality and ability to differentiate between groups known to differ in childbirth experience. Two subscales were revised in order to include new items with more relevant content about decision-making and aspects of midwifery support. The aim of the study was to develop new items in two subscales and to test construct validity and reliability of the revised version of CEQ, called CEQ2. Method A total of 11 new items (Professional Support and Participation) and 14 original items from the first CEQ (Own capacity and Perceived safety), were answered by 682 women with spontaneous onset of labour. Confirmatory factor analysis was used to analyse model fit. Results The hypothesised four-factor model showed good fit (CMIN = 2.79; RMR = 0.33; GFI = 0.94; CFI = 0.94; TLI = 0.93; RMSEA = 0.054 and PCLOSE = 0.12) Cronbach’s alpha was good for all subscales (0.82, 0.83, 0.76 and 0.73) and for the total scale (0.91). Conclusions CEQ2, like the first CEQ, yields four important aspects of experience during labour and birth showing good psychometric performance, including decision-making and aspects of midwifery support, in both primiparous and multiparous women.
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Affiliation(s)
- Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
| | - Liselotte Bergqvist
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University hospital, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University hospital, Gothenburg, Sweden
| | - Josephine T V Greenbrook
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Mason Institute of Medicine, Life Science and the Law, University of Edinburgh, Edinburgh, UK
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University hospital, Gothenburg, Sweden
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Barkensjö M, Greenbrook JTV, Rosenlundh J, Ascher H, Elden H. The need for trust and safety inducing encounters: a qualitative exploration of women's experiences of seeking perinatal care when living as undocumented migrants in Sweden. BMC Pregnancy Childbirth 2018; 18:217. [PMID: 29879940 PMCID: PMC5992748 DOI: 10.1186/s12884-018-1851-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 05/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background Studies from around the world have shown that women living as undocumented migrants have limited and deficient access to perinatal care, increasing their risks of both physical and psychological complications during pregnancy and childbirth. Failures to provide equal access to healthcare have been criticized extensively by the United Nations. In 2013, undocumented migrants’ rights to healthcare in Sweden were expanded to include full access to perinatal care. Research surrounding clinical encounters involving women living as undocumented migrants remains largely lacking. The present study aimed to provide a composite description of women’s experiences of clinical encounters throughout pregnancy and childbirth, when living as undocumented migrants in Sweden. Methods Taking an inductive approach, qualitative content analysis was implemented. Thirteen women from ten different countries were interviewed. Meaning-units were extracted from the data collected in order to identify emergent overarching themes. Results In clinical encounters where healthcare professionals displayed empathic concern and listening behaviours, women felt empowered, acknowledged, and encouraged, leading them to trust clinicians, diminishing fears relating to seeking healthcare services. Conversely, when neglectful behaviour on part of healthcare professionals was perceived in encounters, anxiousness and fear intensified. Vulnerability and distress induced by the women’s uncertain living circumstances were apparent across themes, and appeared exacerbated by traumatic memories, difficulties in coping with motherhood, and fears of deportation. Conclusion The present study contributes unique and important knowledge surrounding women’s experience of being pregnant and giving birth when living as undocumented migrants. The overarching findings indicated that the needs of undocumented migrant women were largely similar to those of all expectant mothers, but that due to vulnerabilities relating to their circumstances, flexible and informed care provision is essential. Being knowledgeable on undocumented migrants’ rights to healthcare is vital, as clinical encounters appeared highly consequential to the women’s well-being and help-seeking behaviours. Negative encounters inflicted emotional distress and fear. Contrastingly, positive encounters promoted trust in clinicians, personal empowerment, and relief. Positive clinical encounters could provide rare opportunities to assist an otherwise elusive population at increased risk for both physical and psychological complications, highlighting the crucial need for adherence to ethical principles in clinical practice.
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Affiliation(s)
- My Barkensjö
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden.
| | - Josephine T V Greenbrook
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden.,School of Psychology, Institute of Psychology, Health, and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.,School of Law, University of Edinburgh, Old College, South Bridge, Edinburgh, Scotland, EH8 9YL, UK
| | - Josefine Rosenlundh
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden
| | - Henry Ascher
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 16A, Box 414, 405 30 Gothenburg, Sweden.,Department of Research and Development, Angered Hospital, Gothenburg, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30, Gothenburg, Sweden
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Barkensjö M, Greenbrook JTV, Rosenlundh J, Ascher H, Elden H. 7.3-O7The need for trust and safety inducing encounters: a qualitative exploration of women's experiences of seeking perinatal care when living as undocumented migrants in Sweden. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Barkensjö
- Knowledge Centre for Sexual Health, Närhälsan, Västra Götalandsregionen, Sweden
| | - J T V Greenbrook
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - J Rosenlundh
- Sahlgrenska Hospital, Västra Götalandsregionen, Sweden
| | - H Ascher
- Department of Public Health Community Medicine, Sahlgrenska Academy, University of Gothenburg, and Department of Research and Development, Angered Hospital, Gothenburg, Sweden
| | - H Elden
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Sweden
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