Mia Ramklint

• MD, PhD
• Professor at Uppsala University

Background During the peripartum period, four to 13 percent of women may be affected by eating disorders (ED). Previous reviews of qualitative studies in pregnant women with ED have mainly focused on the women’s experiences during pregnancy and not on their expressed needs. This systematic review aimed to identify which types of support were reques...

We aimed to explore how specialist nurses and psychiatrists perceive and conceptualize their own responsibility and autonomy in relation to interprofessional colleagues when caring for inpatients with deliberate self-harm. Eight psychiatrists and 10 nurses were interviewed. The interviews underwent thematic analysis by an interdisciplinary group of...

Aim Examine the psychometric properties of the Swedish Child Behaviour Check List (CBCL) 1.5–5. Methods CBCL 1.5–5 responses were collected from 1156 mothers about their 18‐month‐old children in a population‐based study. Representation was analysed by comparing the study sample with two Swedish national samples; scores were reweighted to adjust fo...

Background Insecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups....

Objective: This study aimed to explore factors influencing functioning in psychiatric outpatients, both separately and in combination. The primary objectives were to determine predictors of functioning, assess their significance in a combined analysis, and quantify their collective predictive power. Method: A sample of 137 psychiatric outpatient...

Evidence links immune system alterations to major psychiatric disorders. The few previous studies on personality traits or personality disorders (PDs) indicate that immunometabolic dysregulation may be prevalent in this population. This study aimed to investigate relationships between personality traits, PDs, and immunometabolic markers in peripher...

Background: The WHO Adult ADHD Self-report Scale (ASRSv1.1 and ASRS-S) is used for screening for attention-deficit/hyperactivity disorder (ADHD). The capacity of the Swedish version of the scale to discriminate ADHD from borderline personality disorder (BPD) and bipolar disorder (BP) has not been tested. Aim: Evaluate scoring methods, psychometr...

Background Insecure adult attachment has been associated with emotional dysregulation and subsequently with disorders involving this concept, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the characteristics related to different attachment pat...

In Attention-deficit/hyperactivity disorder (ADHD) the transition from childhood to adolescence encompass changes in symptom manifestation and related problems. Given the potential negative impact of ADHD on adolescents, and the increased risk for dropping out from treatment, there is a need to understand more about how adolescents experience their...

Purpose The current U-BIRTH cohort (Uppsala Birth Cohort) extends our previous cohort Biology, Affect, Stress, Imaging and Cognition (BASIC), assessing the development of children up to 11 years after birth. The U-BIRTH study aims to (1) assess the impact of exposure to peripartum mental illness on the children’s development taking into account bio...

Background: The aim of this study was to investigate if temperament and experience of childhood trauma differed between young psychiatric patients with borderline personality disorder (BPD), bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD). Methods: Diagnoses were based on the Structured Clinical Interview for DSM Axis I...

The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of...

Background: Personality disorders (PDs) in adulthood are considered stable over time and are likely to have lasting psychosocial impact on the affected individual, including in areas like vocational functioning. The aim of this study was to study labor market marginalization (LMM) and receipt of social welfare benefits during 13 years from age 18...

Aims: Over the past 20 years, a trend towards non-drinking and less use of alcohol has been reported among young adults. This study aimed to investigate if a similar trend in alcohol consumption can be seen among young adult psychiatric outpatients. Methods: This was a cross-sectional study based on two comparable samples of young adult (18-25 y...

There is conflicting evidence whether single-suture craniosynostosis (SSC), is linked to adversities of cognitive development. To assess the evidence for a link between SSC and cognition, a systematic literature search was conducted and eligible studies assessed for inclusion by two independent readers. Forty-eight studies met inclusion criteria. S...

Background Personality style can partly be described as the way an individual controls and regulates emotions and can be divided into over- and undercontrol. Studies have indicated that personality style may impact the onset, clinical presentation, and recovery from an eating disorder (ED). Furthermore, symptoms of anxiety and depression are common...

Background Social safeness and pleasure refer to the extent to which people experience their world as safe, warm, and soothing. Difficulties in achieving social safeness have been identified as a transdiagnostic vulnerability factor for developing and maintaining psychopathology and for feeling less contentment and self-compassion. The study aim wa...

Background Psychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with...

Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic instrument for the assessment of functioning in six domains, resulting in a total health-related disability score. The aim of this study was to investigate the psychometric properties of the Swedish-language version of the self-rated 36-item versio...

Background: Physicians' communication skills are important for patient-centered care. Although working with simulated patients (SPs) in case simulations is common for training communication skills, studies seldom include a wide range of challenging behaviors or explore students' own experiences of learning communication skills with SPs. Therefore,...

Purpose: The aim of this study was to investigate concurrent validity of the Swedish self-rated 36-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 by comparison with professional Global Assessment of Functioning (GAF) ratings in psychiatric outpatients. Material and methods: A cross-sectional convenience sample of 444...

Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with behavioural, emotional and interpersonal problems, and non-pharmacological treatments targeting these difficulties have been requested. The objective of this study was to evaluate the effectiveness and acceptance of an age-adapted structured skills training group (SST...

Background Nonsyndromic orofacial clefts (OFC) are associated with neurodevelopmental disorders. The aim of this study was to compare children with bilateral clefts with unilateral clefts regarding psychiatric disorders. Methods We utilized data on all children born in Sweden between 1973 and 2012 with unilateral cleft lip (UCL), bilateral cleft l...

Background Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of...

Objective: Borderline personality disorder (BPD) is characterized by instability in emotions, relationships, and behaviors, such as self-injury and suicidal behavior. Dialectical Behavioral Therapy (DBT) is an established intervention for BPD, but there are long waiting times for treatment. This study aimed to explore if a brief internet-delivered...

Purpose: Parents of children scheduled for surgery often experience emotional distress and anxiety. This study aimed to explore parents' experiences of hospital care after their child's craniosynostosis surgery and their perception of support during the year after discharge. Design and methods: A purposive sample of 19 parents of 12 children wit...

Aim: This study investigated the perceptions of men who worked on the streets of Iraq when they were children. It looked at the risks they faced, how they developed resilience and what support they feel current working children need. Methods: In 2021, semi-structured interviews were held with 40 men aged 24-33 who used to work on the streets as...

Background Though the heterogeneous expression of symptoms of borderline personality disorder (BPD) is well-known, it is far from fully understood. Hybrid models combining dimensional and categorical ways of diagnosing BPD have been suggested to better handle this heterogeneity, but more research is needed. The aim of this study was to identify pot...

Purpose Depression at all ages is recognized as a global public health concern, but less is known about the welfare burden following early-life depression. This study aimed to (1) estimate the magnitude of associations between depression in adolescence and social transfer payments in adulthood; and (2) address the impact of major comorbid psychopat...

Purpose of the review: To evaluate and summarize recent research investigating psychological, social and environmental risk factors for development of psychopathology in childhood, while controlling for biological (genetic) influences by using a matched sibling, twin or adoptee design. Recent findings: Nineteen studies were included, of which el...

Aim Examination of psychometric properties and diagnostic accuracy of the Depression Self-Rating Scale for Adolescents (DSRS-A) as well as development and evaluations of a shorter version, DSRS-A-Screener. Methods Analyses of component structure and internal consistency were performed in a community-based sample of adolescents N = 4,506 and among...

Background: Assessment of disability is part of the psychiatric diagnostic process, and validated scales are needed for the assessment of functioning. The Swedish translations of the Child Sheehan Disability Scale (CSDS) for adolescents and parents (CSDS-P) have been adapted for use in psychiatric settings. Objective: The purpose of the study was t...

Frequent assessment of eating disorder (ED) symptoms (e.g., on a weekly basis) may guide treatment planning in clinical services, and be an invaluable tool for improving clinical research. The aim of the present study was to evaluate the psychometric properties of a brief eight‐item scale designed to assess ED behaviors during the preceding week (E...

The aim of the study was to describe nursing and medical students’ experiences of participation in an interprofessional education (IPE) activity, “round school,” during their clinical rotations in psychiatric care. Data were collected in six focus groups with 32 students from nursing and medical programs, focusing on their experiences of the IPE ac...

Adolescent depression is linked to adult ill-health and functional impairment, but recent research suggests that individual/contextual factors might account for this association. This study aimed to test whether the clinical heterogeneity of adolescent depression is related to marginalization from the labor market across early to middle adulthood....

Background and objectives No treatment for adult anorexia nervosa (AN) has shown sufficient effectiveness or superiority to other treatments. Overcontrol has been suggested as a viable mechanism to target in the treatment of patients with AN. Radically open dialectical behavior therapy (RO DBT) is developed for disorders related to maladaptive over...

Aim The aim of this study was to evaluate the reliability and validity of the Swedish version of the self-rated 36-item WHODAS 2.0 in patients from Swedish psychiatric outpatient settings, using classical test theory. Methods The 36-item WHODAS 2.0, together with the Sheehan Disability Scale (SDS), was filled in by a sample of 780 participating ps...

Background Personality has been suggested to be an important factor in understanding onset, maintenance, and recovery from eating disorders (ED). The objective of the current study was to evaluate personality style in different ED diagnostic groups as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). M...

Background: Physicians’ communication skills (CS) are important for improving patient-centred care. The aim of this study was to evaluate simulation training in difficult consultations with actors as standardised patients (SPs) for training CS with medical students, as regards both student satisfaction and effects on CS used. Methods: In this mixed...

Introduction Street working children are often poor, deprived of love and care, and lack supervision by responsible adults. The Kurdistan region of Iraq has experienced war conflicts for decades. Many families have been displaced and their children forced into the streets. However, little is known about mental health among the street working childr...

Background Recovery rates after psychological treatments for anorexia nervosa are low to moderate, and in adults, no treatment outperforms any other. The aim of this study was to evaluate patient experiences of Radically open dialectical behavior therapy (RO DBT), a treatment developed for disorders related to maladaptive overcontrol. Methods Elev...

The Ego Resilience scale (ER) and The Ego Undercontrol scale (EUC) are designed to assess personality types based on how people inhibit or express their emotional impulses. The study aim was to evaluate the psychometric properties of the Swedish version of both scales. Two community samples were recruited through convenience sampling and were infor...

Background Personality disorders (PDs) are related to poor psychosocial function, including fewer relationships with friends and romantic partners. Methods One‐hundred eighty‐six psychiatric patients were included in a study cohort in 2002–2003. In 2017, data regarding living arrangements and marital status between 2003 and 2016 were collected for...

Background >Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls. Methods Gastrointestinal symp...

Background: Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis. Methods: The authors reviewe...

Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based...

Background: Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls. Methods: Gastrointestinal symp...

Background: Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls. Methods: Gastrointestinal symp...

Background: Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls. Methods: Gastrointestinal symp...

Background Maternal perinatal depression is a public health problem affecting mothers and children worldwide. This study aimed to increase the knowledge regarding the impact of timing of maternal depression on child behavioral difficulties at 18 months, taking into consideration child gender and maternal bonding. Methods Data from a Swedish popula...

Background: The Montgomery–Åsberg Depression Rating Scale – Self Assessment (MADRS-S) is used to assess symptom severity in major depressive disorder (MDD) among adolescents, but its psychometric properties and diagnostic accuracy are unclear. Aim: The aim of this study was to explore psychometric properties, including diagnostic accuracy, of the M...

Objective Few studies report about the feedback students receive in undergraduate psychiatry training. The aim of this study was to evaluate an effort to optimize feedback to medical students during rotations in psychiatry. Methods A structured feedback tool was constructed and introduced during psychiatric rotations. At the end of each week durin...

Background: The bidirectional interaction between melatonin and the immune system has largely gone unexplored in a clinical context and especially in a psychiatric population. This study explored the association between melatonin during the day and inflammatory cytokines in young adult patients seeking psychiatric care. Methods: Samples and data...

Craniosynostosis is usually diagnosed in early infancy. Treatment almost always involves surgery and care is optimally organized around an interdisciplinary team of specialists at a craniofacial center. This study aimed to investigate Swedish parents' experiences of having a child with craniosynostosis and their perceptions of the initial care proc...

Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Upps...

Background: Attention-deficit/hyperactivity disorder (ADHD) is linked to high levels of perceived stress in adult populations. Thus, it is not surprising that stress managing techniques are being included in treatment protocols for adults with ADHD. There is, however, a paucity of studies on perceived stress in adolescents with ADHD. Aims: This stu...

Background Meaningful and generalizable research depends on patients' willingness to participate. Studies often fail to reach satisfactory representativeness. Objective This paper aims to investigate reasons for not participating in research among young adult patients with psychiatric illness. Method A quantitative cross‐sectional study was perfo...

Aim: The aim of this study was to explore the relevance of asking young psychiatric patients about childhood symptoms of attention deficit hyperactivity disorder (ADHD). Method: A total of 180 young adults (18–25 years of age) from a general psychiatric out-patient clinic in Uppsala filled in the Child and Adolescent Psychiatric Screening Inventory...

Background: The aim of this study was to describe personality traits in psychiatric patients and to investigate whether these traits are stable over 13 years. Methods: A total of 95 individuals who were patients at a psychiatric outpatients’ clinic in 2003 completed the Swedish universities Scales of Personality (SSP). Scores from 2003 were compare...

Background: Attention deficit/hyperactivity disorder (ADHD) has a negative impact on several domains of life. However, there is a shortage of evidence-based non-pharmacological treatments for adolescents with ADHD. A structured skills training group (SSTG) based on dialectical behaviour therapy (DBT) has been used in adult patients with ADHD with...

Purpose: Childhood trauma in an important public health concern, and there is a need for brief and easily administered assessment tools. The Early Trauma Inventory (ETI) is one such instrument. The aim of this paper is to test the psychometric properties of the Swedish translation of the short, self-rated version (ETISR-SF), and to further validate...

Purpose To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-r...

Introduction: Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low-risk women, taking predisposing and need factors for health care utilization into consideration. Materi...

Circulating levels of adipokines are known to be associated with depression. This study aimed to investigate a possible association between leptin, adiponectin and dimensional measures of depressive symptoms in young adults with and without psychiatric illness. Total plasma adiponectin and leptin levels were measured in 194 young adults seeking psy...

Objective: The aim of this study was to examine the psychometric properties and diagnostic accuracy of the Swedish version of the Wender Utah Rating Scale (WURS) in psychiatric patients with similar symptoms but diagnosed with either attention deficit hyperactivity disorder (ADHD), bipolar disorder (BP), and/or borderline personality disorder (BPD)...

Objective: The pathophysiology of irritable bowel syndrome (IBS) is not completely understood, although we do know that patients with IBS have a high prevalence of psychiatric comorbidity (mainly depression and anxiety disorders). Melatonin, produced in the gastrointestinal tract, influences gut motility. Psychiatric conditions are associated with...

Objective: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type. Method: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842)...

Background: Treatment of Hepatitis C virus (HCV) infection has evolved from interferon (IFN)-based treatments to direct-acting antivirals (DAAs). Patients with HCV have an elevated psychiatric morbidity (including substance abuse) and patients with such comorbidity have often been excluded from treatment with IFN. To date, little is known about ps...

Background: The diagnostic accuracy of the parent report of the Montgomery–Åsberg Depression Rating Scale (MADRS-P) for the screening of major depressive disorder (MDD) in adolescents has not been evaluated. Aim: The aim was to explore the psychometric properties and diagnostic accuracy of the MADRS-P in general child and adolescent psychiatric out...

Background Personality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPD...

Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. Background: Adult attachment insecurity is currently included as a major risk factor...

Background Anorexia nervosa (AN) is a psychiatric disorder with high mortality. Method A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The...

Background Research in vulnerable individuals must insure voluntariness and minimize negative reactions caused by participation. This study aimed to describe consent and completion rate in young psychiatric patients in relation to study components, degree of disability and to compare response to research participation in patients and controls. Meth...

Background: Bulimia nervosa (BN) is characterized by dysregulated eating behaviour and present data suggest adipokines may regulate food intake. We investigated a possible association between BN and adipokine levels and hypothesized that plasma (P)-adiponectin would be elevated and P-leptin and P-leptin-adiponectin-ratio would be reduced in women...

Self-harm is prevalent in non-psychiatric populations as well as in psychiatric settings, and is common in patients with most psychiatric diagnoses. Persons with self-harm behaviour can be incorrectly diagnosed with borderline personality disorder. There is support for self-harm having an emotion regulating function. Most treatments for self-harm a...

Background: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12 weeks of daycare...

Rationale, aims and objective: The Sheehan Disability Scale (SDS) is a brief instrument used to measure functional disability, but the Swedish translation has not been psychometrically evaluated. The aim of this paper is to test the psychometric properties of the Swedish translation and to further examine concurrent and external validity.Method: In...

Background: Psychiatric illness is common among young adults, but there are only a few studies examining their views about the care they receive. There is a paradigm shift towards person-centred care and, therefore, a need for patients' perspectives in the development of clinical guidelines. Aim: The aim of this study was to examine the views ab...

Reduced levels of melatonin have been associated with severe depression. The aim was to investigate the correlation between salivary melatonin and dimensional measures of depressive symptom severity in young adult psychiatric patients. Levels of melatonin were analyzed in six saliva samples during waking hours from 119 young adult patients under ou...

Background Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the et...

Self-harm is prevalent in non-psychiatric populations as well as in psychiatric settings, and is common in patients with most psychiatric diagnoses. Persons with self-harm behaviour can be incorrectly diagnosed with borderline personality disorder. There is support for self-harm having an emotion regulating function. Most treatments for self-harm a...