Sofie Bäärnhielm

Sofie Bäärnhielm
Karolinska Institutet | KI · Centrum för psykiatriforskning

MD, PhD

About

71
Publications
10,069
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904
Citations

Publications

Publications (71)
Article
Full-text available
Aims The aim of this study was to determine possible differences in psychiatric care contact and the type of contact in the year prior to suicide by migrant status and region of origin compared to Swedish persons. Methods A population-based open cohort design, using linked national registers, to study all individuals aged 20–64 years who died by s...
Article
Full-text available
Aims Underutilisation of mental health services among migrant youth has been demonstrated repeatedly, but little is known about potential discrepancies in terms of treatment receipt for those who do reach services. This study examines the type and level of care received among migrant children and descendants of migrants, particularly investigating...
Article
This special issue of Transcultural Psychiatry on training in cultural psychiatry discusses translating research into improvements in mental health care for refugees and migrants. This topic is timely because, in addition to a global increase in migration, the number of forcibly displaced people is growing rapidly due to war and conflicts. We know...
Article
Full-text available
Background Culture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive...
Article
Full-text available
Purpose Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopme...
Article
Full-text available
The Cultural Formulation Interview (CFI), included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders , is a person-centered instrument for systematically appraising the impact of cultural factors in psychiatric assessment. A number of key areas in the future development of the CFI have been identified in order to ens...
Article
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Background Refugees tend to have a higher risk of mental ill-health and use mental health services less than the native-born population during their first 10 years in Sweden. Intercultural interactions between refugees and mental health professionals have been described as challenging. Cross-cultural training is proposed as one way to improve care...
Article
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Objectives To develop conceptual understanding of perceived barriers to seeking care for migrant children and young people (aged 0–25 years) with mental health problems and/or neurodevelopmental differences in high-income countries. Design Qualitative evidence synthesis using meta-ethnography methodology. We searched four electronic databases (Med...
Preprint
Full-text available
Background Culture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive...
Article
Full-text available
Background Despite availability of effective treatments, migrants in high-income countries seek care for conditions associated with stigma to a lower extent than the rest of the population. We conducted a scoping review to map the literature on interventions to increase migrants’ care-seeking behaviour in high-income countries for stigmatised condi...
Chapter
Full-text available
In this chapter, we discuss the pros and cons of separate versus integrated services for immigrants and refugees. Our discussion is based on experiences from three high-income countries: Germany, Norway, and Sweden. All three, regardless of general public insurance systems covering healthcare costs, have barriers to mental health care for migrants...
Article
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PurposeTo better understand underutilisation of psychiatric care among migrant children, we compared utilisation of psychiatric care among unaccompanied refugee minors and accompanied migrant minors, with Swedish-born minors.Methods Using a large longitudinal database of linked national registers, we established a retrospective cohort of 1,328,397...
Article
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Background: To investigate differences in psychiatric care use over time between Swedish born and those born abroad who migrate to Sweden. Methods: Population-based cohort study analysing linked population and health registers, following individuals born 1944-1990 from 1 January 2005 to 31 December 2016. Time-stratified survival analysis using C...
Article
The Swedish word, 'bemötande', has no direct equivalent in English but refers to contact, treatment and the relationship with a patient. 'Bemötande', in the context of care, concerns amongst other things how the session is conducted and takes place. The experience of a positive 'bemötande' is important for the patient and relatives to be able to fe...
Article
Psychiatric treatment must be developed and adapted, as Sweden's population has become increasingly multicultural and many migrants are refugees from war and conflict areas. Methods and ways of working need to take account of cultural variation in the expression of symptoms and the fact that many refugees have experienced deeply traumatic events, s...
Article
Background Global migration and increasingly diverse populations poses new challenges to mental health services. Cultural differences between refugees and mental health professionals and lack of cultural competency is described as challenging. Cross-cultural training has been proposed as one way to reduce these problems. There are few evaluations o...
Chapter
Access to good quality intercultural psychotherapy for minorities and displaced persons is dependent on mental healthcare systems embracing and actively cultivating an intercultural perspective. In this chapter, we discuss what is needed to improve the accessibility and relevance of mental healthcare for minorities and displaced persons, using Swed...
Article
Full-text available
Traditional Chinese medicine (TCM) is an alternative medical system utilised by many Chinese. However, the knowledge of TCM concepts of depression is limited amongst clinicians with training in Western biomedicine. The purpose of this study was to obtain a better understanding of the conceptualisation of depression from a group of TCM practitioners...
Chapter
The number of refugee, asylum seeker and immigrant patients over the globe is growing dramatically, and industrialized countries are likely to receive increasing numbers of people belonging to ethnic minorities in the form of refugees and asylum seekers due to a global increase in social and political instability as well as socioeconomic conflicts....
Article
Background: Mental health services in Sweden are confronted with globalization and refugee migration from conflict- and war-torn countries. Aim: To discuss how clinicians in Sweden can deal with a series of challenges in a changing globalized society, ranging from difficulties of overcoming barriers to help seeking to difficulties of identifying tr...
Article
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Background: Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female...
Article
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Background Even though asylum seekers are considered vulnerable to mental ill-health, knowledge of their suicidal behaviour is limited. The aim of this study was to improve our understanding of factors that influence the clinical assessment of asylum seekers who have attempted suicide compared to the assessment of non-asylum seekers. Methods The s...
Chapter
This chapter offers an overview of aspects of patient-clinician communication in psychiatry, and the importance of this for diagnostics and therapy. It also offers a questionnaire which can be used in clinical practice.
Chapter
This chapter offers an overview of the research and applicability of the Cultural Formulation Interview in clinical settings in psychiatry and psychotherapy, specially in the assessment phase. Researchers from Sweden, Kenya, the Netherlands and India cooperated in this research.
Article
Immigrants and refugees, especially those who are newly settled, often have poor knowledge about how the health-care system works, what help they can obtain, and how to communicate their suffering and need for help in an understandable way in the new context. It is therefore necessary for health and mental health professionals to be sensitive to cu...
Article
Full-text available
This study evaluated the use of the Outline for Cultural Formulation (OCF) from the DSM-IV in the diagnosis of immigrants and refugee patients at an outpatient psychiatric clinic in Sweden. Using the OCF in conjunction with standard diagnostic procedures led to major revisions of diagnoses for 56.5% of patients. Anxiety disorders, especially PTSD,...
Article
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This study evaluates the outcomes of cross-cultural mental health training given to professionals in health care and refugee reception in Stockholm, Sweden. A mixed method approach, with quantitative data from questionnaires (n = 232) and ten qualitative focus group interviews, was used. After training, the participants reported that the hindering...
Article
Full-text available
The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings...
Article
There are inequalities in health among migrants and local populations in Europe. Due to migration, Germany, Norway and Sweden have become ethnic culturally diverse nations. There are barriers to mental health care access for refugees, migrants and minorities, and problems with quality of culturally sensitive care in the three countries. This is des...
Article
Globalization and cultural diversity challenge mental health care in Europe. Sensitivity to culture in mental health care benefits effective delivery of care to the individual patient and can be a contribution to the larger project of building a tolerant multicultural society. Pivotal for improving cultural sensitivity in mental health care is know...
Article
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This paper explores the contributions of the Cultural Formulation (CF) interview to an overall understanding of patients, and focuses on the narratives of 23 newly referred patients with migrant backgrounds seeking help at a psychiatric outpatient clinic in Stockholm. Through text content analysis methods we identified five themes: displacement in...
Article
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Ethnography provides a method for psychiatric assessment to obtain an insight into the patient's culture, context, and life situation. The Outline for a Cultural Formulation (CF) is an ethnography-based, idiographic formulation intended to complement the multiaxial assessment in DSM-IV. Its contribution to routine clinical praxis will be discussed...
Article
This article discusses the experience of adapting and applying the Outline for a Cultural Formulation in DSM-IV to the Swedish context. Findings from a research project on the Cultural Formulation highlight the value of combining psychiatric nosological categorization with an understanding of patients' cultural life context in order to increase the...
Article
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This qualitative study was performed with the aim of exploring structures of illness meaning among somatizing Swedish-born women. Patients in contact with local health care services were interviewed about illness experiences and beliefs. An analysis was made using a grounded theory approach, and results are presented in terms of the patient's versu...
Article
Culturally capable care requires that clinicians possess insights into patients' reasoning about illness. It is universally common for emotional distress to be expressed in terms of somatic symptoms. Converting meanings of illness from a somatic to a psychological agenda for understanding distress may be complicated for patients. Objectives of this...
Article
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The aim of this study was to investigate barriers to diagnosis and adequate treatment of patients with early-onset dysthymia by studying how understandings of illness by patients and providers have evolved and how treatments have been negotiated over time. A theory-testing and explorative multiple-case study design was used with developmental cogni...
Article
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A better understanding is needed of factors behind the long-term outcome of dysthymic and panic disorders. Combining patients' perceptions of factors that help and hind remission with objective assessments of outcome may give greater insight into mechanisms for maintaining recovery. Twenty-three dysthymic and 15 panic disorder patients participated...
Article
Psychiatric care for adult asylum seekers has been an area of conflict and turbulence in Sweden over the last 20 years. Sweden has been criticised for being one of the most restrictive EU countries in providing health care for asylum seekers. Mental health care for asylum seekers is characterised by short-term emergency measures and inequality. The...
Article
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This article discusses historical reflections on the response of Swedish mental health care to cultural diversity and immigration and our views regarding future directions for clinical care, research and training. Sweden has become increasingly multicultural through immigration. Mental health care in Sweden faces the challenges of encountering cult...
Article
This study explores restructuring of illness meaning among eight Swedish-born female patients, assessed as somatizing, encountering caregivers imposing a "psychological language" of distress. Data were collected 1997-2001 from 32 interviews and analysed with a Grounded Theory approach. Two major trends were identified in the participants' process o...
Article
Full-text available
Videoconferencing is an innovative method that potentially allows medical students exposure to international teachers in refugee mental health who would otherwise be inaccessible. This article reports a pilot study using videoconferencing with international teachers from Australia, Sweden and the USA participating in the training of ten senior Swed...
Article
This study explores restructuring of illness meaning among ten Turkish-born women, assessed as somatizing, encountering caregivers imposing a "psychological language" for understanding distress. Participants were referred from local health care services in Western Stockholm, Sweden. Data were collected between 1997 and 2001 from 37 interviews with...
Article
The present study examined results of cognitive-behavioral treatment (CBT) in a 22-year-old, male, tortured asylum-seeker living in Sweden. The patient received 16 sessions of CBT involving mainly self-exposure to trauma-related cues. Clinical measures (assessor- and self-rated) were completed at pre-treatment, weeks 6, 8, 12, and 16, post-treatmen...
Article
This article examines ethical issues for qualitative cross-cultural mental health research. Qualitative research methods may give access to intimate aspects of participants’ lives. Data collection can be intrusive and invasive regarding sensitive experiences. The research methods may generate unique and subtle ethical problems. A case illustrating...
Article
We discuss the use of focus group interviews as a research method in transcultural psychiatry. Focus groups are a new method in health research that can provide a contextual basis for making culturally sensitive interpretations. We illustrate advantages as well as disadvantages of this method with examples from our own research with immigrants and...
Article
This paper presents the results from a qualitative study conducted with the aim of exploring structures of illness meaning among somatizing Turkish-born migrant women (age 31-48) living in a poor and low status suburb of Stockholm in contact with local health care services. Two to three interviews regarding experiences and understanding of illness...
Article
A considerable proportion of the Swedish population are of immigrant or refugee origin. This puts new demands on psychiatric care. In Stockholm county, immigrants of non-Scandinavian origin are characterised by lower psychiatric care utilisation rates than are the remainder of the county population. Population studies of multi-ethnic suburban areas...
Article
A considerable proportion of the Swedish population are of immigrant or refugee ori-gin. This puts new demands on psychiatric care. In Stockholm county, immigrants of non-Scandinavian origin are characterised by lower psychiatric care utilisation rates than are the remainder of the county population. Population studies of multi-ethnic suburban area...

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