Risk Factors for Sexual Offending in Men Working with Children: A Community-Based Survey

Identifying risk factors for sexual abuse in men who work with children and who have already abused a child could lead to more appropriate screening and prevention strategies and is thus of major scientific and societal relevance. 

A total of 8649 German men from the community were assessed in an extensive anonymous and confidential online survey. Of those, 37 (0.4 %) could be classified as child sexual abusers working with children, 90 (1.0 %) as child sexual abusers not working with children, and 816 (9.4 %) as men who work with children and who have not abused a child. 

We assessed the impact of working with children as an individual risk factor for self-reported child sexual abuse and compared personal factors, pedophilic sexual fantasies, deviant sexual behaviors, antisocial behaviors, and hypersexuality among the three groups. Most interestingly, working with children was significantly associated with a self-reported sexual offense against children; however, it explained only three percent of its variance. 

Child sexual abusers working with children admitted more antisocial and more sexually deviant behaviors than child sexual abusers not working with children and than men working with children who have not abused a child. 

Our findings support some of the suggestions made by other researchers concerning factors that could be considered in applicants for child- or youth-serving institutions. However, it has to be pointed out that the scientific basis still seems premature.

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By:  Turner D1, Hoyer J2, Schmidt AF3, Klein V4, Briken P4.

• 1Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. turner.daniel@gmx.de.
• 2Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
• 3Institute for Health and Behaviour, Health Promotion and Aggression Prevention, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
• 4Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
• Arch Sex Behav. 2016 May 16.

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Clinical characteristics of alcohol combined with other substance use disorders in an American Indian community sample

HIGHLIGHTS

• Multi-substance use disorder was more prevalent than single use disorder.
• Alcohol was the most common drug followed by stimulants and cannabis.
• Multi-substance use disorder was more severe and had greater co-morbidity.

BACKGROUND:

Alcohol and other substance use disorders (SUD) pose major problems of morbidity and mortality in some American Indian communities, but little is known about the clinical characteristics, risk factors, and consequences of combined alcohol and other substance use disorders (multi-substance use disorder, MSUD) in those communities.

METHODS:

Using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), in a community sample of 876 American Indians, the clinical characteristics of lifetime DSM-5 moderate or severe alcohol use disorder alone (AUD alone) (n=146) and MSUD (defined as alcohol and ≥1 other SUD) (n=284) were evaluated and compared to 347 participants with no lifetime SUD (no SUD).

RESULTS:

The majority (57%) of participants with a SUD had multi-substance use disorder and 94% of those were with AUD. Stimulants (cocaine and/or amphetamine) and/or cannabis were the most common other SUDs. Participants with AUD alone were more likely to be male and have an earlier age of first alcohol intoxication than those with no SUD. Those with MSUD were more likely to have dropped out of high school, have antisocial personality disorder (ASPD) or conduct disorder (CD), have earlier ages of first alcohol intoxication and first use of cannabis and stimulants, an earlier age of onset of AUD, and more of several AUD symptoms than those with AUD alone, but the same temporal course and time to remission of AUD.

CONCLUSIONS:

MSUD is prevalent in this sample, is associated with multiple comorbidities and denotes a more severe alcohol syndrome than AUD alone.

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By:  Gilder DA1, Stouffer GM1, Lau P1, Ehlers CL2.

• 1Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
• 2Molecular and Cellular Neuroscience Department, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA. Electronic address: cindye@scripps.edu.
• Drug Alcohol Depend. 2016 Apr 1;161:222-9. doi: 10.1016/j.drugalcdep.2016.02.006. Epub 2016 Feb 8. 

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Risk Assessments & Recidivism among a Population-Based Group of Swedish Offenders Sentenced to Life in Prison

BACKGROUND:

In Sweden, the number of people serving life sentences has steadily increased. To date, few studies have examined the recidivism rate or the predictive validity of different risk assessment instruments in this group.

AIMS:

Our aim was to test the predictive validity among inmates serving life sentences of two different instruments used for assessing risk-the Historical, Clinical and Risk Management-20 (HCR-20), most widely used in clinical populations, and the Psychopathy Checklist-Revised (PCL-R), commonly applied in both penal and clinical settings.

METHOD:

Ninety-eight life-sentenced prisoners were included, 26 of whom were released during the study period. Data on risk assessments and dates for release were collected from administrative records, while recidivism data were retrieved from a national database on criminal convictions.

RESULTS:

Sex offenders obtained the highest scores and inmates charged with domestic violent offences obtained the lowest scores on both instruments. The released prisoners were followed for a mean period of 33 months. During this time five prisoners (19%) reoffended, four of them violently, with an average time to recidivism of 10 months. Only PCL-R Facet 4, which reflects antisocial features, was significantly associated with recidivism.

CONCLUSIONS:

This small, but population-based, study demonstrates that antisocial behaviour shows incremental predictive validity for reoffending among life-sentenced offenders, but other measures have little to add for this specific task. The fact that those life sentenced prisoners who reoffended did so so soon after release should prompt allocation of earlier interventions towards preventing this.

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By:  Sturup J1, Karlberg D2, Fredriksson B3, Lihoff T3, Kristiansson M2.

• 1National Board of Forensic Medicine, Karolinska Institutet and Stockholm University, Sweden.
• 2National Board of Forensic Medicine and Karolinska Institutet, Sweden.
• 3National Board of Forensic Medicine, Sweden. 
• Crim Behav Ment Health. 2016 Apr;26(2):124-35. doi: 10.1002/cbm.1941. Epub 2015 Jan 30.

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Gendered Contexts: Psychopathy and Drug Use in Relation to Sex Work and Exchange

Few scholars have examined psychopathology correlates of sex work. It has been suggested that sex work may reflect manifestations of impulsive-antisocial psychopathic traits (e.g., reckless disregard, delinquency) in women more than men. 

The current work examined relative contributions of drug dependence and distinct psychopathic features in relation to traditional forms of sex work (i.e., prostitution) in women, along with gender differences in psychopathy relationships with casual forms of sex exchange (i.e., trading sex for necessities). 

Study 1 included 171 community-dwelling women offenders, and Study 2 included 319 participants (42.3% women) with histories of drug use and/or violence. Participants completed the Psychopathy Checklist: Screening Version, prostitution was measured as self-report and/or public record data across studies, and sex exchange in Study 2 was assessed using a questionnaire based on prior research on sexual risk-taking. 

Findings across both studies demonstrated that although psychopathic traits, particularly impulsive-antisocial features, were associated with prostitution in women above the use of drugs, drug dependence did not moderate the relationship between psychopathic traits and prostitution in women. 

Analyses of Study 2 data revealed that impulsive-antisocial traits were associated with sex exchange at low, but not high, levels of interpersonal-affective traits across participants. As well, interpersonal-affective traits were significantly positively related to sex exchange in men and not significantly (and negatively) related in women. 

In sum, impulsive-antisocial traits related to prostitution among women, suggesting that women may manifest these traits within intimate contexts. Moreover, findings indicated gender differences in the manifestation of interpersonal-affective traits within sexual exchange contexts.

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By:  Edwards BG, Verona E. [Vitae]

Department of Psychology, University of South Florida

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Risk Factors for Intimate Partner Violence: A Comparison of Antisocial and Family-Only Perpetrators

Subtyping male perpetrators of intimate partner violence (IPV) based on their generality of violence could facilitate the difficult task of matching perpetrator subtype with efficient risk management strategies. 

As such, the aim of the present study was to compare antisocial and family-only male perpetrators of interpersonal violence in terms of 

1. demographic and legal characteristics, 
2. risk factors for violence, and 
3. assessed risk and the importance of specific risk factors for violence. 

A quantitative design was used in this retrospective register study on data obtained from the Swedish police. Risk assessments performed with the Swedish version of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) and police registers were used. A sample of 657 male alleged IPV perpetrators were classified as antisocial (n= 341) or family-only (n= 316) based on their generality of violence. 

The results showed that the antisocial perpetrators were significantly younger, as well as more psychologically abusive. Antisocial perpetrators also had significantly more present risk factors for IPV, and were assessed with a significantly higher risk for acute and severe or deadly IPV, compared with the family-only perpetrators. The subtypes also evidenced unique risk factors with a significant impact on elevated risk for acute and severe or deadly such violence. Key findings in the present study concerned the subtypes evidencing unique risk factors increasing the risk for acute and severe or deadly IPV. 

Major implications of this study include the findings of such unique "red flag" risk factors for each subtype. To prevent future IPV, it is vital for the risk assessor to be aware of these red flags when making decisions about risk, as well as risk management strategies.

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By:  Petersson J1, Strand S2, Selenius H3.

• 1Mid Sweden University, Sundsvall, Sweden joakim.petersson@miun.se.
• 2Örebro University, Örebro, Sweden Swinburne University of Technology, Melbourne, Australia.
• 3Örebro University, Örebro, Sweden. 
• J Interpers Violence. 2016 Mar 27. pii: 0886260516640547. 

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Discriminant Factors for Adolescent Sexual Offending: On the Usefulness of Considering Both Victim Age & Sibling Incest

Understanding the pathways and circumstances of juvenile sexual offending is of utmost importance. However, juvenile sexual offenders (JSO) represent an especially diverse group of individuals, and several categorizations have been proposed to obtain more homogeneous subgroups. Victim age-based and family relation-based categorizations are particularly promising because they seem theoretically and clinically relevant. Empirical results however are still inconsistent, and most studies have not considered these two dimensions jointly. 

The first goal of this study was to further examine the value of subgrouping JSO according to the age of their victim. A second goal was to determine the supplementary value, if any, of considering sibling incest. Based on a sample of 351 male JSO, it was first confirmed that sexual abuse of children was more strongly related to asociality (social skill deficits) than sexual abuse of peers, the latter being more closely associated with antisociality (general delinquency). 

The relevance of considering mixed-type JSO (with both child and peer victims) separately was also confirmed. More importantly, multivariate statistical analyses demonstrated that adding sibling incest to the equation was useful. JSO of intra-familial child were significantly more likely to have been victimized during their own childhood compared to JSO with extra-familial victims. Nevertheless, adolescents who had committed sibling incest obtained middle ground results on most variables (except for crime severity), suggesting that they constitute a distinct but not extreme, subgroup. 

This study confirmed the utility of using both the age and the family relation with the victim in characterizing juvenile sexual offending.

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By:  Joyal CC1, Carpentier J1, Martin C1.

• 1Psychology Department, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, Quebec, Canada, G9A 5H7; Research Center, Institut Philippe-Pinel de Montréal, Quebec, Canada; International Center for Comparative Criminology, Université de Montréal, Quebec, Canada. 
• Child Abuse Negl. 2016 Feb 19;54:10-22. doi: 10.1016/j.chiabu.2016.01.006.

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Genetic Background of Extreme Violent Behavior

In developed countries, the majority of all violent crime is committed by a small group of antisocial recidivistic offenders, but no genes have been shown to contribute to recidivistic violent offending or severe violent behavior, such as homicide. 

Our results, from two independent cohorts of Finnish prisoners, revealed that a monoamine oxidase A (MAOA) low-activity genotype (contributing to low dopamine turnover rate) as well as the CDH13 gene (coding for neuronal membrane adhesion protein) are associated with extremely violent behavior (at least 10 committed homicides, attempted homicides or batteries). No substantial signal was observed for either MAOA or CDH13 among non-violent offenders, indicating that findings were specific for violent offending, and not largely attributable to substance abuse or antisocial personality disorder. 

These results indicate both low monoamine metabolism and neuronal membrane dysfunction as plausible factors in the etiology of extreme criminal violent behavior, and imply that at least about 5–10% of all severe violent crime in Finland is attributable to the aforementioned MAOA and CDH13 genotypes.

Below:  Age- and gender-adjusted odds ratios for low-activity MAOA genotype and CDH13 (rs11649622) as a function of the number of committed violent crimes. The number of individuals, allele frequencies and odds ratios are shown below. The number of control subjects was 1946 for MAOA and 1877 for CDH13 analysis.

Below:  Manhattan plot of extremely violent offenders GWAS. The highest cluster is seen in locus 16q23.3

Full article at:   http://goo.gl/Bbrucl

By:  J Tiihonen,^1,2,3,19 M-R Rautiainen,^3,19 HM Ollila,^3,4 E Repo-Tiihonen,² M Virkkunen,^5,6 A Palotie,^7,8,9,10,11 O Pietiläinen,³ K Kristiansson,³ M Joukamaa,¹² H Lauerma,^3,13,14 J Saarela,¹⁵ S Tyni,¹⁶ H Vartiainen,¹⁶ J Paananen,¹⁷D Goldman,¹⁸ and T Paunio^3,5,6

¹Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

²Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland

³National Institute for Health and Welfare, Helsinki, Finland

⁴Stanford University Center for Sleep Sciences, Palo Alto, CA, USA

⁵Department of Psychiatry, University of Helsinki, Institute of Clinical Medicine, Helsinki, Finland

⁶Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland

⁷Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, England

⁸Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

⁹Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA

¹⁰Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland

¹¹Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

¹²Social Psychiatry Unit, School of Health Sciences, University of Tampere, Finland

¹³Psychiatric Hospital for Prisoners, Turku, Finland

¹⁴University of Turku, Turku, Finland

¹⁵Finnish Genome Center, Helsinki, Finland

¹⁶The Criminal Sanctions Agency, Helsinki, Finland

¹⁷University of Eastern Finland, Bioinformatics Center, Kuopio, Finland

¹⁸Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA

Correspondence: Professor J Tiihonen, Karolinska Institutet, Department of Clinical Neuroscience, Byggnad R5, Stockholm, S-171 76, Sweden or Professor T Paunio, National Institute for Health and Welfare, PO Box 30, FI-00271, Finland. Email: es.ik@nenohiit.iraj or ; Email:if.lht@oinuap.aniit

¹⁹These authors contributed equaliy to this work.

Mol Psychiatry. Author manuscript; available in PMC 2016 Mar 3. Mol Psychiatry. 2015 Jun; 20(6): 786–792.

  

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Like Parent Like Child? The Role of Delayed Childrearing in Breaking the Link Between Parent's Offending and Their Children's Antisocial Behavior

This paper investigates the impact of parents' history of violent offending, their age at first birth, and the interaction of the two on their adolescent children's violent behavior. We employ intergenerational longitudinal data from the Rochester Youth Development Study to estimate parental trajectories of offending from their early adolescence through early adulthood. We show that the particular shape of the parents' propensity of offending over time can interact with their age at first birth to protect their children from delinquency. We investigate these relationships for children at 6 and 10 years of age. We find that for some groups delaying childrearing can insulate children from their parents' offending.

Below: Three Hypothetical Paths of Offending

Below:  Violence Prevalence Trajectory Groups, Waves 1 – 10

Below:  Interquartile Ranges of Age at First Birth By Trajectory Group

...The more important research question is whether among those parents who put their children at risk by having participated in delinquent behavior, are there some relatively distal behaviors that can offset the effects of parental delinquency? That is, can even those parents who are in the high delinquent trajectory groups behave in ways that serve to protect their children from problematic behavior? Specifically, the question posed was whether having children later rather than earlier would serve to offset the effects of high parental involvement in delinquency.

The results answer the question affirmatively for those 10-year-old children of parents who were in the most delinquent trajectory group, the chronic group (group 5). The age of first birth is a protective factor for all three measures of problematic behavior for our 10-year-olds. Moreover, the impact of having parents who are in the group 5 is no longer significant once the interaction between age of first birth and group 5 membership is entered into the equation. It is important to note that this was not the case for the declining group (group 4). Their main effects of group membership on problematic behaviors were reduced to insignificance for two of the three outcomes when the interaction terms were entered into the equations. However, the interaction terms measuring the protective efficacy of delaying childbirth were not statistically significant. So, there is no protective effect of delaying childbirth. Although both group 4 and group 5 were similarly high in their offending patterns initially, the trajectory for group 4 sloped down while group 5 remained relatively high. In contrast, for group 4 (but not group 5) we found some evidence of a supportive effect for the protective role of age of first birth for the 6 year olds. The only significant impact of parental delinquency on the child’s problematic behavior was for the relationship between having parents in group 4 and the Achenbach delinquency scale. The interaction between age of first birth and parental membership in group 4 was significant as well, indicating that delaying having children protects children of relatively high risk parents even at the age of 6. The differences between 6- and 10-years-olds pose interesting questions about how mediators and protective factors might operate at different ages but we leave this for future research...

Full article at:   http://goo.gl/olPNYa

By:  Lizotte AJ1, Phillips MD1, Krohn MD2, Thornberry TP3, Bushway SD1, Schmidt NM4.

• 1School of Criminal Justice, University at Albany, Albany NY.
• 2Department of Sociology and Criminology & Law, University of Florida, Gainesville FL.
• 3Department of Criminology and Criminal Justice, University of Maryland, College Park MD.
• 4Institute on Urban Health Research, Northeastern University, Boston MA. 
• Justice Q. 2015;32(3):410-444.

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Early Life Risks, Antisocial Tendencies & Preteen Delinquency

Early age-of-onset delinquency and substance use confer a major risk for continued criminality, alcohol and drug abuse, and other serious difficulties throughout the life course. Our objective is to examine the developmental roots of preteen delinquency and substance use. 

Using nationally representative longitudinal data from the UK Millennium Cohort Study (n = 13,221), we examine the influence of early childhood developmental and family risks on latent pathways of antisocial tendencies from ages 3 to 7, and the influence of those pathways on property crime and substance use by age 11. We identified a normative, non-antisocial pathway; a pathway marked by oppositional behavior and fighting; a pathway marked by impulsivity and inattention; and a rare pathway characterized by a wide range of antisocial tendencies. 

Children with developmental and family risks that emerged by age 3-specifically difficult infant temperament, low cognitive ability, weak parental closeness, and disadvantaged family background-face increased odds of antisocial tendencies. There is minimal overlap between the risk factors for early antisocial tendencies and those for preteen delinquency. Children on an antisocial pathway are more likely to engage in preteen delinquency and substance use by age 11, even after accounting for early life risk factors.

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By:  Staff J1, Whichard C1, Siennick S2, Maggs J1.

• 1Pennsylvania State University.
• 2Florida State University. 
• Criminology. 2015 Nov;53(4):677-701. Epub 2015 Oct 20.

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The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans

The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs’ (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. 

These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population.

...The objectives of the current study were to determine the availability of services for justice-involved veterans that address empirically-supported risk factors for recidivism that are targeted by the RNR model, the types of treatment options and resources that are perceived as being most helpful in addressing these risk factors, and whether justice-involved veterans have access to empirically-based treatments for recidivism risk. For most risk factors (substance abuse, lack of positive school or work involvement, family/marital dysfunction, and lack of prosocial activities/interests), responses from the majority of Veterans Justice Program Specialists in our sample included description of some type of treatment option or resource that was available to address these issues among justice-involved veterans. By comparison, only a little more than half of the Specialists’ responses included description of any treatment options or resources to address antisocial tendencies and antisocial associates. This is noteworthy, given that risk factors related to antisociality (i.e., the Big Four) have been identified as the strongest predictors of criminal recidivism (Andrews & Bonta, 2010a, 2010b).

The current findings are largely consistent with research on availability of services for offenders in general. For example, a recent review highlighted the range of offender reentry programs and services that target vocational training, substance abuse prevention, and other psychosocial needs of offenders (e.g., housing; James, 2015). By contrast, others have noted that extant programming for offenders tend not target antisocial tendencies, despite the centrality of these issues in the prediction of recidivism risk (Epperson et al., 2014;Wolff et al., 2013). This potential gap may be greater among justice-involved veterans, given that in the current study the availability of interventions that directly target antisocial cognitions and attitudes (e.g., MRT, T4C) were reported to be less prevalent in VA (vs. non-VA settings)...

Full article at:   http://goo.gl/ty4VwX

By:  Daniel M. Blonigen,1,2 Allison L. Rodriguez,3 Luisa Manfredi,1 Jessica Britt,2 Andrea Nevedal,1 Andrea K. Finlay,1 Joel Rosenthal,4 David Smelson,5,6 and Christine Timko1,7

¹ HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System

² Palo Alto University, Palo Alto, CA

³ National Center for PTSD, VA Palo Alto Health Care System

⁴ Veterans Justice Programs, Veterans Health Administration

⁵ HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center

⁶ University of Massachusetts Medical School, Worcester, MA

⁷ Stanford University School of Medicine, Palo Alto, CA

Correspondence to: Daniel M. Blonigen, Ph.D., HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152), Menlo Park, CA 94025. Phone: 650-493-5000, ext. 27828, Fax: 650-617-2736. Email: vog.av@neginolB.leinaD

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Parent Programs for Reducing Adolescent’s Antisocial Behavior and Substance Use: A Randomized Controlled Trial

Two theoretically based parent training programs, delivered in real-world settings by the social services, were examined in this randomized controlled trial for effectiveness in reducing adolescents’ antisocial behavior and substance use. 

Two hundred and thirty-seven (237) adolescents in ages between 12 and 18 and their parents were assigned to one of two programs or to a wait-list control condition. The programs were the nine weekly group sessions program Comet 12–18 (Swedish Parent Management Training Program) and the six weekly ParentSteps (Swedish shortened version by Strengthening Families Program 10–14). Outcome measures were antisocial behavior, substance use, and delinquency, and psychosocial dysfunction. Data based on adolescents’ and parents’ ratings of the adolescents’ problem behavior at baseline and 6 months later were analyzed with repeated measures ANVOA, Logistic regression, and Kruskal–Wallis H test. 

The results showed that parents’ ratings of adolescents’ antisocial behaviors decreased significantly over time, but no time by group effect emerged. No program effects were found in the adolescents’ self-reported antisocial behavior, delinquency, or psychosocial functioning. A threefold risk of illicit drug use was found in both intervention groups. 

The results suggest that neither Comet nor ParentSteps had beneficial effects on adolescent’s antisocial or delinquent behavior, or on alcohol use. The only significant group difference found was a threefold risk of drug use in the intervention adolescents at follow-up, but for several reasons this finding should be interpreted with caution.

Below:  Flow chart of recruitment and dropout following the Consort Statement 2010 Flow Diagram

Full article at:   http://goo.gl/a6v54R

By:  Camilla Jalling,* Maria Bodin, Anders Romelsjö, Håkan Källmén, Natalie Durbeej, and Anders Tengström

STAD, Stockholm Center for Psychiatry Research and Education, Karolinska Institutet, Norra Stationsgatan 69, 113 64 Stockholm, Sweden

Department of Knowledge-Based Policy and Guidance, National Board of Health and Welfare, Stockholm, Sweden

Department of Public Health Sciences, Social Medicine, Karolinska Institutet, Stockholm, Sweden

Department of Clinical Neuroscience, Stockholm Centre for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden

Department of Clinical Neuroscience, Stockholm Centre for Psychiatry Research and Education, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

Camilla Jalling, Email: es.lls@gnillaj.allimac.

^*Corresponding author

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