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Sarkadi, Anna, ProfessorORCID iD iconorcid.org/0000-0001-6594-2291
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Publications (10 of 91) Show all publications
Sarkadi, A., Warner, G., Salari, R., Fängström, K., Durbeej, N., Lampa, E., . . . Keeshin, B. (2020). Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT): study protocol for a randomised controlled trial.. Trials, 21(1), Article ID 63.
Open this publication in new window or tab >>Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT): study protocol for a randomised controlled trial.
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2020 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 21, no 1, article id 63Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms.

METHODS/DESIGN: A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation).

DISCUSSION: This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden.

TRIAL REGISTRATION: ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.

Keywords
Post-traumatic stress disorder, Randomised controlled trial, Teaching Recovery Techniques, Unaccompanied refugee minors
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-402288 (URN)10.1186/s13063-019-3814-5 (DOI)31924247 (PubMedID)
Available from: 2020-01-13 Created: 2020-01-13 Last updated: 2020-01-20Bibliographically approved
Ssegonja, R., Alaie, I., Philipson, A., Hagberg, L., Sampaio, F., Möller, M., . . . Feldman, I. (2019). Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study. Journal of Affective Disorders, 258, 33-41
Open this publication in new window or tab >>Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study
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2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed) Published
Abstract [en]

Background: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

Methods: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

Results: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

Limitations: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

Conclusions: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

Place, publisher, year, edition, pages
ELSEVIER, 2019
Keywords
Adolescence, Depression, Direct costs, Adulthood, Psychiatric healthcare, Non-psychiatric healthcare
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-393715 (URN)10.1016/j.jad.2019.07.077 (DOI)000482176400004 ()31382102 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVinnova
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2019-09-30Bibliographically approved
Warner, G., Zaruhi, B., Osman, F., Lampa, E. & Sarkadi, A. (2019). ‘I felt like a human being’: An exploratory, multi‐method study of refugee involvement in the development of mental health intervention research. Health Expectations
Open this publication in new window or tab >>‘I felt like a human being’: An exploratory, multi‐method study of refugee involvement in the development of mental health intervention research
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2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Great advancements have been made in patient and public involvement (PPI), including the development of guidance on how to conduct, report and evaluate PPI. Despite these efforts, the evidence base remains relatively weak. A substantive methodological development is required. This is particularly important for vulnerable groups within society, for whom PPI can be challenging but has the potential to play a transformative role in shaping research.

Objectives: To describe the group dynamic characteristics and immediate impact of PPI from the user representatives’ perspective in a case study of refugee involvement in the development of mental health intervention research. To pilot and methodologically appraise the Active Involvement of Users in Research Observation Schedule and Questionnaire.

Design: The Active Involvement of Users in Research Observation Schedule and Questionnaire were administered together with a focus group discussion. Setting: ‘Refugee Advisors’ were involved in the development of a randomized con‐ trolled trial protocol evaluating a brief group intervention for refugee children expe‐ riencing symptoms of post‐traumatic stress in Sweden.

Results: The multi‐method approach demonstrated good feasibility. There were clear examples of how the advisors influenced research development. The advisors described a perceived impact on the research, equality and acceptance, and knowledge gain. A sense of appreciation and empowerment was also interpreted. However, potential issues relating to the relevance of contributions and use of an interpreter were identified.

Discussion and conclusion: The methodological approach piloted in this study offers a promising, rigorous way to evaluate PPI. The research tools require further refinement and validation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
group dynamics, mental health, observation, patient and public involvement, refugees
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-396996 (URN)10.1111/hex.12990 (DOI)000495185400001 ()31705620 (PubMedID)
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2020-01-16Bibliographically approved
Pérez-Aronsson, A., Warner, G., Sarkadi, A. & Osman, F. (2019). “I’m a Mother Who Always Tries to Give My Children Hope”—Refugee Women’s Experiences of Their Children’s Mental Health. Frontiers in Psychiatry, 10, Article ID 789.
Open this publication in new window or tab >>“I’m a Mother Who Always Tries to Give My Children Hope”—Refugee Women’s Experiences of Their Children’s Mental Health
2019 (English)In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 10, article id 789Article in journal (Refereed) Published
Abstract [en]

Background: The prevalence of mental health problems is high among refugee children. Childhood mental health problems have long-term negative consequences and costs both for the individual child and society. The present study aimed to explore refugee parents’ experiences of their children’s mental health.

Methodology: A qualitative explorative study was conducted. Data were collected through semistructured interviews with nine refugee mothers who have been in Sweden less than 5 years and with at least one child in the ages 8–14 years. Data were analyzed inductively using thematic network analysis.

Results: The global theme that emerged from the analysis was Navigating the moving landscape of forced migration, which described the refugee mothers’ experiences of the previous adversity the family went through, the ongoing transition in the new context, and, lastly, the pathways to promote their children’s mental health. Two organizing themes described mothers’ and children’s navigation of the forced migration: Previous adverse events and new suffering and Promoting children’s well-being. Mothers described aggression and frequent conflicts, or refusal to play or eat, in their children related to living conditions at asylum centres and social isolation. This improved when children started school and possibilities of social relations increased. Mothers’ own mental health and lack of language skills could also have a negative impact on the children. To focus on the present and have hope of the future was helpful to the children. Encouragement and social support from parents, teachers, and friends promoted children’s well-being.

Conclusion: The role of the host country in the promotion of the mental health of refugee children is emphasized. Interventions aimed to improve peer relations and reduce discrimination are needed, and these point to the school as a potential arena for positive change. Parental support groups were also mentioned as helpful in understanding the children’s need for support.

Keywords
child, mental health, mother, refugee, well-being
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Identifiers
urn:nbn:se:uu:diva-396999 (URN)10.3389/fpsyt.2019.00789 (DOI)000497449100001 ()31736806 (PubMedID)
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2020-01-16Bibliographically approved
Ssegonja, R., Nystrand, C., Feldman, I., Sarkadi, A., Langenskiöld, S. & Jonsson, U. (2019). Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression. Preventive Medicine, 118, 7-15
Open this publication in new window or tab >>Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression
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2019 (English)In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 118, p. 7-15Article, review/survey (Refereed) Published
Abstract [en]

Depression contributes about 2% to the global burden of disease. A first onset of depressive disorder or subsyndromal depressive symptoms is common in adolescence, indicating that early prevention is a priority. However, trials of preventive interventions for depression in youths show conflicting results. This systematic review and meta-analysis investigated the effectiveness of group-based cognitive behavioral therapy (GB-CBT) as a preventive intervention targeting subsyndromal depression in children and adolescents. In addition, the impact of different covariates (type of comparator and use of booster sessions) was assessed. Relevant articles were identified from previous systematic reviews, and supplemented with an electronic search spanning from 01/09/2014 to 28/02/2018. The retrieved articles were assessed for eligibility and risk of bias. Relevant data were extracted. Intervention effectiveness was pooled using a random-effects model and the impact of covariates assessed using meta-regression. 38 eligible articles (34 trials) were obtained. The analysis showed GB-CBT to significantly reduce the incidence (relative risk 0.43, 95% CI 0.21-0.87) and symptoms (Cohen's d -0.22, 95% CI -0.32 to -0.11) of depression at post-test compared to all controls. Comparisons with passive comparators suggested that the effect decayed over time. However, compared to active controls, a significant intervention effect was evident only after 12 month or more. Our results suggest that the preventive effect of GB-CBT wears off, but still lasts longer than the effect of active comparators. Only a few studies included booster sessions, precluding firm conclusions. Future studies should clarify to what extent maintenance strategies can prolong the preventive effect of GB-CBT.

Keywords
Depression, Dysthymia, Cognitive-behavioral therapy, Meta-analysis, Meta-regression, Indicated prevention interventions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-375899 (URN)10.1016/j.ypmed.2018.09.021 (DOI)000454933300002 ()30287331 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVINNOVA
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2019-02-04Bibliographically approved
Nayeb, L., Lagerberg, D., Westerlund, M., Sarkadi, A., Lucas, S. & Eriksson, M. (2019). Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier. Acta Paediatrica, 108(9), 1642-1648
Open this publication in new window or tab >>Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 9, p. 1642-1648Article in journal (Refereed) Published
Abstract [en]

Aim We examined if routine Swedish language screening for developmental language disorder (DLD) carried out at three years of age could be performed as effectively six months earlier. Methods This study observed 105 monolingual Swedish-speaking children (53% boys) aged 29-31 months at three Swedish child health centres. We compared their ability to combine three words, as per the existing protocol, and two words. They also underwent a comprehension task. Speech and language pathologists clinically assessed the children for DLD and their results were compared with the nurse-led screening. Results The results for the three-word and two-word criterion were the following: sensitivity (100% versus 91%) specificity (81% versus 91%), positive predictive (38% versus 56%) and negative predictive value (100% versus 99%). The three-word criterion identified 29 children with possible DLD, including 11 cases later confirmed, and the two-word criterion identified 18 possible cases, including 10 confirmed cases. DLD was overrepresented in the 10% of children who did not cooperate with the nurse-led screening. Conclusion Changing the required word combinations from three to two words worked well. The three-word test identified one extra confirmed case, but resulted in 10 more false positives. Lack of cooperation during screening constituted an increased risk for DLD.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
Childhealth care, Developmental language disorder, Language screening, Monolingual children, Word production
National Category
General Language Studies and Linguistics Pediatrics
Identifiers
urn:nbn:se:uu:diva-393651 (URN)10.1111/apa.14790 (DOI)000479320100015 ()30896050 (PubMedID)
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-09-25Bibliographically approved
Durbeej, N., Abrahamsson, N., Papadopoulos, F. C., Beijer, K., Salari, R. & Sarkadi, A. (2019). Outside the norm: Mental health, school adjustment and community engagement in non-binary youth.. Scandinavian Journal of Public Health, Article ID 1403494819890994.
Open this publication in new window or tab >>Outside the norm: Mental health, school adjustment and community engagement in non-binary youth.
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2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819890994Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents. Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data. Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%). Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.

Keywords
Transgender, adolescents, mental health problems, non-binary gender, school adjustment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-400644 (URN)10.1177/1403494819890994 (DOI)31868564 (PubMedID)
Available from: 2020-01-01 Created: 2020-01-01 Last updated: 2020-02-06Bibliographically approved
Dahlberg, A., Ghaderi, A., Sarkadi, A. & Salari, R. (2019). SDQ in the Hands of Fathers and Preschool Teachers: Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds. Child Psychiatry and Human Development, 50(1), 132-141
Open this publication in new window or tab >>SDQ in the Hands of Fathers and Preschool Teachers: Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds
2019 (English)In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 50, no 1, p. 132-141Article in journal (Refereed) Published
Abstract [en]

The Strengths and Difficulties Questionnaire (SDQ) is a well-established instrument for measuring social and behavioural problems among children, with good psychometric properties for older children, but less validity reports on pre-schoolers. In addition, there is a knowledge gap concerning fathers as informants. The present work is one of the few validity studies to include preschool teachers and the first on preschool children where fathers are included as separate informants. In this study, SDQs were collected from a large community sample (n = 17,752) of children aged 3-5, rated by mothers, fathers, and preschool teachers and analysed using confirmatory factor analysis. Our results revealed acceptable fit for all informant groups and measurement invariance across child gender, child age, and parental education level. Our findings suggest good construct validity of the SDQ for a non-clinical preschool population and imply that it may be used for assessing child behaviour problems from different informant perspectives.

Keywords
Confirmatory factor analysis (CFA), Construct validity, Fathers, Preschool children, Strengths and Difficulties Questionnaire (SDQ)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-355978 (URN)10.1007/s10578-018-0826-4 (DOI)000458372000012 ()29959588 (PubMedID)
Funder
Swedish Research Council FormasVINNOVA, 259-2012-68Swedish Research Council
Available from: 2018-07-10 Created: 2018-07-10 Last updated: 2019-03-12Bibliographically approved
Sarkadi, A., Fält, E., Ghaderi, A., Sarkadi, A. & Salari, R. (2019). Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers.. Scandinavian Journal of Psychology
Open this publication in new window or tab >>Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers.
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2019 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Article in journal (Refereed) Epub ahead of print
Abstract [en]

The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3-5, based on mothers', fathers', and preschool teacher's ratings. Preschool teachers' ratings were generally lower than parents' ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut-offs are presented for each age group, gender and rater category. Population-specific norms and percentile cut-offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross-country comparisons of children's mental health problems.

Keywords
Strengths and difficulties questionnaire, Sweden, mental health, norms, preschool children, psychometrics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-400645 (URN)10.1111/sjop.12606 (DOI)31833080 (PubMedID)
Available from: 2020-01-01 Created: 2020-01-01 Last updated: 2020-02-04Bibliographically approved
Bergström, M., Sarkadi, A., Hjern, A. & Fransson, E. (2019). "We also communicate through a book in the diaper bag"-Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody. PLoS ONE, 14(4), Article ID e0214913.
Open this publication in new window or tab >>"We also communicate through a book in the diaper bag"-Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214913Article in journal (Refereed) Published
Abstract [en]

Joint physical custody (JPC) refers to a practice where children with separated parents share their time between the parents' respective homes. Studies on parents' views of JPC for young children are scarce. The aim of this interview study was to explore parents' perceptions on how they experience and practice equally shared JPC for their 1-4 year-olds in Sweden. Forty-six parents (18 fathers and 28 mothers) of 50 children (31 boys and 19 girls) under 5 years of age were interviewed. Parents were recruited through information in the media and represented a broad range of socioeconomic backgrounds, as well as both voluntary and court-ordered custody arrangements. The interviews were semi-structured and analyzed using systematic text condensation. Two themes emerged regarding the research question. In the first theme, Always free, never free, parents described their striving to coparent without a love relationship. While they appreciated the freedom of being a "half-time parent", doing things one's own way, they felt constrained by the long-term commitment to live close to and keep discussing child rearing issues with the ex-partner. Good communication was key and lessened parent's feelings of being cut-off from half of the child's life. When JPC was ordered by court or conflicts were intense, parents tried to have less contact and worried when the children were in the other home. The second theme, Is it right, is it good?, included descriptions of how the parents monitored the child's responses to the living arrangement and made changes to optimize their adjustment. Adaptations included visits for the child with the other parent mid-week, shared meals or adapting schedules. In conclusion, these parents worked hard to make JPC work and cause minimal damage to their children. Most parents were pleased with the arrangements with the notable exception of couples experiencing ongoing conflict.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-382554 (URN)10.1371/journal.pone.0214913 (DOI)000463992600041 ()30970037 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-0843
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-03Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6594-2291

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