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  • 1.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Philipson, Anna
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hagberg, Lars
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Moller, Margareta
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Olsson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Karolinska Inst KIND, Dept Womens & Childrens Hlth, Ctr Neurodev Disorders,Pediat Neuropsychiat Unit, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Ctr Psychiat Res, Stockholm, Sweden.
    Uppsala Longitudinal Adolescent Depression Study (ULADS)2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed)
    Abstract [en]

    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-related long-term outcomes and cost-of-illness analyses.

    Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

    Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

    Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

  • 2.
    Alaie, Iman
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Anna, Philipson
    Faculty of Medicine and Health, Örebro University.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Margareta, Möller
    Faculty of Medicine and Health, Örebro University.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Psychiatry, University hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Södersjukhuset, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lars, Hagberg
    Faculty of Medicine and Health, Örebro University.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Institutet Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Adolescent depression, early psychiatric comorbidities, and adult welfare burden: A 25-year longitudinal cohort studyManuscript (preprint) (Other academic)
  • 3. Axford, Nick
    et al.
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hobbs, Tim
    Heilmann, Sarah
    Raja, Anam
    Berry, Vashti
    Ukoumunne, Obioha C
    Matthews, Justin
    Eames, Tim
    Kallitsoglou, Angeliki
    Blower, Sarah
    Wilkinson, Tom
    Timmons, Luke
    Bjornstad, Gretchen
    The effectiveness of the Inspiring Futures parenting programme in improving behavioural and emotional outcomes in primary school children with behavioural or emotional difficulties: study protocol for a randomised controlled trial.2018In: BMC Psychology, E-ISSN 2050-7283, Vol. 6, no 1, article id 3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need to build the evidence base of early interventions promoting children's health and development in the UK. Malachi Specialist Family Support Services ('Malachi') is a voluntary sector organisation based in the UK that delivers a therapeutic parenting group programme called Inspiring Futures to parents of children identified as having behavioural and emotional difficulties. The programme comprises two parts, delivered sequentially: (1) a group-based programme for all parents for 10-12 weeks, and (2) one-to-one sessions with selected parents from the group-based element for up to 12 weeks.

    METHODS/DESIGN: A randomised controlled trial will be conducted to evaluate Malachi's Inspiring Futures parenting programme. Participants will be allocated to one of two possible arms, with follow-up measures at 16 weeks (post-parent group programme) and at 32 weeks (post-one-to-one sessions with selected parents). The sample size is 248 participants with a randomisation allocation ratio of 1:1. The intervention arm will be offered the Inspiring Futures programme. The control group will receive services as usual. The aim is to determine the effectiveness of the Inspiring Futures programme on the primary outcome of behavioural and emotional difficulties of primary school children identified as having behavioural or emotional difficulties.

    DISCUSSION: This study will further enhance the evidence for early intervention parenting programmes for child behavioural and emotional problems in the UK.

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN32083735 . Retrospectively registered 28 October 2014.

  • 4.
    Bergström, Malin
    et al.
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fransson, Emma
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hjern, Anders
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed)
    Abstract [en]

    AIM: Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

    METHODS: In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

    RESULTS: Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

    CONCLUSION: Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.

  • 5.
    Brew, B. K.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Söderberg, J.
    Karolinska Inst, Stockholm, Sweden.
    Lundholm, C.
    Karolinska Inst, Stockholm, Sweden.
    Holmberg, Kirsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Almqvist, C.
    Karolinska Inst, Stockholm, Sweden.
    Academic achievement of adolescents with asthma and atopic diseases2018In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 73, no Suppl. 105, p. 313-313, article id 580Article in journal (Other academic)
  • 6.
    Brew, Bronwyn K.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Soderberg, Joakim
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Lundholm, Cecilia
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Afshar, Soren
    Karolinska Univ Hosp, Dept Med, Div Resp Med, Stockholm, Sweden.
    Holmberg, Kirsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Almqvist, Catarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Pediat Allergy & Pulmonol Unit, Stockholm, Sweden.
    Academic achievement of adolescents with asthma or atopic disease2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 6, p. 892-899Article in journal (Refereed)
    Abstract [en]

    Background

    Over a fifth of children and adolescents suffer with asthma or atopic disease. It is unclear whether asthma impacts academic performance in children and adolescents, and little is known about the association of eczema, food allergy or hayfever and academic performance.

    Objective

    To examine whether asthma, eczema, food allergy or hayfever impacts on adolescent academic performance and to assess the role of unmeasured confounding.

    Methods

    This study used the Childhood and Adolescent Twin Study of Sweden cohort born 1992‐1998. At age 9‐12 years, parents reported on their child's ever or current asthma, eczema, food allergy and hayfever status (n = 10 963). At age 15, linked national patient and medication register information was used to create current and ever asthma definitions including severe and uncontrolled asthma for the same children. Academic outcomes in Grade 9 (age 15‐16 years) included: eligibility for high school (Grades 10‐12), and total mark of the best 16 subject units, retrieved from the Grade 9 academic register. Whole cohort analyses adjusted for known covariates were performed, and co‐twin control analyses to assess unmeasured confounders.

    Results

    There were no associations found for asthma or food allergy at 9‐12 years and academic outcomes in adolescence. In addition, at age 15, there were no statistically significant associations with current, ever, severe or uncontrolled asthma and academic outcomes. Eczema and hayfever at age 9‐12 years were found to be positively associated with academic outcomes; however, co‐twin control analyses did not support these findings, suggesting the main analyses may be subject to unmeasured confounding.

    Conclusion and clinical relevance

    Having asthma or an atopic disease during childhood or adolescence does not negatively impact on academic performance. This information can be used by clinicians when talking with children and parents about the implications of living with asthma or atopic disease.

  • 7.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ghaderi, A.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Validity of Strengths and Difficulties Questionnaire in non-clinical samples of parents and teachers2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 8.
    Dahlberg, Anton
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ghaderi, Ata
    Karolinska Institute.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    SDQ in the Hands of Fathers and Preschool Teachers: Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds2019In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 50, no 1, p. 132-141Article in journal (Refereed)
    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.

  • 9. Durbeej, Natalie
    et al.
    Abrahamsson, Ninnie
    Papadopoulos, Fotios C
    Beijer, Karin
    Salari, Raziye
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Outside the norm: Mental health, school adjustment and community engagement in non-binary youth.2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819890994Article in journal (Refereed)
    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.

  • 10.
    Durbeej, Natalie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Sörman, Karolina
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Norén Selinus, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    Institute of Neuroscience and Physiology, Gillberg Neuropsychiatry Centre, Centre of Ethics Law and Mental Health, Gothenburg University, Gothenburg, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hellner, Clara
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Halldner, Linda
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry Research center, BUP Klinisk forskningsenhet, Stockholm, Sweden; Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, SE-901 87 Umeå, Sweden.
    Trends in childhood and adolescent internalizing symptoms: results from Swedish population based twin cohorts2019In: BMC Psychology, E-ISSN 2050-7283, Vol. 7, article id 50Article in journal (Refereed)
    Abstract [en]

    Background

    Previous research has noted trends of increasing internalizing problems (e.g., symptoms of depression and anxiety), particularly amongst adolescent girls. Cross-cohort comparisons using identical assessments of both anxiety and depression in youth are lacking, however.

    Methods

    In this large twin study, we examined trends in internalizing symptoms in samples of 9 year old children and 15 year old adolescents, gathered from successive birth cohorts from 1998 to 2008 (age 9) and 1994–2001 (age 15). Assessments at age 9 were parent-rated, and at age 15 self- and parent-rated. We examined (i) the relation between birth cohorts and internalizing symptoms using linear regressions, and (ii) whether percentages of participants exceeding scale cut-off scores changed over time, using Cochrane Armitage Trend Tests.

    Results

    Among 9 year old children, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off on anxiety symptoms, but not on depressive symptoms. At age 15, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off particularly on self-reported internalizing symptoms. On parent-reported internalizing symptoms, only girls demonstrated a corresponding trend.

    Conclusion

    In line with previous studies, we found small changes over sequential birth cohorts in frequencies of depression and anxiety symptoms in children. Further, these changes were not exclusive to girls.

  • 11.
    Fabian, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP. Uppsala Univ, Uppsala, Sweden..
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Mental health and academic failure in Swedish adolescents2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, p. 388-388Article in journal (Other academic)
  • 12.
    Feldman, Inna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Helgason, Asgeir Runar
    Karolinska Inst, Dept Publ Hlth Sci, Social Med, Stockholm, Sweden;Reykjavik Univ, Reykjavik, Iceland;Reykjavik Univ, Iceland Canc Soc, Reykjavik, Iceland.
    Johansson, Pia
    Publ Hlth & Econ, Stockholm, Sweden.
    Tegelberg, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Malmo Univ, Fac Odontol, Malmo, Sweden.
    Nohlert, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, article id e030934Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up.

    Design and outcome measures: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (Euro) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio.

    Setting: The study was conducted in dental clinics in Sweden.

    Participants: 294 smokers aged 19-71 years were included in the study.

    Interventions: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT).

    Results: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to Euro918 and Euro3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden.

    Conclusion: CEA favours the more costly HIT if decision makers are willing to spend at least Euro4000/QALY for tobacco cessation treatment.

  • 13.
    Feldman, Inna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Virtanen, S.
    Karolinska Inst, Stockholm, Sweden..
    Galanti, M. R.
    Karolinska Inst, Stockholm, Sweden..
    Johansson, P.
    Publ Hlth & Econ, Huddinge, Sweden..
    Economic Evaluation Of A Brief Counselling For Smoking Cessation In Dentistry - A Case Study Comparing Two Health Economic Models2017In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 20, no 9, p. A751-A751Article in journal (Other academic)
  • 14.
    Fäldt, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Thunberg, Gunilla
    Dart Centre for Augmentative and Alternative Communication (AAC) and Assistive Technology (AT), Sahlgrenska University Hospital, Sweden.
    Lucas, Steven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research. Uppsala University, National Centre for Knowledge on Men.
    The study design of ComAlong Toddler: a randomised controlled trial of an early communication intervention2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819834755Article in journal (Refereed)
    Abstract [en]

    AIMS: This study design article aims to describe a research study focused on evaluating the use of the Infant-Toddler Checklist to identify children at 18 months with early communication difficulties, and to study the ComAlong Toddler intervention for parents to support their child's communication development.

    BACKGROUND: Communication disorders are a common public health problem affecting up to 20% of children. Evidence points to the importance of early detection and intervention to improve young children's communicative abilities and decrease developmental delay. Early identification of communication difficulties is possible with instruments such as Infant-Toddler Checklist. The ComAlong Toddler intervention is tailored to the needs of parents of young children with communication delay before definitive diagnosis. The parents are provided with guidance in communication enhancing strategies during home visit and five group sessions.

    METHODS: The study uses a prospective cohort design. Children were consecutively recruited during 2015-2017, and data will be collected 2015-2023. The screening was performed at the child health centre through use of the Infant-Toddler Checklist. An assessment and first consultation were then performed by a speech and language therapist for children with suspected communication delay according to the screen as well as for children referred for other reasons before the age of 2.5 years. Children with confirmed communication delay were randomised between two interventions: the ComAlong Toddler parental course or a telephone follow-up. Outcome measures include child communication and language skills and use of augmentative and alternative communication. To gain insight into the participants' perspectives, surveys have been collected from parents.

    CONCLUSION: The study will provide information regarding identification and intervention for 18-month old children with communication delay.

    TRIAL REGISTRATION: ISRCTN13330627.

  • 15.
    Fäldt, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Nordlund, H.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Holmqvist, U.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lucas, Steven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Nurses' experiences of screening for communication difficulties at 18 months of age2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 4, p. 662-669Article in journal (Refereed)
    Abstract [en]

    Aim: Early identification of communication disorders is important and may be possible through screening in the child health services. The aim of the study was to investigate nurses' experiences and sense of competence when using the Infant-Toddler Checklist (ITC) communication screening at the 18-month health visit.

    Methods: A mixed-methods design including three focus group interviews (n = 14) and a web-based survey (n = 22) among nurses using the ITC or the standard method. Interview data were analysed through systematic text condensation and a deductive analysis based on implementation theory. Groups were compared using Mann-Whitney tests.

    Result: Three themes emerged: Using a structured evaluation of communication changes, the dynamic, ITC is a beneficial tool and Implementation of the ITC faces a few challenges. Nurses who used the ITC perceived to a greater extent that they used a structured method (p = 0.003, r = 0.9) and felt more secure in describing the child's communication and language development to parents (p = 0.006, r = 0.83) compared to the standard method group.

    Conclusion: Using the ITC supported the nurses in their assessment of communication at 18 months. Nurses' sense of competence was higher when using the ITC, both in their assessment and in communicating with parents.

  • 16.
    Fält, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    A cross-service approach to identify mental health problems in 3–5-year-old children using the Strengths and Difficulties Questionnaire2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The Child Healthcare Services (CHS) in Sweden offer regular health check-ups and reach almost all 0–5-year-old children. Although one of the objectives of the CHS is to detect mental health problems, evidence-based methods are not used for this purpose at the Child Health Clinics (CHCs). Therefore, an evidence-based instrument to assess children’s emotional and behavioural problems through parent and teacher reports, the Strengths and Difficulties Questionnaire (SDQ), was introduced, as part of the Children and Parents in Focus trial, run between 2013 and 2017 in Uppsala, Sweden. The overall aim of this thesis was to evaluate the introduction of the procedure, including the facilitation strategies provided to support implementation, and to provide inter-rater correlations and norms for the SDQ in this population.

    Data were collected through individual interviews with nurses, parents and preschool teachers; group interviews with nurses; and a survey performed at the end of the trial to evaluate nurses’ experiences of the SDQ-procedure and the implementation process. In addition, delivery, response rate and population coverage of the questionnaires were calculated. Quantitative data were analysed using descriptive statistics, Pearson correlations and Intraclass Correlation Coefficients (ICC), and qualitative data using Grounded Theory and content analysis.

    Results showed that nurses found it useful for their assessment to have access to preschool teachers’ SDQ-ratings. Parents were also positive to the procedure but had concerns regarding confidentiality of the responses. Preschool teachers were least positive, fearing labelling of children and negative parental reactions. Significant, albeit poor, agreement (ICC) was found between parent and teacher ratings and good agreement between parents’ ratings. Teachers were found to report lower levels of problems compared to parents. Cut-off values differed for age and were somewhat higher for boys (lower for prosocial), suggesting that boys display more behaviour problems. Nurses perceived facilitation strategies used by the research team useful to support implementation and delivered the procedure, essentially, as intended. However, response rate remained lower than expected, around 50%.

    The findings suggest that implementing the SDQ to aid CHC-nurses’ assessment of 3-5-year-olds’ mental health is feasible, but requires further effort in regular services to reach all children.

    List of papers
    1. Exploring Nurses', Preschool Teachers' and Parents' Perspectives on Information Sharing Using SDQ in a Swedish Setting - A Qualitative Study Using Grounded Theory
    Open this publication in new window or tab >>Exploring Nurses', Preschool Teachers' and Parents' Perspectives on Information Sharing Using SDQ in a Swedish Setting - A Qualitative Study Using Grounded Theory
    2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0168388Article in journal (Refereed) Published
    Abstract [en]

    Evidence-based methods to identify behavioural problems among children are not regularly used within the Swedish Child healthcare. A new procedure was therefore introduced to assess children through parent- and preschool teacher reports using the Strengths and Difficulties Questionnaire (SDQ). This study aims to explore nurses', preschool teachers' and parents' perspectives of this new information sharing model. Using the grounded theory methodology, semi-structured interviews with nurses (n = 10) at child health clinics, preschool teachers (n = 13) and parents (n = 11) of 3-, 4- and 5-year-old children were collected and analysed between March 2014 and June 2014. The analysis was conducted using constant comparative method. The participants were sampled purposively within a larger trial in Sweden. Results indicate that all stakeholders shared a desire to have a complete picture of the child's health. The perceptions that explain why the stakeholders were in favour of the new procedure-the 'causal conditions' in a grounded theory model included: (1) Nurses thought that visits after 18-months were unsatisfactory, (2) Preschool teachers wanted to identify children with difficulties and (3) Parents viewed preschool teachers as being qualified to assess children. However, all stakeholders had doubts as to whether there was a reliable way to assess children's behaviour. Although nurses found the SDQ to be useful for their clinical evaluation, they noticed that not all parents chose to participate. Both teachers and parents acknowledged benefits of information sharing. However, the former had concerns about parental reactions to their assessments and the latter about how personal information was handled. The theoretical model developed describes that the causal conditions and current context of child healthcare in many respects endorse the introduction of information sharing. However, successful implementation requires considerable work to address barriers: the tension between normative thinking versus helping children with developmental problems for preschool teachers and dealing with privacy issues and inequity in participation for parents.

    National Category
    Nursing Pediatrics
    Identifiers
    urn:nbn:se:uu:diva-316035 (URN)10.1371/journal.pone.0168388 (DOI)000391857100010 ()28076401 (PubMedID)
    Funder
    Swedish Research Council Formas, 259-2012-68Swedish Research Council, 259-2012-68VINNOVA, 259-2012-68
    Available from: 2017-02-24 Created: 2017-02-24 Last updated: 2019-06-04Bibliographically approved
    2. Agreement between mothers', fathers', and teachers' ratings of behavioural and emotional problems in 3-5-year-old children
    Open this publication in new window or tab >>Agreement between mothers', fathers', and teachers' ratings of behavioural and emotional problems in 3-5-year-old children
    Show others...
    2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0206752Article in journal (Refereed) Published
    Abstract [en]

    Background: The Strengths and Difficulties Questionnaire (SDQ), a valid and reliable instrument for measuring children's mental health, is available in parent- and teacher versions, making it an ideal tool for assessing behavioural and emotional problems in young children. However, few studies have evaluated inter-parent agreement on the SDQ, and in most studies on SDQ agreement, parent scores are either provided by only one parent or have been combined into one parent score. Furthermore, studies on SDQ inter-rater agreement usually only reflect degree of correlation, leaving the agreement between measurements unknown. The aim of the present study was therefore to examine both degree of correlation and agreement between parent and teacher SDQ reports, in a community sample of preschool-aged children in Sweden.

    Methods: Data were obtained from the Children and Parents in Focus trial. The sample comprised 4,46 children 3-5-years-old. Mothers, fathers and preschool teachers completed the SDQ as part of the routine health check-ups at Child Health Centres. Inter-rater agreement was measured using Pearson correlation coefficient and intraclass correlation (ICC).

    Results: Results revealed poor/fair agreement between parent and teacher ratings (ICC 0.25-0.54) and good/excellent agreement between mother and father ratings (ICC 0.66-0.76). The highest level of agreement between parents and teachers was found for the hyperactivity and peer problem subscales, whereas the strongest agreement between parents was found for the hyperactivity and conduct subscales.

    Conclusions: Low inter-rater agreement between parent and teacher ratings suggests that information from both teachers and parents is important when using the SDQ as a method to identify mental health problems in preschool children. Although mothers and fathers each provide unique information about their child's behaviour, good inter-parent agreement indicates that a single parent informant may be sufficient and simplify data collection.

    National Category
    Psychiatry Pediatrics Other Medical Sciences not elsewhere specified
    Identifiers
    urn:nbn:se:uu:diva-369597 (URN)10.1371/journal.pone.0206752 (DOI)000449027600094 ()30383861 (PubMedID)
    Funder
    Swedish Research Council Formas, 259-2012-68Swedish Research Council, 259-2012-68Forte, Swedish Research Council for Health, Working Life and Welfare, 259-2012-68VINNOVA, 259-2012-68
    Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-06-04Bibliographically approved
    3. Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers
    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
    Show others...
    (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Article in journal (Other academic) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-384320 (URN)
    Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2019-06-04
    4. Facilitating implementation of an evidence-based method to assess the mental health of 3–5-year-old children at Child Health Clinics: a mixed-methods process evaluation
    Open this publication in new window or tab >>Facilitating implementation of an evidence-based method to assess the mental health of 3–5-year-old children at Child Health Clinics: a mixed-methods process evaluation
    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-384323 (URN)
    Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2019-06-04
  • 17.
    Fält, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Wallby, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Agreement between mothers', fathers', and teachers' ratings of behavioural and emotional problems in 3-5-year-old children2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0206752Article in journal (Refereed)
    Abstract [en]

    Background: The Strengths and Difficulties Questionnaire (SDQ), a valid and reliable instrument for measuring children's mental health, is available in parent- and teacher versions, making it an ideal tool for assessing behavioural and emotional problems in young children. However, few studies have evaluated inter-parent agreement on the SDQ, and in most studies on SDQ agreement, parent scores are either provided by only one parent or have been combined into one parent score. Furthermore, studies on SDQ inter-rater agreement usually only reflect degree of correlation, leaving the agreement between measurements unknown. The aim of the present study was therefore to examine both degree of correlation and agreement between parent and teacher SDQ reports, in a community sample of preschool-aged children in Sweden.

    Methods: Data were obtained from the Children and Parents in Focus trial. The sample comprised 4,46 children 3-5-years-old. Mothers, fathers and preschool teachers completed the SDQ as part of the routine health check-ups at Child Health Centres. Inter-rater agreement was measured using Pearson correlation coefficient and intraclass correlation (ICC).

    Results: Results revealed poor/fair agreement between parent and teacher ratings (ICC 0.25-0.54) and good/excellent agreement between mother and father ratings (ICC 0.66-0.76). The highest level of agreement between parents and teachers was found for the hyperactivity and peer problem subscales, whereas the strongest agreement between parents was found for the hyperactivity and conduct subscales.

    Conclusions: Low inter-rater agreement between parent and teacher ratings suggests that information from both teachers and parents is important when using the SDQ as a method to identify mental health problems in preschool children. Although mothers and fathers each provide unique information about their child's behaviour, good inter-parent agreement indicates that a single parent informant may be sufficient and simplify data collection.

  • 18.
    Fält, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Wallby, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Fabian, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Inter-rater agreement between parent and teacher SDQ ratings in Swedish 3-5-year-olds2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 19.
    Fängström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Dahlberg, Anton
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ådahl, Kajsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Rask, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Durbeej, Natalie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Is the Strengths and Difficulties Questionnaire with a Trauma Supplement a Valuable Tool in Screening Refugee Children for Mental Health Problems?2019In: The Journal of Refugee Studies, ISSN 0951-6328, E-ISSN 1471-6925, Vol. 32, no Special issue 1, p. 122-140Article in journal (Refereed)
    Abstract [en]

    The high number of asylum seekers in Sweden has highlighted the need to develop and evaluate structured assessment tools for children. In this study, we aimed to explore the utility of the Strengths and Difficulties Questionnaire (SDQ) with a trauma supplement of six items for preschool children in routine care. Parents of two- to six-year-olds (N = 61) were asked to complete the questionnaire during the routine health check-up offered to all refugees upon their arrival to Sweden. Focus-group interviews were conducted with the nurses who used the SDQ. The nurses found the SDQ valuable once they established a routine and felt that the SDQ contributed to a more structured and informative conversation about the child’s mental health. The SDQ total difficulties showed good internal consistency (alpha = 0.82). A significant proportion of children scored above the clinical cut-off and SDQ scores correlated significantly with the number of post-traumatic stress disorder symptoms measured using the supplement (rho = 0.29). The findings suggest that the SDQ with the trauma supplement is a useful tool in this clinical setting.

  • 20.
    Gavra, P.
    et al.
    Uppsala University.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Qualitative evaluation of a group intervention for unaccompanied refugee minors with PTSD symptoms2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 21. Gulenc, Alisha
    et al.
    Butler, Emma
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hiscock, Harriet
    Paternal psychological distress, parenting, and child behaviour: A population based, cross-sectional study.2018In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 44, no 6, p. 892-900Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Child behaviour problems are common and can lead to later mental health problems. Poor maternal mental health and adverse parenting practices are known risk factors for child behaviour problems. Less is known about the association between paternal mental health and parenting, and child behaviour. We aimed to explore the association between paternal psychological distress and parenting (harsh discipline, low warmth, unreasonable expectations, and overinvolved/protectiveness) with children's internalising and externalising behaviour at 3 years of age.

    METHODS: Cross-sectional surveys of 669 (80% response) fathers of 3-year-old children, nested within a randomised controlled trial. Main outcomes of behaviour (Child Behavior Checklist), parenting (Parent Behavior Checklist and overinvolved/protective parenting scale), and psychological distress (Kessler-6) were measured. Regression modelling examined the associations between paternal factors and child behaviour, adjusting for maternal mental health and parenting, as well as child and family variables.

    RESULTS: In adjusted analyses, paternal psychological distress (b = 0.43, 95% confidence interval [CI] [0.26-0.60], p < 0.001), harsh discipline (b = 0.20, 95% CI [0.13-0.27], p < 0.001), and maternal mental health (b = 0.08, 95% CI [0.03-0.12], p = 0.001) were associated with externalising symptoms. However, only paternal psychological distress, harsh discipline, and being a boy were associated with borderline/clinical levels of externalising problems (all p < 0.05). Paternal psychological distress, harsh discipline, overinvolved parenting, maternal mental health, and difficult child temperament were associated with internalising symptoms (all p < 0.05). However, only paternal harsh discipline and overinvolved parenting were associated with borderline/clinical internalising problems.

    CONCLUSIONS: Paternal mental health and parenting are independently associated with child behaviour. Treatments for children with behavioural problems should also address paternal mental health and parenting.

  • 22. Jangmo, Andreas
    et al.
    Stålhandske, Amanda
    Chang, Zheng
    Chen, Qi
    Almqvist, Catarina
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bulik, Cynthia M
    Lichtenstein, Paul
    D'Onofrio, Brian
    Kuja-Halkola, Ralf
    Larsson, Henrik
    Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication2019In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 58, no 4, p. 423-432Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk of poor school performance and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance.

    METHOD: A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum.

    RESULTS: ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio of 0.80, 95% confidence interval (CI) 0.76-0.84, and a higher grade point sum (range 0.0-320.0) of 9.35 points, 95% CI=7.88-10.82; standardized coefficient of 0.20.

    CONCLUSION: ADHD has a substantial negative impact on school performance while pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.

  • 23. Lalouni, Maria
    et al.
    Ljótsson, Brjánn
    Bonnert, Marianne
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Benninga, Marc
    Bjureberg, Johan
    Högström, Jens
    Sahlin, Hanna
    Simrén, Magnus
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hedman-Lagerlöf, Erik
    Serlachius, Eva
    Olén, Ola
    Clinical and Cost Effectiveness of Online Cognitive Behavioral Therapy in Children with Functional Abdominal Pain Disorders2019In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 17, no 11, p. 2236-2244Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Scalable and effective treatments are needed for children with functional abdominal pain disorders (FAPDs). We performed a randomized controlled trial of the efficacy and cost effectiveness of cognitive behavioral therapy delivered online (internet CBT) compared to usual therapy.

    METHODS: We studied children (8-12 years old) diagnosed with FAPDs, based on the Rome IV criteria, in Sweden from September 2016 through April 2017. The patients were randomly assigned to groups that received 10 weeks of therapist-guided, internet-delivered cognitive behavioral therapy (internet CBT, n=46) or usual treatment (treatments within the healthcare and school systems, including medications and visits to doctors and other healthcare professionals; n=44). The primary outcome was Global child-rated gastrointestinal symptom severity assessed using the Pediatric Quality of Life Gastrointestinal Symptom scale. All outcomes were collected from September 2016 through January 2018. Secondary outcomes included quality of life, gastrointestinal-specific anxiety, avoidance behaviors, and parental responses to children's symptoms. Societal costs and costs for healthcare consumption were collected during the treatment.

    RESULTS: Children who received internet CBT had a significantly larger improvement in gastrointestinal symptom severity with a medium effect size (Cohen's d=0.46; 95% CI, 0.05-0.88; number needed to treat, 3.8) compared with children who received the usual treatment. The children's quality of life, gastrointestinal-specific anxiety, avoidance behaviors, and parental responses to children's symptoms also improved significantly in the internet CBT group compared with the usual treatment group. The effects of internet CBT persisted through 36 weeks of follow up. Children who received internet CBT had significantly less healthcare use than children who received usual treatment, with an average cost difference of US $137 (P=.011). We calculated a cost saving of US $1050 for every child treated with internet CBT compared with usual treatment.

    CONCLUSION: In a randomized trial of pediatric patients with FAPDs, we found internet CBT to be clinically and cost effective compared with usual treatment. Internet CBT has the potential to increase the availability of treatment for a number of patients and reduce healthcare costs. ClinicalTrials.gov no.: NCT02873078.

  • 24. Malki, Ninoa
    et al.
    Hägg, Sara
    Tiikkaja, Sanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Koupil, Ilona
    Sparén, Pär
    Ploner, Alexander
    Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-20092019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e026192Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population.

    DESIGN: Population-based cohort study based on Swedish national registers.

    METHODS: We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009.

    RESULTS: Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects.

    CONCLUSION: Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.

  • 25.
    Månsdotter, Anna
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden.
    Ekman, Björn
    Lund Univ, Fac Med, Box 117, S-22100 Lund, Sweden.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hagberg, Lars
    Orebro Univ, Fac Med & Hlth, Hlth Care Res Ctr, S-70185 Orebro, Sweden.
    Hurtig, Anna-Karin
    Umea Univ, Unit Epidemiol & Global Hlth, S-90187 Umea, Sweden.
    Lindholm, Lars
    Umea Univ, Unit Epidemiol & Global Hlth, S-90187 Umea, Sweden.
    We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs2017In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 15, no 4, p. 437-440Article in journal (Other academic)
    Abstract [en]

    Monitoring and evaluation within the area of social welfare and public health comprise theoretical and methodological challenges [1, 2]. Indeed, current approaches may fail to consider essential aspects and to capture the broad spectrum of beneficial impacts from interventions. Therefore, we propose a novel measure taking into consideration the concept of capabilities: capability-adjusted life-years (CALYs). This commentary suggests principles, reflecting the Swedish context, to build the measure on. Of course, years of empirical research and refinement remain.

  • 26.
    Nayeb, Laleh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lagerberg, Dagmar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Westerlund, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lucas, Steven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation, Metabolism and Child Health Research.
    Eriksson, Mårten
    Univ Gavle, Fac Hlth & Occupat Studies, Dept Social Work & Psychol, Gavle, Sweden.
    Modifying a language screening tool for three-year-old children identified severe language disorders six months earlier2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 9, p. 1642-1648Article in journal (Refereed)
    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.

  • 27.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Enebrink, P.
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Cost-offset analysis of parenting interventions to prevent externalizing behavior problems2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, p. 332-332Article in journal (Other academic)
  • 28.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Enebrink, Pia
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden .
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children2019In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0225503Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.

    METHODS: A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.

    RESULTS: Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.

    CONCLUSIONS: Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

  • 29.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hultkrantz, L.
    Orebro Univ, Orebro, Sweden.
    Vimefall, E.
    Orebro Univ, Orebro, Sweden.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Indicated Parenting Interventions and Long Term Outcomes: A Health Economic Modeling Study2018In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S76-S76Article in journal (Other academic)
  • 30.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hultkrantz, Lars
    Vimefall, Elin
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Economic Return on Investment of Parent Training Programmes for the Prevention of Child Externalising Behaviour Problems.2019In: Administration and Policy in Mental Health, ISSN 0894-587X, E-ISSN 1573-3289Article in journal (Refereed)
    Abstract [en]

    Economic models to inform decision-making are gaining popularity, especially for preventive interventions. However, there are few estimates of the long-term returns to parenting interventions used to prevent mental health problems in children. Using data from a randomised controlled trial evaluating five indicated parenting interventions for parents of children aged 5-12, we modeled the economic returns resulting from reduced costs in the health care and education sector, and increased long-term productivity in a Swedish setting. Analyses done on the original trial population, and on various sized local community populations indicated positive benefit-cost ratios. Even smaller local authorities would financially break-even, thus interventions were of good value-for-money. Benefit-cost analyses of such interventions may improve the basis for resource allocation within local decision-making.

  • 31.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Jonsson, U.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Langenskiöld, Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Economics.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Indicated preventive interventions for depression in Children and Adolescents: A meta-analysis2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, p. 371-371Article in journal (Other academic)
  • 32.
    Nystrand, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ssegonja, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Quality of life and service use amongst parents of young children: Results from the Children and Parents in Focus trial2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 7, p. 774-781Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to assess the quality of life (QoL) and service use of parents who have preschool-aged children, and whether the mental-health problems of parents and their children predict these outcomes. 

    Methods: Cross-sectional data were gathered in 2015–2016 in Uppsala County in Sweden where 3164 parents of children aged three- to five-years-old were asked to self-report their own and their children’s mental-health status and service use in the past 12 months. Data from the General Health Questionnaire were used to derive health-related quality of life (HRQoL) measures for adults. 

    Results: Very few parents reported mental-health problems, while approximately 15% of the sample used any type of parental support and/or psychological health-care service. Families without problems used the least amount of resources. Parents’ own mental-health problems predicted usage of both psychotherapy and couples’ therapy, while child problems predicted the former but also the use of a parenting program. Parental HRQoL was predicted by mental-health problems, and all families with at least one individual experiencing problems rated their QoL lower than families without problems. 

    Conclusions: Parental service use and HRQoL is associated not only with their own mental-health status but also with their children’s mental-health problems.

  • 33.
    Osman, Fatumo
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm.; Dalarna Univ, Sch Educ Hlth & Social Studies, Falun.
    Salari, Raziye
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Klingberg-Allvin, Marie
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm.; Dalarna Univ, Sch Educ Hlth & Social Studies, Falun.
    Schön, Ulla-Karin
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun.
    Flacking, Renée
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun.
    Effects of a culturally tailored parenting support programme in Somali-born parents' mental health and sense of competence in parenting: a randomised controlled trial2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e017600Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effectiveness of a culturally tailored parenting support programme on Somali-born parents’ mental health and sense of competence in parenting.

    Design: Randomised controlled trial.

    Setting: A city in the middle of Sweden.

    Participants: Somali-born parents (n=120) with children aged 11–16 years and self-perceived stress in their parenting were randomised to an intervention group (n=60) or a waiting-list control group (n=60).

    Intervention: Parents in the intervention group received culturally tailored societal information combined with the Connect parenting programme during 12 weeks for 1–2 hours per week. The intervention consisted of a standardised training programme delivered by nine group leaders of Somali background.

    Outcome: The General Health Questionnaire 12 was used to measure parents’ mental health and the Parenting Sense of Competence scale to measure parent satisfaction and efficacy in the parent role. Analysis was conducted using intention-to-treat principles.

    Results: The results indicated that parents in the intervention group showed significant improvement in mental health compared with the parents in the control group at a 2-month follow-up: B=3.62, 95% CI 2.01 to 5.18, p<0.001. Further, significant improvement was found for efficacy (B=−6.72, 95% CI −8.15 to −5.28, p<0.001) and satisfaction (B=−4.48, 95% CI −6.27 to −2.69, p<0.001) for parents in the intervention group. Parents’ satisfaction mediated the intervention effect on parental mental health (β=−0.88, 95% CI −1.84 to −0.16, p=0.047).

    Conclusion: The culturally tailored parenting support programme led to improved mental health of Somali-born parents and their sense of competence in parenting 2 months after the intervention. The study underlines the importance of acknowledging immigrant parents’ need for societal information in parent support programmes and the importance of delivering these programmes in a culturally sensitive manner.

    Clinical trial registration: NCT02114593.

  • 34.
    Pérez-Aronsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Osman, Fatumo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    “I’m a Mother Who Always Tries to Give My Children Hope”—Refugee Women’s Experiences of Their Children’s Mental Health2019In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 10, article id 789Article in journal (Refereed)
    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.

  • 35. Pérez-Vigil, Ana
    et al.
    Fernández de la Cruz, Lorena
    Brander, Gustaf
    Isomura, Kayoko
    Jangmo, Andreas
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Hesselmark, Eva
    Serlachius, Eva
    Lázaro, Luisa
    Rück, Christian
    Kuja-Halkola, Ralf
    D'Onofrio, Brian M
    Larsson, Henrik
    Mataix-Cols, David
    Association of Obsessive-Compulsive Disorder With Objective Indicators of Educational Attainment: A Nationwide Register-Based Sibling Control Study2018In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 75, no 1, p. 47-55Article in journal (Refereed)
    Abstract [en]

    Importance: To our knowledge, the association of obsessive-compulsive disorder (OCD) and academic performance has not been objectively quantified.

    Objective: To investigate the association of OCD with objectively measured educational outcomes in a nationwide cohort, adjusting for covariates and unmeasured factors shared between siblings.

    Design, Setting, And Participants: This population-based birth cohort study included 2 115 554 individuals who were born in Sweden between January 1, 1976, and December 31, 1998, and followed up through December 31, 2013. Using the Swedish National Patient Register and previously validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, we identified persons with OCD; within the cohort, we identified 726 198 families with 2 or more full siblings, and identified 11 482 families with full siblings discordant for OCD. Data analyses were conducted from October 1, 2016, to September 25, 2017.

    Main Outcomes and Measures: The study evaluates the following educational milestones: eligibility to access upper secondary school after compulsory education, finishing upper secondary school, starting a university degree, finishing a university degree, and finishing postgraduate education.

    Results: Of the 2 115 554 individuals in the cohort, 15 120 were diagnosed with OCD (59% females). Compared with unexposed individuals, those with OCD were significantly less likely to pass all core and additional courses at the end of compulsory school (adjusted odds ratio [aOR] range, 0.35-0.60) and to access a vocational or academic program in upper secondary education (aOR, 0.47; 95% CI, 0.45-0.50 and aOR, 0.61; 95% CI, 0.58-0.63, for vocational and academic programs, respectively). People with OCD were also less likely to finish upper secondary education (aOR, 0.43; 95% CI, 0.41-0.44), start a university degree (aOR, 0.72; 95% CI, 0.69-0.75), finish a university degree (aOR, 0.59; 95% CI, 0.56-0.62), and finish postgraduate education (aOR, 0.52; 95% CI, 0.36-0.77). The results were similar in the sibling comparison models. Individuals diagnosed with OCD before age 18 years showed worse educational attainment across all educational levels compared with those diagnosed at or after age 18 years. Exclusion of patients with comorbid neuropsychiatric disorders, psychotic, anxiety, mood, substance use, and other psychiatric disorders resulted in attenuated estimates, but patients with OCD were still impaired across all educational outcomes.

    Conclusions and Relevance: Obsessive-compulsive disorder, particularly when it has an early onset, is associated with a pervasive and profound decrease in educational attainment, spanning from compulsory school to postgraduate education.

  • 36. Rice, L J
    et al.
    Emerson, E
    Gray, K M
    Howlin, P
    Tonge, B J
    Warner, Georgina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Einfeld, S L
    Concurrence of the strengths and difficulties questionnaire and developmental behaviour checklist among children with an intellectual disability.2018In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 62, no 2, p. 150-155Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID.

    METHOD: Parents of 83 young people with ID aged 4-17 years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour.

    RESULTS: The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off.

    CONCLUSION: The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information.

  • 37.
    Salari, Raziye
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Enebrink, Pia
    Karolinska Institutet.
    Role of universal parenting programs in prevention2018In: Handbook of parenting and child development across the lifespan, Springer, 2018, p. 713-743Chapter in book (Refereed)
  • 38.
    Salari, Raziye