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The Demand and Ability Protocol (DAP) is used in three-party meetings involving an employee, an employer, and a representative from the rehabilitation team. The aim of this study is to investigate the inclusion of an intervention using the DAP in an interdisciplinary pain rehabilitation programme (IPRP) compared to usual care. This non-randomised controlled trial included patients assigned to an IPRP in Sweden. The intervention group received a DAP intervention targeting their work situation in addition to the usual care provided by the IPRP. The control group received IPRP only. Outcome measures were collected from the Swedish Quality Registry for Pain Rehabilitation. Results demonstrated improvements in both groups regarding self-reported anxiety, depression and EQ5D. Sleep was improved in the intervention group but not in the control group. No statistical differences in outcomes were observed between the groups. In conclusion, adding the DAP intervention to IPRP seemed to have the potential to improve sleep among the patients, which may indicate an overall improvement regarding health outcomes from a longer perspective. The results were less clear, however, regarding the work-related outcomes of sickness absence and workability.

Purpose: To describe how managers of employees on sick-leave, due to chronic pain conditions, experience participating in a three-party meeting using the Demand and Ability Protocol (DAP) in the return-to-work process.

Materials and methods: This study is based on individual semi-structured interviews with 17 managers of employees with chronic pain. Interviews were conducted after participating in a three-party meeting including the employee, manager, and a representative from the rehabilitation team. The data were analyzed using thematic analysis with an inductive approach.

Results: Two main themes were identified - "to converse with a clear structure and setup" and "to be involved in the employee's rehabilitation." The first theme describe experiences from the conversation, and the second theme reflected the managers' insights when being involved in the employee's rehabilitation. The themes comprise 11 sub-themes describing how the DAP conversation and the manager ' s involvement in the rehabilitation may influence the manager, the manager-employee relationship, and the organization.

Conclusions: This study show, from a manager's perspective, how having a dialogue with a clear structure and an active involvement in the employee's rehabilitation may be beneficial for the manager-employee relationship. Insights from participating in the DAP may also be beneficial for the organization.

Background: Skills training is believed to be essential in dialectical behavior therapy (DBT) and is also offered as a standalone intervention. There is a need to better understand each skills module's separate contribution to treatment outcomes. Several assessment instruments are available, but none of them provides specific information about patients' perceived ability to use skills promoting distress tolerance. The aim of the present study was to develop and evaluate the psychometric properties of a Swedish adaptation of the General Self-Efficacy scale (GSE) for skills use in distress tolerance - the Self-Efficacy in Distress Tolerance scale (SE-DT).

Methods: Cross-sectional and longitudinal data were gathered in a non-clinical (NC) community sample (n = 407) and a clinical psychiatric (CP) sample (n = 46). Participants in the NC sample were asked to complete a set of 19 self-report instruments, including the SE-DT, and 45 participants repeated the assessment after 2 weeks. The patients in the CP sample filled out a subset of eight instruments; twenty patients repeated the assessment after completing a treatment intervention including mindfulness skills and distress tolerance skills or emotion regulation skills.

Results: The analyses showed that the SE-DT is unidimensional with high internal consistency (Cronbach's alpha = .92) and good test-retest reliability (intraclass correlation = .74). The SE-DT also showed good convergent and divergent validity, demonstrating positive correlations with general self-efficacy and self-compassion, and negative correlations with difficulties in emotion regulation, psychiatric symptoms, and borderline symptoms. The SE-DT showed sensitivity to change, when pre- and post-treatment assessments were compared (Cohen's d = 0.82).

Discussion: This is preliminary evidence that the SE-DT has adequate to good psychometric properties, supporting the use of a total sum score. The results indicate that the SE-DT can adequately measure the construct of self-efficacy with regard to dealing with distress and emotional crises. The instrument enables continued investigation of standalone skills training and the specific contribution of distress tolerance skills to treatment outcomes in DBT. Further studies are needed to investigate whether these results are valid in other populations. In addition, the field would benefit from a common definition of distress tolerance.

Background We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).

Methods Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.

Results In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively).

Conclusions Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.

Background

We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).

Methods

Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19–29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.

Results

In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16–1.33 and 1.15, 1.08–1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34–1.76 and 3.64, 2.14–6.18, respectively).

Conclusions

Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.

Aim This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). Method A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. Result This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. Conclusion It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008.

Method: A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments.

Result: The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders. For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs. Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated. For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option.

Conclusion: OCD and PTSD can be effectively treated with CBT and medications.

Könsdysforiregistret (KDR) är ett nationellt kvalitetsregister med syfte att följa upp och utveckla den könsbekräftande vården i Sverige. Könsbekräftande vård är vård och behandling vid könsdysfori: ett psykiskt lidande eller en försämrad förmåga att fungera i vardagen som orsakas av att det vid födelsen tillskrivna könet inte stämmer överens med könsidentiteten. Vård vid könsdysfori tillhör såväl specialistpsykiatrin som varierande somatiska vårdområden.

Registret ämnar följa personer livslångt och är unikt i sitt slag i världen. Flera specialiteter är involverade under utredning och behandling. Dessa är psykiatri, endokrinologi, plastikkirurgi, gynekologi, reproduktionsmedicin, logopedi, foniatri och dermatologi. Den könsbekräftande vården i landet är för närvarande centrerad till Lund, Göteborg/Alingsås, Linköping, Stockholm, Uppsala och Umeå samt till några andra orter. Vården följer de nationella kunskapsstöd som Socialstyrelsen har tagit fram (Socialstyrelsen 2015/2021).

Vården vid könsdysfori är multidisciplinär och multiprofessionell. Ett nationellt kvalitetsregister behöver därför spegla hela vårdområdet och KDR avser att samla data från samtliga delar. Det innebär att uppgifter registreras av vuxenpsykiatrin och barn- och ungdomspsykiatrin, barnendokrinologi och vuxenendokrinologi, logopedi och plastikkirurgi. Registret skiljer sig från övriga nationella kvalitetsregister som vanligen samlar in uppgifter från en specialitet eller möjligen två. Vi har också ambitionen att följa patienter som påbörjat kontakten med barn- och ungdomspsykiatri och barnendokrinologi i registret för att erhålla långtidsinformation om denna grupp. KDR är anslutet till Registercentrum Syd i Lund sedan 2015 och IT-plattformen är 3C.

Data började registreras i KDR 2017 och hade år 2021 17 registrerande enheter (av 35 möjliga). Det är ett 100-tal enskilda användare som är verksamma inom psykiatri, endokrinologi, logopedi och plastikkirurgi. Totalt deltar 1994 patienter i registret, varav 266 nya registreringar gjordes under 2021. Täckningsgraden varierar påtagligt mellan olika enheter i landet. Under 2021 och var det i medeltal 21 procent av psykiatrins nybesök som registrerades och drygt 40 procent av logopedins. Den totala täckningsgraden av patienter i landet uppskattas till 32 procent för registret i sin helhet 2021. Merparten av deltagarna i registret är mellan 18 och 25 år. I åldern 0–17 år var två tredjedelar tillskrivet kvinnligt kön vid födelsen. I äldre åldersgrupper var fördelningen utifrån tillskrivet kön vid födelsen jämnare.

Före könsbekräftande behandling krävs utredning vid någon av landets sex utredningsenheter för könsdysfori. Det är stor skillnad på varifrån remisserna för utredning av könsdysfori kommer. När 7 möjligheten till egenremiss tydligt uttrycks är det 40–50 procent som väljer att skriva en egenremiss. Av samtliga deltagare hade 79,7 procent efter utredningen fått diagnosen F64.0 (Transsexualism), 6,6 procent F64.9 (Könsidentitetsstörning, ospecificerad) och 8,5 procent F64.8 (Andra specificerade könsidentitetsstörningar).

En central kvalitetsindikator är väntetider. Sammanfattningsvis har väntetiderna till nybesök ökat kraftigt inom psykiatrins utredningsenheter, från i medeltal 9 månader föregående år till 17 månader 2021. De totala antalet faktiskt genomförda nybesök vid landets två största utredningsenheter har samtidigt minskat, och en enhet pausade utredningsverksamheten helt. Det är sammantaget en mycket oroväckande utveckling i den del av vårdkedjan som tar emot flest remisser per år.

Inom endokrinologin gjordes mycket få nyregistreringar under året, men underlaget tyder på att vårdgarantin om 90 dagar hålls vid två enheter, medan väntetiden är 10 månader vid en tredje enhet. Logopedin har i medeltal 5 månaders väntetid, vilket är en förbättring gentemot tidigare år. Plastikkirurgin har nyss börjat registrera vid en enhet, denna enhet hade i medel 3,5 månads väntetid till sina nybesök.

Eftersom endast delar av landets enheter registrerar och täckningsgraden är låg ger inte den data som presenterats i rapporten någon fullständig bild av den könsbekräftande vården i Sverige och informationen behöver tolkas med försiktighet. Eftersom vården utvecklas och kunskapsläget förändras snabbt har KDR behövt revideras flera gånger sedan starten. Information om utredning och behandling av barn och ungdomar har tillkommit, vilket krävt revidering av formulären framför allt inom psykiatri och endokrinologi under år 2020 och 2021. Detta har försenat enheter att komma i gång med registrering av data.

Vi ser nu att registreringsgraden ökar 2022 i och med att viktiga uppdateringar är gjorda och nya formulär kan tas i bruk. De nya formulären innebär både förenklingar i inmatning av data och förbättrad datakvalitet. För mer aktuell data om väntetider och registrering hänvisas till hemsidan och Delårsrapport 2022-09-15. Denna årsrapport ska läsas med Årsrapport 2018 som bakgrund vad gäller den könsbekräftande vårdens historia i Sverige samt en mera utförlig kunskapssammanställning inklusive referenser. Det har ännu inte skett någon forskning på data från Könsdysforiregistret, vilket gör att inga egna artiklar kan presenteras. Mer information finns på registrets hemsida, www.konsdysforiregistret.se

Background: The purpose of this study was to investigate whether treatment of a depressive episode with intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) had any effects on heart rate variability (HRV). We also investigated if changes in HRV covaried with symptom change after iTBS and if HRV could predict symptom change.

Methods: We included 49 patients with a current depressive episode. All were randomized to receive a double-blind treatment course with active or sham iTBS over the DMPFC. HRV data were obtained from 1 h of night data before and after the iTBS. The standard deviation of the RR interval (SDNN) was chosen as primary outcome measure. Depressive, negative, and anxiety symptoms as well as self-rated health were assessed by clinicians or by self-report.

Results: The group×time linear mixed model revealed no effect of iTBS on SDNN (estimate = −1.8, 95% confidence interval [CI]: −19.9 to 16.2). There were neither correlations between HRV and depressive, negative, or anxiety symptom change after iTBS nor with self-assessed health. No predictive value of HRV was found.

Conclusions: Treatment for depression with dorsomedial iTBS had neither negative nor positive effects on the cardiac autonomic nervous system.

Background

There is a conceptual overlap between negative and depressive symptoms, requiring further exploration to advance the understanding of negative symptoms. The aim of this study was to examine psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression, and to explore the relationship between the negative and affective symptoms domains.

Methods

Fifty-one patients with a depressive episode were included and interviewed with the CAINS and the Brief Psychiatric Rating Scale—Expanded (BPRS-E). Self-reported depressive symptoms were collected with the Montgomery-Asberg Depression Rating Scale (MADRS-S). Inter-rater agreement, internal consistency and validity measures were examined, as were correlations between negative and affective symptoms.

Results

The intraclass correlation for the CAINS motivation and pleasure subscale (CAINS-MAP) was 0.98 (95% CI 0.96–0.99) and that for the expressional subscale (CAINS-EXP) was 0.81 (95% CI 0.67–0.89). Cronbach’s alpha was 0.71 (95% CI 0.57–0.82) for the CAINS-MAP and 0.86 (95% CI 0.79–0.92) for the CAINS-EXP. The correlation with the negative symptoms subscale of the BPRS-E was 0.35 (p = 0.011, blinded/different raters) or 0.55 (p < 0.001, not blinded/same rater). The CAINS-MAP correlated with the affective symptoms subscale of the BPRS-E (r = 0.39, p = 0.005) and the MADRS-S total score (r = 0.50, p < 0.001), but not with anxiety symptoms.

Conclusions

Negative symptoms in depression can be assessed with the CAINS with good inter-rater agreement and acceptable internal consistency and validity. There are associations between negative and depressive symptoms that call for further exploration.

Higher stress during pregnancy associates with negative outcomes and elevated inflammation. The gut microbiota, reflecting environment and social interactions, alongside host immune responses have the potential to better understand perceived stress and identify when stress is excessive in pregnancy. Two U.S. cohorts of 84 pregnant individuals, composed of urban women of color and suburban white women, completed the Perceived Stress Scale-10 (PSS-10) and provided fecal and blood samples at two time points. Confirmatory Factor Analysis assessed the robustness of a two-factor PSS-10 model (Emotional Distress/ED and Self-Efficacy/SE). Gut microbiota composition was measured by 16 S rRNA amplicon sequencing and the immune system activity was assessed with a panel of 21 T-cell related cytokines and chemokines. ED levels were higher in the suburban compared to the urban cohort, but levels of SE were similar. ED and SE levels were associated with distinct taxonomical signatures and the gut microbiota data improved the prediction of SE levels compared with models based on socio-demographic characteristics alone. Integration of self-reported symptoms, microbial and immune information revealed a possible mediation effect of Bacteroides uniformis between the immune system (through CXCL11) and SE. The study identified links between distinct taxonomical and immunological signatures with perceived stress. The data are congruent with a model where gut microbiome and immune factors, both impacting and reflecting factors such as close social relationships and dietary fiber, may modulate neural plasticity resulting in increased SE during pregnancy. The predictive value of these peripheral markers merit further study.