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Background:

Immigrant and refugee adolescents often face traumatic experiences and are vulnerable to mental health problems, such as post-traumatic stress disorder (PTSD), anxiety and depression. Yet, they also show remarkable resilience in the face of these stressors. Research is still scarce on how both mental health problems and resilience dynamically interplay in immigrant and refugee adolescents' development.

Objective:

We aimed to identify latent profiles of immigrant and refugee adolescents' wellbeing, consisting of externalizing and internalizing symptoms, PTSD (intrusion and avoidance), and resilience, and analyse the demographic and contextual determinants of these profiles. Method: We employed cross-sectional survey data from the RefugeesWellSchool project for 1607 immigrant and refugee adolescents (mean age 15.3 years, SD 2.15, 42.3% girls) from six European countries: Belgium, Denmark, Finland, Norway, Sweden, and the United Kingdom. Latent profile analysis and three-step procedure with BCH weights were used to identify the wellbeing profiles and their determinants.

Results:

Results identified four adolescent wellbeing profiles: (1) Low symptoms (49.7%, n = 791); (2) High symptoms with intrusion (10.6%, n = 169); (3) Moderate symptoms (26.9%, n = 428); and (4) Resilient avoidant (12.8%, n = 203). Older participants, those with refugee background, shorter residence in the host country, more experiences of daily stressors or discrimination, or low family support were less likely to belong to the Low symptoms or Resilient avoidant groups (p <= .001).

Conclusions:

The profiles reflected distinct differentiation of intrusive and avoidance dimensions of the PTSD-symptoms. Intrusion clustered with high level of other mental health problems, whereas avoidance co-occurred with high resilience. Experiences related to immigration, stressors, and family support were crucial determinants of the wellbeing profile membership. Future interventions should utilize information obtained by person-centered studies to create better targeted and tailored support for immigrant and refugee adolescents.

AIM: This study re-evaluated the classification accuracy of language screening. This is because the new Swedish child health programme moved this screening from 3 to 2.5 years of age. Another aim was to investigate the stability of diagnoses between these two time points.

METHODS: Children were recruited consecutively during 2016-2017 from three Child Health Services in Gävle, Sweden. Forty-eight monolingual children (31 boys) and 93 bilingual children (38 boys) underwent language screening and a clinical examination by a speech and language pathologist at 2.5 years of age. They were re-examined after 6 months (at 36-38 months) for clinical diagnosis.

RESULTS: Of the 48 monolingual children, 45 retained their status at both 2.5 and 3 years of age, while three no longer met the criteria for development language disorder. Among the 93 bilingual children, 87 retained their 2.5-year status at age 3, two no longer met the criteria, and four new cases were diagnosed. These differences were not statistically significant. All changes in screening parameters between 2.5 and 3 years were within the 95% Confidence Interval, indicating stable classification.

CONCLUSION: Screening accuracy and language status were robust between 2.5 and 3 years, providing no support for a wait-and-see approach.

Aim

The aim of this study was to describe parental concerns about child health and behaviour and their sociodemographic predictors in 3-year-olds, in relation to the national guidelines of well-baby clinics.

Methods

The study included parents of 33 526 children in Stockholm who had completed a questionnaire prior to a routine visit to a well-baby clinic at age 3 years. Multivariate regression was used to analyse predictors for concerns.

Results

Child behaviour problems, defined as defiance and problem with adherence to daily routines, were the most common parental concerns (36.4%), with poor social skills and relations being second (21.8%). Regarding development, 9.6% had concerns about speech and 4.7% about motor development. Screen use (9.5%) and being underweight (6.3%) were other common parental concerns, while lifestyle concerns regarding physical activity and overweight were rare. Parents raised about twice as many concerns for first-born children compared with younger siblings. Child behaviour and developmental concerns were more frequent in families where the mother had primary education only and attended a well-baby clinic with a high Care Need Index.

Conclusion

Parents' concerns reflected the national guidelines about child development and behaviour, but not its emphasis on a healthy lifestyle.

Background: Experiencing gender-based violence (GBV) is common among refugees. Intersecting systems of oppression can increase the risk of GBV and of suffering detrimental consequences, while concurrently creating barriers to meaningful support. Despite this, refugees with lived experience of GBV are rarely involved in the development, planning and adaptation of services and policies.

Methods: This article reports on a formative research process that aimed to involve public contributors (refugee victim-survivors of GBV) and relevant stakeholders in co-designing a service model aimed at improving psychosocial support in Sweden. Led by a partnership of public contributors and academic researchers, the research process consisted of iterative cycles of co-design workshops, complemented by scoping of existing literature.

Results: The co-design process resulted in a characterisation of the psychosocial service system needs, as perceived by the survivor co-researchers and stakeholders, and a two-level empowerment and support service model. The model included (i) a community-based intervention to promote help-seeking and (ii) psychosocial group support delivered in specialist clinics. Outcomes of the project included perceived benefits for those involved, service-led direct changes and acquisition of funding for continued research on the co-designed model.

Conclusion: Improving psychosocial support for refugees in Sweden affected by GBV requires safe spaces to connect with peers and familiarise with available services, laws and rights in the society. Further, strengthened collaborations across sectors are necessary to meet the variety of needs. Co-design workshops were an effective way to initiate changes in the service delivery model for psychosocial support for refugees in Sweden affected by GBV.

Patient or Public Contributions: This is a participatory reflection on a participatory process. The survivor co-researchers contributed to designing and carrying out the PPI process and have co-authored this manuscript.

Background During recent years, Europe has faced the arrival of migrants whereof a considerable group of youth present mental health problems, such as symptoms of post-traumatic stress disorder (PTSD). Schools offer a safe environment for mental health interventions to these groups, yet there is limited research on the impact of school-based interventions addressing mental health problems in newcomer youths, especially in the Swedish context. This cluster randomized controlled trial (RCT) aimed to explore the effectiveness of the Teaching Recovery Techniques (TRT) intervention among newcomer students with PTSD symptoms in Swedish secondary schools. Methods Nine schools were randomly assigned to TRT or a wait list control group prior to the baseline assessment. Follow-up data were collected immediately following the intervention and three months post-intervention. In total, 531 students were approached, of which 61 gave consent and were eligible to be included in the study: 55 in TRT and 6 in the control condition. Given the low number of participants in the control condition, we merely analyzed students who had received TRT. Results We report on feasibility of recruitment, data collection, intervention delivery and intervention effectiveness. In terms of intervention effectiveness, within subjects ANOVAs revealed significant reductions in PTSD symptoms and general mental health problems from baseline to the three months-follow-up (p < 0.001). Conclusions Our results indicate that TRT is a promising school-based intervention for newcomer students with PTSD symptoms. For a successful implementation of TRT in the school context, schools need to be engaged and the implementation should be managed by a local coordinator. Trial registration ISRCTN, ISRCTN48178969, Retrospectively registered 20/12/2019.

BackgroundHistorically marked by a high infant mortality rate, Sweden's healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0-5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively.MethodsCCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement's implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke's framework. Participants represented a cross-section of Sweden's varied healthcare regions.ResultsThree main themes emerged from the thematic analysis: "Easy come, easy go," highlighting funding uncertainties; "What are we supposed to do?" expressing dilemmas over project prioritization and partner collaboration; and "Building castles on sand," focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services.ConclusionsThis study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.

The value of taking advantage of the participants’ interactions when analyzing focus group data is often stressed. However, there is a lack of detailed descriptions of how focus group data can be merged with interview data, and considered throughout a thematic analysis process. This article describes a systematic way to include focus group interactions in data analysis, using a coding scheme. The aim was threefold: to develop a coding scheme for focus group interactions; to test and describe a process for interaction analysis, merged into the thematic data analysis process, and to test the coding scheme on another dataset. Based on focus group literature a comprehensive coding scheme for analyzing focus group interactions, was developed, including symbols for these interactions. Data from five focus group interviews involving adolescents were subsequently coded using this scheme. Further analysis of the identified interactions was conducted simultaneously with thematic data analysis, using Systematic Text Condensation (STC) as an illustrative method. The coding scheme was then tested on data from a different focus group involving adolescents in another setting. A comparison between the two coders was made, leading to a slight modification of the coding scheme. The resulting coding scheme is a practical tool adding to the previous knowledge on focus group interaction analysis. More specifically, the scheme facilitates focus group interactions to be visible and accounted for thought the thematic analysis process.

In this cross-sectional study, we aimed to I) investigate the dual-factor model of mental health by forming and describing four participant groups and II) examine associations between mental health status and background factors, school-related factors, stress, and resilience among adolescents in a community population in Sweden. Data were collected through a survey completed by 2,208 students in lower and upper secondary school on the Swedish island of Gotland. After missing data were removed, a total of 1,833 participants were included in the study. The survey included the Mental Health Continuum Short Form (MHC-SF) for the assessment of mental well-being and the Strengths and Difficulties Questionnaire (SDQ) for the assessment of mental health problems. These two measures were combined into a dual-factor model, forming four mental health status subgroups: Vulnerable (47.5%), Complete mental health (36.2%), Troubled (13.9%), and Symptomatic but content (2.5%). Associations between these groups were explored regarding background factors, school-related factors, stress, and resilience through chi-squared tests and logistic regressions. Girls (OR: 1.88) and participants with high stress levels (OR: 2.23) had elevated odds for Vulnerable mental health status, whereas higher resilience (OR: 0.87) and subjective social status in school (OR: 0.76) were factors associated with reduced odds for this mental health status classification. Female gender (OR: 5.02) was also associated with Troubled mental health status. Similarly, a high level of stress (ORs: 4.08 and 11.36) was associated with Symptomatic but content and Troubled mental health status, and participants with higher levels of resilience had decreased odds for being classified into these groups (ORs: 0.88 and 0.81). The findings highlight the importance of interventions to increase resilience, reduce stress, and address stereotypic gender norms as well as social status hierarchies to support adolescents’ mental health.

Scholars draw increasing attention to the importance of belonging for young refugees' and migrants' well-being, indicating the need to develop an in-depth understanding of their experiences seeking to belong in resettlement. For refugee and migrant newcomers, schools might constitute particularly significant spaces in their negotiation of belonging, due to being a central developmental and acculturative context in resettlement, and a context where newcomers are situated within interpersonal and cultural positions of their families, home, and host society. Rooted in a conceptualization of belonging as a dynamic, plural, and relationally negotiated experience, this study explores how young newcomers' negotiation of belonging takes shape within the school context and how their experiences seeking to belong relate to their well-being. To that, the study engages with the qualitative inquiry of 163 newcomers' (age 11-24) experiences through focus groups conducted in Belgium, Denmark, Norway, and Sweden. Cross-national, joint thematic analysis resulted in two themes: 1. Ambivalences shaping belonging; and 2. Challenging barriers to belonging. Our findings suggest that, in school, newcomers meet opportunities and barriers in their negotiation of belonging that takes shape at the intersection of family, transnational, and host society relations. Schools furthermore seem central spaces for newcomers to exercise agency and creativity in their search for belonging in resettlement. Our findings spark thought on belonging as a reconstructive process in coping with migration and have implications for how schools can support belonging and well-being, through engaging with life stories of migration and the plurality of meanings encroaching upon newcomers' school trajectories.

Aims:

The aim of this study was to explore the association between preschool-level socio-economic deprivation and emotional and behavioural problems among preschool children in Sweden using a multilevel approach.

Methods:

In this cross-sectional study, we used data on 2267 children whose parents and preschool teachers had responded to items measuring individual-level socio-economic deprivation and the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems. Further, the Socioeconomic Structure Compensation Index (SSCI), collected from Uppsala municipality, was used to assess preschool-level socio-economic deprivation. Unadjusted and adjusted multilevel logistic regression models were used to explore the relations between preschool-level socio-economic deprivation and emotional and behavioural problems.

Results:

In unadjusted models, children who attended preschools classified as highly deprived had elevated odds for emotional symptoms (odds ratio (OR) 1.71) as rated by parents. However, this association did not remain significant after adjusting for individual-level socio-economic deprivation factors. In both unadjusted and adjusted models, children who attended preschools classified as moderately deprived had elevated odds for peer-relationship problems as rated by parents (OR 1.63; adjusted OR 1.48). There were no significant associations between preschool deprivation and emotional and behavioural problems as rated by preschool teachers.

Conclusions:

Swedish preschools may have a compensatory capacity in addressing children’s emotional and behavioural problems, whereas preschool-level deprivation remained significantly associated with peer-relationship problems after controlling for individual-level socio-economic deprivation factors. This implies that peer-relationship problems in deprived preschools need to be addressed in a broader community context.