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Efter våldsdådet på Campus Risbergska, en stor skolbyggnad i Örebro för vuxenutbildning, den 4 februari 2025 behövde region och kommun snabbt mobilisera stöd, hjälp och omsorg till drabbade och anhöriga. Den här rapporten kartlägger det krisstöd till drabbade som Region Örebro län och Örebro kommun mobiliserade under februari månad.

Kartläggningen baseras på intervjuer genomförda huvudsakligen under maj-juni 2025 med företrädare för regionens och kommunens krisstödsorganisationer och Länsstyrelsen Örebro samt på dokumentation av krisstödsplaner och händelseloggar. 

Regionen aktiverade omgående krisstödsinsatser på Universitetssjukhuset Örebro i form av en krisstödstelefon och stöd i lokaler på sjukhuset. Dessa insatser avvecklades i huvudsak inom 24h men viss personal fortsatte arbeta med krisstöd, dels till patienter och anhöriga, dels i samarbete med kommun och primärvård. 

Även Örebro kommun aktiverade omedelbart krisstödsinsatser. Inledningsvis gavs dessa i olika stadsdelar. Efter några dagar inrättades ett krisstödscentrum riktat till elever och drabbade, bemannat av personal från kommun, krisstödjare från andra kommuner som samordnades av Länsstyrelsen, sjuksköterskor från Region Örebro Län, och representanter från andra organisationer. Krisstödscentrumet var aktivt månaden ut och besöktes av ett stort antal personer. Kommunen förstärkte även sin tillgänglighet för allmänheten via ordinarie kanaler. Vissa insatser pågick fortfarande under datainsamlingen, bland annat av krisstödjare i tillfälliga utbildningslokaler.

Kartläggningen visar att omfattande åtgärder vidtogs för att ge stöd och stärka hopp och tillit hos berörda. Ett stort antal personer har tagit del av insatserna. Samarbetet tycks i stort ha fungerat väl samtidigt som det finns frågor om hur region och kommun effektivt kan ta hjälp av varandras kompetens. Samarbetet med Länsstyrelsen är ett gott exempel på hur externt stöd kan stärka uthållighet. 

Händelsen aktualiserar frågor som är gemensamma för flera regioner och kommuner vid större kriser; exempelvis vilka målgrupper regioners krisstödsinsatser ska avgränsas till, och hur kommuner kan planera för att bistå med ett brett praktiskt stöd till hjälpsökande. Särskilt för skolskjutningar behöver krisstödet hantera lärarnas och personalens viktiga men dubbla roller som både länkar och drabbade. Vår förhoppning är att regioner och kommuner i Sverige kan använda sig av denna rapport för att utveckla sina insatser framöver och kan fortsätta sitt arbete utifrån de rekommendationer vi riktar till regioner och kommuner i hela landet.

Mobile health applications (apps) are increasingly used to reduce mental health problems. However, few effective apps are available for bereaved adults. Recently, a randomized controlled trial demonstrated the short-term beneficial effects of access to the My Grief app in mitigating symptoms of prolonged grief and posttraumatic stress in bereaved parents. The present study examined the long-term outcomes of app access and their predictors in a longitudinal survey of participants who had access to the My Grief app. We assessed symptoms of prolonged grief (PG-13), posttraumatic stress (PCL-5), and depressive symptoms (PHQ-9) at 3-, 6-, and 12-month follow-up assessments. Potential predictors of symptom change included baseline symptom levels, sociodemographic and loss-related variables, rumination (UGRS), negative grief-related cognitions (GCQ-SF), avoidance processes (DAAPGQ), and self-reported app use reported at each follow-up. Significant small-to-moderate reductions in prolonged grief, posttraumatic stress, and depressive symptoms were observed in people with app access at most follow-ups, ds = 0.26-0.66. For each symptom type, more severe baseline symptoms significantly predicted larger symptom reductions, Bs = 0.37-0.55. Lower baseline negative grief-related cognitions significantly predicted larger 3-month prolonged grief, B = -0.15, and posttraumatic stress symptom reductions, B = -0.23. Lower baseline anxious avoidance significantly predicted larger 3-month depressive symptom reductions, B = -0.23. Self-reported app use did not significantly predict symptom changes. Participants with access to the My Grief app experienced decreased symptom levels over a 1-year period. Specific cognitive behavioral processes (avoidance, negative cognitions) appear to be implicated in the short-term effects of app access.

Background:

App interventions show promise as effective interventions for trauma-related distress, but evaluations of their cost-effectiveness are scarce. Objective: This study aimed to assess the cost-effectiveness of an app-based intervention for self-management of posttraumatic stress compared to no guided self-management.

Methods:

An economic evaluation from a Swedish public health care perspective was conducted alongside a randomized controlled trial in which participants (N=179) were randomly assigned to either immediate exposure (intervention group; n=89, 49.7%) or delayed exposure at 3 months (waitlist group; n=90, 50.3%). The number of quality-adjusted life years (QALYs) gained or lost, increases or decreases in the use of different types of health care, and the monetary costs (in SEK; 2023 price level) saved or incurred with the intervention versus the comparator at 9 months after exposure were estimated based on functional disability and health care consumption reported by participants via a web-based written questionnaire at baseline and at 3, 6, and 9 months of follow-up. Estimation was done via linear regression with clustering at the participant level. The probability of the intervention being cost-effective was calculated over a range of cost-effectiveness thresholds up to SEK 1 million per QALY (US $94,225 per QALY; 2023 average exchange rate, US $1=SEK 10.61), and value of information analysis was used to interpret statistical uncertainty in the cost-effectiveness results.

Results:

There was no statistically significant difference between the intervention and comparator at 9 months after exposure when QALYs and all categories of health care consumption were analyzed jointly (P=.46). When analyzed separately, there was a significant increase in the number of consultations made in private mental health care (P=.03). The intervention was associated with 0.0065 (95% CI -0.0219 to 0.0349) QALYs gained per user and an increment in costs of SEK -46,359 (95% CI -111,696 to 18,977; US $-4368, 95% CI -10,525 to 1788) per user compared to no guided self-management. Cost savings were due to fewer consultations and care days per user in public health care (-5.50, 95% CI -14.83 to 3.83). The intervention had a 62% probability of both gaining QALYs and saving costs, and the probability that it would be cost-effective remained constant at 92%

Conclusions:

The use of a mobile app for self-management of posttraumatic stress was found to be cost-effective in a Swedish setting. A value-of-information analysis suggests that current research is sufficient to support the use of the app in Swedish

Trial Registration:

ClinicalTrials.gov NCT04094922; https://clinicaltrials.gov/ct2/show/NCT04094922

Background: Apps have the potential to support psychological treatments by providing psychoeducation, increasing homework compliance, and generalizing therapeutic skills outside of sessions. However, there are few apps developed to support specific evidence-based treatment for PTSD for adolescents.

Objective: This paper shares experiences developing an app to complement Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). It also describes adolescents’ and therapists’ perceived usefulness and the potential effect of the app ‘My everyday life’ on posttraumatic stress symptoms (PTSS).

Methods: We did a needs assessment with adolescents, therapists, and TF-CBT trainers, followed by programming and beta-testing. We carried out a mixed methods study of 59 adolescent patients (aged 13–18 years) and their therapists. Using a triangulation design, we combined quantitative data on app use and changes in PTSS with qualitative data from interviews with 10 adolescents and 10 therapists who described their experiences with the app.

Results: The app includes psychoeducation, mental health self-monitoring, coping tools, and goal-setting functionality. The most used features were psychoeducation and breathing exercises. Few therapists actively used the monitoring progress feature. Both adolescents and therapists found the app beneficial for everyday use, though some therapists were unsure about how to integrate it with TF-CBT. Adolescents reported significant PTSS improvement during TF-CBT with the app as a complement. Adolescents with post-treatment data (n = 13) did not report significantly different PTSD improvement compared to adolescents without access to app, but the study lacked power to draw strong conclusions.

Conclusions: The app ‘My everyday life’ can be useful for adolescents receiving TF-CBT. The therapists may benefit from clearer guidelines on how to integrate apps with evidence-based treatments. Digital tools are a promising avenue for supporting the implementation of evidence-based treatment.

Antecedentes: Las Apps tienen el potencial de apoyar los tratamientos psicológicos al proporcionar psicoeducación, aumentar el cumplimiento de tareas y generalizar habilidades terapéuticas fuera de las sesiones. Sin embargo, existen pocas Apps desarrolladas para apoyar el tratamiento específico para TEPT en adolescentes, basadas en la evidencia.

Objetivo: Este artículo comparte experiencias en el desarrollo de una App para complementar la Terapia Cognitivo-Conductual Focalizada en Trauma (TCC-FT). También describe la utilidad percibida por adolescentes y terapeutas, así como el posible efecto de la App "My everyday life" en los síntomas de estrés postraumático (SEPT).

Métodos: Se realizó una evaluación de necesidades con adolescentes, terapeutas y formadores en TCC-FT, seguido de programación y prueba beta. Realizamos un estudio de métodos mixtos con 59 pacientes adolescentes (13 a 18 años) y sus terapeutas. Mediante un diseño de triangulación, combinamos datos cuantitativos sobre el uso de la App y cambios en SEPT con datos cualitativos de entrevistas con 10 adolescentes y 10 terapeutas que describieron sus experiencias con la App.

Resultados: La App incluye psicoeducación, automonitoreo de la salud mental, herramientas de afrontamiento y una funcionalidad para establecer objetivos. Las caracteristicas más utilizadas fueron la psicoeducación y los ejercicios de respiración. Pocos terapeutas utilizaron activamente la función de monitorización de progreso. Tanto los adolescentes como los terapeutas encontraron la App beneficiosa para el uso diario, aunque algunos terapeutas no estaban seguros de cómo integrarla con la TCC-FT. Los adolescentes reportaron una mejoría significativa en SEPT durante la TCC-FT con la App como complemento. Los adolescentes con datos posteriores al tratamiento (n = 13) no reportaron una mejoría significativamente diferente del TEPT en comparación con los adolescentes sin acceso a la App, pero el estudio carecía de la potencia suficiente para obtener conclusiones sólidas.

Conclusiones: La App “My everyday life” puede ser útil para adolescentes que reciben TCC-FT. Los terapeutas podrían beneficiarse de directrices más claras sobre cómo integrar las Apps con tratamientos basados en la evidencia. Las herramientas digitales son una vía prometedora para apoyar la implementación de tratamientos basados en la evidencia.

Background: Violence exposure has been associated with cardiovascular disease. Less is known about underlying mechanisms, including early cardiometabolic risk factors, and possible sex differences of such associations.

Methods: We used data from the Swedish LifeGene study on 23 215 men and women, aged 18 to 50 years. Participants answered the Life Stressor Checklist-Revised regarding physical and sexual violence alongside questions on medical diagnoses of hypertension, diabetes, dyslipidemia, and smoking history in 2009 to 2016. At a clinical visit, blood pressure, body mass index, glycated hemoglobin, total cholesterol, apolipoprotein B/apolipoprotein A1 ratio, and hs-CRP (high-sensitivity C-reactive protein) were measured. Modified Poisson and linear regression were used to test the association between violence and cardiometabolic risk factors.

Results: At mean age 33 ± 8 years, lifetime exposure to violence was reported by 23% of women and 15% of men. Those exposed to violence reported higher prevalence of smoking (prevalence ratio [PR], 1.74 [95% CI, 1.56-1.94]) and diagnosis of hypertension (PR, 1.36 [95% CI, 1.15-1.60]) but not hyperlipidemia (PR, 1.06 [95% CI, 0.82-1.36]). Men and women exposed to violence had higher body mass index (Beta, 0.45 [95% CI, 0.39-0.63]) and hs-CRP (Beta, 0.08 [95% CI, 0.04-0.13]), after multivariable adjustment, whereas no differences were observed in glycated hemoglobin (B, 0.04 [95% CI, -0.11 to 0.18]) or total cholesterol (Beta, -0.01 [95% CI, -0.05 to 0.02]), and systolic blood pressure was marginally lower among individuals exposed to violence (B, -0.42 [95% CI, -0.78 to -0.06]).

Conclusions: In a young healthy Swedish sample, lifetime exposure to physical and/or sexual violence was associated with some but not all early cardiometabolic risk factors among both men and women.

Background: The consequences of moral challenges among healthcare workers (HCWs) have been increasingly recognized. To date, however, there is limited knowledge about the predictors of and associations between moral distress, moral residue, and other psychological consequences among HCWs working in a pandemic context.

Objective: We aimed to assess the levels of, and the associations between HCWs’ experiences of moral distress and moral residue with traumatic stress, burnout, and general psychological distress, and evaluate the role of empathic and compassion aspects for these outcomes, while adjusting for demographic and professional factors.

Methods: This is a cross-sectional study of 6551 Swedish HCWs participating in a survey during the COVID-19 pandemic, in the autumn of 2020. The survey included questions related to moral challenges, moral distress and residue, and self-report scales for general psychological distress (GHQ-5), traumatic stress (ITQ), compassion satisfaction and fatigue (ProQoL), empathic ability (B-IRI), and burnout (SMBQ).

Results: There were strong associations between moral challenges and moral distress and residue. There were also clear associations between moral distress and residue and psychological distress scales. Empathic ability, compassion fatigue, and compassion satisfaction were associated with moral residue whereas compassion satisfaction was not associated with moral distress. Demographic and professional predictors included gender, age, and occupational role. No interactions between moral challenges and empathic ability were found for moral distress or residue.

Discussion/conclusion: Moral distress and moral residue share some variance with both general and stress-related psychological distress; however, moral distress and residue are both theoretically and empirically distinct outcomes of moral challenges as compared to other established psychological consequences of occupational stress. Empathic ability was associated with moral distress, but not with moral residue. Moving forward, longitudinal research is needed to better understand the interplay among moral aspects relevant to HCWs.

A minority of bereaved adults experiences prolonged grief disorder, depression, and/or posttraumatic stress disorder, with heightened risks observed among bereaved parents. Cognitive-behavioural therapies, both face-to-face and online, have demonstrated efficacy in treating post-loss mental health problems. Mobile phone applications potentially offer an efficient and cost-effective way to deliver self-help to bereaved adults, yet controlled effectiveness studies are lacking. Therefore, we examined the short-term efficacy of the My Grief app, based on cognitive-behavioural therapy, in 248 bereaved parents, in a randomised controlled trial (Clinicaltrials.gov, identifier: NCT04552717). Participants were randomly allocated to access to the My Grief app (n = 126) or a waitlist (n = 122). At baseline and post-assessment, symptoms of prolonged grief, posttraumatic stress, and depression, negative grief cognitions, rumination, and avoidance were assessed. Reductions in prolonged grief and posttraumatic stress symptoms and negative cognitions in the intervention group were larger than in the control group, albeit with small effect sizes. Fifteen app users reported negative experiences with the app; for example, some mentioned that it elicited painful memories and emotions related to their loss. My Grief appears to achieve modest improvements in mental health in bereaved parents. Given that it is accessible and low-cost, it is an important addition to the suite of prolonged grief interventions.

Background

The current study examined whether coping strategies and symptoms of Adjustment Disorder in adults with ADHD differed from what was observed in the general adult population during the Covid-19 pandemic, and compared the extent to which coping strategies and symptom levels of Adjustment Disorder were related to ADHD.

Method

This cross-sectional study was based on survey data collected during the spring of 2021 from 231 adult ADHD patients in specialist care and 1148 volunteers without ADHD in Sweden. The survey included questions about sociodemographic and clinical characteristics, along with the Brief-COPE and Adjustment Disorder–New Module 8 questionnaires. Regression models adjusting for sociodemographic and clinical characteristics were used for between-group comparisons of coping strategies and symptoms of Adjustment Disorder.

Results

There were some notable differences in the use of coping strategies between persons with and without ADHD; however, many of these differences were not observed in the adjusted models. The use of behavioral disengagement was more frequently observed among individuals with ADHD, whereas planning was more common among individuals without ADHD. Individuals with ADHD appeared to show higher symptom levels of Adjustment Disorder during the pandemic. Passive coping strategies, such as denial, self-blame, and behavioral disengagement, were associated with higher symptom levels of adjustment disorder in both individuals with and without ADHD.

Conclusion

In conclusion, the results highlight that persons with ADHD may need more support to adjust to large societal changes than the general public. Potential targets for intervention towards members of this group include reducing resignation and maladaptive coping strategies.

Importance Traumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear.Objective To determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events.Design, Setting, and Participants This cohort study evaluated 3 separate cohorts of individuals residing in Sweden who were free of previous diagnosed psychiatric disorders when first exposed to assault (n = 49 957), injury (n = 555 314), or bereavement (n = 321 263) from January 1987 to December 2013, together with their unexposed full siblings, and 10 age-, sex-, and birthplace-matched unexposed individuals (per exposed individual). Cohorts were created from the Swedish Total Population Register linked to health and population registers. Data were analyzed from March 2022 to April 2023.Exposures Potentially traumatic events, including various types of assault, injuries, and bereavement (death of a child or of a spouse or partner), were ascertained from the Swedish national registers.Main Outcomes and Measures Incident psychiatric disorders were ascertained from the Swedish Patient Register. Flexible parametric and Cox models were used to estimate associations of potentially traumatic events with incident psychiatric disorders after multivariable adjustment.Results The median (IQR) age at exposure to assault, injury, and bereavement was 22 (18-31), 19 (8-40), and 60 (51-68) years, respectively. During a median (IQR) follow-up of 4.9 (2.2-8.2), 9.1 (4.1-15.6), and 8.1 (3.4-14.8) years, the incidence rates of any psychiatric disorder were 38.1, 13.9, and 9.0 per 1000 person-years for the exposed groups of the 3 cohorts, respectively. Elevated risk of any psychiatric disorder was observed during the first year after exposure to any assault (hazard ratio [HR], 4.55; 95% CI, 4.34-4.77), injury (HR, 3.31; 95% CI,3.23-3.38), or bereavement (HR, 2.81; 95% CI, 2.72-2.91) and thereafter (assault HR, 2.50; 95% CI, 2.43-2.56; injury HR, 1.69; 95% CI, 1.68-1.70; bereavement HR, 1.42; 95% CI, 1.40-1.44). Comparable associations were obtained in sibling comparison (first year: assault HR, 3.70; 95% CI, 3.37-4.05; injury HR, 2.98; 95% CI, 2.85-3.12; bereavement HR, 2.72; 95% CI, 2.54-2.91; thereafter: assault HR, 1.93; 95% CI, 1.84-2.02; injury HR, 1.51; 95% CI, 1.48-1.53; bereavement HR, 1.35; 95% CI, 1.31-1.38). The risk elevation varied somewhat by type of traumatic events and psychiatric disorders, with the greatest HR noted for posttraumatic stress disorder after sexual assault (sibling comparison HR, 4.52; 95% CI, 3.56-5.73 during entire follow-up period).Conclusions and Relevance In this study, the long-term risk elevation of psychiatric disorders after potentially traumatic events was largely independent of familial factors. The risk elevation observed immediately after these events motivates early clinical surveillance and mental health services for these vulnerable populations.

Background: The active mechanisms of change are unclear in early-provided exposure-based interventions for psychological trauma. This study aimed to address this gap by analysing weekly data from a randomised trial involving a 3-week therapist-guided online intervention based on prolonged exposure compared to a waiting-list control group.

Method: The objective was to investigate whether changes in each of the four subscales of the Posttraumatic Stress Disorder Checklist, fifth version (PCL-5; i.e. intrusions, avoidance behaviours, negative alternations in cognitions and hyperarousal) during the three-week intervention period mediated subsequent improvements in other post-traumatic stress symptoms at the controlled 1-month follow-up. We included baseline levels of both the mediator and the outcome as well as changes in the outcome from baseline to week 3 as covariates in a mediation model.

Results: The results showed that reductions in avoidance during the intervention period mediated reduced symptom levels of intrusions, negative alternations in cognitions, and hyperarousal at week 7 (z-scores of indirect effect estimates = −0.12 to −0.07). No other PCL-5 subscales were found to be mediators of change.

Conclusions: The results from this study highlight the importance of addressing avoidance behaviours in online exposure-based interventions provided in the early aftermath of trauma. Sensitivity analysis showed that the mediation effects were sensitive to assumptions related to mediator-outcome confounders, which could be considered a study limitation.

Trial registration: ClinicalTrials.gov identifier: NCT03850639.