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Introduction: Problem drinking (PD), defined as hazardous or harmful drinking, constitutes a major health and economic burden worldwide. However, most individuals with PD typically remain untreated for many years as part of the "treatment gap" between prevalence and treatment access. The main objective of this study was to evaluate an unguided, app-based intervention for reducing alcohol consumption, compared to an information control app. Secondary analyses targeted motivation effects, subgroup differences in heavy drinking days, and the proportion of participants with excessive drinking.

Methods: In this two-armed randomized controlled trial (RCT), Swedish-speaking adults seeking help for PD on the Internet were recruited via online ads (n = 576). Eligible participants, defined as those who reported PD without significant comorbid conditions, were randomly assigned to one of two unguided interventions, either the "TeleCoach" app (n = 293) or the information control app (n = 283), and followed up via online questionnaires at six-, 12- and 26-weeks post-recruitment. Participants and researchers were blinded to group assignment at recruitment but not for outcome analyses. The primary outcome was the number of standard drinks consumed per week.

Results: Participants reported drinking a mean of 28 (SD = 18) standard drinks per week at the baseline recruitment measure, and 65% of the participants reported a history of PD for over three years; only 7% of the participants reported less than a year of PD history. Only 26% of the participants had sought help before. A significant within-group reduction in alcohol consumption occurred in both conditions at the six-week follow-up (B = -10.57, SE = 0.83, 95% CI [-12.20, -8.94], p < 0.01; Cohen's d = 0.69), sustained until the 26-week follow-up (B = -11.44, SE = 0.91, 95% CI [-13.23, -9.65], p < 0.01, Cohen's d = 0.67), with no significant differences between the two groups. No adverse events were reported.

Conclusions: The findings, although null, nonetheless supported app-based interventions' feasibility and potential as a scalable digital approach for reaching individuals who have not previously sought help for PD.

Objectives

To establish diagnostic prevalences for common mental disorders among students at higher education institutions (HEI's) in Sweden.

Methods

This was a cross-sectional study assessing diagnostic prevalences for 17,948 students at 30-day, 12-month and lifetime timepoints, according to the Diagnostic and Statistical Manual, fifth edition (DSM-5). Sample participants at 15 HEI's answered an online survey 2020-2023 within the World Mental Health International College Student (WMH-ICS) initiative. Diagnoses are reported for Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), Panic Disorder (PD), Bipolar Disorder (BD, any), Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD). Multilevel logistic regression was used to estimate odds ratios in relation to diagnoses of any mental disorder.

Results

Respondents (69.4% women, 25.5 mean age, range 18 to ≥ 36) reported 25.2%, 39.3% and 44.5% prevalences for any mental disorder at 30-day, 12-month and lifetime periods. Odds for any mental disorder were markedly higher for non-binary students and those with non-heterosexual orientation; odds were also higher for students aged 20–29 years, women, heterosexual individuals with same-sex attraction and post-pandemic respondents.

Conclusions

The findings augment existing concern over student mental health. Student mental health services should expand menus for low-threshold treatment interventions, to promote flourishing and resilience.

Objective

We examined psychopathological conditions accounting for the highest risk of role impairment among university students.

Method

Cross-sectional online survey of first-year students (60 universities, 10 countries) assessing role impairment due to emotional problems in previous 30 days with the 3-item emotional subscale of the VR-36. Cross-tabulations and Poisson regression examined associations between 12 psychopathological conditions (8 probable mental disorders and 4 SITB) and socio-demographics with "significant role impairment" ("most"/"all of the time" in 2+ VR-36 items). We used machine learning methods to predict probabilities (risk) of significant role impairment based on the 12 psychopathological conditions. Observed prevalence of significant role impairment was examined within and across the 20 population ventiles to assess risk concentration using sensitivity (SN) and positive predictive value (PPV).

Results

43,990 students responded to the survey (median age = 19, IQR = 18-23). 27.1 % had significant role impairment due to emotional problems and 65.8 % had at least one psychopathological condition. Students with one or more of these conditions were more likely to have significant impairment than those without (RR = 3.9; 95 %CI: 3.6-4.2). In multivariable analyses, probable Depression and Bipolar disorders were the strongest correlates of significant impairment. Most (69.6 %) of the observed significant role impairment occurred among the roughly 35 % of respondents with highest predicted risk (PPV = 53.2 %).

Conclusion

Significant role impairment due to emotional problems is highly prevalent among university students. High risk of significant role impairment concentrates in one third of the students, those with several psychopathological conditions. Assessing these conditions should help identifying highest role impairment risk university students.

Background: University students show a high prevalence of diverse mental health problems, requiring adaptable interventions to assist them in improving their mental health. Objective: This study aimed to evaluate the feasibility of transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for anxiety and depression in preparation for a randomized controlled trial. ICBT incorporated 2 innovative approaches to increase precision: user-steered content personalization and within-treatment adaptive modification based on early symptom trajectory.

Methods: This single-group, open-label study was conducted online in Sweden in the autumn of 2021, recruiting from students who had completed the World Health Organization (WHO) World Mental Health International College Student (WMH-ICS) mental health survey. Participants were eligible if they scored 5-19 on the Patient Health Questionnaire-9 (PHQ-9), or >= 5on the Generalized Anxiety Disorder-7 (GAD-7), or both. Participants completed an 8-week ICBT program with therapist support. They initially personalized their program by selecting a primary problem orientation, anxiety or depression, and choosing additional elective modules, and could consult their therapist regarding these choices. At midtreatment, stepped care was piloted, in which participants without symptom improvement were randomized to adaptive enhancement of therapist support or to continuetreatment as before. The main feasibility outcomes included data on reach and uptake, intervention acceptability, stepped care procedures, and assessment retention up to 6 months. The GAD-7 and PHQ-9 were the primary outcome measures, with changes in scores calculated using mixed effects models.

Results: Of 749 invited students, 55 (7%) completed the study screening, and 28 (4%) were included. The GAD-7 baseline score was 9.5 (SD 4.4), and the PHQ-9 baseline score was 11.2 (SD 5.2). Participants opened 6.2 (SD 2.2) out of the 8 treatment modules. The user-directed personalization yielded 27 unique treatment configurations across 28 participants. At week 4, 16/27 (59%) participants remaining in treatment were randomized in the stepped care procedure. Ratings on self-report measures showed acceptable to good therapeutic alliance and treatment satisfaction. Eleven participants reported increased stress associated with the treatment. Reductions in depression and anxiety symptoms were observed at postmeasurement and 6 months follow-up, with 43% attrition at those times.

Conclusions: This pioneering study of personalized ICBT with adaptive change among university students demonstrated the overall feasibility of the treatment. To enhance the design of a future definitive trial, modifications are necessary to mitigate assessment attrition and reduce treatment-related stress.

Background and aims: Substance-related emergency department (ED) visits represent a critical opportunity to link individuals with sustained treatment for substance use disorders (SUD), yet few transition to post-acute treatment. Among emerging initiatives to integrate specialized SUD care into ED services, the Stockholm SUD-ED is an example of a fully integrated model that remains unmapped. This study aimed to systematically map care pathways and identify predictors of post-acute SUD treatment engagement among SUD-ED patients in Stockholm.

Design: Retrospective cohort study. Electronic health records data were linked with five registries covering, among other aspects, clinical history and healthcare consumption.

Setting: The Stockholm SUD-ED, Sweden.

Participants: n = 9771 SUD-ED patients during a sixteen-month period (2018-2019).

Measurements: For care flow mapping, post-acute SUD treatment engagement was defined as ≥2 outpatient visits during a six-month follow-up. Four engagement levels (none, low, moderate, high) were derived using a quantile regression approach and regressed on 19 candidate predictors in multinomial logistic regression models.

Findings: Of all SUD-ED patients, one-third (33.2%; n = 3248) primarily engaged in post-acute outpatient SUD treatment, 16.9% (n = 1651) primarily engaged in non-SUD psychiatric services and 49.9% (n = 4872) did not engage in either. Police-initiated admissions had lower odds of moderate or high post-acute treatment engagement than ambulance-initiated admissions [high engagement: adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.53-0.95]. Prior needle and syringe program visits increased the odds of post-acute treatment engagement (aOR = 2.09, 95% CI = 1.59-2.75). Lack of prior SUD outpatient treatment was consistently associated with lower odds of post-acute engagement across all levels (e.g. moderate engagement: aOR = 0.3, 95% CI = 0.25-0.35).

Conclusions: The Stockholm model for fully integrating specialized substance use disorder care into emergency departments appears to generate high post-acute treatment engagement and highlights the need for (1) targeted interventions for police-initiated admissions and (2) broad aftercare options to better attract treatment-na & iuml;ve patients.

Objective

Research in the mental health field has focused on exploration and implementation of digital interventions both in research and society. However, demographic and mental health factors that may influence engagement with research on such interventions have not been explored. This study aims to investigate the relationship between demographics, signs of mental disorders, and interest in participating in an intervention study. Using data collected in the Swedish arm of the World Health Organization's World Mental Health International College Student (WHO-WMH-ICS) initiative (n = 9140), we conducted a multinomial logistic regression to assess relationships between these factors.

Results

Older age, as well as female and non-binary gender identities, were factors significantly associated with increased interest in the intervention study. Treatment flags, indicating fulfilment of criteria for possible mental disorder diagnosis, were significantly associated with clear interest ("yes" response) in intervention research for five of the 15 treatment flags: depression, general anxiety, social anxiety, panic disorder and self-harm. Possible interest ("maybe" response) was also indicated for four of these, excluding general anxiety. These findings may facilitate a better-informed approach to recruiting student participants for treatment research, enhancing unbiased recruitment practices, reducing treatment gaps, and increasing engagement in digital intervention studies for improved mental health.

The Visualization Psychotherapy/Symbol-drama (VPT/S) approach is a guided affective imagery method involving evocation of patients' inner visualized scenes following the therapist's thematic cues, enhanced by imagery rescripting. Treatment effects have not been investigated in controlled studies. The objective of the current study was to investigate the treatment effects of VPT/S in a controlled study. A Single Case Experimental Design (SCED) with multiple baselines explored VPT/S effects for 15 adults with diverse mental health problems. Outcome measures consisted of three problem variables, individually defined for each patient based on the three problems that most affected their emotional well-being. Tau-values were used to calculate treatment effects, comparing both baseline and treatment phases, and comparing baseline and a follow-up phase three-months post-treatment. Thirteen of the 15 patients showed statistically significant changes over time in the individualized problem variables, after 6-22 treatment sessions. Aggregated across all patients, changes between the baseline and treatment phases were also significant, as were changes between the baseline and three-month post-treatment follow-up. This indicates that therapy improved patient-defined outcome measures and that this change was stable for at least 3 months post treatment. Visual inspection of diagrams depicting the psychotherapeutic processes complemented the statistical analyses, showing that treatment effects were visible for many of the patients within just a few sessions. These promising results suggest that VPT/S can be part of an effective short-term psychotherapy for patients with mild-to-moderate symptoms. A pre-registered, randomized controlled trial is warranted to further evaluate VPT/S.

Purpose: This study investigates associations of childhood adversities (CAs) with lifetime prevalence, 12-month prevalence, and 12-month persistence of mental disorders in a large cross-national sample of university students.

Methods: Data came from epidemiologic surveys carried out by the World Mental Health International College Student (WMH-ICS)Initiative across 18 countries (n=60,719). The web-based surveys screened for lifetime and 12-month prevalence and age-of-onset of common DSM-5 disorders (Major Depressive Disorder, Bipolar I/II Disorder, Generalized Anxiety Disorder, Panic Disorder, Posttraumatic Stress Disorder, Alcohol and Drug Use disorders, Attention-Deficit/Hyperactivity Disorder) and five types of CAs (family dysfunction, emotional abuse, physical abuse, sexual abuse, neglect). Multivariable Poisson regression models estimated associations of CA type, number, and frequency with disorders.

Results: The majority of incoming students reported exposure to at least one CA (64.9%), including 50.0 % family dysfunction, 42.2 % emotional abuse, 21.2 % physical abuse, 18.8 % neglect, and 5.0 % sexual abuse. Lifetime and 12-month disorders were significantly associated with CAs in multivariable models, although associations with disorder persistence were weaker. Population attributable risk proportions of 12-month disorders associated with CAs were in the range of 40.7-61.0 % for anxiety and mood disorders and 13.5-55.2 % for substance use disorders.

Conclusion: Six out of ten university students arrive at university having been exposed to CAs. These students have substantially higher risk of mental disorders than other students, primarily due to associations with lifetime risk rather than persistence. Given the considerable distress and impairment caused by mental disorders, these results underscore the need for primary and secondary prevention efforts.

Background

Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students.

Methods

The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders.

Results

27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5–7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa.

Conclusions

Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities.

Background: Every year about three million people die globally due to harmful alcohol use. The treatment gap remains high: only about 14% of individuals with problematic alcohol use access treatment. The implementation of digital interventions, addressing problematic alcohol use, into healthcare can be one way of reducing the treatment gap. However, little is known about how healthcare staff perceive the integration of digital interventions in routine addiction care. The aim of the study was to identify and describe healthcare staff's experiences of perceived benefits of digital interventions for patients with alcohol use disorders (AUD), introduced in recent years within routine specialized addiction care in Sweden. The aim was further to explore how the use of such interventions in this setting could be further developed.

Methods: This study was conducted as an exploratory qualitative interview study with 16 informants from addiction care staff in Stockholm, Sweden. The informants came from three different groups: clinical managers, staff referring outpatients to digital interventions from within addiction care, and therapists from an e-support unit. The interviews were recorded, transcribed, and analyzed with thematic analysis.

Results: Three themes illustrated the benefits of digital interventions in routine addiction care, and future development areas. The theme An easy way in reflected the importance of easy access to addiction care where care would be flexible and available to everyone. Meeting individual patient needs raised the question of how to adapt treatment formats to the patients' individual needs. Smoothly interlocking organizational gears highlighted the need for structure and cooperation between digital care and in-person care. Each theme included three additional subthemes.

Conclusions: The study identifies key factors for successfully integrating digital interventions in addiction care, highlighting the importance of staff engagement, structured workflows, training, and ongoing evaluation using a sociological framework.