| 1. |
- Demetry, Youstina, et al.
(författare)
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Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden : Qualitative Feasibility Study
- 2023
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Ingår i: JMIR Formative Research. - : JMIR PUBLICATIONS, INC. - 2561-326X. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. Objective: This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. Methods: A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. Results: The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. Conclusions: The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation.
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| 2. |
- Forsström, David, 1981-, et al.
(författare)
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Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic : A mediation study
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- When the COVID-19 pandemic started spreading globally, there was a fear that addictive behaviors would increase due to changes in everyday life caused by restrictions due to COVID-19. Studies were carried out to explore if this was true for gambling, typically revealing no overall increase in gambling behavior, although individuals who had previous experience with gambling problems were more likely to increase gambling during the pandemic. However, these studies only included individuals with previous gambling problems. It remains unknown whether other vulnerable groups, such as individuals with common mental disorders increased their gambling. This study aimed to explore the level of gambling problems among individuals with a history of mental disorders, namely, (i) pre-pandemic gamblers and (ii) pandemic-onset gamblers. Furthermore, we explored if worry and isolation mediate gambling and problem gambling. The data were analyzed using descriptive statistics and a structural equation model to investigate mediation. The results showed a high prevalence of at-risk and problem gambling in both groups. The pre-pandemic gamblers had a high level of at-risk and problem gambling. Furthermore, the individuals that started to gamble during the pandemic had an even higher degree of at-risk and problem gambling. The mediation showed that the onset of gambling was linked with the worry of COVID-infection and that worry predicted the level of gambling problems. This study highlights that vulnerability factors, isolation, and worry can be triggers for individuals with common mental disorders to engage in gambling as well as the importance of screening this population for gambling problems.
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| 3. |
- Höglund, Markus, et al.
(författare)
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Dental clinicians recognizing signs of dental anxiety : a grounded theory study
- 2023
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 81:5, s. 340-348
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and ObjectiveThere is a knowledge gap in how dental clinicians recognise dental anxiety. The aim of this study was to identify, describe and generate concepts regarding this process.Materials and MethodsEleven semi-structured interviews were conducted with dental clinicians from the public dental service of ostergotland, Sweden. Purposive and theoretical sampling was used. Theoretical saturation was reached after eight interviews. The interviews were audio-recorded and transcribed verbatim. Classical grounded theory was used to inductively analyse data by constant comparative analysis.ResultsThe core category was identified as; 'the clinical eye', clinicians noticing behaviours possibly due to dental anxiety based on their knowledge, experiences, or intuition. The core category comprises the five categories: Sympathetic activation, Patient-reported anxiety, Controlling behaviours, Avoidance and Accomplishment. Initially there is usually uncertainty about whether a behaviour is due to dental anxiety or part of a patient's normal behaviour. To gain additional certainty, clinicians need to recognise a stressor as something in the dental setting by observing a change in behaviour, for better or for worse, in the anticipation, presence or removal of the stressor.ConclusionsClinicians identify patients as dentally anxious if their behaviour changes with exposure to a stressor.
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| 4. |
- Höglund, Markus, et al.
(författare)
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Evaluation of the ability of dental clinicians to rate dental anxiety
- 2019
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Ingår i: European Journal of Oral Sciences. - : WILEY. - 0909-8836 .- 1600-0722.
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of ostergotland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients levels of dental anxiety on a Visual Analogue Scale. The correlation (r(s)) between the clinicians and patients ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians and patients ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians confidence and their ability to rate a patients dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.
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| 5. |
- Meurling, Jennifer, et al.
(författare)
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An online tiered screening procedure to identify mental health problems among refugees
- 2023
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Many refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure. METHODS: Seven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers. RESULTS: The results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%). DISCUSSION: This study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation.
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| 6. |
- Rozental, Alexander, 1985-, et al.
(författare)
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Mental health in individuals with self-reported psychiatric symptoms during the COVID-19 pandemic : Baseline data from a swedish longitudinal cohort study
- 2022
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Individuals with psychiatric disorders may be both vulnerable and sensitive to rapid societal changes that have occurred during the COVID-19 pandemic. To fully understand these impacts, repeated measurements of these individuals are warranted. The current longitudinal study set out to perform monthly assessment of individuals with common psychiatric disorders using established questionnaires with a possibility for them to self- rate their symptoms, over time.Methods: Recruitment of individuals who identified themselves as struggling with mental health problems, living in Sweden between July 2020 and June 2021 using an online survey. The individuals answered questions on demographics, psychiatric history, current psychiatric symptoms (e.g., Patient Health Questionnaire, PHQ-9; General Anxiety Disorder, GAD-7), somatic health, health-care contacts and any changes therein during the pandemic. Monthly, longitudinal assessments are still ongoing (consenting participants provide data for 1 year), and here we present descriptive statistics from the baseline measurement. All measurements from baseline (>400 items), and follow-ups are presented in detail.Results: A total of 6.095 participants (average age 35 years) submitted complete baseline data. Marital status (43% single) and number of years of education (48% highest degree being high school) were evenly distributed in this population. The most common lifetime psychiatric disorder in the sample was depressive disorder (80.5%) and generalized anxiety disorder (45.9%), with a substantial proportion having severe symptoms of depression. (30.5%) and anxiety (37.1%). Lifetime suicidal ideation (75.0%) and non-suicidal self-harm (57.7%) were prevalent in the group and 14.5% reported drug use during the pandemic. Allergies (36.8%) were the most common somatic condition, followed by irritable bowel syndrome (18.7%). For those having experienced a traumatic event, 39% showed symptoms during the pandemic indicating PTSD. Regarding contact with mental health services during the pandemic, 22% had established a new contact, and 20% reported to have increased their psychiatric medication compared to before the pandemic.Conclusion: Baseline data collected during the pandemic from individuals in Sweden with pre-existing psychiatric disorders demonstrate that this sample represents a population suitable for an investigation on the long-term impact of the pandemic, as intended by the longitudinal investigation that is ongoing. Follow-up questionnaires over a 12-month period are being collected and will indicate how the health and well-being of this population was impacted during the changes and uncertainties that have been characteristic of the past 2 years.
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| 7. |
- Schibbye, Robert, et al.
(författare)
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Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental or Injection Phobia : Randomized Controlled Trial
- 2024
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 26
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dental phobia (DP) and injection phobia (IP) are common in children and adolescents and are considered some of the biggest obstacles to successful treatment in pediatric dentistry. Cognitive behavioral therapy (CBT) is an evidence -based treatment for anxiety and phobias. As the availability of CBT in dentistry is low, internet-based CBT (ICBT) was developed. Open trials have shown that ICBT is a promising intervention, but randomized trials are lacking. Objective: This randomized controlled trial tests whether therapist -guided ICBT supported by a parent could reduce fear, allowing children and adolescents with DP or IP to receive dental treatment. Methods: We enrolled 33 participants (mean age 11.2, SD 1.9 y) whom a clinical psychologist had diagnosed with DP, IP, or both. After inclusion, participants were randomized to either ICBT (17/33, 52%) or a control group of children on a waitlist (16/33, 48%). ICBT was based on exposure therapy and comprised a 12 -week at-home program combined with visits to their regular dental clinic. Participants corresponded weekly with their therapist after completing each module, and 1 parent was designated as a coach to support the child in the assignments during treatment. All participants completed measurements of the outcome variables before treatment start and after 12 weeks (at treatment completion). The measurements included a structured diagnostic interview with a clinical psychologist. Our primary outcome measure was the Picture -Guided Behavioral Avoidance Test (PG -BAT), which assesses the ability to approach 17 dental clinical procedures, and a positive clinical diagnosis. Secondary outcome measures included self -report questionnaires that measured self -efficacy and levels of dental and injection anxiety. The children and their parents completed the questionnaires. Results: All participants underwent the 12 -week follow-up. After treatment, 41% (7/17) of the participants in the ICBT group no longer met the diagnostic criteria for DP or IP, whereas all participants in the control group did (P=.004). Repeated -measure ANOVAs showed that ICBT led to greater improvements on the PG -BAT compared with the control group; between -group effect sizes for the Cohen d were 1.6 (P<.001) for the child -rated PG -BAT and 1.0 (P=.009) for the parent -rated PG -BAT. Reductions in our secondary outcomes-dental fear and anxiety (P<.001), negative cognitions (P=.001), and injection fear (P=.011)-as well as improvements in self -efficacy (P<.001), were all significantly greater among children in the ICBT group than in the controls. No participants reported adverse events. Conclusions: ICBT seems to be an effective treatment for DP and IP in children and adolescents. It reduced fear and anxiety and enabled participants to willingly receive dental treatment. ICBT should be seriously considered in clinical practice to increase accessibility; this therapy may reduce the need for sedation and restraint and lead to better dental health in children and adolescents.
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| 8. |
- Shahnavaz, Shervin
(författare)
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Cognitive behavioral therapy for children and adolescents with dental phobia
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Dental phobia is a disabling and clinically significant fear that interferes with the dental care necessary for a child’s or adolescent’s well-being. In fact, the definition of oral health in children and adolescents stresses, not only sound and well-functioning dental and oral structures, but also an absence of dental fear and anxiety. Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment for specific phobias that has been used, to a limited extent, in pediatric dental care. Guided internet-based CBT (ICBT) is a variant of CBT that has emerged as an efficacious treatment for many psychiatric disorders, with results similar to face-to-face CBT. At the time of these studies, this new form of CBT had not been tested for dental phobia. Aims: The purpose of this thesis was to (i) explore how school-aged children and adolescents, and their parents, experience and benefit from CBT for dental phobia (Study I), (ii) test the hypothesis that CBT is more efficacious than treatment as usual for dental phobia in school-aged children and adolescents (Study II), and (iii) test the hypothesis that psychologist-guided ICBT improves the ability of school-aged children and adolescents to manage dental phobia, while also testing the feasibility and acceptability of a novel ICBT for pediatric dental phobia (Study III). Methods: The studies used both qualitative and quantitative research methods. Study I involved telephone interviews of 12 children (7–18 years) who had received CBT and one parent of each participant, with data collected and analyzed using qualitative methods. Study II employed a randomized controlled design to evaluate 30 children referred from general dentistry to pediatric specialist clinics with a diagnosis of dental phobia. These children were randomized to either CBT or treatment as usual. Psychologists provided 10 hour-long sessions of CBT, based on a structured treatment manual. The primary outcome measure was the Behavior Avoidance Test (BAT). Other assessments included in Study II measured diagnostic status, fear, and self-efficacy. Study III was an open trial with parent-referred participants. It included 18 participants (8–15 years) with a diagnosis of dental phobia. Participants received psychologist-guided ICBT comprising 12 chapters of texts, animations, and dentistry-related video clips. The treatment also included visits and training at dental clinics and participants received an exercise package of dental instruments. The primary outcome measure for Study III was the picture-based BAT. Other assessments for dental phobia included in the study measured the diagnostic status, fear, negative thoughts, and child and parental self-efficacy. Assessments in Studies II and III occurred before treatment (baseline) and immediately after treatment (3 months), as well as at a 1-year follow-up. Study II analyzed both within-group and between-group changes, while Study 3 only analyzed within-group changes. Results: Analysis of the interviews in Study I showed that CBT led to a perspective shift, which means that children experienced mastery, feelings of safety, and reduced fear in a dental context. According to the participants, the new experiences of dental care was mediated by CBT and arose from gradual exposure, increased autonomy and control, therapeutic alliance, changed appraisal, reduced anticipatory anxiety, and access to new coping strategies. Overall the parents’ and children’s experiences of CBT were positive. Study II showed larger improvements in the CBT group compared to treatment as usual. Results were statistically and clinically significant in both the primary and secondary outcome measures, both after treatment and at the 1-year follow-up. We found a large between-group effect size for the primary (Cohen’s d = 1.4 at post-treatment and 1.9 at the 1- year follow-up) and secondary outcome measures. Results of Study III also showed large within-group effect sizes for the primary (Cohen’s d = 1.4 and 1.5) and secondary outcome measures. Within-group improvements for participants were statistically and clinically significant. Average clinician support time during the 12 weeks was 5.4±2.3 hours per participant and, on average, patients completed 9.2±3.3 treatment modules. Study III showed that ICBT for pediatric dental phobia is a feasible and acceptable treatment. Conclusions: School-aged children and adolescents with dental phobia who received CBT could benefit from the treatment. They experienced mastery, reduced fear, and increased feelings of safety, which helped them to change their view of dentistry and their own potential (perspective shift). CBT was more efficacious than treatment as usual. Children and adolescents in the CBT group improved more in their ability to manage dental procedures, and showed reduced anxiety and increased self-efficacy. Children and adolescents participating in a novel psychologist-guided internet-based CBT improved their ability to manage procedures in dental care. The children’s and adolescent’s dental fear and negative thoughts decreased while both participants and parents experienced increased self-efficacy. CBT is an efficacious treatment for children and adolescents with dental phobia and should be made accessible in pediatric dentistry. ICBT seems to have similar effects as face-to-face CBT. It has the potential to increase access to evidence-based psychological treatment. Important advantages that enable increased accessibility are that ICBT requires a limited amount of therapist time, that large geographic distances distance between therapist and patient is no obstacle, and that it does not require access to specialist pediatric dental care. The efficacy of ICBT needs to be confirmed in future randomized controlled trials.
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| 9. |
- Shahnavaz, Shervin, et al.
(författare)
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Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety : Open Trial
- 2018
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects.Objective: The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment.Methods: This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability.Results: The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment.Conclusions: ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.
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| 10. |
- Woodward, Aniek, et al.
(författare)
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Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden
- 2023
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Ingår i: SSM-MENTAL HEALTH. - : ELSEVIER. - 2666-5603. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- E-mental health interventions may offer innovative means to increase access to psychological support and improve the mental health of refugees. However, there is limited knowledge about how these innovations can be scaled up and integrated sustainably into routine services. This study examined the scalability of a digital psychological intervention called Step-by-Step (SbS) for refugees in Egypt, Germany, and Sweden. We conducted semi-structured interviews (n = 88) with Syrian refugees, and experts in SbS or refugee mental health systems in the three countries. Data collection and analysis were guided by a system innovation perspective. Interviewees identified three contextual factors that influenced scalability of SbS in each country: increasing use of e-health, the COVID-19 pandemic, and political instability. Nine factors lay at the interface between the innovation and potential delivery systems, and these were categorised by culture (ways of thinking), structure (ways of organising), and practice (ways of doing). Factors related to culture included: perceived need and acceptability of the innovation. Acceptability was influenced by mental health stigma and awareness, digital trust, perceived novelty of self-help interventions, and attitudes towards non-specialist (e-helper) support. Factors related to structure included financing, regulations, accessibility, competencies of e-helpers, and quality control. Factors related to practice were barriers in the initial and continued engagement of end-users. Many actors with a potential stake in the integration of SbS across the three countries were identified, with nineteen stakeholders deemed most powerful. Several context-specific integration scenarios were developed, which need to be tested. We conclude that integrating novel e-mental health interventions for refugees into routine services will be a complex task due to the many interrelated factors and actors involved. Multi-stakeholder collaboration, including the involvement of end-users, will be essential.
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