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1.	Sarkadi, Anna, Professor, 1974-, et al. (författare) Evaluation of the Teaching Recovery Techniques community-based intervention for unaccompanied refugee youth experiencing post-traumatic stress symptoms (Swedish UnaccomPanied yOuth Refugee Trial; SUPpORT) : study protocol for a randomised controlled trial 2020 Ingår i: Trials. - : NLM (Medline). - 1745-6215. ; 21:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms.METHODS/DESIGN: A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation).DISCUSSION: This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden. TRIAL REGISTRATION: ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.
2.	Warner, Georgina, et al. (författare) Evaluation of the teaching recovery techniques community-based intervention for accompanied refugee children experiencing post-traumatic stress symptoms (Accompanied refugeeS In Sweden Trial; ASsIST) : study protocol for a cluster randomised controlled trial 2020 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:7 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Refugee children have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue for years after resettlement. The Accompanied refugeeS In Sweden Trial (ASsIST) aims to evaluate a community-based intervention, called 'Teaching Recovery Techniques' (TRT), for accompanied refugee minors experiencing PTSD symptoms. METHODS/DESIGN: A cluster randomised controlled trial will be conducted in which participants will be randomly allocated to one of the two possible arms: the intervention arm (n=113) will be offered the TRT programme and the waitlist-control arm (n=113) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; c.8 weeks after randomisation) and follow-up (T3; c.20 weeks after randomisation). ETHICS AND DISSEMINATION: Ethical approval was granted by the Regional Ethical Review Board in Uppsala (Ref. 2018/382) (24th February 2019). Results will be published in scientific journals. TRIAL REGISTRATION DETAILS: ISRCTN17754931. Prospectively registered on 4th June 2019.
3.	Rondung, Elisabet, 1980-, et al. (författare) Feasibility of a randomised trial of Teaching Recovery Techniques (TRT) with refugee youth : results from a pilot of the Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) 2022 Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 8:1 Tidskriftsartikel (refereegranskat)abstract Background: Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection. Methods: A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial. Results: Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up. Conclusions: The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded. Trial registration: ISRCTN47820795, prospectively registered on 20 December 2018
4.	Sarkadi, Anna, Professor, 1974-, et al. (författare) Is the refugee health screener a useful tool when screening 14-18 year old refugee adolescents for emotional distress? 2019 Ingår i: The Journal of Refugee Studies. - Oxford, UK : Oxford Academic. - 0951-6328 .- 1471-6925. ; 32:Special_Issue_1, s. i141-i150 Tidskriftsartikel (refereegranskat)abstract The high number of asylum seekers in Sweden has highlighted the need for structured assessment tools to screen for refugee mental health problems in clinical services. We examined the utility of the Refugee Health Screener (RHS) in refugee adolescents, aged 14-18, attending routine clinical examinations or staying in group homes/refugee centres (N=29). Participants completed a survey, including the RHS, administered through iPads in their native language. The RHS showed excellent internal consistency (α = .96) and correlated moderately with symptoms of PTSD (r=0.41, p=.025). Mean scores and prevalence rates were comparable to a study of adult refugees in Sweden. Unaccompanied refugee minors (URM) scored significantly higher (M=32.0, SD=12.9) compared to youth staying with their families (M=7.5, SD=8.2, p<.001, d=2.27). Our findings confirm that the RHS can be used in the adolescent population in Sweden. These findings moreover suggest that URMs are a particularly vulnerable group with a large burden of mental health problems.
5.	Sarkadi, Anna, Professor, 1974-, et al. (författare) Are We Ready to Really Hear the Voices of Those Concerned? : Lessons Learned from Listening to and Involving Children in Child and Family Psychology Research 2023 Ingår i: Clinical Child and Family Psychology Review. - : Springer Nature. - 1096-4037 .- 1573-2827. Tidskriftsartikel (refereegranskat)abstract A changing view of children, accelerated by the Convention of the Rights of the Child (UN in Convention on the rights of the child, UN Doc. A/RES/44/25, 1989, http://www2.ohchr.org/english/law/pdf/crc.pdf) has shifted the landscape of child and family research over the last few decades. Once viewed with low credibility and operating outside the interpretive framework of adult researchers, the rights-bearing child is increasingly recognized not only as having the capacity but also the right to participate in research. More recently, this movement has transitioned from the direct engagement of children as research participants—now considered commonplace, although less so for those who are structurally vulnerable—to the involvement of children in research design, review, conduct, and dissemination. Yet, both practical and ethical challenges remain. While children have the right to participation, they also have the right to protection. In this commentary, we set out to: (i) lay forth epistemic, child rights, and child sociology arguments for doing research about, with and by children and youth; (ii) recount our own journey of including children and youth in research to demonstrate the unique knowledge and insights gained through these approaches; and (iii) offer lessons learned on how to engage children and youth in research, including the involvement of structurally vulnerable groups.
6.	Ssegonja, Richard, et al. (författare) Cost-effectiveness of an indicated preventive intervention for depression in adolescents: a model to support decision making 2020 Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 277, s. 789-799 Tidskriftsartikel (refereegranskat)abstract Background: Adolescent depression has negative health and economic outcomes in the shortand long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are ef-fective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions. Methods: A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option in a Swedish setting. Taking a time horizon of 5and 10 years, incremental differences in societal costs and health benefits expressed as differences in the proportion of cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%. Results: The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented a larger proportion of cases of depression and generated higher QALYs compared to the no -intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. Limitations: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect. Conclusions: GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.
7.	Ssegonja, Richard, et al. (författare) Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood : A longitudinal cost-of-illness study 2019 Ingår i: Journal of Affective Disorders. - : ELSEVIER. - 0165-0327 .- 1573-2517. ; 258, s. 33-41 Tidskriftsartikel (refereegranskat)abstract Background: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.Methods: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).Results: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.Limitations: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.Conclusions: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.
8.	Fäldt, Anna, 1975-, et al. (författare) Experiences of children with disabilities during the COVID-19 pandemic in Sweden : a qualitative interview study 2022 Ingår i: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 6:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The impact of the COVID-19 pandemic on people with disabilities has been described as a 'triple jeopardy'. Not only have they experienced the negative social impacts of disease control measures, but access to required health services has been affected, and, not least, they are at increased risk of severe outcomes from COVID-19. This study aimed to determine how children with disabilities have experienced the pandemic in Sweden and its impact on their lives.METHODS: Six children (5-13 years) were interviewed via video conferencing. An interview guide was adapted based on the children's communicative abilities and included augmentative and alternative communication support. Reflective field notes were included in the analysis. The data were analysed using qualitative content analysis.RESULTS: Two themes were identified: The child's knowledge of Corona raises anxiety and fear; and Boring Corona makes the child even lonelier. The children had knowledge about and were worried about COVID-19, primarily about illness and death of their grandparents. The children longed for their grandparents and other social contacts at school, and life was described as boring and lonely. Many families lacked adequate tools to communicate with their children about the pandemic.CONCLUSION: Given adequate support, children with disabilities and communication difficulties can give insights to their unique life situations. The interviewed children reported significant impact on their life and school life. Children were worried about their grandparents based on their knowledge about the virus. The enthusiasm with which the children engaged in the interviews is testament to the need and right of all children, regardless of communicative competence, to voice their experiences.
9.	Inge, Elin, et al. (författare) Ameliorating epistemic injustice in practice : Communication strategies in a research project with refugee youth coresearchers 2023 Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 27:1 Tidskriftsartikel (refereegranskat)abstract IntroductionMany researchers want to include seldom involved groups, such as refugees and youth, in patient and public involvement (PPI), but experience a number of barriers. The PPI research community calls for critical evaluations that are prospective, data-based and conducted by researchers and public contributors together. In this study, we conducted a longitudinal evaluation of a core activity in all collaborations: communication strategies. The aim was to evaluate the communication strategies adopted throughout a research project with refugee youth coresearchers.MethodsThis article is based on the evaluation of a project where refugee youth were involved in the online adaptation of a group-based programme for youth with posttraumatic stress. Behavioural observations and field notes collected during the project were analysed with qualitative content analysis and a readability index, and discussed through the lens of epistemic injustice. The article was cowritten by researchers and refugee youth.FindingsFour manifest categories were identified: Facilitating engagement through coplanning and circumstantial flexibility; Different needs require different channels; It's not just about the channel—facilitation skills matter; Finding a common language opens a communicative flow. In addition, a latent underlying theme reflecting the role of trust was identified: Interactive moments facilitate trust—trust facilitates richer involvement.ConclusionAt the core of the identified communication strategies were strengthening relationship-building and actively facilitating involvement. Establishing trusting relationships enabled refugee youth to share input. The communication strategies increased hermeneutical justice by contributing to a common understanding; thus, taking a step towards ameliorating epistemic injustice.
10.	Johansson, Nina, et al. (författare) Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS) : study protocol for a randomised controlled trial of the healthier wealthier families model in Sweden 2022 Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1 Tidskriftsartikel (refereegranskat)abstract BackgroundSweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with families; however, this has not been realised. The Healthier Wealthier Families (HWF) model embeds universal screening for economic hardship into child health services and creates a referral pathway to economic support services. Given the universal child health system in Sweden, which is freely available and has excellent coverage of the child population, implementation of the HWF model has potential to support families to access the freely available municipal budget and debt counselling and ultimately improve rates of child deprivation in Sweden.Methods/designWe will conduct a two-arm randomised waitlist-control superiority trial to examine the effectiveness and cost-effectiveness of the HWF model in the Sweden. A longitudinal follow-up with the cohort will explore whether any effects are maintained in the longer-term.DiscussionHWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address child deprivation in Sweden. The study outlined in this protocol is the first effectiveness evaluation of the HWF model in Sweden and is a crucial step before HWF can be recommended for national implementation within the child health services.
11.	Pérez-Aronsson, Anna, et al. (författare) "I'm a Mother Who Always Tries to Give My Children Hope" : Refugee Women's Experiences of Their Children's Mental Health 2019 Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 10 Tidskriftsartikel (refereegranskat)abstract Background: The prevalence of mental health problems is high among refugee children. Childhood mental health problems have long-term negative consequences and costs both for the individual child and society. The present study aimed to explore refugee parents’ experiences of their children’s mental health.Methodology: A qualitative explorative study was conducted. Data were collected through semistructured interviews with nine refugee mothers who have been in Sweden less than 5 years and with at least one child in the ages 8–14 years. Data were analyzed inductively using thematic network analysis.Results: The global theme that emerged from the analysis was Navigating the moving landscape of forced migration, which described the refugee mothers’ experiences of the previous adversity the family went through, the ongoing transition in the new context, and, lastly, the pathways to promote their children’s mental health. Two organizing themes described mothers’ and children’s navigation of the forced migration: Previous adverse events and new suffering and Promoting children’s well-being. Mothers described aggression and frequent conflicts, or refusal to play or eat, in their children related to living conditions at asylum centres and social isolation. This improved when children started school and possibilities of social relations increased. Mothers’ own mental health and lack of language skills could also have a negative impact on the children. To focus on the present and have hope of the future was helpful to the children. Encouragement and social support from parents, teachers, and friends promoted children’s well-being.Conclusion: The role of the host country in the promotion of the mental health of refugee children is emphasized. Interventions aimed to improve peer relations and reduce discrimination are needed, and these point to the school as a potential arena for positive change. Parental support groups were also mentioned as helpful in understanding the children’s need for support.
12.	Perez Aronsson, Anna, et al. (författare) Training Allied Professionals to Hold Mental Health Support Groups for Children Who Have Experienced Trauma : Can Online Education Meet the Need? 2021 Ingår i: Academic Psychiatry. - : Springer Nature. - 1042-9670 .- 1545-7230. ; 45:5, s. 623-628 Tidskriftsartikel (refereegranskat)
13.	Sarkadi, Anna, Professor, 1974-, et al. (författare) An Integrated Care Strategy for Pre-schoolers with Suspected Developmental Disorders : The Optimus Co-design Project that has Made it to Regular Care 2021 Ingår i: International Journal of Integrated Care. - : Ubiquity Press. - 1568-4156. ; 21:2 Tidskriftsartikel (refereegranskat)abstract Introduction: Multiple neurodevelopmental problems affect 7-8% of children and require evaluation by more than one profession, posing a challenge to care systems.Description: The local problem comprised distressed parents, diagnostic processes averaging 36 months and 28 visits with 42% of children >4 years at referral to adequate services, and no routines for patient involvement. The co-design project was developed through a series of workshops using standard quality improvement methodology, where representatives of all services, as well as parents participated. The resulting integrated care model comprises a team of professionals who evaluate the child during an average of 5.4 appointments (N = 95), taking 4.8 weeks. Parents were satisfied with the holistic service model and 70% of children were under 4 at referral (p < 0.05). While 75% of children were referred, 25% required further follow-up by the team.Discussion: The Optimus model has elements of vertical, clinical and service integration. Reasons for success included leadership support, buy-in from the different organisations, careful process management, a team co-ordinator, and insistent user involvement.Conclusion: Evaluating multiple neurodevelopmental problems in children requires an integrated care approach. The Optimus care model is a relevant showcase for how people-initiated integrated care reforms can make it into usual care.
14.	Sarkadi, Anna, Professor, 1974-, et al. (författare) Children's Expressions of Worry During the COVID-19 Pandemic in Sweden 2021 Ingår i: Journal of Pediatric Psychology. - : Oxford University Press (OUP). - 0146-8693 .- 1465-735X. ; 46:8, s. 939-949 Tidskriftsartikel (refereegranskat)abstract Objective: Sweden is an international exception in its public health response to the COVID-19 pandemic, with a higher number of deaths, albeit not pediatric, compared with other Nordic countries. The objective of this study was to investigate what worries children and adolescents living in Sweden expressed in relation to the pandemic.Methods: Using an anonymous web-survey, 1,047 children (4–12 years; N = 717) and adolescents (13–18 years; N = 330) responded to five background and four open-ended questions, one of which was: Is there anything that you are worried about when it comes to ‘Corona’? The responses were coded using manifest content analysis. Interrater reliability was .95, assessed on the code level.Results: Worry was common (77%); mostly (60%) related to disease or death of elderly relatives, parents, the child him/herself or general worry for the elderly/risk groups. Existential worry (15%) comprised worries about the future, including economy and worries about the world perishing or the contagion becoming uncontrollable. A developmental trajectory was evident in the nature of responses. Adolescents’ worries about the future included missing out on their youth and employment. They also worried about society (6%), for example, the future of democracy and the world economy. There was no indication of socioeconomic status or geographic area (urban vs. rural) affecting the presence of worrisome thoughts.Conclusions: Worry about “Corona” was common. Universal preventative mental health intervention is warranted and could be conducted in the school setting. Intervention could be tailored by age, covering discussion on financial aspects with adolescents.
15.	Ssegonja, Richard, et al. (författare) Indicated Preventive Interventions for Depression in Children and Adolescents : A Meta-Analysis And Meta-Regression 2018 Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 21, s. S181-S181 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
16.	Ssegonja, Richard, et al. (författare) Indicated preventive interventions for depression in children and adolescents : A meta-analysis and meta-regression 2019 Ingår i: Preventive Medicine. - : Elsevier BV. - 0091-7435 .- 1096-0260. ; 118, s. 7-15 Forskningsöversikt (refereegranskat)abstract Depression contributes about 2% to the global burden of disease. A first onset of depressive disorder or subsyndromal depressive symptoms is common in adolescence, indicating that early prevention is a priority. However, trials of preventive interventions for depression in youths show conflicting results. This systematic review and meta-analysis investigated the effectiveness of group-based cognitive behavioral therapy (GB-CBT) as a preventive intervention targeting subsyndromal depression in children and adolescents. In addition, the impact of different covariates (type of comparator and use of booster sessions) was assessed. Relevant articles were identified from previous systematic reviews, and supplemented with an electronic search spanning from 01/09/2014 to 28/02/2018. The retrieved articles were assessed for eligibility and risk of bias. Relevant data were extracted. Intervention effectiveness was pooled using a random-effects model and the impact of covariates assessed using meta-regression. 38 eligible articles (34 trials) were obtained. The analysis showed GB-CBT to significantly reduce the incidence (relative risk 0.43, 95% CI 0.21-0.87) and symptoms (Cohen's d -0.22, 95% CI -0.32 to -0.11) of depression at post-test compared to all controls. Comparisons with passive comparators suggested that the effect decayed over time. However, compared to active controls, a significant intervention effect was evident only after 12 month or more. Our results suggest that the preventive effect of GB-CBT wears off, but still lasts longer than the effect of active comparators. Only a few studies included booster sessions, precluding firm conclusions. Future studies should clarify to what extent maintenance strategies can prolong the preventive effect of GB-CBT.
17.	Abdi, Saida, et al. (författare) Promoting positive development among refugee adolescents 2023 Ingår i: Journal of research on adolescence. - : John Wiley & Sons. - 1050-8392 .- 1532-7795. ; 33:4, s. 1064-1084 Forskningsöversikt (refereegranskat)abstract Of the estimated 35.3 million refugees around the world (UNHCR, Figures at a Glance, 2022), approximately 50% are children under the age of 18. Refugee adolescents represent a unique group as they navigate developmental tasks in an unstable and often threatening environment or in resettlement contexts in which they often face marginalization. In addition to physiological, social, and psychological changes that mark adolescence, refugee youth often face traumatic experiences, acculturative stress, discrimination, and a lack of basic resources. In this consensus statement, we examine research on refugee adolescents' developmental tasks, acculturative tasks, and psychological adjustment using Suarez-Orozco and colleague's integrative risk and resilience model for immigrant-origin children and youth proposed by Suarez-Orozco et al. Finally, we discuss recommendations-moving from proximal to more distal contexts.
18.	Bergström, Malin, et al. (författare) Narrative review of interventions suitable for well-baby clinics to promote infant attachment security and parents' sensitivity 2020 Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:9, s. 1745-1757 Tidskriftsartikel (refereegranskat)abstract Aim The aim of this narrative review was to evaluate the evidence for interventions for children's secure attachment relationships and parents' caregiving sensitivity that could potentially be implemented in the context of a well-baby clinic. Methods Literature search on programmes for parental caregiving sensitivity and secure attachment for infants aged 0-24 months. Randomised controlled trials (RCTs) published 1995-2018 with interventions starting from one week postpartum, and with a maximum of 12 sessions (plus potential booster session) were included. Results We identified 25 studies, of which 22 studied effects of home-based programmes using video feedback techniques. Positive effects of these interventions in families at risk were found on parental caregiving sensitivity and to a lesser extent also on children's secure or disorganised attachment. The effects of two of these programmes were supported by several RCTs. Three intervention studies based on group and individual psychotherapy showed no significant positive effects. Most of the interventions targeted mothers only. Conclusions The review found some evidence for positive effects of selective interventions with video feedback techniques for children's secure attachment and strong evidence for positive effects on parental caregiving sensitivity. Important knowledge gaps were identified for universal interventions and interventions for fathers and parents with a non-Western background.
19.	Bergström, Malin, et al. (författare) Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent 2018 Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 107:2, s. 294-300 Tidskriftsartikel (refereegranskat)abstract AIM: Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.METHODS: In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.RESULTS: Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.CONCLUSION: Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.
20.	Bergström, Malin, et al. (författare) "We also communicate through a book in the diaper bag" - Separated parents' ways to coparent and promote adaptation of their 1-4 year olds in equal joint physical custody 2019 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:4 Tidskriftsartikel (refereegranskat)abstract Joint physical custody (JPC) refers to a practice where children with separated parents share their time between the parents' respective homes. Studies on parents' views of JPC for young children are scarce. The aim of this interview study was to explore parents' perceptions on how they experience and practice equally shared JPC for their 1-4 year-olds in Sweden. Forty-six parents (18 fathers and 28 mothers) of 50 children (31 boys and 19 girls) under 5 years of age were interviewed. Parents were recruited through information in the media and represented a broad range of socioeconomic backgrounds, as well as both voluntary and court-ordered custody arrangements. The interviews were semi-structured and analyzed using systematic text condensation. Two themes emerged regarding the research question. In the first theme, Always free, never free, parents described their striving to coparent without a love relationship. While they appreciated the freedom of being a half-time parent, doing things one's own way, they felt constrained by the long-term commitment to live close to and keep discussing child rearing issues with the ex-partner. Good communication was key and lessened parent's feelings of being cut-off from half of the child's life. When JPC was ordered by court or conflicts were intense, parents tried to have less contact and worried when the children were in the other home. The second theme, Is it right, is it good?, included descriptions of how the parents monitored the child's responses to the living arrangement and made changes to optimize their adjustment. Adaptations included visits for the child with the other parent mid-week, shared meals or adapting schedules. In conclusion, these parents worked hard to make JPC work and cause minimal damage to their children. Most parents were pleased with the arrangements with the notable exception of couples experiencing ongoing conflict.
21.	Bokström, Pär, 1980-, et al. (författare) Föräldrastöd i förskolan 2013. - 1 Ingår i: Föräldrar, förskola och skola. - Lund : Studentlitteratur. - 9789144079523 ; , s. 193-207 Bokkapitel (populärvet., debatt m.m.)abstract Trots att utvecklingen mot en socialt ansvarstagande skola har pågått under lång tid, så är föräldrastödsprogram som levereras i förskolans regi någonting nytt i Sverige. Närheten till både barn och föräldrar har visat sig vara en utmärkt utgångspunkt för den här typen av verksamhet. Föräldrarna litar på pedagogernas kompetens och känner en trygghet i att de känner deras barn väl. Men det medför också utökade arbetsuppgifter och fördjupade ansvarsområden för pedagogerna, då föräldrastöd går utanför den traditionella verksamheten. Det medför i sin tur att pedagogerna i viss mån får en ny roll i sitt arbete med barnen, och även gentemot föräldrarna. Forskning på området är ytterst sparsam, både i Sverige och internationellt. Anledningen till det är att föräldrastöd på förskola är ovanligt, med hittills endast ett genomfört projekt i Sverige.
22.	Cederblad, Maria, 1968-, et al. (författare) Infrequent enuresis, the uninvestigated majority : comparisons between children with enuresis of varying severity. 2015 Ingår i: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 11:1, s. 24.e1-24.e6 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: The main objective was to compare children with frequent enuresis (FE) and children with infrequent enuresis (IE) using anamnestic data and variables related to bladder and kidney function. A secondary aim was to look at the group of children who wet their beds every single night, a phenomenon we chose to call constant enuresis (CE).SUBJECTS AND METHODS: The parents recorded the number of wet and dry nights for a period of 14 days, and measured the voided volumes as well as nocturnal urine production for 48 h. History data relevant to bladder and bowel function was also recorded.RESULTS: The children could be grouped as follows: IE, n = 14; FE, n = 18; and CE, n = 22. The children with IE were slightly older than the other groups, IE mean 7.57; FE mean 6.22; CE, mean 6.56 (p = 0.004). When comparing the groups in terms of the measured parameters, only one significant difference was found: the FE group had larger average daytime voided volumes, but only when the first morning void was included. The only significantly differing anamnestic variable was previous daytime incontinence, which was more common among the children in the IE group.CONCLUSIONS: When comparing children with varying enuresis severity, no major differences regarding bladder function and urine production were found. Furthermore, children with infrequent enuresis tend to be slightly older when they seek medical help.
23.	Cederblad, Maria, 1968-, et al. (författare) No effect of basic bladder advice in enuresis : a randomised controlled trial 2015 Ingår i: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 11:3 Tidskriftsartikel (refereegranskat)abstract BackgroundThere are two firstline, evidence-based treatments available for nocturnal enuresis: desmopressin and the enuresis alarm. Prior to use of these therapies, international experts usually recommend that the children also be given basic bladder training during the daytime. The rationale behind this recommendation is that daytime bladder training or urotherapy, is a mainstay in the treatment of daytime incontinence caused by detrusor overactivity. Still, there is, as yet, no firm evidence that daytime bladder training is useful against nocturnal enuresis.AimTo explore whether basic bladder advice has any effect against nocturnal enuresis.Study designThe study was prospective, randomized, and controlled. The evaluated intervention was bladder advice, given in accordance with ICCS guidelines and focused on regular voiding, sound voiding posture, and sufficient fluid intake. Forty children aged 6 years or more with previously untreated enuresis, but no daytime incontinence, were randomized (20 in each group) to receive either first basic bladder advice for 1 month and then alarm therapy (group A) or just the alarm therapy (group B). Based on power calculations, the minimum number of children required in each treatment arm was 15.ResultsThe basic bladder advice did not reduce the enuresis frequency in group A (p = 0.089) and the end result after alarm therapy did not differ between the two groups (p = 0.74) (see Table). Only four children in group A had a partial or full response to bladder training, and two of these children relapsed immediately during alarm therapy.DiscussionThis was the first study to evaluate, in a prospective, randomized manner, the value of daytime basic bladder training as a treatment of enuresis. It was found that the treatment neither resulted in a significant reduction in the number of wet nights, nor did it improve the success of subsequent alarm therapy.ConclusionsThe recommendation that all children with enuresis be given bladder training as a firstline therapy can no longer be supported. Instead, we recommend that treatment of these children start with the enuresis alarm or desmopressin without delay.
24.	Cederblad, Maria, et al. (författare) "Nobody asked us if we needed help" : Swedish parents experiences of enuresis 2014 Ingår i: Journal of Pediatric Urology. - : Elsevier BV. - 1477-5131 .- 1873-4898. ; 10:1, s. 74-79 Tidskriftsartikel (refereegranskat)abstract Objective: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals.Subjects and methods: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation.Results: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers.Conclusion: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families. .
25.	Coscini, Nadia, et al. (författare) Multicountry review : developmental surveillance, assessment and care by outpatient paediatricians 2023 Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 0003-9888 .- 1468-2044. ; 108:3, s. 153-159 Forskningsöversikt (refereegranskat)abstract BACKGROUND: Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups.METHODS: Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points.RESULTS: Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking.CONCLUSION: Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
26.	Dahlberg, Anton (författare) Capturing and addressing preschool children’s emotional and behavioural problems : Using parents’, teachers’ and children’s perspectives 2021 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Emotional and behavioural problems (EBP) are among the most common mental health problems in preschool children. EBP are also associated with poor parent mental health. Untreated, EBP can persist or worsen over time. In order to capture and address preschool children’s EBP, we need scientifically valid instruments that can access the perspectives of informants from different contexts of the child. We also need cut-off values for questionnaires assessing EBP that are representative of the population. Parenting support is a recommended intervention for addressing EBP in preschool children. Most parenting support programmes have a solid evidence-base and show positive effects on child EBP and parent wellbeing. However, we need a better understanding of the children’s emotional and relational experiences, especially in relation to their parents. Further, although the implementation of evidence-based interventions is a complex matter with substantial impact on intervention success, few studies assess the implementation process of parenting programmes. The studies constituting this thesis focused on preschool children. The Strengths and Difficulties Questionnaire (SDQ) was assessed for capturing EBP. Study I assessed the construct validity of the SDQ and its five subscales, when rated by fathers and preschool teachers. Confirmatory factor analysis was applied to evaluate construct validity. Results indicated that the SDQ can be used as an instrument to measure EBP in preschool children, rated by parents and preschool teachers. In study II, we established Swedish norms for the SDQ for preschool children. Results suggested lower SDQ cut-offs for Swedish preschool children compared with other countries, and higher cut-offs for boys compared with girls. In study III, preschool children whose parents participated in a parenting programme were interviewed regarding their emotional and relational experiences at home. Data were analysed using qualitative content analysis. The children provided accounts of negative and positive interactions with their parents, elaborately describing a coercive cycle with escalating conflicts and lack of problem resolution. In study IV, the implementation of the parenting programme Triple P in a preschool setting was assessed using the RE-AIM framework. Results indicated a successful implementation that relied on customisation of the programme; assessment of the process from parent, staff, and organisation levels; interdisciplinary collaboration; and continuous work on securing maintenance over time. This thesis provides pieces to a complex puzzle of understanding and addressing child mental health problems, particularly EBP. Assessing EBP from different perspectives and promoting children’s voices are essential, as well as actively working with the implementation of evidence-based programmes.
27.	Dahlberg, Anton, et al. (författare) SDQ in the Hands of Fathers and Preschool Teachers : Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds 2019 Ingår i: Child Psychiatry and Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327. ; 50:1, s. 132-141 Tidskriftsartikel (refereegranskat)abstract The Strengths and Difficulties Questionnaire (SDQ) is a well-established instrument for measuring social and behavioural problems among children, with good psychometric properties for older children, but less validity reports on pre-schoolers. In addition, there is a knowledge gap concerning fathers as informants. The present work is one of the few validity studies to include preschool teachers and the first on preschool children where fathers are included as separate informants. In this study, SDQs were collected from a large community sample (n = 17,752) of children aged 3-5, rated by mothers, fathers, and preschool teachers and analysed using confirmatory factor analysis. Our results revealed acceptable fit for all informant groups and measurement invariance across child gender, child age, and parental education level. Our findings suggest good construct validity of the SDQ for a non-clinical preschool population and imply that it may be used for assessing child behaviour problems from different informant perspectives.
28.	Dahlberg, Anton, et al. (författare) Successful implementation of parenting support at preschool : An evaluation of Triple P in Sweden 2022 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:4 Tidskriftsartikel (refereegranskat)abstract Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff "buy-in", designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena.
29.	Dahlberg, Anton, et al. (författare) Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers 2020 Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 61:2, s. 253-261 Tidskriftsartikel (refereegranskat)abstract The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3-5, based on mothers', fathers', and preschool teacher's ratings. Preschool teachers' ratings were generally lower than parents' ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut-offs are presented for each age group, gender and rater category. Population-specific norms and percentile cut-offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross-country comparisons of children's mental health problems.
30.	Dahlberg, Anton, et al. (författare) 'They Yell and I Yell Back' : Pre-schoolers' Descriptions of Conflict Laden Interactions at Home 2023 Ingår i: Journal of Child and Family Studies. - : Springer. - 1062-1024 .- 1573-2843. ; 32:12, s. 3835-3847 Tidskriftsartikel (refereegranskat)abstract Over the past 50 years, extensive research has been published on the parent–child relationship and parenting. However, there are very few examples where young children are at the centre of attention for describing family dynamics, relationships and conflicts. This study aimed at addressing this research and knowledge gap through exploring the emotional and relational experiences of preschool children whose parents attended a universal parenting programme. Seventeen preschool children aged 3–6 were interviewed, using an emotion-focused, pictorial-based computer assisted interview method. The children’s descriptions of their family relationships were analysed using qualitative content analysis. The children described negative interplay within the families in rich detail, especially experiences where conflicts with parents escalated and were left unresolved. Moments of positive family interactions were described as well, but they were heavily overshadowed by the narratives containing negative parenting. The children also described compensatory behaviours, such as looking for comfort from siblings or pets. The narratives in this study gave a unique insight into the emotional and relational domestic context of children in families seeking universally offered parenting support. Given adequate tools and support, children as young as 3 or 4 years old could provide extensive information about their lives. We urge future research examining parenting or family interventions to include the children’s perspectives.
31.	Dahlberg, Anton, et al. (författare) “They yell and I yell back”: Pre-schoolers’ voices from inside the coercive cycle Ingår i: Children and youth services review. - 0190-7409 .- 1873-7765. Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
32.	Dahlberg, Anton, et al. (författare) Validity of Strengths and Difficulties Questionnaire in non-clinical samples of parents and teachers 2017 Ingår i: European Journal of Public Health. - 1101-1262 .- 1464-360X. ; 27 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
33.	Durbeej, Natalie, et al. (författare) Evaluation of a school-based intervention to promote mental health of refugee youth in Sweden (The RefugeesWellSchool Trial) : study protocol for a cluster randomized controlled trial 2021 Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 22:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Sweden is home to a large and growing population of refugee youths who may be at risk of mental health problems such as post-traumatic stress disorder (PTSD). Thus, there is a need for interventions that address mental health problems in these populations. Schools have been identified as an ideal setting for delivering such interventions as they offer a non-stigmatizing space and are often central to young refugees' social networks. The RefugeesWellSchool trial in Sweden will investigate an intervention comprising two programmes: Teaching Recovery Techniques (TRT) and In-service Teacher Training (INSETT), delivered in a school setting, among refugee youth. TRT is a group-based programme for children and adolescents, informed by Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). INSETT is a multi-module course for teachers providing information on trauma and the refugee experience to build teachers' cultural competence and capacity for supporting refugee youths in schools.METHODS: This trial employs a cluster randomized-control design with two arms: (1) the intervention arm in which the TRT and INSETT programmes are offered (n = 350), (2) the wait-list control arm (n = 350) in which services are provided as usual until the TRT and INSETT programmes are offered approximately six months later. Data will be collected prior to the intervention, immediately following the intervention, and at three months post-intervention. Outcomes for the trial arms will be compared using linear mixed models or ANCOVA repeated measures as well as the Reliable Change Index (RCI).DISCUSSION: This study will provide knowledge about the effectiveness of an intervention comprising two programmes: a group-based programme for youth reporting symptoms of PTSD and a training course for teachers, in order to build their competence and ability to support refugee youths in schools.TRIAL REGISTRATION: ISRCTN, ISRCTN48178969 , Retrospectively registered 20/12/2019.
34.	Durbeej, Natalie, et al. (författare) Outside the norm : Mental health, school adjustment and community engagement in non-binary youth 2019 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:5, s. 529-538 Tidskriftsartikel (refereegranskat)abstract Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents.Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data.Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%).Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.
35.	Dyar, Oliver J., et al. (författare) Rainbows over the world's public health : determinants of health models in the past, present, and future 2022 Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:7, s. 1047-1058 Tidskriftsartikel (refereegranskat)abstract The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.
36.	Edvinsson Sollander, Sofia, et al. (författare) Asthma and allergies correlate to mental health problems in preschool children 2021 Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:5, s. 1601-1609 Tidskriftsartikel (refereegranskat)abstract AIM: To explore the relations between asthma, allergies and mental health problems in preschool children, aged 3-5-years.METHODS: In this cross-sectional Swedish study, we used data on 4649 children in Uppsala municipality whose parents and preschool teachers had responded to questions measuring asthma and allergies, and the Strengths and Difficulties Questionnaire (SDQ) for assessment of mental health problems. Logistic regression models were used to explore the relations between asthma and allergies and mental health problems.RESULTS: Children with asthma (8.5%) had elevated odds of having emotional symptoms as rated by parents (OR: 1.34; 1.02-1.76) and teachers (OR: 1.44; 1.09-1.91). According to parents' ratings, these children also had elevated odds of showing mental health problems in general according to the SDQ total score (OR: 1.42; 1.05-1.94). Children with food allergies or intolerance (4.4%) only had elevated odds of having emotional symptoms (OR: 1.64; 1.16-2.33), as reported by parents. These results remained significant after adjustment for parental background factors.CONCLUSION: Preschool children with asthma and food allergies or intolerance are at risk of having concurrent mental health problems. Mental health problems should be assessed in children with these disorders. Adequate support and/or referral to specialised services should be offered when needed.
37.	Fabian, Helena, 1971-, et al. (författare) Mental health and academic failure in Swedish adolescents 2017 Ingår i: European Journal of Public Health. - 1101-1262 .- 1464-360X. ; 27, s. 388-388 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
38.	Feldman, Inna, 1951-, et al. (författare) Cost-effectiveness of public health interventions - a new methodological approach 2014 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
39.	Feldman, Inna, 1951-, et al. (författare) Response to Invited Commentary : Methods to address control for confounding and nonperfect randomization when using outcome distribution curves to estimate the population-level impact of a public health intervention. 2014 Ingår i: Journal of Clinical Epidemiology. - : Elsevier BV. - 0895-4356 .- 1878-5921. ; 67:11, s. 1286-1288 Tidskriftsartikel (refereegranskat)
40.	Frielingsdorf Lundqvist, Helena, et al. (författare) Anpassa digitala medier efter barn, inte tvärtom 2023 Ingår i: Svenska Dagbladet. - Stockholm : Svenska Dagbladet AB & Co.. - 1101-2412. Tidskriftsartikel (populärvet., debatt m.m.)
41.	Fält, Elisabet (författare) A cross-service approach to identify mental health problems in 3–5-year-old children using the Strengths and Difficulties Questionnaire 2019 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The Child Healthcare Services (CHS) in Sweden offer regular health check-ups and reach almost all 0–5-year-old children. Although one of the objectives of the CHS is to detect mental health problems, evidence-based methods are not used for this purpose at the Child Health Clinics (CHCs). Therefore, an evidence-based instrument to assess children’s emotional and behavioural problems through parent and teacher reports, the Strengths and Difficulties Questionnaire (SDQ), was introduced, as part of the Children and Parents in Focus trial, run between 2013 and 2017 in Uppsala, Sweden. The overall aim of this thesis was to evaluate the introduction of the procedure, including the facilitation strategies provided to support implementation, and to provide inter-rater correlations and norms for the SDQ in this population.Data were collected through individual interviews with nurses, parents and preschool teachers; group interviews with nurses; and a survey performed at the end of the trial to evaluate nurses’ experiences of the SDQ-procedure and the implementation process. In addition, delivery, response rate and population coverage of the questionnaires were calculated. Quantitative data were analysed using descriptive statistics, Pearson correlations and Intraclass Correlation Coefficients (ICC), and qualitative data using Grounded Theory and content analysis.Results showed that nurses found it useful for their assessment to have access to preschool teachers’ SDQ-ratings. Parents were also positive to the procedure but had concerns regarding confidentiality of the responses. Preschool teachers were least positive, fearing labelling of children and negative parental reactions. Significant, albeit poor, agreement (ICC) was found between parent and teacher ratings and good agreement between parents’ ratings. Teachers were found to report lower levels of problems compared to parents. Cut-off values differed for age and were somewhat higher for boys (lower for prosocial), suggesting that boys display more behaviour problems. Nurses perceived facilitation strategies used by the research team useful to support implementation and delivered the procedure, essentially, as intended. However, response rate remained lower than expected, around 50%.The findings suggest that implementing the SDQ to aid CHC-nurses’ assessment of 3-5-year-olds’ mental health is feasible, but requires further effort in regular services to reach all children.
42.	Fält, Elisabet, et al. (författare) Agreement between mothers', fathers', and teachers' ratings of behavioural and emotional problems in 3-5-year-old children 2018 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:11 Tidskriftsartikel (refereegranskat)abstract Background: The Strengths and Difficulties Questionnaire (SDQ), a valid and reliable instrument for measuring children's mental health, is available in parent- and teacher versions, making it an ideal tool for assessing behavioural and emotional problems in young children. However, few studies have evaluated inter-parent agreement on the SDQ, and in most studies on SDQ agreement, parent scores are either provided by only one parent or have been combined into one parent score. Furthermore, studies on SDQ inter-rater agreement usually only reflect degree of correlation, leaving the agreement between measurements unknown. The aim of the present study was therefore to examine both degree of correlation and agreement between parent and teacher SDQ reports, in a community sample of preschool-aged children in Sweden.Methods: Data were obtained from the Children and Parents in Focus trial. The sample comprised 4,46 children 3-5-years-old. Mothers, fathers and preschool teachers completed the SDQ as part of the routine health check-ups at Child Health Centres. Inter-rater agreement was measured using Pearson correlation coefficient and intraclass correlation (ICC).Results: Results revealed poor/fair agreement between parent and teacher ratings (ICC 0.25-0.54) and good/excellent agreement between mother and father ratings (ICC 0.66-0.76). The highest level of agreement between parents and teachers was found for the hyperactivity and peer problem subscales, whereas the strongest agreement between parents was found for the hyperactivity and conduct subscales.Conclusions: Low inter-rater agreement between parent and teacher ratings suggests that information from both teachers and parents is important when using the SDQ as a method to identify mental health problems in preschool children. Although mothers and fathers each provide unique information about their child's behaviour, good inter-parent agreement indicates that a single parent informant may be sufficient and simplify data collection.
43.	Fält, Elisabet, et al. (författare) Facilitating implementation of an evidence-based method to assess the mental health of 3–5-year-old children at Child Health Clinics: a mixed-methods process evaluation 2020 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; :6 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Background: A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. Methods: The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. Results: Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. Conclusion: The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.
44.	Fält, Elisabet, et al. (författare) Inter-rater agreement between parent and teacher SDQ ratings in Swedish 3-5-year-olds 2017 Ingår i: European Journal of Public Health. - 1101-1262 .- 1464-360X. ; 27 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
45.	Fängström, Karin, et al. (författare) “And they gave me a shot, it really hurt” – Evaluative content in investigative interviews with young children 2017 Ingår i: Children and youth services review. - : Elsevier. - 0190-7409 .- 1873-7765. ; 82, s. 434-443 Tidskriftsartikel (refereegranskat)abstract Research is scarce on the suitability of the evidence-based components of child investigative interviews when used in non-forensic contexts such as social work or school, particularly in relation to children’s reports on emotional content.This explorative study investigated to what extent a structured forensic interview protocol aids children in verbalizing negative emotional experiences of distress or discomfort. To do this we assessed and compared children’s displayed distress or discomfort during a video-recorded health visit with the verbalized distress or discomfort in interviews 2-4 weeks later about this visit. The children, aged 4 and 5 years (N = 26), were interviewed with a forensic interview protocol. Children’s statements regarding distress and discomfort and the interviewer questions preceding these statements were analyzed qualitatively.The results showed that 46% of the 4-year-olds and 39 % of the 5-year-olds displayed discomfort or distress during their health visit. In the interviews, open-ended questions were posed to all children, however, these questions were sufficient to aid only some children (n = 6) to share evaluative content. None of the children who displayed distress or discomfort during the visit verbalized such experiences after an invitation only. Most children who described experiences of distress or discomfort did so in relation to evaluative questions.The results suggest that more research is warranted to investigate exactly how and when evaluative questions should be posed and whether this differs depending on severity of experience or the child’s age. The need for protocol development and its suitability when used in other fields of practice is discussed.
46.	Fängström, Karin, et al. (författare) Is the Strengths and Difficulties Questionnaire with a Trauma Supplement a Valuable Tool in Screening Refugee Children for Mental Health Problems? 2019 Ingår i: The Journal of Refugee Studies. - : Oxford University Press (OUP). - 0951-6328 .- 1471-6925. ; 32:Special issue 1, s. 122-140 Tidskriftsartikel (refereegranskat)abstract The high number of asylum seekers in Sweden has highlighted the need to develop and evaluate structured assessment tools for children. In this study, we aimed to explore the utility of the Strengths and Difficulties Questionnaire (SDQ) with a trauma supplement of six items for preschool children in routine care. Parents of two- to six-year-olds (N = 61) were asked to complete the questionnaire during the routine health check-up offered to all refugees upon their arrival to Sweden. Focus-group interviews were conducted with the nurses who used the SDQ. The nurses found the SDQ valuable once they established a routine and felt that the SDQ contributed to a more structured and informative conversation about the child’s mental health. The SDQ total difficulties showed good internal consistency (alpha = 0.82). A significant proportion of children scored above the clinical cut-off and SDQ scores correlated significantly with the number of post-traumatic stress disorder symptoms measured using the supplement (rho = 0.29). The findings suggest that the SDQ with the trauma supplement is a useful tool in this clinical setting.
47.	Fängström, Karin, et al. (författare) The computer-assisted interview In My Shoes can benefit shy preschool children's communication 2017 Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:8 Tidskriftsartikel (refereegranskat)abstract Interviewing children is a cognitively, socially, and emotionally challenging situation, especially for young and shy children. Thus, finding methods that aid rapport and increase these children's communication is important. The present study investigated whether children's verbal and non-verbal communicative behavior developed differently during the rapport phase, depending on whether children were situationally shy or not, and whether the interview was conducted using the computer-assisted interview In My Shoes (IMS) or a Standard verbal interview. The sample consisted of 60 children aged 4 to 5-years-old. The results showed that for the shy children in the IMS group their talkativeness increased and their answer latency decreased including the amount of encouragement the child needed to talk, while no changes were observed for the shy children in the Standard verbal interview group. There were no significant differences in the non-verbal behavior for the shy children regardless of the interview method used. For the non-shy children, overall, the interview method did not affect either the verbal or the non-verbal outcomes. Our findings indicate that IMS can be a useful tool during the rapport-building phase with shy children as it helps these children to improve their verbal communication.
48.	Gavra, P., et al. (författare) Qualitative evaluation of a group intervention for unaccompanied refugee minors with PTSD symptoms 2017 Ingår i: European Journal of Public Health. - 1101-1262 .- 1464-360X. ; 27 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
49.	Gulenc, Alisha, et al. (författare) Paternal psychological distress, parenting, and child behaviour : A population based, cross-sectional study. 2018 Ingår i: Child Care Health and Development. - : Wiley. - 0305-1862 .- 1365-2214. ; 44:6, s. 892-900 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Child behaviour problems are common and can lead to later mental health problems. Poor maternal mental health and adverse parenting practices are known risk factors for child behaviour problems. Less is known about the association between paternal mental health and parenting, and child behaviour. We aimed to explore the association between paternal psychological distress and parenting (harsh discipline, low warmth, unreasonable expectations, and overinvolved/protectiveness) with children's internalising and externalising behaviour at 3 years of age.METHODS: Cross-sectional surveys of 669 (80% response) fathers of 3-year-old children, nested within a randomised controlled trial. Main outcomes of behaviour (Child Behavior Checklist), parenting (Parent Behavior Checklist and overinvolved/protective parenting scale), and psychological distress (Kessler-6) were measured. Regression modelling examined the associations between paternal factors and child behaviour, adjusting for maternal mental health and parenting, as well as child and family variables.RESULTS: In adjusted analyses, paternal psychological distress (b = 0.43, 95% confidence interval [CI] [0.26-0.60], p < 0.001), harsh discipline (b = 0.20, 95% CI [0.13-0.27], p < 0.001), and maternal mental health (b = 0.08, 95% CI [0.03-0.12], p = 0.001) were associated with externalising symptoms. However, only paternal psychological distress, harsh discipline, and being a boy were associated with borderline/clinical levels of externalising problems (all p < 0.05). Paternal psychological distress, harsh discipline, overinvolved parenting, maternal mental health, and difficult child temperament were associated with internalising symptoms (all p < 0.05). However, only paternal harsh discipline and overinvolved parenting were associated with borderline/clinical internalising problems.CONCLUSIONS: Paternal mental health and parenting are independently associated with child behaviour. Treatments for children with behavioural problems should also address paternal mental health and parenting.
50.	Heltne, Unni Marie, et al. (författare) Training non-specialists in teaching recovery techniques (TRT) to help traumatised children in humanitarian settings : a qualitative analysis of experiences gained from 20 years of practice 2023 Ingår i: International Journal for Equity in Health. - : Springer Nature. - 1475-9276. ; 22:1 Tidskriftsartikel (refereegranskat)abstract Background: Although several manuals and guidelines have been developed to enhance the quality of task-sharing interventions, it remains challenging to train non-professional personnel in mental health and psychosocial support. Practitioners must translate general recommendations into practical applications to make them relevant in demanding contexts. However, limited research exists on practical experiences with standardised programmes in the field.Aim: To explore how experiences gained from the training of first-line health providers in a low-threshold intervention for children with trauma symptoms may guide implementation of such interventions in local communities in low-income countries.Method: We summarise 20 years of experience in the training of first-line health providers, teachers, and school counsellors in providing a low-threshold intervention. The intervention is called teaching recovery techniques (TRT), developed by the Children and War Foundation (CAW). Field notes containing notes from trainings and oral, informal feedback from participants are analysed using thematic analysis, a method well-suited for identifying, analysing, and reporting patterns, or themes, within data in qualitative research.Findings: The analysis showed three main themes/ challenges: (1) Who can conduct the TRT intervention? (2) What form and content should the training take? (3) How can the intervention be used in a responsible way to follow the 'do no harm' principle? We discuss the implications of the findings for trainings in scalable interventions and further research.

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