| 1. |
- Alfonsson, Sven, et al.
(författare)
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Group Behavioral activation for patients with severe obesity and Binge eating disorder : A randomized controlled trial
- 2015
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Ingår i: Behavior modification. - : SAGE Publications. - 0145-4455 .- 1552-4167. ; 39:2, s. 270-294
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to assess whether behavioral activation (BA) is an efficacious treatment for decreasing eating disorder symptoms in patients with obesity and binge eating disorder (BED). Ninety-six patients with severe obesity and BED were randomized to either 10 sessions of group BA or wait-list control. The study was conducted at an obesity clinic in a regular hospital setting. The treatment improved some aspects of disordered eating and had a positive effect on depressive symptoms but there was no significant difference between the groups regarding binge eating and most other symptoms. Improved mood but lack of effect on binge eating suggests that dysfunctional eating (including BED) is maintained by other mechanisms than low activation and negative mood. However, future studies need to investigate whether effects of BA on binge eating might emerge later than at post-assessment, as in interpersonal psychotherapy for bulimia nervosa.
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| 2. |
- Bråthén Wijana, Moa, et al.
(författare)
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Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents
- 2018
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families. METHODS: Forty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress. RESULTS: From pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups. CONCLUSIONS: The adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group. TRIAL REGISTRATION: This study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).
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| 3. |
- Dahlberg, Anton, et al.
(författare)
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SDQ in the Hands of Fathers and Preschool Teachers : Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds
- 2019
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Ingår i: Child Psychiatry and Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327. ; 50:1, s. 132-141
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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.
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| 4. |
- Enö Persson, Johanna, et al.
(författare)
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Prevention of Childhood Obesity in Child Health Services : Follow-Up of the PRIMROSE Trial
- 2018
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Ingår i: Childhood Obesity. - : Mary Ann Liebert Inc. - 2153-2168 .- 2153-2176. ; 14:2, s. 99-105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI). Methods: A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect. Results: There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons. Conclusions: A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.
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| 5. |
- Finnes, Anna, et al.
(författare)
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Cost-Effectiveness of Acceptance and Commitment Therapy and a Workplace Intervention for Employees on Sickness Absence due to Mental Disorders.
- 2017
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Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752 .- 1536-5948. ; 59:12, s. 1211-1220
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to evaluate cost-effectiveness of Acceptance and Commitment Therapy (ACT) and workplace dialogue intervention (WDI), both as stand-alone interventions and in combination, compared with treatment as usual (TAU), for employees on sickness absence with mental disorders.METHODS: Employees (n = 352, 78.4% females) on sickness absence were randomized to one of four groups. Cost-utility analyses were conducted from a health care perspective and a limited societal perspective.RESULTS: All groups reported significant improvements in health-related quality-of-life (HRQoL) and there were no significant differences in HRQoL or costs between groups. The probability of cost-effectiveness for ACT+WDI was 50% compared with ACT, indicating that both treatment alternatives could be considered equally favorable for decision-makers. TAU and WDI were rejected due to less economic efficiency.CONCLUSION: Adding WDI to ACT cannot be recommended on the basis of our study results.
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| 6. |
- Finnes, Anna, et al.
(författare)
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Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders : a systematic review and meta-analysis of randomized-controlled trials
- 2019
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 92:3, s. 273-293
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Forskningsöversikt (refereegranskat)abstract
- Purpose: Common mental disorders (CMDs) and musculoskeletal disorders are highly prevalent in the population and cause significant distress and disability, and high costs to society. The main objective of this systematic review and meta-analysis was to examine the outcome and comparative effectiveness of psychological interventions in reducing sickness absence (SA) due to CMDs or musculoskeletal disorders, compared to a waitlist control group, usual care or another clinical intervention.Methods: We reviewed 3515 abstracts of randomized controlled trials published from 1998 to 2017. Of these, 30 studies were included in the analysis.Results: The psychological interventions were overall more effective than treatment as usual in reducing SA (small effect sizes), but not compared to other clinical interventions. Results were similar for studies on CMDs and musculoskeletal pain. A few significant moderating effects were found for treatment-specific variables. However, these were difficult to interpret as they pointed in different directions.Conclusion: There was a small but significant effect of psychological treatments in reducing SA. We identified areas of improvement such as methodological problems among the included studies and failure to specifically address RTW in the interventions that were evaluated. Clinical implications of the findings, and ways of improving methodological rigour of future studies are discussed.
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| 7. |
- Finnes, Anna, et al.
(författare)
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Randomized Controlled Trial of Acceptance and Commitment Therapy and a Workplace Intervention for Sickness Absence Due to Mental Disorders.
- 2019
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Ingår i: Journal of Occupational Health Psychology. - : Educational Publishing Foundation. - 1076-8998 .- 1939-1307. ; 24:1, s. 198-212
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Tidskriftsartikel (refereegranskat)abstract
- Mental disorders contribute to high rates of sickness absence (SA) and impaired work functioning. The aim of the present study was to evaluate the efficacy of 3 interventions targeting SA of workers. Participants (n = 352; 78.4% females) of working age with current employment, and SA due to depression, anxiety disorders, or exhaustion disorder, were recruited to the study and randomized to (a) acceptance and commitment therapy (ACT), (b) a workplace dialogue intervention (WDI), (c) a combination of ACT and WDI, or (d) treatment as usual (TAU). For SA days, there was a significant interaction effect for the follow-up period, in which ACT + WDI generated more SA compared with TAU. When diagnostic group was included as a moderator, participants with exhaustion disorder had less SA days in the WDI group compared with TAU. For symptoms of depression, anxiety, and stress-related ill health, there were significant interaction effects for ACT and ACT + WDI, when compared with TAU, from pre- to postmeasurement (small to moderate between-groups effect sizes). Within-group effect sizes pre- to postmeasurement (Cohen’s d) ranged from .55 to 1.17 (ACT), .40 to .94 (WDI), .26 to 1.13 (ACT + WI), and −.06 to .70 (TAU). There were no differences between groups during follow-up for symptoms.
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| 8. |
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| 9. |
- Ghaderi, Ata, et al.
(författare)
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Skolbaserade program för att förebygga självskadebeteende inklusive suicidförsök : En systematisk litteraturöversikt
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Slutsatser„ Det finns två skolbaserade program som möjligen kan förebygga suicid- försök. Dessa är dock inte testade på ett vetenskapligt sätt i Sverige.Båda de program som har visat effekt är universella, dvs riktas till alla elever i klasserna.– Good Behavior Game (GBG) ges på lågstadiet under ett till två år. GBG är inte utvecklat för att förebygga självskada utan syftar till att förstärka positiva beteenden och attityder mellan skolelever och lärare.– Youth Aware of Mental Health (YAM) ges på högstadiet och består huvudsakligen av fem timmars interaktiva övningar. YAM är utvecklat specifikt för att förebygga suicid.„För övriga program saknas tillräckligt underlag för att dra slutsatser om effekt på suicidförsök.„Studier av program som förebygger andra former av självskade- beteende har enbart undersökt effekter på attityder eller har saknat uppföljningstid.„Det går inte att dra några slutsatser om eventuella negativa effekter av de skolbaserade programmen eftersom det finns få studier på området.
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| 10. |
- Hassler Hallstedt, Martin, 1973-
(författare)
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Closing the Gap : How an Adaptive Behavioral Based Program on a Tablet Can Help Low Performing Children Catch Up in Math: a Randomized Placebo Controlled Study
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early mathematic skills have a substantial impact on later school achievement. Children with poor school achievement are at risk for adverse consequences later in life. Math competencies also have consequences for the economy at large because societies are becoming increasingly dependent on skill sets including mathematics. Proficiency with basic arithmetic, also known as math fact (i.e., 3+8, 12-3), is considered to be a critical early math skill. Intervention research in mathematics have demonstrated that math fact deficits among students with low math performance can be improved with additional targeted, non- technological interventions (i.e., small-group tutoring).The aim of the present thesis was to investigate the effect, using a randomized placebo controlled design, of addititional adaptive, behavioral based, math training on a tablet on low performing second graders. The first study (study I), investigated if arithmetic skills could be assessed in a reliable and valid way on tablet. The examination showed that arithmetic scales could be transferred from paper-based tests to tablet with comparable psychometric properties, although not for a pictorial scale, and that separate norms are needed for tablet. Study II demonstrated that training on a tablet, for on average 19 hours across 20 weeks, improved basic arithmetic skills after training in the math conditions compared to control/ placebo conditions. The effects were medium sized at post assessment. There was a fadeout of effects at 6 months follow-up, where small effects were shown, and the effects decreased further at 12 months follow-up. Children with lower non-verbal IQ seemed to gain significantly more at follow- ups than children with higher non-verbal IQ. The study found no additional effects of combining working memory training and math training. Study III, using a machine learning analysis, found that children demonstrating a positive response at 6 months follow-up were characterized by having completed 90 % or more of the math program at the default level, in combination with having a fairly favorable socioeconomic background.In summation, this work demonstrates how an adaptive behavioral based program on a tablet can help low performing children improve critical early math skills.
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| 11. |
- Hassler Hallstedt, Martin, 1973-, et al.
(författare)
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Short and Long-Term Effects of a Mathematics Tablet Intervention for Low Performing Second Graders
- 2018
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Ingår i: Journal of Educational Psychology. - : American Psychological Association (APA). - 0022-0663 .- 1939-2176. ; 110:8, s. 1127-1148
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Tidskriftsartikel (refereegranskat)abstract
- Using a randomized placebo controlled design, we examined the direct and follow-up effects (at 6 and 12 months) of a mathematics tablet intervention. Math training focused primarily on basic arithmetic (addition and subtraction facts up to 12), and secondarily on number knowledge and word problems. We investigated the moderating effects of IQ and socioeconomic factors, and additive effects of working memory (WM) training. A representative sample of 283 low performing second-grade students were randomly assigned to control (n = 52), reading placebo (n = 78), math intervention (MA; n = 76), or math plus WM training (MA + WM; n = 77). Both math conditions scored significantly higher than control and placebo on the posttest of basic arithmetic, but not on arithmetic transfer and problem solving. WM training did not show additive effects. Given the virtually identical patterns, we collapsed the control and placebo, respectively, MA and MA + WM conditions. The collapsed MA/MA + WM condition demonstrated significant medium-sized effects (d = 0.53-0.67) on basic arithmetic compared with the collapsed control/placebo condition at posttest. There was a fadeout of effects at 6-month follow-up (d = 0.18 -0.28), that declined further at 12 months (d = 0.03-0.13). IQ was a significant moderator of direct and long-term effects on addition up to 12 and subtraction up to 18, where students with lower IQ benefitted more than higher IQ students. Socioeconomic factors did not moderate outcome. The intervention effectively improved basic arithmetic among low performing second graders. Although the effects waned at 6-month follow-up, there was some indication that children with lower IQ demonstrated sustained gains.Educational Impact and Implications StatementThis study shows that adaptive math training on tablet can help low performing 8-year-olds catch up about half a year of schooling in critical math skills. Students with lower IQ benefitted in particular and made long-term gains 12 months after training finished. Additional short-term memory training did not result in further math improvement. Because math is a strong predictor of later school achievement, these findings highlight the potential of well-designed adaptive teaching on tablets to significantly improve students' success at school. Evidence-based programs covering the bulk of elementary math might be widely spread, potentially at a low cost.
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| 12. |
- Hassler Hallstedt, Martin, 1973-, et al.
(författare)
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Tablets instead of paper-based tests for young children? Comparability between paper and tablet versions of the mathematical Heidelberger Rechen Test 1-4
- 2018
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Ingår i: Educational Assessment. - : Informa UK Limited. - 1062-7197 .- 1532-6977. ; 23:3, s. 195-210
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Tidskriftsartikel (refereegranskat)abstract
- Tablets can be used to facilitate systematic testing of academic skills. Yet, when using validated paper tests on tablet, comparability between the mediums must be established. Comparability between a tablet and a paper version of a basic math skills test (HRT: Heidelberger Rechen Test 1–4) was investigated. Five samples with second and third grade students participated. The associations between the tablet and paper version of HRT showed that these modes of administration were comparable for three arithmetic scales, but unacceptable for a pictorial counting scale. Scores were lower on tablet. Test-retest reliability for arithmetic scales on tablet was satisfactory, but was inferior for a low-performing sample. The overall convergent validity was satisfactory. No effect of test administrator was found. Arithmetic scales can potentially be transferred to tablet with good comparability and maintained test-retest reliability. Precautions are necessary when transferring pictorial scales into tablet. Separate norms for tablet are needed when interpreting scores.
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| 13. |
- Holmes, Emily A., et al.
(författare)
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'I Can't Concentrate' : A Feasibility Study with Young Refugees in Sweden on Developing Science-Driven Interventions for Intrusive Memories Related to Trauma
- 2017
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Ingår i: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 45:2, s. 97-109
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Tidskriftsartikel (refereegranskat)abstract
- Background: The number of refugees is the highest ever worldwide. Many have experienced trauma in home countries or on their escape which has mental health sequelae. Intrusive memories comprise distressing scenes of trauma which spring to mind unbidden. Development of novel scalable psychological interventions is needed urgently. Aims: We propose that brief cognitive science-driven interventions should be developed which pinpoint a focal symptom alongside a means to monitor it using behavioural techniques. The aim of the current study was to assess the feasibility and acceptability of the methodology required to develop such an intervention. Method: In this study we recruited 22 refugees (16-25 years), predominantly from Syria and residing in Sweden. Participants were asked to monitor the frequency of intrusive memories of trauma using a daily diary; rate intrusions and concentration; and complete a 1-session behavioural intervention involving Tetris game-play via smartphone. Results: Frequency of intrusive memories was high, and associated with high levels of distress and impaired concentration. Levels of engagement with study procedures were highly promising. Conclusions: The current work opens the way for developing novel cognitive behavioural approaches for traumatized refugees that are mechanistically derived, freely available and internationally scalable.
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| 14. |
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| 15. |
- Livheim, Fredrik, et al.
(författare)
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The Effectiveness of Acceptance and Commitment Therapy for Adolescent Mental Health : Swedish and Australian Pilot Outcomes
- 2015
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Ingår i: Journal of Child and Family Studies. - : Springer Science and Business Media LLC. - 1062-1024 .- 1573-2843. ; 24:4, s. 1016-1030
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Tidskriftsartikel (refereegranskat)abstract
- Depression, anxiety and stress are common problems among adolescents. Teaching young people coping strategies in school-based intervention programs is one promising approach hoped to remedy the negative consequences of distress in adolescence. The aim of the two pilot studies was to examine the effect of a brief intervention based on the principles of Acceptance and Commitment Therapy (ACT) on depressive symptomatology (Australian study, N = 66) and stress (Swedish study, N = 32) among adolescents screened for psychosocial problems in school settings. In both studies, subjects were assigned to receive the ACT-group-intervention, or a control intervention featuring individual support from the school health care. The Australian study was a planned comparison, with random allocation for girls, plus one replication of a boys group. The Swedish study used a randomized controlled design. The ACT-intervention was an 8-session manualized group program. The Australian study showed significant reductions in depressive symptoms with a large effect, and significant reductions in psychological inflexibility with a medium effect when compared to the control group who received standard care. In the Swedish study, the ACT-intervention group, when compared to the control group, reported significantly lower levels of stress with a large effect size, and marginally significant decrease of anxiety, and marginally significant increased mindfulness skills. Taken together, the ACT-intervention seems to be a promising intervention for reducing stress and depressive symptoms among young adolescents in school and should be tested in full-sized studies. Limitations of these two pilots include small samples.
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| 16. |
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| 17. |
- Ljungman, Lisa, 1981-, et al.
(författare)
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An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization
- 2018
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Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveA subgroup of parents of children who have been treated for childhood cancer report high levels of psychological distress. To date there is no empirically supported psychological treatment targeting cancer-related psychological distress in this population. The aim of the current study was to test the feasibility and preliminarily evaluate the effect of individualized face-to-face cognitive behavior therapy (CBT) for parents of children after the end of treatment for childhood cancer. A secondary aim was to present a cognitive behavioral conceptualization of cancer-related distress for these parents.MethodsAn open trial was conducted where 15 parents of children who had completed successful treatment for cancer three months to five years earlier and who reported psychological distress related to a child’s previous cancer disease were provided CBT at a maximum of 15 sessions. Participants were assessed at baseline, post-intervention, and three-month follow-up using self-reported psychological distress (including posttraumatic stress symptoms (PTSS), depression, and anxiety) and the diagnostic Mini-International Neuropsychiatric Interview. Feasibility outcomes relating to recruitment, data collection, and delivery of the treatment were also examined. Individual case formulations for each participant guided the intervention and these were aggregated and presented in a conceptualization detailing core symptoms and their suggested maintenance mechanisms.ResultsA total of 93% of the participants completed the treatment and all of them completed the follow-up assessment. From baseline to post-assessment, parents reported significant improvements in PTSS, depression, and anxiety with medium to large effect sizes (Cohen’s d = 0.65–0.92). Results were maintained or improved at a three-month follow-up. At baseline, seven (47%) participants fulfilled the diagnostic criteria for major depressive disorder and four (29%) fulfilled the criteria for posttraumatic stress disorder, compared to none at a post-assessment and a follow-up assessment. The resulting cognitive behavioral conceptualization suggests traumatic stress and depression as the core features of distress, and avoidance and inactivity is suggested as the core maintenance mechanisms.ConclusionThe treatment was feasible and acceptable to the participants. Significant improvements in distress were observed during the study. Overall, results suggest that the psychological treatment for parents of children after end of treatment for childhood cancer used in the current study is promising and should be tested and evaluated in future studies.
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| 18. |
- Ljungman, Lisa, 1981-
(författare)
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Parents of Children with Cancer : Psychological Long-Term Consequences and Development of a Psychological Treatment for Parents of Survivors
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs.Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p<.001), depression (p<.001), and anxiety (p<.01) with medium to large effect sizes (Cohen’s d=0.65-0.92).Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect.
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| 19. |
- Parling, Thomas, 1968-, et al.
(författare)
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A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up
- 2016
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n=24) and TAU (n=19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION: Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.
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| 20. |
- Possmark, Sofie, et al.
(författare)
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To be or not to be active – a matter of attitudes and social support? : Women’s perceptions of physical activity five years after Roux-en-Y Gastric Bypass surgery
- 2019
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric surgery patients, the majority is not sufficiently physically active. The aim was to explore women’s perceptions and experiences concerning PA five years after Roux-en-Y Gastric Bypass (RYGB) surgery.Methods: Eleven women were interviewed five years post-surgery. Grounded Theory approach was applied.Results: The core-category “Attitudes and surrounding environment influence activity levels” includes three attitudes towards PA: “Positive attitudes”, “Shifting attitudes” and “Negative attitudes”. Participants with a positive attitude were regularly physically active, felt supported and proud of their achievements. Contrary, participants with a negative attitude didn’t prioritize PA, didn’t feel supported and saw no need or benefit of PA. Some participants revealed an on-off behaviour, hovering between the attitudes of vigorous PA and sedentary lifestyle, without sustainable balance. The majority mostly viewed PA as a mean to lose weight.Conclusion: The level of perceived post-surgery PA was related to the participants’ attitudes towards PA and whether or not they had a supportive environment. These findings might explain why bariatric surgery patients often fail to be sufficiently active post-surgery, and highlight the need for prolonged support and motivational interventions to promote sustainable PA post-bariatric surgery.
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| 21. |
- Schaumberg, Katherine, et al.
(författare)
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The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders
- 2017
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Ingår i: European eating disorders review. - : WILEY. - 1072-4133 .- 1099-0968. ; 25:6, s. 432-450
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Forskningsöversikt (refereegranskat)abstract
- ObjectiveIn 2015, the Academy for Eating Disorders collaborated with international patient, advocacy, and parent organizations to craft the Nine Truths About Eating Disorders'. This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the Nine Truths'. MethodsThe literature supporting each of the Nine Truths' was reviewed, summarized and richly annotated. ResultsMost of the Nine Truths' arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes and their treatments. ConclusionsThe Nine Truths About Eating Disorders' is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders. Copyright (c) 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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| 22. |
- Sellberg, Fanny, et al.
(författare)
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A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery : study protocol for a randomized controlled trial
- 2018
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Ingår i: BMC Surgery. - : BioMed Central. - 1471-2482. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB.METHODS: The ongoing RCT, the "WELL-GBP"-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients' baseline characteristics are presented in this protocol paper.DISCUSSION: A total of 259 RYGB female patients has been enrolled in the "WELL-GBP"-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.TRIAL REGISTRATION: The trial was registered on February 23th 2015 with registration number ISRCTN16417174.
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| 23. |
- Sellberg, Fanny, et al.
(författare)
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A dissonance-based randomized intervention study to improve quality of life and physical activity 24 months post roux-en-Y gastric bypass surgery
- 2018
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Ingår i: Obesity Surgery. - 0960-8923 .- 1708-0428. ; 28:S2, s. 224-224
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roux-en-Y gastric bypass (RYGB) surgery is usually followed by great weight loss and improved health related quality of life (HRQoL). However, weight regains are seen in some patients approximately 1-2 years post-surgery, associated with a decrease in HRQoL and physical activity (PA).Objectives: To investigate if a dissonance-based group intervention post RYGB surgery has an effect on women’s HRQoL, PA and other health-related behaviors: a protocol paper.Methods: The ongoing RCT is a dissonance-based intervention for female RYGB patients from five Swedish hospitals. Participants are randomized to either control (usual follow-up care) or intervention group (4 sessions, 3 months post-surgery). Main topics of intervention sessions are (1) PA, (2) eating behavior, (3) social and (4) intimate relationships. Participants are asked to wear an accelerometer and complete questionnaires measuring HRQoL (SF-36), social adjustment, eating behavior and body esteem, pre-surgery and 6, 12 and 24 months post-surgery. Planned analysis includes intention to treat and per protocol analysis on differences between intervention and control group. Trial registration number: ISRCTN16417174.Results: We recruited 259 women (156 intervention and 103 controls). Mean BMI was 40.9 ± 4.7, mean SF36 score was 42.1 ± 9.5 (physical component summary score) and 45.8 ± 11.1 (mental component summary score). Mean time spent in moderate to vigorous PA was 28.8 ± 19.4 min/day and sedentary was 458.3 ± 100.4 min/day.Conclusions: This trial aims to improve outcomes after RYGB. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.
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| 24. |
- Sellberg, Fanny, et al.
(författare)
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Change in Children's Self-Concept, Body-Esteem, and Eating Attitudes Before and 4 Years After Maternal RYGB
- 2018
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:10, s. 3276-3283
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The aim of the present study was to look at longitudinal changes in children's self-concept, body-esteem, and eating attitudes before and 4 years after maternal RYGB surgery.METHODS: Sixty-nine women and 81 appurtenant children were recruited from RYGB waiting lists at 5 hospitals in Sweden. Families were visited at home pre-surgery, 9 months, and 4 years post-maternal RYGB to measure BMI. Furthermore, all participating family members completed questionnaires. Mothers' questionnaires measured eating behavior, depression, anxiety, and sleep quality, and children's questionnaires measured body-esteem, self-concept, and eating attitudes.RESULTS: Thirty-five/sixty-nine mothers and 43/81 children participated in all 3 measurements. Mothers reduced their BMI from pre-surgery (39.2) to 9 months (27.0) and 4 years post-surgery (27.4). Children's prevalence of overweight/obesity was lower 9 months post-surgery (48.8%) but at the same levels again 4 years post-surgery (58.1%), compared to pre-surgery (58.1%). The same rebound pattern was seen among children's eating attitudes, mothers' symptoms of depression and anxiety, and sleep quality. We found no correlations between mothers' BMI or eating behavior and children's BMI or eating behavior.CONCLUSION: Children's prevalence of overweight/obesity and eating attitudes improves soon after their mothers' RYGB, but then return to pre-surgery levels at 4 years post-surgery, as do mothers' sleep quality and symptoms of depression and anxiety, even though their weight loss was maintained.
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| 25. |
- Weineland, Sandra, et al.
(författare)
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Effects of Tailored and ACT-Influenced Internet-Based CBT for Eating Disorders and the Relation Between Knowledge Acquisition and Outcome: A Randomized Controlled Trial
- 2017
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Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 48:5, s. 624-637
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. This study utilized a randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted 8 weeks, and was adapted to the participant's individual needs. A clinician provided support. The main outcome measures were eating disorder symptoms and body shape dissatisfaction. Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35–0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r = -0.27 to -r = 0.23). The results provide preliminary support for Internet-based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology.
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| 26. |
- Welch, Elisabeth, et al.
(författare)
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A comparison of clinical characteristics between adolescent males and females with eating disorders
- 2015
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Eating disorders (ED) are serious disorders that have a negative impact on both the psychological and the physiological well-being of the afflicted. Despite the fact that ED affect both genders, males are often underrepresented in research and when included the sample sizes are often too small for separate analyses. Consequently we have an unclear and sometimes contradictory picture of the clinical characteristics of males with ED. The aim of the present study was to improve our understanding of the clinical features of adolescent males with eating disorders. Methods: We compared age at presentation, weight at presentation, history of significantly different premorbid weight and psychiatric (Attention Deficit Hyperactivity Disorder (ADHD)) and somatic comorbidity (celiac disease and diabetes) of 58 males to 606 females seeking medical care for eating disorders at the Children's Hospital in Uppsala, Sweden during the years 1999-2012. As all boys were diagnosed with either AN or Other Specified Feeding or Eating Disorder (OSFED) atypical AN, the age and weight comparisons were limited to those girls fulfilling the diagnostic criteria for AN or OSFED atypical AN. Results: There was no significant difference in age at presentation. Differences in weight at presentation and premorbid weight history were mixed. A significantly higher percentage of males had a history of a BMI greater than two standard deviations above the mean for their corresponding age group. As well, there was a higher prevalence of ADHD among the males whereas celiac disease and diabetes only was found among the females. Conclusions: A better understanding of the clinical characteristics of males with ED at presentation should improve our ability to identify males with ED and thereby aid in tailoring the best treatment alternatives.
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| 27. |
- Willmer, Mikaela, et al.
(författare)
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Changes in BMI and Psychosocial Functioning in Partners of Women Who Undergo Gastric Bypass Surgery for Obesity
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 25:2, s. 319-324
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Tidskriftsartikel (refereegranskat)abstract
- There is very little research exploring the effects of Roux-en-Y gastric bypass surgery (RYGB) on the patient's partner. The aim of the present study was to investigate longitudinally whether male partners of female RYGB patients were affected in terms of BMI, sleep quality, body dissatisfaction, depression, and anxiety. Thirty-seven women, with partners who were willing to participate, were recruited from RYGB waiting lists at five Swedish hospitals. Data collection took place during two home visits, 3 months before and 9 months after RYGB surgery. Anthropometrical data were documented, and both women and men completed the Hospital Anxiety and Depression Scale (HADS) and the Karolinska Sleep Questionnaire (KSQ). The men also completed the Male Body Dissatisfaction Scale (MBDS). The men's BMI changes between the two time points that were analysed using general estimating equation (GEE) regression. Their BMI decreased significantly (beta = -0.9, p = 0.004). The change was more pronounced in the 26 men who had a baseline BMI of a parts per thousand yen25 (beta = -1.4, p < 0.001). Fixed-effects regression showed a statistically significant association between the men's weight loss and that of the women (beta = 0.3, p = 0.004). There were no significant changes in the men's HADS, KSQ, or MBDS scores. Overweight/obese male partners of RYGB patients also lose weight during the first 9 months post-operatively. However, symptoms of body dissatisfaction, anxiety, and depression remain unchanged, as does self-reported sleep quality.
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| 28. |
- Åhlén, Johan, et al.
(författare)
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Development of the Spence Children’s Anxiety Scale - Short Version (SCAS-S)
- 2018
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Ingår i: Journal of Psychopathology and Behavioral Assessment. - : Springer Science and Business Media LLC. - 0882-2689 .- 1573-3505. ; 40:2, s. 288-304
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Tidskriftsartikel (refereegranskat)abstract
- The literature provides several examples of anxiety symptoms questionnaires for children. However, these questionnaires generally contain many items, and might not be ideal for screening in large populations, or repeated testing in clinical settings. The Spence Children’s Anxiety Scale (SCAS) is an extensively used and evaluated 44-item questionnaire developed to assess anxiety symptoms in children, and provides a sound base for the development of an abbreviated anxiety symptoms questionnaire. Although methodological standards have been presented in how to develop abbreviated questionnaires, previous studies have often suffered from several limitations regarding validating procedures. Guided by these methodological standards, the current study aimed at developing an abbreviated version of the SCAS, while retaining the content, convergent, and divergent validity of the original scale. A school-based sample (n = 750) was used to reduce the number of items, and an independent school-based sample (n = 371) together with a clinical sample (n = 93), were used to validate the abbreviated scale. The abbreviated version of the SCAS contained 19 items, it showed a clear factor structure as evaluated in the independent sample, and it performed as good as the original questionnaire regarding classification accuracy, convergent, and divergent validity. In our view, the abbreviated version is a very good alternative to the original scale especially for younger children, in initial screening, or in order to reduce response burden.
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| 29. |
- Åhlén, Johan, et al.
(författare)
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Evaluation of the Children's Depression Inventory-Short Version (CDI-S)
- 2017
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Ingår i: Psychological Assessment. - : American Psychological Association (APA). - 1040-3590 .- 1939-134X. ; 29:9, s. 1157-1166
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Tidskriftsartikel (refereegranskat)abstract
- The Children's Depression Inventory-Short Version (CDI-S), an abbreviated version of the widely used Children's Depression Inventory (CDI), has been regularly used in recent research. In comparison to the original CDI, the CDI-S has not been rigorously evaluated for its psychometrics. The present study examined the dimensionality, convergent and discriminant validity, and gender differences of the CDI-S in a school-based sample of 809 children 8-12 years of age. All children completed the CDI-S. One subsample additionally completed another measure of depression, 1 subsample completed a measure of anxiety, and 1 subsample completed the CDI-S at a second occasion, after 2 weeks. Information regarding parents' education and household income were available for 476 children. We evaluated the dimensionality of the CDI-S in a series of exploratory factor analyses. Despite some evidence of multidimensionality, a bifactor model revealed that the variation of scores was primarily explained by variations of the general factor. Consequently, the CDI-S is most adequately interpreted as a univocal measure. The CDI-S showed high correlation to another measure of depression and a moderately high correlation to a measure of anxiety, with nonoverlapping confidence intervals. We also found that girls reported higher levels of depressive symptoms than did boys, and we found a negative correlation between depressive symptoms and socioeconomic factors for boys only. Future studies should preferably include a broader age range, to acquire a more comprehensive understanding of the validity of the CDI-S.
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| 30. |
- Åhlén, Johan, et al.
(författare)
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Long-term Outcome of a Cluster-Randomized Universal Preventive Intervention targeting Anxiety and Depression in School Children
- 2019
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Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 50:1, s. 203-213
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Tidskriftsartikel (refereegranskat)abstract
- The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8–11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child’s anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.
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| 31. |
- Åhlén, Johan, et al.
(författare)
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Prevention of Anxiety and Depression in Swedish School Children: a Cluster-Randomized Effectiveness Study
- 2018
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Ingår i: Prevention Science. - : Springer. - 1389-4986 .- 1573-6695. ; 19:2, s. 147-158
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Tidskriftsartikel (refereegranskat)abstract
- Our study aimed at evaluating FRIENDS for Life, an intervention to prevent anxiety and depression in Swedish school children. A total of 695 children between the ages of 8 and 11 were recruited from 17 schools in Stockholm, Sweden, and cluster-randomized to either the intervention or control group. Teachers in the intervention group received a full day of training and administered FRIENDS for Life in their classrooms. We assessed the children's anxiety and depressive symptoms, general mental health, and academic performance at pre- and post-intervention as well as at the 12-month follow-up. A multi-informant approach was used with data collected from children, parents, and teachers. Assessment was done with the Spence Children's Anxiety Scale, Children's Depression Inventory, and the Strengths and Difficulties Questionnaire. Children's baseline symptoms, gender, and age as well as their teacher's use of supervision were examined as moderators of effect. Our study found no short- or long-term effects of the intervention for any outcome with regard to the entire sample. We found an enhanced effect of the intervention regarding children with elevated depressive symptoms at baseline. We found a decrease in anxiety symptoms among children whose teachers attended a larger number of supervision sessions, compared to children whose teachers attended fewer supervised sessions or the control group. Mediation analyses showed that this effect was driven by change in the last phase of the intervention, suggesting that supervision might play an important role in enhancing teachers' ability to administer the intervention effectively.
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| 32. |
- Åhlén, Johan, et al.
(författare)
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Universal Prevention for Anxiety and Depressive Symptoms in Children : A Meta-analysis of Randomized and Cluster-Randomized Trials
- 2015
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Ingår i: Journal of Primary Prevention. - : Springer Science and Business Media LLC. - 0278-095X .- 1573-6547. ; 36:6, s. 387-403
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Forskningsöversikt (refereegranskat)abstract
- Although under-diagnosed, anxiety and depression are among the most prevalent psychiatric disorders in children and adolescents, leading to severe impairment, increased risk of future psychiatric problems, and a high economic burden to society. Universal prevention may be a potent way to address these widespread problems. There are several benefits to universal relative to targeted interventions because there is limited knowledge as to how to screen for anxiety and depression in the general population. Earlier meta-analyses of the prevention of depression and anxiety symptoms among children suffer from methodological inadequacies such as combining universal, selective, and indicated interventions in the same analyses, and comparing cluster-randomized trials with randomized trials without any correction for clustering effects. The present meta-analysis attempted to determine the effectiveness of universal interventions to prevent anxiety and depressive symptoms after correcting for clustering effects. A systematic search of randomized studies in PsychINFO, Cochrane Library, and Google Scholar resulted in 30 eligible studies meeting inclusion criteria, namely peer-reviewed, randomized or cluster-randomized trials of universal interventions for anxiety and depressive symptoms in school-aged children. Sixty-three percent of the studies reported outcome data regarding anxiety and 87 % reported outcome data regarding depression. Seventy percent of the studies used randomization at the cluster level. There were small but significant effects regarding anxiety (.13) and depressive (.11) symptoms as measured at immediate posttest. At follow-up, which ranged from 3 to 48 months, effects were significantly larger than zero regarding depressive (.07) but not anxiety (.11) symptoms. There was no significant moderation effect of the following pre-selected variables: the primary aim of the intervention (anxiety or depression), deliverer of the intervention, gender distribution, children's age, and length of the intervention. Despite small effects, we argue for the possible clinical and practical significance of these programs. Future evaluations should carefully investigate the moderators and mediators of program effects to identify active program components.
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| 33. |
- Åhlén, Johan
(författare)
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Universal prevention of anxiety and depression in school children
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anxiety and depression are common in children and adolescents, and involve individual suffering, risk of future psychiatric problems, and high costs to society. However, only a limited number of children experiencing debilitating anxiety and depression are identified and receive professional help. One approach that could possibly reduce the prevalence of these conditions is universal school-based prevention aimed at reducing the impact of risk factors and strengthening protective factors involved in the development of anxiety and depression. The current thesis aimed to contribute to the literature on universal prevention of anxiety and depression in children. Study I involved a meta-analysis of earlier randomized, and cluster-randomized trials of universal prevention of anxiety and depression. Overall, the meta-analysis showed small but significant effects of universal preventive interventions, meaning that lower levels of anxiety and depression were evident after intervention completion and partially evident at follow-up assessments. No variables were found to significantly enhance the effects, however, there was a tendency for larger effects to be associated with mental health professionals delivering the interventions. In Study II, a widely adopted prevention program called Friends for Life was evaluated in a large school-based cluster-randomized effectiveness trial. The results showed no evidence of an intervention effect for the whole sample. However, children with elevated depressive symptoms at baseline and children with teachers who highly participated in supervision, seemed to benefit from the intervention in the short term. Study III involved a 3-year follow-up of Study II and an examination of the effects of sample attrition. The results showed no long-term effects for the whole sample and no maintenance of the short-term subgroup effects observed in Study II. Finally, to increase our understanding of the development of anxiety in children and to assist future improvements of universal prevention, Study IV evaluated different trajectories of overall anxiety together with related patterns of disorder-specific symptoms in a school-based sample over 39 months. Evidence favored a model of three different developmental trajectories across age. One trajectory was characterized by increasing levels of overall anxiety, but fluctuating disorder-specific symptoms arguably related to the normal challenges of children’s developmental level, which warrants an increased focus on age-relevant challenges in universal prevention. The four studies provide further understanding of the overall effectiveness of universal prevention of anxiety and depression in children, the short- and long-term effects of universal prevention in a Swedish context, and ideas for further development of preventive interventions.
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