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Garke, M. Å., Hentati Isacsson, N., Kolbeinsson, Ö., Hesser, H. & Månsson, K. N. T. (2025). Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions. Cognitive Behaviour Therapy, 54(1), 78-95
Open this publication in new window or tab >>Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions
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2025 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 54, no 1, p. 78-95Article in journal (Refereed) Published
Abstract [en]

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

Place, publisher, year, edition, pages
Routledge, 2025
Keywords
Emotion regulation, cognitive behavior therapy, social anxiety disorder, therapeutic processes
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-114763 (URN)10.1080/16506073.2024.2373784 (DOI)001269817600001 ()38985458 (PubMedID)2-s2.0-85198059988 (Scopus ID)
Funder
Swedish Research Council, 2018-06729Karolinska Institute
Available from: 2024-07-11 Created: 2024-07-11 Last updated: 2025-01-21Bibliographically approved
Karlsson-Good, M., Kraepelien, M., Holländare, F., Hesser, H., Kaldo, V. & Forsell, E. (2024). A Transdiagnostic Tailored Digital Self-Help Intervention for Anxiety and Low Mood. In: : . Paper presented at The 13th Swedish Congress on Internet Interventions, Stockholm University, Stockholm, 20-21 May, 2024..
Open this publication in new window or tab >>A Transdiagnostic Tailored Digital Self-Help Intervention for Anxiety and Low Mood
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2024 (English)Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

INTRODUCTION: Therapist-guided internet interventions have increased access to care for a range of psychiatric and somatic conditions during the last decades. However, there is still a need for more easily accessible self-care interventions to improve treatment dissemination further. Brief digital self-care interventions, i.e. self-help interventions without therapist-guidance that are given together with a clinical assessment interview, reduce both patient burden and clinical resources.

METHODS: A new individually tailored self-care intervention for anxiety and low mood has been developed and will be tested in a pilot study. The study is a single-blind randomized controlled trial with parallel arms design. Participants are randomized to one of two groups: with or without weekly support from a therapist during the intervention. The intervention is eight weeks long and consists of less text and less number of exercises compared to the more comprehensive therapist-guided internet interventions used in Swedish routine care. A telephone interview evaluating the intervention will take place at the end of the eight weeks. The goal is to recruit 160 participants.

RESULTS AND CONCLUSIONS: The design of the self-care intervention and preliminary efficacy data from the trial will be presented. Data on participant characteristics, adherence and choice of tailored problem area will also be shown. If successful, self-care interventions can further increase accessibility to care for people suffering with low mood and anxiety. Future studies aim to adapt the level of support by a clinician based on participant response to the self-care intervention, i.e. offering more support to participants that have a predicted negative outcome of the intervention.

National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-118958 (URN)
Conference
The 13th Swedish Congress on Internet Interventions, Stockholm University, Stockholm, 20-21 May, 2024.
Available from: 2025-01-30 Created: 2025-01-30 Last updated: 2025-02-06Bibliographically approved
Lind, A., Cao, Y., Hesser, H., Hårdstedt, M., Jansson, S. P. O., Lernmark, Å., . . . Jendle, J. (2024). Anxiety, depression and quality of life in relation to SARS-CoV-2 antibodies in individuals living with diabetes during the second wave of COVID-19. Diabetes epidemiology and management, 13, Article ID 100194.
Open this publication in new window or tab >>Anxiety, depression and quality of life in relation to SARS-CoV-2 antibodies in individuals living with diabetes during the second wave of COVID-19
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2024 (English)In: Diabetes epidemiology and management, ISSN 2666-9706, Vol. 13, article id 100194Article in journal (Refereed) Published
Abstract [en]

Aims: The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic.

Methods: Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays.

Results: Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS-CoV-2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS-CoV-2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %).

Conclusions: A higher SARS-CoV-2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Diabetes, SARS-CoV-2, COVID-19, Anxiety, Depression, Quality of life, Virus antibodies
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-111559 (URN)10.1016/j.deman.2023.100194 (DOI)001154927400001 ()38463606 (PubMedID)2-s2.0-85182889973 (Scopus ID)
Funder
Swedish Foundation for Strategic Research, IRC15-0067
Note

This work was supported by NIH SBIR 2R44DK110005-02, Strategic Research Area Exodiab Dnr 2009-1039, and the Swedish Foundation for Strategic Research Dnr IRC15-0067.

Available from: 2024-02-14 Created: 2024-02-14 Last updated: 2024-03-19Bibliographically approved
Fors, M., Öberg, B., Enthoven, P., Schröder, K., Hesser, H., Hedevik, H. & Abbott, A. (2024). Are illness perceptions and patient self-care enablement mediators of treatment effect in best practice physiotherapy low back pain care? Secondary mediation analyses in the BetterBack trial. Physiotherapy Theory and Practice, 40(8), 1737-1750
Open this publication in new window or tab >>Are illness perceptions and patient self-care enablement mediators of treatment effect in best practice physiotherapy low back pain care? Secondary mediation analyses in the BetterBack trial
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2024 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 40, no 8, p. 1737-1750Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: A best practice physiotherapy model of care (BetterBack MoC) for low back pain (LBP) aimed to improve patients' illness perceptions and self-care enablement, according to the Common-Sense Model of Self-Regulation (CSM).

OBJECTIVE: To confirm if illness perceptions and patient self-care enablement, in line with the CSM, are mediators of treatment effects on disability and pain of the BetterBack MoC for patients with LBP compared to routine primary care. A secondary aim was to explore if illness perceptions and patient self-care enablement are mediators of guideline adherent care.

METHODS: Pre-planned single mediation analyses tested whether hypothesized mediators at 3 months mediated the treatment effect of the MoC (n = 264) compared to routine care (n = 203) on disability and pain at 6 months. Secondary mediation analyses compared guideline adherent care with non-adherent care.

RESULTS: No indirect effects were identified. The BetterBack intervention did not have superior effects over routine care on the hypothesized mediators. Illness perceptions and self-care enablement were significantly associated with disability and pain at 6 months. Secondary analyses showed significant indirect effects of guideline adherent care through tested mediators.

CONCLUSION: Despite no indirect effects, patients' illness perceptions and self-care enablement were associated with disability and back pain intensity outcomes and are potentially relevant treatment targets.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Physiotherapy, illness perception, low back pain, mediation analysis, self-management
National Category
Physiotherapy
Identifiers
urn:nbn:se:oru:diva-105988 (URN)10.1080/09593985.2023.2210676 (DOI)000992675300001 ()37204261 (PubMedID)2-s2.0-85159687254 (Scopus ID)
Funder
Region Östergötland, RO-938179 RO-921021
Note

Funding agency:

Research Council in Southeast Sweden FORSSx?660371 FORSS?x?757721 FORSS?x?931966

Available from: 2023-05-22 Created: 2023-05-22 Last updated: 2025-01-21Bibliographically approved
Gentili, C., Rickardsson, J., Holmström, L., Wicksell, R. K., Hesser, H. & Zetterqvist, V. (2024). Exploring psychological flexibility as in-treatment behaviour during internet-delivered acceptance and commitment therapy for paediatric chronic pain: Occurrence and relation to outcome. Journal of Contextual Behavioral Science, 31, Article ID 100725.
Open this publication in new window or tab >>Exploring psychological flexibility as in-treatment behaviour during internet-delivered acceptance and commitment therapy for paediatric chronic pain: Occurrence and relation to outcome
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2024 (English)In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 31, article id 100725Article in journal (Refereed) Published
Abstract [en]

Acceptance and Commitment Therapy has gained preliminary evidence for paediatric chronic pain. Several studies show that psychological flexibility/inflexibility is a process driving treatment change in ACT for chronic pain. The literature supporting psychological flexibility as a change process in ACT is typically based on selfreport. The aim of the present study was to investigate psychological flexibility (i.e. acceptance, defusion, values formulation and committed action) as in-treatment behaviour during internet-delivered Acceptance and Commitment Therapy for paediatric chronic pain, by having two independent observers rating patient written statements. The sample was self-recruited and consisted of 28 girls between ages 13 and 17 years. Results showed that psychological flexibility could be operationalised as in-treatment behaviours and reliably assessed using observer ratings. Also, data illustrated a within subject variability in ratings of acceptance and defusion, with a considerable difference in degree of acceptance or defusion evoked by different experiential exercises. Furthermore, analyses showed that a higher average degree of acceptance in patient statements during the early phase of treatment was related to larger treatment effects. Defusion, values formulation and committed action showed no significant influence on outcome. Results should be interpreted with caution due to the small sample size.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
In-treatment behavior, Chronic pain, Psychological flexibility, Adolescent
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-112311 (URN)10.1016/j.jcbs.2024.100725 (DOI)001170455500001 ()2-s2.0-85183019780 (Scopus ID)
Note

Funding agency:

Clas Groschinsky Foundation

Available from: 2024-03-15 Created: 2024-03-15 Last updated: 2024-03-15Bibliographically approved
Molander, P., Novo, M., Ringqvist, Å., Hållstam, A., Hesser, H., Löfgren, M., . . . Gerdle, B. (2024). Interdisciplinary pain rehabilitation for patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders. Journal of Rehabilitation Medicine, 56, Article ID jrm12431.
Open this publication in new window or tab >>Interdisciplinary pain rehabilitation for patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders
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2024 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 56, article id jrm12431Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Chronic pain is a common manifestation of Ehlers-Danlos syndrome and hypermobility spectrum disorders; thus it is often suggested that patients undergo generic interdisciplinary pain rehabilitation, despite there being little evidence to support this decision. The aim of this study is to examine the effectiveness of standard rehabilitation programmes for chronic pain on patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders, compared with patients with other chronic pain disorders.

SUBJECTS: Data, collected between 2008 and 2016, were extracted from a Swedish national registry. The patient data comprised of 406 cases with Ehlers-Danlos syndrome or hypermobility spectrum disorders, 784 cases with a whiplash-related diagnosis, 3713 cases with diagnoses relating to spinal pain, and 2880 cases of fibromyalgia.

METHODS: The differences between groups on key outcome measures from pre- to 1-year follow-up after interdisciplinary pain rehabilitation were analysed using linear mixed effects models. Sensitivity analysis in the form of pattern-mixture modelling was conducted to discern the impact of missing data. RESULTS: No significant differences were found in improvements from pre- to 1-year follow-up for patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder compared with other diagnostic groups regarding measures of health-related quality of life, mental health, or fatigue. At follow-up, differences in pain interference (d = -0.34 (95% confidence interval [95% CI] -0.5 to -0.18)), average pain (d = 0.22 (95% CI 0.11-0.62)) and physical functioning (d = 2.19 (95% CI 1.61-2.77)) were detected for the group with spinal-related diagnoses in relation to those with EDS/HSD, largely due to pre-treatment group differences. Sensitivity analysis found little evidence for missing data influencing the results.

CONCLUSION: This study suggests that patients with Ehlers-Danlos syndrome/hypermobility spectrum disorders may benefit from inclusion in an interdisciplinary pain rehabilitation programme.

Place, publisher, year, edition, pages
Foundation for Rehabilitation Information, 2024
Keywords
chronic pain, rehabilitation, Ehlers-Danlos syndrome
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-111471 (URN)10.2340/jrm.v56.12431 (DOI)001166964300001 ()38323531 (PubMedID)2-s2.0-85186941238 (Scopus ID)
Funder
Region Östergötland, RO-926131
Available from: 2024-02-08 Created: 2024-02-08 Last updated: 2024-03-15Bibliographically approved
Wallen, H., Ljótsson, B., Lindfors, P., Forsell, E., Hesser, H. & Svanborg, C. (2024). Internet delivered exposure based cognitive behavior therapy for IBS - A clinical effectiveness study. American Journal of Gastroenterology
Open this publication in new window or tab >>Internet delivered exposure based cognitive behavior therapy for IBS - A clinical effectiveness study
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2024 (English)In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: IBS is a common and debilitating disorder. When dietary and pharmacological interventions are not satisfactory, psychological treatment may produce good results. But the access to such treatment is scarce and therefore it is of importance to make use of technical solutions. In the present study we wanted to investigate the real-world effectiveness of an internet-delivered exposure based cognitive behavioral treatment (ECBT) for IBS and to replicate an earlier finding regarding the working mechanism of the treatment.

METHODS: 309 consecutively recruited patients from the Internet Psychiatry Clinic in Stockholm received ECBT for 12 weeks. The patients' IBS symptoms, quality of life, avoidance behaviors and gastro-intestinal symptom-specific anxiety (GSA) were monitored and we used a bivariate cross-lagged panel model to investigate time-related change in symptoms and avoidance behaviors.

RESULTS: IBS symptoms, measured with The Gastrointestinal Symptom Rating Scale for IBS (GSRS-IBS) were reduced from 48.06 (SD = 11.26) pre-treatment to 33.06 (SD=10.81) 6 month after treatment (p<.001). The effect size was (Cohens d) 1.30 [1.08-1.51]. There was a significant (p<.001) cross-lagged effect from reduction in avoidance behavior to reduction in symptoms but not in the reversed direction, indicating that the treatment effect is mediated by behavioral change.

CONCLUSIONS: We conclude that ECBT is effective under real world conditions, also when delivered via the internet, and that an important treatment mechanism is the reduction of avoidance behaviors.

Place, publisher, year, edition, pages
Blackwell Publishing, 2024
National Category
Gastroenterology and Hepatology Applied Psychology
Identifiers
urn:nbn:se:oru:diva-115684 (URN)10.14309/ajg.0000000000003059 (DOI)39194012 (PubMedID)2-s2.0-85202765927 (Scopus ID)
Available from: 2024-08-29 Created: 2024-08-29 Last updated: 2025-01-20Bibliographically approved
Ojala, O., Hesser, H., Gratz, K. L., Tull, M. T., Hedman-Lagerlöf, E., Sahlin, H., . . . Bjureberg, J. (2024). Moderators and predictors of treatment outcome following adjunctive internet-delivered emotion regulation therapy relative to treatment as usual alone for adolescents with nonsuicidal self-injury disorder: Randomized controlled trial. JCPP Advances, 4(3), Article ID e12243.
Open this publication in new window or tab >>Moderators and predictors of treatment outcome following adjunctive internet-delivered emotion regulation therapy relative to treatment as usual alone for adolescents with nonsuicidal self-injury disorder: Randomized controlled trial
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2024 (English)In: JCPP Advances, E-ISSN 2692-9384, Vol. 4, no 3, article id e12243Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite the wide-ranging negative consequences of nonsuicidal self-injury (NSSI), there are few evidence-based treatments for NSSI among adolescents and little is known about what treatments that work best for whom. The objective of this study was to investigate moderators (i.e., for whom a specific treatment works) and predictors (i.e., factors associated with treatment outcome independent of treatment type) of treatment outcome in a randomized clinical trial comparing internet-delivered emotion regulation individual therapy for adolescents (IERITA) plus treatment as usual (TAU) to TAU alone.

METHODS: Adolescents (N = 166; mean [SD] age = 15.0 [1.2] years) with NSSI disorder were randomized to IERITA plus TAU (n = 84) or TAU-only (n = 82). Adolescent emotion regulation difficulties, suicidality, NSSI frequency, depressive symptoms, sleep difficulties, global functioning, and age, and parental invalidation, were measured pre-treatment and investigated as moderators and predictors of treatment outcome (i.e., NSSI frequency during treatment and for 4 weeks post-treatment). A zero-inflated negative binomial generalized linear mixed effects regression model was used to estimate the rate of NSSI change as a function of both treatment condition and moderator/predictor.

RESULTS: No significant moderators of treatment outcome were found. Parental invalidation was a significant predictor of treatment outcome regardless of treatment condition, such that high levels of parental invalidation pre-treatment were associated with a less favorable NSSI frequency.

CONCLUSIONS: We did not find evidence of a differential treatment effect as a function of any of the examined client factors. Future research should investigate moderation in larger samples and with sufficient statistical power to detect moderation effects of smaller magnitude. Results suggest that parental invalidation may have a negative impact on treatment response and highlight the importance of further investigating parental invalidation in the context of NSSI treatments.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Emotion regulation, internet‐delivered therapy, moderator, nonsuicidal self‐injury, self‐injurious behaviors
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-116875 (URN)10.1002/jcv2.12243 (DOI)001336635900010 ()39411472 (PubMedID)
Funder
Swedish Research Council, 2017–01506Marcus and Amalia Wallenberg Foundation, MAW 2014.0021Fredrik och Ingrid Thurings StiftelseClas Groschinski Memorial Foundation, SF18121Sven Jerring FoundationKempe-Carlgrenska FoundationStiftelsen Professor Bror Gadelius MinnesfondKnut and Alice Wallenberg Foundation, KAW 2018.0426The Royal Swedish Academy of Letters, History and Antiquities (KVHAA)
Note

Funding: This study was supported by the National Self Injury Project in Sweden, grant 2014–1008 and grant 2017–01506 from the Swedish Research Council, grant MAW 2014.0021 from the Markus and Amelia Wallenberg Foundation, Fredrik och Ingrid Thurings Foundation, grant SF18121 from the L. J., Clas Groschinskys Foundation, the Sven Jerring Foundation, the Kempe-Carlgrenska Foundation, and Bror Gadelius Foundation. Johan Bjureberg was supported by grant KAW 2018.0426 from the Knut och Alice Wallenberg's Foundation, The Royal Swedish Academy of Letters, History and Antiquities and Stiftelsen Natur & Kultur.

Available from: 2024-10-18 Created: 2024-10-18 Last updated: 2024-11-01Bibliographically approved
Frick, M. A., Hesser, H. & Sonuga-Barke, E. (2024). Pervasive versus situational childhood ADHD: latent classes and their clinical characteristics, based on parent and teacher ratings in a large longitudinal population sample. European Child and Adolescent Psychiatry, 33(7), 2253-2256
Open this publication in new window or tab >>Pervasive versus situational childhood ADHD: latent classes and their clinical characteristics, based on parent and teacher ratings in a large longitudinal population sample
2024 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 33, no 7, p. 2253-2256Article in journal (Refereed) Published
Abstract [en]

Attention-deficit/hyperactivity disorder (ADHD) diagnoses require symptoms to be present in two settings. Low levels of concordance between symptoms rated at home and school raise questions regarding this approach. The aim was to examine whether there are sub-groups with context-specific expressions of ADHD symptoms (i.e., at home or school only) with clinically significant problems sufficient to support a new diagnostic formulation. We applied latent class transition analysis to parent and teacher data (N = 10,476) from the Avon Longitudinal Study of Parents and Children (ALSPAC), collected at ages 8, 10, and 20 years. We examined the short-term stability of emergent classes and their childhood and adult-associated risk profiles. In addition to an Unaffected class (~ 45%), there was a Pervasive Combined class with elevated inattentive and hyperactive/impulsive symptoms at both home and school (~ 11%) and three classes with situational expressions; School Combined (~ 9%), Home Combined (~ 18%), and School Inattentive (~ 16%). Stability ranged from 0.27 to 0.78. The Pervasive Combined class was most symptomatic and impaired. School inattentive also displayed clinical symptom levels, whereas the School and Home Combined classes displayed subclinical levels. Different profiles regarding sex, cognition, conduct problems, and substance use emerged for the three situational classes. Distinct groupings of pervasive and situational ADHD expressions are identifiable in the general population. The isolation of a stable and burdensome Pervasive Combined class lends support to the current diagnostic approach. However, there are indications of situational expressions of ADHD with clinical symptom levels and associated difficulties.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
ALSPAC, Latent class analysis, Longitudinal, Pervasive and situational ADHD
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109012 (URN)10.1007/s00787-023-02308-3 (DOI)001084812900001 ()37845375 (PubMedID)2-s2.0-85174207073 (Scopus ID)
Available from: 2023-10-17 Created: 2023-10-17 Last updated: 2024-07-31Bibliographically approved
Zhao, X., Dannenberg, K., Repsilber, D., Gerdle, B., Molander, P. & Hesser, H. (2024). Prognostic subgroups of chronic pain patients using latent variable mixture modeling within a supervised machine learning framework. Scientific Reports, 14(1), Article ID 12543.
Open this publication in new window or tab >>Prognostic subgroups of chronic pain patients using latent variable mixture modeling within a supervised machine learning framework
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2024 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 12543Article in journal (Refereed) Published
Abstract [en]

The present study combined a supervised machine learning framework with an unsupervised method, finite mixture modeling, to identify prognostically meaningful subgroups of diverse chronic pain patients undergoing interdisciplinary treatment. Questionnaire data collected at pre-treatment and 1-year follow up from 11,995 patients from the Swedish Quality Registry for Pain Rehabilitation were used. Indicators measuring pain characteristics, psychological aspects, and social functioning and general health status were used to form subgroups, and pain interference at follow-up was used for the selection and the performance evaluation of models. A nested cross-validation procedure was used for determining the number of classes (inner cross-validation) and the prediction accuracy of the selected model among unseen cases (outer cross-validation). A four-class solution was identified as the optimal model. Identified subgroups were separable on indicators, predictive of long-term outcomes, and related to background characteristics. Results are discussed in relation to previous clustering attempts of patients with diverse chronic pain conditions. Our analytical approach, as the first to combine mixture modeling with supervised, targeted learning, provides a promising framework that can be further extended and optimized for improving accurate prognosis in pain treatment and identifying clinically meaningful subgroups among chronic pain patients.

Place, publisher, year, edition, pages
Nature Publishing Group, 2024
Keywords
Latent variable mixture modeling, Machine learning, Pain classification, Pain prognosis
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-114005 (URN)10.1038/s41598-024-62542-w (DOI)001236740000064 ()38822075 (PubMedID)2-s2.0-85194992854 (Scopus ID)
Funder
Region Örebro CountyAFA Insurance, 190054
Available from: 2024-06-03 Created: 2024-06-03 Last updated: 2024-08-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9736-8228

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