To Örebro University

Background: Neighborhoods shape daily life through physical and social structures, such as socioeconomic conditions, population density, and resident turnover. Decades of research link neighborhood characteristics to health and behavioral outcomes. However, these factors are often studied independently, neglecting their interrelated nature.

Methods: Using Swedish population registry data, we employed latent class analyses to identify neighborhood typologies across six timepoints spanning 1991-2020. Neighborhoods, defined by Demographic Statistical Areas, were characterized by socioeconomic conditions, ethnic heterogeneity, residential instability, and urbanicity. Latent transition analyses examined changes over time.

Results: Four neighborhood types emerged in the early period (1991-2000): Rural Low-Diversity (45 %), Urban Professional (27 %), Urban Affluent (21 %), and Resource-Limited (7 %). From 2001 onwards, five types were identified, with the addition of Urban High-Diversity (9 %) and Rural Resource-Limited (3 %). Three types, Rural Low-Diversity, Urban Professional, and Urban Affluent, persisted across 30 years, representing 87-93 % of neighborhoods, with over 90 % of neighborhoods retaining their classification over time.

Conclusions: This multidimensional framework offers a foundation for future research, urban planning, and policy development.

BACKGROUND: Non-suicidal self-injury (NSSI) among adolescents is linked to adverse outcomes for youth and their families. While parental involvement is considered essential in treating adolescent NSSI, the effects on parents remain unclear.

OBJECTIVE: To evaluate if Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA) adjunctive to treatment as usual (TAU) is superior to TAU alone in improving parental coping with adolescents' negative emotions, the durability of potential effects and whether reductions in parents' minimising of their adolescent's emotions mediate adolescent outcomes.

METHODS: 166 adolescents with NSSI disorder (93% female; mean (SD) age=15.0 (1.2) years) and their parents (83% female; mean (SD) age=46.5 (5.1) years) were randomised to IERITA plus TAU (n=84) or TAU-only (n=82). IERITA is a 12-week, therapist-guided emotion regulation behavioural therapy, including both adolescents and parents. In parallel to the adolescent, parents participate in a separate internet-delivered course designed to provide skills for understanding and supporting their adolescent. The outcomes were parental coping measured by the Coping with Children's Negative Emotions Scale-Adolescent version, including minimisation (primary outcome), distress, punitive and expressive encouragement responses at baseline, post-treatment (primary endpoint) and 3 months post-treatment. Parental minimisation was tested as a mediator of adolescent NSSI absence and emotion regulation difficulties.

FINDINGS: There were statistically significant treatment effects on parental minimisation and distress responses at post-treatment and 3 months post-treatment, and punitive responses at 3 months post-treatment, favouring IERITA. Parental minimisation did not mediate adolescent NSSI absence or emotion regulation difficulties.

CONCLUSION: IERITA shows promise for supporting parents of youth with NSSI. Further studies are needed to understand how parental improvement may impact youth with NSSI.

CLINICAL IMPLICATIONS: Online family treatment for NSSI can improve how parents handle their adolescents' emotions.

TRIAL REGISTRATION NUMBER: NCT03353961.

Therapist-guided internet-based cognitive behavioural therapy (iCBT) has improved access to treatment for depression and anxiety, but scalability is limited by reliance on trained therapists. This feasibility trial evaluated a tailored digital self-help intervention for adults with depressive and anxiety symptoms, delivered with or without clinician guidance. In total, 124 participants in Sweden with at least mild depressive or anxiety symptoms were recruited through social media and randomized (1:1) to an eight-week program with (n = 63) or without (n = 61) clinician guidance. All participants completed telephone assessments before and after the intervention. The primary aim was to assess feasibility of both versions, while considering outcome advantages of guidance and reduced clinician time with self-help. Feasibility outcomes included adherence, credibility, satisfaction, and adverse events. The intervention was perceived as credible, with high satisfaction and engagement: most participants used the program weekly, and two thirds completed at least three of five modules. Outcomes were similar across groups, though participants with guidance reported higher satisfaction. Clinician time averaged 36 minutes for self-help participants and 66 minutes for those receiving guidance. Both groups showed large symptom reductions (Cohen's d = 1.05-1.10), supporting feasibility and motivating future trials comparing self-help and clinician-guided delivery.

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.

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

METHODS: A total of 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 gastrointestinal symptom-specific anxiety 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, were reduced from 48.06 (SD = 11.26) before treatment to 33.06 (SD = 10.81) 6 months after treatment (P < 0.001). The effect size (calculated by Cohen d) was 1.30 (1.08-1.51). There was a significant (P < 0.001) cross-lagged effect from reduction in avoidance behavior to reduction in symptoms but not in the reverse direction, indicating that the treatment effect is mediated by behavioral change.

DISCUSSION: We conclude that ECBT is effective under real-world conditions, also when delivered through the Internet, and that an important treatment mechanism is the reduction of avoidance behaviors.

Despite documented risks associated with excessive anger inhibition, few treatments specifically target maladaptive anger inhibition. Building on a previously evaluated treatment for general anger, this study evaluated the feasibility, acceptability, and preliminary efficacy of a brief (4-week), therapist-supported online emotion-regulation treatment for maladaptive anger inhibition. In total 38 participants (89.5% female; M-age = 43.8, SD = 14.1) with elevated levels of maladaptive anger inhibition were offered treatment, which was evaluated using a pooled interrupted time series design (ITS). Treatment outcomes included measures of anger inhibition, anger rumination, and anger assertion that were assessed during a baseline phase (4 weeks) and a treatment phase (4 weeks). Feasibility was supported by high retention and adherence, and minor adverse events. Moreover, participants reported high treatment credibility and satisfaction, indicating good acceptability of the treatment. Piecewise growth curve analysis for ITS, comparing baseline and treatment phases, revealed significant and large immediate effects on all outcomes: anger inhibition (d = 1.26), anger rumination (d = 0.80), and anger assertion (d = 0.79), with small additional gains observed at 3-month follow-up. Taken together, the findings suggest that this brief online emotion-regulation treatment for maladaptive anger inhibition is feasible, acceptable, potentially effective, warranting further investigation in an RCT. ClinicalTrials.gov identifier: NCT06697587

IMPORTANCE: Mental health problems are common during adolescence, but access to effective treatments is limited. Transdiagnostic treatments could address this treatment gap, but their feasibility, acceptability, and effectiveness remain unknown.

OBJECTIVE: To test the feasibility and acceptability of an online emotion regulation treatment for adolescents with mental health problems and investigate the preliminary effects on clinical outcomes and the target mechanism, emotion regulation.

DESIGN, SETTING, AND PARTICIPANTS: This single-blind randomized clinical trial was conducted between October 16, 2022, and July 28, 2023, in a primary care setting in Sweden. Participants in the intention-to-treat analysis were adolescents aged 12 to 17 years with mental health problems and their parents.

INTERVENTION: Participants were randomized 1:1 to 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control condition consisting of 6 weeks of online supportive treatment.

MAIN OUTCOMES AND MEASURES: The primary outcomes were feasibility and acceptability measures, including consent rate, completion of assessments, adherence, credibility and expectancy ratings (Credibility/Expectancy Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire), immediately after treatment. Clinical outcomes, rated by blinded assessor, included global symptom severity and improvement, symptoms of depression and anxiety, global functioning, and emotion regulation.

RESULTS: A total of 30 adolescents (mean [SD] age, 14.2 [1.48] years; 28 females [93%]) were randomized to experimental treatment (n = 15) or active control treatment (n = 15). The consent rate (30 of 37 eligible participants [81%]) and rate of assessment completion immediately after treatment (28 [93%]) were high. Adherence, credibility, expectancy, and satisfaction in both groups were adequate. Participation in the experimental condition, but not the control condition, was associated with large within-group reductions in symptom severity (effect size, 1.30; 95% CI, 0.73-1.86) and symptoms of anxiety and depression (Cohen d, 1.07; 95% CI, 0.37-1.84), improved global functioning (Cohen d, 1.26; 95% CI, 0.66-1.85), and reductions in maladaptive cognitive coping (Cohen d, 1.10; 95% CI, 0.52-1.70) immediately after treatment.

CONCLUSION AND RELEVANCE: In this randomized clinical trial, a brief online transdiagnostic emotion regulation treatment targeting adolescents with mental health problems was found to be feasible, acceptable, and potentially efficacious in primary care and may increase treatment outreach and accessibility for this population.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05032547.

INTRODUCTION: Little is known about what pretreatment patient characteristics the outcome of Cognitive Therapy (CT) and Behavioral Therapy (BT) for insomnia disorder depends on. Identifying for whom treatment is most useful is essential for treatment optimization and personalized care. Therefore, this investigation aimed to examine both theory-driven constructs and insomnia-associated clinical variables as potential predictors and moderators of outcomes in CT and BT.

MATERIALS AND METHODS: One hundred forty-five participants diagnosed with insomnia disorder were randomly assigned to 10 weekly internet-delivered modules of CT or BT, along with 15 min of weekly telephone support. General clinical predictors and theory-driven moderators (cognitive and behavioral processes) assessed in a previous randomized controlled trial were analyzed using multiple linear regression, with insomnia severity as the outcome.

RESULTS: Bedtime variability and early morning awakening interacted with treatment and indicated that lower bedtime variability and early morning awakening were associated with a higher effect for CT, whereas the opposite was true for BT. Wake time after sleep onset, insomnia severity index, and sleep efficiency emerged as predictors, indicating prognostic value for treatment outcome.

CONCLUSIONS: In addition to identifying three insomnia-associated variables as predictors of outcome across both treatments, this trial showed that CT and BT could be differentially effective based on patient insomnia heterogeneity at baseline. The differential moderator findings are in line with the theoretical models of CT and BT and might clinically implicate the ability to match therapy to patient features to optimize outcomes.

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.

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.