Parenting under pressure: a cross-sectional questionnaire study of psychological distress, parenting concerns, self-efficacy, and emotion regulation in parents with cancer.

BACKGROUND AND PURPOSE: As many as one in four adults with cancer have children under 18 years. Balancing parenting and cancer is challenging and can be a source of psychological distress. This study aimed to examine psychological distress in parents with cancer and its associations with parenting concerns, self-efficacy, and emotion regulation. MATERIALS AND METHODS: This was a cross-sectional questionnaire study of 406 parents (aged 25-60 years) diagnosed with cancer within the last 5 years, with at least one dependent child (≤ 18 years). Parents completed questionnaires on psychological distress (DASS-21), parenting concerns (PCQ), self-efficacy (GSE), emotion regulation (ERQ), mental and physical health, and sociodemographics. Data were analysed using multiple logistic regressions on depression (yes/no), anxiety (yes/no), and stress (yes/no). RESULTS: Higher parenting concerns were associated with greater odds of depression (OR = 2.33, 95% CI: 1.64-3.31), anxiety (OR = 2.30, 95% CI: 1.64-3.20), and stress (OR = 3.21, 95% CI: 2.20-4.69) when adjusting for health and sociodemographic factors. Poorer self-efficacy was associated with increased odds of anxiety (OR = 0.94, 95% CI: 0.89-0.99, p < 0.05), whereas lower use of cognitive reappraisal and higher use of expressive suppression increased the odds of depression (OR = 0.76, 95% CI: 0.59-0.98 | OR = 1.46, 95% CI: 1.18-1.80). INTERPRETATION: The findings highlight the complexity of parental well-being in relation to parenthood and cancer, stressing the need for interventions that address relevant psychological factors to improve overall mental health in this population.

Psychometric properties of the Swedish version of the Parenting Concerns Questionnaire in parents with cancer.

BACKGROUND AND PURPOSE: Parenting concerns can be a major source of distress for patients with cancer who are parents of dependent children; however, these are often not addressed in health care. The Parenting Concerns Questionnaire (PCQ) is an instrument designed to assess parents' worries about the impact of cancer on their children and their ability to parent during this time. The Swedish version of the PCQ has, however, not been evaluated. This study therefore aimed to examine the psychometric properties of the PCQ in a sample of Swedish parents with cancer. MATERIAL AND METHODS: A sample of 336 patients with cancer having dependent children (≤18 years) were included in a cross-sectional web-based survey. Participants completed questionnaires assessing parenting concerns, depression, anxiety, and stress symptoms (DASS); self-efficacy, family functioning (FAD-GF); and sociodemographic and clinical characteristics. Descriptive analyses, as well as reliability and validity analyses, were conducted followed by a confirmatory factor analysis of the factor structure proposed by the authors of the original version of the PCQ. RESULTS: The majority were mothers (94.9%) with breast cancer (66.4%) aged 40-50 years (59.5%). The results showed evidence for convergent, criterion, and known group's validity, but the original three-factor structure of the PCQ was not fully supported by confirmatory factor analysis. INTERPRETATION: Evaluating parenting concerns may be an important step towards identifying patients who could benefit from targeted psychosocial interventions. However, the PCQ may require some further refinement to fully capture the breadth of parenting concerns in parents with cancer in different settings.

The efficacy of psychological prevention, and health promotion interventions targeting psychological health, wellbeing or resilience among forced migrant children and youth: a systematic review and meta-analysis.

There are over 40 million displaced children and youth worldwide and there is a need promote their mental wellbeing. This study aimed to synthesize evidence regarding promotion interventions to increase wellbeing, resilience, and quality of life (primary outcomes), and prevention interventions to reduce internalizing and externalizing symptoms (secondary outcomes) in this population. The review protocol was registered with PROSPERO (CRD42022329978). Medline, PsycINFO, and Web of Science were searched. Inclusion criteria were: ≥ 10 participants, sample ≤ 18 years of age, no parental participation, explicated forced migrant populations, implementation in non-clinical context, and validated measures. Fifteen studies (N interventions = 18, N participants = 5741) were eligible. Two studies included outcomes related to wellbeing and quality of life. The remaining studies reported depression, PTSD, anxiety, internalizing and externalizing behaviours, and behavioural and emotional problems. There was only sufficient data to perform random-effects meta-analysis of depression scores. No significant effects were observed in comparison to control condition in randomized trials (n = 4994, k = 5) but a small significant positive trend was observed in within-group analyses (n = 537, k = 12). Cochrane's risk of bias tools and the GRADE certainty of evidence tool were applied. No studies achieved low risk of bias and certainty of evidence was very low. In sum, there remains a dearth of rigorous intervention studies investigating the effects of promotive and preventative psychological interventions on the wellbeing, resilience, and quality of life of forcibly displaced minors. However, the few eligible studies in this review indicate promise.

Family therapy and cognitive behavior therapy for eating disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis.

Family therapy for eating disorders (ED) is well-established and represents the treatment choice for ED in children and adolescents according to guidelines, with cognitive behavior therapy (CBT) as a second line treatment. There is limited knowledge about how these treatments work in routine clinical care. The goal of the present meta-analysis is to investigate the effectiveness of family therapy and CBT for various EDs in children and adolescents when carried out in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until December 2023. The outcome of family therapy and CBT, methodological quality, risk of bias, and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with ED efficacy studies. Forty-four effectiveness studies comprising 3251 family therapy or CBT patients were included. Large to very large within-group effect sizes (ES) were found for ED-psychopathology (0.80) and weight measures for AN (1.64) at post treatment. The attrition rate was 15%. Risk of bias was considerable. Moderate to large ES were found for family therapy and CBT, respectively. The benchmarking analysis showed that effectiveness studies had comparable ESs to efficacy studies (0.80 and 0.84 for the ED-psychopathology at post treatment). The findings support family therapy and CBT for ED in children and adolescents as effective treatments when delivered in routine clinical care, with effects comparable with those found in efficacy studies. The evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.PROSPERO [CRD42023441794].

"All Children in Focus": Effects of a Universal Parenting Program at a 6-Month Follow-Up in a Randomized Controlled Trial in Sweden.

Parenting programs have been shown to empower parents and prevent mental health problems in children. However, few programs are designed to promote wellbeing, which led to the development of the Swedish-promotive universal program, "All Children in Focus" (ACF). This study aimed to understand the effects of parents' participation in the ACF program on parents' emotion regulation and parenting practices over a 6-month follow-up and if intervention-produced changes predict child wellbeing (CW). Parental self-efficacy (PSE) was also included to assess the relation with parental outcomes and CW. This is an evaluation of a multicenter randomized waitlisted control trial conducted in Stockholm County, Sweden, with parents of children aged 3 to 12 years (n = 621) in 2012. Parents were randomized 1:1 to enter the program or to a waitlist. Questionnaires were completed by parents at baseline, post-intervention, and 6 months post-baseline. We used generalized mixed modeling to test effects on parental outcomes over time and regression analyses to study the predictive role of parental outcomes on CW. From baseline to the post- and to the 6-month follow-ups, parents in the intervention group reported greater levels of emotion regulation skills, cognitive reappraisal, and positive parenting than did parents in the control group. A decrease in negative and harsh parenting was evident in both groups, although it was greater in the intervention group. An increase in PSE was associated with high negative parenting at baseline in the intervention group. Child gender moderated positive parenting, suggesting that parents of girls in the intervention group had more favorable development of positive strategies. The findings indicate that a change in PSE predicts a change in CW at 6 months. The ACF program can be used to strengthen and develop parenting. This study advances our knowledge about the potential advantages of using a health-promoting approach to strengthen the wellbeing of families in the general population. Clinical trial registration: ISRCTN70202532 Current Controlled Trials.

Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial.

Parent management training (PMT) is recommended treatment for children with oppositional defiant disorder (ODD) and child-directed cognitive behavior therapy (CBT) is also recommended for school-aged children. The current study examined 2-year follow-up effects of parent management training (PMT) combined with the CBT based group intervention Coping Power Program (CPP) compared to PMT only. Results showed long-term effectiveness of both PMT and PMT combined with CPP in reduced disruptive behavior problems and harsh parenting strategies, and increased emotion regulation- and social communication skills. The earlier reported increase in emotion regulation- and social communication skills in the PMT with CPP condition during treatment remained stable while the PMT condition showed continued improvement during the follow-up period. To conclude, PMT with CPP did generally not provide significant benefits at the 2-year follow-up compared to PMT, apart from an improvement earlier in time regarding emotion regulation- and social communication skills.Trial registration number ISRCTN10834473, date of registration: 23/12/2015.

The Efficacy of Parent Management Training With or Without Involving the Child in the Treatment Among Children with Clinical Levels of Disruptive Behavior: A Meta-analysis.

A systematic review and meta-analysis was conducted where we evaluated the effects of Parent Management Training (PMT), Parent-Child Interaction Therapy (PCIT) and PMT combined with child cognitive behavioral therapy (CBT) using data from 25 RCTs on children with clinical levels of disruptive behavior (age range 2-13 years). Results showed that PMT (g = 0.64 [95% CI 0.42, 0.86]) and PCIT (g = 1.22 [95% CI 0.75, 1.69]) were more effective than waiting-list (WL) in reducing parent-rated disruptive behavior, and PMT also in improving parental skills (g = 0.83 [95% CI 0.67, 0.98]) and child social skills (g = 0.49 [95% CI 0.30, 0.68]). PCIT versus WL had larger effects in reducing disruptive behavior than PMT versus WL. In the few studies found, the addition of child CBT to PMT did not yield larger effects than PMT or WL. These results support offering PMT to children with clinical levels of disruptive behavior and highlight the additional benefits of PCIT for younger ages.

A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption.

BACKGROUND: Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent's healthcare consumption 1 year before and 1 year after treatment. METHOD: The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication. RESULTS: The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs. CONCLUSIONS: Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. TRIAL REGISTRATION: This study has been registered with the ISRCTN: 15885573 .

Adding the Coping Power Programme to parent management training: the cost-effectiveness of stacking interventions for children with disruptive behaviour disorders.

Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8-12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015.

Gambling at Work: A Qualitative Study of Swedish Elite Athletes, Coaches, and Managers.

Considering the financial connections between sport and the gambling industry, more should be learned about gambling and problem gambling in this setting. This study explores how male athletes, coaches, and sports managers experience gambling activities and problems in their sports. Interviews were conducted with 30 male elite athletes, coaches, and managers in four sports. The interviews were analysed using content analysis, and the results indicated two main themes: 1) desire for and concerns with money and 2) in the shadow of performance, and three categories. The first main theme emerged as a result of the respondents recurring reference to money as the reason to different actions: It is important to win money,'too little' or 'too much' money is described as reason for gambling, athletes status is affected by money and sponsor money from the gambling companies are considered important. 'In the shadow of the performance' captures the reason to and value of performance: The thrill and money are rewards for the gambling performance, everyday sporting life emphasizes performance both in training and matches. Lack of successful performance is perceived as a threat and evokes a fear of being seen as weak and being ejected from the team. This study identifies gambling as normalized within male elite sport. Preventing gambling problems calls for action at all levels of the involved socio-ecological framework. Management, coaches, and athletes need more knowledge of gambling and how to create a sustainable framework to prevent gambling problems.

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.

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.

Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents.

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).

Relational Skills and Client Language Predict Outcome in Smoking Cessation Treatment.

BACKGROUND: We currently lack insight into the predictive processes of Motivational Interviewing (MI) in smoking cessation treatment. More knowledge is necessary to be able to further enhance the treatment effect in smoking cessation interventions. OBJECTIVES: To examine certain hypothesized active components of MI in smoking cessation treatment delivered in an ordinary clinical setting. METHODS: Audio-recordings of 106 smoking cessation treatment sessions were analyzed using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE) Coder's Manual and the Motivational Interviewing Treatment Integrity code (MITI) Manual, version 3.1. The outcome measure was self-reported 6-month continuous abstinence at 12-month follow-up. RESULTS: Client Activation utterances in favor of change were positively associated with smoking cessation at follow-up. The combined category of client language expressing a Desire or a Need to continue to smoke was negatively predictive of smoking cessation. In addition, we found preliminary support for a negative interaction effect between counselors' demonstration of the spirit of MI and clients Activation utterances in favor of change. Conclusions/Importance: Our data suggest that if smoking cessation counselors cultivate client Activation utterances in favor of abstinence and softening client utterances expressing desire or perceived need to smoke, this could contribute to higher rates of treatment success. In addition, counselors' demonstration of the spirit of MI was a statistically significant predictor of outcome when the negative interaction effect between Activation utterances in favor of change and MI spirit was taken into account. These findings should be evaluated in larger studies in the future.

Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems.

BACKGROUND: Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design. AIM: This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years. METHODS: This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs. RESULTS: All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results. DISCUSSION: The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made. IMPLICATIONS FOR FUTURE RESEARCH: Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach. CONCLUSIONS: The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.

Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden.

INTRODUCTION: Borderline personality disorder (BPD) is a severely disabling condition, associated with substantially increased risk of deliberate self-harm and, particularly in men, also with interpersonal violence and other criminal behavior. Although BPD might be common among prison inmates, little is known about prevalence and psychiatric comorbidity in probationers and parolees. METHOD: In 2013, a consecutive sample of 109 newly admitted adult male offenders on probation or parole in all three probation offices of Stockholm, Sweden, completed self-report screening questionnaires for BPD and other psychiatric morbidity. Participants scoring over BPD cut-off participated in a psychiatric diagnostic interview. RESULTS: We ascertained a final DSM-5 BPD prevalence rate of 19.8% (95% CI: 12.3-27.3%). The most common current comorbid disorders among subjects with BPD were antisocial personality disorder (91%), major depressive disorder (82%), substance dependence (73%), attention deficit hyperactivity disorder (ADHD) (70%), and alcohol dependence (64%). Individuals diagnosed with BPD had significantly more current psychiatric comorbidity (M=6.2 disorders) than interviewed participants not fulfilling BPD criteria (M=3.6). Participants with BPD also reported substantially more symptoms of ADHD, anxiety and depression compared to all subjects without BPD. CONCLUSIONS: BPD affected one fifth of probationers and was related to serious mental ill-health known to affect recidivism risk. The findings suggest further study of possible benefits of improved identification and treatment of BPD in offender populations.

Eighteen-Month Follow-Up of Internet-Based Parent Management Training for Children with Conduct Problems and the Relation of Homework Compliance to Outcome.

The primary aim of the present study was to evaluate if previously reported treatment gains of a parent management training (PMT) program, administered via Internet, were retained from post to the 18-month follow-up. Another aim was to evaluate homework compliance as a predictor of short and long-term outcomes. Participants were parents of 58 children (3-11 years) with conduct problems who received a 10-week self-directed PMT program, with limited therapist support. Parents of 32 children (55.2 %) responded at all measurement point (baseline, post-test and follow-up) and analyses showed that child conduct problems continued to decrease during the 18-month period after the intervention whereas parenting skills deteriorated somewhat from post treatment. Pre- to post-treatment change in child conduct problems was predicted by parental engagement in homework assignments intended to reduce negative child behaviors. The findings provide support for the use of Internet-based PMT and stress the importance of parental compliance to homework training.

Effectiveness of a universal health-promoting parenting program: a randomized waitlist-controlled trial of All Children in Focus.

BACKGROUND: Parenting programs have been highlighted as a way of supporting and empowering parents. As programs designed to promote children's health and well-being are scarce, a new health-promotion program, All Children in Focus, has been developed. The purpose of this trial was to evaluate the potential effectiveness of the program in promoting parental self-efficacy and child health and development, as well as to investigate possible moderators of these outcomes. METHODS: A multicenter randomized waitlist-controlled trial was conducted. The trial included 621 parents with children aged 3-12 years. Parents were randomized to receive the intervention directly or to join a waitlist control group. Parents completed questionnaires at baseline, 2 weeks after the intervention, and 6 months post-baseline. To evaluate potential effects of the program, as well as any moderating variables, multilevel modeling with a repeated-measures design was applied. RESULTS: Parents in the intervention group reported that their self-efficacy (p < .001), as well as their perceptions of children's health and development (p < .05), increased 6 months post-baseline when compared with parents in the control group. One variable was found to moderate both outcomes: parents' positive mental health. Furthermore, parents' educational level and number of children moderated parental self-efficacy, while the children's age moderated child health and development. Having a poor positive mental health, a university-level education, more than one child in the family, and older children, made the families benefit more. CONCLUSIONS: In the first randomized controlled trial of All Children in Focus, we found that the program appears to promote both parental self-efficacy and children's health and development in a general population. Additionally, we found that families may benefit differently depending on their baseline characteristics. This contributes to an existing understanding of the advantages of offering universal parenting programs as a public health approach to strengthening families. However, further research is needed to investigate long-term effects and mediating variables, as well as the potential cost-effectiveness of the program. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN70202532. November 7th 2012.

VR-assisted aggression treatment in forensic psychiatry: a qualitative study in patients with severe mental disorders.

Introduction: Improvements in virtual reality (VR) have made it possible to create realistic, virtual settings for behavioral assessment and skills training that cannot otherwise be accessed in a safe way in forensic psychiatric settings. VR interventions are under development but little is known how forensic psychiatric patients with severe mental disorders experience VR-assisted assessments or treatments. Methods: The present study aimed to help fill this knowledge gap via qualitative interviews with seven patients with severe mental disorders at a high-security forensic psychiatric clinic who had completed the newly revised Virtual Reality Aggression Prevention Training (VRAPT). All participants were interviewed 12 weeks after the VRAPT intervention, and interview data analyzed with manifest inductive content analysis. Results: Six manifest content categories were identified: 1. Therapeutic process, 2. VRAPT method, 3. VR technology, 4. Previous treatment experiences, 5. Challenges to treatment of aggression, and 6. Unexpected experiences. The participants had diverse experiences related to both the VRAPT intervention and forensic psychiatric care. Participants described a mixture of positive experiences in relation to VR-assisted role-plays, and less positive in relation to motivation for aggression-focused treatment and technological limitations. Discussion: The present findings suggest further studies are needed on how to best implement VR-assisted treatments for aggression in forensic settings, and potentially further modification of treatment content in interventions like VRAPT.

The effects and costs of the universal parent group program - all children in focus: a study protocol for a randomized wait-list controlled trial.

BACKGROUND: In recent decades, parents have been involved in programs that aim to improve parenting style and reduce child behavior problems. Research of preventive parenting programs has shown that these interventions generally have a positive influence on both parents and children. However, to our knowledge there is a gap in the scientific literature when it comes to randomized controlled trials of brief, manual-based structured programs which address general parenting among the population, and focus on promoting health. A four-session universal health promotion parent group program named All Children in Focus was developed. It aims at promoting parental competence and children's positive development with the parent-child relationship as the target. There is currently no randomized controlled trial existing of the program. METHODS/DESIGN: A prospective multicenter randomized wait-list controlled trial is being conducted. Approximately 600 parents with children ranging in age from 3-12 years have been recruited in eleven municipalities and city districts in the County of Stockholm, Sweden. Parents are randomized at baseline to an intervention group, which receives the program directly, or to a waiting-list control group, which participates in the program six months later. Changes in parenting and child health and development are assessed with measures immediately post-intervention and six months after the baseline. Observations of a minor group of parents and children are conducted to explore possible relations between parental reports and observed behaviors, as well as changes in the interaction between parent and child. Further, data collected within the evaluation will also be applied to evaluate the possible cost-effectiveness of the program. DISCUSSION: This paper describes a study protocol of a randomized controlled trial. Except for the quantitative outcome measures to evaluate the effectiveness of All Children in Focus, this protocol also describes health economic and qualitative analyses to deepen the knowledge of the program. We further discuss some issues regarding the implementation of the program in municipalities and city districts. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70202532.

Participating in a parenting intervention in prison, perceptions from incarcerated fathers and mothers-A convergent mixed-methods study.

BACKGROUND: Children of incarcerated parents run a high risk of ill-health and future delinquency, whereas positive parenting can support children's healthy development. The For Our Children's Sake (FOCS) parenting intervention for parents in prison was evaluated as a controlled trial during 2019-2021 within The Swedish Prison and Probation Service (SPPS). This study reports on the process evaluation and aimed to describe how parents perceived their participation and aspects that influenced implementation of the FOCS intervention. METHODS: This convergent mixed-methods study (QUAL + quan) included qualitative interview data after participation in the FOCS intervention group (12 parents), and quantitative questionnaire data from intervention and control groups (46 parents). Qualitative data were analysed using inductive qualitative content analysis and quantitative data using descriptive and non-parametric statistics. RESULTS: An integrated synthesis of the qualitative and quantitative results showed three joint concepts that provided an extended understanding of the importance of a child and parent focused intervention available to parents in prison, where FOCS was perceived as the only place where inmates could openly reflect, and express sensitive feelings and thoughts related to the children and being a parent. Also, that the SPPS as an organisation entails partly unsupportive organisational norms with irregular individual staff engagement, which made FOCS invisible in prisons, and the importance of engagement and motivation from all participants and group leaders in the group was essential for a successful FOCS group. CONCLUSION: This study showed that availability of a child and parent focused intervention in prison is perceived as very important, and at the same time dependent on a trustful relationship in the group to be rewarding to the participants, where organisational norms within the SPSS need amendments for successful implementation of FOCS. These findings can guide further implementation of similar interventions in prison.