Sexual harassment and patterns of symptoms and functional abilities in a psychiatric sample of adolescents.

PURPOSE: To investigate how commonly adolescent psychiatric outpatients with symptoms of depression and anxiety report having been subjected to sexual harassment, and to explore how symptoms and functional abilities differ between adolescent psychiatric outpatients with symptoms of depression and anxiety who do report and those who do not report having been subjected to sexual harassment. METHODS: Swedish adolescent psychiatric outpatients with symptoms of depression or anxiety (n = 324; 66 boys and 258 girls, aged 12-19 years, M = 15.6, SD = 1.7) answered the PROMIS paediatric measures. Logistic regression analyses were performed to assess differences between the respondents classified as 'Sexually harassed' and 'Not sexually harassed' based on these self-report questionnaires. RESULTS: About 60% of the adolescents reported having been subjected to sexual harassment, and reported higher levels of suicidal ideation, disturbed sleep, fatigue, anxiety, depression, anger, and pain interference, as well as lower functional ability in terms of school problems, alcohol consumption, and poor family relationships. Logistic regression analyses showed that the strongest associations were with suicidal ideation, disturbed sleep, anger, and alcohol consumption. CONCLUSIONS: About 60% of the adolescents in the studied psychiatric cohort reported having been subjected to sexual harassment. Reported experiences were high in all three subtypes, with the most reports on having been subjected to verbal harassment. Clinicians should ask about experiences of sexual harassment and give information about the consequences of sexual violence and treatment options. Alcohol consumption should be addressed and tested for. Structured assessment of suicidality should always be done.

Compassion in three perspectives: Associations with depression and suicidal ideation in a clinical adolescent sample.

Background: Adolescence is a critical period for mental development where the consequences of psychopathologies can be exceedingly harmful, and compassion has been identified as a protective factor for adolescents' mental well-being. Aim: The aim of this study was to explore three perspectives of compassion - Self-compassion, Compassion for others, and Compassion from others - and their relationship with depression and suicidal ideation in adolescents. Method: This Swedish cross-sectional study included 259 psychiatric patients (ages 16-22). Participants completed a survey including the self-assessment scales "Reynolds Adolescent Depression Scale - Second Edition" (RADS-2), "Suicidal Ideation Questionnaire - Junior Version" (SIQ-JR), and "Compassion Engagement and Action Scale - Youth" (CEAS-Y). Linear regression analyses were used to determine whether participants' levels of compassion predicted depression and suicidal ideation. Results: Self-compassion and Compassion from others significantly predicted both depression and suicidal ideation. Girls, on average, reported higher levels of depressive symptoms and suicidal ideation and lower levels of self-compassion compared to boys. The correlation between compassion and depressive symptoms, however, appeared to be stronger in boys. There was also a positive correlation between Compassion for others and suicidal ideation. Conclusions: The results suggest that Self-compassion and Compassion from others may have a significant protective effect against depression and suicidal ideation, especially in boys. However, due to the relatively small sample of boys (n = 40), further research is needed before any solid conclusion can be drawn regarding possible gender differences. Additionally, the combination of low Self-compassion and higher levels of Compassion for others may be associated with suicidal ideation.

Experiences of Online Sexual Violence: Interviews With Swedish Teenage Girls in Psychiatric Care.

Research about online sexual violence (OSV) is needed to be able to better meet the needs of girls in psychiatric care. The objectives of this study are to explore experiences of online sexual violence among young female psychiatric service users. Interviews with nine girls with psychiatric care needs were analyzed with thematic analysis. The findings are summarized in four themes which contribute to the notion that online sexual violence is only one, albeit important, part of a more complex picture of violence among young girls in psychiatric care. The girls' narratives are shaped by, as well as reproducing gender norms.

Psychometric validity of the Montgomery and Åsberg Depression Rating Scale for Youths (MADRS-Y).

BACKGROUND: Because of all the serious consequences of major depressive disorder (MDD), it is important to screen for MDD in adolescents. The aim of this study was to test the psychometric properties of the newly developed self-report depression scale MADRS-Y for adolescents in a normative Swedish sample. METHODS: The study included 620 adolescents in the age range of 12-20 years old. The normative sample was randomly split into two equal parts, to perform principal component analysis (PCA) on sample one and confirmatory factor analysis (CFA) on sample two. We investigated the psychometrics. RESULTS: The result from the PCA suggested that all 12 potential items should be used, and the items loaded on the same construct of depression. The CFA supported the one-factor structure with good fit indices. Measurement invariance was confirmed, allowing interpretation regardless of gender or age differences. Reliability was good, α .89, for both samples separately. Test-retest reliability was good to excellent (intraclass correlation coefficients = .87 and .91). Evidence of convergent and discriminant validity was shown. CONCLUSIONS: The results in the current study suggest that the MADRS-Y is a brief, reliable, and valid self-report questionnaire of depressive symptoms for adolescents in the general population.

The association between gender, sexual harassment, and self-compassion on depressive symptoms in adolescents.

AIM: The study aims to identify the prevalence of bullying and sexual harassment as well as possible risk and protective factors for depression among adolescents. We focus on the association of different types of sexual harassment, gender, bullying, and self-compassion to depression criteria according to DSM 4. METHODS: This cross-sectional study included 318 adolescents aged 15-20 years, from Sweden. Participants answered the self-assessment scales Reynolds Adolescent Depression Scale, Second Edition, and Compassionate Engagement and Action Scales for Youth, as well as questions about sexual harassment and bullying. Regression analyses were conducted to examine the association between bullying, sexual harassment, self-compassion, and gender with depressive symptoms. RESULTS: Few students had been subjected to bullying, whereas sexual harassment was more common. About 32.7% of students had been subjected to verbal harassment and girls were more frequently exposed. Both bullying and sexual harassment were associated with depressive symptoms, and gender patterns were observed. For boys, verbal harassment and bullying correlated with negative self-evaluation and somatic complaints. For girls, bullying correlated with all depressive symptoms. Higher levels of self-compassion were associated with less depression, and the correlation was especially strong among boys. CONCLUSION: Boys and girls express different types of depressive symptoms when subjected to bullying and sexual harassment. Not asking boys about negative self-evaluation or somatic complaints could lead to missing depression. However, for girls, all four symptoms are equally important to inquire about. Self-compassion is a possible protective factor against depression and future studies will show if teaching this to adolescents could lead to less depression.

Psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample.

Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample.Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery-Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks.Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 - 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts.

Disturbed sleep and patterns of psychiatric symptoms and function in a school-based sample of adolescents.

BACKGROUND: Sleep problems are common in adolescence and often related to psychopathology and impaired functioning. However, most studies have used summative scores, and little is known about how adolescents with disrupted sleep perceive their specific symptoms and dysfunctions. This study explored differences in levels of psychiatric symptoms and functional ability between Swedish adolescents with and without self-reported disturbed sleep in a school-based sample. METHODS: Swedish adolescents (n = 618, mean age 15.7+/-1.9yrs) answered the PROMIS pediatric measures for fatigue, anxiety, depression, pain interference, anger, physical activity and peer and family relationships. Logistic regression analyses were performed to assess differences between respondents with and without disturbed sleep. RESULTS: Disturbed sleep was associated with higher levels of symptoms of fatigue, anxiety, depression, anger and pain interference, as well as lower functional abilities in terms of physical activity and peer- and family relationships. Adolescents reporting disturbed sleep generally displayed a pattern of impaired executive functioning, internal emotional distress and school- and sleep related worry and dysfunction, as compared to physical disability, aggressive behavior, stress and generalized worry. CONCLUSIONS: The present study adds to the understanding of how disturbed sleep and specific psychiatric symptoms and functional ability are interrelated, which may also have clinical implications.

Training for Awareness, Resilience and Action (TARA) for medical students: a single-arm mixed methods feasibility study to evaluate TARA as an indicated intervention to prevent mental disorders and stress-related symptoms.

BACKGROUND: Medical students have a higher risk for depression, anxiety, stress-related symptoms, burnout, and suicide, and more rarely seek professional help or treatment than the general population. Appeals are being made to address the mental health and resilience of physicians-to-be. The novel program Training for Awareness, Resilience, and Action (TARA) was originally developed to treat depressed adolescents, targeting specific neuroscientific findings in this population. TARA has shown feasibility and preliminary efficacy in clinically depressed adolescents and corresponding brain-changes in mixed community adolescent samples. The present study investigated the feasibility and acceptability of TARA as a potential indicated prevention program for symptoms of depression, anxiety, stress and burnout in Swedish medical students. METHODS: We conducted a single-arm trial with 23 self-selected students in their early semesters of medical school (mean age 25.38 years, 5 males and 18 females), with or without mental disorders. All participants received TARA. Self-reported symptoms of depression, anxiety, perceived stress and psychological inflexibility were collected before (T0) and after the intervention (T1). Qualitative data on the participants' experiences of TARA were collected in focus-group interviews conducted halfway through the program and upon completion of the program. Individual interviews were also conducted 2 years later. Qualitative content analysis was performed. RESULTS: The mean attendance rate was 61.22% and the dropout rate was 17.40%. The Child Session Rating Scale administered after every session reflected an overall acceptable content, mean total score 34.99 out of 40.00. Trends towards improvement were seen across all outcome measures, including the Hospital Anxiety and Depression Scale Anxiety (t = 1.13, p = 0.29) and Depression (t = 1.71, p = 0.11) subscales, Perceived Stress Scale (t = 0.67, p = 0.51) and Avoidance and Fusion Questionnaire for youth (t = 1.64, p = 0.10). None of the participants deteriorated markedly during the intervention. Qualitative content analysis resulted in a main theme labeled: "An uncommon meeting-ground for personal empowerment", with 4 themes; "Acknowledging unmet needs", "Entering a free zone", "Feeling connected to oneself and others" and "Expanding self-efficacy". CONCLUSION: TARA is feasible and acceptable in a mixed sample of Swedish medical students. The students' reports of entering an uncommon meeting-ground for personal empowerment supports effectiveness studies of TARA in this context.

Psychometrics of three Swedish physical pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)®: pain interference, fatigue, and physical activity.

BACKGROUND: The Patient-Reported Outcomes Measurement Information System (PROMIS®) aims to provide self-reported item banks for several dimensions of physical, mental and social health. Here we investigate the psychometric properties of the Swedish pediatric versions of the Physical Health item banks for pain interference, fatigue and physical activity which can be used in school health care and other clinical pediatric settings. Physical health has been shown to be more important for teenagers' well-being than ever because of the link to several somatic and mental conditions. The item banks are not yet available in Sweden. METHODS: 12- to 19-year-old participants (n = 681) were recruited in public school settings, and at a child- and psychiatric outpatient clinic. Three one-factor models using CFA were performed to evaluate scale dimensionality. We analyzed monotonicity and local independence. The items were calibrated by fitting the graded response model. Differential Item analyses (DIF) for age, gender and language were calculated. RESULTS: As part of the three one-factor models, we found support that each item bank measures a unidimensional construct. No monotonicity or local dependence were found. We found that 11 items had significant lack of fit in the item response theory (IRT) analyses. The result also showed DIF for age (seven items) and language (nine items). However, the differences on item fits and effect sizes of McFadden were negligible. After considering the analytic results, graphical illustration, item content and clinical relevance we decided to keep all items in the item banks. CONCLUSIONS: We translated and validated the U.S. PROMIS item banks pain interference, fatigue and physical activity into Swedish by applying CFA, IRT and DIF analyses. The results suggest adequacy of the translations in terms of their psychometrics. The questionnaires can be used in school health and other pediatric care. Future studies can be to use Computerized Adaptive Testing (CAT), which provide fewer but reliable items to the test person compared to classical testing.

Swedish translation and cross-cultural adaptation of eight pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)®.

BACKGROUND: This study is part of the Swedish initiative for the establishment of standardized, modern patient-reported measures for national use in Swedish healthcare. The goal was to translate and culturally adapt eight pediatric Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks (anger, anxiety, depressive symptoms, family relationships, fatigue, pain interference, peer relationships and physical activity) into Swedish. METHODS: Authorization to translate all currently available pediatric PROMIS item banks (autumn, 2016) into Swedish was obtained from the PROMIS Health Organization. The translation followed the Functional Assessment of Chronic Illness Therapy translation recommendations with one major modification, which was the use of a bilingual multi-professional review workshop. The following steps were applied: translation, reconciliation, a two-day multi professional reviewer workshop, back translation, and cognitive debriefing with eleven children (8-17 years) before final review. The bilingual multi-professional review workshop provided a simultaneous, in-depth assessment from different professionals. The group consisted of questionnaire design experts, researchers experienced in using patient-reported measures in healthcare, linguists, and pediatric healthcare professionals. RESULTS: All item banks had translation issues that needed to be resolved. Twenty-four items (20.7%) needed resolution at the final review stage after cognitive debriefing. The issues with translations included 1. Lack of matching definitions with items across languages (6 items); 2. Problems related to language, vocabulary, and cultural differences (6 items); and 3. Difficulties in adaptation to age-appropriate language (12 items). CONCLUSIONS: The translated and adapted versions of the eight Swedish pediatric PROMIS item banks are linguistically acceptable. The next stage will be cross-cultural validation studies in Sweden. Despite the fact that there are cultural differences between Sweden and the United States, our translation processes have successfully managed to address all issues. Expert review groups from already-established networks and processes regarding pediatric healthcare throughout the country will facilitate the future implementation of pediatric PROMIS item banks in Sweden.

Parental caregiver burden and recovery of adolescent anorexia nervosa after multi-family therapy.

This study investigated whether parental caregiving burden changed during adjunct multi-family therapy of adolescent anorexia nervosa and eating disorders not otherwise specified (EDNOS) and whether caregiver burden at baseline and changes in caregiver burden during treatment were associated with treatment outcome.Twenty-four females, 13 to 16 years old, and their parents, participated in the study. Caregiver burden was measured with the Eating Disorders Symptom Impact Scale, by mothers (n = 23) and fathers (n = 22). Treatment outcome was measured by adolescent body mass index, level of global functioning and self-rated eating disorder symptoms by the Eating Disorders Examination Questionnaire 4.0.All patient outcomes improved and overall caregiver burden decreased significantly during treatment. When broken down in aspects of caregiver burden the decrease in parental perceived isolation, was found to be associated with improvement of BMI and Children's Global Assessment Scale. When analyzing fathers and mothers separately, we found that maternal feelings of guilt and paternal perceived burden of dysregulated behaviors at base-line were correlated to treatment outcome. Future studies are needed to clarify the role of caregiver burden as a potential mediator of treatment results.

Validation of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a normative sample.

BACKGROUND: Due to the sharp global increase in prevalence of adolescent major depressive disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, we need internationally validated tools for multi-dimensional assessment. Reynolds Adolescent Depression Scale second edition (RADS-2) measures dysphoric mood, anhedonia/negative affect, negative self-evaluation and somatic complaints and is widely used internationally, but not yet available in Swedish. AIM: The aim of this study is to test the psychometric characteristics of the Swedish version of RADS-2 in a normative sample. MATERIAL AND METHOD: Data was gathered from junior and high school students in Northern Sweden (N = 637). We performed: 1. Confirmatory factor analysis to examine the 4-factor structure proposed by Reynolds, 2. Measurement invariance analysis for sex (girls, boys) and age group (12-15 years, 16-20 years). 3. Reliability testing and 4. Tests for concurrent, discriminant and convergent validity using Beck's Youth Inventories of Emotional and Social Impairment Depression and Anger subscales, the Patient Reported Outcome Measurements Information System, Anxiety and Friends subscales and the World Health Organization Wellness Index. RESULTS: The sample consisted of n = 637 students (n = 389 girls and n = 248 boys), mean age 15.73 (SD = 1.76); 12-20 years. The 4-factor structure was confirmed, as well as measurement invariance for sex and age group. Reliability was acceptable to excellent for all subscales and RADS-2 total scale. Concurrent, convergent and discriminant validity was good. CONCLUSION: The Swedish version of RADS-2 showed acceptable reliability and validity in a Swedish normative sample.

Online and offline sexual harassment associations of anxiety and depression in an adolescent sample.

PURPOSE: The aims of this study were to study the prevalence of sexual harassment online and offline, to analyse the associations between subjection to sexual harassment and adolescents' mental health and analyse if there are any significant differences between girls and boys. We also examine if good peer-relationships interact with the associations between sexual harassment and mental health complaints. METHODS: This cross-sectional study included 594 adolescents, age 12-20. Participants responded to a web survey including the self-assessment scales Revised Children´s Anxiety and Depression Scale and Beck Youth Inventories as well as subjection to online and offline sexual harassment and peer-relational quality. Linear regression analysis was used to study whether symptoms of anxiety and depression correlated to subjection to online and offline sexual harassment and peer-relational quality. RESULTS: We found that 48.50% of girls and 28.19% of boys reported sexual harassment victimization. Offline was the most frequently reported site of victimization. Online harassment correlated significantly with increased anxiety and depressive symptoms in girls but not boys. Offline harassment as well as online and offline harassment correlated significantly with increasing symptoms for both genders. Participants who reported good peer-relationships had significantly less symptoms. CONCLUSIONS: This study shows that sexual harassment remains a common plague for adolescents, especially for girls. Offline sexual harassment is the most common form of harassment for both genders. For girls, but not for boys, online sexual harassment correlated significantly with anxiety and depressive symptoms. A strong negative correlation between satisfaction to peer-relationships and mental health symptoms was found.

Psychometric validity of the Compassionate Engagement and Action Scale for Adolescents: a Swedish version.

BACKGROUND: There is increasing evidence that compassion is linked to mental health and well-being while difficulties in receiving and expressing compassion to self and others is associated with mental health and social difficulties. For the most part the self-report scales that measure these processes have been developed for adults and little is known how they function in adolescents. This study investigates a Swedish adaption for adolescents of the Compassionate Engagement and Action Scales (CEAS), developed by Gilbert et al. (2017) for adults. This assesses different competencies associated with being compassionate to others, the experience receiving compassion from others, and being compassionate with one-self. OBJECTIVE: To evaluate the psychometric properties and gender differences of CEAS for Youths - Swedish version (CEASY-SE), in a school-sample of adolescents (n = 316) aged 15-20 years. METHOD: The Compassionate Engagement and Action Scales were translated into Swedish. A back-translation method was used. It was then adapted for adolescents with age-appropriate language. Adolescents were recruited by research assistants at two public high schools. RESULTS: After removing one item of each subscale, the dimensionalities of the three scales were good. Confirmatory factor analysis showed that engagement and action constituted different dimensions in each scale. Internal consistency was good to excellent in all three sub-scales (α from 0.74 to 0.92). Intra Class Correlations demonstrated good to excellent test-retest reliability over a period of three weeks (0.67 to 0.85). Convergent and divergent validity were as expected, except for Compassion for others, which did not correlate with anxiety and depression symptoms as expected. Girls showed less self-compassion compared to boys and more compassion for others. CONCLUSIONS: Present study suggests that CEASY-SE has good to excellent psychometric properties and further study is needed for more definite establishment of the psychometric properties. Girls and boys have different patterns of compassion.

Trainee psychotherapists' development in self-rated professional qualities in training.

This study investigated changes in trainees' self-rated experience as a therapist over the course of one practicum treatment case in basic psychotherapy education in Sweden. Undergraduate students (n = 76) provided longitudinal information on their healing involvement and stressful work involvement. The results of the Development of Psychotherapists Common Core Questionnaire (DPCCQ) demonstrated that trainees' basic relational skills, technical skills, perceived difficulties, and constructive coping strategies changed linearly, with an increasing slope. Technical expertise changed the most, and relational skills developed moderately. In-session feelings of anxiety and boredom did not change. The individualized reliable change scores show that the process during training is different for different students. Most students did not change at all, and some students even changed negatively. Investigation of how pedagogic variables affect therapists' development is necessary to support the professional growth of trainees in their involvement with different types of psychotherapy.

Do supervisors and independent judges agree on evaluations of therapist adherence and competence in the treatment of cocaine dependence?

The current study examined the agreement between supervisors' and independent judges' evaluations of therapist adherence and competence in three treatments of cocaine dependence: supportive expressive therapy (SE), cognitive therapy CT), and individual drug counseling (IDC). We used data from The National Institute on Drug Abuse Collaborative Cocaine Treatment Study (n = 295). Trained and experienced supervisors and independent judges rated treatment fidelity. At the therapist level of analysis, the agreement between supervisors' and independent judges' ratings was weak for SE competence, CT adherence, and CT competence. Moderate relations were found for IDC adherence and competence. Supervisors consistently rated adherence and competence more positively than judges in CT and IDC. The potential bias in supervisors' ratings is discussed.

Baseline training in cognitive and psychodynamic psychotherapy during a psychologist training program. Exploring client outcomes in therapies of one or two semesters.

This effectiveness study explored the outcomes of 187 clients seen by 187 students undergoing baseline training in psychotherapy. Clients reduced their symptoms (SCL-90) and increased their positive self-image (SASB introject) during the therapy. Multiple regression analyses showed no differences between the cognitive and the psychodynamic training approaches and no differences between one and two semesters duration of the therapies. However, 2-3% of variance in end states was accounted for by the interaction between the variables, indicating a moderating effect of duration in the two approaches. Outcomes for clients in the cognitive training approach were significantly better with two semesters than with one semester, while there was no such difference in the psychodynamic approach. Consequences for baseline training are discussed.

How many treatment sessions and patients are needed to create a stable score of adherence and competence in the treatment of cocaine dependence?

The study utilized a generalizability theory analysis of adherence and competence ratings to evaluate the number of sessions and patients needed to yield dependable scores at the patient and therapist levels. Independent judges' ratings of supportive expressive therapy (n = 94), cognitive therapy (n = 103), and individual drug counseling (n = 98) were obtained on tapes of sessions from the NIDA Collaborative Cocaine Treatment Study. Generalizability coefficients revealed that, for all three treatments, ratings made on approximately five to 10 sessions per patient are needed to achieve sufficient dependability at the patient level. At the therapist level, four to 14 patients need to be evaluated (depending on the modality), to yield dependable scores. Many studies today use fewer numbers.

Self-image patterns as predictors of change and outcome of trainee-led psychotherapy.

This study investigated the outcome of undergraduate trainee-led psychotherapy and how different self-image patterns explain symptom change. Pre- and post-treatment data from 235 Swedish outpatients were used. Clients were assessed with Symptom Checklist-90 (SCL-90) and the Structural Analysis of Social Behavior (SASB). Outcome effect size was moderate and in line with earlier studies on trainees. Clinical significant change showed that 42% of all clients were recovered or improved after 18 sessions in either training condition PDT or CBT. Regression analysis showed that a more negative self-image and higher levels of self-control before treatment predicted improvement in both psychiatric symptoms and personality factors. A negative self-image, when observed before treatment, can be understood as an increased motivation for change.