Mid Sweden University

The present study was conducted in order to investigate treatment effects in spider phobic individuals on EEG and eye movements. A previous study has shown larger ERP amplitudes in the late positive complex (LPC) post treatment compared to pre treatment during exposure of spider pictures (Leutgeb, Schäfer, & Schienle, 2009). The authors hypothesize that the result might mirror an increase in attention towards the stimuli and reduced attentional avoidance generating enhanced LPC amplitude as a consequence of directing attention to the spider pictures post treatment. In the present study spider fearful individuals (treatment and waitlist group) and control individuals were measured with EEG and Eye tracking during exposure to pictures of spiders, snakes and flowers pre and post treatment. Based on behavioral and self-assessed measures treatment effects were high. Contrary to Leutgeb et al. (2009), our results showed relatively smaller LPC amplitudes post treatment during presentations of spider pictures. Moreover, the eye movement data indicated no avoidance from spider pictures compared to other pictures, neither pre nor post treatment. These results indicate that when individuals attend to visual threat stimuli, LPC amplitude differences follow the pattern of emotional significance and attention allocation.

Fear is a central aspect in mammalian evolution, prompting escape from and avoidance of threat and dangers. Therefore, it is reasonable to believe that we have a well developed system to detect dangers and quickly respond to them. It has been shown that threatening information has an advantage in information processing; it seems to promote a rapid capture of selective attention and puts demand on processing resources. It has been suggested that the elicitation of fear occurs automatically, and that it is independent of and impenetrable to cognition.

The idea with the present research is that fear processing is dependent on all concurrent internal or external processing demands. One visual search study (Study II) and two secondary task studies (Study I & III) have been conducted to investigate if external or internal distraction can interfere with fear processing. In order to provoke fear responses, spider or snake fearful individuals have been exposed to pictures of their feared stimulus. The aim of Study II was to investigate if the selective attention to fear stimuli could be influenced by contextual factors, such as the nature of the distracting stimuli in a visual search. Study I and III aimed to investigate manipulation of resources allocated to fear stimuli. In Study I, task demand was used as the manipulation, and in Study III an internal cognitive directive was used. The results from these studies indicate that fear is susceptible to manipulation by both external and internal means. By changing circumstances in the surrounding or in the individuals’ internal states, responses to threatening stimuli can be altered. This means that processing of threatening stimuli is influenced by other concurrent processing demands, suggesting that a fear response is not occurring as an isolated and impenetrable process. In an evolutionary perspective, a fear system that is easily triggered but has access to cognitive evaluation at all times ought to be far more flexible, thus creating a better chance for survival than a modular and impenetrable fear system.

För att undersöka resursallokering av processresurser vid informations-bearbetning av hotstimuli har ett ”Dual Task” experiment utförts med spindelrädda försöksdeltagare. Uppgiften bestod av att respondera på olika probe-stimuli som exponerades, direkt på bilder av olika djur (däribland spindlar), med olika tidsintervall. Latens och träffsäkerhet mättes, för ett mått på prestation, och EKG användes för att kontrollera att spindel-bilderna faktiskt utlöste rädsloresponser. Resultaten visar att större processresurser allokerades till spindelbilderna jämfört med alla de övriga bildkategorierna, men att denna differentiering inte verkar ske innan en kognitivt kontrollerad bearbetning och utvärdering av stimulus ägt rum. När uppgiften krävde mer resurser minskade de fysiologiska responserna, vilket indikerar att en variation i den kognitiva belastningen kan modifiera rädsloresponsen.

Many people experience distress from memories of adverse events, so called trauma memories. Trauma interventions are often long and expensive and not easily accessible to, for example, people with sub clinical symptoms or refugees. Based on findings in neurocognitive basic research, a brief method to remedy symptoms related to trauma memories has been developed. The method consists of a one hour psychoeducative session in which individuals learn about distressing traumatic memories and how to handle them. The method aims to teach a way to deploy brain resources during reactivation of a memory in order to reduce fear and anxiety at reconsolidation. Nineteen individuals with difficult and distressing memories participated in a pilot trial. In a one hour session, participants were tought the method and basic knowledge about underlying brain functioning. They were instructed to practice the method during the following week. Pre, post (+1 week), and follow up (+ 5 weeks) measures of symptoms of posttraumatic stress, depression, and anxiety, showed significant decrease on all three scales with a persistant decrease at follow up. In general, results indicate that brief treatment methods can help results indicate that briefer methods can help people suffering from trauma memories.

Influences of a concurrent cognitive demand on allocation of attentional resources and physiological responses to threatening stimuli was investigated. In two secondary task experiments, pictures of fear-relevant and fear-irrelevant stimuli (Experiment 1), as well as feared and non-feared stimuli (Experiment 2), were used as backgrounds in a discrimination task. The cognitive manipulation was provided by a constraint, induced with a threat of punishment motivating participants to respond quick and accurately. The control condition imposed no such constraint. Results showed a larger allocation of attentional resources for both fear-relevant and feared stimuli. More importantly, it was also shown that resources allocated to threatening stimuli could be manipulated by a concurrent cognitive demand. However, both response accuracy and physiological reactions persisted the manipulation when a feared versus a non-feared animal was shown, indicating that attentional resources can be manipulated by an internal cognitive demand even though a fear reaction occurs.

In two visual search experiments, the impact of distractor sets on fear relevant stimuli was investigated.  A search set with spiders, snakes, flowers, and mushrooms was compared to a search set with spiders, snakes, rabbits, and turtles. Speeded responses to spider and snake targets were found when flowers and mushrooms served as distractors, but no such effect occurred with rabbit and turtle distractors. In Experiment 2, spider sensitive individuals were compared to non-fearful individuals. Spider sensitive individuals responded faster to spider targets than did non-fearful individuals, but only in the set with flowers and mushrooms.  When using rabbit and turtle distractors, spider sensitive individuals did not show any speeded responses to their feared animal. These results indicate that behavioural expressions of the visual search task depends not only on the individual’s relationship to the stimuli included in a search set, but also on the context in which feared or fear relevant objects are presented.

The recent inflow of refugees to Sweden has put pressure on health care as well as revealing a need for methods regarding assessment of refugees' mental health status. The present study investigated the use of the Refugee Health Screener (RHS; Hollifield et al., 2013) to distinguish among severity levels of symptoms of psychological distress in refugees. Refugees residing in asylum accommodations (n = 510) were screened with RHS-13, together with screeners for depression, anxiety, and posttraumatic stress disorder (PTSD). Risk for mild, moderate, or severe levels of depression, anxiety, or/and PTSD was used as screening proxy. Receiver operating characteristic analysis rendered cutoff scores of 11, 18, and 25, for mild, moderate, and severe symptoms, respectively. Evaluated against each symptom scale separately, cutoffs performed well. Cutoff 11, previously identified by Hollifield et al. (2016), was also confirmed. However, utilization of additional cutoffs could improve refugee mental health by guiding clinical decision making.

Road hazard perception is considered the most prominent higher-order cognitive skill related to traffic-accident involvement. Regional cultures and social rules that govern acceptable behavior may influence drivers’ interpretation of a traffic situation and, consequently, the correct identification of potentially hazardous situations. Here, we aimed to compare hazard perception skills among four European countries that differ in their traffic culture, policies to reduce traffic risks, and fatal crashes: Ukraine, Italy, Spain, and Sweden. We developed a static hazard perception test in which driving scenes with different levels of braking affordance were presented while drivers’ gaze was recorded. The test required drivers to indicate the action they would undertake: to brake vs. to keep driving. We assessed 218 young adult drivers. Multilevel models revealed that the scenes’ levels of braking affordance (i.e., road hazard) modulated drivers’ behavior. As the levels of braking affordance increased, drivers’ responses became faster and their gaze entropy decreased (i.e., visual search strategy became less erratic). The country of origin influenced these effects. Ukrainian drivers were the fastest and Swedish drivers were the slowest to respond. For all countries, the decrement in response times was less marked in the case of experienced drivers. Also, Spanish drivers showed the most structured (least erratic) visual search strategy, whereas the Italians had the most rigid (most constant) one. These results suggest that road hazard perception can be defined cross-culturally, with cultural factors (e.g., traffic climate, legislation) modulating response times and visual search strategies. Our results also support the idea that a multimodal assessment methodology is possible for mass testing of road hazard perception and its outcomes would be relevant to understand how different traffic cultures shape driving behavior. 

Research on bilingualism and emotions has shown stronger emotional responses in the native language (L1) compared to a foreign language. We investigated the potential of purposeful second language (L2) use as a means of decreasing the experience of psychological distress. Native Swedish speakers read and answered questions about negative and neutral texts in their L1 (Swedish) and their L2 (English) and were asked to rate their level of distress before or after the questions. The texts and associated questions were either written in the same (within-language), or different languages (cross-language). We found that within-language trials when the text was written in participants’ native language (Swedish–Swedish) resulted in an increase of distress, whilst cross-language trials (Swedish–English) resulted in a decrease of distress. This implies that purposeful second language use can diminish levels of distress experienced following a negative event encoded in one's first language.

Body dissatisfaction is an important factor in the development and maintenance ofeating disorders. The comparison with the thin ideal prevalent in different mediachannels, can be one of the factors that contribute to widespread of dissatisfaction withthe own body. Thus, even people not meeting the criteria for eating disorders, mightshow a very problematic way to cope with their body and food intake. The present studyaimed to investigate the attentional pattern evoked when young women were exposed topictures of female bodies varying in their body shape.Eighty-one women, aged 18 to 37 years, viewed a series of pictures, each onecontaining four photos of women. The photos were generated and manipulated digitallyin order to get different body shapes, ranging from a slim to a heavy body shape. Thephotos were exposed in a 2x2 array during 4 seconds. Body Shape Questionnaire wasused to divide participants into two groups; high and low body dissatisfaction. Thedirection and fixation of the gaze were recorded continuously by means of an eyetracker.In general, an attentional bias in the body dissatisfaction group was observed, i.e.,women looked longer to the slimmest picture in the array. Women in the control group(low body dissatisfaction) showed distributed attention to the four body shapes.These results suggest promising possibilities of using ocular tracking tests in the earlydetection of symptoms associated with eating disorders, and perhaps possibilities ofimproving clinical and preventive interventions.

Matrix (i.e grid pattern) arrays from visual search studies (e.g. Flykt, in press) were presented before the probe in two dot-probe experiments. This was done to investigate to what extent probe reaction times (RTs) would reflect the RTs to targets in visual search tasks. The participants were instructed to try to ignore the arrays and to focus on fast and accurate responses to the dot-probe. The results suggest two different processing stages, at 45 and 90 ms array exposure respectively. These processing stages were interpreted as one that orients attention towards a deviant item in the array and another, latter stage, that is dependent on what overarching categories of the deviant items and the remaining items in the array belongs to. It is further suggested that caution should be taken when making inference about the mechanism behind RTs in relation to emotional stimuli.

The difference in dynamics of resource allocation to pictures of spiders and pictures of other animals in spider fearful participants was investigated. The tasks of the participants were to respond rapidly and accurately to various probe stimuli superimposed on pictures of different animals. These were supposedly fear-relevant (spiders, snakes, and wolfs) and fear-irrelevant (beetles, turtles, and rabbits). The probes were exposed at different stimulus onset asynchronies (SOAs) from picture onset to address the dynamics of resource allocation. The results showed a larger allocation of resources to spider pictures than to pictures of other animals and the resource allocation showed differences depending on task and dependent measure.

Background: Assessing pain in critically ill patients is difficult. Skin conductance variability (SCV), induced by the sympathetic response to pain, has been suggested as a method to identify pain in poorly communicating patients. However, SCV, a derivate of conventional skin conductance, could potentially also be sensitive to emotional stress. The purpose of the study was to investigate if pain and emotional stress can be distinguished with SCV.

Methods: In a series of twelve 1-min sessions with SCV recording, 18 healthy volunteers were exposed to standardized electric pain stimulation during blocks of positive, negative, or neutral emotion, induced with pictures from the International Affective PictureSystem (IAPS). Additionally, authentic intensive care unit (ICU) sound was included in half of the sessions. All possible combinations of pain and sound occurred in each block of emotion, and blocks were presented in randomized order.

Results: Pain stimulation resulted in increases in the number of skin conductance fluctuations (NSCF) in all but one participant. During pain-free baseline sessions, the median NSCF was 0.068 (interquartile range 0.013-0.089) and during pain stimulation median NSCF increased to 0.225 (interquartile range 0.146-0.3175). Only small increases in NSCF were found during negative emotions. Pain, assessed with the numeric rating scale, during the sessions with pain stimulation was not altered significantly by other ongoing sensory input.

Conclusion: In healthy volunteers, NSCF appears to reflect ongoing autonomous reactions mainly to pain and to a lesser extent, reactions to emotion induced with IAPS pictures or ICU sound.

Background: The purpose was to investigate if potentially stressful reminders of the intensive care unit (ICU) stay influenced variability in transient skin conductance responses, and whether such changes were associated with post-traumatic stress symptoms (PTSS), and development of symptoms over time. Methods: Thirty patients with an ICU length of stay > 48 h were included in the study. Within the week after ICU discharge (T1), patients were exposed to authentic ICU sound and questions regarding traumatic ICU memories while skin conductance reactivity was monitored. PTSS was assessed using PTSS-10 at T1 and again 3 months later (T2). Changes in number of skin conductance fluctuations per second (NSCF) between baseline and during the cueing conditions and in relation to PTSS scores (T1) were investigated. PTSS scores at T2 and changes between T1 and T2 (PTSS-CS) were used to investigate if reactivity in NSCF could predict symptoms of PTSD. Results: The results showed increases in NSCF during both situational and verbal cueing, compared to baseline. However, no relation to PTSS scores was indicated. Negative correlations between NSCF during situational cueing and both PTSS-T2 and PTSS-CS were found among women, but not among men. Conclusion: A low variability, or reactivity in skin conductance responses to situational cues could imply a risk of developing, or not being able to recover from, symptoms of PTSD in women. As such, the measurement could be used to predict this risk in women. However, further studies are necessary to evaluate this area of application.

In 2015 there was an unforeseen increase of refugees worldwide. In order to face the high rates of psychological distress refugees suffer, the AMIR-project created a model for early assessment and intervention of mental health among refugees. Previous research might not be applicable to the groups seeking asylum in Europe from 2015, so as a first step, a study aiming to estimate the prevalence of mental health problems was conducted.  

Methods. Five hundred and ten refugees participated at open screenings conducted at refugee housing facilities. Of the participants, 367 were asylum seekers and 143 had received a residence permit. Instruments included measures of depressive symptoms, anxiety, risk of having PTSD and quality of life.

Preliminary results. A high percentage of individuals (56-58.4%) reported clinically significant levels of depression, anxiety and risk of having PTSD. Prevalence estimates were significantly higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated significantly with mental health outcomes.

Conclusions. Individuals residing in refugee housing facilities show high levels of psychological distress. Asylum seekers are worse off than those having received a residence permit. Actions should be taken to improve conditions in housing facilities, to shorten the time awaiting the asylum decision and to provide psychosocial support to help individuals manage their distress during the time of waiting.

Key words: Refugee – asylum seeker – mental health – quality of life - prevalence

In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals. 

Methods. Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF).

Results. Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes.

Conclusions. Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process wait time and improve conditions at the housing facilities.  

Refugees worldwide suffer high levels of distress and are at increased risk for death by suicide. The Refugee Health Screener (RHS) was developed to screen for emotional distress among refugees and can be used to assess distress severity. This paper examines the association between distress severity and suicidal ideation in a sample of refugees residing in asylum accommodations. Data from the RHS and item 9 on the Patient Health Questionnaire-9 (PHQ-9) was analyzed. Results showed that individuals at moderate and severe levels of distress were much more likely to exhibit suicidal ideation than individuals with low levels of distress. Even though we cannot conclude that individuals with low levels of distress do not have thoughts of ending their lives, further suicide assessment is warranted in asylum seekers with moderate to severe distress on the RHS. 

Refugees often experience multiple losses. Despite this, and even though the loss is often due to unnatural causes and violent killings, the presence of Prolonged Grief (PG) among refugees may be obscured by other diagnoses such as depression and post-traumatic stress disorder (PTSD). In this cross-sectional study, we assessed the prevalence of PG and its comorbidity with depression and PTSD among 679 adult refugees in Sweden. Results showed that 401 (59.06 %) individuals had lost someone close to them, whom they were grieving intensely. Of these, 76 individuals (18.95 % of 401) fulfilled the criteria for PG. In the full sample, 304 individuals fulfilled the criteria for depression and 56 (18.42 % of 304) of these individuals also fulfilled the criteria for PG. Similarly, 315 fulfilled the criteria for PTSD. Among these individuals, 201 reported loss and 64 (20.32 % of 315) also fulfilled the criteria for PG. The results indicate that behind symptoms of depression and PTSD, there may be a layer of grief. This needs to be considered if we are to provide accurate and effective assessments and interventions for refugees. 

Asylum seekers suffer high levels of distress but have restricted access to mental health care. This paper constitutes an evaluation of a psycho-educational group intervention, called AMIN, which was provided at two asylum accommodation centers in Sweden. A mixed-methods approach was used. To assess potential effectiveness, acceptability, and feasibility, quantitative outcome measures were combined with qualitative information from interviews with both intervention participants and staff providing the intervention. Potential effectiveness in reducing symptoms of distress and insomnia and in increasing physical quality of life was found, even though the intervention participants suffered from more severe distress than expected. In general, the intervention seemed to be acceptable to both participants and staff, with concrete strategies seeming more meaningful than abstract psychological techniques. Finally, regardless of the asylum process itself being a complicating factor, the intervention seemed feasible to deliver to individuals with different backgrounds and conditions. Taken together, these results indicate that some sessions may need further elaboration, but also that the transition to a randomized control trial is reasonable.

Research indicates that subgroups of refugees may be at increased risk for suicidal ideation, but further knowledge on this topic is needed. This study aimed to assess both prevalence and factors associated with suicidal ideation among newly arrived refugees in Sweden. Assessing suicidal ideation was part of a larger project, aiming to develop a model for assessment and treatment of mental health problems among refugees. The included data were based on a cross-sectional survey among 510 asylum seekers and refugees, all under the care of the Swedish Migration Agency. The project group visited 12 asylum accommodations and 9 other locations, asking potential participants to answer a survey with questions on mental health, suicidal ideation and quality of life. Data were analysed using logistic regression. Symptoms of depression, anxiety and posttraumatic stress disorder, low physical and psychological quality of life, and being of young age were all independently associated with suicidal ideation. This study points to the importance of identifying refugees with mental health problems and of providing them with adequate care. It also indicates the importance of assuring a decent quality of life at asylum accommodations, and it shows that the young may constitute an especially vulnerable group. 

BACKGROUND: Many refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure. METHODS: Seven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers. RESULTS: The results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%). DISCUSSION: This study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation. 

In this cross-sectional study we aimed to assess symptoms of depression and anxiety at an early stage of the COVID-19 pandemic, and to explore factors predictive of these mental health outcomes. A sample of 1,503 participants, recruited from the general Swedish population, completed an online survey distributed through social media. In this sample, 22.2% reported clinically significant levels of depressive symptoms (PHQ-9 >= 10) and 10.9% indicated possible major depression using the PHQ-9 algorithm. Moreover, 28.3% reported clinically significant levels of anxiety (GAD-7 >= 8) and 9.7% severe anxiety and possible GAD (GAD-7 >= 15). Multiple linear regression analyses identified some common predictors for both outcomes. Age, having a stable income, and sufficient social stimulation, sleep, and recovery showed negative associations, whereas worry about the economy and overall burden showed positive associations. These results suggest an impact on mental health already at an early stage of the COVID-19 pandemic.

Background: Although post-traumatic stress is prevalent among unaccompanied refugee minors (URM), there are few evidence-based psychological interventions for this group. Teaching Recovery Techniques (TRT) is a brief, manualised intervention for trauma-exposed youth, which has shown promising results in exploratory studies. The aim of the present study was to assess the feasibility of conducting a randomised controlled trial (RCT) evaluating the use of TRT among URM by investigating key uncertainties relating to recruitment, randomisation, intervention delivery and data collection. Methods: A 3-month long non-blinded internal randomised pilot trial with a parallel-group design assessed the feasibility of a planned nationwide multi-site RCT. URM with or without granted asylum were eligible if they were 14 to 20 years old, had arrived in Sweden within the last 5 years and had screened positive for symptoms of post-traumatic stress disorder (PTSD). Quantitative data were collected pre- and post-intervention, and 18 weeks after randomisation. On-site individual randomisation (1:1) followed directly after pre-intervention assessment. Participants allocated to the intervention were offered seven weekly group-based TRT sessions. Quantitative pilot outcomes were analysed using descriptive statistics. Qualitative information was gathered through on-site observations and follow-up dialogue with group facilitators. A process for Decision-making after Pilot and feasibility Trials (ADePT) was used to support systematic decision-making in moving forward with the trial. Results: Fifteen URM (mean age 17.73 years) with PTSD symptoms were recruited at two sites. Three of the youths were successfully randomised to either TRT or waitlist control (TRT n = 2, waitlist n = 1). Fourteen participants were offered TRT for ethical reasons, despite not being randomised. Six (43%) attended ≥ 4 of the seven sessions. Seventy-three percent of the participants completed at least two assessments, with a response rate of 53% at both post-intervention and follow-up. Conclusions: The findings demonstrated a need for amendments to the protocol, especially with regard to the procedures for recruitment and randomisation. Upon refinement of the study protocol and strategies, an adequately powered RCT was pursued, with data from this pilot study excluded. Trial registration: ISRCTN47820795, prospectively registered on 20 December 2018 

The high number of asylum seekers in Sweden has highlighted the need for structured assessment tools to screen for refugee mental health problems in clinical services. We examined the utility of the Refugee Health Screener (RHS) in refugee adolescents, aged 14-18, attending routine clinical examinations or staying in group homes/refugee centres (N=29). Participants completed a survey, including the RHS, administered through iPads in their native language. The RHS showed excellent internal consistency (α = .96) and correlated moderately with symptoms of PTSD (r=0.41, p=.025). Mean scores and prevalence rates were comparable to a study of adult refugees in Sweden. Unaccompanied refugee minors (URM) scored significantly higher (M=32.0, SD=12.9) compared to youth staying with their families (M=7.5, SD=8.2, p<.001, d=2.27). Our findings confirm that the RHS can be used in the adolescent population in Sweden.  These findings moreover suggest that URMs are a particularly vulnerable group with a large burden of mental health problems.

BACKGROUND: In 2015, 162,877 persons sought asylum in Sweden, 35,369 of whom were unaccompanied refugee minors (URMs). Refugee children, especially URMs, have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue years after resettlement. The Swedish UnaccomPanied yOuth Refugee Trial (SUPpORT) aims to evaluate a community-based intervention, called Teaching Recovery Techniques (TRT), for refugee youth experiencing PTSD symptoms.

METHODS/DESIGN: A randomised controlled trial will be conducted in which participants will be randomly allocated to one of two possible arms: the intervention arm (n = 109) will be offered the TRT programme, and the waitlist-control arm (n = 109) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; about 8 weeks after randomisation) and follow-up (T3; about 20 weeks after randomisation).

DISCUSSION: This study will provide knowledge about the effect and efficiency of a group intervention for URMs reporting symptoms of PTSD in Sweden. TRIAL REGISTRATION: ISRCTN, ISRCTN47820795. Prospectively registered on 20 December 2018.

Previous self-report measures of attachment have used different assessment approaches, and a common conceptualization is using a dimensional perspective in which attachment is measured with two factors: attachment anxiety and attachment avoidance. The Experiences in Close Relationships—Relationship Structures Questionnaire (ECR-RS) has, prior to this study, been assessed for psychometric properties regarding specific relationships, but not in a shorter version for close relationships in general. In this paper, we present a Swedish translation of the ECR-RS Global nine-item version assessed for factor structure and psychometric properties by using a cross-validation approach with two separate adult samples. In Study 1 (N = 492), participants were randomly split into two subsamples. Using an exploratory factor analysis (EFA), the first subsample was used for finding the best-fitting model while the second subsample was used to test the a priori model using confirmatory factor analysis (CFA). In Study 2 (N = 806), we set out to validate the factor structure yet again by using CFA. Results from the EFA supported a two-factor structure with six items for attachment avoidance and three items for attachment anxiety. In the validation of the factor structure using CFA, both studies showed that all model-fit indices were good only after some modification, including removal of one avoidance item. Methodological reasoning and implications are discussed. The final eight-item model showed good internal consistency, as well as good convergent and discriminant validity, and multi-group invariance tests for gender and age showed no violations to invariance. Findings are encouraging to use this short global attachment self-report instrument, but further validation is advised. 

Introduction: The aim of the present study was to investigate how emotions influence pain, measured by one subjective self-rated measure, the numeric rating scale (NRS), and one objective physiological measure, the number of skin conductance responses (NSCR). Method: Eighteen volunteers were exposed to conditions with pictorial emotional stimuli (neutral, positive, negative), authentic ICU-sound (noise, no-noise) and electrical stimulation (pain, no-pain) individually titrated to induce moderate pain. When using all combinations of picture inducing emotions, sound, and pain, each of these conditions (12 conditions lasting for 60 seconds each) were followed by pain ratings. Ratings of arousal (low to high) and valence (pleasant to unpleasant) were used as indicators of affective state for each condition. Mean NSCR was also measured throughout the experiment for each condition. Results: Even though NRS and NSCR increased during painful stimuli, they did not correlate during the trial. However, NSCR was positively correlated with the strength of the electrical stimulation, r = 0.48, P = 0.046, whereas NRS showed positive correlations with the anxiety level, assessed by affective ratings (arousal, r = 0.61, P < 0.001, and valence, r = 0.37, P < 0.001). Conclusions: The NRS was strongly influenced by affective state, with higher pain ratings during more anxiety-like states, whereas NSCR correlated to the strength of electrical pain stimulation. That reported pain is moderated by anxiety, puts forward a discussion whether reduction of the anxiety level should be considered during analgesia treatment.

BACKGROUND: Refugee children have often experienced traumas and are at significant risk of developing mental health problems, such as symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, which can continue for years after resettlement. The Accompanied refugeeS In Sweden Trial (ASsIST) aims to evaluate a community-based intervention, called 'Teaching Recovery Techniques' (TRT), for accompanied refugee minors experiencing PTSD symptoms. METHODS/DESIGN: A cluster randomised controlled trial will be conducted in which participants will be randomly allocated to one of the two possible arms: the intervention arm (n=113) will be offered the TRT programme and the waitlist-control arm (n=113) will receive services as usual, followed by the TRT programme around 20 weeks later. Outcome data will be collected at three points: pre-intervention (T1), post-intervention (T2; c.8 weeks after randomisation) and follow-up (T3; c.20 weeks after randomisation). ETHICS AND DISSEMINATION: Ethical approval was granted by the Regional Ethical Review Board in Uppsala (Ref. 2018/382) (24th February 2019). Results will be published in scientific journals. TRIAL REGISTRATION DETAILS: ISRCTN17754931. Prospectively registered on 4th June 2019.