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ObjectivesTo estimate the prevalence of and associations between anxiety, depression, post-traumatic stress disorder (PTSD), low subjective well-being (SWB), potential traumas and postmigration stress among refugees from Syria resettled in Sweden.DesignA cross-sectional and population-based questionnaire study based on a known and complete sample frame. The survey included multiple measures of mental ill health and factors of particular relevance for refugees. Weighted analyses were conducted to calculate representative prevalence rates and associations. Associations were investigated through a series of logistic regression analyses. All analyses were supplemented with robust 95% CIs.SettingSweden.ParticipantsA random sample of 1215 individuals (response rate 30.4%) from Syria aged 18–64 years that were granted residency in Sweden on grounds of asylum between 2011 and 2013.Main outcome measuresAnxiety, depression, PTSD and low SWB were assessed through Hopkins Symptom Checklist, Harvard Trauma Questionnaire and WHO-5 Well-being Index, using established cut-offs.ResultsA majority of the participants met the criteria for at least one of the studied types of mental ill health, and the comorbidity was high. Depression was the most the common type with 40.2% (95% CI 36.9% to 43.3%), followed by low SWB with 37.7% (95% CI 34.8% to 40.1%), anxiety with 31.8% (95% CI 29.2% to 34.7%) and PTSD with 29.9% (95% CI 27.2% to 32.6%). Refugee-related potentially traumatic events (PTEs) experienced before or during migration was common as was substantial levels of postmigration stress. Most types of refugee-related PTEs, especially being exposed to interpersonal violence, and postmigration stress were associated with increased risks for anxiety, depression, low SWB and PTSD.ConclusionsMental ill health, in terms of anxiety, depression, low SWB and PTSD, are highly elevated and comorbid among refugees from Syria. Increased attention from multiple societal sectors to adequately support Syrian refugees’ mental health needs, promoting recovery and reducing postmigration stress are needed.

Aim: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population. Methods: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25–75-year-olds living in Sweden in 2000 that received a postal questionnaire (n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed. Results: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI. Conclusions: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

Background Parenting practices, such as emotional support and warmth, are key determinants of adolescent mental health, whereas the role of parental knowledge is less well understood. Parental warmth is thought to foster openness and disclosure, raising the question of whether parental knowledge independently predicts mental health outcomes or primarily reflects the quality of the parent-adolescent relationship. The present study used prospective data to test whether parental knowledge in late adolescence contributes independently to depression and anxiety symptoms in young adulthood after accounting for parental warmth and relevant covariates. Methods Data from two waves of the national Swedish cohort study Futura01 were used ( n  = 2,697). Parental warmth and parental knowledge were measured at age 18, each using two items. Depression and anxiety symptoms were measured at age 21 with the Patient Health Questionnaire-4 (PHQ-4). Covariates included participant sex, parental education, immigration background, living arrangements at age 18, and indicators of mental health problems at age 18. Linear probability models were performed. Results In unadjusted analyses, higher parental warmth and parental knowledge during late adolescence were both associated with a lower probability of reporting depressive and anxiety symptoms in young adulthood. However, when mutually adjusting for parental warmth and parental knowledge, the effect of parental knowledge was no longer statistically significant, indicating that its association with mental health outcomes was confounded by parental warmth. In contrast, parental warmth remained significantly associated with lower probabilities of both depression and anxiety symptoms, even after accounting for parental knowledge, sociodemographic characteristics, and earlier mental health problems. There were no significant interactions between parental warmth and parental knowledge, and participant sex did not moderate the associations. Conclusion This study highlights the protective role of parental warmth during late adolescence for depression and anxiety symptoms in young adulthood, with warmth showing a consistent association with lower probabilities of these outcomes. However, parental knowledge did not demonstrate an independent effect on mental health after accounting for warmth and covariates. The findings underscore the importance of fostering warm, supportive parent–adolescent relationships during late adolescence, as these relationships appear to have lasting benefits into young adulthood.

The number of patients presenting for care at gender clinics is increasing, yet the proportion of adults in the general population who want gender-affirming medical treatment remains essentially unknown. We measured the wish for cross-sex hormones or gender-affirming surgery, as well as other aspects of gender incongruence, among the general adult population of Stockholm County, Sweden. A population-representative sample of 50,157 Stockholm County residents ages 22 and older comprise the Stockholm Public Health Cohort. They were enrolled in 2002, 2006, and 2010 and followed-up in roughly 4-year intervals, with questions on health, lifestyle and social characteristics. In 2014, participants received the item \"I would like hormones or surgery to be more like someone of a different sex.\" Two additional items concerned other aspects of gender incongruence: \"I feel like someone of a different sex\", and \"I would like to live as or be treated as someone of a different sex.\" Each item had four answer options (\"Not at all correct\", \"Somewhat or occasionally correct\", \"Quite correct\", and \"Absolutely correct\"). For each item, any of the three affirmative answer choices were considered as some level of agreement. Calibration weights were used to estimate population-representative rates with 95% confidence intervals. The desire for cross-sex hormones or surgery was reported by 0.5% (95% CI, 0.4%-0.7%) of participants. Feeling like someone of a different sex was reported by 2.3% (95% CI, 2.1%-2.6%). Wanting to live as or be treated as a person of another sex was reported by 2.8% (95% CI, 2.4%-3.1%). These findings greatly exceed estimates of the number of patients receiving gender-affirming medical care. Clinicians must be prepared to recognize and care for patients experiencing discomfort due to gender incongruence and those who would like gender-affirming medical treatment.

Objectives The Major Depression Inventory (MDI) was constructed to assess DSM‐IV and ICD‐10 depression symptoms, and does not fully cover the symptoms listed in DSM‐5 and ICD‐11. This study aimed to augment the MDI to the new diagnostic standards by adding a new item, and to assess and compare the measurement performance of the MDI items and diagnostic algorithms for major depression according to DSM‐IV, ICD‐10, DSM‐5 and ICD‐11. Methods Surveys collected 2001–2003 and 2021, including self‐assessed MDI were used. A new hopelessness item was constructed and analyzed alongside the hopelessness item in the Symptom Checklist. The performance of items was compared using Rasch and Mokken analyses. Criterion validity was examined using equivalent diagnoses from psychiatric interview (Schedules for Clinical Assessments in Neuropsychiatry [SCAN]) as standard. Results MDI information was provided by 8511 individuals in 2001–2003 (SCAN subsample n = 878), and 8863 in 2021. All items, including hopelessness had good psychometric properties. Sensitivity ranged between 56% and 70%, and specificity between 95% and 96%, indicating similar criterion validity. Conclusions Hopelessness and the MDI items had good psychometrics. MDI for DSM‐5 and ICD‐11 had similar validity as for DSM‐IV and ICD‐10. We recommend that MDI is updated to DSM‐5 and ICD‐11 by adding a hopelessness item.

Background Previous research has shown that exposure to bullying is linked to long-term adverse mental health consequences. However, prospective studies examining the persistence of bullying, using information from repeated time points, are limited. The aim of this study was to examine, firstly, the extent to which exposure to bullying among adolescents in Sweden changes between grades 9 (age 15–16) and 11 (age 17–18) (i.e., before and after the transition from lower to upper secondary school); secondly, whether being bullied in grade 9 or 11 is associated with depression and anxiety symptoms at age 20–21; and thirdly, if being bullied in both grade 9 and 11 is linked to an even higher likelihood of subsequent depression and anxiety symptoms. Potential differences by gender were investigated throughout. Methods Data was derived from the Swedish cohort study Futura01 involving individuals attending grade 9 in the school year 2016/17 ( n  = 2323). We utilised self-reported information from three survey waves conducted in 2017, 2019, and 2022, and linked registry information on sociodemographic characteristics. Bullying was assessed using a single item in waves 1 and 2. Depression and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4) in wave 3. Gender stratified binary logistic regressions were performed. Results Among those who were bullied in grade 9, 22.6% of males and 35.8% of females continued to experience bullying in grade 11. For females, exposure to bullying in grade 9 or 11 was associated with an increased likelihood of reporting depression and anxiety symptoms at age 20–21, with the highest odds for those bullied at both time points. For males, only one statistically significant association was identified – specifically, between being bullied in grade 9 and subsequent depression symptoms. Conclusions For a majority of adolescents who experience bullying in lower secondary school, but not all, the transition to upper secondary school proves to be beneficial as the bullying typically does not persist. However, bullying can have long-term health effects, in particular for females. These findings emphasise the importance of effective measures to address bullying within schools.

Objectives This study aimed to examine if the General Health Questionnaire (GHQ)‐12 and Kessler 6 (K6) assess the same underlying construct and to develop a score conversion table for the two scales. Methods A random sample of 4303 people who completed both the GHQ‐12 and K6 in 2021 were analyzed. Exploratory bifactor analysis evaluated if both scales measured the same construct, and Rasch analysis assessed item severities. The scales were transformed using Equipercentile equivalence for comparability and score conversion. Agreement was estimated with Cohen's Kappa coefficient, along with raw positive and negative agreement. Results We found that the two scales measure the same phenomenon to the extent that they can be made equivalent. Conversion tables between GHQ‐12 and K6 are presented. Applying the commonly used cut‐off of ≥3 on the GHQ‐12 bi‐modal scoring, we found that the best corresponding cut‐off on the K6 would be ≥8. The prevalence of psychological distress was then 22% with GHQ‐12% and 21% with K6. Conclusions The GHQ‐12 and K6 measure the same construct and corresponding cut‐off scores on one scale were found for the other scale. This is valuable for longitudinal studies or time series where one scale has replaced the other scale.

Problematic alcohol use is a major contributor to the global burden of death and disabilities, and it represents a public health concern that has grown substantially following the COVID-19 pandemic. The available treatment options remain limited and to develop better pharmacotherapies for alcohol misuse we need to identify suitable biological targets. Previous research has implicated the brain’s endocannabinoid system (ECS) in psychiatric and stress-related outcomes, including substance use and habituation to repeated stress. Moreover, genetic variants in the cannabinoid-1 receptor gene ( CNR1 ; CB1R ) have been associated with personality traits, which are in turn predictors of substance use disorders. To date, however, no human genome-wide association study has provided evidence for an involvement of the ECS in substance use outcomes. One reason for this ECS-related “missing heritability” may be unexamined gene-environment interactions. To explore this possibility, we conducted cross-sectional analyses using DNA samples and stress-exposure data from a longitudinal Swedish population-based study ( N  = 2,915). Specifically, we genotyped rs2023239, a functional C/T single nucleotide polymorphism in CNR1 , previously reported to be associated with CNR1 binding in the brain, subjective reward following alcohol intake, and alcohol cue-elicited brain activation. Our two outcomes of interest were (i) problematic alcohol use based on the Alcohol Use Disorders Identification Test (AUDIT), and (ii) personality trait scores based on the Five Factor Model. We found no baseline association between rs2023239 and problematic alcohol use or personality traits. However, there was a clear trend for interaction between rs2023239’s risk allele (C) and stressful life events (SLEs) in both childhood and adulthood, which predicted problematic alcohol use. Although not significant, there was also some indication that the risk allele interacted with child SLEs to increase scores on neuroticism. Our study supports the notion that the ECS can affect alcohol intake behaviors by interacting with life adversities and is—to the best of our knowledge—the first to focus on the interaction between CNR1 and stressors in both childhood and adulthood in humans. Further studies are warranted to confirm these findings.

Objective To investigate the associations between low education and risk of mental disorders, substance use disorders and self‐harm in different age‐groups. Methods All subjects in Stockholm born between 1931 and 1990 were linked to their own or their parent's highest education in 2000 and followed‐up for these disorders in health care registers 2001–2016. Subjects were stratified into four age‐groups: 10–18, 19–27, 28–50, and 51–70 years. Hazard Ratios with 95% Confidence Intervals (CIs) were estimated with Cox proportional hazard models. Results Low education increased the risk of substance use disorders and self‐harm in all age‐groups. Males aged 10–18 with low education had increased risks of ADHD and conduct disorders, and females a decreased risk of anorexia, bulimia and autism. Those aged 19–27 years had increased risks of anxiety and depression, and those aged 28–50 had increased risks of all mental disorders except anorexia and bulimia in males with Hazard Ratios ranging from 1.2 (95% CIs 1.0–1.3) for bipolar disorder to 5.4 (95% CIs 5.1–5.7) for drug use disorder. Females aged 51–70 years had increased risks of schizophrenia and autism. Conclusion Low education is associated with risk of most mental disorders, substance use disorders and self‐harm in all age‐groups, but especially among those aged 28–50 years.

ObjectiveTo investigate to what extent being outside education, employment or training after completed secondary education in Sweden might affect the risk of subsequent alcohol use disorders (AUDs), with sociodemographic indicators, such as sex, domicile and origin, taken into account.DesignPopulation register-based cohort study with 485 839 Swedish youths.SettingSweden.ParticipantsAll youths who were born between 1982 and 1991 and were aged between 19 and 24 years when they completed secondary education in Sweden, between 2005 and 2009.Primary outcome measureCox regression models were used to estimate the HR of first record of entry into alcohol-related medical care with a diagnosis of an AUD, by level of labour market attachment, from 1 January 2009 to 31 December 2016.ResultsAbout 4% of the youth population were outside education, employment or training and 25% were in insecure workforce after they completed secondary education. The risk of AUD was higher among youths in insecure workforce, HR 1.40 (95% CI 1.30 to 1.50), and among those outside education, employment or training, HR 1.30 (95% CI 1.11 to 1.51), compared with youths within the core workforce, also after adjusting for age, domicile, sex and origin. Being in education was associated with lower HR of AUD, HR=0.84 (95% CI 0.78 to 0.90).ConclusionYouths who are in insecure workforce and outside education, employment or training are at higher risk of AUD. Targeted policy actions are needed to support a successful school-work transition to secure equal opportunities for young people.