Erik Hedman-Lagerlöf

Mental health problems in youth is causing incalculable suffering in youth and families. Existing treatments in Primary Care are not fully addressing these problems because they focus on a subset of mental health problems

are limited in efficacy, and are not provided to most youth in need. Transdiagnostic online treatments addressing mechanisms underlying mental health problems, such as emotion regulation, have been called for. We will include 388 participants aged 12-17 years and their parents in a RCT comparing a 6-week Primary care Online Emotion-regulation Treatment (POET) to a 6-week active Supportive Treatment (ST) during 2023-2025, at several Primary Care clinics across Sweden. Both interventions will be delivered in blended format combining online therapist-supported treatment modules with a video-link session. Findings from our pilot RCT (N=30) demonstrated that the study procedures and treatment protocols are feasible and that POET is promising. The primary study aims are to examine the effects of POET vs ST at post-treatment, 3-, and 12-month follow-up on mental health problems, emotion regulation, and to test whether changes in emotion regulation mediates reduction in mental health problems. The broad long-term goal is to examine cost-effectiveness, for whom the treatment is efficacious, and to show how a brief treatment provided in youth in a Primary Care setting may have a positive impact on the trajectory into young adulthood.

Exhaustion disorder (ED, utmattningssyndrom) is one of the most common and costly mental disorders in Swedish primary care. However, the validity of ED is debated and there are no evidence-based treatments. The core of ED - fatigue - is common across a range of disorders. Recent advances in international research indicate that fatigue is best understood as a transdiagnostic symptom dimension rather than a diagnosis-specific pathology. This paves the way for new, potentially more effective, approaches to assessment and treatment.The purpose of this project is to increase knowledge of fatigue as a transdiagnostic symptom in primary care patients and to build evidence for a highly accessible transdiagnostic treatment for fatigue. Consecutively recruited primary care patients (N=500) with fatigue will be included in a multicenter randomized controlled trial and receive internet-delivered transdiagnostic cognitive behavioral therapy adjunct to care as usual, or care as usual only. Primary outcome will be change in fatigue severity (pre-post treatment) with controlled follow-ups up to 2 years from baseline. Moderators and mechanisms of treatment effect, and cost-effectiveness, will be analyzed.This project has the potential to build solid evidence for an accessible, cost-effective treatment of fatigue that can be readily implemented in primary care. Results will contribute to development of guidelines for assessment and treatment of fatigue, and better use of healthcare resources.

Research problem and specific questionsExhaustion disorder (ED, utmattningssyndrom) is one of the most common and costly mental disorders in Sweden, but the validity of ED is debated and there are no evidence-based treatments. The core of ED - fatigue - is common across a range of disorders, associated with work-disability and excess mortality. There is mounting evidence from international research supporting that fatigue should be conceptualized as a transdiagnostic symptom dimension rather than a diagnosis-specific pathology. Cognitive behavioral therapy (CBT) is effective in reducing fatigue across a range of medical conditions by the same change mechanisms. This speaks for a transdiagnostic treatment approach. The purpose of this project is to increase knowledge of fatigue as a transdiagnostic symptom in primary care patients and to evaluate the effect of a highly accessible transdiagnostic CBT for fatigue on symptom reduction and long-term work disability. We also aim to investigate moderators and mediators of treatment effect and treatment cost-effectiveness.Data and method Consecutively recruited primary care patients (N=500) with fatigue (independent of primary diagnosis) will be included in a multicenter randomized clinical trial and receive internet-delivered transdiagnostic CBT adjunct to care as usual, or care as usual only. Primary outcome will be change in fatigue severity (pre-post treatment). Secondary outcomes include self-rated symptoms, functional ability, and objective measures of cognitive impairment. Registry data will be used for analysis of healthcare consumption and sickness absence to the 1-year follow-up. Societal relevance and utilization  Fatigue is associated with suffering, work-disability, and high societal costs. This project can build solid evidence for an accessible, cost-effective treatment for fatigue with the potential to improve functional ability and prevent long-term sickness absence. Results can contribute to development of guidelines for assessment and treatment of fatigue, evidence-based recommendations for sick-leave prescription, and more efficient use of healthcare resources.Plan for project realization:Patients will be recruited from at least 3 primary care centers in Stockholm, using existing infrasturctures for care. The project group is a multidisciplinary team of researchers and clinicians from Karolinska Institutet, Stockholm University, and Amsterdam University Medical Center, Netherlands.

Mental health problems in children and adolescents are a major public health concern. Anxiety is the most common problem, but only a minority of those affected receive adequate care. Access to early interventions within primary care has the potential to combat a detrimental trajectory for children and adolescents, but more research is needed. Today, there is a lack of studies exploring early interventions for anxiety adequate to implement within primary care.In response to the increasing mental health problems in children and adolescents in Sweden, a first line mental health (FLMH) has been developed. A challenge for the FLMH has been to identify evidence-based interventions fitting the needs of their patients and organization, as interventions almost exclusively have been developed and evaluated within a psychiatric context. Adaptations of evidence-based interventions are made regularly in everyday practice, but research shows that such adaptations typically are conducted reactively rather than proactively. Adaptations are made in response to practical restraints rather than to provide a better fit for the target group and commonly without considerations of how core components will be affected.The overall aim of this project is to increase access to evidence based interventions for children suffering from mild to moderate anxiety. Using a scientific method, we will develop an intervention targeting childhood anxiety adapted to fit within primary care. We will explore the process of adapting evidence-based interventions within the FLMH and evaluate the effect of the intervention in a randomized controlled trial conducted at FLMH-units. The project provides guidelines on how evidence-based interventions can be adapted in the FLMH. If proven effective, the intervention could be beneficial for a large part of the population and contribute to better public health. After development and evaluation in everyday clinical practice, implementation will be straight-forward.