Anna Ohlis

Research problem and specific questionsMental health problems among youths are common and seemingly increasing. Social media has been assigned a possible causative role. However, scientific evidence is inconclusive. To gain a better understanding of the effect of social media on youths’ mental health, this project will explore the association in a longitudinal design, considering type of social media platform, the user’s motive and activity, and the impact on everyday life and sleep.This project aims to explore:if different patterns of social media use (SMU) predict the course of well-being and mental health problems among youthsif individual factors affect the impact of SMU on the individual’s mental healthif there is a bidirectional relationship between SMU and mental healthData and methodAll participants in the ongoing study “Prevalence of emotional distress and mental disorders among teenagers in Sweden and their need for support” (PEDALS), a cross-sectional study with a representative sample of 6000 students age 14-15 and age 17-18, will be invited to participate in the here described longitudinal study. The longitudinal study implies that the participants will be followed up at one year and two years after the PEDALS assessment (baseline assessment). At each assessment (baseline, one year, two year) the participants will be asked about patterns of SMU, well-being, sleep, gender identity, sexual orientation, and mental distress. Mental disorders are also assessed with a digital diagnostic interview where the responses are assessed by a clinician.Societal relevance and utilizationThere are widespread concerns about the seemingly steadily increasing prevalence of mental health problems among youths and increase in suicide rates. Society needs to present preventive actions. This requires longitudinal studies to gain knowledge on underlying factors that are influenceable.Exploring the relationship between SMU and mental health in youths would inform youths on beneficial SMU, offer guidance to parents and teachers, and recommendations to developers of social media platforms on favorable features. Plan for project realizationThe study time frame is three years. Participants are recruited within the PEDALS. All assessments are digital. The questionnaires are developed in collaboration with non-governmental organizations and youth representatives. The budget of 3,7 million covers salaries for the applicant and part time research assistant and operating costs.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder marked by significant comorbidity and serious outcomes. The use of ADHD medication has surged in Sweden and many other countries, and it prompts questions about its effectiveness and safety amid broadened diagnostic criteria. Despite the general efficacy of these medications, patient responses vary, and high discontinuation rates prevail, highlighting an urgent need for more personalized treatment strategies. This proposal aims to enhance our understanding of the individualized treatment effects of ADHD medication related to patient characteristics and to develop a decision-aid tool for personalized treatment decisions. It focuses on key clinical decisions: whether to initiate medication and the choice of first- and second-line treatments. Utilizing extensive healthcare data from Sweden, Denmark, and the US, we plan to employ cutting-edge study designs and statistical methods. The decision-aid tool, created with end-user collaboration, will be evaluated in a pilot study. The project will be carried out by an interdisciplinary team of researchers from Karolinska Institutet, clinicians from region Stockholm and Skåne, and international experts in the field. This innovative approach aims to improve patient outcomes, reduce side effects, and tackle the challenges associated with the rising use of ADHD medications, marking a substantial step towards personalized ADHD treatment.

Self-injury is a growing health crisis among youth, and the strongest risk factor for suicide attempts. Scalable treatments are needed but lacking. We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious and cost-effective. However, not all patients respond sufficiently to the standard treatment procedure. Now we aim to implement and evaluate IERITA within regular health services and optimize treatment outcomes. First, we will develop and validate a classification tool to predict non-remission (continued self-injury after treatment). This tool will subsequently be used in the second step: a randomized controlled trial (N=341) between 2025 to 2028, which compares adaptable to standard IERITA. Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will recieve adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks. We will (1) follow participants one- three- and twelve-month post-treatment

(2) use self-reports and blinded assessments

(3) study distal effects in national registers

(4) investigate several clinically relevant outcomes

and (5) conduct cost-effectiveness analyses. If successful, more patients could receive evidence-based treatment for self-injury, and treatment outcomes could be improved. In extension, queues to care may be reduced, and suicide attempts and suicides prevented.

Research idea and purposeSelf-injury is a growing and urgent health crisis among youth and the strongest risk factor for suicide attempts. Scalable and evidence-based treatments are needed but lacking. We have recently shown that a brief digital treatment, IERITA (Internet-delivered Emotion Regulation Individual Therapy for Adolescents), can be efficacious compared to treatment as usual only. However, not all patients respond sufficiently to the standard treatment procedure, and established efficacy does not guarantee successful uptake in regular care. This project aims to implement and evaluate IERITA in real-world settings and optimize treatment outcomes. A planning grant creates opportunities to test the project´s feasibility, an essential part of preparation for a large-scale study.Work plan, methods and project realisationFirst, a classification tool to predict continued self-injury after treatment (non-remission) will be developed and subsequently used in a randomized controlled pilot trial (N=30) comparing adaptable to standard IERITA. Adolescents allocated to adaptable IERITA and classified as likely non-remission in treatment week four will change to adapted IERITA (e.g., personalized dose and treatment delivery) for the remaining eight weeks. Feasibility will be evaluated through the number of completed treatment parts, degree of participation in data collection, satisfaction, adherence, and therapist time. Clinically relevant outcomes will also be measured, which include remission (primary clinical outcome), frequency of self-injurious behaviour, suicidality and level of functioning. Participants will be followed up one- and three months post-treatment. The project will be conducted within regular health care services in several regions which we have collaborated with previously. Patient organizations and health professionals will contribute to increasing relevance and feasibility. The budget includes salaries for the project manager and patient organization, and a smaller part for operating costs.Societal relevance and utilisationSelf-injury is rapidly increasing, posing severe risks for youths. The queue to healthcare services is long, and current treatments are costly and not widely or equally accessible. If this project is successful, more youths across the country could receive effective early intervention for self-injury, with the hope of reduced waiting times, equal care, and suicide preventive effects.

Suicide is the leading cause of death among 10–18-year-olds in Sweden. Suicide attempt is the most robust predictor of future attempts and suicide. Yet, no evidence-based treatment currently exists for preventing suicide reattempts. Safe Alternatives for Teens and Youths (SAFETY) is a novel scalable family-based cognitive-behavioural suicide prevention program designed to fill this critical gap. SAFETY has shown promise in reducing suicide attempts. In the present trial we aim to evaluate the effect of SAFETY on youth suicide attempts by comparing SAFETY to the active control condition “Enhanced Treatment as Usual” in a randomized clinical trial (RCT

N=282), recruiting from five sites across Sweden. The analyses will be conducted on an intention-to-treat basis. The primary outcome is the difference in the proportion of individuals with a new suicide attempt between the two groups at 3- (primary end-point) and 12-month post-treatment, analyzed using Pearson´s chi-squared test. Patients will be enrolled and treated between 2025 and 2027. Our initial findings from a feasibility RCT of SAFETY (N=30) in Stockholm indicate that our research protocol, including participant recruitment and treatment conditions, is feasible. The present study will investigate the impact of SAFETY on suicide attempts, evaluate the durability of the effects, and evaluate the cost-effectiveness of the intervention. The pilot and planning for the RCT have already been partially funded by other sources.

The discussion on how to support the possibly increasing group of adolescents with mental health problems sometimes becomes polarized due to our fragmentary knowledge of the actual needs and numbers. This project will, for the first time, systematically assess:the proportions of adolescents in Sweden with different levels of mental health problems, ranging from emotional distress (which does not fulfill diagnostic criteria) to mental disorders (fulfilling criteria, for, e.g., depression or anxiety), andtheir need and utilization of support and care, taking a broad view of potential support structures beyond, but including, the health care system.The study is based on computer assisted assessments of 6,000 eligible 14- and 17-year-olds in schools and their parents online. Emotional distress will be measured with validated symptom scales (GAD-7 and PHQ-A) and mental disorders using a well-established diagnostic instrument (DAWBA). Information on the frequency, severity, and duration of symptoms and their impact on function will be integrated into Children’s Global Assessment Scale (CGAS) ratings. All together these measures form a solid ground for experienced psychiatrists to appraise  levels of emotional distress and diagnosed mental disorders as well as need of support. Information on self-reported need of a wide range of support functions will be compared with professionals’ assessments of need. Health care data from registers in combination with self-reported utilization of support and care will be compared with professionals’ judgement of need, to estimate hidden proportions of those who are not in contact with care despite an existing need or identify potential “overutilization”. Key demographic and socioeconomic information will be linked from registers to understand how the prevalence of emotional distress and mental disorders varies among different populations, as well as the degree to which needs for support are met in different groups.  The main applicant is responsible for the project, supported by a senior researcher as academic coordinator and a fulltime project leader for practical tasks. Questions on self-reported needs and utilization will be developed in collaboration with e.g. adolescents, NGOs, school health care. The budget is estimated to total 6.9 million over four years.Not until we have the facts can we appropriately act and lay the ground for a broader perspective on support for mental health for adolescents in Sweden.