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Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionalsand managers in the youth mental health system in Sweden. Interviews explored participants’ experience andunderstanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergentstudy design using reflexive thematic analysis.

Results: The analysis produced three themes. The first shows that collaboration is considered as essential andimportant, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles andresponsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, andtarget levels, and the third captures the challenges and criticisms in collaborating across the youth mental healthlandscape, but also in growing possibilities for future development.

Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

Purpose: The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness".

Methods: Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke.

Results: The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'.

Conclusion: This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health

Social-emotional problems occurring early in life can place children at future risk of adverse health, social and economic outcomes. Determinants of social-emotional problems are multi-layered and originate from different contexts surrounding children, though few studies consider them simultaneously. We adopted a holistic approach by using Bronfenbrenner's process-person-context-time model as a structuring device. We aimed to assess what characteristics of families and children from pregnancy, over birth, and up to 3 years of age are associated with social-emotional problems in boys and girls. This study used regional data from the Salut Programme, a universal health promotion programme implemented in Antenatal and Child Health Care, and data from national Swedish registers. The study population included 6033 3-year-olds and their parents during the period 2010–2018. Distinct logistic regression models for boys and girls were used to assess associations between the family social context, parents' lifestyle, parent's mental health, children's birth characteristics, and indicators of proximal processes (the independent variables); and children's social-emotional problems as measured by the parent-completed Ages and Stages Questionnaire: Social-Emotional between 33 and 41 months of age (the outcome). Overall, a less favourable family social context, detrimental lifestyle of the parents during pregnancy, and parents' mental illness from pregnancy onwards were associated with higher odds of social-emotional problems in 3-year-olds. Higher screentime and infrequent shared book-reading were associated with higher odds of social-emotional problems. The multifaceted determinants of children's social-emotional problems imply that many diverse targets for intervention exist. Additionally, this study suggests that Bronfenbrenner's process-person-context-time theoretical framework could be relevant for public health research and policy.

Purpose – Young prisoners are one of the most vulnerable groups in society for mental health problems and ill-being. Therefore, there is a crucial need to understand their physical, psychological and social situations. This study aims to explore young Cambodian prisoners’ experiences and perceptions of mental health and well-being, their determinants and their coping strategies.

Design/methodology/approach – Six focus group discussions were carried out in three prisons with atotal of 48 young prisoners between the ages of 15 and 24 years (50% women, 50% men). Semistructured questions guided the discussions, and thematic analysis was applied to analyse the data.

Findings – Young prisoners reported multifaceted experiences of mental health and well-being. The majority described adverse mental health experiences, while some revealed better well-being, partlyinfluenced by the socio-economic support from outside the prisons and previous involvement or not indrug abuse. The experience of physical overcrowding without emotional attachment among the fellow prisoners was perceived as the overarching determinant of loneliness and mental health problems, while socio-emotional support and rituals were described as the most important coping mechanisms.

Originality/value – This pioneering study from Cambodia gives young prisoners an opportunity to voice their experiences and perceptions of mental health and well-being in the prison setting. The findings inthis study underline the importance of prison authorities tackling overcrowding to promote well-being andreduce mental health problems. Also, the coping mechanisms outlined by the participants should be considered when planning psychosocial interventions.

Introduction: Numerous studies globally confirmed that young prisoners are more susceptible to mental health problemscompared to adult prisoners and the general population. The lack of life skills has been reported as one of the main reasons forthis vulnerability. This study aimed to assess the effectiveness of a life skills education program on mental health and life skillsamong young prisoners in Cambodia.

Method: This is an intervention study, applying a ‘difference-in-difference’ analysis. The life skills education program wasimplemented to promote essential skills for mental health and social competence among young prisoners. Mental health and lifeskills competence were evaluated using the Youth Self-Report and Life Skills Development – Adolescent Form scales, respectively.Four prisons were selected from a total of 24 prisons in Cambodia, a post-conflict country in Southeast Asia. A total of 412 youngprisoners aged 15–24 years participated in the study and were randomly assigned to intervention and control groups.

Results: Both the intervention and control groups reported decreased mental health problems (DiD=3.78, p=0.34) and improvedlife skills competencies (DiD=0.39, p=0.80) after the intervention; however, the differences were not statistically significant.

Conclusion: The life skills intervention program had no significant effect on young prisoners’ mental health and life skillscompetencies. Further studies should be conducted to evaluate the impact of the life skills education program in the prison setting,particularly in low- and middle-income countries (LMICs) such as Cambodia.

Introduction: Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities.

Material and methods: For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities.

Results: The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion.

Conclusion: We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.

BACKGROUND: Both undiagnosed celiac disease and some chronic childhood diseases are associated with lower academic achievement. However, there is little knowledge of achievements in those diagnosed with celiac disease. Our aim was to investigate school achievements in upper secondary school among Swedish adolescents with celiac disease.

METHODS: We performed a retrospective cohort study using register data. We analyzed choice of upper secondary school program, completion of upper secondary school including achievements of basic eligibility for college/university, and final grade in individuals with celiac disease diagnosed before 15 years of age, born 1991-97. We compared with the Swedish population of the same birth years. Analyses were adjusted for sex, year of birth, living region at 17 years of age, and parental education as well as income.

RESULTS: The cohort included 734 074 individuals, whereof 3 257 (62% females) with celiac disease. There was no significant difference in choice of upper secondary school program. No significant difference was found in completion or achieving basic eligibility for college/university in adjusted analyses. The mean final grade in the celiac disease group was 13.34 (standard deviation 4.85) compared to 12.78 (standard deviation 5.01) in the reference population (p < 0.001), out of a maximum of 20. The effect of celiac disease on final grade remained in adjusted analyses (p = 0.012).

CONCLUSIONS: We found that diagnosed celiac disease does not negatively affect school achievements in upper secondary school. This finding suggests the diagnosis, treatment and follow-up programs of celiac disease could reverse potential deleterious academic processes.

PURPOSE: To examine how rural municipalities develop services to people with serious mental illness in relation to evidence-based practice and national guidelines. Additional sources of knowledge and strategies used by the municipalities in relation to their development needs were explored as well.

METHOD: Qualitative multiple-case approach, with 43 deep-interviews involving 84 informants representing selected social psychiatric services from 11 sites.

RESULTS: National guidelines and evidence-based practices have a limited impact on how rural municipalities develop services to the target group. The municipalities favor other sources of knowledge, including regional networks, pragmatic problem-solving approaches and community-based knowledge.

DISCUSSION AND CONCLUSION:  Most of the informants expressed a need for more systematic and evidence-based knowledge in order to meet their clients’ needs. A major challenge to improve the utilization of these methods, is to make adaptions to match the rural municipalities’ needs and actual resources without risking the quality of these evidence-based services.

Folkhälsomyndigheten (Fohm) har sedan 2018 regeringens uppdrag att bidra med kunskapshöjande insatser för att minska stigmatiseringen av psykisk ohälsa och suicid. Avtal har inledningsvis slutits med tre regioner för att stärka dessas främjande och preventiva arbete för att minska stigmatisering av psykisk ohälsa och suicid.

Umeå universitet har fått uppdraget att genomföra en processutvärderingmed implementeringsperspektiv under 2021. Utvärderingen har syftat till att bidra med en fördjupad förståelse för implementeringen av det regionala utvecklingsarbetet. Utvärderingen vilar på analyser av dokument, enkäter och fokusgruppsintervjuer från de medverkande regionerna. Utvärderingen har delvis tagit sin utgångspunkt i det teoretiska ramverket the Consolidated Framework for Implementation Research (CFIR). CFIR sammanfattar befintlig litteratur om faktorer som påverkar implementeringsprocesser och utfall.

Resultaten visar att de undersökta faktorerna, av de allra flesta medverkande aktörerna, betraktas som viktiga förutsättningar för utvecklingsarbetets implementering. Det råder viss variation i deltagarnas uppfattningar om i vilken utsträckning dessa förutsättningar finns på plats och hur väl de fungerar idag. Förutsättningar och utmaningar har varierat i regionerna. De faktorer som en övervägande del respondenter skattat som extra utmanande i genomförandet av utvecklingsarbetet återfinns i organisationernas inre kontext och utgörs av Utvecklingsarbetets givna prioritet; Målens tydlighet och hur dessa kommunicerats; Utvecklingsarbetets organisering och; Hur kända mottagarkontextens behov är i organisationen.

Gemensamma framgångsfaktorer som beskrivits är en god samverkan mellan olika aktörer; en ökad medvetenhet i regionerna om vikten av att arbeta med stigma av psykisk ohälsa och suicid; ett yttre tryck från nationella aktörer som bidrar till att prioritera dessa frågor; samt att det finns en bred förankring i politisk- och tjänstemannaledning som ger ett tydligt mandat. Man lyfter fram vikten av att utvecklingsarbetet integreras i befintliga strukturer, samtidigt som man ser att själva integreringen också kräver tidför matchning och anpassning. Den pågående pandemin Covid-19 har medfört ytterligare utmaningar och har på ett betydande sätt påverkat såväl planering som genomförande.

Baserat på studiens resultat, föreslås att genomföra en kartläggning av organisationens beredskap för utvecklingsarbetet i utgångsläget, liksom att i ett initialt skede enas om viktiga aspekter som är nödvändiga att vara överens om, till exempel gemensamma och tydliga förväntningar.