Offenders with mental health problems and problematic substance use : treatment interventions and crime relapse

Background: The relationships between problematic substance use, mental health problems and criminal behavior have been firmly established in research. Offenders with mental health problems and concurrent problematic substance use have high risk of reoffending and may display low rates of treatment retention. The overall aim of this thesis was to explore treatment needs, treatment participation and crime relapse among Swedish offenders with mental health problems and problematic substance use. Methods: The studies composing this thesis were part of the larger ongoing prospective follow-up project: Mental Disorder, Substance Abuse and Crime (MSAC) (n = 207) including offenders with mental health problems and problematic substance use in Stockholm County. Data from the baseline assessment and follow-up assessments of the MSAC-project were analyzed, as well as data gathered from Swedish registers and semi structured in-depth interviews. The participants were followed for approximately three years. Both quantitative and qualitative methodological approaches were used. Results: The following main findings emerged: (1) Participation in planned substance abuse outpatient visits was associated with a significantly reduced risk of criminal recidivism in the study population. (2) Higher scores of the Antisocial Psychopathy Checklist-Revised (PCL-R) facet and membership of a subgroup described as “Triply troubled with medical problems” were associated with an increased risk of criminal recidivism. (3) The Affective PCL-R facet was negatively related with participation in planned outpatient substance abuse visits and dry housing residence. (4) Among participants with various degrees of psychopathic personality traits, there were more similarities than differences in perceptions of substance abuse treatment. However, participants with a low degree of such traits stated that control requirements in treatment were rather manageable; whereas those with a high degree of psychopathic personality traits expressed that those requirements were difficult to fulfill. (5) All participants of the four previously defined subgroups/clusters of the study population showed improvements with regard to problem severity over the course of time, but the improvements were cluster-specific rather than sample specific. Cluster membership could also predict treatment participation and quality of life. (6) The Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) showed reliability and concurrent validity in screening for substance dependence of alcohol and illicit drugs, as well as problem severity with regard to alcohol, drugs and illegal areas. Conclusions: Among offenders with mental health problems and problematic substance use, participation in planned outpatient substance abuse interventions should be considered important from a clinical risk management perspective, and be encouraged. Some personality traits as well as subgroup membership (based on specific problem profiles) could be considered in order to individualize treatment planning and improve outcomes. In order to identify problematic substance use, the AUDIT and the DUDIT questionnaires could be used

Interpersonal trauma and its relation to childhood psychopathic traits : what does ADHD and ODD add to the equation?

Acknowledgements Thank you to the parents and young people who participated in the CATSS-9 studies.Peer reviewedPublisher PD

Social Determinants of the Mental Health of Young Migrants

Background: Young migrants face particular risks to develop mental health problems. Discrimination and social support impact mental health, yet little is known about the differential impact thereof on mental health in newcomers, non-newcomer migrants, and nonmigrants. Aim: This study sheds light on mental health (posttraumatic stress, behavioral problems, hyperactivity, emotional distress, peer relationship problems, prosocial behavior) and the overall well-being of newcomers, non-newcomer migrants, and non-migrants. Furthermore, the impact of social support and discrimination on mental health is investigated. Method: Descriptive analysis and Structural Equation Modelling (SEM) were applied to analyze responses of 2,320 adolescents through self-report questionnaires in Finland, Sweden, and the UK. Results: Newcomers, non-newcomer migrants, and non-migrants have different psychological profiles. While newcomers suffer more from posttraumatic stress disorder (PTSD) and peer problems, non-newcomers and non-migrants report more hyperactivity. Discrimination strongly threatens all mental health dimensions, while support from family serves as a protective factor. Support from friends has a positive impact on PTSD among newcomers. Limitations: As this study has a cross-sectional design, conclusions about causality cannot be drawn. In addition, history of traumatic life events or migration trajectory was lacking, while it may impact mental health. Conclusion: Different mental health profiles of newcomers, non-newcomer migrants, and non-migrants point to the need for a tailored and diversified approach. Discrimination remains a risk factor for mental health, while family support is a protective factor for adolescents. Interventions that foster social support from friends would be especially beneficial for newcomers.acceptedVersionPeer reviewe

Mental Health of Refugee and Non-refugee Migrant Young People in European Secondary Education : The Role of Family Separation, Daily Material Stress and Perceived Discrimination in Resettlement

While scholarly literature indicates that both refugee and non-refugee migrant young people display increased levels of psychosocial vulnerability, studies comparing the mental health of the two groups remain scarce. This study aims to further the existing evidence by examining refugee and non-refugee migrants’ mental health, in relation to their migration history and resettlement conditions. The mental health of 883 refugee and 483 non-refugee migrants (mean age 15.41, range 11-24, 45.9% girls, average length of stay in the host country 3.75 years) in five European countries was studied in their relation to family separation, daily material stress and perceived discrimination in resettlement. All participants reported high levels of post-traumatic stress symptoms. Family separation predicted post-trauma and internalizing behavioral difficulties only in refugees. Daily material stress related to lower levels of overall well-being in all participants, and higher levels of internalizing and externalizing behavioral difficulties in refugees. Perceived discrimination was associated with increased levels of mental health problems for refugees and non-refugee migrants. The relationship between perceived discrimination and post-traumatic stress symptoms in non-refugee migrants, together with the high levels of post-traumatic stress symptoms in this subsample, raises important questions on the nature of trauma exposure in non-refugee migrants, as well as the ways in which experiences of discrimination may interact with other traumatic stressors in predicting mental health.acceptedVersionPeer reviewe

Migrant Students’ Sense of Belonging and the Covid‐19 Pandemic: Implications for Educational Inclusion

This article investigates school belonging among migrant students and how this changed during the Covid‐19 pandemic. Drawing on quantitative data gathered from 751 migrant students in secondary schools in six European countries (Belgium, Denmark, Finland, Norway, Sweden, and the UK), we examined the impact of Covid‐19 school closures, social support, and post‐traumatic stress symptoms on changes in school belonging. Linear regression showed a non‐significant decrease in school belonging, and none of the studied variables had a significant effect on this change in our whole sample. However, sensitivity analysis on a subsample from three countries (Denmark, Finland, and the UK) showed a small but significant negative effect of increasing post‐traumatic stress symptoms on school belonging during Covid‐19 school closures. Given that scholarship on school belonging during Covid‐19 is emergent, this study delineates some key areas for future research on the relationship between wellbeing, school belonging, and inclusion.</p

Homo- och bisexuella kvinnors upplevelse av sin livssituation

Forskning visar att homo- och bisexuella utsätts för diskriminering och att dessa har en nedsatt psykisk hälsa jämfört med heterosexuella. Endast fåtalet studier, specifikt om bi- och homosexuella kvinnor, existerar. Denna studie är en beskrivning av unga homo- och bisexuella kvinnors upplevelse av sin livssituation med avseende på bland annat bemötanden från samhället vilka stundtals är negativa och den mentala hälsan vilken i allmänhet upplevs som god även om samhällets heteronormativitet är påfrestande. Data hämtades ur enskilda intervjuer med fem respektive fyra homo- och bisexuella kvinnor och analyserades kvalitativt genom systematisk sortering i kategorier. Fortsatt forskning, med bredare grupper av homo- och bisexuella kvinnor, behövs vilket kan leda till minskad heteronormativitet och homofobi som i sin tur borde medföra en förbättrad hälsa för populationen

Feeling mentally unwell is the “new normal” : A qualitative study on adolescents’ views of mental health problems and related stigma

Young people suffering from mental health problems is a public health issue, and it is important to listen to adolescents’ views on the issues that affect their lives. This qualitative study describes adolescents’ perceptions of the prevalence of and public stigma towards mental health problems among young people. A total of 32 Swedish adolescents, aged 15–18 years old, took part in either semi-structured focus groups or individual interviews. The data were analyzed using systematic text condensation, resulting in three themes: Having mental health problems is the new normal; What others think of you affects you; If others lack experience and knowledge, they don’t respond well. The adolescents considered mental health problems to be common in young people and a normal feature of their lives. They displayed an in-depth understanding for reasons of the increase in mental health problems in young people, and factors such as pressure from school, stereotypical gender norms, rumors and prejudice were suggested as possible explanations for the increase, alongside improved openness about mental health problems. The adolescents’ perceptions of the stigmatization of mental health problems were consistent with a trifold definition of stigma, comprising stereotypes, prejudice and discrimination. The adolescents suggested that better education about mental health problems, and more inclusive gender norms, would help reduce stigma and improve young people’s mental health

Family and child health centre characteristics associated with exposure to universal language and literacy promotion

Aims: This study investigated which specific socio-demographic characteristics of the family and child health service centre are associated with parents receiving a video guide. The video guide, intended to be offered universally, aimed at promoting language and literacy development. Methods: The video guide included language and literacy activities and was offered through child healthcare centres to all visiting families. Cross-sectional data were collected during three years through parental self-reported questionnaires when the children were three years old, and families of 2512 children were included. Results: In 60% of the families, none of the parents reported receiving the video guide, and in 84%, none of the parents reported that they had watched the video guide. Most of the parents who watched the video guide reported having tried the presented activities. Socio-demographic characteristics associated with parents having received the video guide were: being married or cohabiting, having a university education, or if the mother was native-born. The child's age when the video guide was initially offered and the child's birth order were also factors associated with parents having received the video guide. Conclusions: The results indicate that few parents overall received the video guide. Socio-economically advantaged parents seemed to have received the video guide to a higher extent

Parental sociodemographic characteristics and mental health referrals by nurses in Swedish child health centres

Aim To explore the influence of parents' socio-economic characteristics on child healthcare nurses' mental health referrals of 3- to 5-year-olds and also to test the association between mental health problems and referrals. Methods Repeated cross-sectional data including parents' Strengths and Difficulties Questionnaire (SDQ) assessments and referral data (psychologist and speech and language pathologist). Hierarchical regression was used to analyse whether parents' country of birth, education level, marital status and mental health problem scores (SDQ; total difficulties and impact scores) were associated with nurses' referrals. Results About 9% of mothers and 12% of fathers rated high SDQ scores (total difficulties) in their children. Approximately, 1% of the children were referred. The influence of parents' socio-economic characteristics on referral rates was not observed. However, for children with Swedish-born mothers, referral rates were significantly lower. Scores for SDQ total difficulties and impact were associated with the child's referral to specialists. Conclusion In general, parental sociodemographic characteristics do not influence Swedish child healthcare nurses' mental health referrals. Although there was a significant association between problem behaviour and referral, a disproportion between children rated with high SDQ scores (9% and 12%) and children referred to specialists (1%) should be addressed