Longitudinal studies of neurocognition in schizophrenia spectrum disorders (SSD) usually follow relatively young first-episode patients across several years. Comparatively little is known about the neurocognitive trajectory of samples also consisting of older patients. This is a 20-year follow-up study of participants who performed the baseline assessment at different ages and utilizes data from the Swedish Clinical Long-Term Psychosis Study (CLIPS). At baseline, 61 SSD patients were included and available for clinical assessment after 20 years. Of these, 28 performed neurocognitive assessment at both baseline and 20 years later. The test results from this group were used for this study. After 20 years, the participants exhibited significantly worsening cognitive flexibility, verbal learning, verbal retention memory, and verbal intellectual function compared to baseline. All the statistically significant differences from baseline to follow-up had large effect sizes. The other cognitive domains showed no statistically significant changes from baseline for either group. We conclude that although the overall picture was one of neurocognitive stability across 20 years, our participants showed signs of accelerated ageing in the verbal domain specifically.

Project Support (PS) is an evidence-based individual support and parenting program developed for mothers exposed to intimate partner violence (IPV) whose children have developed conduct disorders. This Swedish feasibility study focuses on changes in the mothers' psychiatric symptoms, in relation to social and emotional support received as part of PS. In a within-subject design in a naturalistic setting (i.e., 10 social service units), mothers (n = 35) reported a significant decrease in symptoms, but from an individual perspective, most mothers still suffered from clinical levels of psychiatric symptoms. The need for additional interventions for mothers exposed to IPV is discussed.

Project Support (PS) is an evidence-based intervention for parents exposed to intimate partner violence (IPV) whose children develop conduct disorders. PS was developed in the US and piloted and transferred to Sweden, where it has only been used in research. It is however important that interventions will be utilized beyond research context. Therefore, the aim of the current study was to explore how counsellors in the Swedish social service experienced their further use of PS. The study was based on digital interviews with 14 trained PS counsellors (13 women and one man) from two domestic violence shelters and five social service units who had previously participated in evaluating PS. A deductive thematic analysis using a theoretical framework based on implementation research and operant conditioning generated three propositions concerning compliance and adherence, efficacy and operant conditioning, and organizational support and readiness. The findings indicate that facilitating an intervention's successful and organization-sustaining implementation presupposes support from organizational structures having an active present leader as well as a team that encourages the intervention's use. Neither an individual counsellor nor a valued intervention such as PS is sufficient in itself in terms of sustainability and the ongoing use of the intervention, as contextual support is also crucial.

Aim: To investigate the experience of Child Health Care Nurses (CHCNs) using language screening for 2.5-year-old children. Design: An exploratory qualitative design with an inductive approach. Method: Data were collected through semi-structured, interviews with Swedish CHCNs who regularly performed language screening for children. The interviews were analysed by thematic analysis. Results: Four themes were identified: ‘The difficult visit’, ‘Explanations for language delay’, ‘Language screening across cultures’ and ‘Language screening with children exposed to adverse life events’. Patient or Public Contribution: Our findings suggest that in routine care a modified procedure is used for the language screening of children aged 2.5 to secure the child’s cooperation and to preserve an alliance with the parents. Consequently, the validity of the screening is called into question, particularly when it comes to children from families with origins outside the dominant culture and children exposed to adverse life events. 

Achieving symptomatic remission, as defined by the Remission in Schizophrenia Working Group, is intended tobe a meaningful outcome for individuals with schizophrenia, resulting in enhanced well-being. Cross-sectionalstudies have reported an association between symptomatic remission and subjective quality of life (QoL). Longitudinal studies aimed at examining this association have showed mixed results. The aim of this study was toexplore the relationship between symptomatic remission and subjective QoL, both cross-sectionally andlongitudinally. The study comprised data from what were at most 386 patients with schizophrenia, of whom 122–140 werefollowed over a period of four years. Based on cross-sectional remission status and longitudinal remissionpattern, differences in subjective QoL were explored. Remission status was assessed using the Positive andNegative Syndrome Scale (PANSS), and subjective QoL using the Short Form-36 Health Survey (SF-36). Both the cross-sectional and the longitudinal approach showed that patients in symptomatic remission hadsignificantly higher subjective QoL. Patients who were in non-remission at baseline, but who achieved remissionat follow-up, also had significantly higher subjective QoL at follow-up compared with baseline. The results from the study show a clear association between symptomatic remission and subjective QoL. However, achieving symptomatic remission does not appear to be a guarantee of sustained subjective QoL, andonly continued stable remission appears to result in such an outcome.

BACKGROUND: Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not. OBJECTIVE: To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, return to work and continuous work. METHODS: Forty-seven women and seven men, 19-60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics. RESULTS: No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC. CONCLUSION: The results indicate variations in QOL, SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted.

Background Stress related psychological problems are growing in nursing education and constitute an essential challenge for educators. This makes research about strategies and interventions to meet these problems important. Stress management interventions need to be tested for feasibility and acceptability, before conducting large scale RCTs. The objective of our study was to assess the feasibility and acceptability of a newly developed cognitive behavioral stress management intervention for nursing students. Methods Data were collected using a combination of standardized measurements and newly created questionnaires in combination with qualitative data. Our data included recruitment capability, sample characteristics, intervention acceptability and preliminary evaluation of participant psychological changes. Results Findings suggested that the feasibility of conducting a full-scale evaluation was confirmed for intervention acceptability, data collection procedures, and adherence. However, difficulties relating to recruitment capability and homework were identified. All aspects taken together, the intervention was found feasible and acceptable to nursing students, and thus a potential stress management intervention for the nurse education context. Conclusions Overall, this study provides an insight into the challenges and complexities of developing and evaluating a new brief cognitive behavioral based stress management training intervention in a nurse education setting.

Background: Anxiety and depressive disorders are associated with problems with everyday occupations, including difficulties achieving occupational balance. The aim of this cross-sectional study was to describe occupational balance in people suffering from anxiety and/or depression and the factors that are associated with better self-rated occupational balance. Material: One hundred and eighteen participants were recruited from outpatient mental health care and primary health care. The participants were 18-65 years, had a diagnosis of anxiety and/or depression, and had problems in everyday occupations. They answered questionnaires on occupational balance, psychological symptoms, quality of life and everyday occupations. Results: A generally low rating of occupational balance was found; however, the scores differed depending on the participants' degree of anxiety and depression, their quality of life, their occupational performance and satisfaction with their occupational performance. Logistic regression analyses revealed that high quality of life, high satisfaction with occupational performance and low level of depression were associated to occupational balance. Conclusion: The results indicate that enhanced satisfaction with life and with performance of everyday occupations are relevant factors for achieving occupational balance in clients diagnosed with anxiety and/or depression.

BACKGROUND: Close relatives of people with severe mental illness (SMI) experience problems known as family burdens. In addition, they may have their own needs for support, something often overlooked by the healthcare system. Meta-syntheses in this area may help explore the meaning of the experience of living with someone who has a SMI.

AIM: Our aim was to describe the burdens experienced and needs perceived on a daily basis by relatives to someone who has a SMI.

METHODS: The databases PubMed, CINAHL, and PsychInfo were searched using a systematic search strategy. Studies were screened for relevance and quality was appraised. A meta-synthesis of nine qualitative studies was then conducted.

RESULTS: The nine studies discerned the following themes. Burden themes; Forced to carry a sometimes unbearable burden; Burdened by own ill-health and disrupted relationships; Distressed and stigmatized by society. Needs themes; strengthening protective factors; Skills and practical support greatly appreciated.

CONCLUSIONS: The burdens and needs of relatives of persons with SMI strongly influence their lives. They require relief from both practical and emotional burdens. Family interventions and other programs to support relatives should be encouraged with this knowledge in mind.

Cognitive impairment is an established feature of schizophrenia. From a cross-sectional perspective, studies have revealed associations between cognition and remission. Few studies have examined this relationship longitudinally. Here we examine which cognitive domains might be related to long-term remission and symptomatic severity. The present study followed 173 outpatients with schizophrenia for five years, divided into groups based on long-term remission status and symptomatic severity, assessed with the Positive and Negative Syndrome Scale. Cognitive functioning was assessed at baseline, with tests of vigilance, executive functions, processing speed, memory and learning, working memory, and premorbid functioning. Cognitive domains related to long-term remission status were executive functions, working memory, and premorbid functioning. The most prominent cognitive differences were found between the group in stable remission with minimal symptoms, and the non-remission group, the first group demonstrating better cognitive functioning. The study highlights the role of premorbid functioning as a cognitive feature in the prediction of long-term remission. It also indicates the possibility of viewing specific cognitive domains as markers for clinical outcome, highlighting the value of early assessment of cognition. In summary, a certain cognitive profile, in coexistence with long-term non-remission, suggests poorer outcome. Hence, this group is in need of increased support.