Background Older adults are underrepresented in suicide prevention research, even though suicide rates are higher in this age group (65+) than in any other age group in many countries worldwide. There are few clinical intervention studies that target this age group. A promising preventive intervention is the Attempted Suicide Short Intervention Program (ASSIP). Given differences in suicidal behaviour between older and younger adults, there is a need for suicide prevention intervention models that are adaptable to the heterogenic needs of older adults. This study protocol outlines the design of our upcoming study, which aims to evaluate a modified version of the Attempted Suicide Short Intervention Program (ASSIP) specifically adapted for older adults (65+), ASSIP for Older Adults (ASSIP-OA), as add-on to Treatment as Usual (TAU) and compared to TAU only. Methods A multicentre two-group parallel randomised controlled trial will be conducted to compare TAU to ASSIP-OA (3-5 sessions) and standardized letters for 2 years as an add-on to treatment as usual. The trial, which is open labelled, will recruit 132 participants (65+) within psychiatric services in Sweden after a suicide attempt or hospitalisation for serious suicidal plans. The main modifications in comparison with the original ASSIP include (a) flexibility in treatment delivery (offering home visits, breaks and shorter/longer sessions as needed), (b) an additional session together with relatives or other support person(s), and (c) age-specific linguistic and content-wise adaptation of homework, letters, and case conceptualization. The primary outcome is a suicidal episode (fatal or non-fatal). Secondary outcomes include psychiatric symptoms, severity of suicidal ideation, coping style and quality of life. The trial also includes measures of feasibility, health-care utilization and negative effects of treatment. Discussion This study has the potential to inform the development and implementation of a more person-centred care for suicidal older adults. Trial registration ClinicalTrials.gov: NCT06831942. Registered February 21, 2025, revised May 21, 2025.

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.

BackgroundThere is a need for age-adapted treatments for older adults with psychological distress and existential therapy could be of particular relevance for mental health issues related to aging. The aim of this study was to understand the process of existential therapy for older adults by exploring how pathways to change are expressed in experiences from existential group treatment.MethodsSeventeen participants aged 75 and above with psychological distress took part in individual interviews after completion of a 7-week existential group treatment in primary care. The participants were recruited from five primary care centers in the V & auml;stra G & ouml;taland Region of Sweden. Data were analyzed using thematic analysis in relation to pathways to change in Wampold's Contextual Model of Psychotherapy.ResultsThe analysis resulted in six themes. Central themes in understanding pathways to change in existential group treatment for older adults were Dare to talk about life and death, Letting myself be old, and Making the most of life despite difficulties. When recognizing things as they are and being able to face the reality of being old without avoidance, a wish to make the most of life despite difficulties emerged. Perspectives on the therapeutic process also included Commitment matters, Engaging with others and Developing new and different relationships. These themes captured the participants' experiences of choosing to commit to treatment and the relational process of engaging in existential group treatment.ConclusionsOlder adults' experiences of existential group treatment suggest that engaging in existential dimensions of aging can be helpful when done in a structured setting together with others. Reduced experiential avoidance, increased determination to do what feels meaningful, relational aspects as well as one's own commitment to therapy can help explain how existential group treatment may contribute to change among older adults with psychological distress.

Background Providing quality palliative care during a pandemic was challenging. Both specialist and communityhealthcare services cared for patients that faced life-threatening illness and who were influenced by the restrictionsof the COVID-19 pandemic. Little knowledge has yet been provided on how registered nurses (RNs) experiencedthe palliative care quality during the COVID-19 pandemic. The aim of this study was to explore RN’s experiences ofproviding palliative care quality during the COVID-19 pandemic. Methods This qualitative study had a descriptive design. Semi-structured individual interviews were conductedbetween November 2021 and January 2022 with 18 RNs who worked in intensive care units in hospitals, dementiacare or palliative care units in nursing homes in Norway during the pandemic. Data were analysed by using qualitativecontent analysis. The study was conducted and reported according to the COREQ’s checklist. Results Analysis of the data resulted in an overall theme: ‘Striving to achieve control’. This theme comprised sixcategories: (1) when the toolbox does not fit; (2) protective equipment—social distance and opportunities forcloseness; (3) unpredictable workday; (4) the right person to the right assignment at the right time; (5) presence andabsence of relatives and friends; and (6) situations that required creativity. RNs had various experiences regarding howthe quality of care was perceived; being worse, preserved, or in some cases even better than before the pandemic. Conclusions The provision of quality palliative care was experienced by RNs as challenging during the pandemic.The pandemic forced them to be creative and to strive for control to provide the best palliative care possible giventhe situation. The results of this study may contribute to important knowledge for leaders, policy makers and RNsto learn from the COVID-19 pandemic and planning for future pandemics or crises. Especially to optimise factorsperceived by RNs to be important for the palliative care quality, related to the specific situation and care context, toinclude the perspectives of those involved and take into consideration the time perspective of the pandemic.

Background

People diagnosed with stress-related exhaustion disorder report high levels of cognitive symptoms. This study aimed to explore how persons diagnosed with Exhaustion disorder (ED) experienced cognitive functioning and recovery 6-10 years after participating in a rehabilitation programme. Specifically, it investigated the experiences of current functioning, change over time, and what had been barriers or facilitators for cognitive recovery.

Methods

Semi‐structured interviews were conducted for 38 persons previously diagnosed with ED (Mean age: 52; Females: 32) and explored using thematic analysis.

Results

The analysis resulted in four themes: “’It’s different now’: Remaining cognitive symptoms”, “The bigger picture: Cognitive recovery in context”, “Overcoming challenges: Strategies for coping with cognitive symptoms”, and “The approach towards cognition matters”. The participants’ experiences varied but included descriptions on how cognitive functioning had become better with some remaining symptoms. These difficulties were reported across cognitive domains, yet often centred around upholding executive control. Cognitive recovery was seen in the context of overall well-being and recovery which differed between the participants. Facilitators and barriers thus varied between persons, and included both restorative and compensatory strategies, external conditions, the degree of worry, and development of a more acceptant or self-compassionate view on cognition and oneself.

Conclusions

The results show that cognitive recovery in ED is multifaceted. 6-10 years after rehabilitation, experiences included improvement of everyday cognitive functioning, but also lingering challenges, often related to maintenance of executive control. Recovery was influenced by factors such as general well-being, restorative or compensatory strategies, worrying, or the adaptation of more accepting or self-compassionate perspectives. The findings indicate a need for tailored, person-centred approaches to supporting cognitive recovery.

Introduction: Transgender and gender-diverse (TGD) youth experience more stressors and are therefore at a higher risk of health problems compared with their cisgender peers. The aim of this study was to investigate the prevalence of TGD youth in a general population sample and to explore a wide variety of health-related factors. We investigate differences in stressors and health outcomes between TGD youth and cisgender girls and boys and the influence of stressors and demographic factors on health outcome in the whole group. Methods: Cross-sectional survey data from a Swedish school-based study were used (N = 3,067, M = 17.8 years). Those who had reported their gender identity as “other” or other than their assigned gender (N = 41) were compared with cisgendered girls (n = 1,544) and boys (n = 1,482). Regression models in the whole group explored if demographics and stressors statistically predicted health outcomes. Results: In comparison with cisgender girls and boys, TGD youth (1.3% of the whole sample) reported a higher prevalence of self-harm and pain problems. Both TGD youth and cisgender girls more frequently reported insomnia, social anxiety, depressive symptoms, pain, and stressors compared with cisgender boys. When only demographic variables were entered, but not when stressors were added to the model, being TGD magnified the odds of depressive symptoms, sub-diagnostic social anxiety, and pain problems. Stressors magnified the odds of reporting health problems for the whole group. Conclusion: TGD youth generally reported more stressors, which negatively influence health outcomes. Results are important for professionals who meet TGD youth. 

Social anxiety and depressive symptoms often co-occur during early adolescence but contributing factors to this development are still a matter of debate. This study examined the role of daily stressors (peers, school performance, and homelife) in the links between adolescent social anxiety and depressive symptoms. 7-8th graders at Time 1 (N = 2,752, M-age = 13.65; 47.5% girls) were followed across three time-points. Cross-lagged path models showed that depressive symptoms predicted later social anxiety, but not vice versa. Bidirectional links were identified between peer stress and social anxiety, and between school performance/homelife stress and depressive symptoms, respectively. Indirect effects of social anxiety, depressive symptoms, and daily stressors were found, though stressors did not mediate the links between social anxiety and depressive symptoms (or vice versa). Our findings indicate an intricate role of daily stressors in different domains, such as peers, school performance, and homelife, on the links between social anxiety and depressive symptoms.