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Refugees are highly trauma burdened with excessive prevalence of posttraumatic stress disorder (PTSD). However, refugees face a large variety of barriers in accessing mental healthcare, resulting in under-utilization of services. Untreated PTSD can have detrimental impact on integration into society. In this proposal, we aim to evaluate an online brief intervention method effective in alleviating symptoms of PTSD. The intervention procedure will be carefully adapted and translated to cater the needs of refugees. Our primary objective is to assess long term mental health outcomes and its influence on social integration. To achieve this, we plan to conduct two randomized control trials involving refugees exhibiting subclinical to clinical symptoms of PTSD. One trial will focus on assessing the direct effects of the intervention on mental health outcomes, while the other will explore effectiveness when implemented within a regular treatment. In this study we follow up mental health status and indicators of social integration over a period of 18 months. The outcomes of this proposal have the potential to provide evidence for a time and resource effective intervention for refugees. We believe that the online format and brevity of the method make it well-suited for the targeted population, and have the potential to overcome some relevant barriers. Additionally, this project will contribute to our understanding of the relationship between mental health and social integration.

Research problem and specific questionsDespite accumulating knowledge regarding various interventions for stress-related mental health problems, few studies have been able to demonstrate the effects on return to work. In order for rehabilitation and the sick leave process to lead to sustainable outcomes, e.g. return to work, collaboration is required between various stakeholders, e.g. Social Insurance Agency, employers, and healthcare. With the present project proposal, we aim to investigate the effects of a digital stress rehabilitation process that involves modules for collaboration. The overall aim is to examine whether the intervention can reduce stress and other mental health problems, promote collaboration, and accelerate return to work. We intend to evaluate the project in a randomized controlled study and a qualitative interview study.Data and methodOur research group has previously conducted several controlled studies on digital interventions for stress-related mental health problems, and therefore, we will be able to transfer many of those experiences to this project. We intend to investigate the effects of the digital interventions on the primary outcomes (stress, return to work) as well as several of the secondary outcome measures (work ability). We aim to evaluate collaboration through an interview survey involving a sample of representatives from the Social Insurance Agency, employers, and primary care physicians.Societal relevance and utilisationThe availability of preventive and rehabilitative interventions is not proportional to the societal needs and highlights the need to develop, evaluate, and implement interventions that are accessible, effective, and can support individuals with mental health problems throughout the sick leave process while facilitating collaboration with relevant stakeholders.Plan for project realisationThe present project will be carried out within the Center of Excellence (E-PABS) at the Swedish School of Sport and Health Sciences. In addition to personnel costs, we are also seeking funding for the development and adaptation of the digital programs and collaboration modules. The study will be structured in three phases, with the first year dedicated to recruitment, development, and co-creation with collaborating stakeholders. The second year will focus on implementing the effectiveness and interview studies, while the final year will involve compiling, analyzing, and reporting the study results.

Eating disorders (EDs) are common conditions that cause significant suffering, reduction in functioning and deterioration in quality of life. The need for efficient preventive interventions against EDs are huge, as the majority of the patients do not seek treatment, and only half of those who receive treatment recover fully. Consequently, EDs tend to have an enduring course. The target of efficient prevention programs has been to reduce risk specific factors for EDs (e.g., internalization of the thin ideal), but they have been difficult to implement on a broad basis to make a notable impact on public health. It has proven difficult to scale up these interventions due to the resources needed for adequate implementation. Recent research has shown that optimization of protective factors (e.g., intuitive eating, appreciation of what we can do with our bodies, or self-compassion) might be a viable option and easier to implement on a large scale. The aim of the current project is to evaluate the efficacy and cost-effectiveness of such an interactive prevention program in a randomized controlled trial, and to investigate the mechanisms of change in the intervention.The innovative aspects of this project are 1) notable focus on optimizing protective factors, instead of only reducing risk factors (e.g., body dissatisfaction), 2) targeting at-risk-groups instead of universal prevention, 3) interactive program instead of standard psychoeducation, 4) possibility of including individuals of all genders and the minority groups, 5) recruitment of participants through social media, and 6) delivery of the intervention through Internet to make it flexible, and to make later large-scale implementation possible.Focus on protective factors has also the benefit of lower potential stigma for participation in prevention, despite recruiting an at-risk-group.In a randomized controlled trial, we recruit 644 participant aged 15-20 years who will receive either the prevention program (one hour per week across four weeks), or a placebo condition (Expressive Writing). In addition to the outcome after the intervention, and at follow-ups (six-, and 12-months post intervention) and cost-effectiveness will be investigated. Mediators and moderators of outcome as well as the reach of the program, risk for stigma, and possibility of spreading the program on a large-scale though collaborative projects in social media channels will also be investigated.

Research area and aims Eating disorders (EDs) are common and cause significant morbidity and mortality. Due to stigma, only 25% seek help and only 50% fully recover after receiving treatments. Large-scale prevention is urgently needed to reduce the emergence and burden of EDs at a population level. However, current prevention programs do not meet requirements for efficient and economically attractive large-scale implementation. The main aim of this project is to investigate the efficacy and cost-effectiveness of a scalable, brief, and interactive prevention program based on reinforcement of protective factors against EDs using a randomized controlled design. A focus on protective factors disrupts the processes by which risk factors increase the probability for EDs to emerge and minimizes the risks for stigmatization. Research questions: How effective is an internet-based prevention program, that reinforces protective factors against EDs, in reducing the onset of EDs 6, 12, and 24 months post-intervention?Does the intervention reduce the incidence of EDs through enhancement of specifically targeted protective factors (mediators)?Is prevention of EDs based on reinforcement of protective factors cost-effective?How sustainable are virtual communities for maintenance of future recruitment and prevention on a large scale? Secondary questions concern gender differences in enrollment and compliance, potential moderators of outcome, participation in booster sessions, and potential risk for stigma. Data and MethodParticipants (15-20 years old, n=644, based on power analysis) will be recruited online and randomized to prevention or a credible placebo. The intervention will be selective (target those with significant body dissatisfaction), delivered in a scalable format (Internet-based), brief (45 minutes/week for four weeks), and with interactive components of the program moderated by artificial intelligence for future scalability. Assessments will be done using the gold standard within the field of EDs.  Plan for project realisationThe proposed project is an extension of our previous work, including the largest controlled trial of prevention of EDs in Sweden. Recruitment, intervention, and assessments will be done using established methods. The costs are necessary for running a large randomized controlled trial. RelevanceA brief, scalable and efficacious prevention program is the pre-requisite for reducing the emergence and burden of EDs on public health level.