BACKGROUND: Help-seeking for mental health problems is a complex process that involves handling both personal challenges and dealing with the organizational structure of the healthcare system. The healthcare system is siloed and fragmented, but it is unclear how the challenges are experienced by the young adults and what their healthcare journeys look like. Therefore, the aim of this study was to explore experiences of young adults' healthcare journeys in the context of help-seeking for common mental health problems.

METHODS: In total, 25 young adults (16 women and 9 men) from a student healthcare centre at a Swedish university seeking help for common mental health problems, such as anxiety and depression, were interviewed. A qualitative thematic analysis with an inductive approach was done, and results were abstracted and presented in terms of journey-related metaphors.

RESULTS: The healthcare journeys of young adults were described as Taxi Riding, Commuting, Sightseeing, and Backpacking. Taxi riding and Commuting are defined by going in a straightforward and smooth way in the healthcare system, without major obstacles to care. In contrast, Sightseeing and Backpacking are characterized by more diffuse and negative experiences, where the young adults are not satisfied with the help received from healthcare providers. Help-seeking is not conformant with the design of the healthcare system but steered by a range of factors, including individual experiences and young adults' agency, the available resources at the various healthcare providers, and interaction with healthcare professionals.

CONCLUSIONS: Young adults' healthcare journeys in the context of help-seeking for common mental health problems are related to individual, relational, and organizational factors. Some journeys run smoothly, epitomizing a functioning healthcare system that accommodates a rational help-seeker. Other journeys depict a rigid healthcare system, where the success and nature of the journey primarily depend on individual agency and on not becoming discouraged by obstacles. There is a need for more knowledge on how to support young adults' mental health help-seeking. However, we also need more insights into how the healthcare system can become more receptive and accommodating toward the needs of young adults with common mental health problems.

Background:Recent advancements in artificial intelligence (AI) have changed the care processes in mental health, particularly in decision-making support for health care professionals and individuals with mental health problems. AI systems provide support in several domains of mental health, including early detection, diagnostics, treatment, and self-care. The use of AI systems in care flows faces several challenges in relation to decision-making support, stemming from technology, end-user, and organizational perspectives with the AI disruption of care processes.

Objective:This study aims to explore the use of AI systems in mental health to support decision-making, focusing on 3 key areas: the characteristics of research on AI systems in mental health; the current applications, decisions, end users, and user flow of AI systems to support decision-making; and the evaluation of AI systems for the implementation of decision-making support, including elements influencing the long-term use.

Methods:A scoping review of empirical evidence was conducted across 5 databases: PubMed, Scopus, PsycINFO, Web of Science, and CINAHL. The searches were restricted to peer-reviewed articles published in English after 2011. The initial screening at the title and abstract level was conducted by 2 reviewers, followed by full-text screening based on the inclusion criteria. Data were then charted and prepared for data analysis.

Results:Of a total of 1217 articles, 12 (0.99%) met the inclusion criteria. These studies predominantly originated from high-income countries. The AI systems were used in health care, self-care, and hybrid care contexts, addressing a variety of mental health problems. Three types of AI systems were identified in terms of decision-making support: diagnostic and predictive AI, treatment selection AI, and self-help AI. The dynamics of the type of end-user interaction and system design were diverse in complexity for the integration and use of the AI systems to support decision-making in care processes. The evaluation of the use of AI systems highlighted several challenges impacting the implementation and functionality of the AI systems in care processes, including factors affecting accuracy, increase of demand, trustworthiness, patient-physician communication, and engagement with the AI systems.

Conclusions:The design, development, and implementation of AI systems to support decision-making present substantial challenges for the sustainable use of this technology in care processes. The empirical evidence shows that the evaluation of the use of AI systems in mental health is still in its early stages, with need for more empirically focused research on real-world use. The key aspects requiring further investigation include the evaluation of the use of AI-supported decision-making from human-AI interaction and human-computer interaction perspectives, longitudinal implementation studies of AI systems in mental health to assess the use, and the integration of shared decision-making in AI systems.

©Hassan Auf, Petra Svedberg, Jens Nygren, Monika Nair, Lina E. Lundgren.

Implementation of artificial intelligence systems for healthcare is challenging. Understanding the barriers and implementation strategies can impact their adoption and allows for better anticipation and planning. This study’s objective was to create a detailed inventory of barriers to and strategies for AI implementation in healthcare to support advancements in methods and implementation processes in healthcare. A sequential explanatory mixed method design was used. Firstly, scoping reviews and systematic literature reviews were identified using PubMed. Selected studies included empirical cases of AI implementation and use in clinical practice. As the reviews were deemed insufficient to fulfil the aim of the study, data collection shifted to the primary studies included in those reviews. The primary studies were screened by title and abstract, and thereafter read in full text. Then, data on barriers to and strategies for AI implementation were extracted from the included articles, thematically coded by inductive analysis, and summarized. Subsequently, a direct qualitative content analysis of 69 interviews with healthcare leaders and healthcare professionals confirmed and added results from the literature review. Thirty-eight empirical cases from the six identified scoping and literature reviews met the inclusion and exclusion criteria. Barriers to and strategies for AI implementation were grouped under three phases of implementation (planning, implementing, and sustaining the use) and were categorized into eleven concepts; Leadership, Buy-in, Change management, Engagement, Workflow, Finance and human resources, Legal, Training, Data, Evaluation and monitoring, Maintenance. Ethics emerged as a twelfth concept through qualitative analysis of the interviews. This study illustrates the inherent challenges and useful strategies in implementing AI in healthcare practice. Future research should explore various aspects of leadership, collaboration and contracts among key stakeholders, legal strategies surrounding clinicians’ liability, solutions to ethical dilemmas, infrastructure for efficient integration of AI in workflows, and define decision points in the implementation process. Copyright: © 2024 Nair et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Study objectives: To examine differences in sample characteristics and longitudinal sleep outcomes according to weighted blanket adherence.

Methods: Children with attention-deficit/hyperactivity disorder (ADHD) (n =94), mean age 9.0 (sd 2.2, range 6-14) participated in a 16-week sleep intervention with weighted blankets (WB). Children were classified as WB adherent (use of WB ≥ 4 nights/week) or non-adherent (use of WB ≤ 3 nights/week). Changes in objectively measured sleep by actigraphy, parent-reported sleep problems (Children's Sleep Habits Questionnaire (CSHQ)) and child-reported Insomnia Severity Index (ISI) were evaluated according to adherence with mixed effect models. Gender, age, and ADHD subtype were examined as potential moderators.

Results: Children adherent to WBs (48/94) showed an early response in sleep outcomes and an acceptance of the WB after four weeks of use as well as a decrease in parent- (CSHQ) (-5.73, P = .000) and child-reported sleep problems (ISI) (-4.29, P = .005) after 16 weeks. The improvement in sleep was larger among WB adherent vs. non-adherent (between-group difference: CSHQ: -2.09, P = .038; ISI: -2.58, P =.007). Total sleep time was stable for children adherent to WB but decreased for non-adherent (between-group difference: +16.90, P = .019).

Conclusions: An early response in sleep and acceptance of the WB predicted later adherence to WBs. Improvements in sleep were more likely among WB adherents vs. non-adherents. Children with ADHD may thus benefit from using WBs to handle their sleep problems.

© 2024 American Academy of Sleep Medicine

This article explores conditions for implementing shared decision-making (SDM) in coordinated individual care planning (CIP) with individuals with complex mental health needs. SDM in CIP are described as central, although such user centred collaboration still remains to be realised. Research underlines the need for a changed way of working, where user expertise is valued and a balance of power is promoted. The aim of the present study is to investigate the conditions for implementing SDM in connection with CIP for and with people with mental illness. To better understand the context and conditions that can promote such an implementation, altogether 15 participants were interviewed in three regions in Sweden within the scope of a stakeholder analysis. Both hindering and supporting factors were identified with respect to an implementation process, such as staff turnover, differences in work culture and committed leadership. Further focus should be directed specifically towards professionals working more closely with CIP and towards in-depth analysis of the construct of culture in terms of implementation processes. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

I denna artikel undersöks förutsättningarna för att implementera delat beslutsfattande (DBF) i samordnad individuell vårdplanering (SIP) för personer med komplexa psykiska behov. DBF i SIP beskrivs som centralt, även om ett sådant personcentrerat samarbete fortfarande återstår att förverkliga. Forskning understryker behovet av ett förändrat arbetssätt, där användarnas expertis värdesätts och en balanserad maktfördelning främjas. Syftet med den här studien är att undersöka förutsättningarna för att implementera DBF i samband med SIP för och med personer med psykisk ohälsa. För att bättre förstå sammanhanget och de villkor som kan främja en sådan implementering intervjuades totalt 15 deltagare i tre regioner i Sverige inom ramen för en intressentanalys. Både hindrande och stödjande faktorer identifierades med avseende på en implementeringsprocess, såsom personalomsättning, skillnader i arbetskultur och engagerat ledarskap. Ytterligare fokus bör riktas specifikt mot yrkesverksamma som arbetar närmare med SIP och mot en djupgående analys av kulturkonstruktionen när det gäller implementeringsprocesser.

Introduction: Using weighted blankets to address sleep problems among children with Attention-Deficit/Hyperactivity Disorder (ADHD) could complement pharmacological treatment in clinical practice. A cross-over RCT showed an effect of weighted blankets (WB) vs. control blankets (CB) on objectively measured sleep and parent-reported sleep problems (Lönn et al., 2023). However, evidence of long-term benefits is scarce, and additional research with longer follow-up time is warranted. This study aimed to evaluate changes in sleep when using weighted blankets among children with ADHD and sleep problems.

Materials and Methods: A longitudinal intervention design was chosen to evaluate children’s sleep during a 16-week sleep intervention with WB. Data was collected during baseline, a cross-over phase (4+4 weeks), and an open-label phase (8 weeks). Children (n= 71) choosing to continue the trial with the WB when entering the open-label phase were included. Outcomes were measured with the parent-reported Children's Sleep Habits Questionnaire (CSHQ total score), the child-reported Insomnia Severity Index (ISI), and actigraphy (Motionware 1.2.47 Camntech) including Sleep Onset Latency (SOL), Wake After Sleep Onset (WASO), Total Sleep Time (TST), and Sleep Efficiency (SE). Bedtime, wake-up time, and age were added as exploratory variables to explain changes in TST. Data was analyzed with mixed effect models, Spearman correlation and linear regression.

Results: Mixed effect models, including children (n=71) mean age 9.49 (sd 2.25, range 6-14) entering the open-label phase, showed that CSHQ decreased by -5.07 (p=0.000), and ISI decreased by -3.40 (p=0.000) from baseline to 16-week follow-up.Mixed effect models showed decreased TST by -11.2 min from baseline to 16-week follow-up (p=0.006). SOL, WASO, and SE did not change during the intervention (p>0.05).Exploratory analysis using mixed effect models on bedtime showed that bedtime was delayed with +13 min from baseline to 16-week follow-up (p=0.000). The wake-up time was not changed (p=0.874).Correlation analyses showed weak non-statistical significant relationships between TST and sleep problems (CSHQ) and TST and insomnia severity (ISI) at baseline (CSHQ: r=-0.15; ISI: r=0.15) and 16-week follow-up (CSHQ: r=-0.20; ISI: r=-0.06). TST and bedtime showed a strong correlation at baseline (r=-0.61, p=0.000) and 16-week follow-up (r=-0.65, p=0.000). TST and wake-up time showed a weak non-statistical significant relationship at baseline (r=-0.15) and 16-week follow-up (r=-0.16).Linear regression on baseline measurements showed that TST decreased with -13.9 min (p=0.000) and bedtime was delayed with 21 min (p=0.000) by increasing age.

Conclusions: Parent-reported sleep problems and child-reported insomnia severity decreased during the 16-week sleep intervention with weighted blankets for children with ADHD. The objective measures with actigraphy showed that total sleep time decreased during the 16-week intervention. Total sleep time was not found to be associated with parent- or child-reported outcomes but was associated with bedtime and age. These findings need to be further investigated to understand essential factors in sleep changes for implementing weighted blankets in clinical practice.

Aim: The aim of this integrative review was to investigate how resilience has been researched and explore experiences of resilience, in children of parents with mental illness or alcohol or substance misuse. Design: An integrative review. Method: The search included three major electronic databases, PubMed, Scopus and PsycINFO with the aim of identifying peer-reviewed studies where the concept of resilience was explored as resilience, coping, adaptation or protective factors. Results: Out of 4016 studies, 14 were included after meeting predetermined criteria and methodological quality evaluation. The findings are presented in five categories: characteristics of the studies, operationalization and interpretation of resilience, individual resources, family resources and resources outside the family. Patient or public contribution: Resilience in children of parents with mental illness or substance misuse refers to coping strategies, protective factors and absence of symptoms or risk behaviour despite being exposed to risk. We suggest a three-level approach for mapping of resilience resources in the target group: the individual level, family level and outside of the family that includes both non-professionals and professionals. The use of disengagement or avoidance strategies implies poor resilience but may be necessary in absence of support, as acts of self-preservation during chaotic periods or harmful situations. © 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.

Background: Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25–85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. Methods: Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6–14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. Results: Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. Conclusions: Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep. © 2024 by the authors. Licensee MDPI, Basel, Switzerland.

Background: The increase in adolescents reporting mental health problems presents a major public health challenge. The complex association between mental health and social capital motivates further investigation of social capital as a crucial aspect in shaping adolescents' help-seeking knowledge, attitudes, and behaviours. Aim: This protocol presents a project that aims to investigate social capital in relation to help-seeking and mental health in close collaboration with adolescents and key stakeholders in the school setting, in the southern part of Sweden. Methods: A mixed-method design with three interconnected work packages (WP) will be undertaken with an emphasis on co-production where adolescents are involved throughout the process. WP1 is a development and validation of two questionnaire instruments for assessing social capital and help-seeking in adolescence. WP2 is a longitudinal quantitative study involving 1,500 adolescents from two regions representing rural and suburban/urban settings. Adolescents aged 15 will be asked to complete questionnaires concerning social capital, mental health, and help-seeking in a baseline and one-year follow-up, allowing for investigation of the role of social capital for help-seeking. WP3 is designed to elucidate experiences and knowledge of adolescents and key stakeholders via collaborative World Café workshops. These will be held along the project to evolve the generated knowledge and maximize it's applicability during and after the project is finalized. Conclusion: The results are expected to further the understanding of the relationship between adolescents' social capital, mental health, and help-seeking, to contribute to a deeper understanding of the mechanisms behind the paradoxical help-seeking patterns among adolescents today and to narrow the gap between research and practice to produce sustainable and efficient strategies, which may facilitate help-seeking and improve the mental health of adolescents within existing organizational structures. Copyright © 2024 Ahlborg, Morgan, Svedberg, Nygren, Eriksson and Westberg.

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. −2.79 min, p = 0.015, Cohen's d = −0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11–14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions. © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.