Clara Hellner

Research problem and specific questions: About one quarter of all children have parents with mental health problems. These children are at increased risk for a wide range of adverse outcomes. Nevertheless, despite the importance of reducing this form of inequality, research on the intergenerational transmission of mental health problems is plagued by three important limitations. These include an overreliance on small samples and retrospective (biased) reports

a failure to address psychiatric comorbidity

and inadequate control of unmeasured confounding. The aim of this project is to answer three research questions: 1) What are the associations between psychiatric diagnoses in parents and adverse outcomes in their children? 2) Can these be attributed to broad comorbidity? 3) Does treatment of the parents’ psychiatric disorders reduce the risk of adverse outcomes in children?Data and method: We will include all individuals born in Sweden between 1970 and 2000 (N = 2 797 086). The exposures are 6 psychiatric diagnoses in their parents, and the outcomes are 34 adverse events in the offspring recorded until the end of 2019 (e.g., psychiatric disorders, psychotropic medications, criminality, school and employment problems, etc.). We will estimate associations between the exposures and outcomes

adjust for comorbidity using multiple regression and a general factor model

and apply causal inference techniques to control for unmeasured confounding.Plan for project realisation: We will hire a PhD student and a postdoc to complete the project. The PI, along with experts in epidemiology and psychiatry, will provide support.Relevance: Our project will contribute to the study of intergenerational transmission of mental health problems in three important ways. First, because psychiatric treatment resources are becoming increasingly scarce as more individuals seek help, parental psychiatric history can help guide treatment allocation by identifying those at higher risk and by screening out low risk persons. Second, we will highlight the importance of focusing on parental comorbidity, which will guide clinicians to additionally focus on the number of parental diagnoses (rather than only type) when predicting patient prognosis. Third, if a parental psychiatric diagnosis appears causally related to an outcome, then it would be beneficial to develop a policy for child and adolescent mental health providers to recommend that the parent also seek treatment.

Suicide is the leading cause of death for ages 10-19 years in Sweden. The most reliable predictor of suicide is self-harm (including suicide attempts). Decades of research have failed to produce reliable assessments of risk factors for self-harm that could be applied with confidence in the clinic. Further, few evidence-based out-patient treatments for self-harm exist to date. Instead, involuntary care is increasingly used in this population, despite evidence indicating that it may worsen prognosis. Two studies will be conducted. Study 1 aims to identify clinically applicable risk factors of self-harm and Study 2 is a randomized clinical trial for youth who self-harm. Study 1 will for the first time assess youth at risk of self-harm prospectively (aged 12 to 14 years) at two timepoints: pre onset of self-harm and at follow-up. Participants will be assessed using a range of psychophysiological, cognitive, and psychosocial measures, with a particular focus on pain-sensitivity. Identified individuals with self-harm will be included in a parallel randomized controlled trial (total N=200) of a cognitive behavioral family treatment targeting risk factors for self-harm and suicide, compared to an active control group. By identifying clinically applicable risk factors and evaluating a potentially effective out-patient intervention, this project aims to reduce the need for involuntary care and prevent suicide in youth.

Mental health problems in youth is causing incalculable suffering in youth and families. Existing treatments in Primary Care are not fully addressing these problems because they focus on a subset of mental health problems

are limited in efficacy, and are not provided to most youth in need. Transdiagnostic online treatments addressing mechanisms underlying mental health problems, such as emotion regulation, have been called for. We will include 388 participants aged 12-17 years and their parents in a RCT comparing a 6-week Primary care Online Emotion-regulation Treatment (POET) to a 6-week active Supportive Treatment (ST) during 2023-2025, at several Primary Care clinics across Sweden. Both interventions will be delivered in blended format combining online therapist-supported treatment modules with a video-link session. Findings from our pilot RCT (N=30) demonstrated that the study procedures and treatment protocols are feasible and that POET is promising. The primary study aims are to examine the effects of POET vs ST at post-treatment, 3-, and 12-month follow-up on mental health problems, emotion regulation, and to test whether changes in emotion regulation mediates reduction in mental health problems. The broad long-term goal is to examine cost-effectiveness, for whom the treatment is efficacious, and to show how a brief treatment provided in youth in a Primary Care setting may have a positive impact on the trajectory into young adulthood.