Fabian Lenhard

Background: Individual climate change mitigation behaviours (CCMBs) can meaningfully reduce greenhouse gas emissions, yet many people report uncertainty about what actions to take and difficulty changing established habits. Scalable, digital behavioural interventions remain largely untested. This randomized controlled trial evaluated the effectiveness and acceptability of Sustainable Choices, a five-week, internet-delivered intervention designed to promote CCMBs and psychological well-being.Methods: Adults in Sweden (N = 694) were randomized 1:1 to Sustainable Choices or a waitlist control. The primary outcome was CCMBs at post-intervention, assessed with the Climate Mitigation Behaviour Scale (CLIMBS) and analysed using item-response-theory–derived latent scores in mixed-effects models under an intention-to-treat framework. Secondary outcomes included well-being (SWEMWBS), climate-related worry (GAD-2), low mood (PHQ-2), and meaning and purpose (PROMIS-6a). Follow-ups were conducted at 1, 3, and 6 months. Complier Average Causal Effect analyses examined dose–response relations, and acceptability was assessed through adherence and satisfaction.Results: Compared with controls, the intervention produced significantly greater increases in CCMBs on the CLIMBS general factor (d = 0.34, p < .001), with improvements in food, consumption, and engagement domains but not mobility. Meaning and purpose increased relative to controls (d = 0.23, p = .004), whereas changes in well-being, worry, and low mood were not significant. Engagement showed robust dose-dependent effects: each completed module increased CCMBs by 0.09 points, and full adherence yielded a 0.45-point gain. Satisfaction was high, with 84% recommending the course.Conclusions: Sustainable Choices achieved small-to-moderate improvements in climate mitigation behaviours and enhanced perceived meaning and purpose. Fully digital behavioural interventions may provide a scalable complement to broader climate strategies, meriting further evaluation in diverse populations and with objective behavioural measures.

Introduction: The latest climate reports underscore the importance of climate change mitigation behaviours in reducing greenhouse gas emissions and achieving the climate goals. There is a growing demand among the general population for guidance on sustainable behaviour change. Previous research has indicated that behavioural interventions could play a significant role in facilitating this type of behaviour change. However, the effectiveness of such approaches has yet to be rigorously tested under scientific conditions. This project aims to assess whether a novel, intervention “Sustainable Choices” effectively promotes climate change mitigation behaviours when compared to a control condition. Methods: Voluntary participants will be recruited from the general population in Sweden and randomized to either “Sustainable Choices”, an online, behavioural intervention targeted at Climate Change Mitigation Behaviours (CCMBs), or a waitlist, both 5 weeks of duration. The target sample size is N = 680. The primary outcome of the study will be pre- to post-intervention difference in climate change mitigation behaviours, measured with the Climate Mitigation Behaviour Scale (CLIMBS). Secondary outcomes will include acceptability measures and effects on psychological well-being. Naturalistic follow-up assessments will be administered at 1-, 3- and 6-months after the post-measurement. Discussion: The increasing awareness of the link between climate change and individual sustainable lifestyle choices has generated a significant interest in this field. Our aim is to evaluate a scalable intervention targeted at CCMBs, while also promoting psychological well-being associated with sustainable lifestyles.

Depression is a leading cause of global disease burden. Although psychotherapy and pharmacotherapy effectively reduce depressive symptoms, access to high-quality care remains limited. This study examined whether a Continuous Quality Improvement (CQI) process incorporating measurement-based care and benchmarking could enhance depression treatment outcomes in specialized mental healthcare. Data were drawn from two outpatient mental health clinics in Stockholm, Sweden. First, patient-reported outcome measures (PROMs) were used to compare local clinical results with a meta-analytic benchmark. Next, a CQI framework was implemented to improve outcomes. The sample included 415 patients receiving treatment for depression. Compared to the benchmark, the clinical sample had higher pre-treatment depression severity, attended more appointments, and had lower data attrition. Initial year-to-year analyses showed that treatment effects were significantly lower than the benchmark (Hedge’s g = 0.87–1.01 vs. g = 1.51). After implementing the CQI process, treatment effects improved (g = 1.25–1.27) and were no longer inferior to the benchmark. These findings suggest that integrating measurement-based care, benchmarking, and CQI can improve depression treatment outcomes in specialized settings and may help close the gap between real-world care and evidence-based standards.

Background: There is a paucity of valid instruments to assess behaviours directly related with greenhouse gas reduction. In this study, the Climate Mitigation Behaviour Scale (CLIMBS) was developed, adapted from the General Ecological Behaviour framework to capture everyday climate-relevant behaviours across key domains.Methods: An initial 30-item pool including mobility, food, consumption, and engagement themes was refined through expert review and administered to adults participating in an intervention study in Sweden (N = 694). Items used five-point response formats aligned to behavioural frequency. Dimensionality was tested using bifactor item factor analysis (graded response model). Reliability was evaluated via ordinal α and McDonald’s ω. Associations with related constructs, including sustainability interest, knowledge, lifestyle, climate importance, and worry, assessed external validity.Results: A bifactor model with one general factor and four orthogonal domains showed the best fit (RMSEA = .045, CFI = .92, TLI = .91). After removing seven weak items, the final 23-item scale showed a strong general dimension (ω_total = .83, Ω_H = .69). Subscale reliability was acceptable (α = .68–.85). The general factor showed moderate to strong associations with related constructs (r = .39–.55, all p < .001), with negligible age and gender effects. A reduction of the full scale resulted into an 8-item short form (CLIMBS-8), which correlated highly with the general factor (r = .91). Conclusions: CLIMBS is a psychometrically supported measure of climate change mitigation behaviour with a dominant general factor and interpretable domains. The CLIMBS-8 provides a brief alternative with minimal loss of information.

IntroductionThe latest climate reports underscore the importance of climate change mitigation behaviours in reducing greenhouse gas emissions and achieving the climate goals. There is a growing demand among the general population for guidance on sustainable behaviour change. Previous research has indicated that behavioural interventions could play a significant role in facilitating this type of behaviour change. However, the effectiveness of such approaches has yet to be rigorously tested under scientific conditions. This project aims to assess whether a novel, intervention “Sustainable Choices” effectively promotes climate change mitigation behaviours when compared to a control condition. MethodsVoluntary participants will be recruited from the general population in Sweden and randomized to either “Sustainable Choices”, an online, behavioural intervention targeted at Climate Change Mitigation Behaviours (CCMBs), or a waitlist, both 5 weeks of duration. The target sample size is N = 680. The primary outcome of the study will be pre- to post-intervention difference in climate change mitigation behaviours, measured with an adapted version of the General Ecological Behaviour scale. Secondary outcomes will include acceptability measures and effects on psychological well-being. Naturalistic follow-up assessments will be administered at 1-, 3- and 6-months after the post-measurement. DiscussionThe increasing awareness of the link between climate change and individual sustainable lifestyle choices has generated a significant interest in this field. Our aim is to evaluate a scalable intervention targeted at CCMBs, while also promoting psychological well-being associated with sustainable lifestyles.

Background Depression is a leading cause of global burden of disease. Evidence-based interventions, such as psychotherapy and pharmacotherapy, are effective in alleviating depressive symptoms; however, challenges regarding accessibility of good quality care persist. This study investigated a Continuous Quality Improvement (CQI) process that incorporated measurement-based care and benchmarking to enhance treatment outcomes for depression within specialized mental healthcare settings. Methods This study utilized data from two outpatient mental health clinics in Stockholm, Sweden. In a first step, the study employed patient-reported outcome measures (PROMs) to compare clinical treatment results with a meta-analytic benchmark (Öst et al. 2023). In a second step, a CQI framework was implemented to improve treatment outcomes. Results A total sample size of N = 415 patients treated for depression was included in the analyses. The clinical sample demonstrated higher pre-treatment depression severity scores, more appointments, and a lower data attrition rate compared to the meta-analytic benchmark. Year-to-year analyses indicated that clinical treatment effects were initially significantly lower (Hedge’s g = 0.87 to 1.01, 95% CI[0.58–1.16]) compared to the meta-analytic benchmark (g = 1.51, 95% CI [1.36–1.65]). However, when the results from the CQI process were implemented, treatment effects improved and were found to be non-inferior to the meta-analytic benchmark (g = 1.25 to1.27, 95% CI [0.94–1.61]). Conclusions The findings suggest that the integration of measurement-based care, benchmarking, and CQI have the potential to improve treatment outcomes for depression in specialized mental healthcare.

Predictors for the pharmacological effect of ADHD medication in children and adolescents are lacking. This study examined clinically relevant factors in a large (N = 638) prospective cohort reflecting real-world evidence. Children and adolescents aged 6–17 diagnosed with ADHD were evaluated at baseline and three months following ADHD medication initiation. The outcome was measured as a reduction in total SNAP-IV (Swanson Nolan and Pelham teacher and parent rating scale) score at three months compared to baseline. Outcome groups were defined as Responders (≥ 40% reduction), Intermediate Responders (≥ 20 to < 40% reduction), and Non-responders (< 20% reduction). Included independent variables were the Autism Spectrum Questionnaire (ASSQ), the Spence Children’s Anxiety Scale (SCAS), the Pediatric Side Effect Checklist (P-SEC), anthropometrics measures, geographical region, relative age, Children´s Global Assessment Scale (CGAS), Intelligence quotient (IQ), pharmacological treatment initiation month, ADHD symptom severity, ADHD presentation, and psychotic-like experiences. Multinomial logistic regression suggested that ADHD symptom severity, region, relative age, and stating ADHD medication at three-month follow-up were associated with the response outcome group. However, when validating the data with Bootstrap Forest, none of the variables were significant. Thus, in our large naturalistic cohort, we could not identify any clinically relevant factors that reliably predict pharmacological treatment outcomes. Trial registration: NCT02136147.

Background: Severe disruptions in mental healthcare services were reported during the COVID-19 pandemic. However, little data are available on whether services were able to maintain treatment efficacy during this period.Objective: The aims of this study were to 1) compare outpatient mental healthcare treatment effects before and during the COVID-19 pandemic, and 2) explore whether the proportion of remote visits affected treatment outcomes. Methods: Using a clinical cohort from two outpatient mental healthcare clinics in Stockholm, Sweden, we analyzed data from 2,290 patients to compare treatment outcomes in years 2017 to 2019 (“before” the COVID-19 pandemic) vs. years 2020 to 2022 (“during” the COVID-19 pandemic). Primary outcomes were symptom reductions on patient-reported measures of depression, anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Results: We found a significant increase of remote visits during the COVID-19 pandemic (OR=10.9, 95% CI[10.49-11.27]). There were no statistically significant differences on treatment outcomes in the periods before vs. during the pandemic for any of the disorders under study. The proportion of remote visits did not have an effect on treatment outcomes. Conclusions: This large-scale naturalistic study indicates that, despite unprecedented disruptions, clinical services were able to maintain treatment outcomes during the COVID-19 pandemic.