Steve Berggren

Background: An increasing number of young adults in Sweden are being granted support in daily living through social services. To enhance service planning and resource allocation for this growing group of young service users, we aimed to provide an overview of the social and health-related circumstances of young adults recently granted support in daily living. We had a particular focus on mental health service utilization and whether socio-demographic factors influence the use of care. Methods: Swedish nationwide register data were used to describe the sociodemographic characteristics and utilization of mental health services, including outpatient and inpatient care, treatment for suicidal behavior and pharmacological treatment. Sociodemographic predictors (sex, age, country of birth, education, and parental education) of mental health service utilization were explored using binary logistic regression. Results: All young adults (ages 18–29) granted support between 2017 and 2021 (N = 15,024; 49.2% female) were included. Unfavorable social circumstances were common, including truncated education, unemployment, and the need for financial assistance. Many had a history of psychiatric inpatient care (40.0%) and treatment for suicidal behavior (15.7%). The majority received psychiatric outpatient care (71.6%) and psychopharmacological treatment (73.9%) during their granting year. Common conditions for care included attention deficit hyperactivity disorder, anxiety and fear-related disorders, mood disorders, and autism spectrum disorder. Co-occurring conditions were prevalent. Utilization of mental health services was more common among females, particularly regarding treatment for suicidal behavior (adjusted OR 2.52; 95% CI 2.16–2.93). Higher educational level and being Swedish-born were associated with a greater likelihood of utilizing outpatient care and psychopharmacological treatment. In contrast, those born in Sweden were less likely than foreign-born to be admitted to inpatient care (adjusted OR 0.66; 95% CI 0.59–0.74). Conclusions: While social services recognize the support needs of this group of young adults, our findings suggest that sociodemographic characteristics such as sex, education level, and country of birth may facilitate or obstruct their access to mental health services. It is essential to coordinate efforts so that young adults with support in daily living can seek and access the mental health services they need. Clinical trial number: Not applicable.

TRANSITION is a structured behavioral and educational program to support young adults with mental, behavioral, and neurodevelopmental conditions transitioning into adulthood. This study investigated its feasibility as an add-on to regular daily living support in social services. A non-randomized single-arm mixed method design was used. Twenty-eight service users, aged 19-29, were enrolled to participate in the program for 20 weeks alongside their support workers. They rated their engagement and satisfaction and reported any adverse effects. Eighteen support workers received training in the program. A subsample of service users (n = 11) and support workers (n = 9) was interviewed about their experiences. Qualitative content analysis using an abductive approach and quantitative analyses with descriptive statistics was integrated and mapped to specific feasibility areas in a joint display. Service users completing the study (n = 26) generally rated satisfaction and engagement highly. While some service users experienced stress related to their participation, no serious adverse events were reported. Service users and support workers highlighted the program's clear structure and focus on specific goals as particularly valuable. The results indicate that TRANSITION is a feasible complement to regular support in social service settings. Further evaluation of the program is justified.Implications for rehabilitationThe TRANSITION program is a feasible add-on to regular support in daily living for young adults with mental, behavioral, and neurodevelopmental conditions.Support workers can deliver the program, although training, practice, and regular supervision are needed.Service users perceive that the program adds clarity and valued direction to their support.The program may help service users and support workers become more aware of the inherent benefits of user engagement in daily living support.

Metals are critical to neurodevelopment, and dysregulation in early life has been documented in autism spectrum disorder (ASD). However, underlying mechanisms and biochemical assays to distinguish ASD cases from controls remain elusive. In a nationwide study of twins in Sweden, we tested whether zinc-copper cycles, which regulate metal metabolism, are disrupted in ASD. Using novel tooth-matrix biomarkers that provide direct measures of fetal elemental uptake, we developed a predictive model to distinguish participants who would be diagnosed with ASD in childhood from those who did not develop the disorder. We replicated our findings in three independent studies in the United States and the UK. We show that three quantifiable characteristics of fetal and postnatal zinc-copper rhythmicity are altered in ASD: the average duration of zinc-copper cycles, regularity with which the cycles recur, and the number of complex features within a cycle. In all independent study sets and in the pooled analysis, zinc-copper rhythmicity was disrupted in ASD cases. In contrast to controls, in ASD cases, the cycle duration was shorter (F = 52.25, P < 0.001), regularity was reduced (F = 47.99, P < 0.001), and complexity diminished (F = 57.30, P < 0.001). With two distinct classification models that used metal rhythmicity data, we achieved 90% accuracy in classifying cases and controls, with sensitivity to ASD diagnosis ranging from 85 to 100% and specificity ranging from 90 to 100%. These findings suggest that altered zinc-copper rhythmicity precedes the emergence of ASD, and quantitative biochemical measures of metal rhythmicity distinguish ASD cases from controls.

A comparative randomized controlled pragmatic trial of neurofeedback and working memory training for children with attention-deficit/hyperactivity disorder: protocol