Purpose: Child-to-parent violence (CPV) is an increasingly important social issue, with most research concentrated in a few countries, highlighting a need for more research on the subject. In this study, we therefore validate the Swedish version of the Abusive Behavior by Children-Indices (ABC-I), a self-report tool with subscales for verbal aggression, coercive behavior, and physical aggression. We also explore the prevalence of CPV among Swedish adolescents.

Methods: Using data from a self-report survey conducted among a stratified sample of adolescents in southern Sweden ( N  = 5310; 53.2% female; M age  = 16.17, SD = 1.6), we validated the three-component structure of the ABC-I using Partial Least Squares Structural Equation Modeling (PLS-SEM). We also analyzed differences in the prevalence of various types of abuse and aggression by sons and daughters against mothers, fathers, or either parent using Pearson’s chi-square test.

Results: The Swedish version of the ABC-I shows predictive and concurrent validity in capturing CPV across genders and age groups, although caution is advised when interpreting the verbal aggression scale. The overall prevalence of any form of abusive behavior toward parents was 15% (5% for physical abuse, 4% for verbal abuse, 11% for coercive behavior). Violence against mothers was more common than against fathers, with daughters being more aggressive and abusive, particularly toward mothers.

Conclusions: We argue that the Swedish version of the ABC-I constitutes a valuable tool for assessing CPV. The relatively high prevalence of overall CPV underscores the need for further research in order to develop effective prevention strategies and interventions.

Studies show that child-to-parent violence (CPV) occurs in many families, but the impact of ethnicity on CPV is largely unknown. This cross-sectional study examines whether there are differences in CPV between ethnic Swedish adolescents and adolescents with a background in Muslim countries, both first and second generation. The study is based on a stratified sample of 4222 adolescents and young adults aged 13-20 years. Self-report data were collected in schools across 12 municipalities in southern Sweden. Results indicate that verbal aggression is less frequent among both first- and second-generation immigrants than among ethnic Swedish adolescents. Girls reported more verbal aggression than boys, particularly in the Swedish group. Ethnic differences are smaller and more difficult to interpret for coercive behavior and physical aggression. Ethnic differences in norms around parent-child relationships may influence less severe behaviors to a greater extent, whereas maladaptive behaviors involving more substantial norm violations may be more affected by individual and family-level risk factors.

Background:

Several previous studies have analyzed patient experiences of long-acting injectable buprenorphine (LAIB) in treating opioid use disorder (OUD). This treatment approach reduces the need for daily supervised clinic visits, but also fundamentally changes the dynamic of the relationship between patients and staff. The perspective of staff working with opioid agonist treatment (OAT) on LAIB is lacking. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB. 

Methods:

We conducted 10 individual semi-structured in depth qualitative interviews with OAT physicians in parallel with nine focus groups with OAT nurses, help-nurses, social workers, and other clinical staff categories (n=41) from eight publicly financed and two private OAT clinics in Sweden, covering a variety of rural and urban settings, and different socioeconomic areas. The data was transscribed verbatim and analyzed with thematic text analysis.

Results:

Analysis of interviews and focus groups with OAT physicians and staff revealed, in line with studies on patients’ experiences, themes regarding advantages and disadvantages of the new long-acting formulations and the importance of choice of medication. A learning curve regarding which patient categories were most likely to benefit from LAIBs emerged. Overall staff found more advantages than disadvantages with LAIB, especially for patients with ongoing substance use and low treatment adherence. Other themes concern the need for the staff to balance between control perceived as keeping tabs and being able to intervene and worries regarding patient safety. Less frequent visits were viewed as both enabling for some patients, who benefited from the increased freedom offered by LAIB formulations and also as potentially detrimental to the treatment alliance. 

Conclusions:

Staff in addiction services face dilemmas regarding balancing between care and control. Keeping tabs to some degree was seen as necessary to tailor interventions to patients’ needs. Staff perspectives are valuable in the continued discussion of policy and practice on how to adequately address training and support for addiction staff in order to prepare them to handle emerging ethical and professional dilemmas when new interventions are implemented.

Background: Long-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.

Methods: Individual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis.

Results: Five central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients’ degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB’s impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients’ clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT.

Conclusions: LAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.

BACKGROUND: Understanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life.

METHODS: A retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life.

RESULTS: Three distinct classes were identified: "Few care contacts," with limited interaction with any services; "Social service contacts," comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and "Numerous care contacts," with extensive contacts with both healthcare and social services. The "few care contacts" class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support.

CONCLUSIONS: Using a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts.

This study examines the psychometric structure and properties of the Swedish version of the Super-Brief Pathological Narcissism Inventory (SB-PNI) among adolescents. In order to ensure the validity and feasibility of the measure, we examined the factor structure, measurement invariance across gender, age and ethnicity, and construct validity in relation to a number of correlates of narcissism in adolescence. Data were drawn from a large cross-sectional survey conducted in 35 schools in southern Sweden. The sample consisted of N = 5313 adolescents (Mage = 16.10 SD = 1.55) with 52.2% girls, 45.9% boys and 1.8% adolescents with unspecified gender, from compulsory and upper secondary schools in southern Sweden. The results showed that the measure holds a two-factor structure, suggesting the use of the subscales grandiosity and vulnerability separately, rather than as a unidimensional measure. The correlated factors grandiosity and vulnerability yielded full configural and metric invariance across gender, age, and ethnicity. Both grandiosity and vulnerability were correlated with externalizing and internalizing symptoms, as well as with low self-esteem. The study provides evidence for the utility of the SB-PNI among Swedish adolescents and indicates that the measure can be used across male and female adolescents of different ages and ethnic groups. 

Background/Aim: Opioid overdose deaths have increased in Sweden and other developed countries in recentdecades, despite increased treatment efforts and harm-reduction interventions. Furtherknowledge in this field is needed if this trend is to be reversed. Previous research suggeststhat mental health and patterns of prescription of opioids and other prescription drugs areassociated with increased opioid-related mortality. The present study therefore aimed toinvestigate what drugs were prescribed during the last six months of life to individuals with ahistory of illicit substance use who died with opioids present in their blood, the relationshipbetween drugs prescribed and drugs found in blood at time of death, and if prescription ofspecific drugs was temporally associated with death.

Methods: This was a retrospective, register-based observational study that utilized data from theNational Board of Forensic Medicine, the Prescribed Drug Registry, regional health careservices, and municipal social services. We used conditional logistic regression to findtemporal associations between the prescription and dispensing of drugs and time ofdeath.

Results: Prescription and dispensing of alprazolam and diazepam were temporally associated withdeath. The most frequently dispensed drugs were zopiclone, pregabalin, methylphenidate,diazepam and oxycodone. Methadone, alprazolam, and buprenorphine were the drugsmost often found in the blood. Opioids and tranquilizers in combination were found in a vastmajority of deaths, and prescription data suggested that the use of these drugs was illicit in amajority of cases.

Conclusion: Prescription of certain drugs, especially alprazolam and diazepam, should be made withgreat caution to patients with a history of illicit substance use or concurrent use of opioids.

This study examines whether unstructured and structured activities interact in their association with delinquency and cannabis use. We hypothesize that unstructured activities are more strongly associated with delinquency and cannabis use for those who are less engaged in structured activities. Data are drawn from three nationally representative self-report studies conducted between 2005 and 2011 in Sweden, and include 19,644 adolescents. The results support the hypothesis that unstructured activities interact with structured activities in the association with delinquency and cannabis use. The association between unstructured activities and these outcomes is stronger for those with lower levels of structured activities. Sporting activities constitute the structured activity that most clearly interacts with unstructured activities in the association with delinquency and cannabis use.

Background:

Previous research on the relationship between social media use and well-being in adolescents has yielded inconsistent results. We addressed this issue by examining the association between various digital media activities, including a new and differentiated measure of social media use, and well-being (internalizing symptoms) in adolescent boys and girls.

Method:

The sample was drawn from the four cross-sectional surveys from the Öckerö project (2016–2019) in eight municipalities in southern Sweden, consisting of 3957 adolescents in year 7 of compulsory education, aged 12–13. We measured the following digital media activities: playing games and three different activities of social media use (chatting, online sociability, and self-presentation). Our outcome measure was internalizing symptoms. Hypotheses were tested with linear regression analysis.

Results:

Social media use and playing games were positively associated with internalizing symptoms. The effect of social media use was conditional on gender, indicating that social media use was only associated with internalizing symptoms for girls. Of the social media activities, only chatting and self-presentation (posting information about themselves) were positively associated with internalizing symptoms. Self-presentation was associated with internalizing symptoms only for girls.

Conclusion:

Our study shows the importance of research going beyond studying the time spent on social media to examine how different kinds of social media activities are associated with well-being. Consistent with research in psychology, our results suggest that young girls posting information about themselves (i.e. self-presentation) might be especially vulnerable to display internalizing symptoms.

OBJECTIVES: This study examines the associations between ten family structure types and delinquency, including four groups of symmetrical and asymmetrical living arrangements. We also adjust for attachment to parents and parental monitoring.

METHODS: Data are drawn from four cross-sectional surveys conducted between 2016 and 2019 in southern Sweden. The sample consists of 3,838 adolescents, aged 14-15. Negative binomial models were used to calculate the associations between family structure and delinquency.

RESULTS: The results show that those living in single-father, single-mother, father-stepmother, mother-stepfather families report significantly more delinquency than adolescents living with both their parents. Adolescents living in "symmetrical" family arrangements, i.e. both parents are single or have a new partner, reported lower levels of delinquency, whereas adolescents living in "asymmetrical" family arrangements, i.e. where either the mother or the father, but not both, have a new partner, reported higher levels of delinquency. Most of the associations between family structure and delinquency decline when adjusted for attachment to parents and parental monitoring.

DISCUSSION: This study shows that it is important to move on to the use of more detailed categorisations of family structure in relation to delinquency. We need to increase our knowledge about the group of adolescents that moves between parents and especially about the different constellations of asymmetrical and symmetrical living arrangements.