Although previous studies have suggested an association between digital media use and health, detailed knowledge about how different types of digital media impact adolescent health is limited. This cross-sectional population-based study explored the relationship between time spent on various digital media and adolescents’ self-rated general and mental health. The study included 3566 Swedish high school students aged 16–17 years. Associations between time spent on digital media (social media, gaming, watching movies/series/video clips etc. and digital schoolwork) and self-rated health outcomes (general health, self-esteem, symptoms of worry/anxiety and low mood/depression, trust in other people, head/neck/shoulder pain and sleep quality) was assessed. Statistical analyses employed logistic regression models adjusted for covariates (sociodemographic variables and health behaviours). In the adjusted models, spending very high amounts of time (≥ 6 h/day) on any digital media, except schoolwork, was associated with poor self-esteem, symptoms of low mood/depression and poor sleep (ORs 1.35–2.93, p< 0.05). Spending six hours or more on digital media was also associated with worry/anxiety (for social media and gaming), head/neck/shoulder pain (for social media, watching movies/series/video clips and schoolwork), poor general health (for gaming and watching movies/series/video clips) and low trust (for gaming) (ORs 1.39–3.18, p< 0.05). High amounts of time (4–5 h/day) of watching movies/series/video clips was associated with daily symptoms of low mood/depression, neck/shoulder pain, and low trust in other people (ORs 1.46, 1.41, and 1.32, p< 0.05). This study indicates a dose-response relationship between digital media use and adverse health outcomes in adolescents, where adverse associations start to appear after 4–5 h, particularly for watching movies/series/video clips. However, further longitudinal studies, randomized controlled trials and public health interventions focused on healthy and balanced use of digital media are warranted.

I sin debattartikel i Läkartidningen (7 jan 2025) argumenterar Anna Melin och Lykke Tamm för att relativ energibrist inom idrott (REDs) är ett allvarligt och vanligt problem som bör tas på allvar.

Vi instämmer i att nutrition är en av flera grundläggande förutsättningar för idrottslig utveckling, prestation samt fysisk och psykisk hälsa. Det är självklart att träningsbelastning och energiintag måste anpassas och balanseras på alla nivåer av idrottsutövande. Däremot ifrågasätter vi författarnas framställande av REDs som ett väletablerat »syndrom«, särskilt i Läkartidningen, som riktar sig till den svenska hälso- och sjukvården.

Background: Currently, approximately 100 million people are displaced worldwide, including children and young adults. Previous studies showed exposure to violence and posttraumatic stress disorder (PTSD) are common in this sub-population. However, we still lack comprehensive data on well-being, mental health, and the ability to function. Methods: This study included 291 adolescent (aged 12-17 years) and young adult (18-25 years) refugees recruited nationwide in Sweden between 2019 and 2022. Sociodemographic, mental health and well-beingrelated data (well-being, post-traumatic stress symptoms, psychiatric diagnoses, and functional ability) were collected using semi-structured interviews with structured components. Associations between accompanied status and well-being/depression/suicidal thoughts, generalized anxiety disorder/panic disorder/PTSD symptoms, and functional ability were analyzed using linear and logistic regression, adjusted for age, gender, parental education, asylum status, and region of origin. Findings: Most study participants (mean age 17.9 years) originated from the Middle East and North Africa (70.6 %) or Sub-Saharan Africa (27.0 %). 16.1 % of adolescents and 32.3 % of young adults were unaccompanied. Nearly the entire study sample had experienced violence (92.8 %). However, the sample had a low prevalence of psychiatric diagnoses. For example, only 5.9 % fulfilled the criteria for clinical depression. Self-reported wellbeing (WHO-5, 71.09 (23.91)) and observer-rated functional ability (GAS/GAF, 81.76 (14.15)) were high. There were no significant differences in diagnosis prevalence by gender. However, significant differences existed between accompanied versus unaccompanied groups. Being an unaccompanied refugee individual was associated with a higher risk of suicidal thoughts, adjusted odds ratio, aOR 5.66 (95 % CI 2.15-14.88), higher rates of posttraumatic stress disorder symptoms /3 = 0.72 (0.39-1.05), lower mental well-being /3 = -10.86 95 % CI (- 18.23- -3.48) and lower functional ability /3 = -9.38 (- 13.84- -4.92). There were no differences in outcomes by gender except for worse well-being in males (/3 = 6.83 (1.01-12.66)). Interpretation: In this sample, we found lower prevalence rates for all psychiatric diagnoses compared to earlier published studies. Being an unaccompanied refugee individual was a risk factor for all adverse outcomes. Future studies need to confirm the relatively low rates of psychiatric diagnoses. Regardless, the results highlight the heterogeneous needs among newly arrived refugees.

Background Figure skaters typically jump in only one direction, landing on the same leg. Current prevention programs in figure skating lack knowledge about the importance of jumping direction in injury etiology.Objective To describe lateralisation (handedness, footedness, jumping direction) in female competitive figure skaters and its association with injury risk.Design One-year retrospective cohort study.Setting All licensed competitive figure skaters (n=400) in the southeastern region of Sweden.Participants 137 female figure skaters (mean age 12.9 (SD 3.0) years). Assessment of Risk Factors Lateralisation data and significant sports injury episodes for one year were reported by skaters. Associations were analyzed between handedness and jump-landing leg and between lateralization (right-sided/left-sided/mixed) and injury-sidedness (right/left/bilateral).Main Outcome Measurements Significant sports injury episode with time loss from sports &gt;21 days. Results Most skaters reported right-side handedness (93%), footedness (87%) and landing leg (85%). The jumping direction (landing leg) was associated with handedness/footedness (p=0.035). Forty-two skaters (31%) had suffered a significant sports injury episode. Fifty-nine injuries (64% overuse/36% traumatic) were reported; 48 (83%) were located to the lower extremities; 35% of the lower extremity injuries involved only the landing leg. No association between left-sidedness and overuse injury episode (p=0.463) or traumatic injury (p=0.760) incidence during the study period was observed. Neither was any association found between lateralisation and distribution of injury to sides (p=0.328).Abstract 863 Figure 1 DAGitty on theoretically potential pathways between lateralisation, asymmetrical loading and injury aetiology. In figure skating, you specialise very early in jumping/spining in only one direction(thus all jumps on the sme leg). Accumulated load (skating level, years as a figure skater, training hours) may contribute to a component of exhaustion and more asymmertical loading enhancing lateralisation. The degree of laterlisation may affect balance, coordination and injury location. Athletes prone to left-wise dexterity skate with their “creative” brain and may be more prone to injury when exhaused, as well as having worse mental health in terms of body image, anxiety and depressin indicators. Blue node = outcome and ancestors of the outcome.Green node = exposure. Light grey node = unobserved (latent). Green arrow = casual path.View this table:Abstract 863 Table 1 Localization of injuries sustained in the last 12 months (n=59) with regard to lateralization injuries categorized into overuse and traumatic injuries, respectively.Conclusions Right-side handedness, footedness, and jump landing leg dominated in female competitive figure skaters. No association was found between the side that injury was sustained and the skater’s jumping direction. The relatively small size of the study implies that the risk of type 1 error must be considered. The results can be used to inform injury prevention programs for figure skaters. More research is needed on the contribution of laterality and asymmetric loading.

Background Elite athletes are role models for young sportspersons regarding social media use. Self-objectification, including self-sexualizing, contributes to body dissatisfaction and body shame, especially in young females. For efficient prevention of self-objectification, knowledge is needed about elite athletes’ self-presentation on social media.

Objective To compare social media postings indicative of self-objectification among female elite athletes in an aesthetic and a non-aesthetic individual sport and by age.

Design Cross-sectional quantitative visual content analysis study.

Setting Instagram on October 1st, 2021.

Participants All Swedish elite female athletes aged 16 years or older with open Instagram accounts in figure skaters (n=26) and athletics (track and field) athletes (n=40).

Assessment of Risk Factors The 30 most recently posted images were identified from each athlete’s Instagram account (Figure). Following exclusion of non-topical images, a panel (4 women/4 men) individually scored factors indicative of self-objectification in the remaining images. The scores were analyzed quantitatively by sport (figure skating/athletics) and age group (age-cut at 21 years).

Main Outcome Measurements Proportion of sexually suggestive images in Instagram postings.

Results In total, 1,869 images were analyzed; 669 posted by figure skaters and 1200 by athletics athletes. Seventy-four images (4%) were classified as containing sexually suggestive content. Figure skaters posted more images with sexually suggestive content (p=0.032) than athletics athletes (especially images with sexual posing (p=0.005) and sexualized body parts in focus (chest (p=0.049); hip-region (p=0.001)). Younger athletes published more images interpreted to contain sexual suggestion than older athletes (p<0.001) (especially images focusing on the chest (p=0.008)). 

Conclusions Prevention of self-objectification in young female sportspersons should include moderation of self-presentation practices on social media among female elite athletes in aesthetic sports and young elite athletes in their upper teens. Further research on the role of social media in the etiology of mental unhealth in sportspersons is warranted. 

Background: Participatory approaches in child maltreatment (CM) research increasingly focus on involving children, youth, and adults as co-researchers. However, little is known about their use in Europe. Objective: To review the European literature on participatory approaches in CM research. Methods: The study was undertaken by members of the Euro-CAN (COST Action 19,106) representing 35 countries in the European region. Focusing on the European research literature, we searched eight databases for studies investigating CM and using a participatory approach. The review followed scoping review guidelines and PRISMA-ScR, with thematic analysis for data synthesis. Results: We identified 4927 potentially relevant articles, of which 307 were fully assessed for eligibility, and eight were ultimately included. The included studies addressed all types of CM; however, only two studies involved child and youth survivors of CM, while six involved children and youth from the community. Notably, no studies involving adult survivors were found. The findings indicate that children, youth, and adults can be involved in all stages of the research process, but the level of participation remains low. Eighteen different participatory methods were identified, and the ethical procedures and safeguarding of co-investigators varied significantly. Several barriers and challenges were identified, including issues related to adult gatekeeping behaviors, parental consent, confidentiality, and practical difficulties. Conclusions: The involvement of children, youth, and adults as co-researchers in CM research across Europe remains limited, with considerable variation in methods and procedures. These findings inform an ongoing e-Delphi study aimed at building consensus recommendations for participatory CM research. © 2024 The Authors

The Nordic welfare model is often used as an example for the promotion of health and wellbeing, even in vulnerable groups of children, such as refugees. Nonetheless, there are no published reviews on resilience and/or risk and protective factors for physical and mental health among refugee children living in Nordic countries. In this systematic review, we identified 5181 studies on the topic, screened titles, and abstracts, viewed 632, and finally included 26 studies. These studies described 18 samples with a total of 34,080 individuals ranging in ages 0–18 years. Overall, the studies were of good quality. Nearly all studies assessed adversity. Six studies reported physical health outcomes and all studies mental health outcomes, most often post-traumatic stress disorder and anxiety. None explicitly studied resilience. While we found that age and sex are the most frequently studied  risk- and protective factors, findings are inconclusive, since the direction of the associations was different in the different studies. This systematic review indicates that there is still a need for well-designed and -powered studies using clear definitions of key study concepts to examine health outcomes and resilience among refugee children in Nordic countries.

Background Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents’ experiences of such interventions.

Methods A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13–15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.

Results The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents’ conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents’ experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.

Conclusions Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents’ need for autonomy when planning mental health prevention and intervention.

Epidemiological studies suggest that psychiatric disorders are as prevalent amongst high-performance athletes as in general populations, challenging the myth of invulnerability. Despite efforts of sport organisations to highlight the significance of athletes' mental health, it is still many times tough to combine the sport performance ethos with a discourse on mental health. This narrative cornerstone review examines challenges related to definitions and classifications of athlete mental health in high-performance sports and how these influence assessments and the implementation of interventions. We discuss challenges with concept creep and psychiatrisation and outline their consequences for sport healthcare professionals. Based on this, we present a framework that aligns different categories of athlete mental health conditions (from the reduction of wellbeing to psychiatric disorders) with intervention types (from the provision of supporting environments to pharmacotherapy). We conclude that researchers and sport practitioners need to carefully consider conceptual creep and the risk of pathologising normal and healthy, albeit emotionally aversive, reactions to athlete lifeworld events when assessing athlete mental health. A clear separation of terminology denoting the athlete's resources to handle the lifeworld (including salutogenic factors) and terms describing psychiatric conditions and their management is necessary to avoid misguidance in intervention planning.