BACKGROUND: Refugees and asylum-seekers commonly experience numerous adverse and traumatic events and are therefore at increased risk of mental health problems. Despite the high need for mental health interventions, services tend to be underused by refugees and asylum-seekers, and various barriers compromise access. Digital, efficient screening, adapted for these groups, could facilitate initial assessment and increase accessibility to mental health services. We developed an internet-based tiered screening procedure (i-TAP) aiming to identify clinically relevant symptoms of major depressive disorder (MDD), anxiety disorder, posttraumatic stress disorder, and insomnia disorder among individuals with a refugee background. The i-TAP is an adaptive procedure with 3 tiers aiming to identify general mental distress in Tier 1, differentiate between symptoms in Tier 2, and assess the severity of symptoms in Tier 3. Each tier additionally functions as a gateway to further assessment, as a negative outcome terminates the procedure.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic test accuracy of the i-TAP, using structured clinical assessments as the reference standard.

METHODS: In this prospective study, 70 adult participants with a refugee background, literate in Arabic, Dari, Farsi, or Swedish, and residing in Sweden, completed the i-TAP on tablets and participated in a subsequent structured diagnostic interview.

RESULTS: It has been shown that the i-TAP could identify 91.7% (33/36) of individuals assessed with any psychiatric disorder, and correctly identified 82.1% of all positive cases of MDD, anxiety disorder, posttraumatic stress disorder, and insomnia disorder, with few false negative assessments. Overall test accuracy of the i-TAP ranged between 77.1% and 84.3%, depending on disorder. The tiered design could reduce item burden while maintaining accuracy. A vast majority of participants rated the user experience as positive. In this sample, 36/70 (51.4%) individuals were assessed with one or more psychiatric disorders and comorbidity was high.

CONCLUSIONS: The i-TAP may be a valid, efficient, and feasible screening tool for the identification of common psychiatric disorders among individuals with a refugee background in Sweden. The i-TAP could be implemented as a first screener in various settings, including online and in-person clinical practices. The digital, adaptive, multilingual format could facilitate early assessment and increase the availability of mental health services for refugees and asylum-seekers.

BACKGROUND: Eating disorders are psychiatric conditions that extend beyond concerns with weight, body and shape, encompassing complex issues related to self-esteem, emotion regulation and interpersonal functioning. Moreover, co-occurring depression, often undiagnosed, is a common complicating factor. Gaining an in-depth understanding of living with an eating disorder is vital both theoretically and for identifying factors that maintain or inhibit recovery. Patient-centred studies offer valuable insights into the lived experience of eating disorders, highlighting their impact and interaction with various life phenomena.

METHODS: This qualitative study aimed to capture the meaning and experience of living with an eating disorder from a patient perspective. Semi-structured interviews were conducted with 15 women suffering from eating disorders and comorbid depressive symptoms, prior to the start of treatment. Data were analysed using reflexive thematic analysis.

RESULTS: Two dimensions of relating to the eating disorder emerged. The first dimension, "Relating to the eating disorder over time", followed a temporal trajectory with four themes: "The eating disorder as a way to handle other difficulties", "From control to a consistent loss of control", "The whole existence revolves around the eating disorder" and "Hard to see a life without the eating disorder". The second dimension, "Having an eating disorder- a relentless relating", focused on the present experience and was divided into two themes: "The eating disorder's impact on relating to myself" and "The eating disorder's impact on relating to others".

CONCLUSIONS: Living with an eating disorder involves a constant, entangled and conflicted relationship with the disorder, leading to alienation from significant others and one's own body. This pervasive presence of disordered thoughts and behaviours makes it challenging to relate to oneself and the external world without their influence. Over time, the disorder becomes increasingly ego-syntonic, rendering it difficult to envisage a life without it. Treatment should, therefore, aim to externalise the disorder-to foster new life goals, enhance social engagement, and improve interpersonal skills. Further research is needed to elucidate how co-occurring depressive symptomatology influences an individual's relationship with their eating disorder, as these factors may be crucial in tailoring effective interventions.

Background: To develop and validate the Tinnitus Qualities and Impact Questionnaire (TQIQ), a new tool for evaluating the perceived qualities of tinnitus sound. Method: The study was part of two clinical trials on internet-based tinnitus interventions, using cross-sectional (n = 380) and pretest-posttest data (n = 280). Participants completed various questionnaires online, including the newly developed TQIQ and measures of tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder 7; GAD-7), depression (Patient Health Questionnaire 9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). The psychometric properties of the TQIQ were assessed, including construct validity, internal consistency reliability, floor and ceiling effects, interpretability, and responsiveness to treatment. Results: Exploratory factor analysis resulted in two factors that accounted for 57% of the variance-internal and external tinnitus qualities. Overall, 92% convergent validity predictions were confirmed; TQIQ total scores strongly (≥0.6) or moderately (0.30 to 0.59) correlated with the TFI, GAD-7, PHQ-9, and ISI. The known-groups validity prediction was confirmed as individuals with an overall TFI score > 50 (severe) obtained significantly higher TQIQ scores. All internal consistency reliability statistics were within the required range (Cronbach's α > 0.8). Floor and ceiling effects were negligible. ROC established clinically important cut-off scores, enhancing the interpretability of tinnitus severity classification. Finally, 89% convergent validity predictions were confirmed; TQIQ and TFI change scores were moderately correlated, indicating good responsiveness of the former to treatment. Conclusions: The TQIQ has adequate psychometric properties, providing a standardized measure for the assessment of characteristics of tinnitus sound in clinical practice.

BackgroundSocial anxiety disorder (SAD) is a common condition that affects intrapersonal (e.g., distress and impairment) and interpersonal functioning (e.g., difficulties in amorous relationships). People with SAD tend to have difficulties in communicating feelings to partners and report lower levels of sexual and relationship satisfaction. Cognitive behavioral therapy (CBT) for SAD has been found to reduce symptoms of social anxiety, but less is known about its impact on relationship functioning. Internet-based CBT (iCBT) has gained attention for its primary advantage: bridging distances and saving time for the patient. In the planned study, we aim to translate and culturally adapt an iCBT program for social anxiety for use in Portugal (PORTiSOFIE) and measure the effects of the program on social anxiety symptoms. We will also study the impact on sexual and relationship satisfaction, as well as other relationship- relevant outcomes.MethodsWe will conduct a randomized controlled trial and divide participants in a two-arm study with parallel groups (i.e., intervention group and attention group). After allocation, the intervention group will receive treatment, while the control group (i.e., attention group) will receive treatment 9 weeks later. The treatment is based on the Clark and Wells model of social phobia and consists of nine modules, with one module completed each week. Participants will answer questionnaires to assess social anxiety symptoms and relationship outcomes at pre-treatment, post-treatment, and 6-month follow-up. Participants' partners will also be asked to complete questionnaires on the same periods of time, but only regarding relationship outcomes.DiscussioniCBT for SAD in adults has not yet been tested in Portugal, and overall, there is a gap in the literature regarding the role of partners in iCBT for SAD. We hope our study contributes to increasing accessibility to therapy (and better mental health) by promoting online evidence-based therapies. In addition, we hope it helps to better understand how relationship components are affected and affect clinical symptoms and their progression within receiving treatment.Trial registrationClinicalTrials.gov NCT06767878. Registered on January 10, 2025.

OBJECTIVES: Internet-delivered cognitive behavioral therapy has been found to be effective for various populations with somatic and psychological difficulties. However, older adults are often overlooked and have received relatively less attention in research. This study aimed to test the effects of an 8-week therapist-supported internet-based cognitive behavioral therapy program for depressed older adults compared to a waiting-list control condition.

METHODS: Individuals interested in participating in the study completed self-report questionnaires online, followed by a semi-structured intake interview. Symptoms of depression were the primary outcome and were measured with the PHQ-9 and GDS-15. Secondary outcome measures included anxiety symptoms (GAD-7) and psychological well-being (WHO-5). In total, 84 help-seeking individuals 60+ years old met the inclusion criteria and were included in the study. They were randomized on a 1:1 ratio to either 8 weeks of guided internet-delivered CBT (ICBT) or to a waiting-list control group.

RESULTS: Results analysed on an intention-to-treat and completer basis after 8 weeks of intervention showed treatment effects in favor of the ICBT group compared to a waiting-list at post-treatment with moderate to large between-group effects. Treatment effects in the treatment group were maintained at 3-months and 1-year follow-ups. Treatment dropout was also associated with older age and with lower computer skills.

CONCLUSIONS: This study suggests that therapist-guided ICBT can be a feasible treatment option for older adults with symptoms of depression.

LIMITATIONS: The main limitations of this study is a small sample size and lack of control group in the follow-up assessments.

An intimate partner relationship is one of the most significant life goals for humans. Romantic relationships can promote healthy behavior and buffer against the development of psychiatric disorders. However, reliable and valid measures of relationship satisfaction are lacking. The Valentine scale is a freely available brief measure of relationship satisfaction (https://osf.io/fb72s), intended to provide an easily interpretable index of relationship satisfaction. Across two studies, we evaluated the reliability, validity, and factor structure of the Valentine scale. Study One (n = 851) explored the factor structure of the Valentine scale, assessed its test-retest reliability, and criterion-related validity. Study Two (n = 527) confirmed the factor structure of the Valentine scale, explored its measurement invariance, and further evaluated criterion-related validity. The results supported a unidimensional structure of the Valentine scale. Furthermore, the Valentine scale exhibited good internal reliability (Cronbach's alpha = .75 and .81 in Study One and Two, respectively), high test-retest reliability (ICC3 = .80 at a two-week follow-up in Study One), and appropriate criterion-related validity demonstrating positive correlations with other measures of relationship satisfaction and positive affect, as well as and negative correlations with measures of psychopathology. Together, these findings provide good support for the usage of the Valentine scale to quantify relationship satisfaction.

BACKGROUND: Although there are effective psychological treatments for post-traumatic stress disorder (PTSD), they remain inaccessible for many people. Digitally enabled therapy is a way to overcome this problem; however, there is little evidence on which forms of these therapies are most cost effective in PTSD. We aimed to assess the cost-effectiveness of the STOP-PTSD trial, which evaluated two therapist-assisted, internet-delivered cognitive behavioural therapies: cognitive therapy for PTSD (iCT-PTSD) and a programme focusing on stress management (iStress-PTSD).

METHODS: In this health economic evaluation, we used data from the STOP-PTSD trial (n=217), a single-blind, randomised controlled trial, to compare iCT-PTSD and iStress-PTSD in terms of resource use and health outcomes. In the trial, participants (aged ≥18 years) who met DSM-5 criteria for PTSD were recruited from primary care therapy services in South East England. The interventions were delivered online with therapist support for the first 12 weeks, and three telephone calls over the next 3 months. Participants completed questionnaires on symptoms, wellbeing, quality of life, and resource use at baseline, 13 weeks, 26 weeks, and 39 weeks after randomisation. We used a cost-effectiveness analysis to assess cost per quality-adjusted life year (QALY) at 39 weeks post-randomisation, from the perspective of the English National Health Service (NHS) and personal social services and on the basis of intention-to-treat for complete cases. Treatment modules and the platform design were developed with extensive input from service users: service users also advised on the trial protocol and methods, including the health economic measures. This is a pre-planned analysis of the STOP-PTSD trial; the trial was registered prospectively on the ISRCTN Registry (ISRCTN16806208).

FINDINGS: NHS costs were similar across treatment groups, but clinical outcomes were superior for iCT-PTSD compared with iStress-PTSD. The incremental cost-effectiveness ratio for NHS costs and personal social services was estimated as £1921 per QALY. iCT-PTSD had an estimated 91·6% chance of being cost effective at the £20 000 per QALY threshold. From the societal perspective, iCT-PTSD was cost saving compared with iStress-PTSD.

INTERPRETATION: iCT-PTSD is a cost-effective form of therapist-assisted, internet-delivered psychological therapy relative to iStress-PTSD, and it could be considered for clinical implementation.

FUNDING: Wellcome Trust and National Institute of Health Research Oxford Health Biomedical Research Centre.

Treating culturally diverse patients (CDPs) presents considerable challenges for psychotherapists, including language barriers, differing beliefs, and insecurities. Improving their transcultural competence requires training, but empirical evidence is lacking. This 6-week randomized controlled trial evaluated the impact of standardized internet-based training on psychotherapists' transcultural competence (i.e., awareness, engagement, and handling challenges). Demographic data were collected before training. Transcultural competence was measured at pre-training, post-training, and 3-month follow-up. Training satisfaction was assessed at post-training and follow-up visits. In the guided training group (GTG; n = 83), psychotherapists received hands-on training with practical exercises, weekly knowledge assessments, and online feedback. The second condition comprised a non-guided control group (CG; n = 90) that received only text-based training. Primary analyses on both intent-to-treat (n = 173) and completer analyses (n = 95) indicated significant improvements in transcultural awareness and engagement after 6 weeks of training for both groups. Significant within-group improvements were noted, as evidenced by large Cohen's d effect sizes for both groups. No between-group differences were observed. Qualitative assessments revealed that GTG participants evaluated the training's concept and content significantly more positively than CG participants and felt significantly less insecure about treating CDPs. Such training could pave the way for the long-term development of innovative, culturally sensitive mental health care services that more effectively meet the needs of CDPs.