Research in Psychiatry and Mental Health

In 2009, a research study was initiated within child and adolescent psychiatry. The study examines the well-being of children and adolescents who come to Child and Adolescent Psychiatry (BUP) in Västmanland, the care they receive, and their outcomes over time.

In the autumn of 2018, a follow-up of participants who had previously agreed to take part in the study was conducted at the Centre for Clinical Research in Västmanland. The purpose was to assess the participants’ current well-being and life situation, as well as to collect their experiences of contact with Child and Adolescent Psychiatry (BUP).

The study investigated the prevalence of depression, anxiety, ADHD, and behavioral problems among children and adolescents seeking care. Comorbidity was also examined, that is, how common it is for multiple problems to occur simultaneously, such as both depression and anxiety, and whether there are any associations with upbringing and heredity.

Furthermore, the study explored how participants perceived the effectiveness of the treatment they had received and whether there was a need for improvements.

Participants in the follow-up study completed a web-based questionnaire. Information and login details were sent by post. The questionnaire took approximately 30 minutes to complete. In some cases, saliva samples were also collected. Participation was voluntary, and participants could withdraw at any time without providing a reason.

EPIQ is the result of both planned research studies and a need for a standardized and structured assessment at initial visits to Child and Adolescent Psychiatry (BUP) clinics, with the possibility of follow-up and evaluation of BUP interventions.

In 2008, several research-interested staff members at BUP in Västmanland contacted Professor Kent Nilsson at the Centre for Clinical Research (CKF) in Västerås. Several neglected research areas and topics of interest were presented at various meetings at CKF, such as anxiety, depression, ADHD, and conduct problems. Instead of initiating separate research projects, it was decided to develop a joint data collection instrument that would include screening tools for the most common psychiatric conditions as well as psychosocial risk factors. The overarching project,
“Prevalence of multiple co-occurring psychiatric conditions and treatment response, as well as the interaction between psychosocial risk factors and hereditary vulnerability in patients at BUP,” was created.

Initially, a paper-based questionnaire was designed, which was later converted into a web-based format and integrated with the electronic medical record system to facilitate both data collection and clinical documentation.

EPIQ is an instrument under continuous development, aimed at supporting both research and clinical practice. Changes to its content are made continuously to meet these needs. An EPIQ assessment at an initial visit provides a baseline measurement, which can later be compared with follow-up assessments using selected scales. EPIQ can be used on-site at a clinic or sent to patients via Sweden’s healthcare portal (1177) through a secure, encrypted link.

The criteria for including scales in EPIQ are that they are freely available, not overly extensive, and that psychometric evaluation and validation either exist or are planned.

Currently, EPIQ is available in a youth version (from age 13), a parent version, and a version for school staff, called School-EPIQ.

How it works

• Parents contact Child and Adolescent Psychiatry to schedule an appointment.
• EPIQ is sent to patients and their parents via email. The questionnaire is completed before the visit to BUP.
• The web-based instrument screens for the most common psychiatric conditions and psychosocial risk factors.
• The child and their parents attend the scheduled appointment at BUP.

EPIQ facilitates medical record documentation, measurement, reporting, and follow-up of outcomes through a unified database integrated with the electronic health record system.

After one year, EPIQ is followed up with a follow-up questionnaire.

About EPIQ

• Standardized, structured assessment for an equivalent evaluation process
• Information is collected from both adolescents and parents
• Assesses not only psychiatric symptoms but also family violence, substance use, bullying, parental well-being, and disability
• Web-based data collection allows for more time with patients
• Digital link between patient, healthcare provider, and medical record (EPIQ transfers data directly into the record)
• Baseline measurement enables follow-up and evaluation of BUP interventions

Electronic Psychiatric Semi-Structured Interview for Children and Adolescents

EPSI-C is a semi-structured diagnostic interview for children and adolescents (ages 6–17) that assesses current episodes of psychopathology in accordance with DSM-5 diagnostic criteria. The instrument is designed to support a broad, systematic, and standardized assessment within child and adolescent psychiatry. EPSI-C has been developed in collaboration between Child and Adolescent Psychiatry (BUP) Västmanland and the Centre for Clinical Research in Västerås, Region Västmanland.

• Read further about EPSI-C here (Swedish): EPSI-C Elektronisk Psykiatrisk Semistrukturerad Intervju för barn och ungdomar

Electronic Psychiatric Semi-structured Interview for Children and Adolescents

EPSI-C is a semi-structured diagnostic interview for children and adolescents (ages 6–17) that assesses current episodes of psychopathology in accordance with DSM-5 diagnostic criteria. The instrument is designed to support broad, systematic, and standardized assessment within child and adolescent psychiatric services. EPSI-C was developed in collaboration between the Child- and Adolescent Psychiatric Clinic and Centre for Clinical Research in Västerås, Region Västmanland, Sweden.

• Read further about EPSI-C here: EPSI-C Electronic Psychiatric Semi-structured Interview for Children and Adolescents

SALVe Cohort, or “Heredity and Environment – Mental and Somatic Health among Adolescents in Västmanland”, is a research project that started in 2012 and will follow, over a period of 20 years, adolescents born in 1997 and 1999 in Västmanland who are participating in the study.

During 2017–2019, we are conducting an experimental sub-study in which 200 participants have been randomly selected and offered participation in an in-depth experimental study focusing on gambling behavior and emotional responses.

We aim to investigate which individuals may be at increased risk of excessive gambling or developing gambling addiction. The purpose is to examine the role of genetic and environmental factors in gambling behavior and emotional responses through various measurements in an experimental setting.

Wireless sensors are attached to the face, one hand, and the upper body to measure heart rate, skin conductance, respiratory rate, as well as body and facial movements during the experiment. Participants are compensated with gift vouchers worth 1,000 SEK and also have the opportunity to earn up to an additional 600 SEK depending on their performance in the gaming tasks.

Procedure:

1. A web-based questionnaire is sent to the participant to be completed at home
2. An additional questionnaire is completed by the participant in the laboratory at the Centre for Clinical Research
3. The participant completes four computer-based tests of emotional responses in the lab
4. Break with refreshments
5. Interview about gambling and addiction
6. The participant completes three different computer-based gaming tasks in the lab
7. A saliva sample is collected from the participant

Klicka här för att se en informationsfilm om studien

Biological Sensitivity to the Environment – for Better and for Worse

This project is a cohort study that largely resembles the SALVe and BUP projects. We will follow approximately 2,000 adolescents from Västmanland over a period of 20 years to examine lifestyle habits and their health effects. The study will address these aspects from both biological and psychosocial perspectives. Several PhD students and postdoctoral researchers will conduct their research based on data from this project.

The first data collection began in the autumn of 2012 and was completed in 2013. During the autumn of 2015, the first follow-up study (wave 2) was conducted. Preparations for an experimental in-depth study began in 2016, and data collection for this sub-study was completed in 2019.

During the autumn of 2018, wave 3 of the cohort study was carried out. The third follow-up study in the project (wave 4) began in the autumn of 2021. All participants born in Västmanland in 1997 or 1999 receive a letter by post containing a link to a web-based questionnaire to be completed online.

Comorbidity and Treatment Response among Adolescents with Alcohol and Drug Abuse

This project is a collaborative effort with Professor Sheilagh Hodgins, who is active, among other places, at Maria Youth Clinic in Stockholm. We are currently conducting a five-year follow-up of approximately 200 patients. In addition, their siblings and parents are also being studied.

Comorbidity and treatment response, as well as long-term outcomes, will be examined. Both psychosocial and biological factors will be investigated. In this exclusive project, around one hundred of the research participants have also undergone brain imaging using magnetic resonance imaging (MRI), and we have additionally conducted analyses of methylation levels of a number of candidate genes.

Data from this study will be used by several PhD students and postdoctoral researchers. Two PhD students have included data from this study in their dissertations (2015 and 2016).

Comorbidity in an Adult Outpatient Psychiatric Clinic: What Are the Outcomes of Treatment During Sick Leave – and Are They Influenced by Biology and Gender?

In 2009, a research project was planned within the framework of adult outpatient psychiatric care in Sala. The aim of the study is to map the prevalence of depression, anxiety disorders, ADHD, alcohol and drug abuse, comorbidity, psychosocial stress factors, genetic predisposition, and treatment outcomes among patients attending an adult psychiatric clinic. Gender differences will also be examined.

Patient recruitment has now been completed, and a new PhD project was initiated in 2016.