OBJECTIVE:To investigate if academic achievement among children with nonsyndromic orofacial clefts (OFC) differs compared to nonaffected children and whether this association is modified by sex and psychiatric comorbidity. METHODS:A register-based cohort of children born with cleft lip (CL), cleft lip and palate (CLP), and cleft palate only (CPO) in Sweden between 1973 and 2004 (n = 6286) was compared to a matched community cohort (n = 61,352). Outcomes were academic achievements in mathematics and Swedish in school years 3, 5, 6, 9, and upper secondary school; all subjects' grades in school year 9; and university degree. Binomial-, ordinal logistic-, linear-, and binary logistic regression were used. RESULTS:For the majority of outcomes, no statistically significant group differences were observed, and generally children with CL were less affected than those with CLP and CPO. Children with CPO demonstrated lower achievement in the third school year (Swedish; aOR 0.54, 95% CI 0.40-0.72, mathematics; aOR 0.54, 95% CI 0.42-0.70), in Swedish in the ninth school year (aOR 0.89, 95% CI 0.80-0.99), and in mathematics in upper secondary school (aOR 0.87, 95% CI 0.76-1.00). Individuals with CPO had reduced odds of graduating from university (aOR 0.81, 95% CI 0.67-0.98). Children with CLP demonstrated lower achievement in mathematics in the third school year (aOR 0.72, 95% CI 0.54-0.95) and in both Swedish and mathematics in the ninth school year (Swedish; aOR 0.89, 95% CI 0.80-0.99, mathematics; aOR 0.87, 95% CI 0.78-0.97). The majority of outcomes were less favorable in females but not for those with psychiatric comorbidity. CONCLUSIONS:Our findings emphasize the need to screen children with clefts for learning difficulties to provide additional support in school. Girls with OFC appeared to be particularly vulnerable in this regard.

Background:Transgender and gender-diverse (TGD) people experience elevated mortality risk, yet population-based estimates of cause-specific mortality remain limited. Prior studies have focused on narrow subgroups or outdated cohorts, leaving gaps in understanding current mortality disparities. Therefore, the purpose of this study is to quantify all-cause and cause-specific mortality among all TGD adults with a diagnosis of gender dysphoria in Sweden. Methods:This cohort study provides national cause-specific mortality estimates among TGD adults in Sweden using registry data (2001-2023). TGD people were identified using ICD-10 codes for "gender dysphoria" and matched to approximately 10 cisgender controls of each sex by age and county. Age-standardized mortality rates, absolute mortality risk differences, mortality rate ratios (MRR), and years of potential life lost (YPLL) were calculated overall and stratified by sex assigned at birth. Findings:A total of 9038 TGD people were identified, among them, 211 deaths were observed. All-cause mortality risk was almost twice that of the cisgender comparison group (MRR = 1.9, 95% confidence interval [CI] 1.7, 2.2). Stratified analyses showed distinct mortality patterns for transfeminine (assigned male sex at birth) and transmasculine (assigned female sex at birth) people, with higher risk from ill-defined diseases among transfeminine people (cisgender women as reference: MRR = 4.9, 95% CI 2.3, 10.3; cisgender men: MRR = 5.5, 95% CI 2.6, 11.4) and transmasculine people from neoplasms (cisgender women: MRR = 2.4, 95% CI 1.4, 4.1; cisgender men: MRR = 1.8, 95% CI 1.1, 3.1). These disparities resulted in a mean of 6.3 YPLL for transfeminine people compared to cisgender men and 9.0 YPLL for transmasculine people compared to cisgender women. Interpretation:These findings highlight persistent health inequities and underscore the need for targeted public health interventions and an evaluation of data collection processes to improve health monitoring and support TGD populations in Sweden. Funding:The present study was funded by a Starting Grant (2023-01397) and a project grant (2021-01968) from the Swedish Research Council for Health, Working Life and Welfare (FORTE).

Perinatal depression (PND) is a common mental health disorder associated with childbirth, which has high societal costs affecting up to 10% of individuals during pregnancy or postpartum. Whilst socially assistive robots (SARs) have recently proven to be useful tools in mental healthcare, and our previous work has investigated different stakeholders' perspectives on SARs in PND screening through interview studies, gaps remain in understanding how primary users (i.e., prospective patients) perceive and interact with such technologies. In this article, we use a participatory design methodology with semi-structured interviews of women in Sweden with previous experience of PND to explore the roles that SARs could play in addressing PND challenges and identify design factors for SARs in PND screening. We design and evaluate in a user study a robot prototype in two new interaction contexts for SARs with different levels of human oversight. The results show that SARs are welcomed by most participants, who appreciated the potentially faster assessment process and felt more comfortable opening up with a robot versus a human clinician. However, we found that there is no single solution that fits all, as other participants preferred the flexibility of self-reported digital surveys or interaction with a human clinician. Moreover, results show that transparency and human oversight are crucial requirements to consider when implementing robot-delivered PND screening questionnaires and diagnostic interviews. We reflect on ethical considerations, provide design recommendations and urge HRI designers to carefully consider whom SARs benefit, whom they may not, and which safeguarding factors are necessary to prevent potential negative outcomes.

Abstract Peripartum depression (PPD) affects ~12–25% of pregnant and postpartum women worldwide, yet routine screening often fails to capture real-time symptom changes. Digital phenotyping (DP), using data from digital devices such as text entries, sleep tracking, physical activity, social media behavior, and ecological momentary assessments, has been proposed as a complementary approach to support the prediction and early identification for PPD. This systematic review (PROSPERO: CRD42023461325) examined 14 studies published between 2014 and March 2025 that explored passive and active DP data across the antenatal and postnatal periods. Most studies employed observational designs and used the Edinburgh Postnatal Depression Scale as the primary outcome. Passive DP data related to sleep and circadian rhythms were frequently associated with depressive symptoms, whereas findings for physical activity were inconsistent. Active DP data, including language features from text entries, mood logs, semi-random ecological momentary assessments, and social media behavior, were often reported as informative, particularly when combined with personal history or self-reported measures. However, considerable variation across study designs, data sources, analytical approaches, and validation strategies limits direct comparison of findings and prevents causal interpretation. Overall, the evidence remains largely exploratory, and findings should be interpreted cautiously pending more rigorous validation.

Importance:Paternal psychiatric disorders during the perinatal period can affect the health of the entire family; however, these conditions have often been underrecognized, and little is known about their incidence and timing of onset. Objective:To investigate incidence patterns of new-onset diagnosed psychiatric disorders among men in Sweden before, during, and after a partner's pregnancy. Design, Setting, and Participants:This prospective cohort study used linked national register data for all fathers of children born in Sweden between January 1, 2003, and December 31, 2021, with follow-up from 1 year before to 1 year after pregnancy. Data were analyzed from October 1, 2024, to March 31, 2025. Exposures:The time during pregnancy and 1 year after childbirth (post partum) were considered the risk periods, while 1 year before pregnancy (before conception) was used as the reference period. Main Outcomes and Measures:Annual and weekly incidence rates (IRs) of clinical diagnoses of any psychiatric disorder and 9 type-specific disorders were calculated and standardized by age and calendar year. Adjusted Poisson regression analysis was used to further estimate incidence rate ratios (IRRs) of psychiatric disorders during and after pregnancy compared with before conception. Results:This study included 1 915 722 births from 1 096 198 fathers (mean [SD] age at childbirth, 33.8 [6.2] years) in Sweden. IRs of any diagnosed psychiatric disorder were lower during pregnancy (eg, pregnancy week 1: IR, 5.50 [95% CI, 4.69-6.31] per 1000 person-years) and the early postpartum period (eg, postpartum week 1: IR, 5.19 [95% CI, 4.41-5.97] per 1000 person-years) than in the corresponding preconception weeks (eg, preconception week 1: IR, 7.00 [95% CI, 5.97-8.04] per 1000 person-years); they returned to comparable rates later post partum. This pattern was also observed for IRRs of anxiety, alcohol use, and drug use (ie, the use of nonalcohol, nontobacco psychoactive drugs) disorders. IRRs of depression (eg, postpartum weeks 45-49: IRR, 1.30 [95% CI, 1.12-1.52]) and stress-related disorders (eg, postpartum weeks 45-49: IRR, 1.36 [95% CI, 1.15-1.61]), however, showed a notable 30% increase toward the end of the first postpartum year. In contrast, IRRs of diagnosis of tobacco use disorder, attention-deficit/hyperactivity disorder, bipolar disorder, or psychosis remained relatively stable before, during, and after pregnancy. Conclusions and Relevance:In this nationwide cohort study, fathers in Sweden were less likely to be diagnosed with a psychiatric disorder during a partner's pregnancy and early post partum than before conception, but IRs returned to comparable levels thereafter. These incidence patterns may reflect transient protection and delayed detection during the transition to fatherhood and support the need for paternal mental health surveillance, particularly for increased depression and stress-related disorders in the late postpartum period.

Whether the risks of maternal and paternal suicide attempt during and after pregnancy differ remains unclear. Here, in this nationwide register-based study in Sweden (2,196,276 pregnancies), we defined the year before conception, pregnancy and the year after birth and estimated week-specific incidence rate ratios (IRRs). We identified 7,469 (1.39 per 1,000 person-years) suicide attempts among mothers and 8,338 (1.62 per 1,000 person-years) among fathers. Compared with the corresponding week in the preconception period, mothers had a lower risk of suicide attempt during and after pregnancy (with the lowest IRR of 0.14 (0.11-0.17) at first week postpartum); fathers' risk of suicide attempt remained largely stable before childbirth, but a lower risk was observed during the first 10 postpartum weeks (IRRs ranging from 0.69 (0.58-0.81) to 0.91 (0.84-0.99)), followed by a higher risk in the later postpartum period (IRRs ranging from 1.10 (1.01-1.21) to 1.72 (1.33-2.24)). Compared with fathers, mothers had a lower risk of suicide attempt during and after pregnancy (for example, IRR of 0.22 (0.18-0.28) at first week postpartum). Compared with the general population, the sex difference of suicide attempt is reversed during and after pregnancy, suggesting pregnancy or childbirth may have a more pronounced association with suicide attempt among mothers than fathers.

INTRODUCTION:Despite an increasing amount of research related to gender-affirming treatment (GAT) outcomes among transgender and gender-diverse (TGD) people (ie, people who experience discomfort or distress in the misalignment between their gender and sex assigned at birth) in recent years, the evidence base for current recommendations is suboptimal. One contributing factor is the heterogeneity in the outcomes and outcome measures used. This study seeks to address this challenge by developing a foundational core outcome set (COS) to be used for TGD adults receiving GAT in Sweden. METHODS:Recommendations from the Core Outcome Measures in Effectiveness Trials initiative will be used to address this aim in four phases. Phase 1, an umbrella review of peer-reviewed literature and international guidelines in GAT will be conducted to identify relevant outcomes. In phase 2, we will solicit input from TGD individuals through the review of patient and interest organisations' reports and an anonymous survey to identify outcomes of personal significance. In phase 3, using the Delphi method, 2-3 rounds of assessment will be conducted where researchers, healthcare professionals, policy-makers and TGD adults rate the identified outcomes by perceived importance. In phase 4, a consensus meeting will convene representatives from all stakeholder groups to finalise the COS. ANALYSIS:The results of this study will consist of a COS for GAT regarding TGD adults in Sweden. Participant survey responses will be evaluated using interpretive analysis to identify core outcomes. During each of the Delphi rounds, Likert-type scale ratings will be aggregated for outcomes to advance or be eliminated in each round. ETHICS AND DISSEMINATION:The study has received ethical approval by the Swedish Ethical Review Authority (Umeå medicine department, Registration number: 2024-04672-01). The results of this study will be published open-access and disseminated through TGD interest organisations and a Swedish research network for gender dysphoria. TRIAL REGISTRATION NUMBER:COMET registration number 3223.

BackgroundPeripartum depression is a common but potentially debilitating pregnancy complication. Mobile applications can be used to collect data throughout the pregnancy and postpartum period to improve understanding of early risk indicators.AimThis study aimed to improve understanding of why women drop out of a peripartum depression mHealth study, and how we can improve the app design.MethodParticipants who dropped out of the Mom2B study (n = 134) answered closed and open questions on their motives for dropping out of the study, suggestions for improvement, and preferred timeframe of the study. A mix of quantitative and qualitative strategies was used to analyze the responses.ResultsThe most common reasons for discontinuation were lack of time, problems with or loss of the pregnancy, the use of other pregnancy applications, surveys being too lengthy, the app draining too much battery, and participants incorrectly believing that their answers were irrelevant for the study. Participants suggested fewer survey moments, more reminders, and a need for more unique content compared to commercially available apps.ConclusionsResearcher who want to use mHealth designs in peripartum studies need to ensure that their study designs are as time-efficient as possible, remind participants about the study, manage expectations about the study and what is expected of participants throughout the study, design their apps to be attractive in a competitive market, and follow-up with participants who are excluded from the study due to pregnancy complications.

Background A higher prevalence of autism spectrum disorder (ASD) and autistic traits among transgender and gender diverse individuals compared to the general population has been reported. However, inconsistent findings and methodological limitations have been noted in the literature. This study aims to investigate the prevalence of ASD diagnoses and autistic traits among individuals with gender dysphoria compared to a cisgender group and to explore associations between autism and self-reported levels of gender incongruence in individuals with gender dysphoria. Methods This study is part of the Swedish Gender Dysphoria Study. ASD diagnoses were retrieved from the national patient registers. Autistic traits were assessed using the Ritvo Autism and Asperger Diagnostic Scale-14 (RAADS-14) and Autism Spectrum Quotient (AQ). Gender incongruence was evaluated with the Transgender Congruence Scale. Associations with gender incongruence were examined with linear regression analysis. Results Participants with gender dysphoria, regardless of birth-assigned sex, had a higher prevalence of ASD compared with cisgender participants (RR = 7.8; 95 % CI = 3.9, 15.3). The gender dysphoria group also scored higher on both the RAADS-14 (MD = 8.0; 95 % CI = 6.6, 9.6) and AQ (MD = 5.3; 95 % CI = 4.0, 6.6). When stratified by birth-assigned sex, the prevalence of ASD did not differ among participants with gender dysphoria. No association was found between ASD and gender incongruence among individuals with gender dysphoria. Conclusions Our findings confirm the high co-occurrence of ASD and gender dysphoria and suggest no difference in gender incongruence between autistic and non-autistic people with gender dysphoria.

BACKGROUND:Peripartum depression (PPD) is one of the most common pregnancy complications; nevertheless, it often goes underdiagnosed. Pinpointing important correlates is crucial for early risk identification and pathophysiology understanding. We aimed to investigate the association between self-reported mood swings during oral contraceptive (OC) use and peripartum depressive symptoms (PPDS). METHODS:We used data from the Swedish longitudinal cohort study Mom2B. 3829 women who had reported previous usage of OCs were included. Self-reported mood swings during OC use were assessed through a single question, and PPDS were evaluated using established cut-offs of the Edinburgh Postnatal Depression Scale (EPDS). RESULTS:Self-reported mood swings during OC use were associated with PPDS at gestational weeks 12-22 (OR = 1.30, 95% CI, 1.01-1.66), 24-34 (OR = 1.37, 95% CI, 1.10-1.71) and 36-42 (OR = 1.39, 95% CI, 1.05-1.82) as well as at postpartum weeks 6-13 (OR = 1.46, 95% CI, 1.12-1.92) and 24-35 (OR = 2.07, 95% CI, 1.43-2.99). Interestingly, self-reported mood swings during OC use were associated with higher odds for newly developed PPDS in early postpartum (OR for weeks 6-13 = 1.92, 95% CI: 1.19-3.08). CONCLUSIONS:Women with self-reported mood swings during OC use have higher risk of experiencing depressive symptoms across the peripartum period and twice the risk of newly developed PPDS during the early postpartum, adding to current evidence of a hormonal sensitive subgroup of women and the opportunity to use this simple question in future predictive efforts.

Importance:The number of people seeking treatment for gender dysphoria (GD) has risen in recent decades, yet data remain limited for understanding cases of detransition (ie, the reversal of social, medical, or legal transition). Legal gender change in national registers poses an opportunity to examine legal gender reversals, which may reflect an aspect of the detransition process, while also informing an understanding of the stability after a legal gender change. Objective:To determine the probability of obtaining a legal gender change and its stability over time among people diagnosed with GD in Sweden during a 10-year study period. Design, Setting, and Participants:In this population cohort study using data from Swedish national registers from January 1, 2013, to December 31, 2023, individuals who received their first International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), diagnosis code for GD during the study period were included. While participants may have received a GD ICD-10 code as youths, legal gender changes only occurred for adults (aged ≥18 years) based on legal requirements during the time of data collection. Exposure:Gender dysphoria. Main Outcomes and Measures:Legal gender change and its stability, that is, absence of legal gender reversal, as reported in the registry. Kaplan-Meier survival analysis was used to determine the probability of legal gender change and its stability during a 10-year study period. Results:A total of 7293 people with a GD diagnosis were included (36 025 person-years). Approximately one-third of the sample (n = 2467) obtained a legal gender change during the study period. The probability of legal gender change at 10 years following diagnosis was 58.3% (95% CI, 56.2%-60.4%). Twenty-one cases of legal gender reversal were identified. The probability of legal gender stability at 10 years following the initial change was 97.7% (95% CI, 96.3%-99.2%), with no differences by sex assigned at birth for either outcome. Conclusions and Relevance:In this cohort study using national population registry data, a significant proportion of participants with GD in Sweden obtained legal gender change within 10 years of follow-up. Despite significant growth of the population with GD, the probability of legal gender stability during the 10-year study period was high, at almost 98%. These results highlight that legal gender reversal was an infrequent occurrence in a national sample.

Background Perinatal depression affects a significant number of women during pregnancy and after birth, and early identification is imperative for timely interventions and improved prognosis. Mobile apps offer the potential to overcome barriers to health care provision and facilitate clinical research. However, little is known about users’ perceptions and acceptability of these apps, particularly digital phenotyping and ecological momentary assessment apps, a relatively novel category of apps and approach to data collection. Understanding user’s concerns and the challenges they experience using the app will facilitate adoption and continued engagement. Objective This qualitative study explores the experiences and attitudes of users of the Mom2B mobile health (mHealth) research app (Uppsala University) during the perinatal period. In particular, we aimed to determine the acceptability of the app and any concerns about providing data through a mobile app. Methods Semistructured focus group interviews were conducted digitally in Swedish with 13 groups and a total of 41 participants. Participants had been active users of the Mom2B app for at least 6 weeks and included pregnant and postpartum women, both with and without depression symptomatology apparent in their last screening test. Interviews were recorded, transcribed verbatim, translated to English, and evaluated using inductive thematic analysis. Results Four themes were elicited: acceptability of sharing data, motivators and incentives, barriers to task completion, and user experience. Participants also gave suggestions for the improvement of features and user experience. Conclusions The study findings suggest that app-based digital phenotyping is a feasible and acceptable method of conducting research and health care delivery among perinatal women. The Mom2B app was perceived as an efficient and practical tool that facilitates engagement in research as well as allows users to monitor their well-being and receive general and personalized information related to the perinatal period. However, this study also highlights the importance of trustworthiness, accessibility, and prompt technical issue resolution in the development of future research apps in cooperation with end users. The study contributes to the growing body of literature on the usability and acceptability of mobile apps for research and ecological momentary assessment and underscores the need for continued research in this area.

Background Childhood gender nonconformity is related to psychological distress and behavioral difficulties. Similarly, there is evidence for a link between gender nonconformity, or gender dysphoria in some studies, and autism spectrum disorder and related traits. Our knowledge on those associations mostly originates from clinical populations, which might lead to overestimation. Thus, this study aimed to assess associations between gender nonconformity and behavioral difficulties in a population-based study. Methods In the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy (SELMA) study, cross-sectional associations between gender-specific play behavior and behavioral outcomes and autistic traits were investigated among 718 children at 7-years of age. Play behavior was measured using the Preschool Activities Inventory; behavioral outcomes and autistic traits were measured with the Strengths and Difficulties Questionnaire and the Social Responsiveness Scale, respectively. Linear and logistic regression analyses were performed. Results Higher composite play behavior scores (indicating either increased masculine or decreased feminine play behavior) were associated with increased autistic trait scores in girls (β = 0.13; 95% confidence interval [CI] = 0.00, 0.26). Furthermore, higher composite scores were shown to be associated with behavioral difficulties in both girls (β = 0.11; 95% CI = 0.04, 0.18) and boys (β = 0.10; 95% CI = 0.02, 0.19). Additionally, higher feminine scores were related with increased problems in peer relationships in boys (β = 0.04; 95% CI = 0.00, 0.07). Conclusions This study suggests a link between gender nonconforming play behavior and autistic traits as well as behavioral difficulties among children in a non-clinical population, which calls attention to the necessity of supporting children with gender nonconformity from early ages.

Abstract Background The increasing incidence of the medical diagnosis Gender Dysphoria has led to public debates in Sweden, questioning an already vulnerable group. This study explores relatives’ views on the Swedish transgender health system, in order to identify factors that can be improved. Methods An interview guide was created together with the Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex rights. Care seekers with gender dysphoria included in the Swedish Gender Dysphoria Study were asked to give consent for an interview with a relative of their own choice. Eleven interviews were conducted. The material was examined using thematic analysis. Results The waiting times are long without clear information and lacking coordination. This compels the relative to substitute the deficiencies in the system, especially as an emotional shelter and a coordinating function. Stereotypic questions are being asked without motivation and geographical distances hinder participation in family support groups. Conclusions A coordinating function in the transgender healthcare system would be beneficial for both the care seekers and their relatives. The system flaws have negative impact on the mental health of both the care seeker and the relative. It is important that care givers are transparent about the waiting times and motivate all parts of the process.

Background It has been repeatedly shown that men infected by SARS-CoV-2 face a twofold higher likelihood of dying, being hospitalized or admitted to the intensive care unit compared to women, despite taking into account relevant confounders. It has been hypothesized that these discrepancies are related to sex steroid hormone differences with estrogens being negatively correlated with disease severity. The objective of this study was therefore to evaluate COVID-19-related mortality and morbidity among peri- and postmenopausal women in relation to estrogen-containing menopause hormonal treatments (MHT). Methods This is a national register-based matched cohort study performed in Sweden between January 1 to December 31, 2020. Study participants comprised women over the age of 53 years residing in Sweden. Exposure was defined as prescriptions of local estrogens, systemic estrogens with and without progestogens, progestogens alone, or tibolone. MHT users were then compared with a matched cohort of non-users. The primary outcome consisted of COVID-19 mortality, whereas the secondary outcomes included inpatient hospitalizations/outpatient visits and confirmed SARS-CoV-2 infection. Multivariable adjusted Cox regression-derived hazard ratios (HRs) were calculated. Results Use of systemic estrogens alone is associated with increased COVID-19 mortality among older women (aHR 4.73, 1.22 to 18.32), but the association is no longer significant when discontinuation of estrogen use is accounted for. An increased risk for COVID-19 infection is further observed for women using combined systemic estrogens and progestogens (aHR 1.06, 1.00 to 1.13) or tibolone (aHR 1.21, 1.01 to 1.45). Use of local estrogens is associated with an increased risk for COVID-19-related death (aHR 2.02,1.45 to 2.81) as well as for all secondary outcomes. Conclusions Systemic or local use of estrogens does not decrease COVID-19 morbidity and mortality to premenopausal background levels. Excess risk for COVID-19 morbidity and mortality was noted among older women and those discontinuing systemic estrogens. Higher risk for death was also noted among women using local estrogens, for which non-causal mechanisms such as confounding by comorbidity or frailty seem to be the most plausible underlying explanations. Trial registration details Not applicable.

Predictive measures for postpartum depression (PPD), which affects around 12% of childbearing women, would enable early, targeted support. Here we explore prepulse inhibition (PPI), a measure of sensorimotor processing, as a biological tool for prediction of women at risk for PPD. Using data from the longitudinal BASIC study in Uppsala, Sweden, we used PPI measures from late pregnancy and reports on depressive symptoms assessed 6 weeks postpartum with the Edinburgh Postnatal Depression Scale to determine the association between pregnancy PPI and PPD. Lower PPI was associated with PPD onset in women who were not depressed during pregnancy. Further studies are encouraged to validate these promising results suggesting PPI as a predictive marker of new-onset PPD.

OBJECTIVE:To assess the association between nonsyndromic craniosynostosis (NSC) and academic achievement. METHODS:Registry data were analyzed on demographic background, presence of craniosynostosis and other comorbidities, grades, and results on national standardized tests (NSTs) across primary and upper secondary school, as well as the presence of academic degrees. The analysis used regression modeling on a sample of N = 1110 individuals with NSC and a matched cohort of N = 10,654 individuals. RESULTS:There was a significant negative association between NSC and NST scores in third grade for both mathematics (aOR 0.76, 95% CI 0.60-0.99, p = .020) and Swedish (aOR 0.69, 95% CI 0.54-0.89, p = .004). The association seemed to primarily be carried by females with NSC (aORs for the interaction term 0.26-0.45, all ps <.05). Further, a slightly stronger negative association was observed in individuals with psychiatric comorbidities (aOR 0.44, 95% CI 0.22-0.90, p = .025 for mathematics; aOR 0.45, 95% CI 0.21-0.98, p = .045 for Swedish). No statistically significant association was found between NSC and NST scores or grades in later school years, or with academic degrees. CONCLUSIONS:There is evidence for a limited temporary negative association between NSC and academic achievement. A stronger negative association between NSC and academic achievement seems to be present in girls, and for individuals with psychiatric comorbidities. This has important implications for clinical management and provision of support in educational contexts.

This cohort study examines the incidence of idiopathic intracranial hypertension (IHH) among individuals in Sweden undergoing gonadotropin-releasing hormone analogue (GnRHa) treatment for gender dysphoria.

Introduction There has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin.Methods and analysis The Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022.Ethics and dissemination The ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.