Interpersonal violence and overweight in adolescents: the HUNT Study

Aims:Overweight and obesity in children and adolescents are major public health challenges associated with psychosocial adversity and unfavourable lifestyle. Exposure to interpersonal violence, such as sexual abuse, violence and bullying, could represent precursors, accelerating or sustaining factors. Methods: The Young-HUNT 3 study, 2006–2008, is a population-based, cross-sectional, cohort study of Norwegian youth that includes self-report data on exposure to interpersonal violence; pubertal status and timing; socioeconomic, psychosocial, and lifestyle factors; and clinical anthropometric measures. A cohort of 10,464 adolescents aged 12–20 years from Nord-Trøndelag County were invited to participate. Body mass index served as the outcome in the simple and multiple linear regression analyses. Results: The response rate was 72.3% (7564), and 49.9% (3777) of the respondents were girls. A robust and significant relationship between interpersonal violence and increased BMI for both genders was found. Importantly, interpersonal violence remained significantly correlated with higher BMI following adjustment for pubertal development, socioeconomic and psychosocial adversity and unfavourable lifestyle factors in both genders, although most evident in girls. Adjusted regression coefficients (95% confidence intervals) for the relationship between interpersonal violence and BMI were 0.33 (0.01, 0.65) for 1 type and 0.89 (0.37, 1.41) for 2 types, compared to no exposure in girls, and 0.40 (0.09, 0.71) for 1 type and 0.35 (-0.09, 0.79) for 2 types of interpersonal violence in boys. Conclusions: The empirical evidence of consistent associations between interpersonal violence, related psychosocial and lifestyle factors, and body fatness, indicates that these features play important roles for adolescents struggling with overweight. © 2014 the Nordic Societies of Public Healt

Recurrent headache and interpersonal violence in adolescence: the roles of psychological distress, loneliness and family cohesion: the HUNT study

Background: Recurrent headache is the most common and disabling pain condition in adolescence. Co-occurrence of psychosocial adversity is associated with increased risk of chronification and functional impairment. Exposure to interpersonal violence seems to constitute an important etiological factor. Thus, knowledge of the multiple pathways linking interpersonal violence to recurrent headache could help guide preventive and clinical interventions. In the present study we explored a hypothetical causal model where the link between exposure to interpersonal violence and recurrent headache is mediated in parallel through loneliness and psychological distress. Higher level of family cohesion and male sex is hypothesized to buffer the adverse effect of exposure to interpersonal violence on headache. Methods: The model was assessed using data from the cross-sectional, population-based Young-HUNT 3 study of Norwegian adolescents, conducted from 2006–2008. A cohort of 10 464 adolescents were invited. The response rate was 73% (7620), age ranged from 12 and 20 years, and 50% (3832) were girls. The study comprised self-report measures of exposure to interpersonal violence, loneliness, psychological distress and family cohesion, in addition to a validated interview on headache, meeting the International Classification of Headache Disorders criteria. Recurrent headache was defined as headache recurring at least monthly during the past year, and sub-classified into monthly and weekly headache, which served as separate outcomes. Results: In Conditional Process Analysis, loneliness and psychological distress consistently posed as parallel mediating mechanisms, indirectly linking exposure to interpersonal violence to recurrent headache. We found no substantial moderating effect of family cohesion or sex. Conclusions: Loneliness and psychological distress seem to play crucial roles in the relationship between exposure to interpersonal violence and recurrent headache. To facilitate coping and recovery, it may be helpful to account for these factors in preventive and clinical interventions. Trauma-informed, social relationship-based interventions may represent a major opportunity to alter trajectories of recurrent headache. Keywords: Interpersonal violence; Sexual abuse; Bullying; Loneliness; Social isolation; Psychological distress; Family cohesion; Social support; Recurrent headache

Intimate partner violence and prescription of potentially addictive drugs: prospective cohort study of women in the Oslo Health Study

Objectives:To investigate the prescription of potentially addictive drugs, including analgesics and central nervous system depressants, to women who had experienced intimate partner violence (IPV). Design: Prospective population-based cohort study. Setting: Information about IPV from the Oslo Health Study 2000/2001 was linked with prescription data from the Norwegian Prescription Database from 1 January 2004 through 31 December 2009. Participants: The study included 6081 women aged 30–60 years. Main outcome measures: Prescription rate ratios (RRs) for potentially addictive drugs derived from negative binomial models, adjusted for age, education, paid employment, marital status, chronic musculoskeletal pain, mental distress and sleep problems. Results: Altogether 819 (13.5%) of 6081 women reported ever experiencing IPV: 454 (7.5%) comprised physical and/or sexual IPV and 365 (6.0%) psychological IPV alone. Prescription rates for potentially addictive drugs were clearly higher among women who had experienced IPV: crude RRs were 3.57 (95% CI 2.89 to 4.40) for physical/sexual IPV and 2.13 (95% CI 1.69 to 2.69) for psychological IPV alone. After full adjustment RRs were 1.83 (1.50 to 2.22) for physical/sexual IPV, and 1.97 (1.59 to 2.45) for psychological IPV alone. Prescription rates were increased both for potentially addictive analgesics and central nervous system depressants. Furthermore, women who reported IPV were more likely to receive potentially addictive drugs from multiple physicians. Conclusions: Women who had experienced IPV, including psychological violence alone, more often received prescriptions for potentially addictive drugs. Researchers and clinicians should address the possible adverse health and psychosocial impact of such prescription and focus on developing evidence-based healthcare for women who have experienced IPV

Terror leaves adolescents behind: Identifying risk and protective factors for high-school completion among survivors of terrorism

Terror exposure increases the risk of somatic and psychological health problems in survivors. Yet, knowledge of how such exposure affects survivors’ ability to stay in school is lacking. This study examined whether exposure to the 2011 Utøya terrorist attack in Norway impacted survivors’ ability to complete high school. Further, it aimed to identify important peri- and posttraumatic risk and protective factors. Interview data from the Utøya study, collected 4–5 months postterror, were linked to individual educational registry data for 265 survivors. Chi-square tests and ordinal logistic regression analyses were used to examine (a) high school completion among younger survivors (n = 185, age range: 13–18 years, 52.4% female) compared to both older survivors (i.e., who had the possibility of completing high school before the terror attacks; n = 80, age range: 19–21 years, 40.0% female) and the national average and (b) associations between high school completion and physical injury, posttraumatic stress symptoms (PTSS), somatic symptoms, and social support among younger survivors. Younger survivors were significantly less likely to complete high school on time. Among younger adolescents, physical injury, aOR = 0.36, 95% CI [0.16, 0.81]; higherlevel PTSS, aOR = 0.54, 95% CI [0.33, 0.88]; and somatic symptoms, aOR = 0.51, 95% CI [0.29, 0.91], lowered the likelihood of on-time completion. Terror exposure in adolescence adversely affects long-term educational functioning in young survivors, which can severely hamper their future prospects. These findings reinforce the need for trauma-sensitive teaching and educator-provided support for adolescents exposed to trauma

Association between blood pressure measures and recurrent headache in adolescents: cross-sectional data from the HUNT-Youth study

The relationship between blood pressure and headache in youth has not been explored and the objective of the present study was to provide data on this association in an adolescent population. Cross-sectional data from a large population-based survey, the Young-HUNT study, on 5,847 adolescents were used to evaluate the association between blood pressure (systolic, diastolic, mean arterial and pulse pressure) and recurrent headache, including migraine and tension-type headache. Increasing pulse pressure was inversely related to recurrent headache prevalence, and both tension-type headache and migraine. For systolic blood pressure such an inverse relationship was present for recurrent headache and tension-type headache prevalence. For migraine, the results were not significant, although there was a tendency in the same direction (p = 0.05). High-pulse pressure has previously been found to be inversely related to the prevalence of migraine and tension-type headache in an adult population. This inverse relationship has now been demonstrated to be present among adolescents also, supporting the results from a previous study in adults, that blood pressure regulation may be linked to the pathophysiology of headache

Voldsuttsatte barn og unge i Oslo

Hva er omfanget av erfaringer med seksuelle overgrep og vold blant ungdom i Oslo? Avviker omfanget av slike erfaringer fra det som ungdom i andre deler av Norge rapporterer om? Og hvordan opplever ungdom å bli eksponert for slike erfaringer? På grunnlag av data fra to forskjellige undersøkelser gir vi noen svar på spørsmålene. Rapporten viser at det er noen forskjeller mellom hvor mye ungdom rapporterer om disse erfaringene både innad i Oslo og mellom Oslo og andre deler av landet. Noen av forskjellene kan knyttes til ulikheter i levekår, rus blant foreldre og foreldres innvandrerbakgrunn. Forskjellene er ikke store, men funnene i undersøkelsene kan likevel gi grunnlag for å identifisere noen innsatsområder for forebygging og hjelpetiltak, både i forhold til vold og særlig når det gjelder seksuelle overgrep som finner sted i relasjoner mellom jevnaldrende ungdommer

Posttraumatic stress reactions in children and adolescents

The 1980s mark the beginning of systematic research and theoretical advances in the field of psychic trauma in children. Posttraumatic stress disorder (PTSD) was a diagnosis for adults in the Diagnostic and Statistical Manual of Mental Disorders, DSM-III (American Psychiatric Association, 1980). In a later version, children and adolescents were partially included (American Psychiatric Association, 1987). Since 1980, a range of traumatic events have been identified as having the required stressor characteristics for posttraumatic stress reactions to manifest in children and adolescents. In this study, the role of the stressor and peritraumatic reactions in PTSD of children and adolescents was studied. In addition, co-existing factors were assessed and related to the development and maintenance of PTSD reactions. A cascade of distressing events described the stressor in children who reported sexual abuse in daycare (paper I), and single-incident events were studied in adolescents (paper III). Subjective reactions during or immediately after the traumatic event, such as intense emotions, physiological arousal, dissociation and having thoughts of intervening, were strongly associated to the subsequent development of PTSD reactions in adolescents. The findings indicate that subjective responses to traumatic events play an important role in PTSD etiology. Objective features of the stressor, such as death or physical injury did not relate significantly to the levels of posttraumatic stress reactions. Half the children exposed to the cascade stressor in the case of alleged child sexual abuse, showed significant levels of PTSD reactions four years later. The objective features of the cascade stressor depended on the reported severity of child sexual abuse as well as media exposure, medical examinations, forensic interviews and the court trial. Children with high levels of PTSD reactions reported more severe CSA and were also more exposed to the media and the court trial, but the tendency was not significant. Moreover, co-existing factors not related to the traumatic event may play important roles in the development and maintenance of PTSD reactions. After alleged sexual abuse and subsequent distressing events, older children displayed more PTSD reactions than younger children, which may indicate that younger children were more protected from developing distress in this situation. On the other hand, five weeks after a tram car accident, age was negatively associated with the levels of PTSD reactions in a group of children (paper IV). The findings may be due to the diverse nature of the stressors and methodological issues. Other co-existing factors to PTSD, such as behavior problems in children and adolescents, may represent considerable difficulties in a young person’s life. In the current study, children displayed significant levels of behavioral problems four years after alleged sexual abuse. The impact on parents and the rest of the child’s family cannot be ignored in the assessment of posttraumatic stress reactions of children and adolescents. In this study, comprehensive assessments were made of the parents’ experiences and levels of distress after alleged sexual abuse of their children. The parents were exposed to a cascade of events, including hearing about the sexual abuse, being involved in the police investigation and the court trial and being exposed in media reports. Four years after the events, elements of the stressor were significantly associated to the level of posttraumatic stress reactions. The findings illustrate how child sexual abuse reports may involve the children’s parents and expose them to high levels of distress over a long period of time. In addition, interactions in the family may contribute in the development and maintenance of posttraumatic stress reactions in children and adolescents, and impede the healing processes. After traumatic events in childhood, researchers tend to prefer parental reports of the children’s reactions to spare the children. In this study, children reported significantly higher levels of distress than observed by their parents after a tram car accident (paper IV). These findings indicate that parents unintentionally may bring in a response bias in their reports, which future research and clinical practice should take into account. The study illustrates that traumatic events are complex experiences involving cognitive and emotional reactions, physiological arousal and dissociation, and that these reactions may induce posttraumatic stress reactions in children and adolescents. The cascade stressor subsequent to alleged sexual abuse of children showed how different elements of the stressor may lead to distress over a long period of time. The distress involved both children and parents in this study

Voldsuttsatte barn og unge i Oslo

Hva er omfanget av erfaringer med seksuelle overgrep og vold blant ungdom i Oslo? Avviker omfanget av slike erfaringer fra det som ungdom i andre deler av Norge rapporterer om? Og hvordan opplever ungdom å bli eksponert for slike erfaringer? På grunnlag av data fra to forskjellige undersøkelser gir vi noen svar på spørsmålene. Rapporten viser at det er noen forskjeller mellom hvor mye ungdom rapporterer om disse erfaringene både innad i Oslo og mellom Oslo og andre deler av landet. Noen av forskjellene kan knyttes til ulikheter i levekår, rus blant foreldre og foreldres innvandrerbakgrunn. Forskjellene er ikke store, men funnene i undersøkelsene kan likevel gi grunnlag for å identifisere noen innsatsområder for forebygging og hjelpetiltak, både i forhold til vold og særlig når det gjelder seksuelle overgrep som finner sted i relasjoner mellom jevnaldrende ungdommer