Own and parental war experience as a risk factor for mental health problems among adolescents with an immigrant background: results from a cross sectional study in Oslo, Norway

BACKGROUND: An increasing proportion of immigrants to Western countries in the past decade are from war affected countries. The aim of this study was to estimate the prevalence of war experience among adolescents and their parents and to investigate possible differences in internalizing and externalizing mental health problems between adolescents exposed and unexposed to own and parental war experience. METHOD: The study is based on a cross-sectional population-based survey of all 10(th )grade pupils in Oslo for two consecutive years. A total of 1,758 aadolescents were included, all with both parents born outside of Norway. Internalizing and externalizing mental health problems were measured by Hopkins Symptom Checklist-10 and subscales of the Strengths and Difficulties Questionnaire, respectively. Own and parental war experience is based on adolescent self-report. RESULTS: The proportion of adolescents with own war experience was 14% with the highest prevalence in immigrants from Eastern Europe and Sub-Saharan Africa. The proportion of parental war experience was 33% with Sub-Saharan Africa being highest. Adolescents reporting own war experience had higher scores for both internalizing and externalizing mental health problems compared to immigrants without war experience, but only externalizing problems reached statistically significant differences. For parental war experience there was a statistically significant relationship between parental war experience and internalizing mental health problems. The association remained significant after adjustment for parental educational level and adolescents' own war experience. CONCLUSION: War exposure is highly prevalent among immigrants living in Oslo, Norway, both among adolescents themselves and their parents. Among immigrants to Norway, parental war experience appears to be stronger associated with mental health problems than adolescents own exposure to war experience

Intellectual disability and mental health problems: a qualitative study of general practitioners' views

Vitenskapelig, fagfellevurdert artikkelObjectives: To investigate general practitioners’ (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP). Design: Qualitative study using in-depth interviews. Setting: General practice in Hedmark county, Norway. Participants: 10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation. Results: The participants’ knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits. Conclusions: GPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field

Can use of healthcare services among 15–16-year-olds predict an increased level of high school dropout? A longitudinal community study

Objectives To study associations between healthcare seeking in 15–16-year-olds and high school dropout 5 years later. Design Longitudinal community study. Setting Data from a comprehensive youth health survey conducted in 2000–2004, linked to data from national registries up to 2010. Participants 13 964 10th grade secondary school students in six Norwegian counties. Main outcome measure Logistic regression was used to compute ORs for high school dropout. Results The total proportion of students not completing high school 5 years after registering was 29% (girls 24%, boys 34%). Frequent attenders to school health services and youth health clinics at age 15–16 years had a higher dropout rate (37/48% and 45/71%), compared with those with no or moderate use. Adolescents referred to mental health services were also more likely to drop out (47/62%). Boys with moderate use of a general practitioner (GP) had a lower dropout rate (30%). A multiple logistic regression analysis, in which we adjusted for selected health indicators and sociodemographic background variables, revealed that seeking help from the youth health clinic and consulting mental health services, were associated with increased level of high school dropout 5 years later. Frequent attenders (=4 contacts) had the highest odds of dropping out. Yet, boys who saw a GP and girls attending the school health services regularly over the previous year were less likely than their peers to drop out from high school. Conclusions Adolescents who seek help at certain healthcare services can be at risk of dropping out of high school later. Health workers should pay particular attention to frequent attenders and offer follow-up when needed. However, boys who attended a GP regularly were more likely to continue to high school graduation, which may indicate a protective effect of having a regular and stable relationship with a GP

Do mental health and behavioural problems of early menarche persist into late adolescence? A three year follow-up study among adolescent girls in Oslo, Norway

Early menarche has been linked to mental health and behavioural problems in several studies. Most of these studies are cross-sectional, the data gathered during puberty. Thus, there is a lack of research on the long-term effect of early menarche on mental health. The main aim of this study was to explore whether the differences in mental health problems between girls with early and late menarche persist into late adolescence. The data consisted of responses from a large school-based survey of all 10th grade girls (15 years of age) in Oslo, Norway. Of the 1860 participating girls in the 2001 survey, 1377 were included in the three year follow-up study in 2004, giving a response rate of 74%. Mental distress was measured with the Hopkins Symptom Check list 10-version. Additional items assessed were number of sexual partners, weight and body satisfaction. All information was self-reported, including age of menarche. We found a clear gradient in the cross sectional analyses at baseline of higher odds for mental distress at lower age of menarche even after adjustment for socio demographic and other factors. In the analysis of the follow-up data there was no statistically significant difference in mental distress across age of menarche, even though the differences in body and weight satisfaction and average body mass index remained at the same level between baseline and follow-up. We therefore conclude that the effects of age of menarche on mental health problems are a transitory problem during puberty.Mental distress Behavioural problems Menarche Puberty Follow-up Adolescence Norway, women

A qualitative assessment of adolescents’ attitudes to health and seeking help for health-related problems

Background and Objectives: Adolescence is a time of substantial change, bringing about the transition from childhood into adulthood. Patterns for future health behaviors are developed and continue into adult life. Little is known about adolescents’ perceptions of health and help-seeking within healthcare services. The objective of this study was to explore adolescents’ attitudes to health and seeking help for health-related problems. Methods: A qualitative design was chosen. Interviews were conducted with 5 adolescents visiting a youth health clinic in Moss, Norway. The interviews were audiotaped, transcribed and analyzed according to systematic text condensation. Results: The participants were 2 boys and 3 girls, ranging from 17-19 years of age. We found that all adolescents incorporated psychological and social qualities in their view on health. Positive social connections with family and friends were the most important factors for good health for all participants. They all conveyed resistance to disclosing mental health issues, although this was recognized as the most important barrier for good health. Establishing a trusting relationship with a healthcare provider was necessary before disclosing mental health issues and receiving help. Conclusion: In our small qualitative assessment of adolescents’ attitudes to health and seeking help for health-related problems, we found that adolescents’ focus was on mental and social aspects of health and that a trusting relationship with healthcare providers was necessary for the adolescents to seek help within the healthcare system. Future research should be conducted to study more deeply what characterizes the relationship between adolescents and healthcare providers in order to provide the most effective and appropriate healthcare to patients during this particular period of life

Social participation in young people with nonepileptic seizures (NES): A qualitative study of managing legitimacy in everyday life

This qualitative study explored social participation in young people with nonepileptic seizures (NES), particularly how legitimacy of illness is managed in everyday life.Young people with NES, all female and aged between 14 and 24 years (N = 11), were interviewed and followed up over a 14-month period. The transcripts were analyzed using thematic analysis.Four main themes were elaborated: 1) Delegitimizing experiences from families, schoolteachers, colleagues, and employers were part of everyday life. 2) Fear of being exposed to delegitimizing events resulted in the young people trying to conceal the diagnosis; for some, this resulted in isolation from all social arenas, apart from their closest relationships. 3) Support from close relationships was protective against delegitimization and contributed towards greater social participation. 4) Perceiving NES as a legitimate disorder contributed to increased social participation.We found a relationship between legitimacy of illness experienced by the participants and the extent to which they either participated or retreated socially. Those who had an illness perception that was personally meaningful experienced their condition as being more legitimate and participated more socially

Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice

Objective: To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice. Design: A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practices Setting: Six GP group practices in Groruddalen, Norway. Subjects: All patients aged 16–65 with a registered contact with a GP during 12 months in 2015. Main outcome measures: Frequency and distribution of psychological diagnoses made by GPs, and the number of patients’ consultations. Results: GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (p<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs. Conclusions: Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex. Implications: The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population

GPs’ and child and adolescent psychiatry specialists’ experiences of joint consultations in the GP’s office: a qualitative study

Abstract Background The study is an exploration of a joint consultation model, a collaboration between general practitioners (GPs) and specialists from child and adolescent mental health services (CAMHS) in Lillehammer, Norway. Methods A qualitative study based on two focus group interviews, one with participating GPs and one with participating specialists from the local CAMHS. Participants were five GPs, with work experience varying from 6 months to 20 years (four of them specialists in general medicine) and two CAMHS specialists—a psychiatrist and a psychologist—both with more than 20 years of experience. Results The focus group discussions revealed that both GPs and CAMHS specialists saw the joint consultations as a good teaching method for improving GPs’ skills in child and adolescent psychiatry. Both groups believed that this low-threshold service benefits the patients and that the joint consultation is especially suited to sort problems and determine the level of help required. Conclusions The GPs and CAMHS specialists shared the impression that the collaboration model is beneficial for both patients and health care providers. Close collaboration with primary health care is recommended in the guidelines for child and adolescent psychiatry outpatient clinics. We suggest that the joint consultation model could be a good way for GPs and CAMHS specialists to collaborate

Intellectual disability and mental health problems: a qualitative study of general practitioners' views

Objectives: To investigate general practitioners’ (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP). Design: Qualitative study using in-depth interviews. Setting: General practice in Hedmark county, Norway. Participants: 10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation. Results: The participants’ knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits. Conclusions: GPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field

Somatic symptoms and associations with common psychological diagnoses: a retrospective cohort study from Norwegian urban general practice

Abstract Background Patients with mental health problems often present with somatic symptoms when visiting their general practitioner (GP). Somatic presentations may challenge correct diagnosing of mental health disorders in general practice, where most of these disorders are treated. Objective Explore the associations between common psychological diagnoses and somatic symptom diagnoses in Norwegian urban general practice. Methods A retrospective cohort study including electronic medical data from 15 750 patients aged 16–65 years from 35 GPs in six GP offices in Oslo, Norway, during 12 months in 2014–2015. We explored prevalences and associations between anxiety-, depression-, and stress-related diagnoses, and somatic symptom diagnoses. Results Patients with anxiety-, depression- and stress-related diagnoses had a mean number of 2.9±3.6 somatic symptom diagnoses during the 12 months, compared to 1.9±2.5 for patients without any psychological diagnoses (P &amp;lt; 0.001). The mean number of somatic symptoms was significantly higher for the different psychological diagnoses viewed separately, for both sexes and different age groups. There was an increase in probability for anxiety, depression, or stress-related diagnoses with an increasing number of somatic symptom diagnoses during the 12 months. We found a significant increase in somatic symptom diagnoses from ICPC-2 chapters: General and unspecified, digestive, cardiovascular, musculoskeletal, neurological, urological, female genital disorders and social problems. Associated symptom patterns were different for each of the included psychological diagnoses. Conclusions This study shows that patients with anxiety, depression- and stress-related diagnoses present with increased and characteristic somatic symptoms compared to patients without these diagnoses in general practice