Cardiorespiratory fitness and incident use of anxiolytics and antidepressants in adults. A linkage study between HUNT and the Norwegian Prescription Database

publishedVersio

Factor structure of the patient health questionnaire-4 in adults with attention-deficit/hyperactivity disorder

BackgroundPersons with attention-deficit/hyperactivity disorder (ADHD) frequently experience symptoms of anxiety and depression. In this population, there is a need for validated brief self-report screening questionnaires to assess the severity of comorbid mental health problems. The Patient Health Questionnaire 4 (PHQ-4) is a self-report questionnaire that may contribute to this purpose as it can screen for both disorders efficiently. However, this will be the first study examining the factor structure of the PHQ-4 in samples of adults with ADHD, and also evaluating the validity of the Norwegian version of the PHQ-4.ObjectivesThe aim of the current cross-sectional study was to examine the factor structure and validity of the Norwegian version of the PHQ-4 in a sample of adults who reported having been diagnosed with ADHD.MethodsOf 496 invited, a total of 326 participants (66%) completed the PHQ-4, The World Health Organization Five Well-Being Index, the Oslo Social Support Scale and the 4-item Perceived Stress Scale electronically in a web-portal between the 9th and 30th of June 2020.ResultsConfirmatory factor analysis of the PHQ-4 supported a two-factor structure [RMSEA = 0.038 (90% CI 0.000–0.159), CFI = 1.00, TLI = 0.999, SRMR = 0.004], consisting of a depression factor and an anxiety factor. Standardized factor loadings were 0.79 to 0.97. The PHQ-4 was negatively correlated with well-being and social support and positively correlated with perceived level of stress.ConclusionThis study indicates promising psychometric properties of the PHQ-4 as a measure of anxiety and depressive symptoms in adults with self-reported ADHD who are fluent in Norwegian. The questionnaire’s brevity makes it a valuable resource in research and clinical settings. However, more studies are needed to test the instrument in a clinical sample

Examination of the knowledge gap of return-to-work outcomes in routine outpatient treatment for common mental disorders: a systematic review

ObjectiveLittle is known about the effects of routine mental health care on return-to-work (RTW) outcomes. This systematic review aimed to summarize and evaluate the effects of clinical representative psychotherapy on RTW among patients with a common mental disorder (CMD), treated within public mental health care.MethodA systematic search was conducted using PubMed, PsycINFO, Embase, and SveMED+. Primary outcomes were RTW, sick leave status, or self-reported work functioning. Studies limited to specific treatments and/or specific patient groups were excluded.ResultsOut of 1,422 records, only one article met the preregistered inclusion criteria. After broadening of criteria, a total of nine studies were included. Six were randomized controlled trials (RCT), two were register-based studies, and one was a quasi-experimental study. Descriptions of treatment duration and intensity of usual care were rarely specified but ranged from a few sessions to 3 years of psychotherapy. In the RCTs, two studies favored the intervention, one favored routine care, and three found no difference between conditions. Choice of outcomes differed greatly and included RTW rates (full or partial), number of days until RTW, change in sick leave status, and net days/months of work absence. Time points for outcome assessment also varied greatly from 3 months to 5 years after treatment.ConclusionThere is inconclusive evidence to establish to what extent routine mental healthcare is associated with improved RTW outcomes for patients with CMD. There is a need for more and better clinical trials and naturalistic studies detailing the content of routine treatment and its effect on RTW.Systematic review registrationThis study was pre-registered at PROSPERO (CRD42022304967), https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022304967

The construct validity of an abridged version of the general self-efficacy scale for adults with attention-deficit/hyperactivity disorder

ObjectivesThe General Self-Efficacy (GSE) scale is a validated self-rated questionnaire increasingly used in mental health research. However, despite several psychometric advantages of the GSE scale, its validity in those diagnosed with attention-deficit/hyperactivity disorder (ADHD) has not yet been examined. Moreover, a shorter version of the GSE scale would contribute to a more rational use of resources in extensive multivariate studies. Therefore, as self-rated scales to measure self-efficacy in this population are lacking, the current study aims to develop a condensed version of the GSE for adults with ADHD.MethodsA group of patient collaborators (user representatives) from an ADHD organization and health professionals shortened the original 10-item GSE scale to six items and evaluated the content validity of the revised scale. Second, 525 potential participants were invited to participate in a cross-sectional study conducted in 2021 (between January 19th and February 7th). Of them, 403 filled out the GSE-6 for ADHD and two scales measuring psychological well-being and mental health (the five-item World Health Organization Well-Being Index, WHO-5, and the four-item Patient Health Questionnaire, PHQ-4). The psychometric properties of the new scale were examined, testing a priori formulated hypotheses.ResultsThe brief GSE-6 for ADHD displayed good internal consistency with a Cronbach’s α of 0.907. No floor or ceiling effect was detected. Exploratory and confirmatory factor analyses supported a one-factor structure. The GSE-6 also showed a moderate positive correlation with the WHO-5 (rs = 0.578) and a moderate negative correlation with the depression and anxiety rating scale PHQ-4 (rs = −0.595).ConclusionThe 6-item GSE for ADHD was evaluated to have good content validity. The scale demonstrated good psychometric properties. The results indicate that the GSE-6 may help assess self-efficacy in adults with ADHD

Cognitive behavior therapy for obsessive-compulsive disorder in routine clinical care: A systematic review and meta-analysis

Cognitive behavioral therapy (CBT) has strong research support for obsessive-compulsive disorder (OCD). However, less is known about how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis was conducted of CBT for OCD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until July 2021. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for OCD. Twenty-nine studies (8 randomized controlled trials) were included, comprising 1669 participants. Very large within-group effect sizes (ES) were obtained for OCD-severity at post-treatment (2.12), and follow-up (2.30), on average 15 months post-treatment. Remission rates were 59.2% post-treatment and 57.0% at follow-up. Attrition rate was 15.2%. Risk of bias was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had almost exactly the same ES as efficacy studies at post-treatment and somewhat higher at follow-up. Furthermore, effectiveness studies had significantly higher remission rates than efficacy studies, both at post- and follow-up assessment. CBT for OCD is an effective treatment when delivered in routine clinical care, with ES comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.publishedVersio

Treatment of Obsessive-Compulsive Disorder and the Importance of Assessing Clinical Effectiveness

Obsessive-compulsive disorder (OCD) is a debilitating disorder with a typically chronic course without treatment. The current thesis addresses the following research questions: The first aim is to provide an updated review of evidence-based psychological treatment for adult OCD. A traditional meta-analytic approach is combined with a systematic evaluation of the methodological quality of the included studies in order to provide recommendations for enhanced methodological stringency and study moderators of treatment outcome. These topics are addressed in Paper I. While randomized controlled trials (RCTs) can be considered the “gold standard” for treatment research, it can be argued that when evaluating a new treatment format, a pilot study followed by an effectiveness study and then a replication study is a preferable approach. The OCD-team in Helse Bergen, which is an out-patient clinic part of the specialist health care, has developed a novel treatment format of exposure based cognitive behavioral therapy where individually tailored and therapist assisted exposure and response prevention is delivered in a group format during four consecutive days. The second research aim was thus to assess to which extent OCD patients accepted the novel format, and to investigate its clinical effectiveness. Specifically changes in OCD symptoms, as well as changes in secondary outcomes like depression and work impairment, were investigated. These questions are addressed in a pilot study (Paper II) and an effectiveness study (Paper III). The third aim was to investigate if the results were replicable, which is addressed in Paper IV. Methods: Paper I includes all randomized controlled trials (RCTs) of cognitive behavioral treatment (CBT) for OCD. The term CBT was defined as treatment with CBT, cognitive therapy (CT) or exposure and response prevention (ERP). Included studies were published between 1993 and 2014 and used the interview-based Yale– Brown Obsessive-compulsive Scale as a primary outcome measure. The paper provides a systematic review and meta-analysis of the included studies, as well as an evaluation of methodological aspects by using the Psychotherapy outcome study methodology rating form. Active treatments were compared to active treatment, control, or waitlist conditions, and potential moderators were investigated with a subgroup analysis and meta-regression analyses. Paper II is a pilot study examining six patients undergoing Concentrated Exposure Treatment (cET), focusing on patients’ acceptance of treatment defined as proportion declining treatment, attrition and patients’ satisfaction; as well as clinical changes in OCD symptoms and depressive symptoms. OCD symptoms are assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and depressive symptoms with the Beck Depression Inventory (BDI). Acceptability is assessed with clinical interviews. Paper III is a larger effectiveness study that further investigates patients’ acceptance and the feasibility of cET. Treatment outcome on primary assessment of OCD symptoms is assessed with Y-BOCS and secondary assessment of depressive symptoms are assessed with BDI. Work impairment is assessed with clinical interview. Paper IV provides a replication study of Paper III with the aim to investigate whether a new patient sample undergoing cET would have comparable results as those obtained in Paper III when treatment is delivered by mainly other therapists than the developers of cET. Mixed models analyses and Chi square tests are applied to compare results on Y-BOCS, patient acceptance and occupational functioning. Results: In Paper I the overall effect sizes for comparisons with waiting list (1.31) and placebo conditions (1.33) were very large. Effect sizes for comparisons between individual and group treatment were small and non-significant. CBT was better than medication (0.55), and adding medication to CBT was not more effective than CBT with placebo (0.25). Of treatment moderators, proportion of women, higher age and concurrent SSRI medication were associated with lower effect sizes. Moderators related to larger effect sizes were higher initial symptom severity, using completer analyses as opposed to intent-to-treat-analyses, using passive control (waiting list) as opposed to active control conditions, and studies assessing therapist competence. Overall mean methodological score was 23.03 (SD 4.37) in the 37 studies. The results from Paper II indicated high patient acceptance: None of the patients declined participation, no patients dropped out and the patients expressed a high degree of treatment satisfaction. All patients had marked reductions in symptoms of OCD and depression. Follow-up assessments revealed that the treatment results to a large extent were maintained three and six months after treatment. In Paper III there was high treatment acceptability. Two patients (5.4%) declined the offer of treatment and one patient (3%) dropped out prematurely. Ninety percent of the patients reported a high degree of treatment satisfaction, indicating that cET is an acceptable format. The sample had significant reductions in obsessive-compulsive symptoms after treatment, with gains maintained at the three- and six-month follow- ups. By analyzing clinically significant changes, 77% of the patients were classified as recovered six months after treatment, which is promising as the majority had long OCD duration and most patients had unsuccessfully tried previous treatment. The results in Paper IV showed that the patients had high treatment acceptance, as indicated by no patients declining treatment, no treatment dropout and high self- reported treatment satisfaction. Most patients had marked and significant reductions in symptoms of OCD, with long-term gains maintained at three and six months. By comparing the results with those obtained in Paper III, the most important finding was that equal treatment outcome was achieved by different therapists in a new sample of patients. Conclusions: The present thesis shows that CBT is an effective treatment for OCD, however, the methodological quality of the RCTs is characterized by several limitations with considerable room for improvement. Suggestions of enhanced methodological stringency in future efficacy studies are offered. Furthermore, the thesis shows that a concentrated four-day treatment format is well accepted by the patients and that the approach yields promising results. Promising results were also obtained in terms of the replicability of the format, and it was concluded that Paper IV offered a successful replication of Paper III, also when treatment was delivered by mainly different therapists

Metakognitive prinsipper i behandling av sosial angst.: En kasusrekkestudie

I denne hovedoppgaven har vi utviklet en forståelsesmodell og behandlingsmanual for sosial angst basert på metakognitive prinsipper (Wells, 2009), hvor fokuset for behandlingen har vært rettet mot å endre opprettholdende psykologiske prosesser ved å utfordre metakognitive antagelser. Hensikten med studien var å teste effektiviteten av behandlingen i en klinisk setting. Av totalt sju pasienter var det fire som fullførte, og to av disse oppfylte ikke lenger kriteriene for sosial angst ved terapislutt. Studien viser lovende resultater, men bør replikeres med et større utvalg. Framtidige studier bør utføres av erfarne terapeuter med utdanning i metakognitiv terapi

An empirical investigation of the associations between metacognition, mindfulness experiential avoidance, depression, and anxiety

Abstract Background The aims of this study were to explore the possible relation between metacognition, mindfulness, and experiential avoidance, as well as their association with symptoms of anxiety and depression. Methods Cross-sectional data was collected from a community sample (N = 364) who completed the Metacognitions Questionnaire-30 (MCQ-30), the Five Facet Mindfulness Questionnaire-24 (FFMQ-24), the Acceptance and Action Questionnaire-II (AAQ-II), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Results There were moderate-strong associations between mindfulness (FFMQ-24), metacognition (MCQ-30), and experiential avoidance (AAQ-II) (0.62 − 0.67), and they showed similar relations with symptoms of depression (PHQ-9) and anxiety (GAD-7) (0.57 − 0.71). Mindfulness, experiential avoidance, and the non-judging subscale of FFMQ-24 constituted a latent factor of flexibility in cognition and emotional experience, while three FFMQ-24 subscales (describing, acting with awareness, and observing) constituted a present-centered attention and awareness factor. Regression analyses indicated that flexibility explained more of the variance in symptoms of anxiety and depression than present-centered attention and awareness. Conclusions The results suggest that flexibility in cognitive and emotional regulation skills could be important in explaining symptoms of anxiety and depression

Change in Physical Activity During the Coronavirus Disease 2019 Lockdown in Norway: The Buffering Effect of Resilience on Mental Health

Imposition of lockdown restrictions during the coronavirus disease 2019 (COVID-19) pandemic was sudden and unprecedented and dramatically changed the life of many people, as they were confined to their homes with reduced movement and access to fitness training facilities. Studies have reported significant associations between physical inactivity, sedentary behavior, and common mental health problems. This study investigated relations between participants’ reports of change in physical activity (PA; i.e., Reduced PA, Unchanged PA, or Increased PA) and levels of anxiety and depression symptoms during the COVID-19 pandemic lockdown in Norway in the time period from March 12, 2020 to June 15, 2020. The relations between age and gender and levels of anxiety and depression symptoms as well as how different levels of resilience influenced the relation between changes in PA and levels of anxiety and depression symptoms were also investigated. A cross-sectional survey design was used. Participants (N = 1,314; females = 31%) were members of an endurance sports organization aged between 18 and 81 years (M = 49 years; SD = 11.50 years). Participants completed the Resilience Scale for Adults and the Hospital Anxiety and Depression Scale and reported their changes in PA after lockdown restrictions were implemented on March 12, 2020. Regression analysis, independent samples t-test, and two-way multivariate analysis of variance were conducted. Reduced PA was associated with a higher risk of anxiety and depression symptoms. Younger participants in Reduced PA and Unchanged PA subgroups scored significantly higher on levels of anxiety symptoms and significantly higher on depression symptoms in Unchanged PA subgroup. Females in Unchanged PA and Increased PA subgroups scored significantly higher on levels of anxiety symptoms, whereas no gender differences were found for depression symptoms. The main and interaction effects of change in PA and resilience were significantly associated with depression symptoms. For anxiety symptoms, only the main effect of resilience, but not PA, and the interaction effect were significant. Results further showed that resilience was an important factor that influenced the levels of change in PA. High levels of resilience were associated with lower anxiety and depression symptoms in Reduced, Unchanged, and Increased PA subgroups during the COVID-19 lockdown. Promoting PA while boosting resilience factors such as confidence in own ability and drawing on the social support of even reduced social networks or connections while under lockdown can protect against common mental health problems