Characteristics of parents living apart in Norway: Comparing four residence arrangements

Objective: This study investigates differences in characteristics between parents practicing four different residence arrangements by applying a novel categorisation of residence arrangements. Background: The research field on factors associated with shared and sole physical residence is growing. This binary approach may neglect important differentials within these two groups. Method: The sample included 1007 parents from the FamC-study, recruited from family counselling offices across Norway. Mixed effects multinomial regression analyses were used to estimate the likelihood of practicing four residence arrangements (i.e. symmetric shared, asymmetric shared, extended sole and limited sole residence) based on relevant factors (i.e. number and age of children, time since separation, financial difficulties, employment status, new partners, interparental dynamics and mental health). Results: Parents with more and older children, fewer financial difficulties and who separated more recently had higher likelihood of practising symmetric shared residence. Parents with younger children were more likely to practise asymmetric shared residence. Parents with younger and fewer children and who had been separated for longer had higher likelihood of practising extended sole residence. Lastly, parents with fewer children and who had more financial difficulties were more likely to practise limited sole residence. Conclusion: The current findings reveal differences between four residence arrangements when expanding the traditional division between "shared" and "sole" residence, emphasising the importance of using a nuanced differentiation of residence arrangements.Fragestellung: Ziel dieser Studie ist es, mithilfe einer Neueinteilung von Betreuungsmodellen die Unterschiede in Merkmalen von Eltern, die vier verschiedene Betreuungsmodelle praktizieren, zu untersuchen. Hintergrund: Das Forschungsfeld zu Faktoren, die mit geteilter und alleiniger physischer Wohnsituation zusammenhängen, wächst. Dieser binäre Ansatz vernachlässigt möglicherweise wichtige Unterschiede innerhalb dieser beiden Gruppen. Methode: Die Stichprobe umfasste 1007 Eltern aus der FamC-Studie, rekrutiert in Familienberatungsstellen in ganz Norwegen. Mithilfe multinomialer Regressionsanalysen mit gemischten Effekten wurde die Wahrscheinlichkeit der Ausübung der vier Betreuungsmodelle (symmetrisch- bzw. asymmetrisch-geteilte Betreuung, erweitert- bzw. begrenzt-alleinige Betreuung) auf der Grundlage relevanter Faktoren (z.B. Anzahl und Alter der Kinder, Zeit seit der Trennung, finanzielle Schwierigkeiten, Beschäftigungsstatus, neue Partner, elterliche Dynamik und psychische Gesundheit) geschätzt. Ergebnisse: Eltern mit mehr und älteren Kindern, weniger finanziellen Schwierigkeiten und einer kürzlich erfolgten Trennung hatten eine höhere Wahrscheinlichkeit, eine symmetrisch-geteilte Betreuung zu praktizieren. Bei Eltern mit jüngeren Kindern war die Wahrscheinlichkeit höher, dass sie eine asymmetrisch-geteilte Betreuung praktizierten. Eltern, die schon länger getrennt lebten, mit jüngeren und weniger Kindern, hatten eine höhere Wahrscheinlichkeit, eine erweitert-alleinige Betreuung zu praktizieren. Eltern mit weniger Kindern und größeren finanziellen Schwierigkeiten praktizierten mit größerer Wahrscheinlichkeit eine begrenzt-alleinige Betreuung. Schlussfolgerung: Die vorliegenden Ergebnisse zeigen Unterschiede zwischen vier Betreuungsmodellen auf, wenn man die traditionelle Zweiteilung zwischen „geteilten“ und „alleinigen“ Betreuungsformen erweitert. Dies unterstreicht die Wichtigkeit einer differenzierten Einteilung der Betreuungsmodelle

Handling unobserved confounding in the relation between prenatal risk factors and child outcomes:a latent variable strategy

Abstract Background Several studies have examined maternal health behavior during pregnancy and child outcomes. Negative control variables have been used to address unobserved confounding in such studies. This approach assumes that confounders affect the exposure and the negative control to the same degree. The current study introduces a novel latent variable approach that relaxes this assumption by accommodating repeated measures of maternal health behavior during pregnancy. Methods Monte Carlo simulations were used to examine the performance of the latent variable approach. A real-life example is also provided, using data from the Norwegian Mother, Father, and Child Study (MoBa). Results Simulations: Regular regression analyses without a negative control variable worked poorly in the presence of unobserved confounding. Including a negative control variable improved result substantially. The latent variable approach provided unbiased results in several situations where the other analysis models worked poorly. Real-life data: Maternal alcohol use in the first trimester was associated with increased ADHD symptoms in the child in the standard regression model. This association was not present in the latent variable approach. Conclusion The current study showed that a latent variable approach with a negative control provided unbiased estimates of causal associations between repeated measures of maternal health behavior during pregnancy and child outcomes, even when the effect of the confounder differed in magnitude between the negative control and the exposures. The real-life example showed that inferences from the latent variable approach were incompatible with those from the standard regression approach. Limitations of the approach are discussed

Met and unmet need for mental health care before and during the COVID-19 pandemic

There is a concern that the coronavirus disease 2019 (COVID-19) pandemic will generate large unmet needs for mental health care. Using data from an epidemiological psychiatric diagnostic interview survey (n = 2159) conducted on a probability sample from the general population, the proportions of met and unmet need for mental health care among individuals with and without mental disorders were compared before and during the COVID-19 pandemic. The results showed no statistical difference in met and unmet need for mental health care, but point estimates were suggestive of a higher unmet need for care among those with a current mental disorder after the lock-down period.publishedVersio

Preadolescents with immigrant backgrounds: the relationship between emotional problems, parental achievement values, and comparison

Although strong parental achievement values have been associated with positive outcomes among children (e.g., academic success), they have also been connected to emotional problems. The latter effect may be the result of pressure related to such things as parental comparison of filial achievement, which appears to be more predominant among immigrant parents as compared with non-immigrant parents.Our goals were to assess the following: 1) whether higher levels of parental achievement values and comparison are found among immigrant preadolescents; and (2) whether comparison (i.e., comparing a child's achievements with those of siblings and peers) can account for the link between strong parental achievement values and emotional problems among the children of immigrants.The sample included 902 preadolescents between the ages of 10 and 12 years from two Norwegian cities: Oslo (79%) and Bergen (21%). Forty-seven percent of the sample had immigrant parents, and the others had non-immigrant parents. A self-administered questionnaire was completed by fifth, sixth, and seventh graders from fourteen schools during normal school hours; the questionnaires were completed after school by students from Turkey and Sri Lanka. The questionnaire included measures of emotional problems, parental achievement values, comparison, and school hassles. We used a moderated mediation model to test whether the relationship between parental achievement values and emotional problems was accounted for by comparison and to look at whether this mediation was stronger for preadolescents with immigrant backgrounds as compared with their non-immigrant peers. Background and academic factors that could confound the unique relationships among the main variables were adjusted for in the analyses.The association between parental achievement values and emotional problems was found to be mediated by comparison. Higher levels of parental achievement values were associated with more comparison, and this relationship was stronger for preadolescents with immigrant backgrounds. Comparison was only linked to emotional problems in preadolescents with immigrant backgrounds.This study suggests that stronger parental achievement values among immigrants as compared with non-immigrants in Norway are found as early as preadolescence and that comparison may be part of the link between strong parental achievement values and emotional problems

The impact of smoking in adolescence on early adult anxiety symptoms and the relationship between infant vulnerability factors for anxiety and early adult anxiety symptoms : The TOPP Study

Cigarette smoking is increased in people with trait anxiety and anxiety disorders, however no longitudinal data exist illuminating whether smoking in adolescence can influence the developmental trajectory of anxiety symptoms from early vulnerability in infancy to adult anxiety expression. Using The Tracing Opportunities and Problems in Childhood and Adolescence (TOPP) Study, a community-based cohort of children and adolescents from Norway who were observed from the age of 18months to age 18–19years, we explored the relationship between adolescent smoking, early vulnerability for anxiety in infancy (e.g. shyness, internalizing behaviors, emotional temperaments) and reported early adult anxiety.Structural equation modeling demonstrated that adolescent active smoking was positively associated with increased early adulthood anxiety (β = 0.17, p<0.05), after controlling for maternal education (proxy for socioeconomic status). Adolescent anxiety did not predict early adult smoking. Adolescent active smoking was a significant effect modifier in the relationship between some infant vulnerability factors and later anxiety; smoking during adolescence moderated the relationship between infant internalizing behaviors (total sample: active smokers: β = 0.85,p<0.01, non-active smokers: ns) and highly emotional temperament (total sample: active smokers: β = 0.55,p<0.01,non-active smokers: ns), but not shyness, and anxiety in early adulthood. The results support a model where smoking acts as an exogenous risk factor in the development of anxiety, and smoking may alter the developmental trajectory of anxiety from infant vulnerability to early adult anxiety symptom expression. Although alternative non-mutually exclusive models may explain these findings, the results suggest that adolescent smoking may be a risk factor for adult anxiety, potentially by influencing anxiety developmental trajectories. Given the known adverse health effects of cigarette smoking and significant health burden imposed by anxiety disorders, this study supports the importance of smoking prevention and cessation programs targeting children and adolescence

Prevalence of mental disorders, suicidal ideation and suicides in the general population before and during the COVID-19 pandemic in Norway: A population-based repeated cross-sectional analysis

Background Self-report data on mental distress indicate a deterioration of population mental health in many countries during the COVID-19 pandemic. A Norwegian epidemiological diagnostic psychiatric interview survey was conducted from January to September 2020, allowing for comparison of mental disorder and suicidal ideation prevalence from before through different pandemic periods. Prevalence of suicide deaths were compared between 2020 and 2014–2018. Methods Participants from the Trøndelag Health Study (HUNT) in Trondheim were recruited through repeated probability sampling. Using the Composite International Diagnostic Interview (CIDI 5.0) (n = 2154), current prevalence of mental disorders and suicidal ideation was examined in repeated cross-sectional analyzes. Data on suicide deaths was retrieved from the Norwegian Cause of Death Registry and compared for the months March to May in 2014–2018 and 2020. Findings Prevalence of current mental disorders decreased significantly from the pre-pandemic period (January 28th to March 11th 2020; 15•3% (95% CI 12•4–18•8)) to the first pandemic period (March 12th – May 31st; 8•7% (6•8–11•0)). Prevalences were similar between the pre-pandemic period and the interim (June 1st July 31st; 14•2% (11•4–17•5)) and second periods (August 1st-September 18th; 11•9% (9•0–15•6)). No significant differences were observed in suicidal ideation or in suicide deaths. Interpretation Except for a decrease in mental disorders in the first pandemic period, the findings suggest stable levels of mental disorders, suicidal ideation and suicide deaths during the first six months of the COVID-19 pandemic compared to pre-pandemic levels. Potential methodological and contextual explanations of these findings compared with findings from other studies are discussed.publishedVersio

Risk of attention-deficit hyperactivity disorder in offspring of mothers with infections during pregnancy

Background Maternal infections during pregnancy are common events that have been suggested to be risk factors for Attention-deficit hyperactivity disorder (ADHD) in offspring. Only a few studies have been conducted to date and results are conflicting. The current study investigates the associations between specific groups of prenatal maternal infections and offspring ADHD, considering timing of exposure and the role of fever. Methods We used data from the prospective Norwegian Mother, Father and Child Cohort Study (MoBa), including more than 112,000 pregnancies, linked with data from the Medical Birth Registry of Norway and the Norwegian Patient Registry to estimate odds ratios for the likelihood that children develop ADHD after being exposed to maternal infections during gestation. Results Children exposed to any maternal infection during pregnancy showed increased risk of receiving an ADHD diagnosis (OR = 1.15, CI = 1.03–1.27). Specifically, increased ADHD risk was observed after exposure to genitourinary infections in second (OR = 1.42, CI = 1.06–1.90) or third trimester (OR = 2.04, CI = 1.19–3.49), and to respiratory infections in second trimester (OR = 1.31, CI = 1.12–1.54), provided these infections were accompanied by episodes of fever. Increased ADHD risk was also observed after exposure to diarrhea without fever in the third trimester (OR = 1.25, CI = 1.07–1.46). Conclusions Overall, our results suggest that prenatal exposure to maternal infections, particularly with co-occurring episodes of fever, are risk factors for ADHD. Fever (or severity of the infection) appears to be more important in mid-pregnancy associations. Our results indicate that type of infection and timing of exposure might influence the associations, but small effect sizes require careful interpretations. The association between infection and ADHD should be estimated using discordant siblings or other negative control designs that give better adjustment for unmeasured familial confounding.publishedVersio

Educational attainment and mortality in schizophrenia

Background Individuals suffering from schizophrenia have a reduced life expectancy with cardiovascular disease (CVD) as a major contributor. Low educational attainment is associated with schizophrenia, as well as with all-cause and CVD mortality. However, it is unknown to what extent low educational attainment can explain the increased mortality in individuals with schizophrenia. Aim Here, we quantify associations between educational attainment and all-cause and CVD mortality in individuals with schizophrenia, and compare them with the corresponding associations in the general population. Method All Norwegian citizens born between January 1, 1925, and December 31, 1959, were followed up from January 1, 1990, to December 31, 2014. The total sample included 1,852,113 individuals, of which 6548 were registered with schizophrenia. We estimated hazard ratios (HR) for all-cause and CVD mortality with Cox models, in addition to life years lost. Educational attainment for index persons and their parents were included in the models. Results In the general population individuals with low educational attainment had higher risk of all-cause (HR: 1.48 [95% CI: 1.47–1.49]) and CVD (HR: 1.59 [95% CI: 1.57–1.61]) mortality. In individuals with schizophrenia these estimates were substantially lower (all-cause: HR: 1.13 [95% CI: 1.05–1.21] and CVD: HR: 1.12 [95% CI: 0.98–1.27]). Low educational attainment accounted for 3.28 (3.21–3.35) life years lost in males and 2.48 (2.42–2.55) years in females in the general population, but was not significantly associated with life years lost in individuals with schizophrenia. Results were similar for parental educational attainment. Conclusions Our results indicate that while individuals with schizophrenia in general have lower educational attainment and higher mortality rates compared with the general population, the association between educational attainment and mortality is smaller in schizophrenia subjects than in the general population.publishedVersio

Smoking in pregnancy and child ADHD

BACKGROUND AND OBJECTIVE: There is a well-documented association between maternal smoking during pregnancy and offspring attention-deficit/hyperactivity disorder (ADHD). The degree to which this reflects causal intrauterine effects or is due to unmeasured confounding is not clear. We sought to compare the association between maternal smoking during pregnancy and offspring ADHD with the associations with paternal smoking, grandmother’s smoking when pregnant with mother, and maternal smoking in previous pregnancies. Each of these exposures is expected to be influenced by much of the same confounding factors as maternal smoking during pregnancy, but cannot have direct intrauterine effects. A sibling control design was also used. METHODS: The current study used data from the Norwegian Mother and Child Cohort Study (n > 100 000 children). Mothers and fathers reported on smoking during pregnancy, and mothers reported on smoking in previous pregnancies and their mother’s smoking when pregnant with them. Mothers reported on child ADHD symptoms at 5 years of age. Information about child ADHD diagnosis was obtained from the Norwegian Patient Registry. RESULTS: Maternal smoking during pregnancy was not more strongly associated with offspring ADHD diagnosis than was paternal smoking, grandmother’s smoking when pregnant with mother, or maternal smoking in previous pregnancies. Sibling control analyses showed no association between maternal smoking in pregnancy and child ADHD symptoms among siblings discordant for maternal smoking. CONCLUSIONS: These results suggest that the association between maternal smoking during pregnancy and offspring ADHD is not due to causal intrauterine effects, but reflects unmeasured confounding

Prenatal Exposure to Acetaminophen and Risk of ADHD

OBJECTIVES: To estimate the association between maternal use of acetaminophen during pregnancy and of paternal use before pregnancy with attention-deficit/hyperactivity disorder (ADHD) in offspring while adjusting for familial risk for ADHD and indications of acetaminophen use. METHODS: Diagnoses were obtained from the Norwegian Patient Registry for 112 973 offspring from the Norwegian Mother and Child Cohort Study, including 2246 with ADHD. We estimated hazard ratios (HRs) for an ADHD diagnosis by using Cox proportional hazard models. RESULTS: After adjusting for maternal use of acetaminophen before pregnancy, familial risk for ADHD, and indications of acetaminophen use, we observed a modest association between any prenatal maternal use of acetaminophen in 1 (HR = 1.07; 95% confidence interval [CI] 0.96–1.19), 2 (HR = 1.22; 95% CI 1.07–1.38), and 3 trimesters (HR = 1.27; 95% CI 0.99–1.63). The HR for more than 29 days of maternal acetaminophen use was 2.20 (95% CI 1.50–3.24). Use for &amp;lt;8 days was negatively associated with ADHD (HR = 0.90; 95% CI 0.81–1.00). Acetaminophen use for fever and infections for 22 to 28 days was associated with ADHD (HR = 6.15; 95% CI 1.71–22.05). Paternal and maternal use of acetaminophen were similarly associated with ADHD. CONCLUSIONS: Short-term maternal use of acetaminophen during pregnancy was negatively associated with ADHD in offspring. Long-term maternal use of acetaminophen during pregnancy was substantially associated with ADHD even after adjusting for indications of use, familial risk of ADHD, and other potential confounders. </jats:sec