Incidence of SARS-CoV-2 and all-cause mortality in persons with co-occurring substance use disorder and mental illness during the pandemic: a Norwegian cohort study

Purpose - Most people were affected by the COVID-19 pandemic. Persons with co-occurring substance use disorder (SUD) and mental illness (MI) are already a marginalized group, with above average mortality. Thus, the study aim was to investigate SARS-CoV-2 incidence and mortality among persons with SUD/MI during the first two years of the pandemic. Methods - This historical cohort study merged data from the Norwegian Patient Register, the Norwegian Surveillance System for Communicable Diseases and census data from Statistics Norway. We calculated crude mortality rates for persons with SUD and mild/moderate vs. severe MI and compared them to persons with physical illnesses or healthy controls. The incidence rate ratios for SARS-CoV-2 infection and mortality were estimated using Poisson regression models. Results - Compared to healthy controls, the SARS-Cov-2-infection rate was marginally lower in persons with SUD and mild/moderate MI (IRR,1.19 [95%CI,1.09–1.30]) as in persons with physical illness (IRR,1.35 [95%CI, 1.23–1.47]), whereas persons with SUD and severe MI showed a lower rate compared to healthy controls. Crude mortality rates for persons with SUD/MI were substantially higher and increased much more during the pandemic than for persons with physical illnesses or healthy controls. The IRR for mortality in persons with SUD and mild/moderate MI was 10.61 (95%CI,7.19–15.67) and 11.44 (95%CI,7.50-17.45) for SUD and severe MI, compared to 5.03 (3.34–7.57]) for persons with physical illnesses only. Conclusion - The analysis showed excess mortality during COVID-19-pandemic for SUD/MI, but without higher SARS-CoV-2 infection rates in this group. Consequently, excess mortality among persons with SUD/MI was not due to SARS-CoV-2 infection

Cross-cultural adaptation of the delphi definitions of low back pain prevalence (German DOLBaPP)

Background Assessed dimensions of low back pain (LBP) vary in prevalence studies. This may explain the heterogeneity in frequency estimates. To standardize definitions of LBP, an English consensus with 28 experts from 12 countries developed the “Delphi Definitions of Low Back Pain Prevalence” (DOLBaPP). The optimal definition and the shorter minimal definition with the related questionnaires for online, paper, and face-to-face use and telephone surveys are suitable for population-based studies. The definitions have to be adapted to different languages and cultures to provide comparable frequency estimates. The objective was to culturally adapt and pre-test the English definitions and corresponding Delphi DOLBaPP questionnaire forms into German. Methods The German DOLBaPP adaptation was conducted using the systematic approach suggested by Beaton et al. A pre-test of the Delphi DOLBaPP optimal paper questionnaire including an additional evaluation form was conducted in a sample of 121 employees (mainly office workers). In order to evaluate the comprehensibility, usability, applicability, and completeness of the adapted questionnaire, response to the questionnaire and 6 closed evaluation questions were analyzed descriptively. Qualitative methods were used for the 3 open questions of the evaluation form. Results The cultural adaptation of the DOLBaPP for a German-speaking audience required little linguistic adaptation. Conceptual equivalence was difficult for the expression “low back pain”. The expert committee considered the face validity of the pre-final version of the related Delphi DOLBaPP questionnaires as good. In the pre-test, most participants (95%) needed less than 5 minutes to fill in the optimal Delphi DOLBaPP questionnaire. They were generally positive regarding length, wording, diagram, and composition. All subjects with LBP (n = 61 out of 121 – 50.4%) answered the questions on functional limitation, sciatic pain, frequency and duration of symptoms as well as pain severity. Conclusion The results indicate that the cross-cultural German adaptation of the DOLBaPP Definitions and the corresponding questionnaires was successful. The definitions can be used in epidemiological studies to measure the prevalence of LBP. Some critical issues were raised regarding the general features of the Delphi DOLBaPP questionnaires. Future research is needed to evaluate these instruments

Associations between Mental Health, Lifestyle Factors and Worries about Climate Change in Norwegian Adolescents

Climate change is a serious global health threat that has an impact on young people’s lives and may influence their mental health. Since the global climate strike movement, many adolescents have expressed worries about climate change. Thus, the aim of this study is to examine the prevalence of worries about climate change, and factors associated with worries about climate change, in a representative sample of Norwegian adolescents. Data were retrieved from Ungdata, an annual nationwide online youth survey. Adolescents (n = 128,484) from lower and upper secondary school participated in the study. Data were analyzed descriptively and with logistic regression. Most of the adolescents were not worried or a little worried about climate change. Girls, pupils who had at least one parent with higher education and pupils from urban areas were more inclined to worry about the climate. Adolescents who worried about the climate had more symptoms of depression than those who were less worried. While worry about climate change may constitute an additional burden for adolescents experiencing depressive symptoms, such worry can also be seen to reflect climate-friendly values.publishedVersio

Does migrant background predict to what extent colorectal cancer patients want to be informed about their life expectancy? – a cross-sectional analysis

Background: Although migrant health is a topic of interest across Europe and although health care services in Germany consider migrant health issues, people with a migrant background often experience difficulties regarding health care provision. The prevalence of various cancers among migrants is lower relative to non-migrants although this equalizes with increasing duration of residence. There are documented differences in health behavior and disease-coping strategies between migrants and non-migrants, but data are scarce on this subject. This analysis investigates the extent of information migrant and non-migrant colorectal cancer (CRC) patients in Germany want about their life expectancy and the level of trust they have in their treating physician. Method: Data from 522 CRC patients were collected through a self-reported questionnaire. Migrant background was determined by the patients’ and/or their parents’ birthplace. Bivariate analyses were applied to determine the differences between migrants and non-migrants. A multivariate analysis was used to measure the effect of migration background, demographics, and cancer stage and treatment on the preferred extent of information about life expectancy and trust in their treating physician. Results: There were no significant differences regarding demographics or cancer stage and treatment between migrant and non-migrant CRC patients. Having a migrant background had no influence on the level of trust in the treating physician, but migrants preferred to be less informed about their life expectancy than non-migrants (21.4% vs. 13.4%, p = 0.04). The multivariate analysis showed that men (aOR = 2.102, CI: 1.123–3.932) and patients with a non-migrant background (aOR = 5.03, CI: 1.02–24.73) preferred receiving information about the approximate value of their life expectancy, rather than receiving no information. Conclusion: The study found more similarities than discrepancies between migrant and non-migrant CRC patients regarding demographic factors and stage of disease and treatment, which may be a consequence of an increasingly homogeneous cross-cultural society. However, cultural differences between the minority and host population remain and should always be taken into account in daily clinical practice and in the communication skills training of health care professionals. The study also indicates that recording migration background into health registers would facilitate migrant-sensitive research.publishedVersio

Covid-19: Kontakt med helsesykepleier i skolehelsetjenesten under første nedstengning – en tverrsnittsstudie

Bakgrunn: Covid-19-pandemien, som også rammet Norge, påvirket ungdom i stor grad. Skolene stengte, og strenge restriksjoner ble innført. Ungdommene rapporterte om lavere livstilfredsstillelse, de følte seg ensomme og mindre glade. Samtidig med at skolene stengte, skjedde det endringer i skolehelsetjenestene. Flere av helsesykepleierne ble omdisponert til andre oppgaver, noe som førte til et redusert tilbud til ungdommen. Hensikt: Vi ønsket i denne undersøkelsen å se på hvordan ungdommenes bekymringer og utfordringer under første nedstengning påvirket bruken av helsesykepleier i skolehelsetjenesten. Vi så også på i hvilken grad gutter og jenter tok kontakt med en helsesykepleier, og hvorvidt de hadde fått informasjon om hvordan de kunne komme i kontakt med en helsesykepleier da skolen var stengt. Metode: Tverrsnittsstudien ble gjennomført i Innlandet og Viken i mai 2020. Vi samlet inn data med elektroniske spørreskjemaer. Totalt 3347 ungdommer fra 8.–10. klasse deltok. Vi utførte deskriptive analyser og logistisk regresjonsanalyse. Resultat: Pandemien har påvirket flere av ungdommene i en positiv retning (74,9 prosent) enn i en negativ retning (68 prosent). Av jentene var 49,5 prosent bekymret for å bli smittet av covid-19, mens bare 30 prosent av guttene var det. Under halvparten av ungdommene tok kontakt med hjelpetelefon eller chat, og flere jenter enn gutter vurderte det. Det var 41 prosent som hadde fått informasjon om hvordan de kunne komme i kontakt med en helsesykepleier mens skolene var stengt, mens 36 prosent svarte at de ikke hadde fått det. Den logistiske regresjonsanalysen viste at det var mer sannsynlig at jenter tok kontakt med helsesykepleier under første nedstengning enn gutter. Konklusjon: Undersøkelsen viser at første nedstengning påvirket ungdommene både positivt og negativt. Et fåtall hadde fått informasjon om at de kan ta kontakt med en helsesykepleier i skolehelsetjenesten i denne perioden. I slike situasjoner er det viktig med god informasjon om hvordan helsesykepleieren kan nås, og at helsesykepleieren er tilgjengelig for ungdommen.publishedVersio

Therapists and the topic of meaning in life in their encounters with adolescents with developmental trauma: A qualitative study

This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: Meaning in life is important to achieve quality of life, psychological well-being and good mental health. Existential issues such as meaning in life have limited attention in mental health care and treatment for children and young people in Norway. People in crisis often ponder existential questions. We find little research on this topic in relation to therapists who work with adolescents with developmental trauma. The purpose of this study was to examine how meaning in life is understood and addressed from the perspectives of therapists working with adolescents struggling with trauma. Method: The study has a qualitative design, based on focus groups with therapists in mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text condensation. Results: Therapists had limited professional experience and competence to address and explore meaning as a topic in therapy. Yet there was interest in the topic and they thought that young people with trauma experience may benefit from the incorporation of meaning perspectives into therapy. Conclusion: Therapists at a mental health outpatient clinic for children and adolescents found the topic of meaning important but challenging to involve in the treatment of adolescents with developmental trauma. There is a need for more research to enhance understanding of what it means to include meaning as a topic in child and adolescent psychiatry, and what may be the specific benefit and challenges involved.publishedVersio

Norwegian Cross-Cultural Adaptation of the Social and Communities Opportunities Profile-Mini for Persons with Concurrent Mental Health and Substance Use Disorders.

Persons with concurrent mental health and substance use disorders often do not participate actively in society and remain marginalized. The promotion of social inclusion is important for the care of persons with concurrent disorders. To measure social inclusion, the Social and Communities Opportunities Profile (SCOPE) was developed, followed by its mini version for English-speaking people in Singapore. In Norway, there is no instrument available to measure social inclusion. Thus, the aim was cross-cultural adaptation of SCOPE Mini for persons with concurrent disorders. The Norwegian adaptation was performed using the systematic approach recommended by Beaton et al. After a forward–backward translation, the Norwegian SCOPE-Mini was pre-tested among 30 persons with a concurrent mental health and substance use disorder in three areas to check its psychometric properties. To evaluate comprehensibility and applicability, participants were asked five open questions. The Norwegian cross-cultural adaptation of SCOPE Mini showed acceptable psychometric properties and was considered comparable to the original version. The results of the pre-test showed no linguistic inconsistency, but some indications of the necessity of semantic adaptation regarding the cultural context and persons with concurrent disorders. The Norwegian SCOPE Mini may be a practical tool for health professionals, social workers, and researchers to measure social inclusion among a vulnerable group such as persons with a concurrent mental health and substance use disorder. However, given the relatively small sample size in our study, further research on the validity and reliability of the instrument is recommended

Norwegian Cross-Cultural Adaptation of the Social and Communities Opportunities Profile-Mini for Persons with Concurrent Mental Health and Substance Use Disorders.

Persons with concurrent mental health and substance use disorders often do not participate actively in society and remain marginalized. The promotion of social inclusion is important for the care of persons with concurrent disorders. To measure social inclusion, the Social and Communities Opportunities Profile (SCOPE) was developed, followed by its mini version for English-speaking people in Singapore. In Norway, there is no instrument available to measure social inclusion. Thus, the aim was crosscultural adaptation of SCOPE Mini for persons with concurrent disorders. The Norwegian adaptation was performed using the systematic approach recommended by Beaton et al. After a forward–backward translation, the Norwegian SCOPE-Mini was pretested among 30 persons with a concurrent mental health and substance use disorder in three areas to check its psychometric properties. To evaluate comprehensibility and applicability, participants were asked five open questions. The Norwegian crosscultural adaptation of SCOPE Mini showed acceptable psychometric properties and was considered comparable to the original version. The results of the pre-test showed no linguistic inconsistency, but some indications of the necessity of semantic adaptation regarding the cultural context and persons with concurrent disorders. The Norwegian SCOPE Mini may be a practical tool for health professionals, social workers, and researchers to measure social inclusion among a vulnerable group such as persons with a concurrent mental health and substance use disorder. However, given the relatively small sample size in our study, further research on the validity and reliability of the instrument is recommended.publishedVersio

How did the first covid-19 lockdown affect persons with concurrent mental health and substance use disorders in Norway? A qualitative study

Background: The outbreak of COVID-19 with its severe social restrictions touched the daily life of most people. While everyday social life becomes difficult for citizens with economic and cultural capital, it becomes even worse for vulnerable groups such as persons with mental health and substance use disorders, who are particularly vulnerable to social exclusion. The aim of this study is to investigate how the first COVID-19 lockdown affected the everyday life and health of persons with co-occurring mental health and substance use disorders. Methods: This qualitative study reports data from 17 individual interviews and one focus group of five participants, all with a self-reported mental health and substance use disorder. Interviews were conducted based on a semi-structured interview guide in September and October 2020 in a medium-sized local authority in Norway. Data were analysed using thematic analysis. A reference group of people with varied knowledge and experiences of the phenomenon were involved in study design, recruitment, data generation and analysis. Results: The analysis identified four interrelated main themes, describing how the first lockdown affected the everyday life and health of persons suffering from a mental health and substance use disorder: 1) The COVID-19 outbreak as a perceived challenge, 2) A decline in mental health and well-being, 3) Increased substance use challenges, and 4) Diverse experiences with health and social services. The results show that people with a co-occurring disorder have challenges with digital tools and/or do not have the appropriate equipment. Further, participants were not concerned about becoming infected themselves, but infecting others

Negative social media-related experiences and lower general self-efficacy are associated with depressive symptoms in adolescents

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Social media are an integral part of adolescents’ daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents’ social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-e cacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09–0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-e cacy was directly associated with lower symptom levels (β = −0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-e cacy is an important resource for adolescents’ mental health.publishedVersio