The educational burden of disease: a cohort study

Background Students with health disorders might be at risk of disengaging from education, which can reinforce socioeconomic inequalities in health. We aimed to evaluate the associations between 176 diseases and injuries and later school performance in Norwegian adolescents and to estimate the importance of each disorder using a novel measure for the educational burden of disease (EBoD). Methods We used diagnostic information from government-funded health services for all Norwegian inhabitants who were born between Jan 1, 1995, and Dec 31, 2002, were registered as living in Norway at age 11–16 years, and were participating in compulsory education. School performance was assessed as grade point average at the end of compulsory education at age 16 years. We used a linear regression of school performance on disease in a fixed-effects sibling comparison model (113 411 families). The association (regression coefficients) between disease and school performance was multiplied by disease prevalence to estimate the proportional EBoD among 467 412 individuals participating in compulsory education. Findings Overall, although most diseases were not meaningfully associated with grade point average (regression coefficients close to 0), some were strongly associated (eg, intellectual disability regression coefficients –1·2 for boys and –1·3 for girls). The total educational disease burden was slightly higher for girls (53·5%) than for boys (46·5%). Mental health disorders were associated with the largest educational burden among adolescents in Norway (total burden 44·6%; boys 24·6% vs girls 20·0%), of which hyperkinetic disorder contributed to 22·1% of the total burden (boys 14·6% vs girls 7·5%). Among somatic diseases, those with unknown causes and possibly mental causes were associated with the largest educational burden. Interpretation The EBoD concept could provide a simple metric to guide researchers and policy makers. Because mental health disorders form a large component of the educational burden, investment in mental health might be particularly important for improving educational outcomes in adolescents.publishedVersio

The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments

The aim of this systematic review is to answer the question: Is substantial, stable, and long‐term weight loss a viable goal for adults with obesity? To answer this question, we conducted a broad systematic search of non‐surgical and non‐pharmacological obesity treatment studies with the following strict criteria: (a) minimum 3‐year follow‐up, (b) 5% body mass lost, (c) no continued interventions in the follow‐up‐period, (d) prospective design, and (e) less than 30% attrition from the start of the follow‐up period. While the search revealed a very large number of published articles, only eight studies met the inclusion criteria. Several of the nonincluded studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow‐up period. In contrast, the eight high‐quality studies included in this study demonstrate a trend of weight regain towards pretreatment baseline. This review concludes that the majority of high‐quality follow‐up treatment studies of individuals with obesity are not successful in maintaining weight loss over time. The results suggest that excess weight can be lost but is likely regained over time, for the majority of participants

Comparison between the brief seven-item and full eating disorder examination-questionnaire (EDE-Q) in clinical and non-clinical female Norwegian samples

Abstract Background The Eating Disorder Examination-Questionnaire (EDE-Q) is among the most widely used self-report measures of eating disorder (ED) psychopathology. There is a need for brief versions of the EDE-Q that can be used for general assessment and screening purposes. A three-factor 7-item version (EDE-Q7) seems particularly promising but there is a need for more well-powered studies to establish the psychometric properties in both patient and community samples. Moreover, comparing the EDE-Q7 with the full EDE-Q would be beneficial in determining its utility. In the present study, we provide a psychometric comparison between the brief EDE-Q7 and the full EDE-Q in a large sample of both patients and community comparisons. Methods We pooled available datasets collected in Norway to amass a large female sample comprising both patients (n = 1954, M age = 28 years) and community comparisons (n = 2430, M age = 31 years). We investigated the psychometric properties of both versions, including their internal consistency, factor structure, and ability to discriminate between patients and community comparisons. Results The EDE-Q7 showed similar distributions of scores compared to the full EDE-Q but produced higher scores. Results indicated that the EDE-Q7 have acceptable internal consistency and is adequately able to discriminate between clinical and non-clinical samples. A cut-off threshold of 3.64 was optimal in discriminating between patients and comparisons. We also found support for the three-factor solution for the EDE-Q7, indicating good structural validity. In contrast, we did not find support for the originally proposed four-factor solution of the full EDE-Q. Conclusions We find that the brief EDE-Q7 performs close to the full EDE-Q in several respects. Our findings indicate that the brief EDE-Q7 may be a viable alternative to the full EDE-Q in situations where response burden is an issue (e.g., epidemiological studies). However, the EDE-Q7 may hold limited value over the full EDE-Q in clinical settings, due to the small number of items and lack of assessment of behavioral features

#HeToo? Men trivialize cases of sexual harassment by a female aggressor toward a male victim, but women do not

The #MeToo movement spurred a handful of corresponding #HeToo cases, in which men voiced their experiences of sexual harassment by female aggressors. The general public seemed to respond differently to #HeToo cases compared to the #MeToo cases. As the #HeToo and #MeToo cases differed in morally relevant ways, a direct comparison of public reactions cannot comprehensively explore whether peoples’ evaluation of sexual harassment is influenced by the gender of the aggressor and victim. We performed two experiments (total N = 260), in which participants read a description of sexual harassment from a manager toward an employee. For half of the participants, the manager was referred to as a man, and the employee was described as a woman; for the other half, the manager was described as a woman, and the employee was referred to as a man. We expected participants to judge the case as significantly more harmful and repugnant when the aggressor was a man and the victim was a woman compared to the opposite scenario. However, our analyses revealed a pattern of gender differences. Female participants perceived the case as equally bad whether the aggressor was male or female. Male participants reacted equally strongly to the case of sexual harassment performed by a male aggressor. By contrast, male participants viewed the case as far less serious and warranting milder reactions when the aggressor was female and the victim was male. This suggests the trivialization of sexual harassment of male victims by female aggressors is largely driven by men

Internet-delivered cognitive behavioural therapy with and without an initial face-to-face psychoeducation session for social anxiety disorder: a pilot randomized controlled trial

Background. Guided Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment of social anxiety disorder (SAD). However, the treatment is not effective for all. The amount and type of therapist contact have been highlighted as a possible moderator of treatment outcome. Objective. The aim of this study was to examine whether treatment effects of ICBT are enhanced with an initial 90 min face-to-face psychoeducation (PE) session for university students with SAD. Method. University students with SAD (N = 37) were randomized into one out of two conditions: 1) an initial therapist-led face-to-face PE session followed by guided ICBT, 2) guided ICBT without an initial PE session. Data was analysed with an intent-to-treat approach. Results. Eight participants (21.6%) dropped out of treatment. A statistically significant reduction in symptoms was found for all outcome measures for both groups. There were no significant additional effects of adding the initial face-to-face PE. Moderate to large within-group effect sizes on self-rated social anxiety symptoms were found at post-treatment (d = 0.70–0.95) and at a six month follow-up (d = 0.70–1.00). Nearly half of the participants were classified as recovered. Conclusions. Notwithstanding limitations due to the small sample size, the findings indicate that guided ICBT is an effective treatment for students with SAD. Adding an initial face-to-face PE session to the guided ICBT did not lead to enhanced outcomes in the present study

Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy

Psychotherapy tends to produce meaningful and sustained positive changes for individuals suffering from a mental illness. A salient distinction can be made between patients with a Personality Disorder (PD) and those without. There is some evidence that patients with PD have poorer treatment outcomes, but the majority of these studies are from time-limited interventions that might be less suited for patients with PD. In contrast, the present study provided open-ended psychotherapy to a sample of patients (N = 370), half of which had at least one PD before treatment. The therapists received instruction to organize their treatments in cooperation with patients so that therapy was tailored to each patient’s individual needs and characteristics. The results revealed that patients with a PD demonstrated equal symptomatic improvement and greater interpersonal improvement compared to patients without a PD. Similarly, observer-rated diagnostic changes were equivalent across the two groups. Both groups demonstrated enduring improvements when assessed at a two-and-half-year follow-up. The degree of personality pathology was positively related to the magnitude of change, i.e. patients with more severe personality problems demonstrated greater gains in the open-ended treatment format

Problem severity, treatment duration, and the outcome of psychotherapy: The benefits keep growing with time spent in treatment for longer than previously known

Findings from previous psychotherapy research suggest that the majority of improvement takes place in the initial phase of treatment with the relative effectiveness dropping at a negatively accelerating rate. However, the evidence for this pattern of change comes from investigations of short-term treatments and it is unclear whether this also holds for more flexible and long-term psychotherapy. We provided open-ended treatments under routine-care conditions for a representative sample of 370 patients, including a large proportion characterized by severe psychopathology. Patients attended 52 sessions on average (SD = 59, range = 1 - 364, Median = 36). Our results indicated that the degree of improvement was linearly associated with time spent in psychotherapy and contingent upon the severity of psychological problems at intake. The least severely afflicted received the shortest treatments, experienced the most rapid change but demonstrated smaller overall magnitudes of improvement. More severely suffering patients received longer treatments, had slower rates of change but received greater overall benefits. Among the patients who experienced clinically significant symptomatic improvement (47 %), a dose-response survival analysis indicated a median survival time of 57 sessions. We argue that previous suggestions of psychotherapy dosage have been inappropriate for patients suffering from moderate to severe psychopathology