The overarching concept of salutogenesis in the context of health care

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Self-esteem and mental health in adolescents – level and stability during a school year

Aim: Adolescence represent an important period for positive mental health development. The aim of the present paper was to investigate gender differences as well as the level, stability and predictive role of mental health (symptoms of depression/anxiety and mental well-being) and self-esteem in adolescents during a school year. Methods: The study sample consisted of a cohort of 351 students aged 15–21 years in Mid-Norway. In a survey administrated at the beginning and end of the 2016/2017 school year, mental well-being was assessed with Warwick-Edinburgh Mental Well-Being Scale, depression/anxiety with Hopkins Symptom Checklist and self-esteem with the Rosenberg Self-Esteem Scale. Two models were tested for prediction; self-esteem on mental health (vulnerability model) and mental health on self-esteem (scar model). Results: Girls reported significantly higher depression/anxiety than boys and showed a slightly significant increase in depression/anxiety, stress and self-esteem during the two assessments. Boys scored significantly higher on mental well-being and self-esteem and reported stable mental health during the school year. Selfesteem significantly predicted depression/anxiety and mental well-being. Mental well-being and depression/ anxiety also significantly predicted self-esteem. Conclusion: The results suggest that self-esteem and mental health are reciprocally associated. The results underline the gender differences in overall mental health in adolescents and thus the potential importance of acknowledging gender when working on universal strategies for positive mental health development

Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study

Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available. Objective: This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts. Methods: This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected. Results: The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022. Conclusions: This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation

Sense of Coherence in Association with Stress Experience and Health in Adolescents

This study investigated the associations between sex, age, socio-economic status, stress, sense of coherence (SOC), and health (mental wellbeing, depressive symptoms, self-rated health, and subjective health complaints) in Norwegian adolescents aged 13–19 years. Furthermore, the study investigated the potential protective or compensatory role from SOC on the association between stress and health. Methods: The study was based on a cross-sectional sample of 1233 adolescents. Data were analyzed with descriptive, comparative, and multiple linear regression analyses. Results: Girls reported significantly higher scores on depressive symptoms and subjective health complaints than boys. Stress was significantly and positively associated with depressive symptoms. SOC associated significantly with all outcome variables; and especially with mental wellbeing and depressive symptoms. Significant interaction effects of sex in combination with stress and SOC were found in association with depression and mental wellbeing. Associations were strongest for girls. Conclusion: The findings provided support for the significant role of SOC as a coping resource, especially in relation to adolescents’ mental health; weaker associations were found with subjective health complains and self-rated health. The findings also mainly supported a compensatory role of SOC on the association between stress and health during adolescence.publishedVersio

Stress and health in adolescents:The role of potential protective factors

Adolescence is a developmental period characterized by multiple changes in virtually every aspect of an individual’s life, calling for new psychological adaptations. Exposure to different stressors caused by these changes represents a central and normal part of the process of growth and development during adolescence. However, experience of cumulative and simultaneous negative stressors remains central as a potential threat to the well-being and healthy development during adolescence. Meanwhile, when faced with identical stressors, the stress process and the health outcomes of stress vary individually; the outcome depends on the role of different vulnerabilities and protective factors, in the individual as well as in the environment. The present thesis comprises an investigation of the role and nature of adolescent stressors and the association between stress and different health outcomes (emotional states, selfesteem and subjective health complaints). Gender and age differences on stress and the health outcome variables are also assessed. The thesis further considers the role of three potential protective factors with importance for stress and coping processes, as well as for health and well-being during adolescence; leisure time physical activity, self-esteem and sense of coherence (SOC). The factor structure and psychometric properties of the Norwegian version of the Adolescent Stress Questionnaire (ASQ-N), a questionnaire assessing stressors common in adolescence, are also investigated. The thesis is based on three cross-sectional samples of Norwegian adolescents 13-18 years, attending public elementary and secondary schools in rural and urban areas in the two counties of the middle part of Norway The findings support a reliable and valid nine-factor structure of the ASQ-N. Moreover, girls seem to report higher levels of stress, more emotional symptoms and subjective health complaints than boys, especially in the age group 15-16 years. Conversely boys score higher on self-esteem. Both total sum stress and domain specific stress, especially in interpersonal contexts, is related to more emotional problems, lower self-esteem and more subjective health complaints in both boys and girls. The thesis has also revealed the positive role of leisure time physical activity, sense of coherence and self-esteem, controlled for experience of stress, in association with adolescents’ health outcomes. Methodological, theoretical and practical implications of the results are discussed.Ungdomstiden er en utviklingsperiode i livet der den unge må tilpasse seg mange ulike forandringer, både fysiske, psykiske og sosiale. Å utsettes for ulike stressorer, forårsaket av disse store endringene, utgjør en sentral og normal del av vekst og utvikling hos ungdom. Imidlertid representerer opplevelse av mange negative og samtidige stressorer en potensiell trussel mot ungdoms helse og velvære. Når ungdom utsettes for samme type stressor, vil stressprosessen og utfallet av stresspåvirkningen for de unges helse, gi individuelle variasjoner. Resultatet av stressprosessen og stresspåvirkningen på helse vil være avhengig av ulike sårbarhets- og beskyttende faktorer, både i individet og i omgivelsene. Ph.d. avhandlingen omfatter en undersøkelse av hvilken rolle og betydning stressorer har i ungdoms hverdagsliv; hvordan stress er relatert til ungdoms psykiske helse, selvfølelse, og subjektive helseplager. Kjønns- og aldersforskjeller på stress og de ulike helsevariablene er også undersøkt. Avhandlingen vurderer betydningen av tre faktorer med potensiell betydning for prosesser knyttet til stress, mestring og helse hos ungdom; fysisk aktivitet i fritiden, selvfølelse og opplevelse av sammenheng. Ph.d. avhandlingen omfatter videre en undersøkelse av faktorstrukturen og de psykometriske egenskapene til den norske versjonen av The Adolescent Stress Questionnaire (ASQ-N), et spørreskjema som måler vanlig forekommende stressorer i ungdoms hverdagsliv. Avhandlingen baserer seg på tre tverrsnittsutvalg av ungdom i alderen 13-18 år og inkluderer ungdomsskoler og videregående skoler fra lands- og by områder i Trøndelag. Resultatene av valideringen av ASQ-N støtter en faktorstruktur bestående av ni pålitelige og gyldige stressdimensjoner. Jenter, spesielt i 15-16 årsalderen, rapporterer høyere stressnivå, så  vel som mer emosjonelle og subjektive helseplager sammenlignet med gutter. Gutter derimot rapporterer i alle aldersklasser høyere grad av selvfølelse. Høyere skåre både på total sum stress og områdespesifikt stress, spesielt i mellommenneskelig kontekst, er funnet å være relatert til mer emosjonelle problemer, mer subjektive helseplager og lavere selvfølelse både hos gutter og jenter. Avhandlingen har videre avdekket at fysisk aktivitet, opplevelse av sammenheng og høy grad av selvfølelse har positiv betydning for ungdoms helse, kontrollert for opplevelse av stress. Metodologiske, teoretiske og praktiske implikasjoner av funnene er diskuter

Self-esteem and mental health in adolescents - level and stability during a school year.

Aim: Adolescence represent an important period for positive mental health development. The aim of the present paper was to investigate gender differences as well as the level, stability and predictive role of mental health (symptoms of depression/anxiety and mental well-being) and self-esteem in adolescents during a school year. Methods: The study sample consisted of a cohort of 351 students aged 15–21 years in Mid-Norway. In a survey administrated at the beginning and end of the 2016/2017 school year, mental well-being was assessed with Warwick-Edinburgh Mental Well-Being Scale, depression/anxiety with Hopkins Symptom Checklist and self-esteem with the Rosenberg Self-Esteem Scale. Two models were tested for prediction; self-esteem on mental health (vulnerability model) and mental health on self-esteem (scar model). Results: Girls reported significantly higher depression/anxiety than boys and showed a slightly significant increase in depression/anxiety, stress and self-esteem during the two assessments. Boys scored significantly higher on mental well-being and self-esteem and reported stable mental health during the school year. Selfesteem significantly predicted depression/anxiety and mental well-being. Mental well-being and depression/ anxiety also significantly predicted self-esteem. Conclusion: The results suggest that self-esteem and mental health are reciprocally associated. The results underline the gender differences in overall mental health in adolescents and thus the potential importance of acknowledging gender when working on universal strategies for positive mental health development

Sense of Coherence in Association with Stress Experience and Health in Adolescents

This study investigated the associations between sex, age, socio-economic status, stress, sense of coherence (SOC), and health (mental wellbeing, depressive symptoms, self-rated health, and subjective health complaints) in Norwegian adolescents aged 13–19 years. Furthermore, the study investigated the potential protective or compensatory role from SOC on the association between stress and health. Methods: The study was based on a cross-sectional sample of 1233 adolescents. Data were analyzed with descriptive, comparative, and multiple linear regression analyses. Results: Girls reported significantly higher scores on depressive symptoms and subjective health complaints than boys. Stress was significantly and positively associated with depressive symptoms. SOC associated significantly with all outcome variables; and especially with mental wellbeing and depressive symptoms. Significant interaction effects of sex in combination with stress and SOC were found in association with depression and mental wellbeing. Associations were strongest for girls. Conclusion: The findings provided support for the significant role of SOC as a coping resource, especially in relation to adolescents’ mental health; weaker associations were found with subjective health complains and self-rated health. The findings also mainly supported a compensatory role of SOC on the association between stress and health during adolescence

Sense of Coherence in Association with Stress Experience and Health in Adolescents

This study investigated the associations between sex, age, socio-economic status, stress, sense of coherence (SOC), and health (mental wellbeing, depressive symptoms, self-rated health, and subjective health complaints) in Norwegian adolescents aged 13–19 years. Furthermore, the study investigated the potential protective or compensatory role from SOC on the association between stress and health. Methods: The study was based on a cross-sectional sample of 1233 adolescents. Data were analyzed with descriptive, comparative, and multiple linear regression analyses. Results: Girls reported significantly higher scores on depressive symptoms and subjective health complaints than boys. Stress was significantly and positively associated with depressive symptoms. SOC associated significantly with all outcome variables; and especially with mental wellbeing and depressive symptoms. Significant interaction effects of sex in combination with stress and SOC were found in association with depression and mental wellbeing. Associations were strongest for girls. Conclusion: The findings provided support for the significant role of SOC as a coping resource, especially in relation to adolescents’ mental health; weaker associations were found with subjective health complains and self-rated health. The findings also mainly supported a compensatory role of SOC on the association between stress and health during adolescence

The association between stress, sense of coherence and subjective health complaints in adolescents: Sense of coherence as a potential moderator

The present study investigated the association between domain-specific stress, sense of coherence (SOC) and subjective health complaints (SHC), as well as the possible moderation effect of SOC on the relationship between stress and SHC. The study is based on responses from 1183 adolescents 13-18 years old. The initial results showed that girls scored higher than boys on all stress domains and on SHC. Conversely, boys reported stronger SOC. Results from the hierarchical multiple regression analysis showed a significant association between increasing stress related to each of the stress domains of peer pressure, home life, school attendance, as well as to a higher level of SHC. SOC was inversely related to SHC. However, no moderation effect of SOC was found. The findings in the present study thus show that stress and SOC are separately associated with SHC. The results support the importance of improving coping efficacy with stress during adolescence. The results also give some preliminary support for the view that promoting salutogenic factors has positive implications in relation to subjective health in adolescents

Satisfaction with Life Scale in Adolescents: Evaluation of Factor Structure and Gender Invariance in a Norwegian Sample

In spite of the significance of life satisfaction (LS) for adolescent health and well-being, the past decades have yielded limited progress in investigating the psychometric properties of a well-used inventory measuring LS, The satisfaction with Life Scale (SWLS) in adolescents. The present study aimed at investigating the factor structure, gender invariance, and convergent validity of the Norwegian version of the five-item SWLS in adolescents 13–18 years. The study was based on a cross-sectional sample of 1,073 adolescents from rural areas in Mid-Norway, and the data were analysed using confirmatory factor analysis (CFA) and multi-group analyses in AMOS. Results from the CFA supported a single-factor structure with correlated residual variances between items 4 and 5. The results from the multi-group analyses indicated configural and metric invariance of SWLS between genders, as indicated by invariant factor structure and factor loadings. The SWLS also showed high reliability and correlated in expected directions with measures of emotional symptoms and self-esteem, supporting the convergent validity of the instrument. The psychometric properties of the SWLS need to be further evaluated in adolescents; however the present results indicate that the SWLS is a questionnaire appropriate for assessing LS in a population of Norwegian adolescents