Interpersonal violence and overweight in adolescents: the HUNT Study

Aims:Overweight and obesity in children and adolescents are major public health challenges associated with psychosocial adversity and unfavourable lifestyle. Exposure to interpersonal violence, such as sexual abuse, violence and bullying, could represent precursors, accelerating or sustaining factors. Methods: The Young-HUNT 3 study, 2006–2008, is a population-based, cross-sectional, cohort study of Norwegian youth that includes self-report data on exposure to interpersonal violence; pubertal status and timing; socioeconomic, psychosocial, and lifestyle factors; and clinical anthropometric measures. A cohort of 10,464 adolescents aged 12–20 years from Nord-Trøndelag County were invited to participate. Body mass index served as the outcome in the simple and multiple linear regression analyses. Results: The response rate was 72.3% (7564), and 49.9% (3777) of the respondents were girls. A robust and significant relationship between interpersonal violence and increased BMI for both genders was found. Importantly, interpersonal violence remained significantly correlated with higher BMI following adjustment for pubertal development, socioeconomic and psychosocial adversity and unfavourable lifestyle factors in both genders, although most evident in girls. Adjusted regression coefficients (95% confidence intervals) for the relationship between interpersonal violence and BMI were 0.33 (0.01, 0.65) for 1 type and 0.89 (0.37, 1.41) for 2 types, compared to no exposure in girls, and 0.40 (0.09, 0.71) for 1 type and 0.35 (-0.09, 0.79) for 2 types of interpersonal violence in boys. Conclusions: The empirical evidence of consistent associations between interpersonal violence, related psychosocial and lifestyle factors, and body fatness, indicates that these features play important roles for adolescents struggling with overweight. © 2014 the Nordic Societies of Public Healt

A Systematic Review and Meta-Analysis of Measurement Feedback Systems in Treatment for Common Mental Health Disorders

To investigate the efects of measurement feedback systems (MFSs) in therapy on mental health outcomes through a literature review and meta-analysis. Using a three-level modeling approach, we conducted a meta-analysis of all efect sizes from randomized controlled studies of MFSs used in the treatment of common mental health disorders. Eighty-two efect sizes were extracted from the thirty-one included studies. Analyses were performed to consider the post-treatment efects of the MFS-assisted treatment compared to treatment as usual. A separate analysis was done for the subgroup “not-on-track” patients as it is theorized that MFSs will be clinically useful because they make therapists aware of patients who fail to progress. MFSs had a signifcant efect on mental health outcomes (d=0.14, 95% CI [0.082–0.206], p<.001). Further analysis found a larger efect in patients identifed as less respondent to therapy, the “not-on-track” group (d=0.29, 95% CI [0.114, 0.464], p=.003). Moderation analyses indicated that the type of outcome measurement and type of feedback system used, and whether it was used for a child and youth or adult population, infuenced efect sizes. MFSs seem to have a small positive efect on treatment outcomes. The efects seem to be larger for “not-on-track” patients, the group of patients that would usually not beneft much from treatment

The relationship between personality disorders and quality of life in adolescent outpatients

Background: During recent years, there has been an increasing focus on the benefits of the early detection and treatment of personality disorders in adolescents. Previous studies of adults have shown that the number of personality disorder criteria met is negatively correlated with a patient’s quality of life and general functioning. Objective: The aim of the present study was to investigate the prevalence of personality disorders, particularly with regard to the correlation between the number of personality disorder criteria fulfilled and self-perceived quality of life. Distribution according to gender and age in a clinical sample of adolescent outpatients were also considered. Method: This study included 153 adolescents between the ages of 14 and 17 years who were referred to a mental health outpatient clinic. Personality disorders were assessed using the Structured Interview for DSM-IV Personality. Quality of life was assessed using the Youth Quality of Life Instrument - Research Version, which is a 41-item questionnaire that covers broad aspects of quality of life. Axis I disorders were assessed using the Mini International Neuropsychiatric Interview. Results: Results demonstrated that 21.6% of the adolescents met the diagnostic criteria for at least one personality disorder. A relationship between the number of personality disorder criteria met and reduced quality of life was found. No significant gender differences with regard to the prevalence of each of the personality disorders were revealed. Adjustment for the presence of Axis I disorders did not appreciably affect these findings Conclusion: The present study indicates that reduced quality of life as a result of the number of personality disorder criteria met affects adolescents in much the same way that it does adults. This further emphasizes the clinical importance of including quality of life assessment as part of the general diagnostic procedures used with adolescents

Recurrent headache and interpersonal violence in adolescence: the roles of psychological distress, loneliness and family cohesion: the HUNT study

Background: Recurrent headache is the most common and disabling pain condition in adolescence. Co-occurrence of psychosocial adversity is associated with increased risk of chronification and functional impairment. Exposure to interpersonal violence seems to constitute an important etiological factor. Thus, knowledge of the multiple pathways linking interpersonal violence to recurrent headache could help guide preventive and clinical interventions. In the present study we explored a hypothetical causal model where the link between exposure to interpersonal violence and recurrent headache is mediated in parallel through loneliness and psychological distress. Higher level of family cohesion and male sex is hypothesized to buffer the adverse effect of exposure to interpersonal violence on headache. Methods: The model was assessed using data from the cross-sectional, population-based Young-HUNT 3 study of Norwegian adolescents, conducted from 2006–2008. A cohort of 10 464 adolescents were invited. The response rate was 73% (7620), age ranged from 12 and 20 years, and 50% (3832) were girls. The study comprised self-report measures of exposure to interpersonal violence, loneliness, psychological distress and family cohesion, in addition to a validated interview on headache, meeting the International Classification of Headache Disorders criteria. Recurrent headache was defined as headache recurring at least monthly during the past year, and sub-classified into monthly and weekly headache, which served as separate outcomes. Results: In Conditional Process Analysis, loneliness and psychological distress consistently posed as parallel mediating mechanisms, indirectly linking exposure to interpersonal violence to recurrent headache. We found no substantial moderating effect of family cohesion or sex. Conclusions: Loneliness and psychological distress seem to play crucial roles in the relationship between exposure to interpersonal violence and recurrent headache. To facilitate coping and recovery, it may be helpful to account for these factors in preventive and clinical interventions. Trauma-informed, social relationship-based interventions may represent a major opportunity to alter trajectories of recurrent headache. Keywords: Interpersonal violence; Sexual abuse; Bullying; Loneliness; Social isolation; Psychological distress; Family cohesion; Social support; Recurrent headache

Associations between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>In patients with suspected coronary artery disease (CAD), the overall aim was to analyse the relationships between disease severity and both mental and physical dimensions of health related quality of life (HRQOL) using a modified version of the Wilson and Cleary model.</p> <p>Methods</p> <p>Using a cross-sectional design, 753 patients (74% men), mean age 62 years, referred for elective cardiac catheterisation were included. The measures included 1) physiological factors 2) symptoms (disease severity, self-reported symptoms, anxiety and depression 3) self-reported functional status, 4) coping, 5) perceived disease burden, 6) general health perception and 7) overall quality of life. To analyse relationships, we performed linear and ordinal logistic regressions.</p> <p>Results</p> <p>CAD and left ventricular ejection fraction (LVEF) were significantly associated with symptoms of angina pectoris and dyspnea. CAD was not related to symptoms of anxiety and depression, but less depression was found in patients with low LVEF. Angina pectoris and dyspnea were both associated with impaired physical function, and dyspnea was also negatively related to social function. Overall, less perceived burden and better overall QOL were observed in patients using more confronting coping strategy.</p> <p>Conclusion</p> <p>The present study demonstrated that data from cardiac patients to a large extent support the suggested model by Wilson and Cleary.</p

Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

<p>Abstract</p> <p>Background</p> <p>Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level.</p> <p>Methods</p> <p>Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.</p> <p>Results</p> <p>In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA.</p> <p>Conclusion</p> <p>Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.</p

Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study

Background: Surveys on prescription patterns for antipsychotics in the Scandinavian public health system are scarce despite the prevalent use of these drugs. The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability, and international guidelines for the treatment of schizophrenia offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. The implementation of treatment guidelines in clinical practice have proven difficult to achieve, as reflected by major variations in the prescription patterns of antipsychotics between different comparable regions and countries. The objective of this study was to evaluate the practice of treatment of schizophrenic patients with antipsychotics at discharge from acute inpatient settings at a national level. Methods: Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines. Results: In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA. Conclusion: Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.publishedVersio

Mental health problems in the 10th grade and non-completion of upper secondary school: the mediating role of grades in a population-based longitudinal study

Vitenskapelig, fagfellevurdert artikkelBackground: School drop-out is a problem all over the world with adverse life-course consequences. The aim of this paper is to study how internalising and externalising problems in the 10th grade are associated with non-completion of upper secondary school, and to examine the mediating role of grade points in the 10th grade across general academic and vocational tracks in upper secondary school. We also study the impact of health behaviour. Methods: Population-based health surveys were linked with Norwegian registries on education and sociodemographic factors (n = 10 931). Mental health was assessed by the self-report Strengths and Difficulties Questionnaire. Logistic regression was used to analyse the relations between mental health and health behaviour in 10th grade and non-completion of upper secondary school. The mediating effect of grade points was studied by causal mediation analysis. Results: Adolescents not completing upper secondary school reported more externalising problems and girls more internalising problems in the 10th grade, after adjustments. Smoking and physical inactivity increased the odds of non-completion of upper secondary school. Causal mediation analyses showed that a reduction in externalising problems of 10 percentage points led to lower rates of non-completion of 4–5 percentage points, and about three-quarters of this total effect was mediated by grades. For internalising problems the total effect was significant only for girls (1 percentage point), and the mediated effect of grades was about 30%. The effect of mental health problems on school dropout was mainly the same in both vocational and general tracks. Conclusions: Assuming a causal relationship from mental health problems to school performance, this study suggests that externalising problems impair educational attainment. A reduction of such problems may improve school performance, reduce school drop-out and reduce the adverse life-course consequences

Medical benefits in young adulthood: a population-based longitudinal study of health behaviour and mental health in adolescence and later receipt of medical benefits

Objectives To examine the extent to which smoking, alcohol, physical activity and mental health problems in 15–16-year-olds are associated with receipt of medical benefits in young adulthood, after adjustment for confounders. Design Prospective population-based cohort survey linked to national registers. Participants In the ‘Youth studies’ from the Norwegian Institute of Public Health, 15 966 10th graders in 6 Norwegian counties answered a health behaviour and mental health questionnaire; 88% were linked to National Insurance Administration Registers (FD-Trygd). Outcome measure Time to receipt of medical benefits, based on FD-Trygd. Follow-up was from age 18 years until participants were aged 22–26 years. Method We performed Cox regression analyses to examine the extent to which variations in health behaviour and mental health problems during 10th grade were associated with receipt of medical benefits during follow-up. Results Daily smoking at age 15–16 years was associated with a significant increase in hazard of receiving health benefits at follow-up compared with not smoking for boys, HR (95% CI) 1.56 (1.23 to 1.98), and for girls 1.47 (1.12 to 1.93). Physical activity was associated with a decrease in hazard compared with inactivity from 23% to 53% in boys and from 21% to 59% in girls, while use of alcohol showed a mixed pattern. The hazard for benefits use rose with increasing levels of emotional symptoms, peer problems, conduct problems and hyperactivity–inattention problems (Strengths and Difficulties Questionnaire) at 15–16 years among both genders. Conclusions Health behaviour and mental health problems in adolescence are independent risk factors for receipt of medical benefits in young adulthood