The Importance of Perceived Discrimination and Pre-Adoption Risk for Mental Health Problems among Young Adult Internationally Adopted Students in Norway

The research on mental health problems in adult international adoptees is limited, and while perceived discrimination has been related to increased psychological distress, less is known about its influence on more severe mental health problems. The study investigated mental health problems and the importance of pre- and post-adoption risk factors among internationally adopted students in young adulthood. Data stem from the cross-sectional SHoT study (Students’ Health and Wellbeing Study) of students in higher education in Norway where 409 (0.8%) students identified themselves as internationally adopted. The internationally adopted students reported higher levels of psychological distress and higher occurrence of self-harm, thoughts of non-suicidal self-harm (NSSH), suicide attempts and suicidal ideation compared to their non-adopted peers. Perceived discrimination was associated with increased psychological distress, and higher odds of thoughts of self-harm and suicidal ideation. Being adopted from Asia was associated with lower odds of NSSH and suicide attempts compared to other birth continents. Age at adoption was not associated with any of the mental health outcomes. The results indicate an increased risk of mental health problems for internationally adopted students and suggests that pre- and post- adoption risk factors are associated with different mental health problems.publishedVersio

Do Parental Education-Related Inequality Matter in Child and Adolescent Utilization of Mental Health Services: Results From a Norwegian Register Linkage Study

Equitable access to health care point to equal access to care for those with equal needs, but pro-rich and pro-educated inequities have been documented in specialized mental health care utilization. This study aimed to investigate equity in Norwegian adolescents’ use of child and adolescent mental health services (CAMHS) with regards to parental education levels, using a survey of 10 257 Norwegian 16- to 19-year-olds subsequently linked to CAMHS data from the Norwegian Patient Registry (n = 970 had been in contact with CAMHS). Analyses using concentration indices (C) suggested adolescents with parents with lower education levels had more mental health problems (ie, larger need; C = −0.032, P < .001) and were more in contact with CAMHS (C = −0.025, P < .001). Regression analysis suggested that CAMHS contact, and number of unique admissions was largely distributed according to need, but participants whose parents had basic education levels were in contact with CAMHS for slightly longer than predicted from their self-reported mental health problems, age, and sex. Results from this study suggested that contact with CAMHS was largely equitable and mostly influenced by need. There was little evidence of parental education-related inequity in access to, and use of, specialized mental health services.publishedVersio

Alcohol consumption, life satisfaction and mental health among Norwegian college and university students

Objective: High-level alcohol consumption is common in, and central to, the student community. Among adults, high-level alcohol consumption, and sometimes also low, has been associated with poorer social integration and mental health. We aimed to investigate how alcohol consumption relates to life satisfaction and mental health among students in higher education. Methods: Data from the Norwegian study of students' health and well-being (SHoT, 2014, n = 9632) were used. Associations between alcohol consumption (AUDIT; abstainers, low risk, risky and hazardous consumption) and life satisfaction and mental health complaints, as well as number of close friends, and social and emotional loneliness were investigated using linear regression models. Crude models and models adjusted for age, gender and relationship status were conducted. Results: Students reporting hazardous consumption reported lower life satisfaction, more mental health complaints, and more emotional and social loneliness than students with low risk consumption. Students reporting risky consumption reported slightly reduced life satisfaction and more mental health complaints, but more close friends and less social loneliness. Abstainers did not report reduced life satisfaction or more mental health complaints, despite reporting fewer close friends and more social loneliness. Conclusion: High-level alcohol consumption among students might indicate increased risk of several problems in the future – but also currently. Our findings further imply that the quality of friendships might be more important for life satisfaction and mental health than the number of friends, but also that social integration in student communities might be more difficult for students who do not drink.publishedVersio

Negative Life Events, Protective Factors, and Substance-Related Problems: A Study of Resilience in Adolescence

Background There is compelling evidence for an association between negative life events (NLE) and substance-related problems (SRP) during adolescence. The literature is, however, still limited with regards to protective factors for SRP among adolescents exposed to NLE. Methods A large population-based survey including 9,611 Norwegian adolescents aged 16 to 19 years, comprised the dataset of this study. The main explanatory variable was NLE. The main outcome variable was SRP, assessed by the CRAFFT scale. Potential protective factors were measured with five subscales from the Resilience Scale for Adolescents (READ) questionnaire. The potential protective factors and sex were explored as moderators for the associations between NLE and SRP. Results NLE were strongly associated with SRP. Four out of five potential protective factors (i.e., Goal Orientation, Self-confidence, Family Cohesion, and Social Support) showed evidence of a protective-stabilizing effect. Even if they had protective effect across all levels of exposure to NLE, these effects were even stronger for adolescents with high exposure. For Family Cohesion a protective-stabilizing effect was only evident for boys, while a direct protective effect was found for girls. Finally, Social Competence was the only factor that did not show any evidence of promoting resilience toward SRP. Conclusions NLE had a strong relation with SRP in this study. Protective factors buffered against SRP for all adolescents – but particularly so for adolescents who had high exposure to NLE. These findings highlight the need for preventive efforts to strengthen protective factors that may promote resilience among adolescents at risk for SRP.publishedVersio

Parental separation and school dropout in adolescence

Aims: To document the association between parental separation and school dropout in adolescence and to examine the factors that may potentially account for this association. Methods: Data stem from the large youth@hordaland study that was linked to the Norwegian National Educational Database to obtain objective measures of educational outcomes and disposable income (N = 8323). Logistic regression analysis was used to investigate the association between parental separation and school dropout. A Fairlie post-regression decomposition was used to examine the influence of parental education, household income, health complaints, family cohesion, and peer problems in explaining the association between parental separation and school dropout. Results: Parental separation was associated with a higher odds ratio (OR) of school dropout in crude and adjusted (adjusted odds ratio (AOR)) analyses (OR=2.16, 95% confidence interval (CI) =1.90–2.45; AOR = 1.72, 95% CI = 1.50–2.00). About 31% of the higher odds of school dropout among adolescents with separated parents was explained by the covariates. The decomposition analysis suggested that parental education (43%) and disposable income (20%) accounted for most of the explained differences in school dropout. Conclusions: Adolescents with separated parents are at higher risk for not completing secondary education. Parental education and disposable income accounted for most of the explained differences in school dropout between the groups. Still, the majority of the difference in school dropout remained unaccounted for, indicating that the link between parental separation and school dropout is complex and likely influenced by multiple factors.publishedVersio

Risky Drinking among Norwegian Students: Associations with Participation in the Introductory Week, Academic Performance and Alcohol-related Attitudes

AIMS – Substantial increase in heavy drinking upon transition from high school to college is common. Norwegian universities and university colleges arrange yearly introductory weeks to welcome new students. It has been questioned whether these events are too centered on alcohol. We aimed to investigate whether participation in the introductory week is associated with risky drinking (RD). We further aimed to investigate whether RD is associated with academic performance. Finally, we investigated whether alcohol-related attitudes are associated with both RD and introductory week participation. DESIGN – Data from the Norwegian study of students’ health and well-being (SHoT, 2014, n=13,663) were used. The odds ratio (OR) of RD was calculated for individuals having participated in the introductory week compared to others. Different measures of academic performance (having failed exams, study progression and study-related self-efficacy (SRSE)) were compared between individuals reporting RD compared to others. The association between attitudes and participation in the event and RD was investigated. RESULTS – Individuals having participated in the introductory week are more likely to report RD (OR (95%CI) = 2.41 (2.12-2.74)). Individuals reporting RD report lower SRSE and are more likely to have failed exams more than once. Study progression is unassociated with RD. Liberal alcohol-related attitudes are associated with participation in the event and RD. CONCLUSIONS – RD among students is associated with participation in the introductory week and with poorer academic performance. The university introductory week might be in danger of excluding individuals who do not drink much, or of promoting an unhealthy drinking culture among students.publishedVersio

Sleep and dropout from upper secondary school: A register-linked study

Objective The present study investigates the association between sleep in late adolescence and completion of upper secondary school. Methods The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked with official educational data in Norway (N = 8838). Results High school dropout was more prevalent among adolescents who had insomnia (20.6%) compared to those without insomnia (14.3%; adjusted risk ratios = 1.50; 95% confidence intervals: [2.19-2.92]). There was also a higher rate of school dropout among those who had symptoms of delayed sleep-wake phase (21%) compared to those without delayed sleep-wake phase (14.3%); adjusted risk ratios = 1.43, 95% confidence intervals: (1.28-1.59). School noncompleters were also characterized by reporting 44 minutes shorter sleep duration, longer sleep onset latency, and wake after sleep onset (both approx. 15 minutes) compared to school completers. Conclusion The importance of sleep for high school dropout rates highlights the importance of including sleep as a risk indicator and a possible target for preventive interventions in late adolescence.publishedVersio

Decision making in child protection emergency cases in Norway

Background Research on decision-making factors in child protection emergency cases is scarce, and even less is known about factors that can avert emergency placement. Objective This study aims to explore factors that distinguish emergency cases that conclude in emergency placement (EP) from emergency cases that conclude in averted emergency placement (AEP). Participants and setting The study is based on data from an electronic survey on child protection emergency work, completed by a national sample of child protection leaders (N = 154). Method The survey included questions on external and organisational conditions of the Child Protection Service (CPS), as well as descriptions, activities and assessments related to selected emergency cases. Sixty-three of the selected cases were concluded with EP and ninety-one cases were concluded with AEP. Group differences between EP and AEP cases were analysed using descriptive statistics and logistic regression analyses. Results The findings indicate that the case factor “violence at home/child abuse” and the CPS’s activity of “considering out-of-home measures” at initial assessment phase were significantly associated with EP. Activities like “home visits” and “contact with the network” were significantly associated with AEP. Crucial factors for decision-making according to the leaders were “parents’ opinion” and “resources in the network”, which were both significantly associated with AEP. Conclusions The study has identified several potential important factors for averting emergency placements. Building averting capability in CPS is important to avoid the huge relational and social costs of errors relating to EP decisions.publishedVersio

Divorce and adolescent academic achievement: Heterogeneity in the associations by parental education

Background The link between parental divorce and adolescents’ academic achievement may depend on parental educational levels. However, findings have been inconsistent regarding whether the negative associations between parental divorce and adolescents’ academic outcomes are greater or smaller in highly educated families. The present study aimed to investigate the possible heterogeneity in the associations between divorce and adolescents’ academic achievement by parental educational levels, within the context of the elaborate Norwegian welfare state. Methods The population-based cross-sectional youth@hordaland study of adolescents aged 16–19 years conducted in Norway in 2012, provided information about parental divorce and was linked to national administrative registries (N = 9,166) to obtain high-quality, objective data on the adolescents’ grade point average (GPA), and their parents’ educational qualifications and income. Results The negative association between parental divorce and GPA was stronger among adolescents with educated or highly educated parents compared to adolescents with less educated parents. This heterogeneity was driven by maternal educational qualifications, whereby divorce was more strongly and negatively associated with GPA among adolescents with educated mothers compared to those with less educated mothers, independent of paternal educational levels and income measures. Conclusions Among adolescents whose parents have low educational qualifications, parental divorce is not associated with their academic achievement. Educated divorced mothers appear less likely to transfer their educational advantages onto their children than nondivorced equally educated mothers, perhaps due to a “double-burden” regarding work pressure and child-rearing responsibilities. There is a need for future studies to detail the mechanisms underlying this finding.publishedVersio